Case Law[2025] ZAWCHC 106South Africa
Maarman and Others v Road Accident Fund (993/2023) [2025] ZAWCHC 106 (12 March 2025)
High Court of South Africa (Western Cape Division)
12 March 2025
Headnotes
or Dismissed.
Judgment
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# South Africa: Western Cape High Court, Cape Town
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## Maarman and Others v Road Accident Fund (993/2023) [2025] ZAWCHC 106 (12 March 2025)
Maarman and Others v Road Accident Fund (993/2023) [2025] ZAWCHC 106 (12 March 2025)
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sino date 12 March 2025
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IN THE HIGH COURT OF
SOUTH AFRICA
EASTERN CIRCUIT LOCAL
DIVISION, THEMBALETHU
Case No: 993/2023;
(994/2023);
(894/2023);
(18128/2023); (896/2023);
(929/2023);(18126/2023);
(18125/2023);
(126/2024);
(18090/2023);
(991/2023);
(895/2023);
(18089/2023); (104/2024);
(992/2023);
(105/2024)
REPORTABLE:
YES
OF
INTEREST TO OTHER JUDGES: NO
In the matter between:
HENRICO
JOVIHANO MAARMAN
(993/2023)
PLAINTIFF
JAKOBUS
GEORGE
(994/2023)
PLAINTIFF
JOSLIN
CINDY PETERSEN
(894/2023)
PLAINTIFF
JOHANNA
FRANS
(18128/2023)
PLAINTIFF
JOHANNES
NOMBANDE
(896/2023)
PLAINTIFF
BILLY
ANNE BERDINE LAMONT
(929/2023
)
PLAINTIFF
GLANWILL
CEDERIC PICKAAN
(18126/2023)
PLAINTIFF
AMBROZE
REGAN KEFFERS
(18125/2023)
PLAINTIFF
RENTIA
VELENCIA SEFOOR
(126/2024)
PLAINTIFF
JACKY
KANNEMEYER obo
J[...]
D[...] K[...] (18090/2023)
PLAINTIFF
JACKY
KANNEMEYR obo
T[...]
L[...] L[...] K[...] (991/2023)
PLAINTIFF
SYDNEY
TITUS
(895/2023)
PLAINTIFF
JACKY
KANNEMEYR
(18089/2023)
PLAINTIFF
THULANE
JACKY MSIMANGA
(104/2024)
PLAINTIFF
ESTRALITA
CAROLINE PHILLIPS obo
V[...]
T[...] P[...] (105/2024)
PLAINTIFF
DAVID
CARELSE
(992/2023)
PLAINTIFF
and
ROAD
ACCIDENT FUND
DEFENDANT
Coram:
Kholong AJ
Heard:
28 January 2025
Delivered:
12 March 2025
JUDGMENT
KHOLONG AJ
Introduction
1.
This Court has been called upon to hear a special
plea raised by the Road Accident Fund (herein-after “RAF”)
in defense
to 16 different actions instituted against it before this
Court. Whilst the plaintiffs are different and instituted proceedings
independently, legal representation for plaintiffs and defendant is
the same. Accordingly, the Parties have agreed that the special
plea
raised in each of these matters be heard first and consolidated
together before merits in each separate case are considered.
The
special plea is dealt with below.
2.
The Plaintiffs in these cases are Henrico Jovihano
Maarman; Jakobus George; Joslin Cindy Petersen; Johanna Frans;
Johannes Nombande;
Billy Anne Berdine Lamont; Glanwill Cederic
Pickaan; Ambroze Regan Keffers; Rentia Velencia Sefoor; Jacky
Kannemeyer on behalf
of J[...] D[...] K[...]; Jacky Kannemeyr on
behalf of T[...] L[...] L[...] K[...]; Sydney Titus; Jacky Kannemeyr;
Thulane Jacky
Msimanga; Estralita Caroline Philips on behalf of
V[...] T[...] P[...] and David Carelse.
3.
The defendant in all these actions is the RAF,
which is an entity established by the
Road
Accident Fund Act, 56 of 1996
(“the
Act”) to compensate victims involved in accidents arising from
the driving of motor vehicles. The incidents, which
according to the
record, allegedly involved either motor vehicle collision with driver
and passengers in some instances and in
another pedestrian claiming
to have been hit by a motor vehicle driven negligently. It is common
cause that all these alleged incidents
occurred within this Court’s
area of jurisdiction.
Background/Special
Plea
4.
The parties agreed on a stated case in terms of
rule 33. In summary, the questions of law in dispute that the parties
want this
Court to determine are the following:
5.1.
Did the lodged documents satisfy the requirements in law to be
regarded that the claim submitted
by the plaintiff substantially
complied with the procedural requirements for a validly lodged claim
in terms of
Section 24
of the
Road Accident Fund Act, Act
56 of 1996.
5.2
Whether the lodged documents listed, furnish defendant with
sufficient information to enable
defendant to investigate and
consider the plaintiff’s claim?
5.3
Whether the defendant is entitled to refuse to accept claims which do
not comply with the
terms and conditions set out in Board notice 271
read with the new RAF 1 form?
5.4
Does the decision to refuse to accept claims constitute an
administrative decision?
5.5
Are the requirements for valid lodgment in terms of Board Notice 271
peremptory and can
it be interpreted to make provision for partial
compliance to the Board notice in respect of the lodgment of claims?
5.6
Did the proposed lodgment documents listed satisfy the requirements
of Board Notice 271
and can it be regarded that the claim submitted
by plaintiff complied with the procedural requirements for a validly
lodged claim
in terms of published stipulated terms and conditions in
Board Notice 271 of 2022 read with Section 24 of the Act, which
stipulate
which documents must accompany the claim documentation when
submitting a claim for compensation.
5.7
Consequently whether the special plea should be upheld or Dismissed.
Facts
5.
Essentially in all of these cases RAF in paragraph
1 of the rejection letters stated the following:
“
To
administer claims effectively and efficiently the Road Accident Fund
(RAF) pursuant to section 4(1)(a) of the Road Accident Fund
Act, 1996
(the Act) published the stipulated terms and conditions upon which
claims for compensation shall be administered (the
terms and
conditions) in Board Notice 271 of 2022 which was published in
Government Gazette No. 46322 on 6 May 2022. The terms
and Conditions,
read with section 24 of the Act, stipulate what documents must
accompany the claim documentation when submitting
a claim for
compensation
”
.
6.
In each instance RAF proceeded to object to the
validity of the claims submitted in accordance with paragraph 24(5)
of the Act and
stated that they “
do
not accept the documentation presented/posted/emailed…as a
valid claim for the purposes of lodgment in terms of the Act
and
accordingly return the documents.
.”
.
7.
Plaintiffs had on various dates submitted claims
against RAF for compensation. RAF repudiated all these claims.
For
example, in the case of Maarman, this Plaintiff had on 18 September
2023 following RAF’s rejection letter issued summons
in
pursuance of its claim in the amount of R1 550 000. The RAF
raised a special plea in this
case
as it did in each of the other aforementioned actions. RAF’s
plea which followed a similar thread in other rejection
letters went
as follows:
“
To
administer claims effectively and efficiently the Road Accident Fund
(RAF) pursuant to Section 4(1)(a) of the Road Accident Fund
Act, 1996
(the Act) published the stipulated Terms and Conditions upon which
claims for compensation shall be administered (the
terms and
conditions) in Board Notice 271 of 2022 which was published in
Government Gazette No 46322 on 6 May 2022. The terms and
conditions,
read with section 24 of the Act, stipulate what documents must
accompany the claim documentation when submitting a
claim for
compensation.
On 11 May 2023 the
plaintiff posted his claim with the defendant for the following
products General damages, loss of earning, medical
expenses.
In the claim posted on
11 May 2023 the plaintiff is obliged to comply with Section 24(5) of
the Act as amended.
In the letter dated 01
July 2023, within the time period for the defendant to object, the
defendant in writing, objected to the
plaintiff’s claim
presented on the grounds that there was non-compliance with section
24(5) of the Act as amended.
