In response to inaccurate statements being shared on social media regarding how Discovery Health Medical Scheme pays claims for motor vehicle accidents and refunds from the Road Accident Fund (RAF), we would like to provide the correct information.
Discovery Health Medical Scheme members have full cover for claims related to a motor vehicle accident
Members of the Discovery Health Medical Scheme are fully covered for injuries or any other healthcare claims that result from a motor vehicle accident or any other injury. These claims are paid in line with a member’s plan choice and the guidelines established for the Prescribed Minimum Benefits. Discovery Health settles claims as soon as they are received, including those resulting from motor vehicle accidents.
Claims paid by the RAF for healthcare expenses already paid by a medical scheme must be reimbursed to the medical scheme
If members decide to institute claims against the third parties responsible for sustained injuries, this is their own decision. Should the RAF pay out for medical expenses already paid by the Scheme, members are then required to refund these claims to the scheme. The Council for Medical Schemes has ruled unequivocally in favour of the Discovery Health Medical Scheme on this issue, concluding that the scheme is entitled to claim reimbursement of medical expenses paid in respect of RAF matters. This is in accordance with the Scheme’s rules and in terms of common law principles.
In practice, the Discovery Health Medical Scheme never forces members to institute claims against the RAF. Where the Discovery Health Medical Scheme becomes aware that a member has instituted a claim and has been paid out, the scheme will request that the member reimburses the scheme for medical expenses paid on the member’s behalf.
It is very difficult to determine how many Discovery Health Medical Scheme members recover costs from the RAF. At any given time, there are about 3 600 scheme members claiming from the RAF.
RAF fraud happens in some cases at the expense of medical schemes and its members
Members who claim do sometimes enrich themselves either knowingly or in some cases unintentionally. The biggest problem for Discovery Health Medical Scheme is, however, some unscrupulous attorneys who are enriching themselves at the expense of both the Discovery Health Medical Scheme and its members. The impact of “RAF-stripping”, whereby excessive legal fees are levied on members claiming from the RAF by their attorneys, can have a significant negative impact on these members, who have in many cases suffered serious motor vehicle accident injuries.
Discovery Health spends approximately R120 million annually on medical expenses on behalf of its members, for which the RAF is liable. These are only in respect of the cases we are aware of. There are also no doubt many other claims that we are unaware of, since it is in the interests of the unscrupulous attorneys referred to not to advise us of them. In addition, a substantial number of claims are not payable by the RAF due to lack of merit.
Discovery Health is assisting DHMS members to act against attorneys who are committing fraud
Discovery Health is currently assisting Discovery Health Medical Scheme members to lodge complaints with the Law Society of the Northern Provinces against attorneys who are committing fraud by overcharging their clients. We believe we have an obligation to assist and protect our members, particularly those that find themselves in a vulnerable position. We also believe we have a duty to defend the integrity of the broader structures of our society, in this case the RAF.
We have become increasingly concerned that Discovery Health members may have been subjected to excessive legal costs in respect of legitimate claims that they have against the RAF which would negatively impact both the members and the refunds due to the Discovery Health Medical Scheme.
A complaint was lodged against Ronald Bobroff & Partners
During the course of the last 24 months, information provided to Discovery Health by some of its members suggested that Ronald Bobroff and Partners may have acted to the detriment of some of its clients by, among other things, charging excessive and unlawful fees for claims lodged with the RAF. Confirming our concerns, all Ronald Bobroff’s contracts with his clients were recently declared unlawful by a full bench of North Gauteng High Court in the matter of De La Guerre against Ronald Bobroff & Partners. A copy of the judgement is attached. Ronald Bobroff was refused leave to appeal by the three judges including the Judge President who heard the case as well by the Supreme Court of Appeal. The denial of leave to appeal means that both the full bench, and the Supreme Court of Appeal, concluded that no court could reasonably come to a different decision, effectively confirming the illegality of Ronald Bobroff’s contracts.
The effect of this judgement is that all Ronald Bobroff clients have a potential claim against him for the difference between what he illegally charged and what would be a reasonable fee for the work actually done as determined by an independent taxing master, based on a High Court Tariff. Given his large practice the amounts due to clients is estimated to be in the hundreds of millions of Rands.
About Discovery Limited
Discovery Limited is a South African-founded financial services organisation that operates in the healthcare, life assurance, short-term insurance, savings and investment products and wellness markets. Founded in 1992 by the current Group Chief Executive Officer Adrian Gore, Discovery was guided by a clear core purpose – to make people healthier and to enhance and protect their lives. Underpinning this core purpose is the belief that through innovation Discovery can be a powerful market disruptor.
