Case Law[2023] ZASCA 182South Africa
South African Municipal Workers Union National Medical Scheme (SAMWUMED) v City of Ekurhuleni and Others (1297/2022) [2023] ZASCA 182; [2024] 1 All SA 647 (SCA); (2024) 45 ILJ 479 (SCA) (22 December 2023)
Supreme Court of Appeal of South Africa
22 December 2023
Headnotes
Summary: Collective agreement – s 23 of the Labour Relations Act 66 of 1995 – parties to a collective agreement – medical schemes – accreditation of medical schemes under a collective agreement – intentional and unlawful interference with contractual relationship – s 65 of the Medical Schemes Act 131 of 1998 – Regulation 28 – legality of territorial limitation in a broker agreement with a medical scheme.
Judgment
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## South African Municipal Workers Union National Medical Scheme (SAMWUMED) v City of Ekurhuleni and Others (1297/2022) [2023] ZASCA 182; [2024] 1 All SA 647 (SCA); (2024) 45 ILJ 479 (SCA) (22 December 2023)
South African Municipal Workers Union National Medical Scheme (SAMWUMED) v City of Ekurhuleni and Others (1297/2022) [2023] ZASCA 182; [2024] 1 All SA 647 (SCA); (2024) 45 ILJ 479 (SCA) (22 December 2023)
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sino date 22 December 2023
THE
SUPREME COURT OF APPEAL OF SOUTH AFRICA
JUDGMENT
Reportable
Case
No: 1297/2022
In the matter between:
SOUTH AFRICAN
MUNICIPAL WORKERS’ UNION
NATIONAL MEDICAL
SCHEME (SAMWUMED)
APPELLANT
and
CITY OF
EKURHULENI FIRST
RESPONDENT
MOSO CONSULTING
SERVICES (PTY) LTD SECOND RESPONDENT
THE REGISTRAR OF
MEDICAL SCHEMES THIRD RESPONDENT
THE FINANCIAL SECTOR
CONDUCT
AUTHORITY
FOURTH RESPONDENT
THE SOUTH AFRICAN
LOCAL
GOVERNMENT ASSOCIATION
FIFTH RESPONDENT
THE SOUTH AFRICAN
MUNICIPAL WORKERS
UNION (SAMWU)
SIXTH RESPONDENT
INDEPENDENT MUNICIPAL
AND ALLIED
WORKERS UNION
(IMATU)
SEVENTH RESPONDENT
BONITAS MEDICAL
FUND
EIGHT RESPONDENT
HOSMED MEDICAL SCHEME
NINTH RESPONDENT
KEY HEALTH MEDICAL
SCHEME
TENTH RESPONDENT
LA HEALTH MEDICAL
SCHEME
ELEVENTH RESPONDENT
THE EMPLOYEES OF THE
CITY OF
EKURHULENI
TWELFTH RESPONDENT
THE SOUTH AFRICAN
LOCAL
GOVERNMENT
THIRTEENTH RESPONDENT
Neutral
Citation:
South African
Municipal Workers’ Union National Medical Scheme (SAMWUMED)
v City of Ekurhuleni and Others
(1297/2022)
[2023] ZASCA 182
(22
December 2023)
Coram:
Nicholls and Matojane JJA and Chetty, Masipa and
Unterhalter AJJA
Heard:
20 November 2023
Delivered:
This judgment was handed down
electronically by circulation to the parties’ representatives
via email, publication on the
Supreme Court of Appeal website and
release to SAFLII. The date and time for hand-down is deemed to be
11h00 at 22 December 2023.
Summary:
Collective agreement –
s 23
of the
Labour Relations Act 66
of 1995
– parties to a collective agreement – medical
schemes – accreditation of medical schemes under a collective
agreement
– intentional and unlawful interference with
contractual relationship –
s 65
of the
Medical Schemes Act 131
of 1998
–
Regulation 28
– legality of territorial
limitation in a broker agreement with a medical scheme.
ORDER
On
appeal from
: Gauteng Local Division of
the High Court, Johannesburg (Oosthuizen-Senekal AJ):
1
The appeal is upheld, the costs of the appeal, including the costs of
the application for
leave to appeal, are to be borne jointly by the
first and second respondents;
2
The orders of the high court are set aside and substituted with the
following:
‘
1.
The first respondent is ordered to accept member application forms
and other documents
and communications directly from the applicant,
and to duly process such applications and related documents submitted
by the applicant,
for so long as the applicant remains an accredited
medical scheme in terms of the collective agreement;
2.
It is declared that the second respondent is not entitled to payment
of broker
fees by the applicant in respect of the employees of the
first respondent, in the absence of a written broker agreement having
been concluded between the applicant and the second respondent and in
the absence of the second respondent having actually rendered
broker
services;
3.
