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Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

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Annual Increase in Medical Tariffs for Medical Service Providers - 2025

Private Hospital Gazette 2025

General Information

5. Overview of the COID Claims Process

 

5.1 All claims lodged in the prescribed manner with the Compensation Fund are subjected to the following process:
5.1.1. New claims are registered by the Employers with the Compensation Fund in the prescribed manner. Details of and progress of the claim can be viewed on the online processing system for registered users of the system.
5.1.2. Proof of identity is required in the form of a copy of an Idenmity document/card, will be required in order for a claim to be registered with the Compensation Fund. In the case of foreign nationals, the proof of identity (passport) must be certified.
5.1.3 All supporting documentation submitted to the Compensation Fund must reflect the identity and claim numbers of the employee.
5.1.4. The allocation of a claim number to a claim after the registration thereof by  the Compensation Fund, does not constitute acceptance of liability of a claim. It indicates that the injury on duty has been reported to the Compensation Fund and acknowledged.
5.1.5. When liability for a claim is accepted by the Compensation Fund in terms of the COID Act, reasonable medical expenses, related to the medical condition shall be paid to medical service providers, that treat the employees, in accordance to approved tariffs, billing rules and procedures as published in the medial tariff gazettes of the Compensation Fund.
5.1.6. If a claim is repudiated in terms of the COID Act, medical expenses, 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.
5.1.7. 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 and liability can be determined.
5.1.8. Manner of payment of medical benefits for Compensation Fund claims, where liability has been accepted (adjudicated) on or after 1 April 2025.
5.1.9. 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 and may be rejected.
5.1.10. All service providers should be registered on the Compensation Fund claims processing system in order to capture medical invoices and medical reports for medical services rendered.
5.1.11 Medical reports and medical invoices should ONLY be submitted/transmitted for claims that The Compensation Fund has accepted liability for and thus reasonable medical expenses are payable.