How much is a RAF claim worth?

There is no standard payout. A Road Accident Fund claim is not a fixed amount for a broken leg or a fixed amount for whiplash. It is built up from what the accident has actually cost you, proved with documents and expert evidence. Two people with identical injuries can end up with very different amounts, because their earnings, their ages and their long term prognosis differ.

Be sceptical of anyone who gives you a number at a first consultation. Our RAF claim range calculator shows illustrative bands so you have a rough sense of scale. It is not a prediction, not an offer, and not advice about your claim.

Before you think about value, check the deadline. Under the Road Accident Fund Act 56 of 1996, an identified driver claim must generally be lodged within three years of the accident, and an unidentified driver claim within two years. A claim that has prescribed is worth nothing regardless of how serious the injury was.

The four things a claim is built from

1. Past medical expenses. Everything already spent: ambulance, hospital, doctors, medication, physiotherapy, crutches, home nursing. This is the easiest head to prove and the most commonly under-claimed, because people throw away receipts. Keep everything, including the small amounts.

2. Future medical expenses. Treatment you will still need, such as further surgery, prosthetics, physiotherapy or psychological care. In practice this is usually not paid as a lump sum. The Fund issues an undertaking, which is a written promise to pay for qualifying treatment when you actually need it. That is why a settlement figure can look smaller than expected while still covering a lifetime of treatment.

3. Loss of earnings. Two parts. Past loss covers income you lost while off work, proved with payslips, an employer letter or bank statements if you are self-employed. Future loss covers the difference between what you would have earned over your working life if the accident had not happened, and what you can realistically earn now.

This head usually dominates a serious claim. It is calculated by an actuary using evidence from an industrial psychologist about your career path, and it is then reduced by contingency deductions, which are percentage allowances for the ordinary uncertainties of life such as illness, unemployment and early retirement. The younger you are and the more your earning capacity has been damaged, the larger this becomes.

The Act also places a statutory limit on the amount of loss of earnings, and of loss of support in a fatal claim, that can be claimed. That limit is adjusted periodically, so ask what it is at the time your claim is quantified.

4. General damages. Compensation for pain, suffering, disfigurement and loss of amenities of life, meaning the things you can no longer do. This is the head people mean when they ask what a claim is "worth", and it is the one with the biggest hurdle attached.

A worked example: same injury, different claims

Two people break the same bone in the same way. The figures are illustrative only, invented to show why the claims differ. They are not a prediction of any claim.

Mandla is 52, a warehouse supervisor earning R18 000 a month. His leg heals with a slight limp. He returns to the same job after four months on the same pay.

• Past medical expenses: what he and his medical aid actually paid, proved with accounts.
• Past loss of earnings: four months of pay, less any sick pay he received.
• Future loss of earnings: small or none, because he is back in the same job at the same pay, though an industrial psychologist may consider whether the limp shortens his working life.
• General damages: only if the serious injury assessment accepts his injury as serious.

Ayanda is 24, a newly qualified electrician earning R12 000 a month with a clear path to higher earnings. Her leg heals but she can no longer climb ladders or stand for long periods, and she has to leave the trade.

• Past medical expenses: as above.
• Past loss of earnings: the months she was off work.
• Future loss of earnings: the difference between the career the industrial psychologist says she would have had and the lower-paid work she can now do, calculated by an actuary over roughly forty working years, then reduced by contingency deductions. This head is likely to be by far the largest part of her claim.
• General damages: again, only if her injury is assessed as serious, and the loss of her trade is relevant to that assessment.

Same fracture. Ayanda's claim is likely to be far larger, not because she suffered more pain, but because the accident changed her earning capacity for decades. That is what drives value.

The serious injury hurdle

General damages are only payable where your injury is assessed as serious. A registered medical practitioner examines you and completes the prescribed serious injury assessment report. The Fund then decides whether it accepts that the injury qualifies. If it rejects the assessment, the dispute goes to an appeal tribunal.

This is the single biggest fork in the road for value. A moderate soft tissue injury that heals may produce medical expenses and a short loss of earnings claim and nothing more. The same accident that leaves someone with a permanent limp, a serious head injury or a disfiguring scar opens the general damages head as well.

Do not assume your injury does or does not qualify based on how dramatic the accident was. It turns on the medical assessment.

What reduces the amount

• Contributory negligence. If you were partly to blame, the award is reduced by your share. Being found 30% responsible reduces everything by 30%.
• Not wearing a seatbelt, where that made your injuries worse.
• Contingency deductions applied to future loss of earnings.
• Gaps in proof. No payslips, no receipts, no hospital records means no claim for those amounts, whatever really happened.
• A pre-existing condition, where the Fund argues part of your current problem was already there.
• Settling too early, before your medical position has stabilised. This is the most avoidable of all of them.

What comes off the award

The amount awarded and the amount you receive are different numbers. If an attorney acts on a contingency basis, the Contingency Fees Act 66 of 1997 caps the success fee at double the normal fee or 25% of the award, whichever is lower. Disbursements, such as medico-legal reports and the actuarial calculation, sit outside that cap and are deducted as well. The Fund's contribution towards your legal costs is a separate stream and should not be treated as part of your compensation. Ask for the full breakdown before you accept a settlement. How does no win no fee work in South Africa? explains the arithmetic.

What is not covered at all

The Fund compensates for bodily injury and death. It does not pay for damage to your vehicle, your phone, your laptop or your clothing. Property losses go through your own insurer or a separate civil claim.

In a fatal claim

Dependants can claim for the support they have lost, which is worked out from what the deceased earned and what proportion of it went to supporting each dependant, adjusted for how long that support would have continued. Whoever paid the funeral can claim those costs. There is no general damages payment to the family for grief in the way some other countries allow.

Evidence that protects value

Every head of damages has a document behind it. Without the document the head shrinks or disappears.

• Past medical expenses: every account, receipt and medical aid statement.
• Past loss of earnings: payslips before and after, an employer letter confirming dates off, or bank statements and tax returns if you are self-employed.
• Future loss of earnings: your qualifications, employment history, performance reviews and anything showing the career you were on.
• General damages: hospital records, photographs of the injury over time, and a diary of what you can no longer do.
• Future medical expenses: treating doctors' notes on what treatment is still expected.

Common mistakes that shrink a claim

• Throwing away small receipts. They add up, and each one is proof.
• Not seeing a doctor when symptoms persist. If it is not in the records, the Fund will say it did not happen.
• Going back to work too early and hiding the struggle. The records then show a full recovery that is not real.
• Settling before the medical picture is stable. You cannot come back for more.
• Accepting a global figure without a breakdown by head. You cannot check what was left out.

How to protect the value of your claim

1. Get medical treatment and go back whenever symptoms change, so the records reflect the truth.
2. Keep every receipt, invoice, prescription and sick note.
3. Keep proof of income from before and after the accident.
4. Attend every medico-legal appointment.
5. Do not settle before your treating doctors can say where you will end up.
6. Tell your attorney immediately if you lose your job or have to change work because of the injury.

For the process itself see How to claim from the Road Accident Fund, and for realistic timelines see How long does a RAF claim take?.

If you cannot afford advice, lodging with the Fund is free, and Legal Aid South Africa can be reached on 0800 110 110.