The first and second respondents are interdicted, for so long as the
applicant
remains an accredited medical scheme in terms of the
collective agreement:
3.1
from taking any steps that would prevent or hinder the applicant from
marketing its scheme
and benefit options and rendering services to
its members and all prospective members who are employees of the
first respondent
by way of the applicant’s own internal
consultants or independent brokers appointed by the applicant, should
it so wish;
3.2
from holding out that the second respondent is the exclusive broker
for the five medical
schemes accredited in terms of the collective
agreement concluded on 9 September 2015, and that no other brokers or
consultants
will be allowed to service employees of the first
respondent;
3.3
from refusing to accept member application forms and other documents
and communications
submitted to the first respondent by the
applicant, and from refusing to duly process such applications and
related documents;
3.4
from insisting that all medical scheme member application forms and
other related documents
and communications be submitted to the second
respondent, as opposed to the first respondent;
3.5
from insisting that payment of broker fees be made by the applicant
to the second respondent
in the absence of a written broker agreement
between the applicant and the second respondent and/or in the absence
of the second
respondent having actually rendered broker services;
3.6
from approaching members of the applicant and requesting them to
execute service notes in
favour of the second respondent, in the
absence of a written broker agreement between the applicant and the
second respondent and/or
in the absence of the second respondent
having actually rendered broker services to members of the applicant.
4.
The first and second respondents are jointly ordered to pay the costs
of this
application.’
JUDGMENT
Unterhalter
AJA (Nicholls, Matojane JJA and Chetty and Masipa AJJA concurring)
Introduction
[1]
The appellant, the South African Municipal Workers’ Union
National Medical Scheme (SAMWUMED) is
a self-administered medical
scheme. It is registered in terms of s 24 of the Medical Schemes Act
131 of 1998 (the Act). In September
2015, the South African Local
Government Association (SALGA) concluded a collective agreement with
two trade unions, one of which
was the South African Municipal
Workers’ Union (the collective agreement). In terms of Clause 9
of the collective agreement,
the Bargaining Council, the South
African Local Government Bargaining Council (SALGBC) must annually
accredit medical schemes which
qualify for employer contributions.
Employees who are scheme members may annually elect to move to
another accredited medical scheme.
Clause 15 of the collective
agreement provides criteria for the recognition of medical schemes.
In terms of Clause 15.3.2, accredited
medical schemes may market
their schemes annually between October and November (the window
period) to better inform members who
might wish to switch medical
schemes. SAMWUMED had for a number of years been accredited by the
SALGBC, and was so again in September
2020. Four other medical
schemes were also accredited.
[2]
SAMWUMED had, through its own consultants, and prior to January 2020,
marketed its scheme, as the collective
agreement permitted it to do,
to employees who were members of accredited medical schemes or wished
to become members. In January
2020, SAMWUMED received a letter from
the first respondent, the City of Ekurhuleni (COE). COE informed
SAMWUMED that it had appointed
Alexander Forbes Health (Pty) Ltd
(AFH) as broker service consultants to provide services to COE
employees, pensioners, and the
COE itself. SAMWUMED was informed that
its medical scheme had been allocated to AFH. COE requested SAMWUMED
to ‘rescind all
existing medical aid brokerage contracts’
and stipulated that no other medical aid consultants would be allowed
to service
employees of COE. SAMWUMED was required to ensure that AFH
was paid broker fees for the services it rendered. Like broker
appointments
were made by COE to the other accredited medical
schemes.
[3]
For reasons that are not explained, the second respondent, Moso
Consulting Services (Pty) Ltd (Moso)
replaced AFH as the broker
appointed by the COE to employees, COE, SAMWUMED and the other
medical schemes. SAMWUMED did not
accede to the appointment of Moso.
Nor did it accept that it was required to market its scheme in the
window period through Moso,
and pay Moso brokerage fees to do so.
SAMWUMED had marketed its scheme, in prior years, by using its own
internal consultants,
and wished to continue doing so.
[4]
SAMWUMED had, on 5 April 2019, concluded a written broker agreement
with Moso (the Moso agreement).
SAMWUMED appointed Moso to market
SAMWUMED’s range of products and render services to its
members. It did so on a non-exclusive
basis. And, of consequence for
this matter, to perform these services within a defined territory.
That territory was defined to
mean the City of Johannesburg and its
municipal entities. The territory, as defined, does not include the
COE. I shall refer to
this as the territorial limitation.
[5]
In November 2020, SAMWUMED wrote to COE. It requested COE to
reconsider its decision to preclude SAMWUMED’s
internal
consultants from providing services to COE employees and pensioners.
No response was forthcoming. SAMWUMED also wrote
to Moso and
complained that Moso was not permitted to render services outside the
territory allocated to it in the Moso agreement,
without the
prior written consent of SAMWUMED. Moso, it alleged, was in breach of
the Moso agreement by seeking to render services
on behalf of
SAMWUMED to employees of COE.
[6]
SAMWUMED did not receive the undertakings it sought from either COE
or Moso. It then applied to the
high court, Gauteng Division,
Johannesburg (the high court) for the following relief, in relevant
part:
‘
1.
An order declaring that the first respondent [COE] is in breach of
the collective agreement
concluded on 9 September 2015;
2.
