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 the judge along with a demand to supply a declaratory order regarding the explanation 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 applicants fought that the Courts was required to consider three issues, which is: 1. The first applicant's entitlement to institute actions for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by the candidates; 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 around in force since 1 January 2000. As reported by the candidates, the actual problem started on 11 November 2008 when the Appeal Board resolved two cases on appeal which was forwarded by the Appeal Committee in terms of section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to those two decisions, considered the phrase "pay in full" in regulation 8 to signify that the professional medical scheme should make complete settlement of a service providers' bill in respect of the charges of offering health care services for Prescribed Minimum Benefits if you don't take the rules of the professional medical scheme into consideration in dealing with any grievances.
It was the applicants' contention that "pay in full" signifies repayment in accordance with the regulations of the Professional medical Scheme, while according to the participants, the judgements by the Appeal Board haven't been challenged up to now and presently professional medical aid schemes are bound to this power and still have to pay service providers' invoices fully.
The principle grievance via the respondents was that the first applicant didn't have direct and substantial interest in the application as the verdict will not have a direct impact on it. Although the first applicant contended it defended 75 registered medical aid schemes and for that reason had locus standi, the Court discovered this not to be. This was considering that the first candidate saw fit to have the second candidate, who's an authorized professional medical aid scheme, coupled. Furthermore, only 15 registered professional medical schemes, in the starting and supplementary founding affidavits, confirmed that a declaratory order needs to be sought.
A Legal Court held that had the primary applicant been so confident that it defended all 75 professional medical aid schemes it would not have been necessary to join the 2nd applicant or to get hold of affidavits and signatures of 15 members of the 1st applicant. The Judge came to the conclusion from this that the first applicant did not in reality legally represent 75 members, but only the 15 members stated in the paperwork.
The non-joinder of all the professional medical schemes rendered the application fatally flawed as the Judge couldn't find that the first candidate, as being a general representative of the medical schemes, could be prejudicially impacted by a verdict, but learned that its participants may all be prejudicially affected and accordingly, all the members ought to have jointly instituted the application for the declaratory order.
The Court found out that the primary applicant was without locus standi for these reasons:
1. The issue was one which could be considered a representative issue, although not every one of the medical schemes had been amalgamated and it had not been started as a representative topic due to the fact that the first applicant didn't have any authority to litigate on behalf of all 75 of their members;
2. In order to initiate steps in terms of Section 38 in the Constitution, a litigant should show that the right enshrined inside the Bill of Rights may be encroached upon as well as enough concern in the relief sought. The primary applicant didn't explicitly aver any such encroachment and the Judge found out that the First Plaintiff wouldn't be directly influenced by the verdict and did not have a sufficient involvement with the relief sought.
With regard to the second applicant the judge held it could not succeed in the application by itself, as not one of the alternative professional medical aid schemes or administrators had been joined.
The applicants fought that the Courts was required to consider three issues, which is: 1. The first applicant's entitlement to institute actions for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief sought by the candidates; 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 around in force since 1 January 2000. As reported by the candidates, the actual problem started on 11 November 2008 when the Appeal Board resolved two cases on appeal which was forwarded by the Appeal Committee in terms of section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to those two decisions, considered the phrase "pay in full" in regulation 8 to signify that the professional medical scheme should make complete settlement of a service providers' bill in respect of the charges of offering health care services for Prescribed Minimum Benefits if you don't take the rules of the professional medical scheme into consideration in dealing with any grievances.
It was the applicants' contention that "pay in full" signifies repayment in accordance with the regulations of the Professional medical Scheme, while according to the participants, the judgements by the Appeal Board haven't been challenged up to now and presently professional medical aid schemes are bound to this power and still have to pay service providers' invoices fully.
The principle grievance via the respondents was that the first applicant didn't have direct and substantial interest in the application as the verdict will not have a direct impact on it. Although the first applicant contended it defended 75 registered medical aid schemes and for that reason had locus standi, the Court discovered this not to be. This was considering that the first candidate saw fit to have the second candidate, who's an authorized professional medical aid scheme, coupled. Furthermore, only 15 registered professional medical schemes, in the starting and supplementary founding affidavits, confirmed that a declaratory order needs to be sought.
A Legal Court held that had the primary applicant been so confident that it defended all 75 professional medical aid schemes it would not have been necessary to join the 2nd applicant or to get hold of affidavits and signatures of 15 members of the 1st applicant. The Judge came to the conclusion from this that the first applicant did not in reality legally represent 75 members, but only the 15 members stated in the paperwork.
The non-joinder of all the professional medical schemes rendered the application fatally flawed as the Judge couldn't find that the first candidate, as being a general representative of the medical schemes, could be prejudicially impacted by a verdict, but learned that its participants may all be prejudicially affected and accordingly, all the members ought to have jointly instituted the application for the declaratory order.
The Court found out that the primary applicant was without locus standi for these reasons:
1. The issue was one which could be considered a representative issue, although not every one of the medical schemes had been amalgamated and it had not been started as a representative topic due to the fact that the first applicant didn't have any authority to litigate on behalf of all 75 of their members;
2. In order to initiate steps in terms of Section 38 in the Constitution, a litigant should show that the right enshrined inside the Bill of Rights may be encroached upon as well as enough concern in the relief sought. The primary applicant didn't explicitly aver any such encroachment and the Judge found out that the First Plaintiff wouldn't be directly influenced by the verdict and did not have a sufficient involvement with the relief sought.
With regard to the second applicant the judge held it could not succeed in the application by itself, as not one of the alternative professional medical aid schemes or administrators had been joined.
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