Personal

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That road accidents have reached pandemic proportions in South Africa is well known and is dramatically highlighted by the death toll statistics surrounding our national holiday seasons. In the past Easter holiday season more than 1200 people died on our roads. The frequency of these road accidents make it clear that we should be prepared for the repercussions of motor vehicle accidents which range from injury and disability, to death.

In South Africa all road-users have a security safety net in the form of the Road Accident Fund (RAF). In short, the RAF indemnifies the person(s) who caused the accident and compensates the injured and/or the family of fatal victims for special and general damages.

The procedure to institute a claim is relatively straightforward although it can be time consuming. Accordingly, it is wise to approach an attorney specialising in personal injury cases to assist you in providing advice regarding the merits of your claim as well as to assist you with the process of claiming and what you can claim for.

One of the main concerns with the RAF is that continuous amendments have influenced the ‘pay-out-amount’ to claimants, and not in a beneficial way. For example, a claim for non-pecuniary loss is only possible if a serious injury can be proved. This is further complicated by the regulations published in May 2013 describing what constitutes a serious injury and what not, with the list of what is serious, becoming smaller and smaller with each amendment. Another example is compensation that can be claimed for the loss of income. Section 17(4)(c) of the Road Accident Fund Act determines that annual loss of income cannot exceed the amount published in the Government Gazette. This amount is currently capped at R207 528-00, which is less than R17 300-00 per month. Persons earning in the higher income ranges will accordingly still only receive this amount, irrespective of the fact that a previously earned salary could have been much higher. So have funeral expenses been stripped to the bare minimum to cover only the necessary and actual costs regarding a cremation or burial.

Understanding the role and scope of the RAF is therefore of importance to all road users. The reality is that unfortunately the RAF can no longer extensively provide financially for victims and their families. Therefore, even if the RAF does pay out, the amount could in all probability be insufficient to cover the full extent of the damage or losses suffered and this gap between the pay-out and your true expenses could be vast.

Minding this gap is paramount. The obvious way to protect oneself against such loss is to consider broadening one’s personal insurance to make provision for this potential gap. Not only should you make provision for life insurance, but also for funeral costs, unemployment due to incapacity or temporary loss of income due to injury. Personal credit insurance is also something to consider, but of lesser importance if you have already taken out a second life insurance policy to cover your debts. You may also wish to consider consulting a financial planner to assist you in planning your estate and determining the levels of insurance required to avoid being over-or under-insured should an unfortunate accident occur.

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In simple words an Undertaking is a contract between the claimant, such as Henry, and the RAF, in terms of which the RAF will reimburse the claimant for reasonable future medical expenses the claimant may incur due to injuries sustained in the motor vehicle accident, on submission of acceptable proof.

Reasonable future expenses may, for instance, in Henry’s case, include:

• All costs of future accommodation in a hospital or nursing home.
• Medical treatment or the supply of goods or services.

Excessive, experimental or unproven types of treatment is not included as reasonable future expenses. It is further also important to understand that the Undertaking will not cover any illnesses, diseases or injuries which are not related to the motor verhicle accident or which are related to the normal effects of ageing. The effects that other conditions may have on injuries are also excluded.

For Henry this raises criticial questions as to what will be covered.  These questions relate to medication, physiotherapy, a wheelchair, a pressure care cushion, motor vehicle modifications, home  renovations etcetera. To answer these questions, the following process may be  helpful:

Firstly, Henry must know that the RAF has Undertakings Departments at its various Regional branch offices. These regional branch offices are situated in Menlyn, Johannesburg, Cape Town, Durban, East London and Port Elizabeth. The RAF’s website (www.raf.co.za) or call center (0860 23 55 23) will provide contact details for a particular Regional branch office .

Secondly, the claimant should contact or visit the Regional Undertakings Department and provide a certified copy of the Undertaking document. The claimant should then ask to be linked to a Case Manager. Case Managers are situated at the Regional branch offices and also at various Satellite offices. They handle the initial processing of a claim. It is of crucial importance to know the contact details of the relevant a Case Manager and to contact her or him regularly.

Thirdly, the claimant should obtain a banking details indemnity form from the Case Manager. This should be completed and verified by the claimant’s bank with an original bank stamp. The original banking details indemnity form, accompanied by an original letter from the bank confirming the banking details, must be submitted to the RAF at the following address (one should remember to always include the claim and link numbers as indicated on the Undertaking document in all correspondence to the RAF) :

            The Address Book Administrator

            Private Bag X2003

            Menlyn

            0063

Fourthly, once the banking details are loaded on the RAF’s system, the claimant may start submitting, via fax or email, invoices or proof of payment to the allocated claim-handler. All such invoices or claim documents should at all times be legible and signed by the claimant.

Back to Henry: Henry has bought a ‘high tech’ and expensive wheelchair three and a half years ago. This luxurious wheelchair  met his needs for mobility. Henry now submits the proof of payment by e-mail to his claim handler, and ensures that his claim  is legible and duly signed.

Unfortunately Henry’s claim for reimbursement of the cost he incurred in respect of the wheelchair has prescribed because the service provider supplied the wheelchair, and was paid by Henry, more than three years prior to the submission of the claim. Additionally, even if Henry’s claim did not prescribe, the RAF would only reimburse him partially and not for the full amount he paid for the wheelchair. The reason for this is that he was using a less expensive wheelchair before he bought the new wheelchair. The occupational therapist report on his file with the RAF also recommended the use of a less expensive wheelchair. The RAF will thus not allow the claim as it has prescribed. The medical report additionally does not justify the cost of the more expensive wheelchair.

In practice situations similar to that of Henry occur on a regular basis. The following practical pointers may assist in this regard:

•  An account need not be paid before claiming the amount from the RAF. All that is required is that an contractual obligation to pay the service provider in terms of a binding agreement between the claimant and the service provider must be incurred. However, a mere quotation alone will not suffice to prove the contractual obligation.
• Before entering into an agreement with a service provider, a claimant should inquire from the claim handler what would a reasonable claim for the specific service or provision of goods be. In this way, it is possible to avoid partial reimbursements.
• Claims should be submitted timeously (within three years from the date when the obligation to pay was incurred).

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