Medical Aid for COIDA/WCA when claiming for injuries on duty

Overview

When claiming for injuries on duties, it is imperative that employers are familiar with the process involved with medical aid for COIDA/WCA, ensuring that they cannot be held liable for the medical costs involved with treatment of injured employees.

The Compensation Fund is administered by the Department of Employment and Labour in South Africa, also referred to as DeL, with the fund providing employees who are injured at work, or who become sick from diseases contracted at work, or who die as result of either, with compensation.

Headquartered in Pretoria, South Africa, the Compensation Fund is covered by the Compensation Fund for Occupational Injuries and Diseases Amendment Act (1997).

Further changes to the law which governs the Compensation Fund were adopted in 2020, ensuring that casual workers are also covered by this law.

Compensation may only be claimed by an employee should the injury or occupational illness has been assessed and declared as either ‘permanent disablement’, ‘temporary disablement’, or ‘temporary total disablement’.

According to law, all employers must register with the Compensation Fund and pay an annual assessment fee. The registration must include all employees on the payroll of the employer.

Employers are responsible for paying the Compensation Fund and therefore, employers may not deduct any fees from their employees to pay the Fund.

Injury Reporting Procedure

There is a specific procedure which must be followed when reporting an injury or occupational illness under the Compensation Fund. This procedure is as follows:

• The worker must report the accident to the employer as soon as possible after it has occurred. Should the worker fail to provide the employer and Compensation Fund notice on the prescribed form, the claim will be rejected.
• Should the employer fail to report the accident, the worker must complete a ‘Notice of Accident and Claim for Compensation’ form. This form can then be submitted to the labour centre, or even directly to the Compensation Fund.
• The worker must then assist the employer in obtaining the necessary medical reports. The employer may choose the doctor and the employee must ensure that they consult with the doctor frequently and ensure the claim is finalised.
• The employer has the responsibility of reporting the accident in the prescribed manner. This is done by completing the ‘Employer’s Report of an Accident’ form. Upon completion, it must be submitted to the Compensation Fund within seven days after the accident occurred.
• The employer must obtain the ‘First Medical Report’ from the treating doctor as it is an important requirement where liability for payment of compensation is concerned.
• The employer must also obtain the ‘Progress Medical Report’ indicating that the employee is receiving prolonged medical treatment. This report also indicates that the employee is off duty because of injuries sustained in an accident.
• The Progress Medical Reports must be submitted to the Fund monthly to ensure that compensation with regards to total disablement is paid timeously.
• The employer is also responsible for obtaining the ‘Final Medical Report’ as soon as the employees’ condition has stabilised. The doctor is required to describe the loss of function as result of the accident, should there be any, and the Compensation Fund must assess permanent disability, if there is any.
• The employer must also complete and submit the ‘Resumption Report’. This is done as soon as the employee returns to work.
• Should the employee be booked off for lengthy periods, interim reports must also be submitted.
• Finally, should the claim qualify for payment by the Compensation Fund, the employer must submit the worker’s banking details.

Claim Rejection

Should the Compensation Fund reject the claim and a written, valid, and lawful reason is provided, the decision will be communicated with the employee in writing. In addition, the Compensation Fund will invite the employee to submit a written ‘Objection Form’ within 180 days.

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