RAF Capture

Following a RAF stakeholder round table discussion, George Louw learns the troubles facing the organisation that result in the neglect of road crash victims

The Road Accident Fund (RAF) is a critical life-sustaining support fund for people with disabilities who sustained their disability during a motor vehicle accident. The QuadPara Association of South Africa (QASA) is an important stakeholder in the RAF. Many members became affiliated with QASA due to motor vehicle crashes.

So, when QASA received an invitation to participate in a RAF stakeholder round table discussion on March 1, attendance was mandatory. As the Gauteng-based QASA executive member, I was nominated to attend.

In preparation for the meeting, I requested the executives along with COO, Raven Benny, and former CEO, Ari Seirlis, list their concerns and discussion topics so that I can better represent QASA. The concerns were mainly about administrative issues; red tape and delays in payment. But two issues stood out:

• The funding of renovations to properties in order to accommodate the needs of the person with disabilities was allowed only if the person owned the property. So what about a young person living with relatives?
• The RAF pays the salaries of caregivers; however, all the respondents raised the concern that these payments are often late or delayed for a month or two. In addition, substitute carers in cases of annual or sick leave were not funded.

Regarding the first concern, it was explained that payments are made only to homeowners with disabilities as families often would use the funds for general repairs instead of appliances and ramps to assist the person with a disability. This begs the question: Why punish the innocent for the sins of the guilty? Surely better controls could circumvent this?

However, the burning issue was the erratic payment of caregiver salaries, as evident by an impassionate sketching of the situation by a quadriplegic member of QASA:

My main complaint with the RAF is that they often pay care assistant salaries late and sometimes long after the end of the month. Occasionally, they even fall a month or two behind. This really stresses me; leaving me having to dig into savings to pay my care assistants.

I can’t fail to pay them at the end of the month or wait until RAF decides to pay. They also have families to feed and financial commitments. Besides, if they don’t have money to come to work, then I don’t have anyone to get me out of bed, catheterise me or wipe my butt, let alone feed me or give me a sip of water.

This is unacceptable, especially if all my paperwork and timesheets have been handed in on time. They must be paid on time before the end of the month or at the very least on the last working day of each month.

I also feel that the amount full-time primary care assistants are paid should be reviewed. Or maybe there should be a sliding scale depending on the level of one’s spinal-cord injury? A high-level quad requires a high- level of care; therefore, someone with a lot more experience is required. A low-level quad or paraplegic is more independent, thus requiring less from their care assistants.

A care assistant taking care of a high-level quad often does things that would be expected from a fully qualified sister with years of experience in a hospital. 

They deserve to be paid accordingly. If we are able to pay for top quality care, there would be a lot less other health problems; and, ultimately, cost the RAF less.

The monthly claiming process is quite difficult and I’ve lost track of when last the RAF has actually paid for my monthly medical expenses like sanitisers, catheters, linen savers, wet wipes, medication, not to mention physiotherapy. I would also like to mention that their communication with their claimants is non- existent. I only hear from my case manager through a closed WhatsApp group and only when she’s asking for timesheets for care assistants to be submitted. 

Information, like how to go about claiming monthly expenses or other major medical expenses, salary structures for care assistants and caregiver contracts, should all be available on their website. Maybe a monthly newsletter from them would also be a good idea?

Feeling myself adequately equipped to represent QASA at the RAF stakeholder meeting, I drove out to the Premier Hotel in Midrand only to find that the meeting turned out to be a bit of a misnomer.

There was no round table and the format was more of an information session with a two- hour question-and-answer (Q&A) session after lunch. There were about 100 attendees. The format was that of a conference rather than a stakeholder engagement.

The focus of the conference was on the management of initial claims submitted to the RAF, including dispute resolution, management of fraud and corruption, healthcare provider fees in claims submitted to the RAF and the general financial state of the RAF.

No attention was given to the claims administration of motor vehicle accident survivors with disabilities in the formal part of the conference, but it was extensively addressed during the Q&A.

And this brings us to the title of this article: “RAF Capture”. From the five talks in the morning sessions and Q&A session in the afternoon, it became quite evident that the RAF was being assaulted by role players from all levels. Greed from the outside and “couldn’t-be-bothered” attitudes from within.

The first speaker presented a well prepared talk on the (new) role of mediation as an alternative or precursor to litigation in claims disputes between claimants and the RAF. In order to demonstrate the value of mediation in dispute resolution, the speaker and his team undertook to mediate in 100 RAF cases at no charge.

It was stated that mediation provided a safe space for parties to discuss settlement terms, as opposed to the aggression of cross examination during litigation.

After 73 cases were concluded, the mediation process achieved a 100 percent success rate in settling disputes prior to litigation, with a calculated reduction in settlement cost from R130 million to R59 million.

I was astounded by the cost of arriving at a settlement. It demonstrated the size of the gap between claimant expectation and RAF offering. It is money lost to the real need, landing in the pockets of third parties. A later speaker estimated that up to 55 Cents in the Rand lands in the hands of third parties during the settlement process.

A representative of the Board of Health Funders stated that with the scrapping of the National Health Reference Price List (Medical Aid Tariff structure) in 2009 and the removal of the Ethical Ceiling for Tariffs, funders are obligated by law to pay healthcare providers whatever they charged.

He made an appeal for uniform tariffs and harmonised clinical and diagnostic coding, and alternative funding models (to fee for service). These issues have remained on the table, unresolved, for the 25 years that I was in the healthcare industry.

The third speaker gave a rather rambling, but entertaining critique on the ineptitude of the RAF as cause for litigation. He lamented the impact of fraud and corruption from all sides on the RAF (doctors, claimants and litigators), compounded by the absence of standardised procedures and processes within the RAF. He appealed for well-trained agents to facilitate out- of-court settlements. He also berated the lack of motivation and competence within the RAF.

The RAF Chairman spoke briefly, berating RAF for under-settling of claims, stating that it opens a litigation minefield and set the RAF up for failure. He stressed that mediators must be sensitive to this in reaching settlements.

The presentation by the RAF CEO was a lamentation. Too much of a settled claim goes into the coffers of intermediaries; clinicians milk the RAF by billing up to five times the medical aid rate; injured claimants try their luck for non-motor vehicle accident injuries.

Within the RAF there appeared to be a culture of “tomorrow is another day”. He even questioned the reason for the fund to focus only on road accidents while there were many victims from other sources of violence who are left with no recourse.

The Q&A session was to some extent taken over by people who wanted to make their own speeches, but one in particular was of note. A member of the audience thoroughly berated the RAF for their low carer fees and inconsistent payment. So, that box was ticked.

The event was not what I expected, but it was informative, if somewhat disheartening. I recall a newspaper cartoon in the early 1990s. It showed three vultures picking the bones of a dead buffalo. The caption read: “Let’s take what we can, while we still can.” It seems the RAF has become yet another buffalo being picked bare by the greedy vultures of society; and all in the name of “assisting” the victims of road accidents.

At first glance, it would appear that the hangman’s noose is tightening around the RAF’s neck, but the reality is that the victims of road accidents, who are dependent on the RAF, are being hung out to dry. Just another tragedy in a country beset by ineptitude and greed, and by people seemingly too complacent to step up.

Fortunately, there are individuals, groups and organisations in our country that are stepping up; that have the courage to stand up and draw lines in the sand and say: “Enough! No more!”

It seems to me that we, the stakeholders of the RAF, must now also step up and out of our own comfort zones and draw a line in the sand, and say enough before the RAF becomes just another distant memory.