During the current matter of the Board of Healthcare Funders of Southern Africa v Council For Medical Schemes 2011 JDR 1471 (GNP), the first and second applicants approached the judge with a demand to release a declaratory order regarding the explanation of the words "pay in full" in regulation 8(1) of the General Regulations made pursuant to the Medical Schemes Act, 131 of 1998.
The applicants fought that the Court was required to consider three problems, namely: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening members in opposing the relief wanted by way of the candidates; and 3. The meaning of the terminology "pay in full" in regulation 8(1) of the General Regulations which were promulgated with respect to section 67 of the Act.
Regulation 8 has been in force since 1 January 2000. As reported by the appliers, the actual problem started on 11 November 2008 once the Appeal Board resolved two cases on appeal which was referred by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to these two judgements, interpreted the words "pay in full" in regulation 8 to indicate that the professional medical scheme should effect complete payment of a service providers' invoice in respect of the charges of delivering healthcare services for Prescribed Minimum Benefits without taking the policies of the medical scheme into account in working with any claims.
It was the applicants' argument that "pay in full" suggests settlement in accordance with the guidelines of the Medical Scheme, while according to the respondents, the decisions by the Appeal Board have not been questioned as yet and presently professional medical aid schemes are bound to this power and still have to pay service providers' invoices fully.
The main grievance via the participants was that the first applicant had no direct and substantial interest in the application since the judgment would not have a visible impact over it. Although the first candidate contended that it defended 75 registered professional medical aid schemes and therefore had locus standi, a legal court discovered this to not be. This was due to the fact that the first candidate saw fit to have the second applicant, who is an authorized medical aid scheme, joined. In addition, only 15 licensed professional medical schemes, within the starting and supplementary founding affidavits, verified that a declaratory order should be sought.
A Legal Court held that had the primary candidate been so confident that it defended all 75 medical aid schemes it wouldn't have been necessary to join the other applicant or to obtain affidavits and signatures of 15 members of the first candidate. The Court determined out of this that the first candidate didn't in reality represent 75 members, but only the 15 members stated inside the paperwork.
The non-joinder of all the medical schemes rendered the application fatally defective as the Courts couldn't discover that the primary applicant, as a standard representative of the medical schemes, would be prejudicially impacted by a verdict, but learned that its participants may all be prejudicially influenced and accordingly, many of the members ought to have jointly instituted the request for a declaratory order.
The Court found out that the first applicant did not have locus standi for these reasons:
1. The issue was one that may be classified as a representative matter, although not every one of the healthcare schemes had been combined and it has not been launched as a representative topic due to the fact that the first candidate was lacking any mandate to litigate on the part of all 75 of their members;
2. In order to initiate steps with respect to Section 38 in the Constitution, a litigant needs to show that a right enshrined in the Bill of Rights has been encroached upon as well as satisfactory concern in the relief desired. The initial candidate didn't clearly aver such violation and the Judge found that the First Litigant wouldn't be directly influenced by the verdict and did not have an adequate concern in the relief sought.
For the purpose of the second candidate the judge held that it could not be successful in the application by itself, as none of the other medical aid schemes or administrators have been connected.
The applicants fought that the Court was required to consider three problems, namely: 1. The first applicant's entitlement to commence procedures for declaratory aid; 2. The interest and locus standi of the intervening members in opposing the relief wanted by way of the candidates; and 3. The meaning of the terminology "pay in full" in regulation 8(1) of the General Regulations which were promulgated with respect to section 67 of the Act.
Regulation 8 has been in force since 1 January 2000. As reported by the appliers, the actual problem started on 11 November 2008 once the Appeal Board resolved two cases on appeal which was referred by the Appeal Committee with respect to section 50 of the Act. The Appeal Committee and the Appeal Board had, pursuant to these two judgements, interpreted the words "pay in full" in regulation 8 to indicate that the professional medical scheme should effect complete payment of a service providers' invoice in respect of the charges of delivering healthcare services for Prescribed Minimum Benefits without taking the policies of the medical scheme into account in working with any claims.
It was the applicants' argument that "pay in full" suggests settlement in accordance with the guidelines of the Medical Scheme, while according to the respondents, the decisions by the Appeal Board have not been questioned as yet and presently professional medical aid schemes are bound to this power and still have to pay service providers' invoices fully.
The main grievance via the participants was that the first applicant had no direct and substantial interest in the application since the judgment would not have a visible impact over it. Although the first candidate contended that it defended 75 registered professional medical aid schemes and therefore had locus standi, a legal court discovered this to not be. This was due to the fact that the first candidate saw fit to have the second applicant, who is an authorized medical aid scheme, joined. In addition, only 15 licensed professional medical schemes, within the starting and supplementary founding affidavits, verified that a declaratory order should be sought.
A Legal Court held that had the primary candidate been so confident that it defended all 75 medical aid schemes it wouldn't have been necessary to join the other applicant or to obtain affidavits and signatures of 15 members of the first candidate. The Court determined out of this that the first candidate didn't in reality represent 75 members, but only the 15 members stated inside the paperwork.
The non-joinder of all the medical schemes rendered the application fatally defective as the Courts couldn't discover that the primary applicant, as a standard representative of the medical schemes, would be prejudicially impacted by a verdict, but learned that its participants may all be prejudicially influenced and accordingly, many of the members ought to have jointly instituted the request for a declaratory order.
The Court found out that the first applicant did not have locus standi for these reasons:
1. The issue was one that may be classified as a representative matter, although not every one of the healthcare schemes had been combined and it has not been launched as a representative topic due to the fact that the first candidate was lacking any mandate to litigate on the part of all 75 of their members;
2. In order to initiate steps with respect to Section 38 in the Constitution, a litigant needs to show that a right enshrined in the Bill of Rights has been encroached upon as well as satisfactory concern in the relief desired. The initial candidate didn't clearly aver such violation and the Judge found that the First Litigant wouldn't be directly influenced by the verdict and did not have an adequate concern in the relief sought.
For the purpose of the second candidate the judge held that it could not be successful in the application by itself, as none of the other medical aid schemes or administrators have been connected.
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