Legal  Unit - Protecting the Public

The Unit is headed by Mr. Craig Burton - Durham.  The Unit is comprised of two divisions, namely: Legal services and Complaints & Adjudication .  The duties of the unit are: Provision of legal support to CMS and the Office of the Registrar Facilitation of judicial process in matters concerning the enforcement of the Medical Schemes Act, particularly within the enforcement context The provision of administrative and secretariat support to the Council and Appeal Board with respect to hearings and other ancillary matters Dealing with complaints raised by members of the public - receiving, analyzing and resolving them Investigating inconsistencies with the Medical Schemes Act Ensuring the schemes have dispute committees in place Monitoring the treatment of beneficiaries to ensure fair treatment, and Ensuring that the provisions of the Act are interpreted and applied correctly Legal Unit: Standing from the left: Louis Pautz (Legal Officer), Craig Burton - Durham (Head of the Unit), Rienie Schoeman (Personal Assistant)and Solomon Botolo (Assistant Legal Officer).  Seated from left: Lilian Mathabe), Thembekile Phaswane (Manager) and Ntombi Mahlangu (Legal Officer), Amos Mavuso (Legal Officer) and Stephen Mmatli (Senior Legal Advisor) - not in the picture. This Unit interferes and assists members of Medical Schemes in resolving issues they have with their Medical Schemes in terms of the Medical Schemes act. It is however very important to note that a member should always first seek to resolve an issue through the complaints mechanisms in place at their respective Medical Schemes, before approaching the Council for assistance.  The Complaints Procedure Explained: 1.Who can complain to the Registrar's Office. 2.Time limits for dealing with a complaint. 3.The final response. 4.When is a complaint closed? 5.Keeping of complaints records.  Lodge a Complaint Against a Medical Scheme 1. Who can complain to the Registrar's Office An eligible complainant is a person who would be eligible to refer a complaint to the Council in terms of Section 47(1) read together with the definition of a complaint in Section 1 of the Medical Schemes Act, 1998. The procedure for the handling of complaints must enable complainants to lodge a complaint by any reasonable means, such as a letter, telephone, fax, e-mail or in person from Mondays to Fridays during 10H00 - 16H00. 2. Time limits for dealing with a complaint The Registrar's Office must send a written acknowledgement of a complaint within 5 working days of its receipt, giving the name and contact details of the person dealing with the complaint ( and attaching a copy of the procedure for handling complaints). (a) The Registrar's Office shall, within 3 days of receiving the complaint, analyse the complaint, and if it is necessary to dispatch the complaint to a medical scheme, do so within 5 days. (b) Where, on initial assessment the complaint is found to be without merit, the complaint shall not be forwarded to a medical scheme. Instead the complainant will be informed of the view of the Registrar's Office in this regard. Within (30 days) of receiving a complaint, the Registrar's Office must send the complainant either: (a) A final response; or (b) A holding response, which explain why we are not yet in a position to resolve the complaint and indicate when we will make further contact (which period must be within 60 days of the receipt of the complaint). The Registrar's Office must, by the end of the 60 days, after its receipt of a complaint, send the complainant either: (a) A final response; or (b) A response which:- Explains that a final response is not yet possible, and give reasons for the further delay and indication of when a final response will be provided, or Inform the complainant that the medical scheme failed to respond/failed to respond adequately, and that the complaint has been referred to the Registrar for a ruling. 3. The final response When the Registrar's Office sends a complainant the final response, the final response must: Inform the complainant that he/she may appeal against the decision of the Registrar to the Council, should he/she be unhappy with such decision; That such an appeal must be lodged within 30 days of the Registrar's final response; That, were the complainant appeals against a decision, the operation of such decision shall be suspended pending the Council's review. 4. When is a complaint closed? The Registrar's Office will regard a complaint closed:  The medical scheme has sent a final response; or Where the complainant has indicated in writing acceptance of the medical schemes response, or Where a complainant has not responded to the Registrar within (30 days) of a written response from the medical scheme or the Registrar. 5. Keeping of complaints records The Registrar's Office shall make and retain records of complaints for a minimum of 3 years from the date of its receipt of the complaint. These records must include: The name of the complainant; The substance of the complaint; and All the correspondence between the complainants, the Registrar's Office and the medical scheme concerned, including details of any decision by the scheme or ruling by the Registrar. Call Agent 1: +27-12-4310500 Call Agent 2: +27-12-4310500 Reception Desk: +27-12-4310500 Fax:+27-12-4307644 E-Mail: complaints@medicalschemes.com