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Claims FAQ
FAQ For Compensation Fund Issues
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Q: What does the Compensation Commissioner compensate for?
A: Loss of income (salary) and reasonable medical expenses as well as permanent disablement.
Q: What are reasonable medical expenses?
A: Payment(s) to employees for claims depends on what the Compensation Commissioner is required by Act to compensate for. (That means, the necessary medical expenses, but nothing extra).
Q: What is loss of income?
A: An Employer has to pay an injured employee his salary (75%) for the first three (3) months, or up to the date of stabilization. If an employee is off-duty, (for example for 6 months), and his/her Employer decided not to pay him/her a salary after the 3 month period, the employee can claim his/her salary (75%) from the CC. (A Progress medical report from the doctor, for the period off-duty, as well as an Affidavit (W.Cl.132), completed by the employee, is important in order to claim for loss of income (Temporary Total Disablement).
Q: Where do I report an IOD?
A: Firstly, report to your Manager, Supervisor or the HR Officer who then completes the Employer`s Report (W.Cl.2). Thereafter, the manager or supervisor needs to report the injury to the Compensation Fund in the prescribed manner. Please note that a penalty is levied for late reporting of claims to the Compensation Commissioner. Claims should be reported within 7 days of the incident.
Q: If I must see a doctor, what forms must accompany me?
A: A fully completed, signed, and dated copy of the Employer`s Report of the Accident (W.Cl.2: Part A, pages 1 to 3), as well as a certified copy of your ID. In cases where this form is not available, PLEASE inform the doctor that the treatment is for an injury sustained at work and to treat it as an IOD.
Q: Can I go and see my own doctor?
A: Yes, if he/she is prepared to see IOD patients.
Q: Can I see a second doctor for an additional opinion and what is the procedure to follow?
A: If you see a doctor and you are not satisfied with the treating doctor, he/she must give you a referral letter to see another doctor. (This is important for the Commissioner, allowing them to establish relevant treatment, the connection to the injury and the history of the injury).
Q: What forms do I need when I report a claim to the CC?
A: The Employer need to submit a fully completed, signed, and dated copy of the Employer`s Report of the Accident (W.Cl.2: Part A, pages 1 to 3), as well as a certified copy of the employee's ID and current Payslip.
Q: Do I have to keep copies and records of all medical bills I have paid myself?
A: Yes, you should, and that is to your own benefit. Please note that you might be required to re-submit any or all of these documents when claiming your refund.
Q: What must I do with the medical accounts for my pain medication?
A: If medication is prescribed for pain and the Compensation Commissioner accepts liability for the payment of compensation and/or reasonable medical expenses, then that medication will be paid for according to the tariffs prescribed in the Government Gazette. (This would be for medication straight after the accident. For example: pain tablets for an injury 6 months after the injury stabilized, will not be covered).
Q: Will the CC pay my entire medical account?
A: No, not always. The final decision regarding what is paid on any account is made by the Office of the Compensation Commissioner and according to the tariffs prescribed annually in the Government Gazette.
Q: How long does it take before a medical account is paid out?
A: No definite time frame can be given. It all depends on whether the claim has been accepted and if an account together with supporting medical reports has been submitted. (The Commissioner strives to pay accounts ASAP, but from experience it can take longer due to preparation of payment documentation, processing of payments etc.).
Q: For how long will my claim remain open at the CC?
A: A claim remains open for a maximum of two (2) years subject to the seriousness of the injury. Under normal circumstances your claim is closed on receiving the Final Medical Report (W.Cl.5F).
Q: What do I need to reopen my claim at the CC?
A: Any treatment you received after closure of a claim will only be considered if your doctor requests a re-opening of the claim. The form needed for re-opening a claim can also be obtained from our Offices (Please see our Contact Details).
The following will be considered should you request a re-opening:
- What is the relation between your current condition and that of the original injury?
- What treatment does the doctor contemplate?
- Will it reduce your permanent disablement?
Please bear in mind that the costs to obtain the necessary reopening report(s) will be for the employee’s own expense. Should the Commissioner approve the reopening request, then these costs can be claimed from the Compensation Commissioner.
Q: Does the CC compensate for pain and suffering and if not, why not?
A: No. No compensation is payable for pain and suffering. The Act does not make provision for this. (The reason is that the degree of pain cannot be measured)
Q: Will the Department of Labour investigate my Employer because of the death of my husband as a result of an IOD?
A: Yes, Health and Safety Inspectors of the Department of Labour will follow up fatal cases.
Q: Do I pay tax on monies received from the CC?
A: Compensation payments are tax-free.
Q: Will my employer take my annual leave and sick leave if I’m off work because of my IOD?
