THEY TOLD US WE WERE FRAUDS

In a David and Goliath battle, this Cape Town couple took their medical aid scheme to court after their membership was cancelled without warning

- NASIFA SULAIMAN

THEY were shocked when their medical aid scheme terminated their membership without warning – and left them with hundreds of thousands of rands in medical bills to pay.

Adrian and Mignon Adelia Steyn of Cape Town were horrified. As far as they were concerned, they’d done everything by the book – but their scheme, Profmed, had other ideas.

Administrators claimed the family didn’t disclose medical conditions that would have affected their risk and premiums, which was why they were ending their membership and refusing to honor bills amounting to about R400 000.

Adrian and Mignon refused to let it go. They took the matter up with the Council for Medical Schemes, but the regulatory body and the appeal board ruled in Profmed’s favour.

‘It has been an incredibly stressful journey

Undeterred, they took the medical aid scheme to the Western Cape high court in a David and Goliath legal battle that spanned four years.

The family’s lawyers argued none of the conditions they allegedly failed to disclose were in fact “material conditions” and therefore did not need to be disclosed – and the court agreed.

“There is no duty on a prospective applicant for medical insurance to disclose a condition that is immaterial or non-existent,” acting judge James Lekhuleni ruled.

Mignon Adelia and Adrian Steyn say they’re relieved a recent high court ruling may see their previous medical aid scheme, Profmed, fork out R400 000 in unpaid medical bills. The Steyns have been fighting the scheme since 2016 when it cancelled their membership “out of the blue”.