Steyn v Registrar of Medical Schemes (23378/2018) [2021] ZAWCHC 5; 2021 (3) SA 551 (WCC) (25 January 2021)

Steyn v Registrar of Medical Schemes (23378/2018) [2021] ZAWCHC 5; 2021 (3) SA 551 (WCC) (25 January 2021)

The court found that the Appeal Board failed to afford the applicant procedural fairness by not allowing her to present evidence regarding the hip arthroscopy, which was raised late and not properly ventilated. The Board's reliance on the Momentum application form and findings of arthritis were unsupported by evidence and prejudicial. The applicant was not obliged to disclose the hip arthroscopy, as it occurred outside the relevant period and resulted in no diagnosis. Profmed's representative advised that only conditions within 12 months needed disclosure, creating estoppel. Regarding gastritis, Profmed failed to prove materiality or that non-disclosure induced the contract. The Appeal...

Citation
[2021] ZAWCHC 5
Parties
Applicant: Mignon Adelia Steyn; Respondent: Registrar of Medical Schemes; Respondent: Council for Medical Schemes; Respondent: The Appeal Board established ito section 50 of the Medical Schemes Act; Respondent: Profmed Medical Scheme
Court
Western Cape High Court, Cape Town
Jurisdiction
South Africa
Judgment Date
25 January 2021
Case Number
23378/2018
Procedural Posture
Review Application / Judgment After Opposed Review Application
Outcome
Application granted. The Appeal Board's decision is reviewed and set aside. Profmed's termination of membership is declared unlawful and set aside. Profmed is ordered to honour contractual commitments and pay costs.
Judges
Lekhukeni AJ
Legal Topics
Promotion of Administrative Justice Act, Audi Alteram Partem, Material Non Disclosure, Medical Scheme Membership, Judicial Review, Substitution of Administrative Decision
Administrative Law Civil Procedure Commercial and Corporate Promotion of Administrative Justice Act Audi Alteram Partem Material Non Disclosure Medical Scheme Membership Judicial Review +1 more

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Parties

Mignon Adelia Steyn

Applicant

Registrar of Medical Schemes

Respondent

Council for Medical Schemes

Respondent

The Appeal Board established ito section 50 of the Medical Schemes Act

Respondent

Profmed Medical Scheme

Respondent

Procedural Posture

Review Application / Judgment After Opposed Review Application

Legal Issues

  1. 1 Whether the Appeal Board complied with the audi alteram partem principle and afforded the applicant procedural fairness.
  2. 2 Whether the applicant had a duty to disclose the hip arthroscopy and gastritis, and whether non-disclosure was material to justify termination of membership.
  3. 3 Whether the court should remit the matter to the Appeal Board or substitute its own decision.

Ratio Decidendi

The court found that the Appeal Board failed to afford the applicant procedural fairness by not allowing her to present evidence regarding the hip arthroscopy, which was raised late and not properly ventilated. The Board's reliance on the Momentum application form and findings of arthritis were unsupported by evidence and prejudicial. The applicant was not obliged to disclose the hip arthroscopy, as it occurred outside the relevant period and resulted in no diagnosis. Profmed's representative advised that only conditions within 12 months needed disclosure, creating estoppel. Regarding gastritis, Profmed failed to prove materiality or that non-disclosure induced the contract. The Appeal...

Court Disposition

Application granted. The Appeal Board's decision is reviewed and set aside. Profmed's termination of membership is declared unlawful and set aside. Profmed is ordered to honour contractual commitments and pay costs.

Orders

  • The Appeal Board’s ruling/order of 25 August 2018 is reviewed and set aside.
  • Profmed’s termination of the applicant’s membership under membership number 10118222, and/or that of her dependents, is declared unlawful and set aside.