The High Court in Cape Town has again upheld a claim against the Road Accident Fund for past hospital and medical expenses – including amounts already paid by a medical scheme -– while sharply criticising the Fund for persisting with an argument that the Western Cape Division has treated as settled law.
In a judgment delivered on 7 May, Acting Judge M Louw ordered the RAF to pay R2 231 081.34 in respect of the past hospital and medical expenses of Catherine Yiannakis, who suffered severe injuries in a motor vehicle collision in February 2018. The total comprised R1 678 832.58 due directly to the patient and R552 248.76 paid by Discovery Health Medical Scheme (DHMS).
The judgment forms part of a growing line of Western Cape decisions – including Esack (February 2025), Jaffer (March 2025), and Basson (May 2025) – that have rejected the RAF’s reliance on internal directives to limit liability for medical expenses covered by medical schemes.
It was common cause that Yiannakis’s expenses were connected to the accident. The RAF’s opposition was confined to the portion already covered by DHMS, on the basis that Yiannakis had not suffered a loss in respect of costs paid by the scheme and that the RAF therefore should not have to pay them.
The plaintiff in this matter was Advocate Roxanne van Wyk, acting as curatrix ad litem for Yiannakis. The “Van Wyk” is this judgment should not be confused with the decision delivered in February 2026 (Road Accident Fund v Van Wyk) by the Full Court in the Western Cape Division.
Louw AJ held that the key issue had already been addressed in Road Accident Fund v Van Wyk, and a single judge was therefore bound to follow it. In the Full Court ruling, the RAF’s attempt to avoid liability on the ground that a claimant’s medical insurance had paid the expenses was rejected: the insurance arrangement was treated as a private matter between the claimant and the insurer and did not reduce the RAF’s obligations.
In the present case, Louw AJ said the issue had been “litigated to finality” in the Western Cape Division, where it was “settled law” that the RAF cannot refuse past medical expense claims simply because a medical scheme paid first.
Two witnesses testified for the plaintiff, including Yiannakis’s daughter and a team leader from the DHMS. The RAF called no witnesses and did not cross-examine either of the plaintiff’s witnesses. The RAF also filed no written submissions, and the judge remarked that the precise basis of the Fund’s defence was unclear.
The RAF’s stance appeared to rest largely on the possibility of a future appeal against the Full Court decision in Van Wyk. Louw AJ rejected that approach, holding that courts decide cases on the law as it stands – not based on “speculative hopes” of success in potential future proceedings, particularly where an appeal had not been instituted and would in any event require condonation if late.
Western Cape Division supports minority judgment
The judgment placed the dispute in the broader context of the RAF’s internal directives, which have featured prominently in the dispute between Discovery Health and the RAF.
The RAF issued a directive in August 2022 instructing staff to reject claims for past medical expenses where medical schemes had paid them. This directive was later set aside in October 2022 by the High Court in Pretoria in Discovery Health (Pty) Ltd v Road Accident Fund and Another (“Discovery Health 1”).
The RAF subsequently issued further directives – including one relating to the Prescribed Minimum Benefits and Emergency Medical Conditions, and another aimed at claims where claimants had agreed to reimburse their schemes – which gave rise to further litigation (“Discovery Health 2”).
In “Discovery Health 2”, the Full Bench of the Gauteng Division was divided. The majority held that the later directives were not the same as the one struck down earlier, while the minority took the view that the later directives remained inconsistent with the earlier High Court order and with the RAF’s obligations.
Read: Discovery to appeal ‘far-reaching’ judgment in favour of RAF
In the present matter, Louw AJ said: “I, together with other judges in this Division, am a proponent of the minority judgment in the Discovery Health 2 case.” However, she said it was not necessary to decide the merits of the Full Bench’s split decision: the present claim was disposed of by applying binding Western Cape authority.
Importantly, the accident in the present matter occurred in 2018, long before the RAF issued the directives. The Court accepted the argument that directives of this nature could not be applied retroactively to govern an earlier cause of action and said this was consistent with the Full Court’s reasoning in Van Wyk.
Punitive costs
The Court also criticised the Fund for persisting with litigation on an issue already settled by binding authority and described the RAF’s defence as “flimsy” and “frivolous”, stating that the Fund “could not in good faith have opposed” the matter in the circumstances.
The judgment also warned about the broader consequences of repeated resistance in cases the Court regarded as hopeless: wasted public resources, increased legal costs for both the RAF and claimants, and further delays and backlogs in finalising claims.
Those findings formed the basis for a punitive costs order. The Court directed the RAF to pay the plaintiff’s costs on an attorney-and-client scale, including counsel’s fees, holding that an ordinary party-and-party costs order would not be appropriate.
Use of directives ‘to narrow claimants’ rights’
The judgment also referred to other recent litigation involving the RAF’s use of directives, including Road Accident Fund v Mudawo and Others; Road Accident Fund v Lyton and Others and Road Accident Fund and Others v Legal Practitioners’ Indemnity Insurance Fund, NPC and Others, as examples of the wider concern that the Fund has sought to use administrative measures to narrow claimants’ rights. In that context, Louw AJ observed that the RAF has repeatedly attempted to circumvent court orders and statutory obligations through the issuing of directives.
At the same time, the judgment does not overstate the final position beyond the Western Cape. It records that leave to appeal in Discovery Health 2 was granted, and an appeal was apparently heard in February 2026, so the broader national position may still depend on further appellate development. Even so, the Court treated the law in the Western Cape Division as settled for present purposes and applied the Full Court’s decision in Van Wyk accordingly.
Click here to download the judgment.
