FAQ For Compensation Fund Issues

Q: What does the Compensation Commissioner compensate for?

A: Loss of income (salary) and Reasonable Medical expenses.

Q: What are reasonable medical expenses?

A: This mostly depends on what the Compensation Commissioner is required to pay by Act. (Necessary medical expenses and nothing extra)

Q: What is loss of income?

A: An employer must pay an injured employee for the first three (3) months’ salary (75%) or up to the date of stabilization if it is less than three months. If an employee is off for example 6 months and his/her employer decided not to pay him/her salary after the 3-month period, the employee can claim his/her salary (75%) from the CC. (Progress medical reports from the doctor, for the period off, is very important to claim loss of income (Temporary Total Disablement)

Q: Can I take my employer to court for my IOD?

A: “No action shall lie by an employee or any dependent of an employee for the recovery of damages in respect of any resulting in the disablement or death of such employee against such employee`s employer”

Q: Where do I report an IOD?

A: Firstly, to your Manager, Supervisor, or the HR Officer, who completes the employer`s report (W.cl.2) Then, the manager or supervisor needs to report the injury to the Compensation Fund offices. Please note that a penalty will be levied for late reporting of claims by the Compensation Commissioner. Claims should be reported within 7 days to the Compensation Commissioner.

Q: If I must see a doctor, what forms must accompany me?

A: A copy of the Employer`s Report of the Accident. In cases where the 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 very important for the Commissioner 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: 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 very important for the Commissioner to establish relevant treatment, the connection to the injury and the history of the injury)

Q: Do I have to keep copies and records of all medical bills I have paid myself?

A: Do that for your own benefit. You may have to submit or re-submit any or all of them.

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 reasonable medical expenses, then that medication will be paid per the tariffs prescribed in the Government Gazette (this would be for medication straight after the accident). (Example: pain tablets for 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 per the tariffs prescribed annually in the Government Gazette. (The difference of the account will be for the account of the employee)

Q: How long does it take before a medical account is paid out?

A: No definite period can be given. It all depends on whether the claim has been accepted and if an account has been submitted. (The Commissioner strives to pay accounts ASAP, but from experience it can take very long due to scanning of docs, availability of files, consent of payment, preparation of payment, processing 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) indicating that your condition has stabilized. Any treatment you received after closure of the claim will only be considered if your doctor requests for the re-opening of the claim. The form needed for re-opening a claim can be obtained from the offices of the Compensation Commissioner.

The following will be considered should you request the re-opening of a claim:

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?

PS: Re-opening of a claim can take from 6 months and longer.

Q: Does the CC compensate for pain and suffering and if not, why not?

A: 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 because 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 because of the accident, where this is more than 3 days. (The seriousness of each incident is also taken in consideration. If there is no medical report 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; If you were doing exactly what you were instructed to do by your employer; If you were participating in a team-building exercise to promote morale amongst 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.

The following criteria should always be adhered to:

Transport should be free of charge

The employer must have control over the transport e.g. keeping a logbook etc.

The vehicle must be on a direct route

The employer must drive the vehicle 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 must make use of a taxi to go to the Post Office to send a company cheque, you will be covered. This is not applicable “from home to work” or the other way around.

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. (You will not receive a lump sum for 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 pensioner die because of the accident, benefits will be carried over to the late employee’s dependents.

Q: How long will it take to finalize my claim?

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) indicating that the employee’s condition has stabilized. (Any accounts for treatment after date of closure will not be covered by the Compensation Commissioner)

Q: What do I need to reopen my claim at the CC?

A: Any treatment you received after closure of the claim will only be considered if your doctor requests for the re-opening of the claim. The form needed for re-opening a claim can be obtained from the offices of the Compensation Commissioner.

The following will be considered should you request the re-opening of a claim:

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?

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 (All proof of expenses must be kept and the medical report from the doctor is very important for this exercise)

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. A history to the claim must be monitored by the CC and doctor’s reports 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 duly completed and signed and that all information regarding yourself and your employer is correct.

Q: Will I be covered if I get Aids at the work place?

A: Yes, however, the infection must have arisen out of and during your employment.

Q: Will the CC pay my Aids test if I had a needle prick at work to see if I’m HIV 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 infection and any necessary treatment, including anti-retroviral 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 must 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 must 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 must 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.