In terms of the Compensation for Occupational Injuries and Diseases Act (COIDA) the Compensation Fund (Fund) provides compensation to employees who become disabled due to occupational injuries or diseases caused in the course of their work.
The Fund also provides for compensation to an employee’s dependant/s for death resulting from such injuries or diseases (disablement).
Who is excluded from claiming compensation from the Fund?
- Domestic employees working in private homes.
- Members of the South African National Defence Force (these members have their own fund).
- Members of the South African Police Service (these members have their own fund).
- Employees of the State performing military service or undergoing training in terms of the Defence Act.
- Independent contractors.
- Employees working outside of South Africa for more than 12 months at a time, unless an agreement was entered into with the Fund.
What is the procedure to claim compensation from the Fund?
- Step 1:The employee must report the disablement, in writing, to his/her employer as soon as possible or within 12 months from the date the disability occurred.
- Step 2:The employer must report the disablement to the Fund within 7 days.
- Step 3:The employee must obtain medical reports (first, progress and final report) from the doctor/hospital who is treating him/her and provide these reports to the employer. These reports will state how serious the disablement is and how long the employee is likely to be off from work. The employee must supply truthful information and cooperate with the doctors and other medical staff; failure to do so can result in the non-payment or delay in payment of the compensation.
- Step 4:The employee must also obtain the following documents and provide it to the employer/Fund: the employee’s banking details (bearing the bank’s official stamp) together with a certified copy of his/her identity document and proof of residence; if a dependant is claiming death benefits, the employee’s marriage certificate; death certificate; children’s birth certificates; spouse’s declaration; employer’s accident report; funeral account; and details of the employee’s income and property.
- Step 4:An employer must send a resumption report to the Fund stating, if and when the employee went back to work.
- Step 6:After the Fund received the first medical report and the accident report, it will allocate a claim number, consider the claim and make a decision in respect of payment of compensation.
- Step 7:If the employee disagrees with the decision of the Fund, s/he can object to the decision within 90 days.
What types of compensation are payable?
- Temporary disability of 3 months or more, where the employee eventually recovers.
- Permanent disability where the employee never fully recovers.
- Salary during the period the employee is unable to work.
- Medical expenses.
- Death benefits.
Under what circumstances will the Fund deny, limit or pay additional compensation?
No compensation will be payable:
- if a claim is reported more than 12 months after the work-related disability or death occurred;
- in respect of temporary disablement which lasted for three days or less;
- in respect of pain, shock and suffering;
- if the employee’s own serious and willful misconduct caused the work-related disablement unless the employee was seriously disabled or died;
- if the employee unreasonably refuses or neglects to have medical treatment; or
- if the employee falsely represented that s/he was not suffering from or had not previously suffered from any work-related disablement.
The employee is entitled to additional compensation:
- if the employer was negligent and increased compensation if the disablement was caused by a defect in the employer’s equipment.
There are certain limits set by COIDA on the compensation payable by the Fund to the employees or dependants.
GLOSSARY OF TERMS:
COMPENSATION: give money in recognition of work-related injury or disease.
DEPENDANT: a person who was reliant on the employee’s salary at the time of his/her death such as widower or child under the age of 18 years.
EMPLOYEE: a person who works for another person, receives remuneration and who assists in the carrying on of the business of the employer.