HOW ARE MOTOR VEHICLE ACCIDENTS COVERED?

Motor vehicle accident (MVA) claims have certain procedures, which must be strictly adhered to, although PMB claims that are related to an MVA are exempt from this procedure and subject to normal PMB protocols. If you are involved in a motor vehicle accident where a third party is liable, inform the Scheme as soon as possible. All accounts will be held until you have appointed an attorney to handle your claim from the Road Accident Fund.

The Scheme will assist you, provided that a written undertaking is submitted, signed by both the member and his/her legal representative, confirming that the Scheme will be refunded by the Road Accident Fund (RAF) for all claims that are paid out by the Scheme, free of any legal fees. This will enable the Scheme to process claims timeously. Claims will be paid to the service providers (such as the hospitals and doctors concerned) up to the individual member’s limits.

Cases that are rejected by the RAF will be covered by the Scheme up to the individual member’s limits. However, a letter will be required from the RAF stating that the claim has been rejected. Decisions will be made based on the Rules of the Scheme.

The Scheme (which would have covered the medical costs on your behalf) will have a claim against the RAF for medical expenses incurred as a result of the accident. Therefore, the final settlement paid out by the RAF for medical expenses will not be due to you and must be refunded to the medical scheme.

If you need to claim

To provide you with access to specialised support and assistance with lodging a third-party claim, the Scheme appointed Batsumi as the Scheme’s provider for the recovery of all eligible past medical expenses paid by the Scheme that may be recoverable from a third party.

The new arrangement will provide you with the following benefits:

  • Access to a highly specialised third-party claims team;
  • The option to appoint a reputable firm of attorneys to institute a claim on your behalf, at preferential rates;
  • Consultations with a member of the claims team, by appointment;
  • The option to collect forms from and deliver completed legal forms to walk-in branches and Client Liaison Officers.

Call 0860 100 080 for assistance with third-party claims and you will be transferred to the legal adviser(s) in the third-party claims team. Alternatively, you can contact the team directly on 0800 117 222.

MORE ABOUT THE ROAD ACCIDENT FUND (RAF)

The RAF cover indemnifies the driver or owner of a motor vehicle that wrongfully causes damage or loss to victims of motor vehicle accident, from being liable for losses or death suffered as a result of the accident. However, the RAF does NOT cover any material damages such as property damage which may include vehicles, buildings, and vehicle contents and furthermore, does NOT cover drivers of motor vehicles that contributed towards the cause of the accident due to negligence.

WHO IS ENTITLED TO CLAIM?

  • A driver, passenger, and or a pedestrian physically injured in an accident caused by the negligent driving of a motor vehicle by another person.
  • A dependant of an individual killed, assuming the deceased was the main income provider.
  • Any close relative of the deceased who helped pay for the funeral.
  • A minor, under the age of 18, assisted by a parent or a legal guardian.

WHAT CAN BE CLAIMED FROM THE ROAD ACCIDENT FUND?

  • Medical expenses.
  • Funeral expenses.
  • Compensation for pain and suffering.
  • Loss of earnings if the victim is unable to work as a result of the injuries sustained in the accident.
  • Loss of support – this can be claimed by the dependents of the main income provider of a household who was killed in the accident as a result of another person’s negligence.

KEEP IN MIND…

The RAF system is fault based, thus if the victim has contributed to the occurrence of the accident the amount that the victim can claim will be reduced in relation to his/her contributory negligence. This means that the victim may get partial payment if he/she was partly responsible for the accident.