A: No, an employee will be granted special leave for the injury as the Employer will be reimbursed for the period that the employee has been booked off duty as a result of the accident, where this is more than 3 days. (The seriousness of each incident is also taken into consideration. If there is no medical report(s) to confirm the period off-duty and the employee is off for longer than supposed to be, the Employer can deduct sick and or annual leave).
Q: Will I be covered if I was injured during a team-building exercise?
A: Yes, provided:
- Your Employer approved the event and encouraged and expected personnel to attend;
- You were doing exactly what you were instructed to do by your Employer;
- You were participating in a team-building exercise to promote morale among employees.
Social events like joining a party, having a few drinks after the team building, a game of sport during tea- or lunch breaks, before or after work, falls outside the scope and cannot be covered in terms of the Act.
Q: Am I covered if I travel to and from work using my own or public transport?
A: Not necessarily. The following applies:
- Transport should be free of charge, and,
- The Employer must have control over that transport e.g. keeping a logbook etc., and,
- The vehicle must be on a direct route, and,
- The vehicle must be driven by the Employer himself or one of his employees
Q: Is an employee covered when in a motor vehicle accident in a taxi/transport that the Employee arranged or paid for?
A: If your Employer instructs you to use your own private vehicle or to make use of public transport to carry out your job during working hours, e.g. no transport is available and you have to make use of a taxi to go to the Post Office to collect mail, then you will be covered. Keep in mind, this is not applicable "from home to work" or the other way round.
Q: Will I receive money from the CC if I had an IOD?
A: Not always! If you sustain an injury resulting in Temporary Total Disablement, (more than 3 days), or Permanent Disablement, and medical expenses are incurred, it will be compensated for, provided liability in respect of the claim has been accepted by the Compensation Commissioner. (You will not receive a lump sum for each and every injury you obtain from work. Only in serious cases will there be a lump sum or a pension paid)
Q: When do I receive compensation in the form of a pension?
A: A monthly pension is payable to an employee if he/she sustains permanent disablement of 31% or more. This pension is payable to the employee until his/her date of death. Should the employee die as a result of the accident, benefits will be carried over to the late employee’s dependent(s).
Q: Can I claim my travel expenses to see my doctor?
A: Travel expenses is payable by the Compensation Commissioner. Please submit a covering medical report for the consultation and complete a Claim for Substance and Transport Expenses (W.Cl.69) (All proof of expenses must be kept and the medical report(s) from the doctor is important for these claiming purposes).
Q: How many times can I go to my Physiotherapist?
A: The number of consultations/visits must be in direct relation to the seriousness of the injury and should more than 20 visits be necessary, the Commissioner must be furnished with a detailed motivation.
Q: Do I have to go back to the doctor for follow up reports if I had an IOD?
A: Yes. The follow up consultations is normally scheduled and carried out after the first consultation in connection with the same injury. The history of the claim is monitored by the CC and doctor’s report(s) are important until the condition become stabilized. Temporary Total Disablement, Permanent Disablement and Medical accounts will not be paid without regular Progress Medical Reports (W.Cl.5P).
Q: What can I do to help with the process of my IOD at the CC?
A: Make sure that all documents are fully completed, signed, and dated, and that all information regarding yourself and your Employer is correct.
Q: Will I be covered if I get HIV/Aids at the work place?
A: Yes, however, the infection must have arisen out of and in the course of your employment.
Q: Will the CC pay any HIV/Aids test(s) if I had a needle prick at work so as to determine if I may be HIV/Aids positive?
A: Medical expenses shall be provided for all reasonable treatment from the date of the definitive diagnosis. The medical aid covers the costs of diagnosing HIV/Aids infection and any necessary treatment, including anti-retro-viral drugs provided by any healthcare provider. The Compensation Commissioner will decide on the need for, the nature of and the sufficiency of the medical aid supplied. The immediate cost of Post-Exposure Prophylaxis (PEP) will not be paid for under COIDA and will be the Employer’s responsibility. The Compensation Commissioner will pay reasonable medical expenses including PEP expenses once liability of the claim has been accepted.
Q: My doctor says I have to undergo this operation but my case is not yet reopened at the CC. Who will pay these accounts, what is the process and what if the CC decides later they will not pay my operation?
A: If you are still waiting for approval of reopening your claim, and you urgently need to undergo the operation etc. you will have to pay for it cash or put it through on your Medical Aid or have the operation performed at a State Hospital. If approval is granted, payment will be made to whoever made the original payments. If approval is not granted, you will have to carry the costs yourself or have it paid by your Medical Aid. The same applies if the Compensation Commissioner has repudiated your claim.
Q: If I receive a pension from the CC, can I still work in the future?
A: Yes, it will have no influence on your compensation.
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