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 by way of a application to supply a declaratory order regarding the interpretation of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant towards the Medical Schemes Act, 131 of 1998.
The applicants fought that the Court had to consider three problems, namely: 1. The first applicant's entitlement to institute procedures for declaratory aid; 2. The interest and locus standi of the intervening members in opposing the relief searched for by way of the applicants; and 3. The meaning 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 around in force since 1 January 2000. In accordance with the appliers, the actual problem begun on 11 November 2008 when the Appeal Board decided two cases on appeal which was 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, interpreted the phrase "pay in full" in regulation 8 to signify that the healthcare scheme must make full settlement of a service providers' invoice in respect of the fees of providing health care services for Prescribed Minimum Benefits without taking the guidelines of the health care scheme into consideration in working with any grievances.
It had been the applicants' argument that "pay in full" means settlement in accordance with the guidelines of the Professional medical Scheme, while according to the respondents, the decisions by the Appeal Board haven't been questioned up to now and presently professional medical aid schemes are bound to this authority and have to repay service providers' bills entirely.
The principle claim via the participants could be that the first applicant didn't have immediate and substantial concern in the application since the judgment will not have an effect over it. Even though the first applicant suggested that it defended 75 licensed professional medical aid schemes and therefore had locus standi, the judge identified this to not be the case. This was considering that the first applicant saw suitable to have the second applicant, who's an authorized healthcare aid scheme, coupled. In addition, only 15 registered medical schemes, within the starting and additional founding affidavits, confirmed that the declaratory order should be found.
The Judge held that had the initial applicant been so sure that it represented all 75 professional medical aid schemes it wouldn't have been necessary to join the second applicant or to acquire affidavits and signatures of 15 members of the primary applicant. A Legal Court determined out of this that the first applicant didn't in reality legally represent 75 members, but only the 15 members pointed out in the papers.
The non-joinder of all of the medical schemes rendered the application fatally flawed as the Court could not discover that the first candidate, as being a standard representative of the professional medical schemes, will be prejudicially impacted by a ruling, but found that its participants may be prejudicially influenced and consequently, all the members should have jointly instituted the request for the declaratory order.
The Judge discovered that the first applicant didn't have locus standi for the reasons:
1. The issue was one which may be considered a representative matter, although not all the medical schemes have been combined and it has not been launched as a representative issue because of the fact that the first candidate was lacking any mandate to litigate on the part of all 75 of their members;
2. In order to institute steps in terms of Section 38 of the Constitution, a litigant must show that the right enshrined inside the Bill of Rights has been encroached upon along with adequate interest in the relief wanted. The first applicant didn't explicitly aver such encroachment and the Judge found out that the primary Plaintiff would not be directly influenced by the judgment and did not have an acceptable involvement with the relief sought.
With respect to the other candidate the court held it could not succeed in the application by itself, as not one of the alternative professional medical aid schemes or administrators have been connected.
The applicants fought that the Court had to consider three problems, namely: 1. The first applicant's entitlement to institute procedures for declaratory aid; 2. The interest and locus standi of the intervening members in opposing the relief searched for by way of the applicants; and 3. The meaning 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 around in force since 1 January 2000. In accordance with the appliers, the actual problem begun on 11 November 2008 when the Appeal Board decided two cases on appeal which was 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, interpreted the phrase "pay in full" in regulation 8 to signify that the healthcare scheme must make full settlement of a service providers' invoice in respect of the fees of providing health care services for Prescribed Minimum Benefits without taking the guidelines of the health care scheme into consideration in working with any grievances.
It had been the applicants' argument that "pay in full" means settlement in accordance with the guidelines of the Professional medical Scheme, while according to the respondents, the decisions by the Appeal Board haven't been questioned up to now and presently professional medical aid schemes are bound to this authority and have to repay service providers' bills entirely.
The principle claim via the participants could be that the first applicant didn't have immediate and substantial concern in the application since the judgment will not have an effect over it. Even though the first applicant suggested that it defended 75 licensed professional medical aid schemes and therefore had locus standi, the judge identified this to not be the case. This was considering that the first applicant saw suitable to have the second applicant, who's an authorized healthcare aid scheme, coupled. In addition, only 15 registered medical schemes, within the starting and additional founding affidavits, confirmed that the declaratory order should be found.
The Judge held that had the initial applicant been so sure that it represented all 75 professional medical aid schemes it wouldn't have been necessary to join the second applicant or to acquire affidavits and signatures of 15 members of the primary applicant. A Legal Court determined out of this that the first applicant didn't in reality legally represent 75 members, but only the 15 members pointed out in the papers.
The non-joinder of all of the medical schemes rendered the application fatally flawed as the Court could not discover that the first candidate, as being a standard representative of the professional medical schemes, will be prejudicially impacted by a ruling, but found that its participants may be prejudicially influenced and consequently, all the members should have jointly instituted the request for the declaratory order.
The Judge discovered that the first applicant didn't have locus standi for the reasons:
1. The issue was one which may be considered a representative matter, although not all the medical schemes have been combined and it has not been launched as a representative issue because of the fact that the first candidate was lacking any mandate to litigate on the part of all 75 of their members;
2. In order to institute steps in terms of Section 38 of the Constitution, a litigant must show that the right enshrined inside the Bill of Rights has been encroached upon along with adequate interest in the relief wanted. The first applicant didn't explicitly aver such encroachment and the Judge found out that the primary Plaintiff would not be directly influenced by the judgment and did not have an acceptable involvement with the relief sought.
With respect to the other candidate the court held it could not succeed in the application by itself, as not one of the alternative professional medical aid schemes or administrators have been connected.
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