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The RAF and Post-accident Medical Claims

In South Africa we have something called the Road Accident Fund (RAF). Why does it exist? Well, it’s there so that when an accident happens on a public road the fund is able to pay out for any injuries that were caused by the accident.  The money for the fund comes from a special fuel levy that’s included in the price of petrol and diesel. Statistics as they are, South Africa has an incredibly high amount of road accidents that lead to people being injured and the RAF just isn’t bringing in enough money to fund it all.

Maximum Claims

As of 30 April 2009, the maximum claim someone can make for an annual loss of income is R169 078.00 as stated in the RAF's subsection 17(4)(c). This amount has been adjusted from an original amount of R160 000.00.

Every three months, the powers that may be of the RAF get together and review this amount. In 2008 the maximum claim was far less! Before, there was a fixed limit of not a penny more than R25 000.00 per passenger, whereas now passengers can claim for more.

Everything mentioned above is over and above claiming for reasonable medical expenses that have been racked up, which the person claiming may need to pay back to their medical aid.

When you can Claim

A claim can be lodged within three years if the person knows who the driver of the vehicle is. If someone wants to claim when they don’t know who the driver is, then they only have two years to lodge a claim. If you're worried about costs for claiming - don't. It doesn’t cost anything to lodge a claim – the RAF branch offices help free of charge. If you prefer to hire a lawyer at your own expense, that’s more than okay too.

What You Can Claim

You can claim against losses of the past and future. This means that you can claim for medical expenses, funeral expenses, loss of support for a dependant of a deceased victim, general damages and you can even claim against things like a loss of income for the future.

If someone was on duty while they were injured, if the Compensation Commissioner (Workmen’s Compensation) has already paid for the damages, then the amount that was received will be taken away from whatever you claim from the RAF.

The RAF and Medical Aid Schemes

After you’ve been in an accident, chat to your medical aid. Your medical aid would have probably made payments for you to be treated in an emergency. Certain medical aid schemes have the primary member sign a document that says that should you be in an accident where the RAF pay money to you, you need to pay your medical aid back for the costs they covered initially. So beware that if the RAF pay money to you, you may have to pay your medical aid company back for costs they covered during the emergency.

Why? Well, the reason for this is because most medical schemes have a set of rules that say that they aren’t responsible for any kind of accident-type costs when you can claim from someone else. In this case, the RAF is the someone else.

If you have private medical aid, in an emergency you’re whisked away to a private hospital that can give you much more specialised attention than a public hospital. Another perk of private medical aid is that after your initial treatment you can carry on getting other treatment that’s needed , depending what policy you’ve taken out. Even with private medical aid though you may still need to pay back any medical fees they’ve covered when the RAF pays out.

Claiming from the RAF isn’t a quick process. To make sure the process runs as smoothly as possible though, make sure you’ve kept a record of all the costs you are claiming for that were initially paid by both you and your medical aid.

Important: The owner of the vehicle needs to report the accident to the police. This is essential.

When claiming from the RAF, the same basic kinds of things apply in terms of claiming for just about anything. This means that keeping copies of all paperwork and correspondence involved is extremely important. Things like hospital and clinical records, reports from the doctor treating you, police reports and a SAPS collision report should all be kept in a safe place. Also, don’t forget to lodge an affidavit with the police within two weeks of being able to do so.

Medical Fees

How the RAF compensates Medical Service Providers (MSPs)

You’ll find that the RAF pays out more for when there was a need for emergency medical treatments than when non-emergency treatments were needed after an accident. The lower fee that’s paid out is the Uniform Patient Fee Schedule for fees that are paid to public hospitals, prescribed under section 90(1)(b) of the National Health Act, 2003 (Act No. 61 of 2003). This ruling is revised every now and again.

Claims Involving Future Medical Costs

If you claim for future medical expenses that you’ll need to pay, these are paid back to you as part of an undertaking from section 17(4)(a) of the RAF Act. Basically, an undertaking is a contract between the person claiming and the RAF. It says that if the person is claiming for a reasonable amount of money, for valid medical expenses, then the RAF will pay out. This only applies when the person claiming can show exactly what type of tried-and-tested treatment they’re going to be spending the money on. The RAF won’t cover any unproven types of treatment or experimental ones either.

The RAF is in place to offer some form of help, compensation and support for those who are injured in road accidents on South Africa’s public roads. Let’s try and eliminate the need for a fund like the RAF. Let’s all try to be better drivers today.

Travel safely!

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