Workers' Compensation Claims
The Compensation Fund for Occupational Injuries or Diseases (COID) covers employees for injuries, diseases and death which resulted from work. Claims for compensation can be made by employees that sustained injuries or contracted disease while working, training or completing an apprenticeship. Certain employees are not allowed to claim from this fund, these include domestic workers at a private home, workers that don't work under employers and employees who work outside of South Africa for more than twelve months at a time. Members of the South African National Defence Force and Police Services have a separate fund and may not claim from the Workers' Compensation Fund.
Claims are only paid if they are submitted through the correct procedures within the proper time span after the injury, diagnosis of disease or death of the family member. Claims should be made within twelve months of the accident, death or diagnosis of the disease. The claim will not be paid if the accident resulted from the employee's own negligence or wrong doing or if the employee is only unable to work for less than four days. The employee will also not be compensated if he/she refuses any medical treatment during the time of the injury or illness.
There are procedures that need to be followed to simplify the process of claiming for compensation.
- In the event of occupational injury or illness, the supervisor or employer needs to be notified as soon as possible. A Notice of Accident and Claim for Compensation form needs to be completed. Both the employee and the employer need to take note of witnesses to the accident for the sake of resolving debates on the causes of the injury, disease or death during the course of the claim.
- The employer then has to submit an Employer's Report of Accident to the Commissioner of the Compensation Fund.
- The employee has to consult a doctor as soon as possible and the doctor has to compile a report on the seriousness of the employee's condition as well as the amount of time the employee will be unable to commence work within 14 days of the consultation or examination. This report is sent to the employer, who in turn submits it to the Commissioner of the Compensation Fund.
- If the employee will take a long time to recover, the doctor has to submit a progress report to the Commissioner until the employee's condition is fully stabilised.
- Eventually, the doctor must send a final doctor's report to the employer stating that the employee is fit to commence work or that the employee is permanently disabled. The employer again has to submit this report to the Commissioner of the Compensation Fund.
- Once the employee returns to work, the employer has to submit a resumption report to the Commissioner stating the return of the employee and the amount the employee was paid for in compensation.
Once the claim has been submitted, the Compensation Commissioner will decide whether the employee should be compensated and a claim number will be allocated for use in all paperwork related to the claim. Both employer and employee should keep copies of all the forms submitted.
You do not have to suffer with this complicated segment of company administration. If you want to automate and simplify the injury on duty process, contact Healthy Numbers' specialist COID Administration department on 082 463 2507.