The RAF 4 Serious Injury Assessment Report: A Practical Guide for South African Doctors

Updated 2026-07-05 · Written for South African healthcare practitioners by Sphygmos.

When a road accident victim claims general damages (pain and suffering, loss of amenities of life) from the Road Accident Fund, the claim stands or falls on one document: the RAF 4 Serious Injury Assessment Report. Under the Road Accident Fund Act 56 of 1996 and its Regulations, general damages are payable only where the injury has been assessed as "serious", and that assessment must follow the method prescribed in Regulation 3. For the medical practitioner, the RAF 4 is a statutory instrument in which the clinical findings, the whole person impairment computation and the narrative test findings carry direct legal weight. This guide sets out the statutory framework: what the form is, who may complete it, the Regulation 3 sequence, and what happens after submission.

What the RAF 4 is and when your patient needs one

The RAF 4 is the prescribed Serious Injury Assessment Report under the Road Accident Fund Act 56 of 1996, as amended, and the Regulations made under it. The Act draws a hard line: a claimant may recover general damages from the Fund only if the injury is assessed as "serious" in accordance with the prescribed method. Without a RAF 4 that the Fund accepts, no general damages are payable, however severe the injury may appear on the file.

The assessment must be carried out by a medical practitioner registered as such under the Health Professions Act 56 of 1974. The assessing practitioner completes and signs the form personally and records their qualifications and HPCSA registration details. In practice, attorneys typically brief practitioners with training in the AMA Guides methodology, often specialists in the discipline relevant to the injury.

The completed report is submitted to the Fund or its agent by the claimant's attorney. It may accompany the RAF 1 claim or follow later, but statutory time limits under section 23 of the Act apply to the claim as a whole.

Purpose: to establish whether the injury is "serious" so that general damages become payable
Legal basis: RAF Act 56 of 1996 (section 17 as amended) and Regulation 3 of the RAF Regulations
Assessor: a medical practitioner registered under the Health Professions Act 56 of 1974
Form structure: claimant details; practitioner particulars; the non-serious injury list; the AMA impairment rating; the narrative test

The Regulation 3 sequence: the method the form enforces

Regulation 3 prescribes a fixed sequence, and the RAF 4 form mirrors it section by section. The sequence has three steps.

First, check the prescribed list of non-serious injuries (added to the Regulations by amendment in 2013): if the injury is on that list, it is not serious, and the assessment ends there. Second, if the injury is not on the list, assess whole person impairment (WPI) using the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. A WPI of 30% or more means the injury is serious. Third, if the WPI is below 30%, the injury may still qualify as serious under the narrative test if it resulted in any one of four prescribed outcomes.

Step 1, the list: an injury on the prescribed non-serious injury list cannot be assessed as serious
Step 2, WPI: 30% or more whole person impairment under the AMA Guides, Sixth Edition, qualifies as serious
Step 3, the narrative test: below 30% WPI, any one of the four narrative test limbs can still qualify the injury as serious

Whole person impairment under the AMA Guides, Sixth Edition

The Regulations name a specific instrument and a specific edition: the American Medical Association's Guides to the Evaluation of Permanent Impairment, Sixth Edition. A rating done under an earlier edition does not meet the prescribed method. The WPI figure in section 4 of the RAF 4 must be the assessing practitioner's own computation, derived from their own clinical findings under the methodology of the Guides.

The Guides rate permanent impairment, which presupposes that the patient has reached maximum medical improvement. Where the clinical picture is still evolving, a permanent rating cannot yet be made.

One rule is absolute: a WPI figure recorded without having been computed from actual clinical findings is a false statement in a statutory report signed under the practitioner's HPCSA registration.

The narrative test: four limbs, and one is enough

Where the WPI comes out below 30%, Regulation 3 gives the assessment a second route. The narrative test asks whether the injury, whatever its arithmetic rating, resulted in any of four prescribed outcomes. Only one limb needs to be satisfied, and the RAF 4 form deals with each limb in turn in section 5.

The Regulations state the four limbs as follows.

