Ten years ago Henry was involved in a motor vehicle accident which left him paralysed from the waist down and wheelchair bound for life. Three years later a court order, in favour of Henry, was issued in terms of a third party claim Henry instituted against the Road Accident Fund (RAF). A few weeks after that, the RAF issued an Undertaking which formed part of the settlement of Henry’s claim. Henry is not sure what this means and what he can do in terms of this Undertaking and how this will assist him in living with his disability.
In simple words an Undertaking is a contract between the claimant, such as Henry, and the RAF, in terms of which the RAF will reimburse the claimant for reasonable future medical expenses the claimant may incur due to injuries sustained in the motor vehicle accident, on submission of acceptable proof.
Reasonable future expenses may, for instance, in Henry’s case, include:
- All costs of future accommodation in a hospital or nursing home.
- Medical treatment or the supply of goods or services.
Excessive, experimental or unproven types of treatment is not included as reasonable future expenses. It is further also important to understand that the Undertaking will not cover any illnesses, diseases or injuries which are not related to the motor verhicle accident or which are related to the normal effects of ageing. The effects that other conditions may have on injuries are also excluded.
For Henry, this raises criticial questions as to what will be covered. These questions relate to medication, physiotherapy, a wheelchair, a pressure care cushion, motor vehicle modifications, home renovations etcetera. To answer these questions, the following process may be helpful:
Firstly, Henry must know that the RAF has Undertakings Departments at its various Regional branch offices. These regional branch offices are situated in Menlyn, Johannesburg, Cape Town, Durban, East London and Port Elizabeth. The RAF’s website (www.raf.co.za) or call centre (0860 23 55 23) will provide contact details for a particular Regional branch office .
Secondly, the claimant should contact or visit the Regional Undertakings Department and provide a certified copy of the Undertaking document. The claimant should then ask to be linked to a Case Manager. Case Managers are situated at the Regional branch offices and also at various Satellite offices. They handle the initial processing of a claim. It is of crucial importance to know the contact details of the relevant a Case Manager and to contact her or him regularly.
Thirdly, the claimant should obtain a banking details indemnity form from the Case Manager. This should be completed and verified by the claimant's bank with an original bank stamp. The original banking details indemnity form, accompanied by an original letter from the bank confirming the banking details, must be submitted to the RAF at the following address (one should remember to always include the claim and link numbers as indicated on the Undertaking document in all correspondence to the RAF) :
The Address Book Administrator
Private Bag X2003
Fourthly, once the banking details are loaded on the RAF’s system, the claimant may start submitting, via fax or email, invoices or proof of payment to the allocated claimhandler. All such invoices or claim documents should at all times be legible and signed by the claimant.
Back to Henry: Henry has bought a ‘high tech’ and expensive wheelchair three and a half years ago. This luxurious wheelchair met his needs for mobility. Henry now submits the proof of payment by e-mail to his claim handler, and ensures that his claim is legible and duly signed.
Unfortunately, Henry’s claim for reimbursement of the cost he incurred in respect of the wheelchair has prescribed because the service provider supplied the wheelchair, and was paid by Henry, more than three years prior to the submission of the claim. Additionally, even if Henry’s claim did not prescribe, the RAF would only reimburse him partially and not for the full amount he paid for the wheelchair. The reason for this is that he was using a less expensive wheelchair before he bought the new wheelchair. The occupational therapist report on his file with the RAF also recommended the use of a less expensive wheelchair. The RAF will thus not allow the claim as it has prescribed. The medical report additionally does not justify the cost of the more expensive wheelchair.
In practice situations similar to that of Henry occur on a regular basis. The following practical pointers may assist in this regard:
- An account need not be paid before claiming the amount from the RAF. All that is required is that an contractual obligation to pay the service provider in terms of a binding agreement between the claimant and the service provider must be incurred. However, a mere quotation alone will not suffice to prove the contractual obligation.
- Before entering into an agreement with a service provider, a claimant should inquire from the claim handler what would a reasonable claim for the specific service or provision of goods be. In this way, it is possible to avoid partial reimbursments.
- Claims should be submitted timeously (within three years from the date when the obligation to pay was incurred).
Written by Seugnet Moggee, Associate, Phatshoane Henney Attorneys: Wills & Estates Department