Compensation Fund Presentation to the Consumer Goods Council of South Africa
CONTENTS • BACKGROUND • FACTS ON COMPEASY • REGISTRATION OF CLAIMS • PAYMENT OF MEDICAL CLAIMS • PAYMENT HISTORY • COVID – 19 CLAIMS
Mandate The Compensation Fund is established in terms of section 15 of the Compensation for Occupational Injuries and Diseases Act as amended. The main objective of the Act is to provide compensation for disablement caused by occupational injuries or diseases sustained or contracted by employees or for death resulting from such injuries or diseases and provide for matters connected therewith .
VISION To be a world class provider of sustainable compensation for occupational injuries and diseases, rehabilitation and reintegration services Mission – Provide efficient, quality, client centric and accessible COID service – Sustain financial viability – Ensure an organisation which takes care of the needs of its staff for effective service delivery
FUNCTIONAL STRUCTURING GOVERNANCE Governance Structure Executive Authority – Minister of Employment and Labour Accounting Authority – Director General Advisory Board – Appointed from social partners through NEDLAC Compensation and Disability Care & CHANGES TO THE POLICY AND LEGISLATIVE Medical Benefits Pension Benefits Rehabilitation ENVIRONMENT • COIDA AMENDMENT BILL REGULATIONS ON EMPLOYER • ASSESSMENT COMPLIANCE CORPORATE SUPPORT
ICT LANDSCAPE Employer Registration Claim Registration ROE Medical Invoices LOGS Medical Reports Compeasy.labour.gov.za Cfonline.labour.gov.za Online Services
STATISTICS AND FACTS ON COMPEASY
• R e g i s t r a t i o n o n t h e D e p a r t m e n t o f E m p l o y m e n t L a b o u r w e b s i t e a s a u s e r i s n o t s u f f i c i e n t . • O n c e R e g i s t e r e d a s a u s e r o n t h e d e p a r t m e n t s w e b s i t e , a s e p a r a t e r e g i s t r a t i o n u s i n g t h e s a m e I D n u m b e r n e e d s t o b e c o m p l e t e d o n t h e C O M P E A S Y l i n k f o u n d o n O n l i n e S e r v i c e t a b o f t h e d e p a r t m e n t s w e b s i t e • T h e r e q u i r e d d o c u m e n t s t o s u p p o r t r e g i s t r a t i o n o n C O M P E A S Y d e p e n d i n g o n w h e t h e r y o u a n e m p l o y e r , m e d i c a l s e r v i c e p r o v i d e r o r a n i n t e r m e d i a r y r e p r e s e n t i n g e i t h e r t h e e m p l o y e r o r t h e m e d i c a l s e r v i c e p r o v i d e r
1 . E m p l o y e r • C o m p l e t e t h e E x t e r n a l U s e r r e g i s t r a t i o n t a b o n C O M P E A S Y • P r o o f o f R e s i d e n c e / P r o o f o f b u s i n e s s a d d r e s s • U s e r A c c e s s f o r m f i l l e d a n d S i g n e d b y t h e o w n e r • C e r t i f i e d I D c o p y o f t h e o w n e r o f t h e c o m p a n y • C I P C D o c u m e n t s o f t h e b u s i n e s s • V a l i d C F R e f e r e n c e n u m b e r 9 9 0 0 o r P r a c t i c e n u m b e r f o r m e d i c a l s e r v i c e p r o v i d e r s 2 . M e d i c a l S e r v i c e P r o v i d e r • A b o v e i n 1 p l u s : • H e a l t h P r a c t i c e C e r t i f i c a t e ( B H F ) 3 . I n t e r m e d i a r y ( T h i r d p a r t y ) • A b o v e i n 1 p l u s : • C e r t i f i e d I D c o p y o f t h e o w n e r o f t h e c o m p a n y • C e r t i f i e d c o p y o f I D i f y o u a r e a t h i r d p a r t y r e p r e s e n t i n g t h e a b o v e • P o w e r o f A t t o r n e y o n a c o m p a n y l e t t e r h e a d s i g n e d a n d d a t e d b y t h e d i r e c t o r
REGISTRATION OF CLAIMS
