COIDA IDA Form of insurance for work related incidents/ accidents - - PowerPoint PPT Presentation

COIDA IDA

 Form of insurance for work related incidents/ accidents …compulsory

• Employees have right to compensation….. even if employer fails to

register

• Employer can be penalized for non-registration.
• EPWP

 Section 17.1 - It is the responsibility of the employers (other than a contractor) to arrange for all persons employed on a EPWP to be covered in terms of the Compensation for Occupational Injuries and Diseases Act, 130 of 1993.



Funding

• Exclusively funded by employers

 Probability of injury, determined by employers accident frequency/risk profile…23 classes  Cost of claims, approximated by employers wage bill Applicable to all staff

• Employees are covered for loss of earnings and medical treatment……….more

than 3 days.

• Protect employers against employees who might sue………may not sue

employer, only third party

 Purpose

• Compensate employees…….injured or disease (work related)
• Pay medical expenses
• In the event of employees death….. compensate dependants

Conveyance of injured employee….responsibility of Employer (can claim back) (Section 72)

Who is an employee

Any person, irrespective of age, who is employed by an employer for the purpose of his/her business activities. It includes temporary and casual workers.

 Mandators (employers) and Contractors

• Contractors are compelled to registered and pay

assessment

• If not, the Mandator will be regarded as the

employer……………contractors employees Not for substantive provision of the Act …Section 56

 Accidents outside the Republic

• If temporary employed outside SA for not

more than 12 months…….covered

• Employer bringing in temporary staff from

abroad ……….agreement with CC (unless employed for more than 12 months)

 No compensation payable. When?

• Willful misconduct of employee, unless:

 The accident result in a serious disablement, or  The employee dies and leave dependants

• Can also hold employer individually or mutually

liable for cost

Drunkenness Not adhering to SHE requirements.

 No compensation payable. When?

• Knowing the information is false
• Death or disablement was caused by willful

neglect of the employee by not seeking medical aid

 Definition of Accident

• “accident means an accident arising out of and in the course of an

employee’s employment and resulting in an personal injury, illness

• r the death of the employee”

 “arising out of” – must be related to the employees duty (what

he/she was employed to do)

 “in the course of” – busy performing his/her duty during normal

working hours.

The above does not debar an employee of claiming when injured whilst performing overtime or other special duties.

 Definition of an Occupational Disease (Section 65 (1) (a) or

(b))

• “that an employee has contracted a disease mentioned in the

first column of Schedule 3 and that such a disease has arisen

• ut of and in the course of his or her employment”
• “that an employee has contracted a disease other than a

disease contemplated in paragraph (a) and that such a disease has arisen out of and in the course of his or her employment”

 Difference

• “Accident” – can be specifically related to a

certain event, time and place

• “Disease” – Cannot be pinpointed….could

result of exposure to harmful agents over a long period

 Reporting by employee

• Employee to report as soon as possible after accident happened or

disease has been diagnosed……….employer

• Right to benefits shall lapse if not reported within 12 months

 Reporting by Employer

• Report within 7 days after having learned of it …………”prescribes

manner”

• Employer must report…….whether agree or not that it is an

accident.  Report any “Accident or Alleged Accident”

 Internal

• Receive no COID forms or received claims are incomplete:

 No full names  No I.D numbers  Blank spaces  No date and type of injury

 Causes….

• No or late registration of claims
• Claims cannot be traced…..Commissioner
• Doctors submit accounts…not registered
• One injury……two claim numbers

 Implications

• Injured workers not being compensated
• Department not compensated…3 months
• Outstanding medical accounts
• Refuse medical treatment to injured staff
• Pay penalties

• Improve COID Administration
• Complete required forms
• Ensure submission to designated person
• Ensure timeous submissions
• Prevent fraudulent claims

• Centralized the COID process
• Report telephonically
• Reporting structure
• Submission of COID forms “prescribed”
• Implementation and commitment by all staff

 Benefits

• Injured workers are compensated
• Department compensated… 3 months
• Payment of medical accounts
• Treatment of injured staff
• No penalties