In
the circumstances the plaintiff’s claim is invalid in Law
”
.
8.
It was on this basis that defendant prayed for its
special plea to be upheld and for plaintiff’s claim to be
dismissed with
costs. Save for change in dates on which the claims
were posted in these various actions and variation in reasons, as
shall be
dealt with below, the 16 rejection letters are premised on
largely the same principles, non-compliance with Section 24.
Rejection Letters
Jacky Kannemeyr
9.
In the case of Jacky Kannemeyr, in the letter
dated 7 May 2024 RAF stated that their pre-assessment reveals that
the claim will
prescribe on 7 September 2030 and RAF will take a
special plea should summons be issued. They proceeded to state that
their pre-assessment
having regard to compliance with section 24 and
the terms and conditions, reveals that the documents submitted do not
meet the
requirements for a substantially compliant and valid claim,
the reasons being:
“
1.
Court order or masters letter of appointment (If curator submitting
on behalf of minor-LOS (if applicable).
2. Unabridged birth
certificate (if natural guardian is claiming on behalf of minor).
3. Copies of all
hospital and medical accounts.
4. official
documentation confirming any disability grant.
5. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
6. Proof of payment of
medical expenses”.
10.
This rejection or objection letter followed on an
earlier objection letter of 23 June 2023. That objection letter had
in the main
raised similar objections, that is: “
Academic
registration/school report; all statements and documents as outlined
in terms of section 19(f)(i); Medical reports or documentation
establishing or substantiating claimant’s temporary/permanent
disability and loss of earnings claimed; SMR is not completed
by
first doctor
”
.
Thulane Jacky Msimanga
11.
In the case of Thulane Jacky Msimanga, in
the letter dated 2 October 2023 RAF objected to the validity of the
claim submitted in
accordance with paragraph 24(5) of the Act and
stated that RAF will take a special plea should summons be issued.
The basis thereof
was that their pre-assessment having regard to
compliance requirements with section 24 and the terms and conditions,
reveals that
the documents submitted do not meet the requirements for
a substantially compliant and valid claim because:
“
2.1.
Copies of all medical and hospital records, including photographs of
the injuries.
2.2.
Pay slips pre and post-accident.
2.3.
Employer’s certificate of injured service showing nature of
employment, the period
of service, remuneration, prospect of
advancement and
compensation and retirement age.
2.4.
Proof of any other income, if applicable.
2.5.
Official confirmation of remuneration/ compensation received from
other sources (if
applicable).
2.6.
Claimant’s tax records if not available, communication from
SARS
that claimant is not
registered for tax), in which case a bank statement for three years
preceding accident must be submitted (if
applicable).
2.7.
Medical reports or documentation establishing or substituting
claimant’s temporary/ permanent
disability and the loss of
earnings claimed.
2.8.
Official confirmation of the compensation fund’s award if
claimant was injured during the
course and scope of employment.
2.9.
Official documentation confirming any disability grant.
2.10.
Proof of payment of medical expenses.
2.11. An
itemized tax invoice from a registered medical provider/or hospital
for the past medical expenses.”
12.
This rejection, followed on an earlier rejection
of 2 May 2024 where RAF sought copies of all hospital and medical
accounts; official
documentation confirming any disability grant; An
itemized tax invoice from a registered medical provider/or hospital
for past
medical expenses as well as proof of payment of medical
expenses.
EC Phillips obo VT
13.
In the case of EC Phillips acting on behalf of
another, in the letter dated 11 July 2023, RAF objected to the
validity of the claim
submitted in accordance with paragraph 24(5) of
the Act and stated that RAF will take a special plea should summons
be issued.
The basis thereof was that their pre-assessment having
regard to compliance requirements with section 24 and the terms and
conditions,
revealed that the documents submitted do not meet the
requirements for a substantially compliant and valid claim, thus do
not accept
the documentation. The reasons given were the following:
“
1.
Copies of all hospital and medical accounts
2. Medical reports or
documentation establishing or substantiating claimant’s
temporary/permanent disability and the loss
of earnings claimed.
3. Official
documentation confirming any disability grant.
4. Copies of all
medical and hospital records, including photographs of the injuries.
3. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
4.
Proof of payment of medical expenses”
.
David Carelse
14.
In the case of David Carelse, in the letter dated
7 May 2024 they objected to the validity of the claim submitted in
accordance
with paragraph 24(5) of the Act and stated that RAF will
take a special plea should summons be issued. The basis thereof was
that
their pre-assessment having regard to compliance requirements
with section 24 and the terms and conditions in Board notice 271 of
2022, reveals that the documents submitted do not meet the
requirements for a substantially compliant and valid claim, thus do
not accept the documentation. The reasons were the following:
“
1.
Certified copy of claimants ID (Eligible).
2. Copies of all
hospital and medical records in terms of section 19(e)(i) and
19(e)(ii).
3. Copies of all
hospital and medical records, including photographs of injuries or
scarring.
4. Proof of any other
income, if applicable.
5. Photographs of
injuries or scarring.
6. Copies of all
hospital and medical accounts.
7. Official
documentation confirming any disability grant.
8. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
9. Proof of payment of
medical expenses”.
Rentia
Velentia Sefoor
15.
In the case of
Rentia Velentia Sefoor, in the letter dated 8 August 2023 they
objected to the validity of the claim submitted in
accordance with
paragraph 24(5) of the Act and stated that RAF will take a special
plea should summons be issued. The basis thereof
was that their
pre-assessment having regard to compliance requirements with section
24 and the terms and conditions in Board notice
271 of 2022, they
advised that the documents submitted do not meet the requirements for
a substantially compliant and valid claim,
thus do not accept the
documentation because:
“
1.
Statutory Medical Report ( must be completed by the first treating
Doctor/must be completed using a disclaimer that it was completed
with available hospital records).
2.
Copies of all hospital and medical records in terms of section
19(e)(i) and 19(e)(ii).
3.
Copies of all hospital and medical records, including photographs of
Injuries.
4.
Pay-slips pre and post-accident.
5.
Employer’s certificate of injured’ service showing nature
of employment, the period of service, remuneration, prospects
of
advancement and compensation and retirement age.
6.
Proof of any other income, if applicable.
7.
Photographs of injuries or scarring.
8.
Copies of all hospital and medical accounts.
9.
Medical reports or documentation establishing or substantiating
claimant’s temporary/permanent disability and the loss
of
earnings claimed.
10.Official
documentation confirming any disability grant.
11.
An itemized tax invoice from a registered medical provider/or
hospital for past medical expenses.
12.
Proof of payment of medical expenses”.
16.
This letter was
followed by a letter of 7 May 2024 where many of the objections
reduced but for Employer’s certificate of
injured service
showing nature of employment, the period of service, remuneration,
prospects of advancement and compensation and
retirement age; copies
of all hospital and medical accounts; official documentation
confirming any disability grant; an itemized
tax invoice from a
registered medical provider/or hospital for past medical expenses;
and proof of payment of medical expenses.
This letter stated the
standard paragraphs as in the previous letter of objection with
indication that claim will prescribe on
11 October 2023.
GC PICKAAN
17.
In the case of GC Pickaan, in the letter
dated 12 September 2023 RAF objected to the validity of the claim
submitted in accordance
with paragraph 24(5) of the Act and stated
that RAF will take a special plea should summons be issued. The basis
thereof was that
their pre-assessment having regard to compliance
requirements with section 24 and the terms and conditions in Board
notice 271
of 2022, revealed that the documents submitted do not meet
the requirements for a substantially compliant and valid claim, thus
do not accept the documentation because:
“
1.
Copies of all hospital and medical records, including photographs of
the injuries.
2.
Payslips pre and post-accident.
3. Employer’s
certificate of injured’ service showing nature of employment,
the period of service, remuneration, prospects
of advancement and
compensation and retirement age
4. Proof of any other
income, if applicable
5. Copies of all hospital
and medical accounts.