The company, with headquarters in Johannesburg, South Africa, has expanded its operations globally and currently serves over 6.1 million clients across South Africa, the United Kingdom, the United States, China and Singapore. Vitality, Discovery’s wellness programme, is the world’s largest scientific, incentive-based wellness solution for individuals and corporates. The global Vitality membership base now exceeds five million lives.
Discovery is an authorised financial services provider. It is listed among South Africa’s Top 40 companies on the Johannesburg Securities Exchange and trades under the code “DSY”.
South African operations
- Launched in 1992, Discovery Health isSouth Africa’s largest healthcare funder and manager of medical schemes. It manages 14 medical schemes.
- This includes the Discovery Health Medical Scheme, which has a 51% share in the open medical schemes market, making it South Africa’s largest open medical scheme.
- The Discovery Health Medical Scheme covers more than 2.4 million lives.
- The Scheme is the only one in South Africa to enjoy an AA+ rating for its claims paying ability, the highest possible credit rating from international rating agency Global Credit Ratings. The Scheme has maintained this rating for 12 consecutive years.
- The Discovery Health Medical Scheme holds over R8.2 billion in reserves.
- Discovery Health pioneered consumer-driven healthcare in South Africa with the introduction of innovations like the Medical Savings Account and its wellness programme, Vitality.
- Discovery Health is continuously innovating new products and tools to enhance the quality of care members receive, including HealthID, an iPad-based application for doctors launched in 2012. The HealthID application is also available on Android mobile devices.
- Discovery Health was voted the top medical aid brand in the Sunday Times Top Brands survey for both 2010 and 2011.
- Discovery Health was voted the top healthcare product supplier at the 2010, 2011 and 2012 Financial Intermediaries Association of Southern Africa (FIA) Awards.
- In 2012, the PricewaterhouseCoopers fifth biennial Strategic and Emerging Issues in South African Insurance survey rated Discovery Health’s insurance products as the leader in the industry.
- Discovery Life was launched in 2000 and is South Africa’s fastest growing major life assurer in the risk market, having captured 25% of the overall risk broker market.
- It was the first South African insurer to separate risk from investment, leading significant change in the industry.
- With 364 887 individual policies, the embedded value of its business is now more than R17 billion including Discovery Invest.
- Discovery Life addresses the problem of underinsurance through its unique integrated operating model and through innovative product development.
- Discovery Life was voted the top life assurer in the Sunday Times Top Brands survey for both 2010 and 2011.
- Discovery Life was voted the top risk and life assurance supplier at the 2010 Financial Intermediaries’ Association of Southern Africa (FIA) Awards and the top long-term insurer: recurring savings at the 2011 and 2012 FIA Awards.
- In 2012, the PricewaterhouseCoopers fifth biennial Strategic and Emerging Issues in South African Insurance survey rated Discovery Life’s life products as the leader in the industry.
- Discovery Invest was launched in 2007 and declared its maiden profit in 2010.
- Discovery Invest combines the breadth and skill of the asset management industry with the existing research and development capabilities of Discovery Life.
- The company offers consumers a unique and comprehensive product range that addresses the current gaps in the market by offering greater protection against poor investment choices.
- With 74 327 policies, Discovery Invest now has more than R26.6 billion in assets under management.
- Through Discovery Invest’s LISP platform, clients have access to over 329 local and 65 offshore investment funds.
- Discovery Invest is now the largest writer of endowment policies in South Africa with a 21% market share.
- In 2011, Discovery Invest received the Financial Intermediaries Association of Southern Africa (FIA) award for best recurring premium business.
- Discovery Insure was launched in May 2011 and now has 27 973 policyholders.
- This pioneering product was created by leveraging the behavioural
expertise developed in the Vitality programme with the latest telematics
- The unique Vitalitydrive programme encourages and rewards better driving
behaviour and ensuring that vehicles are roadworthy.
- At the heart of Vitalitydrive is the DQ-Track telematics device that
measures and reports crucial aspects of driving behaviour.
- Vitalitydrive provides up to 50% fuel rewards on clients’ monthly BP fuel
- Young adults between 18 and 25 can receive further discounts of up to 25%
on their motor premiums.
- Discovery Insure offers comprehensive vehicle, personal and household cover.
