RAF Ordered To Pay Millions

CAPE TOWN, 19 October 2026 — The Western Cape High Court has ordered the Road Accident Fund (RAF) to pay more than R5.45 million to a woman seriously injured in a road accident, rejecting the argument that medical expenses already covered by Discovery Health should be excluded from her compensation.

The judgment reinforces the principle that payments made by a private medical scheme do not automatically relieve the RAF of its statutory responsibility to compensate qualifying road accident victims.

Judge Melanie Holderness ruled in favour of the injured pedestrian, who suffered a brain injury and a fractured femur after being struck by an unidentified vehicle in Mitchells Plain on 4 September 2021.

The court ordered the RAF to compensate her for general damages, future loss of earnings and past medical expenses, while also providing an undertaking to cover qualifying future medical costs.

Pedestrian Awarded More Than R5.45 Million

The woman sustained serious injuries when an unknown vehicle struck her while she was walking in Mitchells Plain.

Her injuries required extensive medical treatment and rehabilitation and affected her ability to work and perform everyday activities.

The RAF accepted liability for 100% of her proven or agreed damages arising from the collision.

However, a dispute remained over medical expenses that had already been paid by her medical scheme.

The court ultimately ordered the RAF to pay the following amounts:

Compensation category	Amount
General damages	R1,300,000.00
Future loss of earnings	R3,559,595.00
Past hospital and medical expenses	R591,368.93
Total	R5,450,963.93

The award reflects the serious consequences of the accident and the financial losses assessed in the proceedings.

The court also made a separate order concerning the woman’s future medical needs.

Why RAF Opposed Medical Expense Payments

The dispute centred on whether the RAF should compensate the pedestrian for medical expenses that Discovery Health had already paid.

The Fund argued that these expenses should not form part of the compensation payable because the claimant had not personally carried the financial burden of the medical bills.

This argument reflects a broader position the RAF has taken in disputes involving road accident victims who belong to medical schemes.

Under that approach, medical expenses settled by a scheme were treated differently from expenses paid directly by an injured claimant.

However, courts have repeatedly examined whether this distinction is permitted under the Road Accident Fund Act.

In the Mitchells Plain case, the court rejected the argument that medical-scheme payments eliminated the RAF’s liability.

Judge Rejects RAF’s Legal Argument

Judge Holderness found that the payments made by Discovery Health fell within the legal principle known as res inter alios acta.

This principle concerns benefits arising from arrangements involving third parties that should not necessarily reduce the damages payable by a legally responsible party.

In practical terms, the woman’s private medical cover did not automatically remove her entitlement to claim qualifying medical expenses from the RAF.

The court considered the medical-scheme payments to be separate from the RAF’s compensation obligation.

The finding is important because the RAF is responsible for compensating qualifying victims of road accidents under the applicable legislation.

A claimant’s membership of a medical scheme does not, by itself, extinguish that statutory entitlement.

However, claimants may still have contractual obligations to reimburse their medical schemes from amounts recovered for expenses previously paid by those schemes.

The judgment should therefore not be understood as permission to retain duplicate reimbursement without regard to medical-scheme rules.

RAF’s Postponement Application Refused

At the start of the trial, the RAF sought a postponement.

The Fund argued that it was awaiting further legal clarity on disputes concerning medical expenses already paid by medical schemes.

The court refused the postponement application.

It noted that the relevant legal arguments had already been considered in previous judgments.

The refusal allowed the proceedings to continue and the woman’s compensation claim to be determined.

The case illustrates the difficulties injured claimants may face when disputes over established legal principles delay the finalisation of compensation.

Court Orders Future Medical Care

In addition to the monetary award, the court ordered the RAF to provide an undertaking under section 17(4)(a) of the Road Accident Fund Act.

The undertaking covers 100% of qualifying future costs associated with injuries sustained in the collision.

These may include accommodation in a hospital or nursing home, medical treatment, services and necessary goods.

Such undertakings are particularly important for victims who suffer long-term injuries requiring continuing care.

They provide a mechanism for future accident-related expenses to be covered when the relevant costs arise and the statutory requirements are satisfied.

The court’s order therefore addresses both the woman’s assessed past losses and her potential future medical needs.

When Must RAF Make Payment?

The court ordered the RAF to pay the capital amounts into the trust account of the woman’s attorneys, Sohn and Wood Attorneys.

The payment deadline is 180 calendar days from the date of the court order.

The judgment also provides for interest at the prescribed rate, calculated from 14 days after the date of the order until final payment.

The interest provision is significant because delays in settling compensation awards can place additional financial pressure on injured claimants.

The reported judgment does not establish that the RAF has already paid the award.

Supreme Court Of Appeal Reinforces Claimants’ Rights

The Western Cape judgment comes amid a major development in the broader legal dispute between Discovery Health and the RAF.

On Friday, 16 October 2026, the Supreme Court of Appeal delivered judgment in Discovery Health (Pty) Ltd v Road Accident Fund and Another.

The court ruled that the RAF and its then chief executive had breached an earlier High Court order concerning the treatment of medical expenses paid by medical schemes.

The Supreme Court of Appeal prohibited the Fund from implementing directives issued in April and November 2023 that sought to exclude or restrict these claims.

It also interdicted the RAF from deducting compensation simply because a claimant’s medical expenses had been, or would be, paid by a medical scheme.

The judgment required the RAF to take steps to comply and report on its compliance within 14 days.

The Supreme Court of Appeal’s decision strengthens the legal position of qualifying claimants whose medical expenses have been covered by private medical schemes.

Why The Discovery Dispute Matters

The legal conflict began after the RAF introduced a directive in August 2022 instructing claims officials to reject past medical expense claims where a medical scheme had already settled the bills.

Discovery Health challenged that approach in court.

The High Court ruled against the directive, but subsequent disputes arose over whether the RAF had complied with the order.

Further directives were issued in 2023, prompting additional litigation.

In its October 2026 judgment, the Supreme Court of Appeal found that those later directives unlawfully circumvented the earlier court ruling.

The dispute has implications beyond Discovery Health members.

It concerns how the RAF assesses qualifying compensation claims involving private medical cover and whether claimants can be treated differently because they belong to medical schemes.

What This Means For South African Motorists

The judgments provide important clarity for road accident victims who are members of medical schemes.

Where a person qualifies for compensation under the RAF Act, medical-scheme payments do not automatically justify excluding proven past medical expenses from the RAF claim.

However, every claim must still satisfy the applicable legal requirements.

These include establishing the relevant liability, proving the losses claimed and complying with statutory procedures and time limits.

Medical-scheme members must also consider their scheme’s reimbursement rules.

In some cases, the scheme may require repayment of expenses it previously covered once the claimant receives compensation from the RAF.

The court decisions do not mean that every medical expense is automatically payable or that every road accident victim is entitled to compensation.

They address the specific question of whether payment by a medical scheme is sufficient grounds to reduce or reject an otherwise valid claim.

What Happens Next?

The RAF must comply with the court orders and applicable legal requirements.

The Supreme Court of Appeal’s judgment also requires the Fund to report on the steps taken to implement its ruling.

For the injured Mitchells Plain pedestrian, the Western Cape High Court’s decision establishes a substantial compensation award and a framework for future medical expenses.

For other claimants, the decisions clarify an important issue that has been the subject of repeated litigation.

The broader challenge remains ensuring that valid compensation claims are assessed and paid lawfully and without unnecessary delays.