6. Medical reports or
documentation establishing or substantiating claimant’s
temporary/permanent disability and the loss
of earnings claimed
7. Official documentation
confirming any disability grant.
8. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
9. Proof of payment of
medical expenses”.
18.
This letter was followed by a letter of 21
May 2024 where many of the objections reduced but for copies of
medical records. This
letter stated the standard paragraphs as in the
previous letter which included the question of prescription which RAF
stated will
only be interrupted once a valid claim is lodged.
J George
19.
In the case of J George, in the letter dated 4
July 2023 they objected to the validity of the claim submitted in
accordance with
paragraph 24(5) of the Act and stated that RAF will
take a special plea should summons be issued. The basis thereof was
that their
pre-assessment having regard to compliance requirements
with section 24 and the terms and conditions in Board notice 271 of
2022,
revealed that the documents submitted do not meet the
requirements for a substantially compliant and valid claim, thus do
not accept
the documentation because:
“
1.
Copies
of all h
ospital
and medical records, including photographs of the injuries.
.2. Copies of all
hospital and medical accounts.
3. Medical reports or
documentation establishing or substantiating claimant’s
temporary/permanent disability and the loss
of earnings claimed
4.Official confirmation
of remuneration/compensation received from other sources (if
applicable)
5. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
6. Official documentation
confirming any disability grant.
7.
“SMR
– NOT DULLY COMPLETED AND NOT FIRST TREATING DOCTOR”.
20.
This letter was followed by a letter of 21
May 2024 where many of the objections were restated and added query
on proof of any other
income if applicable. This letter stated the
standard paragraphs as in the previous letter including the question
of prescription
which RAF stated will only be interrupted once a
valid claim is lodged.
Ambrose Regan Keffers
21.
In the case of Ambrose Regan Keffers, in the
letter dated 12 September 2023 they objected to the validity of the
claim submitted
in accordance with paragraph 24(5) of the Act and
stated that RAF will take a special plea should summons be issued.
The basis
thereof was that their pre-assessment having regard to
compliance requirements with section 24 and the terms and conditions
in
Board notice 271 of 2022, revealed that the documents submitted do
not meet the requirements for a substantially compliant and valid
claim, thus do not accept the documentation because:
“
1.
Pay-slips pre and post-accident.
2.
Employer’s certificate of injured’ service showing nature
of employment, the period of service, remuneration, prospects
of
advancement and compensation and retirement age
3. claimant’s
tax records (if not available, communication from SARS that claimant
is not registered for tax), in which
case a bank statement for three
years preceding accident must be submitted (if applicable).
4. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
5. Proof of payment
of medical expenses.
6. Copies of all
hospital and medical accounts.
7. Copies of all
hospital and medical records, including photographs of the injuries.
8. Medical reports or
documentation establishing or substantiating claimant’s
temporary/permanent disability and the loss
of earnings claimed.
9. Official documentation
confirming any disability grant”.
22.
This letter was followed by a letter of 22 May
2024 where some of the objections reduced. Added proof of any other
income; payslips
pre and post accident. This letter stated the
standard paragraphs as in the previous letter which included the
question of prescription
on 29 April 2024 which RAF stated will only
be interrupted once a valid claim is lodged.
Johanna Frans
23.
In the case of Johanna Frans, in the letter dated
19 September 2023 they objected to the validity of the claim
submitted in accordance
with paragraph 24(5) of the Act and stated
that RAF will take a special plea should summons be issued. The basis
thereof was that
their pre-assessment having regard to compliance
requirements with section 24 and the terms and conditions in Board
notice 271
of 2022, revealed that the documents submitted do not meet
the requirements for a substantially compliant and valid claim, thus
do not accept the documentation because:
“
1.
SMR not duly completed
2. Certified copy of
marriage certificate.
3. Deceased’s tax
records ( if not available, communication from SARS that claimant is
not registered for tax, in which case
a bank statement for three
years preceding death must be submitted)
4.Claimant’s tax
records ( if not available, communication from SARS that claimant is
not registered for tax, in which case
a bank statement for three
years preceding death must be submitted.
5. Copy of liquidation
and distribution account, if applicable.
6. The sassa grant
official documents, if applicable.
7. The actuarial report.
8. If applicable,
confirmation of all payments in terms of compensation commissioner,
rand Mutual, Poilce, Defence Force etc.
9. Official confirmation
of remuneration/compensation received from other sources, if
applicable’.
24.
This letter was followed by a letter of 22 May
2024 where some of the objections reduced and others added. RAF
stated the following
as its reasons:
“
1.
Statutory Medical Report (SMR) as per section 24 substantial
compliance.
2. Certified copy of
marriage certificate/certificate proving customary
marriage/unabridged birth certificate (if children).
3. If not married, an
affidavit setting out the legal basis of claimant’s dependency
on deceased.
4.Employer’s
certificate of deceased’s services showing nature of
employment, the period of service, remuneration prospects
of
advancement and compensation and retirement age.
5. Deceased’s
payslips.
6. Copy of maintenance
order. (if divorced).
7.Claimant’s tax
records (if not available, communication from SARS that claimant is
not registered for tax), in which case
a bank statement for three
years preceding death must be submitted.
8. Deceased’s tax
records (if not available, communication from SARS that claimant is
not registered for tax, in which case
a bank statement for three
years preceding death must be submitted)
9. Copy of liquidation
and distribution account.
10. The Child support
grant documentation.
11. Employer’s
certificate of spouse indicating period of employment, remuneration,
prospects of advancement.
12. Proof of guardianship
(if claimant not biological parent).
13. The actuarial report.
14. All payments in terms
of compensation commissioner, rand Mutual, Poilce, Defense Force etc.
15. Specified
voucher for medical costs, if claimed.
16. Any other proof of
income of the deceased, letter from employer, affidavit from
employer/ or any person that can confirm that
deceased had income to
support dependents.
17. Official confirmation
of remuneration/compensation received from other sources/proof of
additional income.
Sydney Titus
25.
In the case of Sydney Titus, in the letter dated
16 May 2024 they objected to the validity of the claim submitted in
accordance
with paragraph 24(5) of the Act and stated that RAF will
take a special plea should summons be issued. The basis thereof was
that
their pre-assessment having regard to compliance requirements
with section 24 and the terms and conditions, revealed that the
documents
submitted do not meet the requirements for a substantially
compliant and valid claim because:
“
2.1.Ceritfied
copy of claimants ID.
2.2. Payslips pre and
post-accident.
2.3. Employer’s
certificate of injured service showing nature of employment, the
period of service, remuneration, prospect
of advancement and
compensation and retirement age.
2.4. Proof of any other
income, if applicable.
2.5. Official
documentation confirming any disability grant.
2.16. Proof of payment of
medical expenses”.
26.
This letter was preceded by a letter of 28
February 2023 requiring a number of documents to be submitted.
Johannes
Nombande
.
27.
In the case of Johannes Nombande, in the
letter dated 21 May 2024 they objected to the validity of the claim
submitted in accordance
with paragraph 24(5) of the Act and stated
that RAF will take a special plea should summons be issued. The basis
thereof was that
their pre-assessment having regard to compliance
requirements with section 24 and the terms and conditions, revealed
that the documents
submitted do not meet the requirements for a
substantially compliant and valid claim because:
“
2.1.
Statutory Medical Report (SMR) as per section 24 substantial
compliance.
2.2. Employer’s
certificate of injured service showing nature of employment, the
period of service, remuneration, prospect
of advancement and
compensation and retirement
age.
2.3. Payslips pre and
post-accident.
2.4. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
2.5. Proof of payment of
medical expenses”.
28.
This letter was preceded by a letter of 2 May 2024
and raising similar queries but one and letter of 11 June 2023 and 28
February
2023 requiring a number of such similar documents to be
submitted.
Billy
Anne Berdine Hendrik
s
(Lamont)
29.
