Medical expenses | Court grants leave to appeal in member’s dispute with RAF
The outcome of Discovery Health’s appeal before the SCA will affect the outcome of the member’s claim for R1.4 million.
claims
Suicide-related life claims surge by 62% over five years
Discovery Life’s claims data reveals rising risks, with increasing concerns about mental health and skin cancer.
Court orders RAF to pay medical scheme members’ claims
Another attempt by the Road Accident Fund to contest liability based on the ‘majority decision’ against Discovery Health has fallen through.
Majority judgment ‘does not alter’ RAF’s liability for medical scheme members’ claims
The High Court in Cape Town rejects the Road Accident Fund’s contention that the Mlambo judgment has altered the legal landscape.
Alexforbes reports R7 billion in two-pot system withdrawals
It says 47% of members intend to make future claims – with 34% of those who have already claimed planning to do so again.
Discovery vs RAF: CMS executive says High Court got it wrong
A regulatory expert believes the judgment misinterpreted key legal principles in its ruling on the RAF’s obligation to reimburse medical schemes.
Discovery to appeal ‘far-reaching’ judgment in favour of RAF
The High Court says Discovery Health misconstrued the scope of the judgment that set aside the RAF’s first directive on the payment of medical scheme members’ claims.
How the dispute between the RAF and Discovery unfolded
Discovery Health’s quest for reimbursement from the RAF for medical expenses incurred by road accident victims has faced multiple legal hurdles, with new RAF directives complicating the situation.
Closing the gaps in cancer care: academic advocates for patient-centred solutions
Associate Professor Tasleem Ras’s analysis of a patient’s case highlights critical pitfalls in cancer care.
Rise in complaints about medical schemes clawing back losses allegedly linked to fraud and waste
Schemes and healthcare professionals are at odds over whether these recoveries are justified, says the Council for Medical Schemes.
Investigation into ‘fruitless and wasteful expenditure’ continues as RAF bleeds another R1.6 billion
The investigation into the Road Accident Fund has uncovered a significant rise in default judgments, accumulating to R4.7 billion from 2018 through the second quarter of 2023.
Santam reports 34% net income growth despite rising weather-related claims
The group attributed the turnaround in motor insurance to managing claims inflation and improving risk selection, resulting in a significant reduction in claims frequency.
Two-pot retirement system – don’t be the weakest link
As the two-pot retirement system goes live on 1 September, intermediaries must prepare to guide clients through the new structure.
Navigating insurance policies: how brokers can help prevent claim rejections
Tarina Vlok, MD of Elite Risk Acceptances, explains the importance of educating policyholders about their insurance coverage and exclusions.
Bonitas plans to ‘return’ up to R700m in reserves to members
The medical scheme says it will use its reserves to limit contribution increases, while possibly improving members’ benefits and reducing co-payments.
Medihelp’s solvency ratio drops below threshold amid high claims and rising costs
Medihelp submitted a CMS-approved three-year plan, requiring gradual contribution increases to restore its reserves to the statutory 25% level.
Short-term insurers with the most and the least complaints in 2023
The important statistic is the proportion of personal lines complaints relative to an insurer’s share of the total personal lines claims.
