Summary of Judgment

1. Introduction

This was a delictual damages claim instituted against the Road Accident Fund (RAF) under the Road Accident Fund Act 56 of 1996 (as amended), arising from bodily injuries sustained in a motor vehicle accident. The proceedings took place in the High Court of South Africa, Free State Division, Bloemfontein, before Jordaan AJ, with the matter heard on 28 November 2023 and judgment delivered on 29 November 2023.

The parties were Ntaopane Caroline Seipati as plaintiff, an adult female injured in the collision, and the Road Accident Fund as defendant, being the statutory body obliged (subject to the Act) to compensate third parties for loss caused by negligent driving.

The procedural history reflected substantial narrowing of the dispute before trial. Liability (merits) was settled by an offer and acceptance dated 12 June 2018, in terms of which the RAF conceded 100% liability in favour of the plaintiff. In addition, the parties reached settlements on various heads of damages over time: loss of earnings was settled by offer and acceptance dated 18 March 2022 (introduced at trial as Exhibit “A”), and future medical expenses and general damages were settled shortly before the trial, on the basis ultimately incorporated into the court order.

By the time the matter came before the court for determination, the remaining controversy was narrow and discrete. The dispute concerned whether the RAF could refuse to pay the outstanding balance of past hospital and medical expenses on the ground that an original voucher was not available, despite the underlying expenses and their payment by medical aid not being disputed.

2. Material Facts

On 12 July 2017 at approximately 07h00, the plaintiff was travelling as a passenger in a white Toyota taxi (the “insured vehicle”). The insured driver lost control of the vehicle when a rear tyre burst, causing the vehicle to overturn.

As a result of the accident, the plaintiff sustained multiple injuries. The injuries recorded by the court included a facial degloving injury requiring surgery, a right lower leg degloving injury requiring two skin grafts, an injury to the left small finger, a rib injury, and a head injury. These injuries formed the factual foundation for the various heads of damages claimed under the RAF statutory scheme.

The plaintiff instituted action for damages initially quantified at R3 800 000.00, including claims for past medical expenses, future medical expenses, past and future loss of earnings, and general damages. At the commencement of trial, the plaintiff amended the amount claimed for past hospital and medical expenses from R150 000.00 to R191 062.96, an amendment that was not opposed.

The court treated several important factual aspects as undisputed. The defendant accepted the plaintiff’s expert reports, and no expert reports were presented for the defendant. The plaintiff also introduced an affidavit by Tanusha Tia Hoosen, an employee of the Discovery Medical Aid Scheme, setting out the expenses incurred by Discovery in funding the plaintiff’s treatment arising from the accident. The affidavit was not disputed. It was also not disputed that the plaintiff was a member of Discovery Medical Aid, and the expenses incurred for treatment were not in dispute.

The factual point that remained contentious was not whether the treatment occurred or whether the amounts were correct, but whether the RAF could withhold payment of the outstanding balance of past hospital and medical expenses due to the absence of an original voucher, notwithstanding the absence of any substantive challenge to the plaintiff’s evidence about treatment and payments.

3. Legal Issues

The central legal question was whether, in the circumstances of the case, the RAF was entitled to refuse payment of outstanding past hospital and medical expenses on a purely documentary basis, namely the alleged lack of an original voucher, where the expenses themselves and the proof of payment by the medical aid were not disputed.

The issue was primarily one of application of law to largely common-cause facts, requiring the court to consider the scope of the RAF’s statutory obligation under section 17(1) of the Road Accident Fund Act, and whether the Act permits an exclusion from compensation in the circumstances advanced by the defendant.

Although the dispute was framed around proof of payment documentation, the court approached it as a question of whether the Act provides a basis to deny compensation where the defendant does not place the underlying treatment, costs, and payments in dispute, and where the plaintiff’s evidentiary material (including the medical aid affidavit) stands unchallenged.

4. Court’s Reasoning

The court located the RAF’s obligation in the language of section 17(1) of the Road Accident Fund Act 56 of 1996, which obliges the Fund (subject to the Act) to compensate a third party for loss or damage suffered as a result of bodily injury caused by or arising from the driving of a motor vehicle, where the injury is due to the negligence or wrongful act of the driver or owner (or employee acting in the course of employment). Against that statutory backdrop, the court emphasised that the RAF’s duty is framed broadly as an obligation to compensate where the statutory requirements are met.

