Copyright Act, 1978
R 385
Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)Scale of FeesAnnual Increase in Medical Tariffs for Medical Service Providers - 2019Optometrist and Speech/Audiologist 2019General InformationClaims with the Compensation Fund are processed as follows |
| 1. | New claims are registered by the Employers and the Compensation Fund and the employer views the claim number allocated online. 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 by the Compensation Commissioner. Enquiries regarding claim numbers should be directed to the employer and not to the Compensation Fund. The employer will be in the position to provide the claim number for the employee as well as indicate whether the claim has been accepted by the Compensation Fund |
| 2. | If a claim is accepted as a COIDA claim, reasonable medical expenses will be paid by the Compensation Commissioner. |
| 3. | If a claim is rejected (repudiated), medical expenses for services rendered will not be paid by the Compensation Commissioner. The employer and the employee will be informed of this decision and the injured employee will be liable for payment. |
| 4. | If no decision can be made regarding acceptance of a claim due to inadequate information, the outstanding information will be requested and upon receipt, the claim will again be adjudicated on. Depending on the outcome, the accounts 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 be taken due to lack of forthcoming information. |
| 5. | If a medical service provider claims an amount less than the published tariff amount for a code, the Compensation -Fund will only pay the claimed amount and the short fall will not paid. |
| 6. | Service providers should not generate the following: |
| a. | Multiple invoices for services rendered on the same date i.e. one invoice for medication and a second invoices for other services. |
*Examples of the new forms (W.CI 4 / W.CI 5/ W.CI 5F) are available on the website www.labour.gov.za
