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 Court with a demand 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 Professional medical Schemes Act, 131 of 1998.
The candidates fought that the Courts had to determine three problems, that is: 1. The first applicant's right to initiate actions for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief searched for by way of 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 power since 1 January 2000. In accordance with the candidates, the actual problem began on 11 November 2008 once the Appeal Board decided two cases on appeal which was referred by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two decisions, interpreted the phrase "pay in full" in regulation 8 to indicate that the professional medical scheme should make full settlement of a service providers' bill in respect of the expenses of supplying medical care services for Prescribed Minimum Benefits if you don't take the policies of the health care scheme into consideration in working with any complaints.
It was actually the applicants' argument that "pay in full" indicates repayment according to the policies of the Professional medical Scheme, while in accordance with the respondents, the judgements by the Appeal Board haven't been questioned up to now and presently medical aid schemes are bound to this power while having to repay service providers' accounts fully.
The primary criticism from the participants could be that the first applicant had no immediate and significant concern in the application since the judgment will not have a direct effect over it. Although the first applicant contended that it defended 75 licensed professional medical aid schemes and therefore had locus standi, a legal court found this not to be. It was considering that the first candidate saw suitable to have the second candidate, who is an authorized professional medical aid scheme, joined. Additionally, only 15 licensed healthcare schemes, within the founding and supplementary founding affidavits, affirmed that a declaratory order must be found.
The Judge held that had the primary candidate been so confident that it defended all 75 healthcare aid schemes it would not have been essential to join the second applicant or to acquire affidavits and signatures of 15 members of the primary applicant. The Judge decided out of this that the first candidate didn't in reality legally represent 75 members, but only the 15 members mentioned in the papers.
The non-joinder of all of the professional medical schemes made the application fatally defective as the Judge couldn't find that the primary applicant, as a standard representative of the professional medical schemes, can be prejudicially affected by a judgment, but found that its members may all be prejudicially impacted and accordingly, many of the members ought to have jointly instituted the request for any declaratory order.
The Court discovered that the primary applicant did not have locus standi for the reasons:
1. The matter was one which might be classified as a representative issue, but not every one of the healthcare schemes have been combined and it had not been launched as a representative issue because of the fact that the first applicant didn't have any authority to litigate on the part of all 75 of their associates;
2. In order to institute action in terms of Section 38 of the Constitution, a litigant needs to show that a right enshrined in the Bill of Rights may be encroached upon along with sufficient interest in the relief wanted. The primary applicant didn't expressly aver such infringement and the Court found out that the 1st Complainant would not be directly influenced by the verdict and was lacking a satisfactory interest in the relief sought.
With respect to the second applicant the judge held it will not be successful in the application by itself, as not one of the alternative professional medical aid schemes or managers have been coupled.
The candidates fought that the Courts had to determine three problems, that is: 1. The first applicant's right to initiate actions for declaratory aid; 2. The interest and locus standi of the intervening respondents in opposing the relief searched for by way of 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 power since 1 January 2000. In accordance with the candidates, the actual problem began on 11 November 2008 once the Appeal Board decided two cases on appeal which was referred by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee as well as the Appeal Board had, pursuant to these two decisions, interpreted the phrase "pay in full" in regulation 8 to indicate that the professional medical scheme should make full settlement of a service providers' bill in respect of the expenses of supplying medical care services for Prescribed Minimum Benefits if you don't take the policies of the health care scheme into consideration in working with any complaints.
It was actually the applicants' argument that "pay in full" indicates repayment according to the policies of the Professional medical Scheme, while in accordance with the respondents, the judgements by the Appeal Board haven't been questioned up to now and presently medical aid schemes are bound to this power while having to repay service providers' accounts fully.
The primary criticism from the participants could be that the first applicant had no immediate and significant concern in the application since the judgment will not have a direct effect over it. Although the first applicant contended that it defended 75 licensed professional medical aid schemes and therefore had locus standi, a legal court found this not to be. It was considering that the first candidate saw suitable to have the second candidate, who is an authorized professional medical aid scheme, joined. Additionally, only 15 licensed healthcare schemes, within the founding and supplementary founding affidavits, affirmed that a declaratory order must be found.
The Judge held that had the primary candidate been so confident that it defended all 75 healthcare aid schemes it would not have been essential to join the second applicant or to acquire affidavits and signatures of 15 members of the primary applicant. The Judge decided out of this that the first candidate didn't in reality legally represent 75 members, but only the 15 members mentioned in the papers.
The non-joinder of all of the professional medical schemes made the application fatally defective as the Judge couldn't find that the primary applicant, as a standard representative of the professional medical schemes, can be prejudicially affected by a judgment, but found that its members may all be prejudicially impacted and accordingly, many of the members ought to have jointly instituted the request for any declaratory order.
The Court discovered that the primary applicant did not have locus standi for the reasons:
1. The matter was one which might be classified as a representative issue, but not every one of the healthcare schemes have been combined and it had not been launched as a representative issue because of the fact that the first applicant didn't have any authority to litigate on the part of all 75 of their associates;
2. In order to institute action in terms of Section 38 of the Constitution, a litigant needs to show that a right enshrined in the Bill of Rights may be encroached upon along with sufficient interest in the relief wanted. The primary applicant didn't expressly aver such infringement and the Court found out that the 1st Complainant would not be directly influenced by the verdict and was lacking a satisfactory interest in the relief sought.
With respect to the second applicant the judge held it will not be successful in the application by itself, as not one of the alternative professional medical aid schemes or managers have been coupled.
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