South Africa Case Law

Basson v Road Accident Fund (5213/2021)

Basson v Road Accident Fund (5213/2021) [2025] ZAWCHC 229 (30 May 2025)

Court

Western Cape High Court, Cape Town

Case number

5213/2021

Judge

Salie

The court found that the plaintiff is entitled to recover past hospital and medical expenses from the Road Accident Fund, including those paid by her medical aid scheme, Discovery Health. The defendant's reliance on the Medical Schemes Act and section 19(d)(i) of the RAF Act was rejected, as the contractual arrangement between the plaintiff and Discovery Health to reimburse the scheme upon recovery from the RAF is valid and enforceable. The court emphasized that the RAF Act is compensatory in nature and aims to restore the plaintiff to her pre-accident financial position. The provisions of th…

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• Road Accident Fund Act
• Medical Schemes Act
• Prescribed Minimum Benefits
• Double Compensation
• Subrogation
• Patrimonial Loss

Discovery Health (Pty) Ltd v Road Accident Fund and Another (2023/117206)

Discovery Health (Pty) Ltd v Road Accident Fund and Another (2023/117206) [2024] ZAGPPHC 1303; [2025] 2 All SA 113 (GP); 2025 (3) SA 225 (GP) (17 December 2024)

Court

North Gauteng High Court, Pretoria

Case number

2023/117206

Judges

Mlambo JP, Opperman J, Bam J

The majority held that the RAF did not breach the Mbongwe J order by relying on the two subsequent directives, as those directives were based on new legal premises not considered in the original judgment. The court found that Discovery Health had standing to enforce the Mbongwe J order as a party with a judgment in its favour. However, the subsequent directives, premised on statutory obligations under the Medical Schemes Act and section 19(d)(i) of the RAF Act, were not unlawful on their face and remained operative until reviewed and set aside. The principles of res judicata and res inter ali…

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• Road Accident Fund Act
• Medical Schemes Act
• Collateral Benefits
• Subrogation
• Res Judicata
• Promotion Of Administrative Justice Act

Swanepoel N.O. (Executor in the Estate Late Mignon Adelia Steyn) v Profmed Medical Scheme (CCT 336/22)

Swanepoel N.O. (Executor in the Estate Late Mignon Adelia Steyn) v Profmed Medical Scheme (CCT 336/22) [2024] ZACC 23; 2025 (1) SA 33 (CC); 2025 (2) BCLR 205 (CC) (9 October 2024)

Court

Constitutional Court

Case number

CCT 336/22

Judges

Zondo CJ, Madlanga ADCJ, Bilchitz AJ, Chaskalson AJ, Dodson AJ, Majiedt J, Mathopo J, Theron J, Tshiqi J

The Constitutional Court held that the right to just administrative action under PAJA is transmissible to a deceased estate where the estate has a financial interest in the outcome. The Appeal Board's proceedings were procedurally unfair, as Ms Steyn was denied the opportunity to respond to new grounds (hip arthroscopy) and lead evidence. The Court found that mere diagnostic procedures and common conditions such as gastritis do not constitute material non-disclosure under section 29(2)(e) of the Medical Schemes Act. The statutory test for materiality does not dispense with the common law requ…

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• Medical Schemes Act
• Material Non Disclosure
• Procedural Fairness
• Promotion Of Administrative Justice Act
• Standing In Review
• Contractual Inducement

Optivest Health Services (Pty) Ltd v Council for Medical Schemes and Others (396/2023)

Optivest Health Services (Pty) Ltd v Council for Medical Schemes and Others (396/2023) [2024] ZASCA 64; [2024] 3 All SA 107 (SCA); 2024 (6) SA 106 (SCA) (30 April 2024)

Court

Supreme Court of Appeal

Case number

396/2023

Judges

Mocumie, Weiner, Goosen, Coppin, Bloem

The Supreme Court of Appeal held that the Council for Medical Schemes could investigate an accredited broker under section 44(4) of the Act. The appeal was dismissed with costs.

