Discovery hits back about road accident claims | Fin24
 
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Discovery hits back about road accident claims

Oct 27 2014 10:53
Carin Smith
accidents

(Picture: Netcare 911)

Company Data

DISCOVERY LIMITED [JSE:DSY]

Last traded 74
Change -6
% Change -8
Cumulative volume 3278684
Market cap 0

Last Updated: 01/01/0001 at 12:00. Prices are delayed by 15 minutes. Source: McGregor BFA

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Johannesburg - Discovery Health [JSE:DSY] always pays for the treatment of any member or dependant injured in a motor vehicle accident in accordance with the member’s specific plan type and "no questions asked", the medical scheme said in a statement.

This is Discovery's response to various allegations by attorney Ronald Bobroff of Ronald Bobroff and Partners.

READ: Bobroff's full statement

These claims include that Discovery does not adequately inform members of its rules and, as a result, has no right to be refunded Road Accident Fund (RAF) claims in respect of medical costs incurred by the scheme on behalf of the member.  

To this Discovery Health responded in its statement that it does not differentiate between medical claims resulting from a motor vehicle accident and claims resulting from any other accident or illness.

"If a member or dependant subsequently becomes entitled to any benefit from the RAF, the member or dependant may submit a claim to the RAF for compensation and reimbursement of related medical expenses," according to Discovery. "The scheme does not force members to claim from the RAF."

If a member or dependant receives compensation from the RAF for medical expenses, the member must then refund those amounts previously paid by the scheme for the member’s medical expenses.

This is to avoid the member being unjustly enriched at the expense of the scheme by receiving double compensation for the same health event, according to Discovery.

"If, however, the member does not receive any compensation from the RAF, Discovery will remain liable for the costs of the treatment subject to the chosen plan type of the member, and will never require that the member repay these funds to the scheme."

Discovery said members can be assured they will always have access to the necessary treatment in the event of a motor vehicle accident and that the scheme’s treatment of RAF claims is consistent with the provisions of the Medical Schemes Act.

"The council for Medical Schemes has ruled unequivocally on this issue in favour of the scheme, concluding that the Scheme is entitled to claim reimbursement of medical expenses paid in respect of RAF matters in terms of its rules and in terms of common law principles," said Discovery.

"The council also confirmed that Discovery adequately informs its members of these rules and obligations in terms of the Medical Schemes Act."

According to Discovery Bobroff also claimed that Discovery Health members and their families are approached while in hospital and forced to sign undertakings to refund the scheme in respect of RAF reimbursements.

To this Discovery responded by saying no Discovery Health employee has ever approached a member in hospital in this regard.

"All Discovery Health members are guaranteed coverage in respect of their medical costs incurred as a result of a motor vehicle accident (as with all other benefits) in line with their plan choice and in terms of the prescribed minimum benefits which all medical schemes cover," said Discovery.

"The scheme has never failed to pay claims for medical expenses after a motor vehicle accident."

Overreaching and other charges against Bobroff

According to Discovery there have recently been numerous court orders, including some by the Supreme Court of Appeal and the Constitutional Court, have been made against Ronald Bobroff and Partners in respect of its excessive and unlawful fees charged to its clients.

The impact of these unlawful fees has created severe repercussions for clients who have typically suffered significant injuries from motor vehicle accidents.

In addition to these court orders, Ronald Bobroff and Partners has also been charged with approximately 20 counts of unprofessional conduct and breaches of ethical duties by the Law Society of the Northern Provinces.

Flowing from these charges, the Supreme Court of Appeal last week ordered an inspection of Ronald Bobroff and Partners' business and trust accounts to determine the extent of its unlawful overcharging of clients.

"Discovery Health has supported these cases against Ronald Bobroff and Partners, because we believe we have an obligation to assist and protect our members, particularly those who find themselves in a vulnerable position," said Discovery.

"We also believe we have a duty to defend the integrity of the broader structures of our society, in this case the RAF."

Attorney responds to allegations

On Monday attorney George van Niekerk of ENS told Fin24 the firm is acting for erstwhile clients of Ronald Bobroff and Partners, who have evidently been grossly overcharged by the practice - "overreaching".  

"The dispute with Ronald Bobroff and Partners relating to overreaching and other unprofessional conduct started in 2011 and is the subject of pending disciplinary enquiries by the Law Society of the Northern Provinces as well as litigation proceedings instituted by our clients in the North Gauteng High Court," said Van Niekerk.  

In April 2014 the North Gauteng High Court ordered inter alia that the Law Society must urgently inspect the books and accounts of the practice of Ronald Bobroff and Partners.  

"You will see that Ronald Bobroff and Partners makes no mention of this in their public fulminations," said Van Niekerk.

"It is also not disclosed that Ronald Bobroff and Partners applied for leave to appeal. The application was dismissed. Presiding Judge Billy Mothle remarked that the application for leave to appeal was disingenuous, and intended to delay an inspection of their books of account."

According to this judgment at the centre of the charges against the Bobroffs is the allegation that as attorneys and court officials, they did not comply with the provisions of the Contingency Fee Agreement Act.

"The Farris report raises serious allegations of misconduct and possible non-compliance with the provisions of the Contingency Fee Agreement [Act] on the part of the Bobroffs, who are officials of this court. It is thus in the interest of this court, the Grahams, RAF as the payers of those funds as well as being in the interest of the Bobroffs, that such allegations be investigated. As counsel for the Grahams contended, the Bobroffs have an opportunity to be cleared if the allegations are unfounded," the judgment reads.

The judge said it seems to him that the Grahams are correct in their submission that the Bobroffs’ application for leave to appeal is intended to delay an inspection of their books of accounts and for no other purpose.

"In my view the numerous grounds of the application for leave to appeal as stated in the application are contrived and based on a self-serving misinterpretation of paragraphs 3 and 5 of the Court Orders,” said the judge.

According to Van Niekerk the Bobroffs then applied to the Supreme Court of Appeal (SCA) for leave to appeal, but the application was dismissed by the SCA on the grounds that the appeal has no reasonable prospects of success.  

"Ronald Bobroff and Partners has now applied to the Constitutional Court for leave to appeal, which application is being opposed on behalf of our clients," said Van Niekerk.

ALSO READ: Over R152m paid to crash survivors

- Fin24

medical schemes  |  health
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