An order compelling the first respondent [COE] to comply with the
collective
agreement concluded on 9 September 2015, more specifically
to allow the applicant to freely market its scheme and benefit
options
and to render services to its members and all prospective
members who are employees of the first respondent, unhindered and by
way of the applicant’s own internal consultants or independent
brokers appointed by the applicant, should it so wish;
3.
An order compelling the first respondent [COE] to accept member
application forms
and other documents and communications directly
from the applicant, and to duly process such applications and related
documents
submitted by the applicant;
4.
An order declaring that the second respondent [MOSO] is not entitled
to payment
of broker fees by the applicant in respect of the
employees of the first respondent [COE], in the absence of a written
broker agreement
having been concluded between the applicant and the
second respondent [Moso] and in the absence of the second respondent
[Moso]
having actually rendered broker services;
5.
An order interdicting and restraining the first and second
respondents [COE and
Moso]:
5.1
from taking any steps that would prevent or hinder the applicant to
market its scheme and
benefit options and render services to its
members and all prospective members who are employees of the first
respondent by way
of the applicant’s own internal consultants
or independent brokers appointed by the applicant, should it so wish;
5.2
from holding out that the second respondent [Moso] is the exclusive
broker for the five
medical schemes accredited in terms of the
collective agreement concluded on 9 September 2015, and that no other
brokers or consultants
will be allowed to service employees of the
first respondent [COE];
5.3
from refusing to accept member application forms and other documents
and communications
submitted to the first respondent by the
applicant, and from refusing to duly process such applications and
related documents;
5.4
from insisting that all medical scheme member application forms and
other related documents
and communications be submitted to the second
respondent, as opposed to the first respondent;
5.5
from insisting that payment of broker fees be made by the applicant
to the second respondent
in the absence of a written broker agreement
between the applicant and the second respondent and/or in the absence
of the second
respondent having actually rendered broker services;
5.6
from approaching members of the applicant and requesting them to
execute service notes in
favour of the second respondent [Moso], in
the absence of a written broker agreement between the applicant and
the second respondent
and/or in the absence of the second respondent
[Moso] having actually rendered broker services to members of the
applicant;
6.
That the first respondent [COE] be ordered to pay the costs of this
application;
7.
Should any party/person oppose the present application, ordering such
party/person
to pay the costs of this application jointly and
severally with the first respondent.’
[7]
Both the COE and Moso opposed the application, and filed answering
affidavits. In addition, Moso brought
a counter-application which, in
relevant part, sought declaratory relief that the Moso agreement does
not preclude Moso from rendering
services outside the territorial
area defined in the agreement. This relief was, in turn, opposed by
SAMWUMED.
[8]
The high court (
per
Oosthuizen-Senekal AJ) dismissed
SAMWUMED’s application, with costs, such costs to be limited to
the hearing of the matter.
It found that SAMWUMED was not a party to
the collective agreement, and hence, SAMWUMED enjoyed no rights under
the collective
agreement. As to the territorial limitation that
SAMWUMED sought to impose upon Moso, the high court found this
limitation to offend
against the right of employees to choose a
broker, and, furthermore, offended against the Financial Advisory and
Intermediary Service
Act 37 of 2002 (FAIS Act) and its Code of
Conduct. The high court declined to decide Moso’s
counter-application.
[9]
With the leave of the high court, SAMWUMED appeals to this court. COE
elected to abide our judgment.
Moso opposed the appeal but was at
pains to emphasize the limited ambit of its opposition. Moso, as in
the high court, opposed
the final relief set out in prayers 4, 5.5
and 5.6 of the notice of motion. It was common ground between the
parties that this
appeal was not concerned with the alternative
interim relief that was originally sought in the notice of motion. By
way of further
clarification, counsel for Moso, during oral argument,
made it plain that Moso’s case rested on the proposition that
the
territorial limitation in the Moso agreement was unenforceable.
Moso did not seek to defend the position of COE. Indeed it disavowed
the conduct of the COE that had sought to impose Moso upon SAMWUMED
as its exclusive broker to market its scheme to employees of
COE. As
Moso’s counter-application was not determined by the
high-court, and Moso had made no cross-appeal, Moso correctly
submitted that the counter-application was not before us.
The
COE appeal
[10]
The principal relief that SAMWUMED sought against COE was that COE
must comply with the collective agreement and
permit SAMWUMED to
market its scheme and benefit options to employees of COE. In
addition, SAMWUMED should be permitted to render
services to
employees of COE who are members or prospective members of SAMWUMED.
It will be recalled that clause 15.3.2 of the
collective agreement
states that accredited medical schemes may market their schemes
annually during the window period. Membership
of an accredited
medical scheme is an important benefit enjoyed by employees under the
collective agreement, to which employers
are required to contribute.
The collective agreement permits employees who are scheme members of
accredited schemes to transfer
from one scheme to another. To allow
scheme members to make informed choices, the collective agreement
provides for a window period
during which accredited schemes may
market their schemes.
