All claims lodged in the prescribed manner with The Compensation Fund undergo the following process:
| 1. |
New claims are registered by the Employers with The Compensation Fund. Details and progress of the claim can be viewed on the online processing system for registered online users. |
| 2. |
The allocation of a claim number after the registration of the claim by The Compensation Fund, does not constitute acceptance of liability. It confirms the injury on duty has been reported and receipt acknowledged by The Compensation Fund. |
| 3. |
In the event of insufficient claim information being made available to The Compensation Fund, the claim will be rejected until the outstanding information is submitted. |
| a. |
Please note that there are claims on which a decision might never be taken due to the non-submission of outstanding information. |
| 4. |
If a claim is repudiated in terms of the COID Act medical expenses for services rendered, will not be payable by The Compensation Fund. The employer and the employee will be informed of this decision and the injured employee will be liable for payment of medical costs incurred |
| 5. |
Reasonable medical expense in terms of the COID Act, become payable subsequent to the acceptance of liability by The Compensation Fund. |
| a. |
Reasonable medical expense shall be paid in line with approved tariffs, billing rules and procedures published in COID medical tariffs. |
| b. |
Only medical treatment related to the injury/disease shall be payable. |
| 6. |
Reasonable medical expenses for COID claims where liability has been accepted (adjudicated) on or after 01 April 2024: |
| a. |
All medical invoices for accepted claims must be submitted, in the prescribed manner within 24 months of the date of acceptance of liability. Medical invoices received after said time frame, will be considered as late submission of invoices. |
| b. |
Payment may be rejected/withheld for medical invoices that fail to meet the requirements as set in 6(a). |
Gold Membership
