Tuesday, March 13, 2012

There seems to be a lot of uncertainty amongst employees and employers when it comes to the procedure that must be followed when reporting and recording claims under the Compensation for Occupational Injuries and Diseases Act 130 of 1993 (“COIDA”) and how to avoid claims being ignored and prescribing.

This article seeks to shed some light on this by providing a step by step procedure that must be followed by employees and employers in making sure that claims are successfully submitted to the Compensation Commissioners.

General right to compensation

Section 22 of COIDA provides that if an employee meets with an accident resulting in disablement or death during the course of their employment, the employee or his or her dependants will be entitled to the benefits provided for in COIDA.  Employees that are covered by COIDA effectively are prevented from suing their employer for damages in common law and it is therefore important for both employees and employers to take cognizance of the correct procedure that must be followed when reporting workplace injuries.

Step 1 – Reporting of workplace injuries

Section 38 of COIDA prescribes that notice of an accident must be given as soon as possible by or on behalf of the employee concerned to the employer.  Written or verbal notice of the injury can be given to the employer.

Notice of the accident must then be given to the Commissioner in the prescribed manner by the employer.  The employer must investigate the incident and interview all witnesses and then report to the Commissioner.  In this regard section 39 (1) and (6) of COIDA dealing with the reporting of accidents provides as follows:

  •  “(1)     Subject to the provisions of this section an employer shall within seven days after having received notice of an accident or having learned in some other way that an employee has met with an accident, report the accident to the commissioner in the prescribed manner…
  • (6)        An employer… who fails to comply with subsection (1) shall be guilty of an offence.”

It must be noted that even if the employer receives notice or becomes aware of an accident in which one of its employees have been injured but believes the injury did not occur during the course and scope of employment, the employer is still under a duty to report the accident.

The official form that must be completed by the employer when reporting to the Commissioner is the W.CL.2 form – “Notice of Accident and Claim for Compensation”.  The W.CL.2 form consists of two parts:  Part A and Part B.

The Employer must complete Part A – “Employer’s Report of an Occupational Injury” and must forward the completed form W.CL.2 – Part A, consisting of page 1 and 2 to the Compensation Fund.

The Employer must also forward the detached Part B to the doctor or hospital involved who is treating the injured employee.  In cases of minor injuries the employee is required to take Part B along with him or her to the doctor or hospital.  In either event the doctor must complete Part B and send it off along with what is called the First Medical Report (W.CI.4) detailing the disease or seriousness of the injury and the likely period the employee will be off work to the Compensation Commissioner.  This must be done within 14 days of seeing the employee.

Step 2  -  Postcard to the Employer

After receiving and registering the claim, the Compensation Fund should forward a postcard (W.CL.55) to the employer.  A claim number is provided on the postcard (W.CL.55).  The claim number is to be used for all processes related to a claim.  When the First Medical Report of the doctor has been submitted with the accident report, the Compensation Fund is in a position to consider the claim and make a decision.

The Compensation Fund will issue a claim number within 2 weeks of the claim being lodged.  If however the forms are not properly completed and sufficient supporting documentation not provided, then the process can be delayed.

Once the claim number is issued and before the claim is submitted to the Commissioner for adjudication, all claim documents are scanned and converted into an electronic format which is stored on the Commission’s central computer database.  Employees and employers have recently experienced rather lengthy delays in having their claims adjudicated.  This is partly due to the Commission’s old computer system being replaced by a new system.  Inevitably, this has resulted in the system being off-line during the transition phase.

Another factor that causes delays in this regard is that this scanning process occurs in a building approximately 20 kilometers away from the Commissioner’s head office.  Be that as it may, claims can only be adjudicated once all claim forms and related documentation have been scanned into the system.

After the Compensation Commissioner has adjudicated and considered the claim, the Commissioner will issue a W.CL.56 form if the Commissioner accepts liability for payment of the claim.  Where a W.CL.56 is not issued, it normally indicates that the Compensation Commissioner has not accepted liability for any payment  if the employee disagrees with the decision, they can appeal the decision within 90 days by submitting an application form to the Commissioner.

Step 3  -  Progress Medical Report

If the injury continues for a long time and the employee is absent for a prolonged period, the medical practitioner involved must send a Progress Medical Report (W.CL.5) to the Compensation Fund on a monthly basis until such time as the condition has been resolved.

Once the condition is resolved the medical practitioner must send in a Final Medial Report, stating either that the worker is fit to return to work or that the worker is permanently disabled.  The doctor submits this form to the employer who is required to forward it to the Commissioner.

Step 4  -  Final Medial Report

Once the medical practitioner handling the case has established that the employee is fit to return to work or that the employee is permanently disabled, the medical practitioner will issue a Final Medical Report (W.CL.5) to the employer stating that the employee is fit to return to work or that the employee is permanently disabled.  The medical practitioner submits this form to the employer who in turn forwards it to the Commissioner.

Step 5  -  Resumption Report

After the employee has returned to work, a Resumption Report (W.CL.6) must be submitted and sent to the Compensation Fund as the Fund will only make final payment and close the case if all the required documentation is submitted.  The employer must complete and send off a Resumption Report (W.CL.6) to the Commissioner after the employee reports for work or is discharged from hospital.  The other reason for having to complete this form is to enable the employer to claim back any compensation the employer paid to the employee during the first three months he or she was off work.

Step 6  -  Keeping copies of all forms:

The employee and employer must keep copies of all the above forms and related documentation as this may be required should the Commission lose documents.  This has happened in the past, considering the fact that documents are scanned in a premises roughly 20 kilometers from the Commission’s offices.  It may also be needed in the event the employee wishes to appeal any decisions made by the Commissioner.

Employees and employers must note that the Compensation is currently experiencing a rather large backlog when it comes to dealing with claims and for this reason employees and employers should expect long delays in having their claims processed.  A new computer system has recently been introduced and is largely to be blamed for the backlog.

This article was written by Ebrahiem Abrahams and Pepler Sandri and first appeared in Health & Safety at work in SA, Issue 2/2012.