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

Regulations

Regulations on IOD/OD Documents to be provided by Employers to Compensation Fund in Administration of Claims Adjudication Processes as per Section 6A(b) and 40(1) of the COIDA

2. Adjudication Process

 

The above information and reports are critical in the adjudication process (determining whether the injury or disease is related to work as per the definition of an Injury on Duty/Occupational Disease), the adjudication process will result to:

Liability accepted (accept liability for the payment of compensation and medical expenses)
Liability not accepted (where outstanding information /reports are required by CF) legal opinion with regards to timeframe refer to Section 40(2), (4) and (5)
Repudiated (where the incident/condition is not work related)
Under-investigation (where there are suspected misstatements of information) clear process and timeframe

 

2.1 Documents /reports required to adjudicate upon liability of a claim:
2.1.1 Injury on duty (IOD):
First Medical Report (W.CI.4) or a valid medical report with a full clinical description by a medical practitioner registered in terms of the Health Professions Act and registered with the relevant medical association(s)
For claims related to Post Traumatic Stress claims, a First Medical Report by a Psychiatrist (W.CI.303) is required
Any other medical report or comments /information should be provided which can have an influence on the consideration of liability of a claim.
In the case of Needle prick/exposure to blood injuries by health workers: Pathologist reports

 

2.1.2 Occupational disease (OD):
First Medical Report (W.CI.22) and /or valid medical report with a full clinical description by a medical practitioner registered in terms of the Health Professions Act and registered with the relevant medical health council including practice number.
First Medical Report (W.CI.303) in the case of Post Traumatic Diseases claims by a Psychiatrist health council including practice number.
Notice of an Accident and Claim for Compensation (W.CI.14) must be completed (Employee report to employer) Any other medical reports or comments/information should be provided which can have an influence on the consideration of liability of a claim.
Work exposure reports
Medical Report detailing the symptoms & clinical features
Industrial History (W.CI.110)
Biopsy / Histology Results 1 Cytology Report where necessary
Radiologist reports confirming a diagnosis, Chest X -Ray reports
Lung Function tests in the case of a lung condition
Laboratory Investigations confirming the diagnosis
In the case of Noise Induce Hearing Loss:
Baseline audiograms, pre -employment report (Medical Services advice on
adjudication) and exposure report.
Two diagnostic audiograms.
Ear, Nose and Throat Specialist Report (ENT) where necessary
In the case of Repetitive Strain injuries:
A detailed description by the employer of the specific work that the employee does, including number of repetitious movements involved and force required in the movements, and time exposed to these and other factors predisposing to the development of WRULDs.
A full medical report detailing symptoms and signs and a specific diagnosis, together with reports of any special investigations that support the diagnosis, together with details of treatment administered and/or planned.