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

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COID Medial Tariffs General Information

2. The Employee and the Medical Service Providers

 

Medical Service Providers are advised to take note of the following as it pertains to the treatment of patients in relation to The Compensation for Occupational Injuries and Diseases Act of 1993 (COID Act):

 

1. An employee as defined in the COID Act of 1993, is at liberty to choose their preferred Medical Service Provider and no interference with this is permitted. As long as it is exercised reasonably and without prejudice to the employee or The Compensation Fund.
a. The only exception rule is in case where an employer, with the approval of The Compensation Fund, provides comprehensive medical aid facilities to his employees, i.e. including hospital,nursing and other services - Section 78 of the COID Act refers.

 

2. In terms of Section 42 of The COID Act, The Compensation Fund may refer an injured employee to a specialist medical practitioner, designated by the Director General for a medical examination and report.

 

3. In terms of section 76,3(b) of the COID Act, no amount in respect of medical expenses shall be recoverable from the employee.

 

4. In the event of a change of a Medical Service Provider attending to a case, the first treating doctor in attendance will, except where the case is transferred to a specialist, be regarded as the principal treating doctor.

 

5. To avoid disputes regarding the payment for services rendered, Medical Service Providers should refrain from treating an employee already under treatment by another medical practitioner without consulting/informing the principal treating doctor. As a general rule, changes of Medical Service Providers are not encouraged by The Compensation Fund, unless sufficient reasons exist for such a change.

 

6. According to the National Health Act no 61 of 2003, Section 5, a health care provider may not refuse a person emergency medical treatment. Such a Medical Service Provider should not request The Compensation Fund to authorise such treatment before the claim has  been registered and liability for the claim is accepted by The Compensation Fund.

 

7. An employee seeks medical advice at their own risk. If such an employee presents themselves to a Medical Service Provider as being entitled to treatment in terms of The COID Act, whilst having failed to inform their employer and/or The Compensation Fund of any possible grounds for a claim. The Compensation Fund cannot accept responsibility for the settlement of medical expenses incurred under such circumstances.

 

8. The Compensation Fund could have reasons to repudiate a claim lodged with it, in such circumstances the employee would be in the same position as any other member of the public regarding payment of his medical expenses.

 

9. Proof of identity is required in order for a claim to be registered with The Compensation Fund.
a. In the case of a South African citizen, a copy of a South African Identity Document.
b. In the case of foreign nationals, the proof of identity (Passport) must be certified.

 

10. All supporting documentation submitted to The Compensation Fund must reflect the identity and claim numbers of the employee.

 

11. The completion of medical reports cannot be claimed separately, fees quoted in the COID medical tariffs are inclusive of medical report completion.

 

12. The tariff  amounts published in the COID medical tariffs guides, for services rendered do not include VAT unless otherwise specified. All invoices for services will therefore be assessed without VAT.
a. VAT will be applied without rounding off, to invoices for service providers that have confirmed their VAT vendor status through the submission of their VAT registration number.

 

13. All Medical Service Providers transacting with The Compensation Fund will be subject to a vetting process.

 

14. All Medical Service Providers must ensure that they are compliant with the Board of Health Funders to avoid payments being due to them being withheld.

 

15. Medical Service Providers may be requested to grant The Compensation Fund access to their premises for auditing purposes.