The court noted that, in this case, the RAF had already conceded the merits 100% and did not dispute that the plaintiff sustained injuries in the collision, that those injuries were medically assessed and treated, and that the medical costs were incurred and paid at the time and thereafter. The evidentiary position at trial was that the defendant accepted the plaintiff’s expert reports and advanced no expert evidence of its own. The plaintiff’s evidence included the affidavit from the Discovery Medical Aid employee describing the medical expenses incurred; this affidavit was not contested, and the plaintiff’s membership of the medical aid scheme was also not disputed.

Against this factual matrix, the court addressed the defendant’s apparent attempt to “escape liability” by reliance on the absence of an original voucher. The court reasoned that the Road Accident Fund Act does not provide for an exclusion of compensation merely because an original voucher is unavailable, especially where the defendant does not substantively dispute the truth and correctness of the plaintiff’s evidence relating to the injuries, the medical treatment, the costs of that treatment, or the proof (in the form of the medical aid account statement and affidavit) that those costs were incurred and paid.

A further consideration in the court’s reasoning was the defendant’s conduct at trial. The court recorded that the defendant made no submissions placing anything in dispute regarding the outstanding past medical expenses. In the absence of any substantive dispute and in light of the accepted evidentiary material, the court stated that it saw no reason to reject the plaintiff’s evidence. The court therefore accepted that the outstanding amount was payable and concluded that the RAF was liable to pay the plaintiff the outstanding balance of R80 637.72 in respect of past hospital and medical expenses.

5. Outcome and Relief

The court found in favour of the plaintiff on the remaining disputed issue and held that the RAF was liable to pay the outstanding past hospital and medical expenses notwithstanding the absence of an original voucher.

The court ordered the defendant to pay the plaintiff a total amount of R780 637.72 within 180 days of the order, comprising R80 637.72 for outstanding past hospital and medical expenses and R700 000.00 for general damages. The court further clarified that the amount for past medical expenses was payable in addition to an interim amount of R110 425.24 previously paid by the defendant in partial settlement of that head of damages.

The order also provided for interest if payment was not made within 180 days, calculated at the prevailing interest rate from the 15th calendar day after the date of the order to date of final payment, in line with prevailing legislation. In addition, the defendant was directed to furnish the plaintiff with an undertaking under section 17(4)(a) of the Act for payment of 100% of future accommodation, treatment, services, or goods necessitated by the accident, to be compensated after the costs are incurred and upon proof thereof.

On costs, the defendant was ordered to pay the plaintiff’s taxed or agreed party-and-party costs on the High Court scale up to and including 28 November 2023, subject to the taxation procedure outlined in the order if costs were not agreed. The order specified various categories of recoverable costs, including costs related to the appointment of counsel, case management meetings, and the preparation and procurement of medico-legal and related reports, among others. The order further directed that the amounts in paragraphs 1 and 5 be paid to the plaintiff’s attorneys, A Wolmarans Incorporated, into their trust account by direct transfer (with the banking details set out in the order).

Cases Cited

No cases were cited in the judgment.

Legislation Cited

Road Accident Fund Act 56 of 1996 (as amended), section 17(1).

Road Accident Fund Act 56 of 1996 (as amended), section 17(4)(a).

Road Accident Fund Act 56 of 1996 (as amended), section 26 (referenced in the quotation of section 17(1)).

Rules of Court Cited

No rules of court were cited in the judgment.

Held

The court held that the RAF could not refuse to pay the outstanding balance of the plaintiff’s past hospital and medical expenses solely on the basis that an original voucher was not available, where the expenses and their payment were not disputed and where the plaintiff’s evidentiary material (including the undisputed medical aid affidavit) was accepted. The RAF was therefore liable to pay the outstanding past medical expenses of R80 637.72, together with the agreed amounts reflected in the final order, including general damages and a statutory undertaking for future medical costs, as well as party-and-party costs.

LEGAL PRINCIPLES

The judgment applied the principle that the RAF’s duty to compensate is grounded in section 17(1) of the Road Accident Fund Act, which obliges the Fund (subject to the Act) to compensate a third party for loss or damage resulting from bodily injury caused by or arising from the negligent driving of a motor vehicle.

The judgment further applied the principle that where the governing statute does not provide an exclusion or statutory basis to deny compensation on a particular ground, a defendant cannot avoid liability by relying on that ground in circumstances where the factual basis of the claim is not disputed. In this case, the court treated the absence of an original voucher as insufficient to defeat an otherwise proven and undisputed claim for past medical expenses, particularly where the defendant accepted the plaintiff’s expert reports and did not contest the affidavit evidence describing the medical aid payments.

Finally, the judgment reflects the evidentiary principle that, where a party’s evidence stands unchallenged and undisputed on the material aspects relevant to the determination, and the opposing party places no substantive dispute before the court, the court may accept such evidence and grant relief consistent with it.