The Compensation Fund refers to a Schedule 3A Public Entity of the Department of Employment and Labor. This fund is responsible for administering Compensation for Occupational Injuries and Diseases Act No 130/1993, amended by the Compensation for Occupational Injuries and Diseases Act No 61/1997. Its main objective is to offer Compensation for disablement due to occupational injuries/ diseases sustained or contracted by employees. In addition, Compensation is also offered for death that results from these injuries or diseases.
The fund gets its revenue from levies paid by employers. This may comprise annual assessments that registered employers pay based on a specific percentage or a fixed rate of their employees’ annual earnings. However, the COID Act offers a minimum assessment that ensures that no less than the administration costs are incurred. This means that an employer has to register with the Compensation Fund within seven (7) days from when the first employee was employed.
Services Offered by the Fund
The fund covers several services, which include:
- Employer Services
- Finance Services
- Claims Services
- Legal Services
- Medical Services
- Rehabilitation and orthotics
Targets of the Compensation as Stipulated by the Act
Note that, like it is with other covers, not everyone is eligible for the Compensation offered by this act. Several people can claim the Compensation as long as they are within the stipulated rules. For example, anyone employed under a contract of service and gets wages or a salary every week or month can make a claim as guided by the terms of the act. It is also possible for dependants to lay claim according to the act if the employee eligible for the Compensation is fatally injured. Note that casual employees have similar rights to permanently employed workers as far as the Compensation is concerned.
Steps to Take when iInjured or When you have Contracted a Disease when employed
Note that you can only make claims based on certain guidelines. These scenarios are described under the following categories based on what you need.
Employer’s Report of an Accident (Form W.C1.2)
Whenever you visit the hospital or get to see a doctor, remember that you should take form (W.CI.2 – Part B). Your employer must duly file this since it is an important part of the process. It contains all the relevant information regarding the employer, your full name, and the explanation of how the injury you suffered occurred. It may also show the injury you sustained at work. Note that the Compensation Fund has an online system known as Compeasy, where all claims should be registered by the employer electronically or by whoever is the designated person.
Your employer or the doctor attending to you must submit the First Medical Report (W.CI.4) and the Progress/ Final Medical Reports (W. CI.5). Also important are all other reports that assist the compensation fund in adjudicating the claim’s liability. The first medical report is vital to the Compensation Fund since the doctor supplies a detailed clinical description of the disease or injury. On the other hand, both the progress and final medical reports are also crucial as they determine the need for further treatment or provide a way forward on when you need to resume work or go back home. In addition, they have specific dates documented.
These documents will also describe any permanent disablement that may have resulted from the diseases you suffered or injury sustained during employment. It is the responsibility of the treating doctor to upload the relevant medical report directly onto the Compeasy portal. Employees need to get copies of the reports to submit to the employer and safekeeping if the same disease occurs.
What type of Compensation Should you Expect?
In this case, compensation refers to the Compensation Fund’s money pays employees who get injured while performing their duty. It is meant to replace their wages or/ and to cater to medical expenses incurred due to the injury or disease. However, only employees that have been off work for more than three days get wage compensation. Therefore, even if you go back to work within three days, the medical bills will still be catered for even if you go back to work. If you have to be off work due to an injury or disease, your employer is eligible to pay you 75% of your regular earnings from when the accident happened. This is an amount that the employer will claim back from the Compensation Fund. However, if the recovery period due to the injury or disease exceeds three months, you need to make your claim directly to the Compensation Fund.
Cases of Temporary Disability
It is possible to suffer a temporary disability due to the injury or disease one suffers while at work. The doctor should indicate this in the official medical reports. In most cases, temporary disability happens due to minor injuries. Once indicated, you are eligible for 75 percent of your earnings from the time of the injury/ accident. This amount is payable only for the duration that you are unable or unfit to work. Note that you will not receive any payment for pain and suffering. The Fund only caters to the lost wages during the recovery period.
Cases of Permanent Disability
Sometimes, the unfortunate happens, and one sustains a permanent disability. This will also be verified and indicated by the doctor in the report. It could be deafness, limb amputation, blindness, or an injury that leaves you with a permanent life disability. The compensation here will be assessed based on the extent of the damage or level of disability. The Act guides such compensations.
If the findings, according to the assessment, reveal that your disability is rated to be 30 percent or less, then you will receive a lump sum cash payout. This is a one-time payment for the injury sustained. On the other hand, if the assessment puts the disability at about 30 percent, you are eligible for a monthly pension coupled with the arrears payment from the day of your conditions stabilization as captured on the final medical report. The monthly pension is payable for the rest of the employee’s life. The important thing is to note that the pension amount will be calculated based on the salary or wages you received at the accident. Also playing an important role is the percentage of the disability and the benefits you are entitled to as stipulated in the act.