- Launched in October 1997, Vitality
is Discovery’s science-based wellness programme that underpins each of the
Discovery businesses and is an international brand in its own right.
- It is the largest programme of its
kind in the world, with a global membership base of over five million.
- Vitality encourages healthy
behaviours that reduce long-term healthcare costs by rewarding members for
improving their health.
- There are now more than 1.6
million Vitality members in South Africa.
- Vitality is accredited by the
Sports Science Institute of South Africa.
- The Vitality value offering is enhanced by the DiscoveryCard, Discovery’s
unique Visa credit card which gives members real cash back.
- Launched in October 2004, the DiscoveryCard is South Africa’s largest
non-bank new generation credit card in issue, with an 8.9% share of
point-of-sales spend. There are now 231 302 primary cardholders.
HealthyLiving benefit offers Vitality members up to 25% cash back on
HealthyCare products at Clicks, HealthyGear at adidas and TotalSports stores,
and HealthyFood items at Pick n Pay.
now has the ability to integrate into over 100 fitness tracking technologies.
In the UK, Discovery has a 75% shareholding in a joint venture with Prudential plc. Through PruHealth and PruProtect, the company offers healthcare cover and protection products.
- Launched in April 2004, PruHealth is the fourth largest Private Medical Insurer in the UK and the only one that rewards people for leading a healthy lifestyle.
- PruHealth now covers 548 970 lives.
- It offers consumer-directed products linked to the Vitality wellness programme.
- In 2010, Discovery acquired Standard Life Healthcare, thereby leveraging the significant assets of both companies and resulting in greater scale for PruHealth.
- PruHealth has won several awards for its product innovations.
- PruProtect, which was launched in
September 2007, markets consumer-engaged life assurance products in the UK
- The company’s products integrate
with those of PruHealth and Vitality to unlock added value and significant
premium savings for clients.
- The company has become a major player
in the UK protection market. With 136 164 policies in force, it now covers 163
- PruProtect has received industry
recognition, including awards in four categories at the 2011 Defacto Awards.
The company was also named Best Individual Protection Provider in 2011 by
Professional Adviser, and walked off with the Innovation Award at the 2011
The Vitality Group
Vitality Group was launched in 2007 and offers a stand-alone version of the
Vitality programme to self-insured, large employer groups and to healthcare
- Discovery holds a 75% share in
The Vitality Group, 25% being held by Humana Inc.
- The Vitality Group now covers
293 674 lives.
- The Vitality Group has entered
into a partnership with Wellness and Prevention, a subsidiary of
Johnson&Johnson, the world’s premier consumer health company.
- The Vitality Group recently announced
a partnership with ADP, one of the world’s largest providers of payroll and
employee benefits administration solutions.
2011, the group was awarded the C Everett Koop National Health Award for its
work with Alcon Laboratories, a highly prestigious award recognising
outstanding workplace health improvement programmes.
in February 2011, HumanaVitality is a joint venture between Humana Inc and Discovery
(through The Vitality Group) that makes Vitality available to Humana clients
with commercial medical plans.
- Discovery holds a 25% share in
is the third largest US insurer,
based on revenue. Humana has approximately 11.8 million medical members and 7.7 million specialty members.
now has more than 1.5 million Vitality members.
Ping An Health
- Ping An Health was launched in China in 2009, after Discovery acquired a
20% share in Ping An Health Insurance Co of China Ltd, a wholly-owned
subsidiary of Ping An Insurance (Group) Company of China.
- Ping An Insurance is China’s leading insurer and the second largest
insurer in the world.
- The joint venture will see Discovery’s product innovation and
consumer-engaged model exported to a potential market of 83 million families.
- Vitality was launched in China through Ping An Health in June 2012.
- AIA Vitality was launched in Singapore in July 2013, after a strategic
joint venture between AIA Group Limited and Discovery Limited that aims to
introduce Discovery’s successful wellness-based life insurance model to the
- AIA Group Limited and its subsidiaries comprise the largest independent
publicly listed pan-Asian life insurance group and holds leading positions
across the majority of its markets. It has operations in 17 markets in
Asia-Pacific and has operated in Singapore for more than 80 years.
- AIA serves the holders of more than 25 million individual policies and
over 13 million participating members of group insurance schemes.
- The investment to be made in AIA Vitality by Discovery is expected to
fall within Discovery’s strategic framework of less than 5% of pre-tax profits
for new business development.