What’s Needed to Prove Serious Injury to the Road Accident Fund

To claim general damages after being seriously injured in a road accident, it’s necessary to prove serious injury to the Road Accident Fund (RAF).

General damages include compensation for pain, suffering, loss of the amenities of life and/or disfigurement.

In this article, we outline:

• the RAF criteria for defining injuries as serious
• how serious injury must be assessed as part of a RAF claim
• examples of injury types that do not count as “serious”
• getting legal help with a RAF claim.

Criteria for defining serious injuries

If a person’s impairment is rated at 30% or more Whole Person Impairment (WPI) as the result of a road accident, the person qualifies as being seriously injured and can claim for general damages.

As a rule, an injury can be classified as serious only if it involves one or more of the following criteria:

• long-term impairment of a bodily function
• loss of a body function
• permanent, severe disfigurement
• serious long-term mental or behavioural disturbances or disorders
• the loss of an unborn child.

How serious injuries are assessed

Serious injury assessments need to be performed by a registered medical practitioner in accordance with the procedure prescribed in the RAF regulations.

These regulations follow the guidelines found in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Sixth Edition).

These guidelines specify the criteria for evaluating the victim’s whole person impairment (WPI) level and whether it qualifies as serious.

Information needed to prove a serious injury to the RAF

As part of a general damages claim, a medical professional must submit a Serious Injury Assessment Report. Without it, the claim won’t be approved.

The report must include the following details:

• details of the patient and medical practitioner
• any non-serious injuries
• serious injuries according to the American Medical Association guidelines
• how the injuries occurred (the nature of the road accident)
• how the injuries were treated
• final diagnosis and current symptoms
• medical history of the patient
• social and personal history of the patient
• educational and occupational history of the patient.

Educational, occupational and personal history must be included to assess how the injury has affected the victim’s life, ability to work and earn an income.

The form should also specify how any dependants may have been affected.

The medical professional will have to confirm that the patient has reached his or her maximum medical improvement (MMI) or maximum medical recovery (MMR).

This means that in the doctor’s opinion, the patient’s injury has reached the point at which it isn’t going to get any better with time or continued medical treatment.

What constitutes a non-serious injury?

For non-serious injuries, RAF claims can be made for medical expenses (past and future) and loss of earnings – or loss of support in the case of the death of a breadwinner. However, compensation associated with these injuries is not awarded for general damages (pain and suffering).

The list of non-serious injuries as stipulated by the Road Accident Fund Act and the Department of Transport include:

• whiplash
• strains, tears, crushes or other damage to soft tissue
• short-term sprains, strains, tears or other damage to ligaments that don’t result in long-term joint instability
• lacerations, abrasions, cuts, tears or damage to skin that doesn’t result in serious disfigurement
• partial or complete amputation of the little finger (pinky) of either or both hands
• partial or complete amputation of a single toe on either or both feet (big toe excluded)
• damage or loss of teeth
• superficial burns
• fracture of nasal bone or damage to the nasal cartilage
• scars caused by any of the above (except for serious disfigurement)
• mild or moderate depression, anxiety, chronic headaches or post-traumatic stress disorder.