If an employee dies, then the dependent who can be the spouse is entitled to the pension for life. All the deceased kids below 18 years are also qualified for inclusion in the parent’s or guardian’s pension, depending on the case details. The pension for the kids will stop once they get to 18 years unless they are in tertiary institutions or school pursuing their education.
Rehabilitation and Orthotics
Injuries sustained during your employment can be fixed in different ways. One of the most common solutions is achieved through orthotics. This refers to an assistive device supporting and correcting issues caused by the injury or disease. In addition, these assisting devices help correct deformities and any aftermath of injuries. These include spectacles, braces, and hearing aids. Besides the orthotics, we also have prosthetics. Prosthetics are assistive devices that replace lost body parts due to injury or disease. The most common in this category would be ocular prosthetics and upper and lower limb prosthetics.
Understanding Orthotics and Prosthetic Case Management
Whenever these two assistive devices are needed due to an injury or disease at work, a request for the same has to be made by the medical service provider in charge. The service provider should indicate the need for such devices on behalf of the patient. Upon this request, the patient then proceeds to see an orthotist or disability manager nurse whose work is to verify the clinical appropriateness of the prescription. All the cases of these clients will be managed over the phone or in person. The prescription has to adhere to the Fund’s protocol.
The orthotics case management process involves several players. These are the disability manager, nurse, and orthotist, who are all involved in ensuring the process, is well managed. They will also verify that the client gets full support from the Compensation Fund.
To access these services, employees should consider any HPCSA registered service providers. These should be registered with the Compensation fund too. The service provider is responsible for assessing, formulating appropriate clinical quotations, motivating, measuring, and fitting the needed device on the patient’s body.
The moment the request is sent, the outcome can either be an approval or a rejection. This response will be out in 15 working days and will be sent through the medical service provider, who relays the message to the patient or client needing the said device.
There are specific individuals you will have to contact for further information. If you feel unsatisfied with the response, especially in request rejection, you may need to contact the office responsible for these approvals.
Rehabilitation and Reintegration
Rehabilitation, in this case, refers to the measures and processes involved in helping the sick or injured individual get back to their normal self. This may involve re-teaching them skills that will help them acquire their independence again. The process may require the involvement of different types of therapists, depending on what your issue is. For example, you may need a physiotherapist, a speech therapist, an occupational therapist, a biokineticist, and an audiologist. The different specialists you need at this rehabilitation stage depend on your current needs.
But Who is Eligible for Rehabilitation?
This is a chance offered to all employees or workers who in their line of duty developed an occupational disease or got injured to such an extent that their physical, functional, and emotional abilities were hindered. This process may be necessary to help boost the worker’s ability to return to their normal job since they cannot continue without getting the right assistance. Rehabilitation increases their chances of recovery and getting better.
The Compensation Fund considers rehabilitation important if the worker develops a physical, functional, or emotional limitation. In addition, the fund considers rehabilitation crucial if it is what will help improve and support the employee to gain back their optimal functionality in every sphere of life.
Therefore, there is also a need for rehabilitation management. This process includes monitoring, assessing, and evaluating the rehabilitation treatment process as a way of managing the injured or deceased worker, in addition to advocating for their rehabilitation treatment.
How the Fund Administers and Conducts Rehabilitation Case Management
First, the compensation fund gets a notification about the admission of the patient/ worker into a rehabilitation center. Next, a visit is organized by the rehabilitation case manager to educate and offer the injured or ill worker, medics, and the patient’s family about the benefits of a compensation fund. After this first meeting, the rehabilitation case manager will have follow-up visits to the rehabilitation facility to monitor the rehabilitation treatment progress. This will go on until the patient is discharged from the center. The process aims to help the worker and the family comes to terms with the new status of the patient. In addition, this will prepare them for the community as they will have adjusted to the new order of things by leaving the rehabilitation facility.
The rehabilitation process is important as it determines how soon the patient can resume normal functions at work. The Compensation fund will facilitate this process by ensuring that they support the rehabilitation management process. Some of the individuals involved in this process include:
- The injured or ill/ sick employee/worker
- The sick worker’s family members and loved ones
- The Compensation Fund Medical case coordinator
- The Compensation Fund Disability manager
- The relevant health care providers. This will depend on the kind of help the patient needs. It could be an expert, including the Physiotherapist and the Occupational Therapist.
The compensation fund goes out of its way to support workers injured or who become ill at work. They will ensure you get the necessary compensation and support to recover or manage the situation adequately.
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