In the case of Billy Anne Berdine Hendriks
(Lamont), in the letter dated 22 May 2024 they objected to the
validity of the claim
submitted in accordance with paragraph 24(5) of
the Act and stated that RAF will take a special plea should summons
be issued.
The basis thereof was that their pre-assessment having
regard to compliance requirements with section 24 and the terms and
conditions,
revealed that the documents submitted do not meet the
requirements for a substantially compliant and valid claim because:
“
2.1.
Statutory Medical Report (SMR) as per section 24 substantial
compliance.
2.2. Employer’s
certificate of injured service showing nature of employment, the
period of service, remuneration, prospect
of advancement and
compensation and retirement age.
2.3. Proof of any other
income, if applicable.
2.4. Payslips pre and
post-accident.
2.5. Photographs of
injuries or scarring.
2.6. Medical reports or
documentation establishing or substantiating claimant’s
temporary/permanent disability and the loss
of earnings claimed
(medico-legal reports)
2.7. Official
documentation confirming any disability grant.
2.8. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
2.9. Proof of payment of
medical expenses.
30.
This letter was preceded by a letter of 22 May
2023 where such similar queries were raised bar certain variations.
Joslyn
Cindy Petersen
.
31.
In the case of Joslyn Cindy Petersen, in the
letter dated 15 May 2024 they objected to the validity of the claim
submitted in accordance
with paragraph 24(5) of the Act and stated
that RAF will take a special plea should summons be issued. The basis
thereof was that
their pre-assessment having regard to compliance
requirements with section 24 and the terms and conditions, revealed
that the documents
submitted do not meet the requirements for a
substantially compliant and valid claim, thus do not accept the
documentation because:
“
1.
Statutory medical report (must be completed by the first treating
doctor/ must be completed using a disclaimer that that it was
completed with available hospital records).
2. Power of attorney.
3. Copies of all medical
and hospital records in terms of section 19.
4. Copies of all medical
and hospital records, including photographs of the injuries or
scarring.
5. Photographs of
injuries or scarring.
6. Official documentation
confirming any disability grant.
7. An itemized tax
invoice from a registered medical provider/or hospital for the past
medical expenses
8. proof of payment of
medical expenses.”
32.
In this letter of 2024 they advise that the ‘claim
will prescribe on Tuesday 2 August 2022”. This letter had been
preceded
by letters of the 16
th
and 17
th
May 2023.
Henrico Jovihano
Maarman
33.
In the case of Henrico Jovihano Maarman, in the
letter dated 7 May 2024 they objected to the validity of the claim
submitted in
accordance with paragraph 24(5) of the Act and stated
that RAF will take a special plea should summons be issued. The basis
thereof
was that their pre-assessment having regard to compliance
requirements with section 24 and the terms and conditions, revealed
that
the documents submitted do not meet the requirements for a
substantially compliant and valid claim because:
“
2.1.
Statutory Medical Report (SMR) as per section 24 substantial
compliance.
2.2. Copies of all
hospital and medical records, including photographs of injuries or
scarring.
2.3. Employer’s
certificate of injured service showing nature of employment, the
period of service, remuneration, prospect
of advancement and
compensation and retirement age.
2.4. Proof of any other
income, if applicable.
2.5. Payslips pre and
post-accident.
2.6. Photographs of
injuries or scarring.
2.7. Copies of all
hospital and medical accounts.
2.8. Official
documentation confirming any disability grant.
2.9. An itemized tax
invoice from a registered medical provider/or hospital for past
medical expenses.
2.10. Proof of payment of
medical expenses.
34.
This letter was preceded by a letter of 1 July
2023 where such similar queries with variation were raised.
Sydney Titus
35.
In the case of Sydney Titus, in the letter dated
15 May 2024 they objected to the validity of the claim submitted in
accordance
with paragraph 24(5) of the Act and stated that RAF will
take a special plea should summons be issued. The basis thereof was
that
their pre-assessment having regard to compliance requirements
with section 24 and the terms and conditions, revealed that the
documents
submitted do not meet the requirements for a substantially
compliant and valid claim because:
“
2.1.
Certified copy of Claimants ID.
2.2. Employer’s
certificate of injured service showing nature of employment, the
period of service, remuneration, prospect
of advancement and
compensation and retirement age.
2.3. Proof of any other
income, if applicable.
2.4. Pay-slips pre and
post-accident.
2.5. Copies of all
hospital and medical accounts.
2.6. Official
documentation confirming any disability grant.
2.7. Proof of payment of
medical expenses”.
36.
This letter was preceded by a letter of 28
February 2023 which such similar queries in that letter including
items removed as per
the items afore-shadowed.
Defendant’s
contentions
37.
State
Attorney, Mr. Goosen on behalf of the RAF, essentially contends that
defendant, RAF, objects to all these claims delivered
on the
different dates referenced above in respect of each claimant as the
claims do not meet requirements for a substantially
valid and
compliant claim. That Plaintiff “requires an answer”
whether the listed and attached documents to the stated
case satisfy
the requirements in law to be regarded as substantially compliant
with the procedural requirements for a validly lodged
claim in terms
of
Section 24
of the
Road
Accident Fund Act
[1
].
Whether the listed and submitted documents furnish defendant with
sufficient information to enable defendant to investigate and
consider the claim.
38.
State Attorney then proceeds to argue
that the decision to reject the lodgment documents amounts to
administrative action. That
it consequently remains valid and binding
unless set aside in terms of administrative review proceedings. That
plaintiff has chosen
a wrong procedure for the relief it seeks, and
thus the application falls to be dismissed.
39.
RAF posits that
Section 24
sets out the procedure
for lodging claims in terms of the Act. That Section 24(1) requires
“a claim for compensation and
accompanying medical report to be
set out in the prescribed form, which “shall be completed in
all its particulars”.
Further that Section 24(4)(a) provides
that “..any form referred to which is not completed in all its
particulars shall not
be acceptable as a claim under this Act”.
40.
The form in question is the RAF1 form, provided
for in terms of Regulation 7(1) of the RAF Regulations, 2008.
Defendant reminds
this Court that regulation 7(1) reads:
“
A
claim for compensation and accompanying medical report referred to in
section 24(1)(a) of the Act, shall be in the form RAF1 attached
as
annexure A to these Regulations, or such amendment or substitution
thereof as the Fund may from time to time give notice in
the
Gazette
”
.
41.
Mr. Goosen in argument explains that RAF is
a juristic person established in terms of Section 2(1) and thus in
terms of Section
4(1) its powers and functions include “the
stipulation of the terms and conditions upon which claims for the
compensation
contemplated in section 3 shall be administered”.
42.
He
contends that the Fund has exercised its statutory authority in terms
of the above section by issuing
Board
Notice (BN) 271 of 2022
[2]
,
which sets out as part of the terms and conditions, a comprehensive
list of documents which must be included and form part of
the claim’s
supporting documents when lodging a claim to the fund. He argues that
the new RAF1 form was duly promulgated
in GN2335 on 4 July 2022. That
these regulatory amendments have not been challenged in these
proceedings and thus remain in force.
43.
Mr.
Goosen then concludes his argument with the contention that the
cumulative effect of these regulatory changes is that the fund
is
entitled to refuse to accept claims which do not comply with the
terms an
d
conditions set out in BN271/2022 read with new RAF1 form. That in any
event this decision constitutes administrative action. In
this regard
State Attorney draws this Court’s attention to the decision in
Road
Accident Fund v Duma and Others
[3]
where the Court noted that whether or not RAF4 form correctly
assessed claimant’s injury as serious constitutes
administrative
action as contemplated by the
Promotion
of Administrative Justice Act
[4]
(“PAJA”).
That the position is thus governed by the provisions of PAJA. He
proceeded to contend that it was found in
that case that the Court’s
control over these decisions is by means of the review proceedings
under PAJA.
44.
Further
that applying the
Oudekraal
[5]
principle, to the extent that such decision constitutes
administrative action until that decision is set aside by a Court on
review
or overturned in an internal appeal, it remained valid and
binding. That consequently whether the RAF decision were right or
wrong
is of no consequence. As per authority in Oudekraal, he argues,
those decisions exist as a fact until set aside or reviewed or
overturned in an internal appeal.