 Purpose  Injury  Occupational Disease  Serious Injury and Death

 Aimed at/role players:

• Contractors
• Project Managers
• Regional COID Administrators (RCA)
• National COID Administrators (NCA)

 Assist with the process of completion of COID

documents

 NCA & RCA must keep record of:

• Minor injuries
• Serious injuries
• Occupational diseases

INJURY

• Report all incidents to responsible manager

…shift incident occurred

• First Aid only – record in dressing book…first

aid kit

• Minor Incidents…require doctor treatment, do

the following…

STEP 1

• After receiving the Part A & Annex 1 Incident Report from the

contractor within 12 hours, the designated Project Manager must notify the RCA telephonically of the incident.

• The RCA inform the NCA by phone immediately. Once the supervisor /

manager has received the Accident Report (Annex 1) from the employee s/he must forward the report to the RCA. ..\..\Safety\Safety standards\Standards

2008\4.12 Incident investigation\Annexure 1.doc

STEP 2

 Designated Project Manager complete the Employers

Telephonic Report of an accident (TR 2) & (Annex A4) within 12 hours. COID Documents 2013\ANNEX,4A1.doc

 Fax them both to the RCA.  The RCA will then fax to the NCA immediately.  The RCA must forward original TR 2 within 24 hours with

certified ID and first medical report.

STEP 3

 Project manager or injured employee must deliver the (TR 2

card) & (WCI4) to the Doctor immediately. STEP 4

 (WCI4), must be returned to the Project Manager.  Fax it to RCA within 12 hours after receipt.  RCA must then fax the (WCI4) to NCA for processing.

STEP 5 – If worker is booked off

 WCI5 – (Final/Progress Report and the account I.r.o. an accident)

must be completed by the Doctor/Hospital

 Forwarded to the Project Manager  Fax it to the RCA immediately.  The RCA should then forward the (Final/Progress Report and

account I.r.o. an Accident) to the NCA immediately. If a worker is booked off for a month or more then a month (WCI5) must be filled in for every month that s/he is booked off.

STEP 6

 If the Doctor is satisfied with employees health, s/he will complete a

WCI5 – (Final/Progress Report and Account i.r.o an Accident)

 Contractor to submit to Project Manager.  The Project Manager must complete the WCI6 – Resumption

Report and fax them both to the RCA.

 The RCA will forward the form to the NCA for final processing.

It is the Project Manager’s responsibility to follow up on the WCI5 forms.

Ensure that you include the following in the TR2 form:



The correct registered name (Working for Water Programme)



The registration number (1132/737/0810)



Ensure that you include the Region, Project Name & Project Manager Name

• n Annexure 4.



Ensure that you include full name, surname and ID number of the injured worker. NB! ALL I.O.D. CLAIM DOCUMENTATION MUST BE COURIERED WITHIN SEVEN WORKING DAYS TO THE REGIONAL COID ADMINISTRATOR A.S.A.P. AND NOT TO THE COMPENSATION COMMISIONER.

OCCUPATIONAL DISEASE

STEP 1

 After being notified that an employee has contracted an

• ccupational disease, the Project Manager must immediately

notify the RCA by telephone.

 A Telephonic report of an Occupational Disease (TR1) must

be completed by the Project Manager and together with the Disease Control List (Annex 5A)

 Must be faxed through to the RCA within 12 hours.  The RCA must then forward immediately to the NCA.

STEP 2

 The Project Manager or infected employee must deliver a First

Medical Report for the Occupational Disease (WCI22), together with a copy of the (TR1) to the Doctor.

 Once completed it must be faxed to the RCA – 12 hours  The RCA must then forward it immediately to the NCA.

STEP 3

 The Project Manager must complete a Claim for Compensation

for Occupational Disease (WCL14) form and fax it to the RCA – 12 hours.

STEP 4 - If the worker is booked off



A Progress/Final medical Report (WCL26) must be completed



Once completed the Project Manager must fax it to the RCA – 12 hours.



