In T N obo B N v The Member of the Executive Council for Health of the Eastern Cape Government and Others (Case no: 383/23) [2026] ZASCA 14, the Supreme Court of Appeal (SCA) reaffirmed a foundational principle of the law of damages: the once-and-for-all rule. The rule has two components: (i) all damages, present and future, must be claimed in a single action; and (ii) damages must be claimed as a lump sum.
The appeal arose from a decision by the Eastern Cape High Court to develop the common law by abolishing the rule. The High Court was faced with a claim for damages for personal injury, where a child had quadriplegic cerebral palsy due to negligence by hospital staff at a public hospital in the Eastern Cape. As a result, the child will require extensive medical care and treatment for the rest of his life. The High Court ordered that the common law be developed to permit “public healthcare” and “undertaking to pay” remedies in place of a conventional lump-sum award.
The SCA held that, while the High Court’s approach may appear superficially attractive, it was fundamentally unsound. A court order must be grounded in evidence and must be effective, enforceable and capable of practical implementation. The High Court’s order failed to meet these requirements. It did not adequately consider the underlying rationale for the once-and-for-all rule, nor the systemic consequences of dismantling it.
The SCA emphasised that radical reform of the law of damages, particularly where it implicates fiscal policy, public healthcare funding and national uniformity, is a matter for the legislature, not the judiciary. The High Court’s order also raised constitutional concerns, including the child’s right to dignity, as it deprived the family of the autonomy to decide how and where future medical care should be obtained.
Reaffirming the rule’s continued relevance, the SCA stressed that it promotes finality, fairness and legal certainty. It protects defendants from multiple, piecemeal claims and shields plaintiffs from the uncertainty and expense of recurring litigation. Although lump-sum awards cannot perfectly predict the future and may result in some degree of over or under-compensation, the SCA reiterated the principle that “immediate certainty and finality are to be preferred above deferred precision".
The SCA was particularly critical of the proposed public healthcare and undertaking remedies. It observed that disputes would inevitably arise each time treatment, medication, equipment or services became unavailable. Such open-ended remedies would generate continuous litigation, escalate legal costs and risk transforming courts into long-term administrators of public healthcare, a role fundamentally inconsistent with the judicial function. The once-and-for-all rule exists precisely to prevent this kind of perpetual supervision.
The appeal was upheld with costs.
What is clear from the judgment is that, although imperfect, the once-and-for-all rule remains a vital cornerstone of our law of damages, ensuring finality, certainty and fairness.
