In the current matter of the Board of Healthcare Funders of Southern Africa v Council For Medical Schemes 2011 JDR 1471 (GNP), the first and second applicants approached the Court along with a request to give out a declaratory order with regards to the explanation of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant to the Healthcare Schemes Act, 131 of 1998.
The candidates fought that the Court needed to consider three issues, which is: 1. The first applicant's entitlement to initiate proceedings for declaratory aid; 2. The interest and locus standi of the intervening participants in opposing the relief sought by way of the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of area 67 of the Act.
Regulation 8 has been around in power since 1 January 2000. According to the candidates, the current problem started on 11 November 2008 when the Appeal Board resolved two cases on appeal which was forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to those two judgements, interpreted the words "pay in full" in regulation 8 to signify that the professional medical scheme should effect full repayment of a service providers' invoice in respect of the fees of providing medical care services for Prescribed Minimum Benefits without taking the policies of the professional medical scheme into account in working with any problems.
It had been the applicants' contention that "pay in full" implies settlement in accordance with the procedures of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board haven't been challenged up to now and presently medical aid schemes are bound to this power and still have to pay for service providers' bills completely.
The main gripe via the respondents could be that the first applicant had no direct and significant concern in the application as the verdict will not have a direct impact over it. Although the first candidate suggested that it represented 75 licensed healthcare aid schemes and for that reason had locus standi, the judge found this to not be. This is due to the fact that the first applicant saw fit to have the second candidate, who's a registered professional medical aid scheme, combined. Additionally, only 15 licensed healthcare schemes, within the starting and supplementary founding affidavits, verified that a declaratory order must be sought.
A Legal Court held that had the initial applicant been so certain that it defended all 75 healthcare aid schemes it would not have been essential to join the 2nd applicant or to acquire affidavits and signatures of 15 members of the first applicant. A Legal Court came to the conclusion out of this that the first candidate didn't in fact legally represent 75 members, but only the 15 members pointed out in the documents.
The non-joinder of all the professional medical schemes rendered the application fatally flawed as the Court couldn't discover that the primary candidate, as a general representative of the healthcare schemes, can be prejudicially impacted by a ruling, but found that its members may be prejudicially influenced and accordingly, all the members ought to have jointly implemented the request for the declaratory order.
The Court discovered that the first applicant was without locus standi for these reasons:
1. The matter was one that could be considered a representative matter, although not every one of the medical schemes have been joined and it had not been announced as a representative matter because of the fact that the first candidate didn't have any mandate to litigate on the part of all 75 of its members;
2. In order to initiate action in terms of Section 38 of the Constitution, a litigant should demonstrate that the right enshrined in the Bill of Rights has been encroached upon as well as sufficient interest in the relief wanted. The 1st applicant didn't clearly aver any such encroachment and the Court found that the First Plaintiff wouldn't be directly affected by the ruling and was lacking a sufficient concern in the relief sought.
With regard to the other applicant the court held it will not be successful in the application on its own, as not one of the other professional medical aid schemes or managers have been coupled.
The candidates fought that the Court needed to consider three issues, which is: 1. The first applicant's entitlement to initiate proceedings for declaratory aid; 2. The interest and locus standi of the intervening participants in opposing the relief sought by way of the applicants; and 3. The meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of area 67 of the Act.
Regulation 8 has been around in power since 1 January 2000. According to the candidates, the current problem started on 11 November 2008 when the Appeal Board resolved two cases on appeal which was forwarded by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to those two judgements, interpreted the words "pay in full" in regulation 8 to signify that the professional medical scheme should effect full repayment of a service providers' invoice in respect of the fees of providing medical care services for Prescribed Minimum Benefits without taking the policies of the professional medical scheme into account in working with any problems.
It had been the applicants' contention that "pay in full" implies settlement in accordance with the procedures of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board haven't been challenged up to now and presently medical aid schemes are bound to this power and still have to pay for service providers' bills completely.
The main gripe via the respondents could be that the first applicant had no direct and significant concern in the application as the verdict will not have a direct impact over it. Although the first candidate suggested that it represented 75 licensed healthcare aid schemes and for that reason had locus standi, the judge found this to not be. This is due to the fact that the first applicant saw fit to have the second candidate, who's a registered professional medical aid scheme, combined. Additionally, only 15 licensed healthcare schemes, within the starting and supplementary founding affidavits, verified that a declaratory order must be sought.
A Legal Court held that had the initial applicant been so certain that it defended all 75 healthcare aid schemes it would not have been essential to join the 2nd applicant or to acquire affidavits and signatures of 15 members of the first applicant. A Legal Court came to the conclusion out of this that the first candidate didn't in fact legally represent 75 members, but only the 15 members pointed out in the documents.
The non-joinder of all the professional medical schemes rendered the application fatally flawed as the Court couldn't discover that the primary candidate, as a general representative of the healthcare schemes, can be prejudicially impacted by a ruling, but found that its members may be prejudicially influenced and accordingly, all the members ought to have jointly implemented the request for the declaratory order.
The Court discovered that the first applicant was without locus standi for these reasons:
1. The matter was one that could be considered a representative matter, although not every one of the medical schemes have been joined and it had not been announced as a representative matter because of the fact that the first candidate didn't have any mandate to litigate on the part of all 75 of its members;
2. In order to initiate action in terms of Section 38 of the Constitution, a litigant should demonstrate that the right enshrined in the Bill of Rights has been encroached upon as well as sufficient interest in the relief wanted. The 1st applicant didn't clearly aver any such encroachment and the Court found that the First Plaintiff wouldn't be directly affected by the ruling and was lacking a sufficient concern in the relief sought.
With regard to the other applicant the court held it will not be successful in the application on its own, as not one of the other professional medical aid schemes or managers have been coupled.
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