[11]
In addition, the collective agreement, in terms of clause 15.2 sets
out the criteria for the accreditation of medical
schemes. Among
these criteria, a scheme must demonstrate the service levels to which
it will adhere to process claims and pay accounts.
The collective
agreement requires an accredited scheme to perform these services.
Part of the relief sought by SAMWUMED is that
it should be permitted
to render these services to its members who are employees of COE,
without having Moso imposed upon it
as the intermediary through
which this will be done.
[12]
The high court held that SAMWUMED is not a party to the collective
agreement, and therefore it cannot seek the
enforcement of this
agreement. SAMWUMED is not reflected as a party to the collective
agreement. The collective agreement
makes provision, as I have
sketched above, for the accreditation of schemes so that employees
may enjoy the benefit of selecting
and joining a scheme to which
their employers contribute. To protect the interests of employees,
the marketing of the schemes,
in the window period, secures
competition between accredited scheme to enhance informed choices by
employees. Hence, Clause 15.3.2
provides that accredited medical
schemes may market their schemes.
[13]
Does this provision give rise to any enforceable right on the part of
SAMWUMED? SAMWUMED is not reflected as a
signatory to the collective
agreement. SAMWUMED nevertheless contended that it was a party to the
collective agreement because
the collective agreement was a contract
for the benefit of a third party.
Total
South Africa (Pty) Ltd
[1]
sets out what is required to find that a provision of an agreement
constitutes a stipulation for the benefit of a third party (a
stipulation
alteri
):
the provision cannot simply be designed to benefit a third person or
merely do so; the parties to the contract must have the
intention
that a third person can, by adopting the benefit, become a party to
the contract.
[14]
I should have been inclined to conclude that Clause 15.3.2 was
designed to benefit accredited medical schemes and
that SAMWUMED had
adopted this benefit by marketing its scheme over a number of years.
However, the collective agreement cannot
constitute a stipulation for
the benefit of a third party because the collective agreement is a
statutory construct. A collective
agreement is defined in s
213 of the Labour Relations Act 66 of 1995 (the LRA) to mean, ‘a
written agreement
concerning terms and conditions of employment or
any other matter of mutual interest concluded by one or more
registered trade
unions, on the one hand, and, on the other hand –
(a) one or more employers; (b) one or more registered employers’
organisations; or (c) one or more employers and one or more
registered employers’ organisations.’
[15]
A collective agreement, in terms of these provisions of the LRA,
is not an agreement concluded with an accredited
medical scheme.
Section 23 of the LRA sets out the legal effect of a collective
agreement. The collective agreement binds the parties
to the
agreement. Since the statutory definition of a collective agreement
identifies the parties to such an agreement, this statuory
scheme
makes no provision for a collective agreement to bind parties who
fall outside of the definition. The LRA thus excludes
a collective
agreement containing a stipulation for the benefit of a third party,
if that third party is not a party falling within
the statutory
definition. To like effect, s 31 of the LRA binds parties to the
bargaining council who are also parties to the collective
agreement.
SAMWUMED is not such a party. Section 32 of the LRA does permit of
the extension of a collective agreement to a non-party
upon request
by the bargaining council to the Minister. But there is no suggestion
this has taken place.
[16]
It follows that SAMWUMED is not a party to the collective agreement.
The parties who concluded the collective agreement,
whatever their
intention, could not, as a matter of law, have made SAMWUMED, upon
adopting the benefit conferred by the collective
agreement, a party
to the agreement. The LRA excludes such an outcome, by definition.
The COE was, in terms of clause 1 of the
collective agreement,
required to observe the terms of the agreement, including clause
15.3.2. But that duty gave rise to no right
on the part of SAMWUMED
to enforce that duty because SAMUWUMED was not a party to the
collective agreement.
[17]
This conclusion does not entail that clause 15.3.2 had no efficacy.
Section 27 of the LRA provides for the
establishment of
bargaining councils. Among the powers conferred upon bargaining
councils by s 28 of the LRA is to establish and
administer medical
schemes for the benefit of parties to the bargaining council or their
members (s 28(1)(g)). Section 33A of the
LRA empowers a bargaining
council to monitor and enforce compliance with its collective
agreements.
[18]
Under the collective agreement with which this case is concerned, the
SALGBC was the bargaining council that concluded
the collective
agreement. Clause 9 of the collective agreement regulates
membership of medical schemes and contributions
to these schemes. The
SALGBC must accredit medical schemes against stipulated criteria.
Employers, which includes COE, must make
contributions on behalf of
their employees to accredited medical schemes. Employees must belong
to one of the accredited medical
schemes, unless they elect to belong
to no medical scheme. And, as I have referenced, on an annual basis,
employees are afforded
a choice before 1 January to move to an
accredited medical scheme.
[19]
The collective agreement thus confers important benefits upon
employees to choose an accredited medical scheme;
to switch schemes
annually; and to enjoy the compulsory contributions of employers. The
collective agreement deputes the SALGBC
to give effect to this
scheme. SALGBC has done so. The accreditation of SAMWUMED, and four
other medical schemes, by SALGBC is
to be found in circular 12/2020
issued by SALGBC. It records the schemes accredited for 2021 by
SALGBC’s executive council.
