‘Smoker’ ordered to pay R186k for duping medical aid

A Randfontein woman who lost a leg because of gangrene has been ordered to repay more than R186 000 to her medical aid fund because she allegedly did not reveal she was a smoker with a serious coronary condition.

Moto Health Care obtained default judgment against Susanna van Wyk, an administrative clerk, after she failed to defend their claim against her.

She must now repay the fund for all of her medical costs, as well as the prosthesis she received.

Van Wyk instituted a damages claim of more than R3.6 million against Moto, a midwife and a specialist surgeon after a series of events resulted in her lower left leg being amputated in 2010.

She accused Moto in court papers of negligence, claiming she lost her leg because they had denied her treatment for a life-threatening emergency condition which was a prescribed minimum benefit.

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Moto initially refused to pay for an angiogram to search for a blood clot in Van Wyk’s leg, which resulted in her receiving conservative treatment and being discharged because she could no longer afford hospitalisation.

The fund only approved an angiogram several days later and she underwent surgery to remove the clots, but eventually lost her leg because of complications.

She also accused some of the doctors who treated her of negligence, claiming they had not treated her pregnancy as a high-risk one, did not prescribe the medicine she needed and failed to take into account that she previously had acute coronary syndrome and was a smoker.

She was forced to give birth earlier because of swelling in her legs and high blood pressure.

The fund countersued her, alleging Van Wyk and her husband had provided false information when she was added as a dependent by stating that both of them were in good health, save for the fact that she was seven weeks pregnant.

The fund alleged her pregnancy was more advanced by then and that she had failed to inform it that she was a smoker and was not in good health.

It claimed her complications were not the result of a sudden unexpected medical condition, but caused by her pre-existing coronary condition and because she was a smoker.

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