During the current 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 meaning of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant to the Medical Schemes Act, 131 of 1998.
The applicants put forward the proposition that the Judge had to consider three issues, which is: 1. The first applicant's entitlement to institute procedures for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief looked for by way of the applicants; and 3. The concise explanation of the terminology "pay in full" in regulation 8(1) of the General Regulations that had been promulgated with respect to section 67 of the Act.
Regulation 8 has been around in power since 1 January 2000. According to the applicants, the actual problem commenced on 11 November 2008 when the Appeal Board decided two cases on appeal which were 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 those two judgements, interpreted the words "pay in full" in regulation 8 to indicate that the healthcare scheme need to make full settlement of the service providers' invoice in respect of the expenses of supplying health care services for Prescribed Minimum Benefits without taking the guidelines of the professional medical scheme into account in dealing with any problems.
It was the applicants' dispute that "pay in full" indicates payment according to the rules of the Professional medical Scheme, while according to the respondents, the decisions by the Appeal Board haven't been questioned as yet and presently professional medical aid schemes are bound to this power while having to pay service providers' accounts fully.
The main gripe by the respondents was that the first applicant had no immediate and substantial concern in the application as the verdict would not have an effect over it. Even though the first applicant suggested it defended 75 registered healthcare aid schemes and therefore had locus standi, the Court discovered this to not be the case. This was due to the fact that the first candidate saw fit to have the second applicant, who's an authorized medical aid scheme, joined. Additionally, only 15 registered healthcare schemes, in the starting and supplementary founding affidavits, confirmed that a declaratory order needs to be found.
A Legal Court held that had the first candidate been so sure that it represented all 75 healthcare aid schemes it would not have been necessary to join the second applicant or to get hold of affidavits and signatures of 15 members of the primary applicant. The Judge decided from this that the first candidate didn't 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 Court could not discover that the primary applicant, as being a standard representative of the medical schemes, can be prejudicially impacted by a judgment, but learned that its participants may all be prejudicially impacted and consequently, many of the members ought to have jointly implemented the application for any declaratory order.
The Judge found out that the 1st applicant didn't have locus standi for these reasons:
1. The issue was one which could be considered a representative issue, but not every one of the professional medical schemes have been joined and it had not been launched as a representative topic due to the fact that the first applicant was lacking any mandate to litigate on the part of all 75 of its associates;
2. In order to start action in terms of Section 38 of the Constitution, a litigant needs to demonstrate that the right enshrined in the Bill of Rights has been encroached upon along with sufficient interest in the relief wanted. The first candidate didn't clearly aver any such infringement and the Court found that the 1st Complainant would not be directly affected by the judgment and was lacking an acceptable concern in the relief sought.
For the purpose of the other candidate the court held that it could not be successful in the application on its own, as none of the alternative professional medical aid schemes or administrators have been coupled.
The applicants put forward the proposition that the Judge had to consider three issues, which is: 1. The first applicant's entitlement to institute procedures for declaratory relief; 2. The interest and locus standi of the intervening respondents in opposing the relief looked for by way of the applicants; and 3. The concise explanation of the terminology "pay in full" in regulation 8(1) of the General Regulations that had been promulgated with respect to section 67 of the Act.
Regulation 8 has been around in power since 1 January 2000. According to the applicants, the actual problem commenced on 11 November 2008 when the Appeal Board decided two cases on appeal which were 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 those two judgements, interpreted the words "pay in full" in regulation 8 to indicate that the healthcare scheme need to make full settlement of the service providers' invoice in respect of the expenses of supplying health care services for Prescribed Minimum Benefits without taking the guidelines of the professional medical scheme into account in dealing with any problems.
It was the applicants' dispute that "pay in full" indicates payment according to the rules of the Professional medical Scheme, while according to the respondents, the decisions by the Appeal Board haven't been questioned as yet and presently professional medical aid schemes are bound to this power while having to pay service providers' accounts fully.
The main gripe by the respondents was that the first applicant had no immediate and substantial concern in the application as the verdict would not have an effect over it. Even though the first applicant suggested it defended 75 registered healthcare aid schemes and therefore had locus standi, the Court discovered this to not be the case. This was due to the fact that the first candidate saw fit to have the second applicant, who's an authorized medical aid scheme, joined. Additionally, only 15 registered healthcare schemes, in the starting and supplementary founding affidavits, confirmed that a declaratory order needs to be found.
A Legal Court held that had the first candidate been so sure that it represented all 75 healthcare aid schemes it would not have been necessary to join the second applicant or to get hold of affidavits and signatures of 15 members of the primary applicant. The Judge decided from this that the first candidate didn't 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 Court could not discover that the primary applicant, as being a standard representative of the medical schemes, can be prejudicially impacted by a judgment, but learned that its participants may all be prejudicially impacted and consequently, many of the members ought to have jointly implemented the application for any declaratory order.
The Judge found out that the 1st applicant didn't have locus standi for these reasons:
1. The issue was one which could be considered a representative issue, but not every one of the professional medical schemes have been joined and it had not been launched as a representative topic due to the fact that the first applicant was lacking any mandate to litigate on the part of all 75 of its associates;
2. In order to start action in terms of Section 38 of the Constitution, a litigant needs to demonstrate that the right enshrined in the Bill of Rights has been encroached upon along with sufficient interest in the relief wanted. The first candidate didn't clearly aver any such infringement and the Court found that the 1st Complainant would not be directly affected by the judgment and was lacking an acceptable concern in the relief sought.
For the purpose of the other candidate the court held that it could not be successful in the application on its own, as none of the alternative professional medical aid schemes or administrators have been coupled.
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