• Powers Of Regulatory Bodies
• Statutory Interpretation
• Procedural Fairness
• Medical Schemes Act
• Investigatory Powers
• Medical-schemes-act

Netcare Medical Scheme v Council for Medical Schemes and Another (2023-006058)

Netcare Medical Scheme v Council for Medical Schemes and Another (2023-006058) [2024] ZAGPPHC 247 (7 March 2024)

Court

North Gauteng High Court, Pretoria

Case number

2023-006058

Judge

Nyathi

The court found that the respondents, by referring to and summarizing the legal opinion in their answering affidavit, acted in a manner that objectively constitutes an implied waiver of privilege. Unlike in Contango, where privilege was asserted and no reliance was placed on the contents of the opinions, the respondents here did not assert privilege in their affidavit and relied on the legal opinion to justify their actions, including the decision to seek curatorship. The legal opinion was integral to the respondents' case and the relief sought. The court held that the shield of privilege was…

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• Discovery Of Documents
• Legal Professional Privilege
• Waiver Of Privilege
• Medical Schemes Act
• Curatorship

Registrar of Medical Schemes and Another v Netcare Plus (Pty) Ltd and Another (007377/2022)

Registrar of Medical Schemes and Another v Netcare Plus (Pty) Ltd and Another (007377/2022) [2023] ZAGPPHC 1808 (13 October 2023)

Court

North Gauteng High Court, Pretoria

Case number

007377/2022

Judge

M P Motha

The High Court dismissed the regulators’ application, holding they had to follow the Medical Schemes Act appeal process before seeking court relief.

• Exhaustion Of Internal Remedies
• Promotion Of Administrative Justice Act
• Medical Schemes Act
• Declaratory Relief
• Interdictory Relief
• Exhaustion-of-internal-remedies

Hosmed Medical Scheme and Others v Registrar of Medical Schemes and Another (36027/2020)

Hosmed Medical Scheme and Others v Registrar of Medical Schemes and Another (36027/2020) [2023] ZAGPPHC 667 (7 August 2023)

Court

North Gauteng High Court, Pretoria

Case number

36027/2020

Judge

Sardiwalla

The High Court struck off an urgent appeal over a proposed medical scheme amalgamation, finding the applicants had not shown urgency or substantial prejudice.

• Medical Schemes Act
• Amalgamation Of Medical Schemes
• Urgency In Motion Court
• Judicial Review Of Administrative Action
• Accreditation Requirements
• Medical-schemes-act

Black Insurance Advisors Council v City of Tswane Metropolitan Municipality (36780/2022)

Black Insurance Advisors Council v City of Tswane Metropolitan Municipality (36780/2022) [2023] ZAGPPHC 10 (16 January 2023)

Court

North Gauteng High Court, Pretoria

Case number

36780/2022

Judge

Sardiwalla

The High Court granted an urgent interim interdict stopping Tshwane’s medical aid brokerage tender pending review and amendment of Circular 20 of 2010.

• Interim Interdict
• Procedural Fairness
• Audi Alteram Partem
• Municipal Tender Process
• Medical Schemes Act
• Natural Justice

KeyHealth Medical Scheme v Glopin (Pty) Ltd (1265/2021)

KeyHealth Medical Scheme v Glopin (Pty) Ltd (1265/2021) [2022] ZASCA 147; 2023 (1) SA 388 (SCA) (28 October 2022)

Court

Supreme Court of Appeal

Case number

1265/2021

Judges

Molemela, Plasket, Mabindla-Boqwana, Weiner, Masipa

The Supreme Court of Appeal held that KeyHealth could not revoke the broker agreement at will because its duration and termination were contractually fixed.

• Revocation Of Mandate
• Contract Duration And Termination
• Broker Services
• Medical Schemes Act
• Remuneration Of Brokers
• Revocation-of-mandate

KeyHealth Medical Scheme v Ngoepe N.O and Others (A203/2021)

KeyHealth Medical Scheme v Ngoepe N.O and Others (A203/2021) [2022] ZAGPPHC 758 (10 October 2022)

Court

North Gauteng High Court, Pretoria

Case number

A203/2021

Judges

L Barit, DS Fourie, C Sardiwalla

The court held that KeyHealth Medical Scheme is prohibited by Regulation 10(6) of the Medical Schemes Act from using a member's Medical Savings Account to fund prescribed minimum benefits. Regulation 8 further obliges the scheme to pay PMBs in full from its risk pool, without co-payment or deductibles. KeyHealth's own Rule 17.5 reinforces this prohibition by stating that no limitations or exclusions apply to PMBs. The court found that KeyHealth's argument, based on the absence of an express prohibition, was flawed; the correct approach is to determine whether there is authorisation for such c…

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• Medical Schemes Act
• Prescribed Minimum Benefits
• Administrative Review
• Regulation Interpretation
• Risk Pool Funding
• Paja Review