Says its reliance on reports by entities investigating an alleged irregular relationship between medical practitioners and Sunshine Hospital did not help its case.
The Supreme Court of Appeal (SCA) has dismissed with costs an application by the Road Accident Fund (RAF) to appeal a judgment that slammed the fund for refusing to abide by 181 court orders in favour of Sunshine Hospital.
The RAF made several attempts to obtain leave to appeal the November 2023 judgment by the High Court in Pretoria and, aggrieved by the dismissal of its application to the SCA for leave to appeal, thereafter applied to the president of the SCA for reconsideration of the dismissal of that application.
The SCA president on 6 August 2025 directed that the SCA dismissal of the application for leave to appeal be referred to the SCA for reconsideration and, if necessary, variation.
SCA rejects RAF’s ‘opportunistic‘ application
In a judgment handed down last week, acting SCA Judge Boissie Mbha – with SCA Judge Xola Petse and acting SCA Judge Daniel Dlodlo concurring – rejected the RAF’s contention there were new facts or evidence that later came to light in the form of an alleged irregular relationship between the medical practitioners and Sunshine arising from alleged unlawful and impermissible combined claims.
Mbha said it was “opportunistic” for the RAF to rely on this issue in the application for reconsideration filed with the president of the SCA.
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He said all the contentions by the RAF were previously raised and thoroughly dealt with before the high court and during the applications for leave to appeal.
The RAF’s application for leave to appeal in the High Court in Pretoria was dismissed on a punitive scale on 30 January 2024 – and an application for leave to appeal, brought on petition to the SCA, was also dismissed with costs on 2 May 2024 on the ground that there was no reasonable prospect of success on appeal and there was no compelling reason why an appeal should be heard.
The RAF thereafter applied to the SCA president for reconsideration of the SCA dismissal of that application.
Mbha said the high court found there was not the slightest indication that any of the claims were irregular, only the RAF’s vague and unsubstantiated belief – which was contradicted by its own Forensic Investigation Department (FID) investigation – that Sunshine has acted unlawfully.
“The high court’s finding in this respect cannot be faulted,” he said, adding that the RAF’s reliance on and mention of investigation reports of multi-disciplinary bodies did not in any way advance its case.
Judge Mbha said:
- There had to date been no report to hand by accounting and auditing firm SizweNtsalubaGobodo Grant Thornton (SNG);
- The Health Professions Council of South Africa (HPCSA) had not given any indication that the medical practitioners concerned had breached any ethical rules referred to by the RAF;
- Registered health care organisation Universal Healthcare filed a report to the effect that it investigated 100 selected files and apparently found savings of some 29.28% of the billed amount in 29 of those files; and
- Despite the fact the Special Investigating Unit (SIU) had investigated Newnet Properties (Pty) Ltd, trading as Sunshine Hospital, since December 2021, it had to date evidently not found any wrongdoing.
Mbha said he was unable to find fault with the reasoning of the high court in any of its findings and was in complete agreement that there were no reasonable prospects of success on appeal and no other compelling reason why an appeal should be heard.
“In the circumstances this application falls to be dismissed,” he said.
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Hospital forced to close its doors
Parliament’s Standing Committee on Public Accounts (Scopa) was told in October 2025 that the private hospital in Benoni was forced to close after it issued 6 285 summonses against the RAF that the fund failed to pay.
This resulted in the RAF being indebted to Sunshine Hospital for R300 million, which by October 2025 had accumulated R21 million in interest.
Sunshine was a private hospital that only admitted victims of motor vehicle collisions.
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Mbha said the RAF approached the high court on an urgent basis seeking the immediate suspension of the writs of execution against the fund obtained by Newnet.
The RAF’s application was to stay the sale in execution of various items, pending the fund instituting an application to declare that the RAF is not liable for any claims submitted to it by Sunshine/Newnet.
Mbha said the notices listed 181 case numbers reflected in the respective writs of execution were made up of 116 magistrates’ court orders, 44 regional magistrates’ court orders and 21 high court orders, which Sunshine was seeking to satisfy.
He said Sunshine had obtained these orders against the RAF in respect of claims for compensation in terms of the RAF Act for medical services rendered to persons who were injured in motor vehicle collisions.
Mbha said it was common cause that all 181 court orders were valid and not a single one was impugned on appeal or reviewed.
“All 181 orders still stand uncontested. Furthermore, some of the orders were granted following trial, others by agreement between the parties while the remainder were granted by default in consequence of wilful default by the RAF.”
Mbha said the central issue before the high court related to the so-called combined or global claims filed by Sunshine, which included the claims of doctors and service providers relating to a particular patient admitted and treated at Sunshine.
The RAF alleged these claims were unlawful as they flouted the provisions of the RAF Act.
‘Cooperation’ agreement
The RAF and Sunshine concluded a cooperation agreement on 27 November 2007.
Judge Mbha said the practice of combined claims – including the claims of doctors and service providers with Sunshine’s claims when lodging claims with the RAF – was introduced and therefore came into existence at the specific request of the RAF to facilitate the evaluation of claims and to avoid duplication of documentation lodged with the fund.
The RAF on 11 July 2008 wrote a letter to Sunshine terminating the cooperation agreement, and effective from 4 April 2020 stopped making payments to Sunshine due to “concerns” it had about the validity of the claims submitted by the hospital and that it was overcharging the RAF in claims it had been submitting.
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There was a suggestion by the RAF that Sunshine was suspected of touting patients from other hospitals, and of overservicing patients to the detriment of the fund.
This led to the RAF tasking its FID to investigate:
- Why many patients were being transferred to Sunshine from other hospitals outside of Gauteng;
- Whether RAF employees had irregularly facilitated their transfer for financial gain; and
- To identify if any items on invoices submitted by Sunshine were duplicated and if there was any overservicing of patients taking place.
Judge Mbha said the letter terminating the agreement does not mention any unhappiness or complaint about the combined claims, the manner of their lodgement or that they were, in any material respect, in violation of the requirements of the RAF.
He said importantly, there was not even the slightest suggestion in the letter that the combined claims were in breach of the RAF Act.
This article was republished from Moneyweb. Read the original here.