In the latest 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 judge by way of a request to give out a declaratory order with regards to the meaning of the phrase "pay in full" in regulation 8(1) of the General Regulations made pursuant for the Medical Schemes Act, 131 of 1998.
The candidates contended that the Judge needed to decide three concerns, that is: 1. The first applicant's entitlement to initiate proceedings for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief wanted by way of the appliers; and 3. The concise explanation of the words "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 force since 1 January 2000. According to the appliers, the current problem started on 11 November 2008 when the Appeal Board determined two cases on appeal which were referred from the Appeal Committee in terms of section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two decisions, considered the phrase "pay in full" in regulation 8 to imply that the medical scheme must effect complete settlement of a service providers' invoice in respect of the charges of supplying medical care services for Prescribed Minimum Benefits if you don't take the principles of the medical scheme into consideration in working with any complaints.
It was actually the applicants' dispute that "pay in full" means payment according to the rules of the Professional medical Scheme, while according to the respondents, the decisions by the Appeal Board haven't been challenged as yet and presently professional medical aid schemes are bound to this power and still have to repay service providers' bills in full.
The primary claim from the respondents was that the first applicant had no immediate and significant interest in the application as the verdict would not have a visible impact on it. Although the first applicant suggested that it defended 75 registered professional medical aid schemes and therefore had locus standi, a legal court identified this to not be the case. This is due to the fact that the first candidate saw fit to have the second applicant, who is a registered professional medical aid scheme, coupled. Moreover, only 15 licensed professional medical schemes, within the starting and extra founding affidavits, confirmed that a declaratory order needs to be found.
A Legal Court held that had the 1st applicant been so confident that it represented all 75 professional medical aid schemes it wouldn't have been necessary to join the other applicant or to get hold of affidavits and signatures of 15 members of the primary applicant. A Legal Court concluded out of this that the first candidate did not in fact represent 75 members, but only the 15 members talked about within the paperwork.
The non-joinder of all the professional medical schemes rendered the application fatally flawed as the Court couldn't find that the primary applicant, as being a standard representative of the professional medical schemes, will be prejudicially impacted by a ruling, but found that its members may be prejudicially impacted and accordingly, many of the members should have jointly implemented the request for any declaratory order.
A Legal Court found out that the initial applicant did not have locus standi for these reasons:
1. The matter was one which could be classified as a representative matter, although not all the healthcare schemes have been combined and it had not been launched as a representative matter due to the fact that the first applicant didn't have any mandate to litigate on the part of all 75 of their associates;
2. In order to initiate action with respect to Section 38 of the Constitution, a litigant should show that the right enshrined inside the Bill of Rights has been encroached upon along with enough interest in the relief wanted. The primary candidate didn't explicitly aver such violation and the Judge found out that the primary Litigant may not be directly influenced by the ruling and did not have a satisfactory involvement with the relief sought.
With regard to the second applicant the court held that it could not be successful in the application on its own, as none of the other medical aid schemes or managers had been coupled.
The candidates contended that the Judge needed to decide three concerns, that is: 1. The first applicant's entitlement to initiate proceedings for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief wanted by way of the appliers; and 3. The concise explanation of the words "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 force since 1 January 2000. According to the appliers, the current problem started on 11 November 2008 when the Appeal Board determined two cases on appeal which were referred from the Appeal Committee in terms of section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two decisions, considered the phrase "pay in full" in regulation 8 to imply that the medical scheme must effect complete settlement of a service providers' invoice in respect of the charges of supplying medical care services for Prescribed Minimum Benefits if you don't take the principles of the medical scheme into consideration in working with any complaints.
It was actually the applicants' dispute that "pay in full" means payment according to the rules of the Professional medical Scheme, while according to the respondents, the decisions by the Appeal Board haven't been challenged as yet and presently professional medical aid schemes are bound to this power and still have to repay service providers' bills in full.
The primary claim from the respondents was that the first applicant had no immediate and significant interest in the application as the verdict would not have a visible impact on it. Although the first applicant suggested that it defended 75 registered professional medical aid schemes and therefore had locus standi, a legal court identified this to not be the case. This is due to the fact that the first candidate saw fit to have the second applicant, who is a registered professional medical aid scheme, coupled. Moreover, only 15 licensed professional medical schemes, within the starting and extra founding affidavits, confirmed that a declaratory order needs to be found.
A Legal Court held that had the 1st applicant been so confident that it represented all 75 professional medical aid schemes it wouldn't have been necessary to join the other applicant or to get hold of affidavits and signatures of 15 members of the primary applicant. A Legal Court concluded out of this that the first candidate did not in fact represent 75 members, but only the 15 members talked about within the paperwork.
The non-joinder of all the professional medical schemes rendered the application fatally flawed as the Court couldn't find that the primary applicant, as being a standard representative of the professional medical schemes, will be prejudicially impacted by a ruling, but found that its members may be prejudicially impacted and accordingly, many of the members should have jointly implemented the request for any declaratory order.
A Legal Court found out that the initial applicant did not have locus standi for these reasons:
1. The matter was one which could be classified as a representative matter, although not all the healthcare schemes have been combined and it had not been launched as a representative matter due to the fact that the first applicant didn't have any mandate to litigate on the part of all 75 of their associates;
2. In order to initiate action with respect to Section 38 of the Constitution, a litigant should show that the right enshrined inside the Bill of Rights has been encroached upon along with enough interest in the relief wanted. The primary candidate didn't explicitly aver such violation and the Judge found out that the primary Litigant may not be directly influenced by the ruling and did not have a satisfactory involvement with the relief sought.
With regard to the second applicant the court held that it could not be successful in the application on its own, as none of the other medical aid schemes or managers had been coupled.
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