If an employee meets with an accident resulting in their disablement or death such employee or the dependants of such employee shall be entitled to the benefits provided for and prescribed in the Compensation for Occupational Injuries and Diseases Act.
The following TYPES OF COMPENSATION can be claimed:
Medical expenses and conveyance of injured employee;
Temporary Disability (including partial disablement or total disablement);
Permanent Disability - The body will not recover (e.g. loss of an eye) or
Death
In this article, we will focus on medical expenses and the conveyance of injured employees.
Transport of an injured employee
If an employee meets with an accident that necessitates their conveyance to a hospital or medical practitioner or from a hospital or medical practitioner to their residence, the employer shall make the necessary conveyance available.
The reasonable expenses incurred for the conveyance of an employee injured in an accident will be refunded from the Compensation Fund or by the carrier of the risk.
To claim for reimbursement of travel expenses, the following documents must be submitted:
i) Claim for Subsistence and Transport Expenses Form – W.cl.69
ii) Proof of payment (e.g. Petrol slip etc.)
iii) Medical reports with the same date of service as indicated W.cl.69
iv) The W.Ac.33 Form must be completed by the Bank.
v) 3 Months Bank Statements (Bank Stamp on Every Page)
vi) Proof of Address
vii) Certified ID Copy of the Account Holder.
The Fund will only pay reasonable medical costs for traveling expenses.
MEDICAL EXPENSES:
The employee is permitted to freely choose his own medical service providers. It is the employee’s right to consult with any medical practitioner of his/her choice, in their area, immediately after incurring an injury or disease.
The employee must report all the injuries incurred at the time of the injury so that they can be covered and paid by the Fund. All the contact details must be provided so that the Fund may contact the employee when necessary. The employee must attend all the consultations on time, if the employee is unable to see the medical service provider cancellation must be done on time otherwise the employee will be liable for medical costs.
All reasonable medical expenses incurred by or on behalf of an employee in respect of medical treatment necessitated are defrayed by the Compensation Commissioner or the carrier of the risk, provided the accident/occupational disease was reported by the employer in the prescribed manner.
The medical service provider must claim according to the tariffs as prescribed in the government gazette. Only COIDA tariffs are payable. The Compensation Fund only pays for the medical expenses where liability is accepted for the claim.
It is the responsibility of the Medical Service Provider who is registered with the Board of Healthcare Funders and Health Professional Council of South Africa to ensure that all medical bills are paid.
Reasonable medical aid expenses arising out of an injury on duty are payable for a period of two years, or longer if further medical treatment will reduce the extent of the disablement.
The employer is not allowed to deduct money from the employee’s salary to cover any expenses that occurred in respect of the injury on duty.
If an employee paid for their own medical expenses, they should seek reimbursement by submitting the following documents:
i) Detailed invoice from the Medical Service Provider
ii) Proof of payment
iii) Medical report with the same date of service as indicated on the invoice
iv) The W.Ac.33 Form must be completed by the Bank.
v) 3 Months Bank Statements (Bank Stamp on Every Page)
vi) Proof of Address
vii) Certified ID Copy of the Account Holder.
MEDICAL AID
No accounts must be submitted to the medical aid for payment unless the Commissioner has repudiated the claim. If an employee’s medical aid was used for medical expenses after an injury/occupational disease the Fund will process refunds to the medical aid. The medical aid or the injured employee may submit relevant documents.
To claim reimbursement the employee must submit the following documents:
i) Detailed medical invoices from the Medical Service Provider
ii) Statement from the medical aid
iii) Medical report with the same date of service as indicated on the invoice
iv) Refunds are processed according to published COIDA tariffs and rates, non COIDA tariffs are not payable.
Refunds are only payable to medical aids not to employees if medical aid was used for payment of medical expenses. Keep an eye on our next newsletter where we will discuss the right to compensation for temporary disablement.