45.
State
Attorney further referred this Court to the authority in
Makupane
v Road Accident Fund
[6]
where the Court held that:
“
The
RAF is an organ of state as defined in section 239 of the
Constitution and it is performing a public function in considering
RAF4 reports submitted to it. Where the RAF is vested with discretion
and powers to consider and determine the acceptance of an
assessment
of plaintiff’s injuries as serious or not, it has concomitant
duty to exercise that power. The exercise of that
power, i.e. the
making of a decision to accept or reject the assessment contained in
the RAF4 report, amounts to administrative
action, which is
reviewable in terms of the Promotion of Administrative Justice
Act”
[7]
.
46.
RAF thus contends that in deciding to reject
the lodgment documents as non-compliant for the reasons it stated in
the different
rejection letters, the RAF as an organ of state was
performing a public function in determining whether the lodgment
documents
complied with the requirements of a valid claim as set out
in regulation 7(1) of the RAF Regulations 2008. That this decision
constitutes
administrative action which remains valid and binding
until reviewed by a `court following PAJA review application. He
concludes
his argument with contention that plaintiff has chosen a
wrong procedure, and must as a matter of law, have its action
dismissed.
Plaintiff’s
Contentions
47.
Plaintiff summarizes defendant’s special
defense essentially as the plea that plaintiff’s claim is
invalid in law as
plaintiff failed to provide defendant with the
documents it required in the rejection letters outlined above. That
it is common
cause between the parties that the documents outstanding
are not documents prescribed by Section 24 of the Act but only
documents
required in terms of RAF Board Notice 271 of 6 May 2022
(herein-after “the board notice”.
48.
Plaintiffs
argue that the noting of the objections by the defendant in the
letters of objection does not preclude the plaintiff
to issue
summons. That the objections would only have legal effect if they are
valid and the noting of an objection by RAF does
not prohibit
applicants from proceeding with the issuance of summons to enforce
their claims. That as determined in Radebe
[8]
the validity of the objection falls to the Courts to decide, once it
is pleaded as a defense.
49.
That
RAF bears the onus to prove that plaintiff’s claims are invalid
in law as plaintiffs failed to provide specific documents
to RAF and
that by so failing, failed to comply with the provisions of Section
24 of the Act, read with the board notice. For this
submission
applicants rely on the case of
Scott
v Road Accident Fund
[9]
.
Relying on the authority of
Touyz
v Greater Johannesburg Transitional Metropolitan Council
[10]
plaintiffs note that:
“…
it
was for the defendant to prove that the plaintiff had forfeited her
right to be compensated by reason of her non-compliance with
those
provisions and… not for the plaintiff to prove that she had
not forfeited her right
”
.
50.
That consequently, if the Court is not convinced
by defendant on a balance of probabilities that the documents
provided by plaintiffs
do not comply with the provisions of section
24 the defendant’s special plea must fail.
51.
Counsel for the plaintiffs argues that contrary to
the agreement between the parties that the disputes raised by the
special plea
should be adjudicated by the Court, the defendant now
elects to raise a completely new dispute by alleging that the
plaintiff’s
should have approached the Court for a review of
the decision of the employees of RAF who objected to and refused to
receive the
documents and claims submitted. That RAF received these
RAF 1 forms twice but elected to return them.
52.
In respect of the Board notice 271 applicants
argued that a full bench of the Gauteng Provincial Division reviewed
and set aside
the Board notice 271 of 2022. That application for
leave to appeal that judgement is still pending. They argue that
plaintiffs
do not attack the validity of the Board notice in these
proceedings and accepts their validity. That instead the parties
specifically
request this Court to consider the documents that were
submitted by the plaintiffs and make a ruling on whether by providing
those
documents,
that
constitutes substantial compliance
.
53.
Counsel for Plaintiffs argues that the documents
supplied by the plaintiffs to the defendant substantially complies
with the requirements
of Section 24 of the Act. It is also their case
that the documents listed in terms of Board notice 271 are not the
documents that
defendant needs in order to be in a position to
consider the claim of the plaintiff and to decide whether or not to
oppose the
plaintiff’s claim.
54.
Plaintiffs
contend that the board notice, being an internal board notice, can
never trump the provisions of an Act of parliament.
That Section
4(1)(a) empowers RAF to issue directives dealing with the internal
administration of RAF and the manner in which claims
shall be
administered. Relying on
Mudawo
and Others v Minister of Transport and Another
[11]
they argue that these directives do not acquire the force of law and
cannot impermissibly conflict with the provisions of the Act.
That
the same applies to the provisions of the RAF 1 form. That the RAF 1
form which is a form prescribed in the Regulations under
the Act,
directs a claimant as follows:
“
In
an affidavit to be attached to this claim form, please describe how
the accident occurred
”
.
That to the extent that this appear on part 5 of the form, this
direction seems to require that the affidavit must accompany the
claim form. Relying on
Scott
v Road Accident Fund
[12]
they submit that this requirement by RAF cannot alter the provisions
of the Act which permit the subsequent filing of a section
19(f)(i)
affidavit.
55.
Counsel for plaintiffs proceeds to submit that the
special plea needs to be considered with reference to Section 24 of
the Act.
Section 24 of the Act
provides:
Procedure
(1)
A claim for compensation and accompanying
medical report under section 17(1) shall-
(a)
Be set out in the prescribed form, which shall
be completed in all its particulars;
(b)
Be sent by registered post or delivered by hand
to the Fund at its principal branch or regional office, or to the
agent who in terms
of section 8 must handle the claim, at the agent’s
registered office or local branch office, and the fund or such agent
shall
at the time of delivery by hand acknowledge receipt thereof and
the date of such receipt in writing.
(2)(a) The medical
report shall be completed on the prescribed form by the medical
practitioner who treated the deceased or injured
person for the
bodily injuries sustained in the accident from which the claim
arises, or by the superintendent (or his representative)
of the
hospital where the deceased or injured person was treated for such
bodily injuries: provided that, if the medical practitioner
or
superintendent (or his or her representative) concerned fails to
complete the medical report on request within a reasonable
time and
it appears that as a result of the passage of time the claim
concerned may become prescribed, the medical report may be
completed
by another medical practitioner who has fully satisfied himself or
herself regarding the cause of the death or the nature
and treatment
of the bodily injuries in respect of which the claim is made
(b) Where a person is
killed outright in a motor vehicle accident the completion of the
medical report shall not be a requirement,
but in such a case the
form referred to in subsection (1)(a) shall be accompanied by
documentary proof, such as a copy of the relevant
inquest record or,
in the case of a prosecution of the person who allegedly caused the
deceased’s death, a copy of the relevant
charge sheet from
which it can clearly be determined that such person’s death
resulted from the accident to which the claim
relates.
(3) A claim by a
supplier for the payment of expenses in terms of section 17(5) shall
be in the prescribed form, and the provisions
of this section shall
apply mutates mutandis in respect of the completion of such form.
(4) (a) Any form
referred to in this section which is not completed in all its
particulars shall not be acceptable as a claim under
this Act.
(b) A clear reply
shall be given to each question contained in the form referred to in
subsection (1), and if a question is not
applicable, the words ‘not
applicable’ shall be inserted.
(c) A form on which
ticks, dashes, deletions and alterations have been made that are not
confirmed by a signature shall not be regarded
as properly completed.
(d) Precise details
shall be given in respect of each item under the heading
“compensation claimed” and shall, where
applicable, be
accompanied by supporting vouchers.
(5) If the Fund or the
agent does not, within 60 days from the date on which a claim was
sent by registered post or delivered by
hand to the Fund or such
agent as contemplated in subsection (1), object to the validity
thereof, the claim shall be deemed to
be valid in law in all
respects.
