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 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.Appeal to Council 5.Appeal to Appeal Board  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 09H00 - 16H00. 2. Time limits for dealing with a complaint The Registrar's Office must send a written acknowledgement of a complaint within 2 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 4 days of receiving the complaint; analyse the complaint and refer the complaint to a medical scheme for comments, as prescribed by section 47 of the Medical Schemes Act, and afford the medical scheme 30 days to respond. (b) Where, on initial assessment the complaint it is found to be without merit, the complaint shall not be forwarded to a medical scheme. The complainant will be informed of the view of the Registrar's Office in this regard while making reference to the provisions of the applicable rules of the medical scheme as well as the relevant clauses of the legislation. Upon receipt of a response from the medical scheme, the Registrar's Office must analyse the response in order to make a decision or ruling. 80% of decisions will be made within 60 days of receipt of a response whilst 20% of decisions will be made within 90 days thereof. However, please note that prior to making rulings, a complainant will be provided with 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 within our operational timelines. 3. The final response When the Registrar's Office sends a determination in a form of a ruling, a complainant is informed of a right to appeal against the decision of the Registrar to the Council should he/she be aggrieved by such decision, and that: That such an appeal must be lodged within 90 days of the Registrar's decision; That the operation of a decision that is subject of an appeal shall be suspended pending review by the Council. 4. Appeal to Council The Registrar's Office advises the disputants of the date, time and venue for the hearings. The said notice shall not be less than 14 days of the date of the hearing. The disputants may appear before the Council and tender evidence or submit written argument or explanation to the Council in person or through a representative. The Council may after hearing the appeal confirm or vary the decision concerned, or rescind it and give other decision as it may deem just. 5. Appeal to the Appeal Board The appellant has 60 days within which to appeal the decision of Council and must submit written arguments or explanation of the grounds of his or her appeal. The Appeal Board shall determine the date, time and venue for the hearing and all parties will be notified in writing. The Appeal Board shall have the powers which the High Court has to summon witnesses, to cause an oath or affirmation to be administered by them, to examine them, and to call for the production of books, documents and objects. Appeal Board shall be heard in public unless the chairperson decides otherwise. The decisions of the Appeal Board are in writing and a copy thereof shall be furnished to parties. 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