In the recent 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 a legal court along with a request to release a declaratory order with regards to the interpretation of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant for the Healthcare Schemes Act, 131 of 1998.
The candidates fought that the Judge was required to determine three concerns, namely: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by way of the appliers; and 3. The concise explanation of the terminology "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of section 67 of the Act.
Regulation 8 has been in power since 1 January 2000. As reported by the appliers, the actual problem commenced on 11 November 2008 once the Appeal Board decided two cases on appeal which were forwarded from the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to those two decisions, interpreted the phrase "pay in full" in regulation 8 to signify that the professional medical scheme should effect complete repayment of a service providers' invoice in respect of the costs of supplying medical care services for Prescribed Minimum Benefits without taking the policies of the health care scheme into account in working with any claims.
It was the applicants' contention that "pay in full" signifies payment according to the rules of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board have not been challenged as yet and presently healthcare aid schemes are bound to this authority while having to pay for service providers' bills entirely.
The principle gripe via the participants was that the first applicant had no direct and substantial interest in the application since the verdict would not have an impact over it. Even though the first applicant contended it defended 75 licensed professional medical aid schemes and for that reason had locus standi, the judge identified this to not be. This is considering that the first applicant saw suitable to have the second applicant, who's a registered healthcare aid scheme, amalgamated. In addition, only 15 registered medical schemes, in the founding and supplementary founding affidavits, confirmed that the declaratory order should be sought.
The Court held that had the first applicant been so certain that it represented all 75 healthcare aid schemes it would not have been essential to join the other applicant or to obtain affidavits and signatures of 15 members of the 1st applicant. The Court came to the conclusion from this that the first candidate did not in fact legally represent 75 members, but only the 15 members mentioned within the papers.
The non-joinder of all the healthcare schemes made the application fatally flawed as the Courts couldn't find that the primary candidate, as a standard representative of the healthcare schemes, would be prejudicially impacted by a ruling, but found that its participants may be prejudicially impacted and accordingly, all the associates ought to have jointly implemented the application for the declaratory order.
The Court discovered that the first applicant was without locus standi for the reasons:
1. The matter was one that could be classified as a representative issue, although not every one of the professional medical schemes had been joined and it had not been launched as a representative matter due to the fact that the first applicant didn't have any authority to litigate on the part of all 75 of their members;
2. In order to commence steps with respect to Section 38 in the Constitution, a litigant should reveal that the right enshrined in the Bill of Rights may be encroached upon along with satisfactory concern in the relief sought. The initial applicant didn't clearly aver such infringement and the Judge found out that the 1st Plaintiff may not be directly influenced by the verdict and did not have an adequate interest in the relief sought.
Regarding the second applicant the judge held it will not be successful in the application by itself, as none of the other medical aid schemes or managers had been connected.
The candidates fought that the Judge was required to determine three concerns, namely: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by way of the appliers; and 3. The concise explanation of the terminology "pay in full" in regulation 8(1) of the General Regulations which were promulgated in terms of section 67 of the Act.
Regulation 8 has been in power since 1 January 2000. As reported by the appliers, the actual problem commenced on 11 November 2008 once the Appeal Board decided two cases on appeal which were forwarded from the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to those two decisions, interpreted the phrase "pay in full" in regulation 8 to signify that the professional medical scheme should effect complete repayment of a service providers' invoice in respect of the costs of supplying medical care services for Prescribed Minimum Benefits without taking the policies of the health care scheme into account in working with any claims.
It was the applicants' contention that "pay in full" signifies payment according to the rules of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board have not been challenged as yet and presently healthcare aid schemes are bound to this authority while having to pay for service providers' bills entirely.
The principle gripe via the participants was that the first applicant had no direct and substantial interest in the application since the verdict would not have an impact over it. Even though the first applicant contended it defended 75 licensed professional medical aid schemes and for that reason had locus standi, the judge identified this to not be. This is considering that the first applicant saw suitable to have the second applicant, who's a registered healthcare aid scheme, amalgamated. In addition, only 15 registered medical schemes, in the founding and supplementary founding affidavits, confirmed that the declaratory order should be sought.
The Court held that had the first applicant been so certain that it represented all 75 healthcare aid schemes it would not have been essential to join the other applicant or to obtain affidavits and signatures of 15 members of the 1st applicant. The Court came to the conclusion from this that the first candidate did not in fact legally represent 75 members, but only the 15 members mentioned within the papers.
The non-joinder of all the healthcare schemes made the application fatally flawed as the Courts couldn't find that the primary candidate, as a standard representative of the healthcare schemes, would be prejudicially impacted by a ruling, but found that its participants may be prejudicially impacted and accordingly, all the associates ought to have jointly implemented the application for the declaratory order.
The Court discovered that the first applicant was without locus standi for the reasons:
1. The matter was one that could be classified as a representative issue, although not every one of the professional medical schemes had been joined and it had not been launched as a representative matter due to the fact that the first applicant didn't have any authority to litigate on the part of all 75 of their members;
2. In order to commence steps with respect to Section 38 in the Constitution, a litigant should reveal that the right enshrined in the Bill of Rights may be encroached upon along with satisfactory concern in the relief sought. The initial applicant didn't clearly aver such infringement and the Judge found out that the 1st Plaintiff may not be directly influenced by the verdict and did not have an adequate interest in the relief sought.
Regarding the second applicant the judge held it will not be successful in the application by itself, as none of the other medical aid schemes or managers had been connected.
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