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Medical Schemes Act, 1998 (Act No. 131 of 1998)

Chapter 10 : Complaints and Appeals

50. Appeal Board

 

(1) There is hereby established an Appeal Board, consisting of three persons appointed by the Minister, of whom—
(a) one shall be a person appointed on account of his or her knowledge of the law, who shall be the chairperson; and
(b) two shall be persons appointed on account of their knowledge of medical schemes.

 

(2) The Registrar shall designate a staff member to act as secretary of the Appeal Board.

 

(3) Any person aggrieved by a decision of the Registrar acting with the concurrence of the Council or by a decision of the Council under a power conferred or a duty imposed upon it by or under this Act, may within a period of 60 days after the date on which such decision was given and upon payment to the Registrar of the prescribed fee, appeal against such decision to the Appeal Board.

 

(4) Any person who lodges an appeal under subsection (3) shall submit with his or her appeal written arguments or explanations of the grounds of his or her appeal.

 

(5) A member of the Appeal Board shall, if before or during the hearing of any appeal it transpires that he or she has any direct or indirect personal interest in the outcome of that appeal, recuse himself or herself and shall be replaced for the duration of the hearing by—
(a) in the case of the member referred to in subsection (2)(a), a person appointed by the Minister with due consideration of the provisions of that subsection; and
(b) in the case of a member referred to in subsection (1)(b), a member appointed b the Minister under the provisions of that subsection.

 

(6) A member of the Appeal Board shall hold office for a period of three years an shall on the expiration of his or her term of office be eligible for reappointment.

 

(7) Subject to the provisions of subsection (1), any casual vacancy that occurs on the Appeal Board shall be filled by the appointment by the Minister of another person, and any person so appointed shall hold office for the unexpired period of office of his or her predecessor.

 

(8) An appeal shall be heard on the date and at the place and time fixed by the Appeal Board and the secretary shall notify the appellant as well as the Council thereof in writing.

 

(9) For the purpose of ascertaining any matter relating to the subject of its investigation, the Appeal Board shall have the powers which a 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.

 

(10) A summons for the attendance of a witness or for the production of any book, document or object before the Appeal Board shall be signed and issued by the secretary in a form prescribed by the chairperson and shall be served in the same manner as a summons for the attendance of a witness at a criminal trial in a High Court at the place where the attendance or production is to take place.

 

(11) A witness shall, if required to do so by the chairperson of the Appeal Board, before giving evidence, take an oath or make an affirmation, which oath or affirmation shall be administered by the chairperson.

 

(12) Any person who has be0n summoned to attend any sitting of the Appeal Board as a witness or who has given evidence before the Appeal Board shall be entitled to the same witness fees from public funds, as if he or she had been summoned to attend or had given evidence at a criminal trial in a High Court held at the place of Such sitting, and in connection with the giving of any evidence or the production of any book or document before the Appeal Board, the law relating to privilege as applicable to a witness giving evidence or summoned to produce a book or document in such a court, shall apply.

 

(13) All the evidence and addresses heard by the Appeal Board shall be heard in public: Provided that the chairperson may, in his or her discretion, exclude from the place where such evidence is to be given or such address is to be delivered any class of persons or all persons whose presence at the hearing of such evidence or address is, in his opinion, not necessary or desirable.

 

(14) The procedure at the hearing of an appeal shall be determined by the chairperson of the Appeal Board.

 

(15) The appellant as well as the Registrar or the Council shall be entitled to be represented at an appeal by a legal practitioner.

 

(16) The Appeal Board may, after hearing the appeal—
(a) confirm, set aside or vary the relevant decision; or
(b) order that the decision be given effect to.

 

(17) The decision of a majority of the members of the Appeal Board shall be the decision of the Appeal Board.

 

(18) The decision of the Appeal Board shall be put in writing, and a copy thereof shall be furnished to the appellant as well as to the Council.

 

(19) If the Appeal Board sets aside any decision by the Council, the prescribed fees paid by the appellant in respect of the appeal in question shall be refunded to him or her, and if the Appeal Board varies any such decision, it may in its discretion direct that the whole or any part of such fee be refunded to the appellant.

 

(20) A member of the Appeal Board who is not in the full-time employment of the State, shall in respect of his or her services as such a member be paid such remuneration, including reimbursement for transport, travelling and subsistence expenses incurred by him or her in the performance of his or her functions as a member of the Appeal Board, as may from time to time be determined by the Minister with the concurrence of the Minister of Finance.

 

(21) Any person who wilfully interrupts the proceedings of the Appeal Board or who wilfully hinders or obstructs the Appeal Board in the performance of its functions shall be guilty of an offence.

 

(22) Any person summoned to attend and give evidence or to produce any book, document or object before the Appeal Board who, without sufficient cause, the onus of proof whereof shall rest upon him or her. fails to attend at the time and place specified in the summons, or to remain in attendance until the conclusion of the appeal or until he or she is excused by the chairperson of the Appeal Board from further attendance, or having attended, refuses to be sworn or to make affirmation as a witness after he or she has been required by the chairperson of the Appeal Board to do so or, having been sworn or having made affirmation, fails to answer fully and satisfactorily any question lawfully put to him or her, or fails to produce any book, document or object in his or her possession or custody or under his or her control, which he or she has been summoned to produce, shall be guilty of an offence.

 

(23) Any person who after having been sworn or having made affirmation, gives false evidence before the Appeal Board on any matter, knowing such evidence to be false or not knowing or believing it to be true, shall be guilty of an offence.