• C l a i m s c a n b e r e g i s t e r e d e x t e r n a l l y u s i n g a n a p p l i c a t i o n t a b o n c e s u c c e s s f u l l y l o g g e d i n o n C O M P E A S Y i f y o u a r e a n e m p l o y e r o r a n i n t e r m e d i a r y ( t h i r d ) p a r t y w i t h t h e r e l e v a n t a u t h o r i s a t i o n t o s u b m i t c l a i m s o n b e h a l f o f a n e m p l o y e r • C l a i m s c a n b e r e g i s t e r e d i n t e r n a l l y b y t h e c l a i m s h a n d l e r s o f t h e C o m p e n s a t i o n F u n d , m a n u a l f o r m s h a v e b e e n f u l l y c o m p l e t e d . • C l a i m s c a n b e a d j u d i c a t e d a n d a u t h o r i s e d f o r p a y m e n t f o r t h e d i f f e r e n t t y p e s o f b e n e f i t s ( T T D , P D , T P D a n d P e n s i o n s )
R e q u i r e d I n f o r m a t i o n i n s u p p o r t o f a c l a i m • A F U L L Y c o m p l e t e d E M P L O Y E R S R E P O R T O N A N A C C I D E N T ( W . C L 2 o r W . C L 1 ) w h i c h c a n b e c a p t u r e d o n C O M P E A S Y • – V a l i d I d e n t i t y D o c u m e n t ( c e r t i f i e d ) I D o r D r i v e r s L i c e n s e o r P a s s p o r t o r B i r t h C e r t i f i c a t e • F U L L Y c o m p l e t e d r e l e v a n t Q u e s t i o n a r e s r e l a t e d t o t h e s p e c i f i c i n c i d e n t • N o t i c e o f A n A c c i d e n t a n d C l a i m f o r C o m p e n s a t i o n ( W . C L 1 4 ) m u s t b e c o m p l e t e d • I n o r d e r t o a d j u d i c a t e o n t h e c l a i m o n c e l i a b i l i t y h a s b e e n a c c e p t e d : IOD Occupation Disease • • First Medical Report (W.Cl22) and/or valid medical report with a full clinical First Medical Report (WCL 4) or a valid medical report with a full clinical description by a medical practitioner registered in terms of the Health description by medical practitioner registered in terms of the Health Profession’s Act Professions Act • • Work Exposure Report For claims related to Post Traumatic Stress Disorder claims, a First Medical Report by Psychiatrist (W.CL303) • Medical Report detailing the symptoms and clinical features • Pathologist report where necessary • Industrial History (W.CL110) • Any other medical report or comment • Which ever is necessary : Biopsy/Histology Results/Cytology Report, Lung Function tests/Laboratory Investigations/Baseline Audiograms, preemployment report, diagnostic audiograms ENT report
MEDICAL CLAIMS
• M e d i c a l I n v o i c e s c a n b e c a p t u r e d i n t e r n a l l y b y t h e c l a i m s h a n d l e r s o f t h e C o m p e n s a t i o n F u n d ( S i n c e 0 1 N o v e m b e r 2 0 1 9 ) • M e d i c a l I n v o i c e s c a n s u b m i t t e d e x t e r n a l l y u s i n g F T P p r o c e s s e d c a l l e d s w i t c h i n g i f y o u a r e a n m e d i c a l s e r v i c e p r o v i d e r o r a n i n t e r m e d i a r y ( t h i r d ) p a r t y w h o c o m p l i e s w i t h r e q u i r e m e n t s G a z e t t e d b y t h e F u n d i n J u l y 2 0 1 9 . ( S i n c e 0 7 N o v e m b e r 2 0 1 9 ) • M e d i c a l I n v o i c e s c a n s u b m i t t e d e x t e r n a l l y u s i n g a n a p p l i c a t i o n t a b o n c e s u c c e s s f u l l y l o g g e d i n o n C O M P E A S Y i f y o u a r e a n m e d i c a l s e r v i c e p r o v i d e r o r a n i n t e r m e d i a r y ( t h i r d ) p a r t y w i t h t h e r e l e v a n t a u t h o r i s a t i o n t o s u b m i t c l a i m s o n b e h a l f o f a n m e d i c a l s e r v i c e p r o v i d e r ( S i n c e 7 F e b r u a r y 2 0 2 0 )
PAYMENTS
HISTORY OF PAYMENT Medical Claims Compensation Benefits Pensions Total FY 2020/2021 (1 April to 31 to date ) 1 002 831 277 19 587 615 372 001 632 1 394 420 524 FY 2019/2020 (1 April to 31 March) 1 865 406 282 180 105 137 1 185 297 355 3 230 808 773 FY 2018/2019 (1 April to 31 March) 2 483 935 444 241 968 776 1 159 701 933 3 885 606 154 FY 2017/2018 (1 April to 31 March) 2 395 539 222 165 546 356 1 083 086 813 3 644 172 391 FY 2016/2017 (1 April to 31 March) 2 963 696 340 152 134 199 1 054 340 133 4 170 170 671 FY 2015/2016 (1April to 31 March ) 2 507 144 019 119 073 439 1 479 941 770 4 106 159 228
COMMON CHALLENGES
Recommend
More recommend