It also records that the accredited
schemes may market their schemes from 1 October 2020 – 30
November 2020.
[20]
The accreditation of SAMWUMED by SALGBC constitutes an agreement. How
otherwise could an accredited medical scheme
be held to the
obligations set out in clause 15 of the collective agreement? The
collective agreement, for example, in clause 15.6
sets out a code of
conduct to which accredited medical schemes are obliged to adhere.
Accredited medical schemes can only be bound
to adhere to the code of
conduct by reason of their agreement with SALGBC. They cannot
be bound to do so by the collective
agreement because, as I have
found, they are not parties to that agreement. Thus, accredited
medical schemes derive their rights
and obligations from their
agreement with SALGBC, arising from their accreditation by SALGBC.
[21]
That agreement provides in express terms for the right of accredited
medical schemes to market their schemes, as
reflected in circular
12/2020. The agreement also neccesarily entails that accredited
medical schemes are entitled and required
to service their members
who are employees that have opted to join one or other of the
accredited schemes. That is so because the
very essence of what
a medical scheme registered in terms of the Medical Schemes Act 131
of 1998 (MSA) must do is to process
the claims of its members and
provide the benefits to which their membership entitles them. That is
also the plain entitlement
of employees under the collective
agreement which SALGBC is mandated to bring about by way of
accreditation. I therefore find that
the accreditation of SAMWUMED
constituted an agreement between it and SALGBC that conferred a right
upon SAMWUMED to market their
scheme in the window period and service
those employees who opted to become members of SAMWUMED.
[22]
SAMWUMED’s principal cause of action was to enforce what it
conceived to be its rights under the collective
agreement and COE’s
breach of that agreement. That cause of action cannot prevail because
SAMWUMED enjoyed no rights under
the collective agreement. However,
SAMWUMED’s application framed an alternative cause of action.
It alleged that the conduct
of COE ‘constitutes unlawful and
intentional interference with the rights of SAMWUMED and its
employees to lawfully participate
in the market comprised of the
COE’s employees’. SAMWUMED did not elaborate upon
the source of its right to participate
in this market. However, there
are sufficient averments in the founding affidavit as to its
accreditation by SALGBC to derive the
source of its rights to be the
agreement between SAMWUMED and SALGBC that I have identified.
[23]
The question that then arises is whether SAMWUMED has made out a
cause of action based on these averments. In
Lanco
[2]
it was held that the delict of the unlawful and intentional
interference by a third party in a party’s contractual
relationship
may be sustained, even though the interference does not
consist of an inducement to breach the contract. The Constitutional
Court
gave further treatment to this species of delictual liability
in
Masstores
.
[3]
Though the case concerned unlawful competition, together with
the holding in
Country
Cloud
,
[4]
the following may be stated of a cause of action founded upon the
delict of unlawful interference with contractual relations. First,
the delict must comport with the general principles of Aquilian
liability. Second, the unlawfulness requirement is not confined
to
the inducement of a breach of contract. An unlawful interference with
contractual relations is ultimately based upon the duty
not to cause
harm and to respect rights. Third, fault is satisfied by proof of
intent which may consist of
dolus
eventualis
(and
perhaps even negligence). The degree of fault may also be relevant to
the enquiry as to unlawfulness.
[24]
Does the conduct of COE amount to an unlawful interference with the
contractual relationship subsisting between
SAMWUMED and SALGBC? It
will be recalled that what COE sought to impose upon SAMWUMED was the
interposition of Moso as the exclusive
broker and intermediary that
SAMWUMED was required to use to service its members who were
employees of COE and to market its scheme
during the window period.
SAMWUMED was also required to pay Moso for rendering its services as
a broker, and to cancel any
agreements that it might have
concluded with other brokers. SAMWUMED was, under this imposition,
not to make use of its own employees
to market its scheme and service
COE employees who were members of the scheme.
[25]
Clause 1 of the collective agreement bound employers falling within
SALGBC to observe the terms of the agreement.
COE is such an
employer. It was bound to observe the collective agreement. The
collective agreement, as I have observed, provided
for the
accreditation of medical schemes and stipulated for a regime under
which employees could choose from among the accredited
schemes and
benefit from their membership. That regime permitted accredited
schemes to market their schemes during the window period
and to
service their members. Nothing in this regime limited the freedom of
accredited medical schemes to determine how to do so.
It did not
require the use by accredited medical schemes of brokers, much less
permit employers to impose the use of brokers upon
these schemes.
[26]
The conduct of COE clearly interfered with the contract subsisting
between SAMWUMED and SALGBC. It did so by restricting
the means by
which SAMWUMED could carry out its duties to service its members and
exercise its right to market its scheme in the
window period. The
collective agreement placed no restraints upon SAMWUMED of the
kind that COE sought to impose. COE had
a duty to observe the terms
of the collective agreement. It did not do so. Rather, it sought to
impose a broker upon SAMWUMED and
stipulated conditions under
which SAMWUMED could enjoy its rights and carry out its duties under
the agreement with SALGBC.
