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Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Scale of Fees

Annual Increase in Medical Tariffs for Medical Service Providers - 2023

Occupational Therapy Gazette 2023

General Information about the Compensation Fund and its Medical Services Benefits Directorate

Overview of claims process within the Compensation Fund

 

All claims lodged in the prescribed manner with the Compensation Fund follow the process outlined below:

 

1. New claims are registered by the Employers with the Compensation Fund and the employer, if registered as a user on the online processing system is able to view claim details like the claim number allocated, and the progress of the claim online.
a. The allocation of a claim number by the Compensation Fund,does not constitute acceptance of liability for a claim,but means that the injury on duty has been reported to and registered with the Compensation Commissioner.
b. Any enquiries related to a claim should be directed to the employer and or the nearest Labour Centre

 

2. If liability for a claim is accepted by the Compensation Fund in terms of the COID Act, reasonable medical expenses, related to the medical condition shall be paid to medical service providers that treat injured/diseased employee's. Reasonable medical expense shall be paid in line with its approved Tariffs and Billing rules and procedures, published annually in Government Gazettes.

 

3. If a claim is repudiated in terms of the COID Act, medical expenses for services rendered will not be paid by the Compensation Fund. The employer and the employee will be informed of this decision and the injured employee will be liable for payment.

 

4. In the case sufficient information pertaining to a claim is unavailable after registration thereof, the status of the claim will be rejected until the outstanding information is submitted and liability of the claim can be determined. Depending on the outcome,the invoices from the service provider will be dealt with as set out in 2 and 3. Please note that there are claims on which a decision might never betaken due to the non-submission of outstanding information.

 

5. The Compensation Fund will only pay reasonable medical expenses for treatment of the condition that liability has been accepted and will not pay for any other unrelated treatment.