(6) No claim shall be
enforceable by legal proceedings commenced by a summons served on the
Fund or an agent-
(a) before the expiry
of a period of 120 days from the date on which the claim was sent or
delivered by hand to the fund or the
Agent as contemplated in
subsection (1); and
(b) before all
requirements contemplated in section 19(f) have been complied with:
Provided that if the
fund or the agent repudiates in writing liability for the claim
before the expiry of the said period, the third
party may at any time
after such repudiation serve summons on the Fund or the agent, as the
case may be…”
The Law
56.
The
Supreme Court of Appeal in
Pithey
v Road Accident Fund
[13]
noted that it has been held in a long line of cases that the
requirement relating to the submission of the claim form is
peremptory
and that the prescribed requirements concerning the
completeness of the form are directory, meaning that substantial
compliance
with such requirements suffices. That the test for
substantial compliance is an objective test.
57.
In
Multilateral
Motor Vehicle Accident Fund v Radebe
[14]
the Court noted the following:
“
It
is true that the object of the Act is to give the widest possible
protection to third parties. On the other hand the benefit
which the
claim form is designed to give the fund must be borne in mind and
given effect to. The information contained in the claim
form allows
for an assessment of its liability, including the possible early
investigation of the case. In addition, it also promotes
the saving
of the costs of litigation…These various advantages are
important and should not be whittled away. The resources,
both in
respect of money and manpower..are obviously not unlimited. They are
not to be expected to investigate claims which are
inadequately
advanced. There is no warrant for casting on them the additional
burden of doing what the regulations require should
be done by the
claimant
”
.
58.
The Court in Pithey concurred with these remarks
in Radebe as to the purpose of the claim forms. In distinguishing
Geldenhuys which
was considering whether regulation 2(3) made under
section 26 was valid. The Court conceded that there was a distinction
on the
facts of that case under section 17(1)(a) and a claim under
section 17(1)(b) but that this cannot mean that even when the fund,
within the prescribed two year period, is in possession of
information which a claimant is statutorily obliged to supply and
which,
when read in tandem with the claim form as intended by
claimant, reveals that the claim really relates to an unidentified
vehicle,
the fund is entitled to repudiate the claim on the basis
that no valid claim had been made. Nor ought the fund to benefit from
its own failure to clarify, with minimal time, effort and expense,
whatever confusion the claim form and attached documentation
revealed. The Court in Pithey went on to observe on the facts of that
case that this was not a case where no information was supplied
to
the Fund in relation to the claim. That there was no suggestion of
fraudulent or made-up claim.
59.
The Court observed that to uphold the Fund’s
contentions in the circumstances of that case would be to:
“
(a)
elevate form above substance; (b) be rigidly technical against a just
result; and (c) subvert the objects of the Act…”
[15]
The Supreme Court of Appeal conceded that it is not laying a general
rule but deciding that case on its own specific merits.
60.
In
Ndlumbini
Mlamli v Road Accident Fund
[16]
the Court concurred with the obiter in
Mautla
and Others v Road Accident Fund
[17]
which observed the following:
“
The
date of delivery of the claim is the essential first step for the
enforcement of any rights in terms of the Act. This first
step is
crucial for claimants because it determines whether or not their
claim in the first instance has been submitted timeously.
There is no
provision in the Act which permits the RAF to refuse to accept the
delivery of a claim or to refuse to acknowledge
receipt of that
claim. Had the legislature contemplated such a situation, it would
have provided for it specifically”.
61.
In
Road
Accident Fund v Busuku
[18]
it was observed as follows:
“…
the
primary concern of the Act is to give the greatest possible
protection to persons who have suffered loss through negligence
or
through unlawful acts on the part of the driver of a motor vehicle.
For this reason, the provisions of the Act must be interpreted
as
extensively as possible in favour of third parties to afford them the
widest possible protection”
.
Analysis of the Facts
62.
It follows from the cases referenced above that in
circumstances where there is no fraud or misrepresentation the
objects of the
Fund as contemplated in section 3 thereof must be
given effect in circumstances where there is loss or damage
wrongfully caused
by the driving of motor vehicles.
63.
This Court holds that the purpose of Section 24 of
the Act is to place defendant in a position where it can evaluate the
merits
of the claim to be instituted against it and to establish
whether the claim is valid or open to opposition. This is so as
respondent
as a creature of statute must give effect, within
permissible limits, to the object of the Act. There is therefore no
basis to
reject a claim or refuse to accept a claim for purposes of
proper investigation purely because information relevant to quantum
of damages is considered by the RAF to be incomplete. Especially in
circumstances where claimants as in some of these cases face
the real
prospect of their claims facing prescription. Nor does RAF
administrative arrangements on processing or investigation
of claims
justify dilatory tactics to otherwise valid claims.
64.
As an example in the case of Maarman, the evidence
is that the RAF 1 form was submitted accompanied by copies of medical
report
from the Mosselbay hospital with clinical notes. The clinical
notes indicate the injuries on the right leg and other parts of the
body and the Docter notes that plaintiff is a MVA passenger. The RAF
1 form clearly outlines the vehicles involved and the accident
report
number. On the face of it this is a legitimate claim that warrants
investigation. From the RAF 1 form it is evident that
Plaintiff is
unemployed as references to employment have been scratched out as not
applicable.
65.
This Court finds that objectively Maarman
substantially complies with requirements of Section 24 of the Act
having submitted the
RAF 1 form and accompanying medical report with
clinical notes for RAF to assess and properly investigate the merits
of the Plaintiffs
claim. To require proof of any other income “if
applicable”; Payslips pre and post accident; medical accounts;
confirmation
of disability grant; itemized tax invoice and proof of
payment of medical expenses is not in this Court’s view a valid
reason
to refuse even the first step of the claim, assessment of the
merits.
Sydney Titus
66.
Similarly in the case of Sydney Titus the evidence
is that the RAF 1 form accompanied by the medical records with
clinical notes
and the accident report were submitted. This Court
thus finds that there is substantial compliance with Section 24 for
RAF to assess
this Plaintiff’s claim. To reject it and refuse
to receive what is otherwise a legitimate claim warranting
investigation
and proper assessment by RAF purely because Titus has
not submitted payslips; proof of other income; disability grant;
proof of
payment of medical expenses; proof of employer’s
certificate which are not relevant to determination of whether RAF is
liable
or not for the claim as a matter of law would not be just and
equitable. It would be contrary to the express objects of the Act
which is to compensate victims who suffered damages arising from
motor vehicle accidents. In the result this Court finds that Sydney
Titus’ claim substantially complies with section 24 and must be
admitted for assessment.
Jacky Kannemeyr
67.
In the case of Jacky Kannemeyr the evidence is
that the RAF 1 document accompanied by a medical report with clinical
notes by a
Docter treating the patient noting “a male parent
driver of bakkie involved in MVA - chest pains”, looked
together
with an accident report makes the submission by Plaintiffs
substantially compliant with Section 24 to enable RAF to assess the
merits of the claim. To reject the claim because of
“
Court
order or masters letter of appointment”; Unabridged birth
certificate; medical accounts and expenses; itemized tax invoice
effectively subverts the object of the Act. This Court on the facts
of this case finds that the claim of Jacky Kannemeyr substantially
complies with the requirements of the Act and the merits of the claim
ought to be assessed by RAF.
J[...] D[...] K[...]
68.
Similarly, this Court finds that in the matter
where Jacky Kannemeyer is acting on behalf of J[...] D[...] K[...]
considering that
a RAF 1 form accompanied inter alia by a medical
report from Mosselbay Hospital with clinical notes. These notes
indicate that
the child who is plaintiff was presented to the
hospital after “being in a MVA”. If these reports are
looked together
with the Kwanonqaba SAPS accident report, this Court
cannot escape the view that there is substantial compliance with the
Act for
purposes of Section 24 for RAF to consider the merits of the
claim. It is this Court’s view that the claim cannot be
rejected
simply because proof of medical expenses; itemized tax
invoice from medical provider; nor official documentation confirming
disability
grant nor masters letter cannot be said to merit an
outright rejection of the assessment of the merits of the claim.
