Presentation to the Consumer Goods Council of South Africa CONTENTS - - PowerPoint PPT Presentation

Compensation Fund Presentation to the Consumer Goods Council

• f South Africa

CONTENTS

• BACKGROUND
• FACTS ON COMPEASY
• REGISTRATION OF CLAIMS
• PAYMENT OF MEDICAL CLAIMS
• PAYMENT HISTORY
• COVID – 19 CLAIMS

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

• ccupational injuries or diseases sustained
• r contracted by employees or for death

resulting from such injuries or diseases and provide for matters connected therewith.

Mandate

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 Compensation and Pension Benefits Medical Benefits Disability Care & Rehabilitation COMPLIANCE CORPORATE SUPPORT Executive Authority – Minister of Employment and Labour Accounting Authority – Director General Advisory Board – Appointed from social partners through NEDLAC

CHANGES TO THE POLICY AND LEGISLATIVE ENVIRONMENT

• COIDA AMENDMENT BILL
• REGULATIONS ON EMPLOYER

ASSESSMENT Governance Structure

ICT LANDSCAPE

Online Services

Claim Registration Medical Invoices Medical Reports Employer Registration ROE LOGS

Cfonline.labour.gov.za Compeasy.labour.gov.za

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

• 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

• 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

• 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

• 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

• n

C O M P E A S Y

• P r o o f
• f

R e s i d e n c e / P r o o f

• 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

• w n e r
• C e r t i f i e d

I D c o p y

• f

t h e

• w n e r
• f

t h e c o m p a n y

• C I P C

D o c u m e n t s

• 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

• 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

• f

t h e

• w n e r
• f

t h e c o m p a n y

• C e r t i f i e d

c o p y

• 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
• f

A t t o r n e y

• 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

• n c e

s u c c e s s f u l l y l o g g e d i n

• 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

• 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

• 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

• 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

• 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

• r

D r i v e r s L i c e n s e

• r

P a s s p o r t

• 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

• 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 Profession’s Act

• For claims related to Post Traumatic Stress Disorder claims, a First Medical

Report by Psychiatrist (W.CL303)

• Pathologist report where necessary
• Any other medical report or comment

Occupation Disease

• First Medical Report (W.Cl22) and/or valid medical report with a full clinical

description by medical practitioner registered in terms of the Health Professions Act

• Work Exposure Report
• Medical Report detailing the symptoms and clinical features
• Industrial History (W.CL110)
• 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

• 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

• 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

N e t w o r k C h a l l e n g e s

• T h e

n a t i o n a l n e t w o r k i s s u e s a f f e c t i n g t h e

• n l i n e

s e r v i c e s i n c l u s i v e

• f

C o m p E a s y .

• E x t e r n a l

u s e r s l i m i t e d b a n d w i d t h a f f e c t i n g c o n n e c t i v i t y .

• F i r e w a l l

s e t t i n g s

• n

t h e s i d e

• f

t h e e x t e r n a l u s e r s p r e v e n t i n g a c c e s s t o C o m p E a s y .

• E x t e r n a l

u s e r s n o t a d h e r i n g t o t h e S A P p r e s c r i b e d b r o w s e r s . E x t e r n a l U s e r R e g i s t r a t i o n C h a l l e n g e s

• L a c k
• f

u n d e r s t a n d i n g

• f

t h e r e g i s t r a t i o n p r o c e s s b y e x t e r n a l u s e r s .

• H i g h

v o l u m e

• f

e x t e r n a l u s e r r e g i s t r a t i o n s u b m i s s i o n r e s u l t i n g i n e x t e n d e d t u r n a r o u n d t i m e f o r p r o c e s s i n g S t a k e h o l d e r R e l a t i o n s

• E m p l o y e r

m a s t e r d a t a n o t u p d a t e d l e a d i n g t o c o m m u n i c a t i o n s e n t t o w r o n g p a r t y .

• P o o r

s t a k e h o l d e r r e l a t i o n s c r e a t e i n f o r m a t i o n g a p

• L a c k
• f

u n d e r s t a n d i n g

• f

C o m p e n s a t i o n F u n d r u l e s a s d e v e l o p e d

• n

C o m p E a s y .

• N o n

c o m p l i a n c e

• f

e m p l o y e r s a f f e c t i n g c l a i m s r e g i s t r a t i o n , a d j u d i c a t i o n a n d p a y m e n t

• f

b e n e f i t s t o e m p l o y e e s

• L a c k
• f

u n d e r s t a n d i n g

• f

r o l e s ( M S P / E m p l o y e r / D u a l r o l e ) a s d e s i g n e d

• n

C o m p E a s y

• C o n t i n u o u s

t r a i n i n g n o t p r o v i d e d b y t h e C o m p e n s a t i o n F u n d .

.

COVID-19 Claims

• Government Notice 23 March 2020
• Directive 23 July 2020
• Information required to adjudicate claims
• Employers Report for Occupational disease WCL 1
• Notice of an occupational disease and claim WCL 14
• Exposure and Medical questionnaire
• First medical report WCL 22 Indicating ICD 10 code U07.1
• Work exposure history WCL 110 and any other history that may be required by the Compensation

Commissioner

• Medical report on employees symptoms that that details the history and establishes a diagnoses of
• Covid 19 as well as confirmed laboratory results .
• Progress medical report WCL 26 for each consultation
• Final medical report

Requirements

Claims Submission

Compensation fund :

CompEasy Covid19claims@labour.gov.za

Rand mutual :

CompCare Contactcenter@randmutual.co.za

FEM

IMS Femregistry@fem.co.za

Medical service provider expectations

• Submit invoices once liability has been excepted
• Provide medical reports and laboratory results to assist with

benefit payment and finalization of claims

• Assist the employee and employer with questionnaire

completion.

Contacts

CompEasy Support E-mail Compeasysupport@labour.gov.za General CF Enquiries CFCallCentre@labour.gov.za COVID-19 Technical Claims enquiries Dr Lucas Mosidi (Medical Services) Lucas.Mosidi@labour.gov.za

Thank you