Public Protector praises court for giving it jurisdiction over government medical scheme

2019-07-01 21:58
The Public Protector says it is pleased with a court ruling giving it jurisdiction over government medical aid scheme GEMS.

The Public Protector says it is pleased with a court ruling giving it jurisdiction over government medical aid scheme GEMS.

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The Public Protector has praised a high court ruling confirming her office has jurisdiction over the GEMS medical aid scheme exclusive to government employees.

Spokesperson Oupa Segalwe, said in a statement on Monday: "The ruling paves the way for advocate [Busisiwe] Mkhwebane to carry on with an investigation that deadlocked for nearly two years, leaving the complainant in the matter in the lurch.

"This was as a result of GEMS' earlier contention that it was neither an organ of state nor a government component and thus did not fall within the remit of the Public Protector," Segalwe explained.

Mkhwebane and the medical aid scheme faced off in court following a complaint by a dependent of a GEMS member alleging it had refused to admit him as the beneficiary after the member's death.

The person died on June 27, 2013 and was a GEMS member with full benefits, including a subsidy.

READ MORE - Ramaphosa to Mkhwebane: 'I will wait for court before disciplining Gordhan … if at all'

The deceased and the dependent were on the medical aid scheme from June 1, 2013.

"GEMS terminated the complainant's membership soon thereafter," Segalwe added.

The Public Protector's investigation on the matter stalled from June 2017 to June 2018 after the medical aid scheme raised questions on jurisdiction.

This was followed by Mkhwebane issuing subpoenas to GEMS' principal officer, Gunvant Goolab, and legal adviser Johannes Kruger to appear before her.

"It was at that point that GEMS turned to the court for a declaratory order with regard to the jurisdiction of the Public Protector to investigate and entertain the complaint in question, together with ancillary relief to set aside any steps by the Public Protector in pursuit of the complaint, including the subpoenas served on Goolab and Kruger," Segalwe said.

Mkhwebane argued that although the medical aid scheme was not an organ of state, it fell in her jurisdiction because it performed a public function and was established by the government for a government purpose.

The High Court in Pretoria ruled that the case, which is in the interest of the public, should be investigated further to determine whether the complainant was unlawfully excluded from the scheme and if this amounted to improper prejudice on the said complainant.

GEMS' application was subsequently dismissed with costs.

Mkhwebane said she was now expecting Goolab and Kruger to appear before her and provide her with all the information required to bring this case to a close.

"It is a pity that the complainant, who does not have the means to go to court to hold GEMS to account, has had to endure these delays to know whether or not he is entitled to the medical aid benefits he deserves," Mkhwebane concluded.

Read more on:    busisi­we mkhwebane  |  medical aid

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