If the worker is booked off for a month or more, then a (WCL26) must be completed for every month that s/he is off. STEP 5



Once the Doctor is satisfied with the condition of the employee’s health, s/he must complete a Progress/Final Medical Report in respect of an Occupational Disease (WCL26)



The Project Manager must complete a Resumption Report (WCI6) and fax both to the RCA for final processing.

 Report incidents before completing shift;  Seek medical attention;  Make sure to return to doctor/hospital for follow up

visits;

 Assist employer to obtain required reports;  Forward any correspondence received from the

Commissioner to the employer.

SERIOUS INJURY OR DEATH

STEP 1 The supervisor / manager must immediately report the incident telephonically to the RCA if a person, who must report immediately to the NCA:

 Has lost a limb or part thereof,  Died, or may die as a result of the injuries,  Is unconscious

The procedure for reporting a serious injury, which has not resulted in death, is the same as for a minor injury. If death occurred, please do the following.

STEP 2

 Project Manager must complete the Employers Telephonic Report

• f an accident (TR2), the Annex 6A form, plus documentary proof

indicating cause of death (Death certificate and Post Mortem Report) STEP 3 The employee leaves a widow/widower and/or children under the age of 18 years as dependants, the following must be supplied:

 A marriage certificate  Birth certificates/baptismal certificates/sworn statements regarding

the age of the widow/widower and /or children

 If the widow/widower is over 18 years, an Id documents is required.

STEP 4

 The Project Manager must send a Claim for Compensation

(WCI3) to the RCA immediately.

STEP 5

 The Project Manager must fax a Statement by the dependant

widow/widower of the diseased employee (WCI32) to the RCA.

STEP 6

 The Project Manager must fax a WCI46 plus specified burial

account and if paid, the receipt to the RCA.

STEP 7

 The Project Manager must fax a Pension ACB Magnetic Tape

Service form (WAC33) to the RCA, if the widow/widower wishes the money to be transferred to his/her personal bank account.

A person receiving a monthly pension from the Commissioner must annually complete a declaration form (W.Ac 22) and submit it with a certified copy of the ID

• f the pensioner. If not received, the pension payment stops.

 In cases of serious injury, the incident must be reported

immediately to the local Department of Labour.

 All serious incidents where a person is booked off for more

that 14 days, should also be reported to the DOL.

 In case of death, the incident must be reported immediately to

the local Police Services and DOL (Inspectors).

 The site where a serious injury or death occurred may not be

disrupted without the consent of an inspector of the Department of Labour.



When is a claim finalized

• Section 73(1) prescribes that the CC shall for the period of not more

than 2 years from date of an accident or disease pay medical expenses….unless specific conditions.

• A claim is finalized if a medical practitioner indicates the condition is

stabilized.

• Will not be kept open for conservative or symptomatic treatment.

Treatment must be aimed at reducing disablement. If a claim is closed no medical expenses will be paid, even if the doctor continue to prescribe medication.



Re-opening will be considered if the injured employee’s condition deteriorated as a result of the injury on duty and further medication will reduce the disablement.



Employee must at his/her own cost submit a medical report describing:  In detail the present clinical condition and anatomical defects and/or impairments of functions as a result of the accident (a definite diagnosis is required).  What is the relation between the present condition and the original injury sustained  The nature of the medical treatment contemplated and how it will reduce the disablement  Where applicable, it must be supported by additional reports of recent x-rays and/or other diagnostic reports. If the claim is approved, the employee will be refunded.

 Travel expenses is considered

• Where an employee has to travel to a medical provider for

treatment

• Type of vehicle and engine capacity determines the rate of

payment (AA rates)

One week after the (TR 1) or TR 2) has been faxed to the National Office, the RCA should contact the Cape Town office to obtain a claim number and composer number. Ensure that you include the following:

 The correct registered name (Working for Water Programme)  The registered number (1132/737/0810)  The complete Project name and Project Manager’s name on the

Disease Control List

 The full name, surname and ID number of the affected worker

 All the original copies of documentation regarding the above

procedures must be forwarded to the NCA by courier: Working for Water Programme 14 Loop Street Foreshore Cape Town 8000

 NCA based in Cape Town

Tel: (021) 441 2700 Fax: (086) 692 3476