That was plainly harmful to SAMWUMED
because it imposed a broker that SAMWUMED did not either need or wish
to employ, and at a
cost that SAMWUMED was required to meet. This
amounts to unlawful interference in the contractual relationship
subsisting between
SAMWUMED and SALGBC.
[27]
Nor can there be doubt that COE interfered with the required intent.
It knew that SAMWUMED was an accredited medical
scheme in terms of
the collective agreement. It knew what the collective agreement
permitted SAMWUMED to do. Yet COE decided to
act as it did knowing it
would interfere with the manner in which SAMWUMED enjoyed its
accreditation from SALGBC and cause it loss.
The COE is thus liable
for its unlawful and intentional interference with the contractual
relationship subsisting between SAMWUMED
and SALGBC.
[28]
While SAMWUMED, for the reasons given, cannot enjoy the relief sought
in its notice of motion that is predicated
upon breach by COE of the
collective agreement and the enforcement of that agreement, SAMWUMED
has made out a case to prevent COE
from: imposing Moso upon SAMWUMED;
requiring SAMWUMED to pay Moso for its unwanted services; and
restricting the basis upon which
SAMWUMED may carry out its duties
and enjoy its rights under its agreement with SALGBC.
The
Moso appeal
[29]
I turn next to consider the appeal of SAMWUMED against the dismissal
by the high court of the relief it sought
against Moso. It will be
recalled that Moso does not seek to defend the conduct of COE and its
unilateral imposition of Moso as
a broker upon SAMWUMED. Moso
confined its case to one issue. It contended that it was not confined
by the territorial limitation
contained in its broker agreement with
SAMWUMED, and hence it was at liberty to offer its services to
SAMWUMED (outside of the
territorial limitation), and to COE, and its
employees. If the territorial limitation is lawful and remained
enforceable, Moso
accepts that SAMWUMED was entitled to restrain it
from offering its services outside of the agreed territorial
limitation.
[30]
Moso sought to impugn the territorial limitation on three grounds.
First, it contended that the territorial limitation
offends against s
65 of the MSA read with Regulation 28 promulgated in terms of the
MSA. Second, it submitted that the territorial
limitation offends
against public policy and it is thus rendered unenforceable. Third,
it claims that SAMWUMED has waived the territorial
limitation. I
consider each of these grounds in turn.
[31]
Section 65 of the MSA provides for the accreditation of brokers and
their compensation. Regulation 28(1) prohibits
any person from being
compensated by a medical scheme in terms of s 65, unless the broker
has entered into a prior written agreement
with the medical scheme
concerned. Regulation 28(6)(a) renders the ongoing payment of a
broker by a medical scheme conditional
upon the broker meeting the
service levels agreed upon in the written agreement between the
broker and the medical scheme. Regulation
28(7) requires a medical
scheme to discontinue payment to a broker upon notice that a
member or employer no longer requires
the services of that broker.
[32]
Moso reads these provisions to mean that members enjoy free
choice as to whether to use a broker and which
broker they wish to
select. Provided the broker is accredited and the other stipulations
as to compensation are met, that choice
is sovereign and the
territorial limitation is repugnant to that sovereignty. Moso, with
the high court, also rely upon the provisions
in s 1(1) of the
Financial Advisory and Intermediary Services Act 37 of 2002 (the FAIS
Act) read with section 20 of its code of
conduct which are said to
privilege the free choice of clients to appoint (and dismiss) a
broker. Moso also placed reliance on
the decision of this Court in
Hlela
[5]
and the decision of the appeals committee of the Council for
Medical Schemes in
LA
Health Medical Scheme
.
[6]
[33]
Nothing in s 65 or Regulation 28 forbids the adoption of a
territorial limitation in the written agreement between
a medical
scheme and a broker. What is required is that there should be a
written agreement; and Regulation 28 regulates
some of the
contents of that agreement, such as the maximum compensation payable
to a broker for the introduction of a member and
the rendering of
ongoing services. Furthermore Regulation 28(3) proscribes certain
differential compensation. This scheme of regulation
contains certain
prohibitions and imposes certain requirements. But beyond these
stipulations, the Regulation runs out, and
it is permissive. Thus,
there must be a written agreement between a broker and a medical
scheme; and it must comply with certain
content requirements and
prohibitions. Nothing in the Regulation, however, states or implies
that a broker agreement cannot contain
a territorial limitation upon
where it is that the broker may render its services.
[34]
Moso contended that s 65 of the MSA read with Regulation 28 is
predicated upon the primacy of member choice. And
the territorial
limitation is a constraint upon such choice and is thus prohibited.
This reasoning does not hold. First, it is
the medical scheme that
appoints the broker to secure introductions and render services, on
its behalf, to members for which the
medical scheme compensates the
broker. It is for the medical scheme to decide whether to appoint
brokers, and if it does, how and
where to deploy them under service
levels set out in a written broker agreement. Brokers may have
utility in one area, but
not in another. The medical scheme may
choose, as in this case, to use its own employees to service its
members in a particular
area. These are all choices for the medical
scheme to make and nothing in Regulation 28 says otherwise.