T[...] L[...]
69.
This Court finds that in the matter where Jacky
Kannemeyer is acting on behalf of T[...] L[...] considering that a
RAF 1 form accompanied
inter alia by a medical report from Mossel Bay
Hospital with clinical notes. These notes indicate that plaintiff was
presented
to the hospital after “being in a MVA” with
lacerations on back of the head and chest pain. If these reports are
looked
together with the Kwanonqaba SAPS accident report, this Court
cannot escape the view that there is substantial compliance with the
Act for purposes of RAF considering the merits of the claim. It is
this Court’s view that the claim cannot be rejected simply
because of the absence proof of medical expenses; itemized tax
invoice from medical provider; nor official documentation confirming
disability grant nor masters letter. These cannot be said to merit an
outright rejection of the claim.
Thulane Jacky Msimanga
70.
This Court finds that in the matter where Thulane
Jacky Msimanga is plaintiff, this Court considers that a RAF 1 form
submitted
was accompanied inter alia by a medical report from
Mosselbay Hospital with clinical notes. These notes indicate that the
plaintiff
was presented to the hospital after “being in a MVA”.
If these reports are looked together with the Grootbrakrivier
SAPS
accident report, this Court cannot escape the view that there is
substantial compliance with Section 24 of the Act for purposes
of RAF
considering the merits of the claim. It is this Court’s view
that the claim’s acceptance by RAF for investigation
and
assessment cannot be rejected simply because of failure to submit
proof of medical expenses; itemized tax invoice from medical
provider; nor official documentation confirming disability grant;
payslips; employer’s certificates of injured service; nor
proof
of other income. These queries are more relevant to quatum in the
main and cannot be said to merit an outright rejection
of the claim.
This Court finds substantial compliance.
EC Phillips obo V[...]
T[...] P[...]
71.
In the case of EC Phillips on behalf of V[...]
P[...] this Court considers that a RAF 1 form accompanied inter alia
by a medical
report from George Regional Hospital with clinical notes
was submitted. These notes indicate that plaintiff was presented to
the
hospital after “being in a MVA”. If these reports are
looked together with the Conville SAPS accident report, this Court
cannot escape the view that there is substantial compliance with the
Act for purposes of RAF considering the merits of the claim.
It is
this Court’s view that the claim cannot be rejected simply
because of failure according to RAF officials to submit
proof of
medical accounts and expenses; itemized tax invoice from a medical
provider; nor official documentation confirming disability
grant. Nor
can it be said that proof of medical accounts can be said to merit an
outright rejection of the claim. This Court finds
substantial
compliance to Section 24 of the Act which merit consideration of the
claim.
David Carelse
72.
In the case of David Carelse considering that a
RAF 1 form accompanied inter alia by a medical report from Mossel Bay
Hospital with
clinical notes. These notes indicate that plaintiff was
presented to the hospital after being in a MVA. If these reports are
looked
together with the Kwanonqaba SAPS accident report, this Court
cannot escape the view that there is substantial compliance with the
Act for purposes of RAF considering the merits of the claim. It is
this Court’s view that the claim cannot be rejected simply
because of failure by plaintiff, according to RAF, to submit itemized
tax invoice from a medical provider; copies of all hospital
and
medical records; proof of any other income, if applicable; copies of
all hospital and medical accounts. Nor can it be
said
reasonably that proof of any other income can be said to merit an
outright rejection of the claim. This Court finds substantial
compliance to Section 24 of the Act which merit consideration of the
claim.
Rentia Velentia Sefoor
73.
In the case of Rentia Velentia Sefoor considering
that a RAF 1 form accompanied inter alia by a medical report from
Mossel Bay Hospital
with clinical notes was submitted. That these
notes indicate that plaintiff was presented to the hospital after
being in a MVA-
“right shoulder and back pain”. If these
reports are looked together with the Dagamaskop SAPS accident report
and case
docket, this Court cannot escape the view that there is
substantial compliance with the Act for purposes of RAF considering
the
merits of the claim. It is this Court’s view that the claim
cannot be rejected simply because of itemized tax invoice from
a
medical provider; copies of all hospital and medical accounts; proof
of any other income, if applicable; proof of payment of
medical
expenses nor can it be said that confirmation of disability grant can
be construed to merit an outright rejection of the
claim. This Court
finds substantial compliance with section 24 to the Act which merit
consideration of the claim.
GC Pickaan
74.
In the case of GC Pickaan this Court considers
that a RAF 1 form accompanied inter alia by a medical report from
George Provincial
Hospital with clinical notes was submitted. These
notes indicate that plaintiff was presented to the hospital after
being in a
MVA- “allegedly hit by a taxi..”. If these
reports are looked together with the Conville SAPS accident report,
this
Court cannot escape the view that there is substantial
compliance with Section 24 of the Act for purposes of RAF considering
the
merits of the claim. It is this Court’s view that the claim
cannot be rejected simply because of what RAF terms itemized tax
invoice from a medical provider; copies of all hospital and medical
accounts; proof of any other income, if applicable; proof of
payment
of medical expenses nor confirmation of disability grant can be said
to merit an outright rejection of the claim. This
Court finds
substantial compliance with Section 24 to the Act which merit
consideration of the claim.
J George
75.
In the case of J George considering that a
RAF 1 form accompanied inter alia by a medical report from George
Provincial Hospital
with clinical notes was submitted. These notes
indicate that plaintiff was presented to the hospital after being in
a MVA. If these
reports are looked together with the Kwanonqaba SAPS
accident report, this Court cannot escape the view that there is
substantial
compliance with the Act for purposes of RAF considering
the merits of the claim. It is this Court’s view that the claim
cannot
be rejected simply because of what RAF terms itemized tax
invoice from a medical provider; copies of all hospital and medical
accounts;
Official confirmation of remuneration; medical accounts and
confirmation of disability grant. These cannot be said to merit an
outright rejection of the claim. This Court finds substantial
compliance with Section 24 to the Act which merit consideration of
the claim.
Ambrose Regan Keffers
76.
In the case of Ambrose Regan Keffers this Court
considers that a RAF 1 form accompanied inter alia by a medical
report from George
Provincial Hospital with clinical notes was
submitted. These notes indicate that plaintiff was presented to the
hospital after
being in a MVA. The note on the report states- “It
was reported that he was hit by a car..”. Consequently, If
these
reports are looked together with the Conville SAPS accident
report, this Court cannot escape the view that there is substantial
compliance with Section 24 of the Act for purposes of RAF considering
the merits of the claim. It is this Court’s view that
the claim
cannot be rejected simply because of what RAF terms itemized tax
invoice from a medical provider; copies of all hospital
and medical
accounts; proof of payment of medical expenses; payslips pre and post
accident; medical accounts and confirmation of
disability grant.
These cannot be said to merit an outright rejection of the claim for
purposes of assessing the merits. This Court
finds substantial
compliance with section 24 to the Act which merit consideration of
the claim.
Johanna Frans
77.
In the case of Johanna Frans this Court considers
that a RAF 1 form accompanied inter alia by a medical report from
Mossel Bay Hospital
with clinical notes was submitted. These notes
indicate that plaintiff was presented to the hospital after being in
a MVA. The
report notes “MVA Came in with lacerations to the
head..”. If these reports are looked together with the
Kwanonqaba
SAPS accident report, this Court cannot escape the view
that there is substantial compliance with Section 24 of the Act for
purposes
of RAF considering the merits of the claim. It is this
Court’s view that the claim cannot be rejected simply because
of what
RAF terms certified copy of medical certificate; deceased’s
tax records; claimant’s tax records; copy of liquidation
and
distribution account; actuarial report; confirmation of all payments
in terms of compensation commissioner. These cannot be
said to merit
an outright rejection of the claim. This Court finds substantial
compliance to Section 24 of the Act which merit
consideration of the
claim.
Sydney Titus
78.
