Compensation for Occupational Injuries and Disease
In South Africa, occupational injuries and diseases is regulated by the Compensation for Occupational Injuries and Disease Act, Act 130 of 1993 (COIDA).
The aim of COIDA
The main objective of the COIDA is to facilitate a process which provides for payment of medical treatment and compensation for disablement caused by occupational injuries and diseases sustained by employees in the course of their employment, or for death resulting from such injuries or diseases; and to provide for matters connected therewith. As employer AISJ is registered with the Compensation Fund and will be responsible to administer claims on behalf of employees. Please note that the Fund doesn’t compensate for pain and suffering. Workers who are injured on duty or obtain an occupational disease can claim compensation for temporary or permanent disablement.
If a worker die because of an injury on duty, his/ her dependents can claim compensation form the Fund. COIDA works on the proviso of “at the discretion of the Compensation Commissioner” and protects AISJ from civil claims in this regard.
Definition of an accident (IOD)
Means an accident arising out of and in the course of an employee's employment and resulting in a personal injury, illness or the death of the employee.
Definition of an occupational disease
Any disease contemplated in section 65(1)(a) or (b). Subject to the provisions of this Chapter, an employee shall be entitled to the compensation provided for and prescribed in this Act if it is proved to the satisfaction of the Director-
(a) that the employee has contracted a disease mentioned in the first column of Schedule 3 and that such disease has arisen out of and in the course of his or her employment; or
(b) that the employee has contracted a disease other than a disease contemplated in paragraph (a) and that such disease has arisen out of and in the course of his or her employment.
Notice of accident by an employee to AISJ.
Who is entitled to receive compensation?
A person who has entered into or works under a contract of service or of apprenticeship or learnership, with an employer, whether the contract is express or implied, oral or in writing, and whether the remuneration is calculated by time or by work done, or is in cash or in kind, and includes:
- a casual employee employed for the purpose of the employer's business;
- a director or member of a body corporate who has entered into a contract of service or of apprenticeship or learnership with the body corporate, in so far as he acts within the scope of his employment in terms of such contract;
- a person provided by a labor broker against payment to a client for the rendering of a service or the performance of work, and for which service or work such person is paid by the labor broker;
- in the case of a deceased employee, his dependents, and in the case of an employee who is a person under disability, a curator acting on behalf of that employee.
Dependent of an employee means
- a widow or widower who at the time of the employee’s death was married to the employee according to civil law;
- a widow or widower who at the time of the employee’s death was a party to a marriage to the employee according to indigenous law and custom, if neither the husband nor the wife was a party to a subsisting civil marriage;
- if there is no widow or widower referred to in the above mentioned, a person with whom the employee was in the at the time of the employee’s death living as husband and wife;
- child under the age of 18 years of the employee or of his or her spouse, and includes a posthumous child, a step-child, an adopted child and a child born out of “wedlock’;
- a child over the age of 18 years of the employee or of his or her spouse, and a parent or any person who in the opinion of the Director-General was acting in the place of the parent, a brother, a sister, a half-brother or half-sister, a grandparent or a grandchild of the employee;
- a parent of the employee or any person who in the opinion of the commissioner was acting in the place of the parent, and who was in the opinion of the Director-General at the time of the employee’s death wholly or partly financially dependent upon the employee.
Type of accidents or diseases that must be reported to the Compensation Fund
- All accidents and diseases deemed to have arisen out of and in the course of the employment of an employee.
- Alleged accidents/diseases that entail medical expenses.
- Temporary or permanent disablement.
- Death Notice of an accident to the employer.
Notice of an accident to the employer
Notice (written or verbal) of an accident shall, as soon as possible after such accident happened, be given by or on behalf of the employee concerned to the AISJ.
Notice of an occupational disease to the employer
- The medical practitioner should report all suspected occupation disease to the employer by making use of the WCL 22 form.
- After receiving the WCL 22 form, the employer should report the disease to the Provincial Director. A copy of the WCL 22 form should be attached to the WCL 1 when the decease is reported.
Administration of the claim
- HR will be responsible for the administration of these claims and should be notified as soon as possible.
- The Compensation Fund does not accept forms any more. All claims must be electronically submitted/ logged electronically on the Umehluko System.
Period for the reporting of claims
- Claims for IOS’s must be logged within 7 days from the date of the accident.
- Claims for Occupational Diseases must be logged within 14 days from the date that the disease was diagnosed.
Procedure for the reporting of claims
- Most medicals service provides would however require a “WCl 2 form” (Employers report for the reporting of an accident) for IOD’s and a “WCl 1 form” (Employers report for the reporting of an occupational disease) for Occupational Diseases.
- These forms will be available at the HR office.
The employee and the doctor
- The employee is permitted to freely choose his own doctor, and no interference with this privilege is permitted as long as it is exercised reasonably and without prejudice to the employee himself or the Compensation Fund.
- Please note that not all medical service providers accept IOD’s. As teacher/ employee; it would be highly advisable to make use of a medical service provider that do accept IOD’s.
- These providers would claim the medical expenses directly from the Compensation Fund.
- It would not be advisable to make use of your own medical aid or to pay for these expenses from your own pocket. AISJ will not be liable for refunds in this regard.
- In the event of a change of doctors attending a case, the first doctor in attendance will, except where the case is handed over to a specialist, to be regarded as the principal, and payment will normally be made to him.
- As a general rule, changes of doctor are not favored, unless there are sufficient reasons therefore.
- The Compensation Commissioner or an AISJ may send an injured employee to another doctor chosen by him (Compensation Commissioner or AISJ) for a special examination and report.
Claims with the Compensation Fund are processed as follows
- If the claim is accepted as a COID Act claim, reasonable medical expenses will be paid by the Compensation Commissioner.
- If the claim is rejected (repudiated), services will not be paid by the Compensation Commissioner.
- All parties are informed of this decision, including the service providers.
- The injured employee will then be liable for payment.