[35]
Second, Regulation 28(7) simply prevents a medical scheme from
compensating a broker if a member or employer no
longer requires the
broker’s services. This provision recognises that a member or
employer may not wish to receive the services
of a particular broker.
Upon notice of this, the broker may no longer be compensated. It is
not possible to derive from this provision
that members may dictate
to a medical scheme that every broker appointed by a medical scheme
must be available to provide services
to them or, more radically,
that if a medical scheme has appointed no brokers at all, they must
do so to provide members with some
(unspecified) plurality of choice.
Regulation 28 does not so provide. Very considerable complexity would
arise if a regulation
sought to do so, requiring detailed provisions,
that are not to be found in Regulation 28.
[36]
Third, as I have observed, Regulation 28 is predicated upon the
premise that it is for medical schemes to decide
whether to appoint
brokers and if so, how many, in what areas and on what terms.
The logic of this is well understood. Provided
there are a sufficient
number of medical schemes competing for members, it is for the
schemes to decide how to win members
and service their needs. If the
medical schemes make bad choices and service suffers, members will
switch. The Regulation could
have been constructed on a different
regulatory premise of broker plurality, but nothing indicates the
adoption of such a scheme.
[37]
Fourth, the
Hlela
decision and the provisions of the FAIS Act
provide no assistance, even of an analogical kind. In
Hlela
,
it was the clients who had appointed the broker, and the question was
whether their choice of broker could be rejected under s
20 of the
FAIS Code of Conduct. This Court held that it could not. Regulation
28, however, is not concerned with a member’s
appointment of a
broker. Under Regulation 28, the medical schemes may appoint brokers,
and members can choose whether to use their
services. That entails no
recognition of some requirement that a medical scheme, at the
instance of a member, must appoint a broker
or do so on particular
terms. Much less, the further entailment that territorial limitations
are impermissible. I find nothing
in the reasoning in
LA Health
Medical Scheme
that persuades me of a different conclusion. And
hence, the contention of Moso that the territorial limitation is
repugnant to s
65 of the MSA and Regulation 28 falls to be rejected.
[38]
Moso next advanced the submission that the territorial limitation
offends against public policy and is therefore
rendered
unenforceable. It relied upon
Beadica
,
[7]
and certain of the cases of the Constitutional Court analysed in
Beadica.
The
majority in
Beadica
held that the value of honouring obligations freely and voluntarily
entered into has no primacy in the pantheon of public policy,
it is
one of the number of constitutional rights and values that may be
implicated in deciding whether the enforcement of a contractual
term
is contrary to public policy.
[8]
[39]
Following
Beadica,
the fact that Moso agreed to the
territorial limitation does not exhaust the considerations of public
policy that might bear upon
the enforcement of such a provision. Moso
reprises its invocation of the value that should attach to the
freedom of members to
choose a broker, and that the territorial
limitation restricts such choice. The statutory scheme, analysed
above, does not reflect
this value. Rather, it recognises that a
member does not need to use a broker if they should choose otherwise.
Apart from the statutory
scheme, I do not apprehend that the
territorial limitation offends against any important constitutional
right or value. It simply
constitutes a means by which medical
schemes may choose to provide services through brokers. This is a
matter of efficacy. Other
means may also be effective. But it is hard
to see how an insistence that once a broker is appointed by a scheme
that broker must
be entitled to operate without territorial
limitation infringes upon any constitutional right or value. Nor has
a case been made
that the territorial limitation has led to any
deterioration of the service rendered by SAMWUMED or any lack of
competitive alternatives
for employees of COE who might want to
switch medical schemes. The invocation of broker choice is an
abstract claim, without an
obvious constitutional mooring.
[40]
It follows that I can discern no consideration of public policy that
counts in favour of rendering the territorial
limitation
unenforceable. On the contrary, Moso agreed to this restriction in
its broker agreement with SAMWUMED, and there is
no reason why it
should not be held to it. Moso’s challenge on this score must
fail.
[41]
Finally, Moso contends that SAMWUMED waived or abandoned the
territorial limitation during the currency of the
broker agreement
with Moso. Moso avers that SAMWUMED appointed Moso to render
brokerage servies in the city of Tshwane; Moso introduced
596 new
members and was paid by SAMWUMED. SAMWUMED contests this version; it
sets out the history of its broker agreements with
Moso, over the
years, which have defined different territories, but these
appointments, prior in time to the current agreement,
could not
amount to a preemptive waiver of a later agreement.
[42]
It is unnecessary to resolve this factual dispute. The version
offered by Moso is struck by clauses 13.1 and 13.2
of the broker
agreement. They provide that no variation of the terms of the
agreement shall be binding unless reduced to writing
and signed by
the parties; and further, that no indulgence shall constitute a
waiver, nor preclude the grantor (of the indulgence)
from exercising
any rights. The documentary evidence proferred by Moso does not meet
the standard set by clause 13.1 to effect
a valid variation. And to
the extent that SAMWUMED permitted Moso to introduce new members in
Tshwane, no such indulgence can constitute
a waiver. The waiver
challenge must be rejected.
