UNRAVELLING THE COMPLEXITIES OF COIDA

UNRAVELLING THE COMPLEXITIES OF COIDA

By Shantonette Pillay, Regional Director, KwaZulu-Natal Region.

COIDA – the Compensation for Occupational Injuries and Diseases Act – is the new name for the Workmen’s Compensation Act (WCA). The Act provides for compensation for disablement caused by injuries sustained or diseases contracted by employees in the course of their work, or death resulting from such injuries and diseases.

Who can claim for compensation?

Anyone who is employed under a contract of service and receiving wages may claim compensation in terms of COIDA, the exception to the rule is domestic workers in private homes. Dependants of an employee who is fatally injured, can also claim for compensation. Casual employees should be treated in the same way as full-time employees.

The procedure when you are injured or have contracted a disease as a result of your work, is that first, the employee must report the injury, disease and/or accident immediately to their supervisor and/or employer.

The employer is legally responsible for reporting the injury on duty/disease to the Compensation Commissioner. The employer needs to submit the necessary forms and/or documents to the Compensation Office, where after a claim will be allocated by the Compensation Office.

The form

When the employee goes to a hospital or doctor he/she will have to take the ‘W.CI.2 – Part B’ form, which was completed by the employer together with the employee.

This form is important because it contains all the information regarding employer and employee details together with the details that relate to the employee’s injury or disease. It is also important because it shows the claimant was injured at work.

The medical report

When the doctor writes the first Medical Report (W-CI-4) and Progress/Final Medical Report (WC-CI-5), this must be given to your employer to send to the Compensation Commissioner Officer. The First Medical Report is important to the Compensation Office because the doctor gives a detailed clinical analysis of the employee’s injury. The Final Medical Report is also important, as it states the date when the employee will be fit to return to work. It also describes any permanent disability, if any, as a result of the accident.

Types of compensation

It must be remembered that any employee who is permanently or casually employed, or being trained by an employer can claim from the compensation fund. An employer must report a claim within seven days or within 14 days of finding out that the employee has an occupational disease. The employer has a duty to report it, even if they don’t believe the accident or disease is work-related.

The fund will cover employees who are hurt in an accident while working, who have contracted an occupational disease or illness through their work, or who have died as a result of a workplace accident or occupational disease.

There are some categories of employees who are excluded from claiming under the fund.

For example, you cannot claim if you are:

  • A domestic worker in a private home (but you can claim if you are a domestic worker employed by a business, such as a hotel or guest house); a member of the South African National Defence Force or South African Police Services as they have their own fund).
  • An employee who works outside South Africa for more than 12 months at a time, unless there is a special agreement with the Commissioner.

Who contributes to the fund?

Employers must pay into the Compensation Fund once a month, and there is no contribution from the employee. Therefore, as an employer you cannot deduct money from the employee’s wages as contributions to the Fund.

When does the fund not pay compensation?

Claims will only be paid if they are submitted in the correct way and within the proper time frames.

The claim will not be paid if:

  • It is more than 12 months after the injury or death, or more than 12 months after the disease has been diagnosed.
  • The employee is off work for three days or less but he/she may be covered by the employee’s own medical aid or sick benefit fund.
  • The accident or injury is a result of the employee’s own wrong doing or misconduct, unless the employee was seriously disabled or died as a result of the accident.
  • The employee unreasonably refuses to have medical treatment.

What compensation can be claimed?

There are five main types of compensation:

  • Temporary disability.
  • Permanent disability.
  • Death.
  • Medical expenses.
  • Additional compensation.

Compensation is worked out as a percentage of the wage the employee was earning at the time the injury occurred or the disease was diagnosed.

The Compensation Fund only pays for loss of movement or use of your body, you cannot claim for pain and suffering.

Temporary disability

Temporary disability means that the employee will eventually get better.

  • If the employee is off work for three days or less, no compensation will be paid.
  • However, if the employee is off for more than three days, he/she will receive compensation that also covers the first three days.
  • Temporary disability can be total or partial.
  • If you have a total temporary disability and cannot work at all, you will receive 75% of your normal weekly or monthly wage.
  • If an employee has a partial temporary disability and is able to do some of his/her work or light duties at less than his/her normal wage, he/she will be paid 75% of the difference between what he/she is paid and his/her normal wage from before the injury.
  • An employee can claim compensation for temporary disability for 12 months. If the condition has not improved after 12 months, the Commissioner may agree to continue payments for up to 24 months. After 24 months, the Commissioner may decide that the condition is permanent and grant compensation on the basis of permanent disability.

Permanent Disability

A permanent disability is an injury or illness that you will never fully recover from.

Disabilities are rated from 100% to 1% depending on the seriousness.

The employee’s doctor needs to write a medical report about the permanent disability, which the Commissioner, together with a panel of doctors, will use to work out the percentage of disability set out in Schedule 2 of the Compensation for Occupational Injuries and Diseases Act.

Some examples:

  • Loss of two limbs: 100%
  • Loss of hearing in both ears: 50%

If the disability is measured at more than 30%, the employee will receive a monthly pension for the rest of his/her life. The amount of pension he/she receives will be worked out from his/her wages at the time of the injury as well as the percentage of disability.

If the injury is 30% or less, the employee will receive a once off lump sum payment.

Death benefits

Death Benefits Compensation can be claimed by a widow or dependants if an employee dies as a result of an occupational injury or disease. If there are no dependant family members then other family members have a claim, for example, the employee’s parents.

The amount of compensation paid depends on the relationship to the deceased, but the total amount paid to the family cannot be more than the pension the deceased employee would have received if he/she was 100% disabled (i.e. 75% of the monthly wage).

The spouse will receive a lump sum of two x 75% of the employee’s wages plus a monthly pension for life of 40% x 75% of the employee’s wages.

The employee’s dependent children under the age of 18 are entitled to a monthly pension of 20% x 75%. This pension stops once the child is 18 years old, but may continue for longer if the child has a mental or physical disability.

When applying for death benefits, certified copies of the following documents must be submitted:

  • Marriage certificate.
  • Children’s birth certificates.
  • Death certificate.
  • Declaration by the spouse (Form WCL32).
  • The employer’s incident report.
  • Funeral accounts (Form WCL46).
  • Details of income and property.

Medical expenses

All medical expenses of an employee will be paid for up to two years from the date of the accident or diagnosis of the disease.

It is important for all medical accounts to be submitted to the Compensation Commissioner.

Additional compensation

In addition to the general compensation, extra compensation may be allowed if the injury or disease was caused by the employer’s negligence or a fault with his/her work equipment or machinery.

Any employee who is under 26 years will receive extra compensation.  An application for additional compensation must be made on form W930 within 24 months of the injury or disease being diagnosed.

Who pays the compensation claim?

The Compensation Commissioner is appointed to administer the Fund and approves employee’s claims.

The employee gets money from the Fund and not from the employer but for the first three months or less that he/she is off work, the employer must pay him/her 75% of the normal monthly or weekly wage and the employer can claim this back from the Compensation Fund.

If an employee is off work for more than three months, the Compensation Commissioner takes over the monthly payments.

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