21 bits of useful information

21 miscellaneous learnings from the Commissioner’s office

following a visit to the Western Cape office in April 2017,

with a list of queries, I put together this information sheet

1.     Pretoria commissioner's office is the only office that deals with Occupational Diseases.

2.     All province/regions have their own offices and each should manage their own injury claims

3.     If your claim ends up in a different province/region, that person should notify the correct province/region who can then work with the claim where it is.  If no notification is sent it seems unlikely that your claim will be dealt with or found.  (I think this is a possible cause of all of our delays and I will make a contact list as per no 4)

4.     There is a backlog of claims from before the system. There are a group of sisters working on either diseases or injuries.  I have at least 1 contact person’s email for each group and will put the contact numbers up on another blog post

5.     There are key people who receive all the emails on queries.  They filter and delegate them individually to appropriate people and apparently keep stats on these claims.  These people will be on a separate post

6.     Apparently wage repayments are not taken off the annual calculations.

7.     A process for claiming wages both before and after the 3 month period was defined.  It apparently is a good system and I have written it up in separate post.Just waiting fro the correct contact details to add.

8.     Pensions and compensation for medical expenses and Temporary Total Disability (TTD) are different systems online .  If you have a problem with obtaining a pension once a case is finalized, I have a contact person who I will put on the contact sheet

9.     Key points that cause problems with the success of claims:

a.      Salary/wages not clearly entered as the total required.

b.     dates on the resumption reports do not match the dates the doctors enter on their medical reports online so will possibly not be paid.

c.      Affidavits need to be entered when the company no longer pays the wages (ie after 3 months).  The final pay period is the date of the Affidavit which means a new Affidavit has to be entered each time.

10.  To avoid problems with deciding whether a case is reportable to Commissioner or not, or when cases become claimable later, I was advised that ALL incidents are reported. Within 30 days a claim number and acceptance/rejection will be received, but the claim is now registered.

11.  If reporting a late claim, i.e. injured person did not feel it was reportable or treatable at the time, it must be done manually.

12.  The Commissioner's office advises you should keep all documents on file even though they are sent in on scans.

13.  The commissioner pays government gazette rates for medical practitioners.  Excess charges for report writing will not be paid by the Commissioner.

14.  The Commissioner, internally, has a range of off time for various injuries.  If that time is exceeded, motivation for the extended treatment time for that injury would be needed.  This tends to be for longer periods, but if there is a query regarding the first 1-7 days, it is suggested the doctor is addressed in the case of doubt.

15.  As a rule, when there are doubts about the event, explain any back story on the documents e.g. the reason for not reporting on time, doubts about validity of claims, infection, breakdown of wounds

16.  As this is a no fault law, only the commissioner can make a decision on whether a claim is valid, so report all, and get his/her judgement.

17.  Even in the case of horse play or obvious misbehaviour, the case might be accepted to protect the family.  (HOWEVER, the OSHact can still be applied separately to this.  The laws do not interact with each other.)

18.  Rand Mutual does manage certain claims, as does FEM (Construction).  The Commissioner’s e-system will prevent you entering the case if it should go to either of these.  Rand Mutual now manages class 13 Employers: all engineering work including petrol stations.

19.  With inhouse doctors, firstly it is possible to claim fees for that visit from the commissioner and secondly, once the practice number of doctor is entered, it should be possible to go to medical reports; general and then select/enter 1^st , progress etc.  Please send screen shots of problems to me and I will follow it up with trainers I have met at the commissioner.

20.  As point 1 said, PTSD would be dealt with in Pretoria, however a date of a causative incident is crucial.  As PTSD develops later this can be problematic.  However, that incident needs to be registered.  Once PTSD is suspected a psychiatrist would diagnose it and go to the set of appropriate forms which sets the claim for PTSD in progress.   I will do a more detailed case on that and speak to the specific OHNP on this case.

21.  Where a person is injured, not claimable and then reinjured, it becomes messy reporting but the commissioner does not penalize the worker (see point 17). Put all information on the case and add documents to show the previous injury so when the doctor refers to it, it does not cause confusion (see point 15).

as I write more detailed posts on these points, I will link them here, updating this list.

6 reasons to manage IOD claims effectively

6 Reasons to manage IOD claims effectively

1. There is a legal responsibility to report all incidents and diseases (that require more than 3 days off and/or medical care) to the commissioner. 

2. The worker is entitled to the protection of the act and it is therefore an ethical duty to report the appropriate cases correctly for any permanent disability payment to be made to the worker. 

3. Claiming back the Temporary Total Disability (wages) is one way of reducing the loss due to lost time accidents and occupational diseases which can cause a huge direct and indirect financial loss, and the annual payment to the commissioner is also a large chunk of cashflow. 

4. To attain the standards set in SHEQ programmes like NOSA etc, the process of claiming has to be effectively managed. 

5. The well managed accidents provide a source of data for analysis for addressing the financial loss due to lost time accidents and occupational diseases. 

6. It is possible to reduce your rating with the commissioner if the full cost of each claim is known and less than the annual payment by approximately 20%-this requires careful monitoring of the process and each claim.

Why should poor safety behaviour be rewarded with compensation?

Why should an employee who was misbehaving and ignoring rules, be paid when they get injured?

  This is a question that gets asked all the time, and the answer is a little complicated, but it always involves reporting it to the commissioner, and he or she will decide. It is possible that the commissioner will reject the case if you give all the facts in the right place on the forms. It is up to the commissioner to make that decision, not the company.

But in the meantime, have an inquiry into the incident under the appropriate safety act and take the action specified there.  It is also possible, that your rules and regulations require dismissal.  If that is so, IT DOES NOT AFFECT the commissioner’s actions or the rights of the worker.  In other words, do what the safety act says you should.

The reasons behind the seeming contradiction:

·        to protect the worker and the his/her family’s income it is a No Fault Law

·        to allow the organisation to practice the promotion of a safe working environment, do an inquiry.

The commissioner will only reject the case if the injury causes disability below a certain level.  If it is above that level, compensation will still be paid.  That is where the first statement above comes into play.  The fact that the commissioner decides on the right to compensation is why you must report it to him/her, but this also gives the organisation the freedom to deal appropriately with the case under the safety act, as the worker’s rights are protected through the commissioner, not the organisation.

The golden rules are:

Report all cases under the Compensation act thoroughly to the commissioner, AND have an inquiry under the Safety act- do not mix the two acts.