[43]
It follows that Moso’s challenges to the territorial limitation
cannot succeed. As counsel made plain at
the commencement of his oral
submissions, if this Court should reach this conclusion, then
SAMWUMED’s appeal must be upheld
and it is entitled to the
relief that Moso contested.
Conclusion
[44]
SAMWUMED has prevailed against COE, and its appeal must be upheld.
SAMWUMED is not entitled to relief predicated
upon the enforcement of
the collective agreement. It is entitled to the relief in its notice
of motion that protects it from the
conduct of COE that sought to
impose a broker upon SAMWUMED, and the entailments of that conduct.
As against COE, the orders sought
in prayers 3,5 and 6 of the notice
of motion should thus be granted. Although COE abided the judgment of
this Court, it did not
abandon the order of the high court in its
favour. This meant that SAMWUMED was required to come to this Court
to appeal the high
court’s order. Once that is so, SAMWUMED is
entitled to the costs of the appeal as against COE, on an unopposed
basis.
[45]
As to the appeal against the dismissal by the high court of the
relief sought by SAMWUMED against Moso, Moso opposed
the appeal on a
limited basis, and, in particular limited its opposition to the issue
of the territorial limitation and prayers
4 and 5.5. That opposition
has not succeeded. SAMWUMED’s appeal is upheld as against Moso.
Costs must follow that result.
[46]
The following order is made:
1
The appeal is upheld, the costs of the appeal, including the costs of
the application for
leave to appeal, are to be borne jointly by
the first and second respondents;
2
The orders of the high court are set aside and substituted with the
following:
‘
1.
The first respondent is ordered to accept member application forms
and other documents
and communications directly from the applicant,
and to duly process such applications and related documents submitted
by the applicant,
for so long as the applicant remains an accredited
medical scheme in terms of the collective agreement;
2.
It is declared that the second respondent is not entitled to payment
of broker
fees by the applicant in respect of the employees of the
first respondent, in the absence of a written broker agreement having
been concluded between the applicant and the second respondent and in
the absence of the second respondent having actually rendered
broker
services;
3.
The first and second respondents are interdicted, for so long as the
applicant
remains an accredited medical scheme in terms of the
collective agreement:
3.1
from taking any steps that would prevent or hinder the applicant from
marketing its scheme
and benefit options and rendering services to
its members and all prospective members who are employees of the
first respondent
by way of the applicant’s own internal
consultants or independent brokers appointed by the applicant, should
it so wish;
3.2
from holding out that the second respondent is the exclusive broker
for the five medical
schemes accredited in terms of the collective
agreement concluded on 9 September 2015, and that no other brokers or
consultants
will be allowed to service employees of the first
respondent;
3.3
from refusing to accept member application forms and other documents
and communications
submitted to the first respondent by the
applicant, and from refusing to duly process such applications and
related documents;
3.4
from insisting that all medical scheme member application forms and
other related documents
and communications be submitted to the second
respondent, as opposed to the first respondent;
3.5
from insisting that payment of broker fees be made by the applicant
to the second respondent
in the absence of a written broker agreement
between the applicant and the second respondent and/or in the absence
of the second
respondent having actually rendered broker services;
3.6
from approaching members of the applicant and requesting them to
execute service notes in
favour of the second respondent, in the
absence of a written broker agreement between the applicant and the
second respondent and/or
in the absence of the second respondent
having actually rendered broker services to members of the applicant.
4.
The first and second respondents are jointly ordered to pay the costs
of this
application.’
_________________________
DN
UNTERHALTER
ACTING
JUDGE OF APPEAL
APPEARANCES
For
Appellant:
E Kromhout
Instructed
by:
Malatji & Co Inc., Sandton
Honey
Attorneys, Bloemfontein
For Second
Respondent:
Y Alli
Instructed
by:
Wadee Attorneys, Johannesburg
Webbers
Attorneys, Bloemfontein
[1]
Total
South Africa (Pty) Ltd v Bekker NO
1992
(1) SA 917
(A) at 625.
[2]
Lanco
Engineering CC v Aris Box Manufacturers (Pty) Ltd
1993
(4) SA 378
(D) at 384.
[3]
Masstores
(Pty) Ltd v Pick n Pay Retailers (Pty) Ltd
2017
(1) SA 613
(CC).
[4]
Country
Cloud Trading CC v MEC, Department of Infrastructure Development
2015
(1) SA 1 (CC).
[5]
Hlela
v SA Taxi Securitisation (Pty) Ltd
2014
JOL 32305 (SCA).
[6]
LA
Health Medical Scheme v The Office of the Registrar & Others
CMS Ref: CMS 76106.
[7]
Beadica
231 CC & Others v Trustees, Oregan Trust & Others
2020
(5) SA 247 (CC).
[8]
Ibid
at para [87].
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