Serious long-term impairment or loss of a body function
Permanent serious disfigurement
Severe long-term mental or severe long-term behavioural disturbance or disorder
Loss of a foetus

After submission: the 90-day decision and the dispute route

Once the report has been sent by registered post or delivered by hand to the Fund or its agent, Regulation 3 gives the Fund 90 days to respond in one of three ways: accept the report, reject it with reasons, or direct that the claimant submit to a further assessment. The exact operation of this mechanism, including the consequences of the Fund failing to respond in time, has been litigated repeatedly, so on any point of dispute the current Regulation wording and case law should be checked rather than assumed.

If the Fund rejects the report, the matter does not end with the rejection. The claimant's side may declare a dispute by lodging the prescribed RAF 5 form with the Registrar of the Health Professions Council of South Africa within 90 days of being notified of the rejection. The dispute is then determined by an appeal tribunal of three independent medical practitioners with expertise in the appropriate areas of medicine, appointed by the Registrar.

What a rejected report costs

A RAF 4 that does not follow the prescribed method is open to rejection by the Fund. Rejection does not end the claim, but it suspends the general damages component until the RAF 5 dispute has been determined by the HPCSA appeal tribunal, and the claimant carries that delay.

The assessing practitioner carries consequences too. The report can be re-examined years after it was signed, the practitioner can be called to account for it before the tribunal, and professional fees attached to a stalled claim can stall with it. General damages that were payable on a compliant report go unpaid on a rejected one until the dispute route has run its course.

How Sphygmos helps

Sphygmos drafts RAF 4 serious injury assessments with the statutory framework built in: the non-serious injury list step, the AMA Guides Sixth Edition whole person impairment structure and the four narrative test limbs, in the order the form requires. It never invents an impairment or disablement rating. The WPI percentage is always the assessing practitioner's own computation from their own clinical findings, and every draft arrives ready for the assessing practitioner's review and sign-off.

See Sphygmos, the clinical operating system for South African doctors

Frequently asked questions

Who can complete a RAF 4 form?

A medical practitioner registered as such under the Health Professions Act 56 of 1974. The assessing practitioner must personally complete and sign the form and record their qualifications and HPCSA registration details. In practice attorneys brief practitioners trained in the AMA Guides Sixth Edition methodology.

What is the narrative test for RAF claims?

The narrative test is the third step in the Regulation 3 method. Where whole person impairment is below 30%, an injury may still be assessed as serious if it resulted in serious long-term impairment or loss of a body function, permanent serious disfigurement, severe long-term mental or severe long-term behavioural disturbance or disorder, or loss of a foetus. Only one of these limbs needs to be satisfied. The RAF 4 form deals with the limbs in section 5.

What WPI percentage qualifies as a serious injury for the RAF?

A whole person impairment of 30% or more, computed under the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, qualifies the injury as serious. Below 30%, the injury is not automatically non-serious. It can still qualify under the narrative test if one of the four prescribed limbs is met.

Do I have to use the AMA Guides Sixth Edition for a RAF 4?

Yes. Regulation 3 prescribes the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, as the instrument for the whole person impairment assessment. A rating done under an earlier edition does not comply with the prescribed method.

How long does the RAF take to accept or reject a RAF 4 report?

Regulation 3 gives the Fund or its agent 90 days from the date the report was sent by registered post or delivered by hand to accept it, reject it with reasons, or direct a further assessment. The consequences of the Fund missing this deadline have been the subject of litigation, so check the current Regulation wording and case law before relying on a deemed outcome.

What happens if the RAF rejects my serious injury assessment?

A rejection is not final. The claimant's side may declare a dispute by lodging the RAF 5 form with the Registrar of the HPCSA within 90 days of being notified of the rejection. An appeal tribunal of three independent medical practitioners, appointed by the Registrar, then determines whether the injury is serious.

Can I complete a RAF 4 from the hospital records without examining the patient?

The RAF 4 records the assessing practitioner's own clinical findings, and the AMA Guides methodology contemplates examination of the patient. The practitioner signs the form personally under their HPCSA registration, so an assessment made without examining the patient rests on records the practitioner did not generate and is open to challenge on that basis.

Sources

This guide is general information for healthcare practitioners, not medical or legal advice. The RAF Act, Regulations, and forms change; verify current requirements before relying on any detail.