Van Sensie v Road Accident Fund

The plaintiff was injured in a motor vehicle collision on 18 January 2016 in Uitenhage. Liability for 100% of her damages was conceded by the Road Accident Fund (RAF). Most heads of damages were settled except for past hospital and medical expenses. Of the total medical expenses of R37,792.83, Discovery Health Medical Scheme paid R34,534.27 directly to service providers pursuant to its statutory and contractual obligations, while the plaintiff personally paid R3,258.56. The RAF admitted the reasonableness and necessity of all expenses but disputed liability for the portion paid by Discovery Health, arguing that payment by the medical scheme extinguished its liability.

The plaintiff’s claim for past hospital and medical expenses paid by Discovery Health in the amount of R34,534.27 was dismissed. Non-compliance with Rule 33(2) was condoned. Each party was ordered to pay its own costs.

This judgment marks a shift in the Eastern Cape Division away from earlier precedent that allowed recovery from the RAF of medical expenses paid by medical schemes. By following the Discovery Health full-court judgment, it clarifies that medical schemes are not indemnity insurers and that subrogation principles do not apply, significantly affecting RAF litigation and the recoverability of past medical expenses where schemes have paid.