Will a Medical Negligence Claim Effect Medical Care Benefits?

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After receiving medical treatment that falls below accepted medical standards causing any undesired complications from this treatment one is entitled to submit a medical negligence claim. It is always best to seek the advice of an experienced attorney to guide you in this regard.

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In the case of injury or complications, various damages can be compensated for. Economic damages include both past and future hospital and medical expenses. One of the most common reasons that victims of malpractice do not make a medical negligence claim is because of the misconception that a medical negligence claim will lead to an increase in the cost of their medical care.

Presentation of a Medical Negligence Claim in court

Four elements need to be presented in court. Firstly, evidence that a physician or health-care professional had a duty to provide care. Secondly, that they failed to provide the standard of medical care as set out by the Health Professions Council of South Africa (HPCSA). Thirdly, that this failure directly resulted in injury or resulting medical complications. Lastly, evidence that the injury or complication has resulted in damages including financial implications.

All evidence is presented to a judge for examination and if medical negligence is established, the medical aid has the right to be reimbursed for the amounts that they have paid in respect of the treatment received . This right is established from a contract that gets entered into by the medical aid and the patient. The medical aid gets the patient, or patient’s representative, to agree to reimburse payments made in respect of the injury incurred. If the patient disagrees with this arrangement, the medical aid as the right to reverse all payments made related to the injury.

All expert reports are sent to an actuary who predicts the costs of the procedures, treatments and medication that will be needed to treat the injury. These are used by the court to determine the amount that needs to be paid for future medical use. A lump sum then gets paid to the injured in advance .

Reimbursement to the Individual and the Medical Aid

Medical aids offer several benefits in exchange for a monthly fee. These benefits typically cover day-to-day and major medical expenses, as well as medicine. All past and future injury related medical costs will be covered by the granted medical negligence compensation, once successful. There is no specific or direct increase in one’s medical aid costs nor is there a negative change in one’s benefits if you make a medical negligence claim. The benefits should also be reinstated to the same state that it was in before the negligence occurred as all costs are covered by the person or institution responsible for the negligence.
At PBK Attorneys we give honest and expert advice on all medical negligence claims. Call or contact us to find out if you have a claim. PBK Attorneys – “Changing lives”.