In the case of Sydney Titus considering that a RAF
1 form accompanied inter alia by a medical report from Medi Clinic
with clinical
notes was submitted. These notes indicate that
plaintiff was presented to the hospital after being in a MVA. If
these reports are
looked together with the Pacaltsdorp SAPS accident
report, this Court cannot escape the view that there is substantial
compliance
with the Act for purposes of RAF considering the merits of
the claim. It is this Court’s view that the claim cannot be
rejected
simply because of what RAF terms payslips pre and post
accident; Employer’s certificate of injured service showing
nature
of employment; proof of other income and confirmation of
disability grant. These cannot be said to merit an outright rejection
of the claim. This Court finds substantial compliance with Section 24
of the Act which merit consideration of the claim.
Johannes Nombande
79.
In the case of Johannes Nombande this Court
considers that a RAF 1 form accompanied inter alia by a medical
report from George Provincial
Hospital with clinical notes was
submitted. These notes indicate that plaintiff was presented to the
hospital after being in a
MVA. The report notes ”..struck by a
taxi..”. If these reports are looked together with the George
SAPS accident report,
this Court cannot escape the view that there is
substantial compliance with Section 24 of the Act for purposes of RAF
considering
the merits of the claim. It is this Court’s view
that the claim cannot be rejected simply because of what RAF terms
itemized
tax invoice from a medical provider; proof of payment of
medical expenses; payslips pre and post accident; employer’s
certificate
of injured service showing nature of employment. These
cannot be said to merit an outright rejection of the claim. This
Court finds
substantial compliance with Section 24 of the Act which
merit consideration of the claim.
Billy Anne Berdine
Hendriks
80.
In the case of Billy Anne Berdine Hendriks
considering that a RAF 1 form accompanied inter alia by a medical
report from Mosselbay
Hospital with clinical notes. These notes
indicate that plaintiff was presented to the hospital after being in
a MVA. If these
reports are looked together with the Dagamaskop SAPS
accident report and docket, this Court cannot escape the view that
there is
substantial compliance with the Act for purposes of RAF
considering the merits of the claim. It is this Court’s view
that
the claim cannot be rejected simply because of what RAF terms
itemized tax invoice from a medical provider; proof of payment of
medical expenses; payslips pre and post accident; proof of any other
income; official documents confirming any disability grant;
employer’s certificate of injured service showing nature of
employment. These cannot be said to merit an outright rejection
of
the claim. This Court finds substantial compliance with Section 24 of
the Act which merit consideration of the claim.
Joslyn Cindy Petersen
81.
In the case of Joslyn Cindy Petersen this Court
considers that a RAF 1 form accompanied inter alia by a medical
report from Mosselbay
Hospital with clinical notes was submitted.
These notes indicate that plaintiff was presented to the hospital
after being in a
MVA. If these reports are looked together with the
Kwanonqaba SAPS accident report, this Court cannot escape the view
that there
is substantial compliance with the Act for purposes of RAF
considering the merits of the claim. It is this Court’s view
that
the claim cannot be rejected simply because of what RAF terms
itemized tax invoice from a medical provider; proof of payment of
medical expenses; official documents confirming any disability grant.
These cannot be said to merit an outright rejection of the
claim.
This Court finds substantial compliance with Section 24 of the Act
which merit consideration of the claim.
Conclusion
82.
In the result this Court finds that all these
claims listed above substantially comply with Section 24 of the Act
and thus substantially
comply with the procedural requirements for a
validly lodged claim in terms of
section 24
of the
Road Accident Fund
Act.
83.
This
Court holds that the lodged documents for
these plaintiffs listed in this matter furnish defendant with
sufficient information
to enable defendant to investigate and
consider the plaintiffs’ claims.
84.
This Court finds that defendant is entitled to
refuse to accept claims which do not comply with
section 24.
This
Court also finds that defendant is not entitled to reject claims
which substantially comply with
section 24
given peculiar
circumstances of each case if the facts of the matter looked upon as
a whole objectively leads to a finding of substantial
compliance with
section 24.
Consequently, any ancillary directives or regulation
cannot as a matter of law trump application of that provision.
85.
This Court accepts that the decision to refuse
claims is an administrative decision. This fact alone does not,
however, constrain
plaintiffs from following any cause of action or
invoking remedies available to them in law to enforce their rights in
avenues
other than those availed by PAJA reviews, as plaintiffs seem
to have elected in these cases.
86.
It is this Court’s conclusion therefore that
the special plea for all 16 plaintiffs in these actions falls to be
dismissed.
Costs
87.
It is trite that costs follows the result.
88.
Wherefore the following order is made:
Order
IT IS ORDERED THAT:
1.
The Special Plea in Henrico Jovihano Maarman V RAF
(993/2023) is dismissed.
2.
The Special Plea in Jakobus George v RAF
(994/2023) is dismissed.
3.
The Special Plea in Joslin Cindy Petersen v RAF
(894/2023) is dismissed.
4.
The Special Plea in Johanna Frans v RAF
(18128/2023) is dismissed.
5.
The Special Plea in Johannes Nombande v RAF
(896/2023) is dismissed.
6.
The Special Plea in Billy Anne Berdine Lamont v
RAF (929/2023) is dismissed.
7.
The Special Plea in Glanwill cederic Pickaan v
RAF(18126/2023) is dismissed.
8.
The Special Plea in Ambroze Regan Keffers v RAF
(18125/2023) is dismissed.
9.
The Special Plea in Rentia Velencia Sefoor v
RAF(126/2024) is dismissed.
10.
The Special Plea in Jacky Kannemeyer obo J[...]
D[...] K[...](18090/2023) is dismissed.
11.
The Special Plea in Jacky Kannemeyer obo T[...]
L[...] L[...] K[...] (991/2023) is dismissed.
12.
The Special Plea in Sydney Titus v RAF(895/2023)
is dismissed.
13.
The Special Plea in Jacky Kannemeyer v RAF
(18089/2023) v is dismissed.
14.
The Special Plea in Thulane Jacky Msimanga v RAF
(104/2024) is dismissed.
15.
The Special Plea in EC Phillips obo V[...] T
P[...] (105/2024) is dismissed.
16.
The Special Plea in David Carelse v RAF (992/2023)
is dismissed.
17.
Defendant to pay costs of this stated case.
SST KHOLONG
ACTING JUDGE OF THE
HIGH COURT
OF SOUTH AFRICA
WESTERN CAPE DIVISION,
CAPE TOWN
APPEARANCES:
For the
Plaintiffs:
Adv
. C.H Botha
Instructed
by:
Attorney
s: Cilliers and Associates
For the
Defendant:
Mr
. F. Goosen
The
State Attorney,
Western
Cape
[1]
Act
56 of 1996.
[2]
Published
in GG46322 ( 6 May 2022).
[3]
2013
(6) SA 9 (SCA).
[4]
Act 3
0f 2000.
[5]
Oudekraal
Estates (Pty) Ltd v City of Cape Town 2004 (6) SA 222(SCA).
[6]
(9077/2022)[2023]
ZAGPPHC 15 (19 January 2023).
[7]
Ibid
at paragraph 9.
[8]
Radebe
v Road Accident Fund (053998/2023;074803/2023) [2024]
[9]
(13/33469)
[2015] ZAGPJHC 120 (11 June 2015). At para 21, 29 and 30.
[10]
[1995] ZASCA 161
;
1996
(1) SA 950(A)
at 96
[11]
(011795/2022)[2024]
ZAGPPHC 258 (26 March 2024) at para 44.
[12]
(13/33469)[2015]
ZAGP JHC 120 (11 June 2015) at para 25.
[13]
2014
(4) SA 112 (SCA).
[14]
1996
(2) SA 145 (A).
[15]
Pithey
. RAF, Op sit at 123.
[16]
955/2024
EC at paragraph 29
[17]
(29459/2021)[2023]
ZAGPPHC 1843 at para 64.
[18]
Road
Accident Fund v Busuku
2023 (4) SA 507
(SCA) at para 6.
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