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2024
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[2024] ZAFSHC 262
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Moeketsane Patrick Marasi v Road Accident Fund (164/2021) [2024] ZAFSHC 262 (30 August 2024)
IN
THE HIGH COURT OF SOUTH AFRICA
FREE
STATE DIVISION, BLOEMFONTEIN
Reportable
/ Not reportable
Case
no: 164/2021
In
the matter between
MOEKETSANE
PATRICK MARASI
PLAINTIFF
And
ROAD
ACCIDENT FUND
DEFENDANT
Neutral
citation:
Moeketsane Patrick Marasi
v Road Accident Fund
Coram:
Ramdeyal AJ
Heard:
28 August 2024
Delivered:
This judgment was handed down electronically by
circulation to the parties’ representatives by email and
released to SAFLII.
The date and time for hand-down is deemed to be
30 August 2024
at 10h30.
ORDER
1.
Judgment is granted in favour of the
plaintiff for the payment of R76 997.14 within 180 days hereof.
2.
Draft order “X” is made an
order of court.
JUDGMENT
Ramdeyal
AJ
[1]
The plaintiff in this case is Moeketsane
Patrick Marasi, a 41 year-old male. He instituted an action against
the defendant, the
Road Accident Fund (RAF), after he sustained
injuries during a motor-vehicle collision which occurred on 30 March
2019.
[2]
The RAF conceded the issue of negligence in
respect of the occurrence of the motor-vehicle collision on the basis
that the insured
driver was negligent in causing the collision. The
parties resolved the plaintiff’s claim for future loss of
income and a
settlement agreement has been proposed in that regard.
General damages have been formally rejected by the defendant. The
only issue
left for determination is in respect of past hospital and
medical expenses.
[3]
The plaintiff initially claimed payment of
the amount of R77 858.24 in respect of past medical and hospital
expenses as per para
9 of the particulars of claim. After evidence of
the plaintiff was led, counsel applied for an amendment which was not
opposed
by the defendant and which had no prejudice as such to the
defendant for a reduction of the amount of claim to the amount of R76
997.14, as an amount of R861.10 was written off as a bad debt by Dr
JJ De Wett. (See pages 30 and 31 of the Amended Index: Notices
and
other pleadings).
[4]
The plaintiff testified and did not call
any witnesses. The defendant did not lead any evidence nor challenge
the evidence of the
plaintiff. The plaintiff is a police officer
employed by the South African Police Services who confirmed that he
was involved in
a motor-vehicle collision on 30 March 2019 and
sustained a fracture to his left leg and an injury on his mouth. He
was taken to
Medi-Clinic Hospital in Welkom. The leg injury required
surgery and the injury to the lip was sutured. After his discharge
from
Medi-Clinic Hospital in Welkom, further X-rays and orthopedic
treatment resulted in further admission to hospital and,
consequently,
even further treatment. He confirmed the statement of
accounts of Medi-Clinic Hospital and Dr De Wett as per pp 13-14 and
30-31
of the Amended Index: Notice and other pleadings, respectively.
These expenses were paid by his registered medical aid, GEMS.
[5]
The plaintiff’s claim for past
medical and hospital expenses have not actually been disputed by the
defendant. The defendant’s
plea in respect of this claim is
that the defendant has no knowledge of the content and therefore does
not admit same and puts
the plaintiff to the proof thereof. (See para
7 of defendant’s plea.) The defendant need only prove his
claim on a
balance of probabilities, and the fact that the
plaintiff’s evidence was not disputed entitles this court to
assume that
the defendant agrees with same.
[6]
Section
17(1) of the Road Accident Fund Act 56 of 1996 (RAF Act) provides for
compensation to third parties, including the plaintiff,
for any
damages or losses incurred due to the negligent or unlawful actions
of the driver of the motor-vehicle. The fact that GEMS
has already
paid for past medical and hospital expenses does not preclude RAF
from its liability. Benefits which a claimant receives
under an
insurance policy where he or she pays a premium are to be left out of
an account. It is a collateral issue based on the
principle of
res
inter alios acta
.
[1]
It
has been said that when a medical aid pays the plaintiff
compensation, it is of ‘no concern’ of the defendant.
[2]
[7]
It
is quite clear that the benefit that accrues to an insured from a
medical aid contract between the plaintiff and the medical
aid does
not absolve the defendant from its liability to the plaintiff in
terms of the RAF Act.
[3]
The
Court previously confirmed that, in respect of the medical aids
payment of expenses, RAF was not entitled to raise the medical
aid
scheme indemnification as a defence:
‘
These
principles have been part of our law for years and bears the weight
of precedent. Our courts have recognized that medical
aid scheme
benefits are a form of indemnity insurance and should accordingly be
disregarded for the purposes of an award for damages,
in accordance
with the principle of
res
inter alios acta
.’
[4]
[8]
Therefore, it can be accepted by the
applicable case law referred to that the fact that GEMS has already
paid for past medical expenses
does not preclude the liability of the
RAF. Therefore, the plaintiff’s claim must succeed.
[9]
In the result the following order is made:
1.
Judgment is granted in favour of the
plaintiff for the payment of R76 997.14 within 180 days hereof.
2.
Draft order ‘X’ is made an
order of court.
RAMDEYAL,
AJ
Appearances
For
the Plaintiff:
Advocate
J H Van der Merwe
Instructed
by:
Honey
Inc. Attorneys
For
the Defendant:
Ms
M Booysen
Instructed
by:
State
Attorney c/o Road Accident Fund
[1]
Zysset
and Others v Santam Limited
1996
(1) SA 278
(C) at 278C-D.
[2]
Gunther
v Road Accident Fund
[2024] ZAWCHC 84
para 30.
[3]
Discovery
Health (Pty) (Ltd) v Road Accident Fund and Another
[2022]
ZAGPPHC 768. See also
Mooideen
v The Road Accident Fund
(an unreported case from the Western Cape Division, case number
17737/2015, delivered on 11 December 2020)
[4]
Banda v Road Accident Fund [2024] ZAGPJHC 483 para 15.