Criteria for Claiming from the Road Accident Fund

Road accidents usually increase this time of the year as people head off on holiday, leaving thousands of South Africans in need of compensation to cover medical costs and other incurred costs. 

The Road Accident Fund provides compulsory cover to all users of South African roads against injuries sustained or death arising from accidents involving motor vehicles within the borders of South Africa.

Anyone who has suffered damage or injury on the road may be allowed to claim, including:

  • Drivers who were not at fault
  • Cyclists
  • Pedestrians
  • Passengers
  • Dependents of any the above

You can not claim for damage damage to vehicles or personal belongings, however you can claim for:

  • Medical and hospital expenses (past and future)
  • Loss of income (Current and future)
  • Loss of financial support
  • Funeral Expenses
  • Pain and suffering

What are the criteria for making a claim with the Road Accident fund?

Under what circumstances do the RAF pay out a claim to the injured patients or the deceased family?

  • The first is there needs to be wrong doing on the road.
  • The second is there needs to be serious injury, which is assessed at a medical level with up to 30% of your bodily impairment.
  • Or,  there of course needs to be the passing away or the loss of a life.

And how do people go about launching a claim?

The easiest is to come to one of the RAF’s (Road Accident Fund) offices. We have an office in every province, or to call our call centre. People can also visit our website. All the information related to claiming is on it, or any one of the social media footprints that we have established.

What we’ve done to promote access, we have 86 people who are hospital service consultants, that are based in hospitals throughout the country where accidents typically happen are cared for.

So those are the various access points people can use to come and contact  the Road Accident Fund.

What happens once a claim has been submitted to you the Road Accident Fund?

Is there some sort of a rigorous investigation the Road Accident fund to make sure that these claims are in fact legitimate?

It is a lengthy process. Frstly, The Road Accident Fund must make sure that the claim is legitimate. They need to establish fault, who was wrong, and then the extent to which they were wrong or  if there was negligence.

Once that’s done, they then go about looking at what is the loss or the impact of this crash on that person’s income, their medical status, and then compensation is quantified and paid out.

So it does take a long time. If claimants make use of a legal representative, it may go to court which itself is a lengthy process.

If it’s for funeral benefits or for medical benefits, you can get paid within a couple of months. If it’s for loss of income or loss of support where they need to quantify your earnings, if you came directly to the RAF, you can get paid within 12 months, typically about 18 months. If you use a legal representative and go to the courts, the process can take up to three years.

Why does it take so long?

There have been a lot of complaints from people saying that there’s so many delays in Road Accident Fund claims.

Surely once you’ve spoken to the insurance companies involved and also physically seen the patient, it should almost be clarified?

Well, If all that was dealt with was the retrospective effect, then it would be relatively short, but if you have a 22 year old who’s at university, and you now need to work out what is the impact of this crash on his or her future income, you need to have various actuarial assessments. Industrial psychologists need to get involved, to quantify what they think this person would earn through their working life and it’s in doing that, and also determining who’s to blame and how much are they to blame or at fault, you then have the toing and froing.

In a recent Road Accident Fund statement, they were actually quoted as saying for many years the RAF performed below expectations. What was meant by that?

The reality is, for a long time, the RAF was not a star performer. Productivity was low. The institution wasn’t efficient. There were issues at a government and management level. But in 2012, decisions were taken by the board, by the Minister of Transport to say, “Look. Turn the Road Accident Fund around.”

And in two years, we’ve seen claim payments double!

You’ve seen two successive clean orders. You’ve seen the processing of claims improve so dramatically that you have half the backlog of five years ago. And in doing this, they’ve supplemented that with access points, as well as more modernized business processes. And you have therefor an institution that is now working more and more efficiently.

How healthy is the Cash Flow of the Road Accident Fund?

Well, the cash is tight…

But, it’s a consequence of our success. We get a levy, which is set annually. It equates to about 20 billion rand a year, but because our claim processing has increased, last year we paid 22 billion rand.

So we’re now at a point where every month we prepare two and a half billion rand worth of claims for payment, but the cash we get in the form of a levy is a little under 2 billion rand a month. And you therefor have this accumulation of claims waiting to be paid which is what that quote is about.

Do I qualify for a Road Accident Fund Claim?

I’m sure a lot of readers out there are wondering…

“Do I qualify for a Road Accident fund Claim?”

Practical examples would be

  • Any serious injury that would cause disability for a very long time, like an amputation for example.
  • If you become paralyzed in a certain part of your body that you use a lot, like your arm, your hand, your legs, and so forth.
  • If you lose your sight, if you lose your hearing and you’re a radio anchor. Those are the also serious examples.
  • You might have been a model and you’re scarred so badly so that you can’t model anymore, and it affects the quality of your life and career going forward.

So it does need to be serious. If it’s something that’s going to recover in a couple of months, the reality is that practically, that may not make the test.

What else does the Road Accident fund do?

Look, at the heart of what they do, besides the laws and the technicalities, the Road Accident Fund supports victims of car crashes.

The best support is to prevent a car crash.

So road safety matters to the Road Accident Fund, and the campaign we’re running is called “Future You”. It basically says at this time of the year, we’re slowing down.

We’re going on holiday. The mood is good, but don’t risk your future you for the party you’re going to tonight.

The journey you’re embarking upon this morning was simply driving to the shop to by charcoal for your fire, where you’re going to relax with your friends and family.

Remember your future you. Respect it.

Obey the rules of the road. Strap up. Follow the speed limit. Overtake carefully, and don’t drive drunk!

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