In the current 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 along with a request to supply a declaratory order with regards to the interpretation of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant towards the Healthcare Schemes Act, 131 of 1998.
The candidates put forward the proposition that the Court was required to determine three issues, that is: 1. The first applicant's right to institute proceedings 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 phrase "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. As reported by the appliers, the current problem commenced on 11 November 2008 once the Appeal Board resolved two cases on appeal which were forwarded from 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 imply that the medical scheme need to effect 100 % payment of the service providers' invoice in respect of the fees of offering health care services for Prescribed Minimum Benefits if you don't take the policies of the professional medical scheme into consideration in dealing with any complaints.
It was actually the applicants' dispute that "pay in full" implies payment according to the policies of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board have not been challenged up to now and presently medical aid schemes are bound to this authority while having to pay service providers' bills fully.
The primary claim by the respondents could be that the first applicant had no direct and substantial concern in the application since the verdict will not have a direct effect on it. Even though the first candidate suggested that it defended 75 registered medical aid schemes and therefore had locus standi, a legal court found this to not be. This is considering that the first candidate saw fit to have the second candidate, who is a registered healthcare aid scheme, amalgamated. Moreover, only 15 registered medical schemes, within the founding and supplementary founding affidavits, verified that a declaratory order needs to be sought.
The Judge held that had the initial candidate been so certain that it defended all 75 healthcare aid schemes it wouldn't have been necessary to join the second applicant or to receive affidavits and signatures of 15 members of the primary applicant. The Judge deducted out of this that the first candidate did not in fact legally represent 75 members, but only the 15 members mentioned in the documents.
The non-joinder of all of the healthcare schemes rendered the application fatally flawed as the Judge couldn't find that the first candidate, as a standard representative of the healthcare schemes, could be prejudicially affected by a ruling, but found that its members may all be prejudicially affected and accordingly, all the associates ought to have jointly instituted the application for a declaratory order.
A Legal Court discovered that the 1st applicant didn't have locus standi for these reasons:
1. The matter was one that could be considered a representative matter, but not all the professional medical schemes had been joined and it has not been announced as a representative issue due to the fact that the first candidate didn't have any authority to litigate on the part of all 75 of their members;
2. In order to commence action in terms of Section 38 of the Constitution, a litigant should reveal that the right enshrined in the Bill of Rights may be encroached upon as well as satisfactory interest in the relief desired. The initial applicant did not explicitly aver any such violation and the Court found that the 1st Plaintiff may not be directly affected by the ruling and did not have a satisfactory concern in the relief sought.
For the purpose of the other candidate the court held that it could not be successful in the application by itself, as not one of the other healthcare aid schemes or administrators have been connected.
The candidates put forward the proposition that the Court was required to determine three issues, that is: 1. The first applicant's right to institute proceedings 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 phrase "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. As reported by the appliers, the current problem commenced on 11 November 2008 once the Appeal Board resolved two cases on appeal which were forwarded from 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 imply that the medical scheme need to effect 100 % payment of the service providers' invoice in respect of the fees of offering health care services for Prescribed Minimum Benefits if you don't take the policies of the professional medical scheme into consideration in dealing with any complaints.
It was actually the applicants' dispute that "pay in full" implies payment according to the policies of the Healthcare Scheme, while according to the participants, the judgements by the Appeal Board have not been challenged up to now and presently medical aid schemes are bound to this authority while having to pay service providers' bills fully.
The primary claim by the respondents could be that the first applicant had no direct and substantial concern in the application since the verdict will not have a direct effect on it. Even though the first candidate suggested that it defended 75 registered medical aid schemes and therefore had locus standi, a legal court found this to not be. This is considering that the first candidate saw fit to have the second candidate, who is a registered healthcare aid scheme, amalgamated. Moreover, only 15 registered medical schemes, within the founding and supplementary founding affidavits, verified that a declaratory order needs to be sought.
The Judge held that had the initial candidate been so certain that it defended all 75 healthcare aid schemes it wouldn't have been necessary to join the second applicant or to receive affidavits and signatures of 15 members of the primary applicant. The Judge deducted out of this that the first candidate did not in fact legally represent 75 members, but only the 15 members mentioned in the documents.
The non-joinder of all of the healthcare schemes rendered the application fatally flawed as the Judge couldn't find that the first candidate, as a standard representative of the healthcare schemes, could be prejudicially affected by a ruling, but found that its members may all be prejudicially affected and accordingly, all the associates ought to have jointly instituted the application for a declaratory order.
A Legal Court discovered that the 1st applicant didn't have locus standi for these reasons:
1. The matter was one that could be considered a representative matter, but not all the professional medical schemes had been joined and it has not been announced as a representative issue due to the fact that the first candidate didn't have any authority to litigate on the part of all 75 of their members;
2. In order to commence action in terms of Section 38 of the Constitution, a litigant should reveal that the right enshrined in the Bill of Rights may be encroached upon as well as satisfactory interest in the relief desired. The initial applicant did not explicitly aver any such violation and the Court found that the 1st Plaintiff may not be directly affected by the ruling and did not have a satisfactory concern in the relief sought.
For the purpose of the other candidate the court held that it could not be successful in the application by itself, as not one of the other healthcare aid schemes or administrators have been connected.
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