Motor vehicle accidents (MVA) and third party injuries

Below is information about Motor Vehicle Accidents (MVA) and Third Party Injuries

Third party injuries refer to situations where an individual, other than the injured party, is responsible for causing the injury. In many cases, this can occur due to a motor vehicle accident (MVA). When such an incident happens, the third party may be held liable for various medical expenses incurred by the injured party. It is important to note that if any compensation is recovered from a third party or from the Road Accident Fund to cover hospital and medical expenses, these amounts must be refunded to the Momentum Medical Scheme. This requirement is in place to avoid any reversal of claims that have already been paid to healthcare providers on behalf of the member.

In instances where the motor vehicle accident has led to injuries that necessitate hospitalization, it is crucial to follow a specific process to ensure that everything is handled correctly. The first step is for the member, a family member, or the hospital staff to get in touch with us. This can be done through our web chat facility available at momentummedicalscheme.co.za, by emailing us at [e-mail], sending a WhatsApp message, or by calling our dedicated line at 0860 11 78 59. It is essential to contact us within 24 hours of the accident to obtain the necessary authorization.

Once we are contacted, our pre-authorization department will provide an undertaking form that must be signed by the member. However, if the member is in a condition that prevents them from signing the form at that moment, it is important to inform our call center about this situation. In cases where the signed form is not returned to Momentum Medical Scheme, we will still release the authorization number to ensure that the member does not experience any delays in receiving care. However, please be aware that claims related to the accident will not be processed until we receive the signed undertaking form from the member.

Additionally, the hospital will require an accident or injury report, and it is also imperative that the incident is reported to the police to obtain a case number. When reaching out to us for authorization, please have the following information ready:

• Your membership number.
• The principal member’s surname, initials, and date of birth.
• The full name(s) of the individuals involved in the accident.
• The date of the accident or incident.
• The police case number, if available at the time of your call.

If you intend to file a claim with the Road Accident Fund, we will send the necessary details to our designated attorneys who specialize in Road Accident Fund claims. If you are already working with your own attorney, our attorney will coordinate with them to ensure a smooth process. Should you require legal representation, you are welcome to utilize the services of Momentum Medical Scheme's attorney. This attorney will manage the communication with the Road Accident Fund, and any settlement received will be directed to your attorney. Subsequently, your attorney will collaborate with us to facilitate the refund of any medical expenses that we have covered on your behalf.