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 not a referral letter or a summary of the file — it is a statutory instrument in which your clinical findings, your whole person impairment computation and your narrative-test reasoning carry direct legal weight. This guide walks through the assessment in the order the form itself enforces, and flags the points where reports most often fail.

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. No RAF 4, or a RAF 4 that does not survive the Fund's scrutiny, means no general damages — 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. In practice, attorneys typically brief practitioners with training in the AMA Guides methodology — often specialists in the discipline relevant to the injury — because the whole person impairment computation must be shown, not asserted. The assessing practitioner completes and signs the form personally, records their qualifications and HPCSA registration details, and usually attaches substantiating reports and hospital records as annexures.

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 — the assessing practitioner should confirm timing with the instructing attorney rather than assume the report can wait.

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. Working out of order — for example, reaching for the narrative test without first computing whole person impairment — is one of the quickest ways to produce a report the Fund will reject.

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 — narrative test: below 30% WPI, any one of the four narrative-test limbs can still qualify the injury as serious

Assessing 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. Using an earlier edition, or a general clinical impression dressed up as a percentage, does not meet the prescribed method. The WPI figure in section 4 of the RAF 4 must be your own computation, derived from your actual clinical findings, following the chapter-by-chapter methodology of the Guides — regional impairments rated, converted and combined as the Guides direct.

The Guides rate permanent impairment, which presupposes that the patient has reached maximum medical improvement. Where the clinical picture is still evolving — pending surgery, active rehabilitation, an unresolved psychiatric presentation — the rating is premature, and the report should say so rather than guess. A defensible RAF 4 shows its working: the diagnosis, the objective findings on the day of assessment, the tables and grids applied, and how the individual ratings combine into the final WPI percentage.

One rule is absolute: never record a WPI figure you have not actually computed from findings you have actually made. A guessed or borrowed percentage is not a clerical shortcut — it is a false statement in a statutory report signed under your 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 in turn in section 5.

The limbs are qualitative, but the reasoning must not be. "Serious", "long-term", "permanent" and "severe" are conclusions that have to be earned with clinical evidence: examination findings, functional history, prognosis, and — for the mental and behavioural limb — psychiatric or neuropsychological assessment where indicated. A bare tick against a limb, unsupported by reasoning, is the classic rejected narrative test.

Limb (a) — serious long-term impairment or loss of a body function: for example, a brachial plexus injury or post-traumatic joint ankylosis that permanently limits the use of a limb even where the WPI arithmetic falls short of 30%
Limb (b) — permanent serious disfigurement: for example, extensive facial scarring or burn scarring, assessed on visibility, extent and permanence
Limb (c) — severe long-term mental or severe long-term behavioural disturbance or disorder: for example, entrenched post-traumatic stress disorder or organic personality change after brain injury, substantiated by specialist assessment
Limb (d) — loss of a foetus: applies on its own facts, independently of any impairment percentage

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. For the assessing practitioner this means your report may be re-read line by line by a panel of peers — which is precisely the standard to draft it to in the first place.

Common reasons RAF 4 reports are rejected

Published case law and practitioner commentary on rejected serious injury assessments point to a consistent set of failure modes. Almost all of them are avoidable at drafting time, and most come down to the same root cause: the form records a conclusion without recording the clinical reasoning that produced it.

A WPI percentage without visible methodology — no AMA Guides chapters, tables or combination steps shown, or an edition other than the Sixth used
Rating before maximum medical improvement, with no prognosis reasoning to support "permanent" or "long-term" findings
Narrative-test limbs endorsed without substantiation — especially the mental and behavioural limb asserted without psychiatric or neuropsychological evidence
Incomplete sections: the non-serious injury list step skipped, practitioner particulars or HPCSA registration details missing, or the declaration unsigned
Findings that contradict the attached records, or annexures (hospital notes, specialist reports, radiology) referred to but not attached
No causation reasoning connecting the assessed impairment to the motor vehicle accident rather than to pre-existing pathology

Practical drafting guidance for the assessing practitioner

Treat the RAF 4 as a piece of expert evidence, because that is how it will be read — first by the Fund, then possibly by an HPCSA appeal tribunal or a court. Examine the patient personally and record the examination date; a rating built purely on the paper file invites rejection. Take a proper functional history: work, activities of daily living, sport, sleep, mood. Where the injury falls outside your discipline, say so and defer that component to the appropriate specialist rather than rating past the edge of your competence.

Show every step. State the diagnosis, link it to the accident, record the objective findings, name the AMA Guides chapter and tables applied, set out the combination arithmetic, and give the final WPI as your own computed figure. If you then reach the narrative test, argue each relevant limb from evidence and prognosis, not adjectives. Complete every section of the form — including the non-serious injury list step even when the answer is obvious — sign it, and keep a full copy with your working papers, since you may be asked to defend the report years later.

Finally, hold the line on independence. The report serves the assessment, not the claim. A RAF 4 that honestly finds an injury non-serious protects your professional standing; one that stretches a rating to help a claim exposes you before the tribunal, the HPCSA and the court.

How Sphygmos helps

Sphygmos drafts RAF 4 serious injury assessments with the Regulation 3 framework built in — the non-serious injury list step, the AMA Guides Sixth Edition WPI structure and the four narrative-test limbs, in the order the form requires. Every draft is exactly that: a draft for the assessing practitioner's review and sign-off. Sphygmos never invents an impairment rating — the WPI percentage is always the practitioner's own computation from their own clinical findings.

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, because the whole person impairment computation must be shown on the form.

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, but each finding must be substantiated with clinical evidence in section 5 of the RAF 4.

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, or a percentage asserted without the Guides' methodology being shown, does not comply with the prescribed method and is a common ground of rejection.

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 — and will scrutinise the assessing practitioner's reasoning in detail.

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

It is a high-risk approach. The WPI rating must reflect your own clinical findings under the AMA Guides methodology, which contemplates examination of the patient, and narrative-test conclusions about long-term function need a current clinical picture. A report built purely on the paper file is far easier for the Fund to reject; examine the patient, record the date of assessment, and attach the supporting records as annexures.

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.