During the recent case 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 along with a application to issue a declaratory order with regards to the meaning of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant to the Medical Schemes Act, 131 of 1998.
The applicants put forward the proposition that the Court needed to determine three concerns, which is: 1. The first applicant's entitlement to institute proceedings for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by the applicants; and 3. The concise explanation of the terminology "pay in full" in regulation 8(1) of the General Regulations that had been promulgated in terms of section 67 of the Act.
Regulation 8 has been in power since 1 January 2000. In accordance with the candidates, the actual problem began on 11 November 2008 once the Appeal Board resolved two cases on appeal which were 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, considered the words "pay in full" in regulation 8 to imply that the healthcare scheme should effect complete repayment of a service providers' invoice in respect of the expenses of supplying health care services for Prescribed Minimum Benefits if you don't take the guidelines of the medical scheme into account in dealing with any claims.
It had been the applicants' dispute that "pay in full" means payment in accordance with the policies of the Healthcare Scheme, while in accordance with the respondents, the judgements by the Appeal Board haven't been challenged as yet and presently healthcare aid schemes are bound to this authority while having to pay for service providers' bills in full.
The principle criticism from the respondents could be that the first applicant didn't have direct and substantial interest in the application since the judgment will not have a direct effect on it. Even though the first candidate contended it defended 75 registered healthcare aid schemes and therefore had locus standi, a legal court identified this not to be. It was due to the fact that the first candidate saw suitable to have the second applicant, who's a registered healthcare aid scheme, coupled. Furthermore, only 15 licensed professional medical schemes, in the starting and extra founding affidavits, affirmed that the declaratory order must be sought.
A Legal Court held that had the 1st applicant been so sure that it represented all 75 medical aid schemes it wouldn't have been necessary to join the other applicant or to receive affidavits and signatures of 15 members of the primary applicant. A Legal Court decided from this that the first applicant did not in fact legally represent 75 members, but only the 15 members mentioned within the paperwork.
The non-joinder of all of the professional medical schemes rendered the application fatally flawed as the Courts couldn't find that the first applicant, as being a standard representative of the medical schemes, would be prejudicially affected by a verdict, but found that its members may all be prejudicially influenced and accordingly, many of the participants ought to have jointly instituted the request for a declaratory order.
A Legal Court discovered that the 1st applicant did not have locus standi for the following reasons:
1. The matter was one which could be considered a representative matter, but not all the professional medical schemes had been joined and it has not been launched as a representative matter because of the fact that the first candidate did not have any authority to litigate on the part of all 75 of its members;
2. In order to initiate steps with respect to Section 38 in the Constitution, a litigant needs to show that a right enshrined inside the Bill of Rights has been encroached upon as well as ample concern in the relief sought. The initial candidate didn't expressly aver such infringement and the Judge found out that the primary Plaintiff would not be directly influenced by the ruling and did not have an adequate involvement with the relief sought.
With regards to the second candidate the judge held that it could not succeed in the application on its own, as none of the alternative healthcare aid schemes or managers ended up being coupled.
The applicants put forward the proposition that the Court needed to determine three concerns, which is: 1. The first applicant's entitlement to institute proceedings for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by the applicants; and 3. The concise explanation of the terminology "pay in full" in regulation 8(1) of the General Regulations that had been promulgated in terms of section 67 of the Act.
Regulation 8 has been in power since 1 January 2000. In accordance with the candidates, the actual problem began on 11 November 2008 once the Appeal Board resolved two cases on appeal which were 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, considered the words "pay in full" in regulation 8 to imply that the healthcare scheme should effect complete repayment of a service providers' invoice in respect of the expenses of supplying health care services for Prescribed Minimum Benefits if you don't take the guidelines of the medical scheme into account in dealing with any claims.
It had been the applicants' dispute that "pay in full" means payment in accordance with the policies of the Healthcare Scheme, while in accordance with the respondents, the judgements by the Appeal Board haven't been challenged as yet and presently healthcare aid schemes are bound to this authority while having to pay for service providers' bills in full.
The principle criticism from the respondents could be that the first applicant didn't have direct and substantial interest in the application since the judgment will not have a direct effect on it. Even though the first candidate contended it defended 75 registered healthcare aid schemes and therefore had locus standi, a legal court identified this not to be. It was due to the fact that the first candidate saw suitable to have the second applicant, who's a registered healthcare aid scheme, coupled. Furthermore, only 15 licensed professional medical schemes, in the starting and extra founding affidavits, affirmed that the declaratory order must be sought.
A Legal Court held that had the 1st applicant been so sure that it represented all 75 medical aid schemes it wouldn't have been necessary to join the other applicant or to receive affidavits and signatures of 15 members of the primary applicant. A Legal Court decided from this that the first applicant did not in fact legally represent 75 members, but only the 15 members mentioned within the paperwork.
The non-joinder of all of the professional medical schemes rendered the application fatally flawed as the Courts couldn't find that the first applicant, as being a standard representative of the medical schemes, would be prejudicially affected by a verdict, but found that its members may all be prejudicially influenced and accordingly, many of the participants ought to have jointly instituted the request for a declaratory order.
A Legal Court discovered that the 1st applicant did not have locus standi for the following reasons:
1. The matter was one which could be considered a representative matter, but not all the professional medical schemes had been joined and it has not been launched as a representative matter because of the fact that the first candidate did not have any authority to litigate on the part of all 75 of its members;
2. In order to initiate steps with respect to Section 38 in the Constitution, a litigant needs to show that a right enshrined inside the Bill of Rights has been encroached upon as well as ample concern in the relief sought. The initial candidate didn't expressly aver such infringement and the Judge found out that the primary Plaintiff would not be directly influenced by the ruling and did not have an adequate involvement with the relief sought.
With regards to the second candidate the judge held that it could not succeed in the application on its own, as none of the alternative healthcare aid schemes or managers ended up being coupled.
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