Road Accident Fund RAF Form 4 medical assessments and patient circumstances

It has recently become a common practice for many attorneys and other parties involved in litigation with, for or on behalf of the Road Accident Fund to simply request a RAF 4 or Serious Injury Assessment Form to be completed.  In the broader context of completing a serious injury assessment, one needs to be cognisant and aware of the key factors and implications of an RAF Form 4 as well as the findings that are made that need to be included in the findings of the RAF Form 4 and serious injury assessment form.

 

Serious injury assessments need to be seen in the context particularly to that individual claimant and his circumstances in which he currently lives, works and functions as an individual in his family and working environment.  This is based on the caterings of the act which very specifically and categorically states that assessments need to be based on the circumstances as well as the assessment of the seriousness of the injuries that the patient has.

 

It is my belief that the circumstances can be obtained from a comprehensive discussion with the claimant or patient to understand his current circumstances, what his/her previous circumstance was and to understand the implications of the accident and the injury which resulted in impairment, if any.  Now, circumstances are matters that include his ability to function on basic activities of daily living, of self-care, of functioning within a household and basic travel requirements.  Further to that, one needs to analyze and quantify to some extent the ability of the individual to be able to do those activities that he was able to do prior to the injury.  These include functioning of various capacities at work as well as capacities within the household.  If the claimant is a primary care giver or head of a household or whatever capacity they function within their household, it is imperative to understand their limitations in any activities within the household need to be considered and commented on.

 

The Whole Person Impairment Assessment System that has been adopted by the Road Accident Fund of South Africa is a comprehensive system that’s based on the AMA Guidelines, the Sixth Edition.  To complete a narrative test or the circumstance understanding and an analysis of a claimant, one has to complete a Whole Person Impairment Assessment first.  It has become common place in which some attorneys or representatives of claimants do what they have been calling Basic Narrative Assessments or Overview Assessments of these patients.  Now, keeping in mind that the Road Accident Fund will only pay for relevant assessments as well as assessments that are related directly to the patient done by a medical practitioner whether specialised or not, but registered at the Health Professions Council of South Africa, and as such these findings will be taken into cognisance.  Any findings otherwise by any other health care professional that is not a medical doctor and as such having not completed the AMA Guides relevant training and/or the important Certified Independent Medical Examiner’s Board Exam should not be granted any merit or weight because it is against the pre-scripts of both the act as well as the Supreme Court of Appeal Findings in November 2012 in favour of the Road Accident Fund.

 

Further in understanding the circumstances of the claimant and using the circumstantial information of the claimant in relation to a narrative test, one needs to be cognisant of contrasting this with any payment that has a direct consequences on the person impaired as compared to claimants who have had the likes of whiplashes and more simpler claims and purely because they been represented by comprehensively qualified and well-seasoned legal firms, settlements are obtained early.  Taking into account the circumstances and the historical profile of South Africa, without compromising integrity, I am of the belief that the historical circumstances of the claimant as well as the broader society has to be assessed to be effective.

-Dr Terrence O. Kommal