Magrietde Beer had an accident in December 2003 whilst employed at Unity Primary inTarlton. She suffered T4 paraplegia and claimed from Workmen’s Compensation.
Magriet receivesa permanent disability pension from the Workmen’s Compensation Fund who alsopay all medical expenses relating to her injury including her colostomyflanches and bags, medication, etc. An additional payment of R280 per month was paid to assist with care and a wheelchair. In 2011 her care assistance was increased to R1300 per month enabling a caregiver to come in twice a day. Magriet says ittook about a year for the Compensation Fund to approve her claim.
According to the Workmen’s Compensation Act (WCA), Magriet is entitled to a new wheelchair every five years. Her first wheelchair was a Quicky RXS and, two years ago, she submitted a quote for a new one as well as a bath hoist and acar carrier for her wheelchair.
“The Fundapproved my first wheelchair, which was a Quicky, but this time they have comeback and approved only R17 000. The same Quicky today, according to the quote I submitted, costs R30 000.00.”
Magriet hasalso requested assistance from the Fund for a bath hoist as she is currentlyusing a bucket of water to bathe herself. It takes two people to lift her intoa bath and “This is not possible because my brother and my sister’s child arenot always available to assist me.”
At thetime of the accident Magriet was married but they divorced two years ago andshe now lives with her mother, brother and his foster child. “They help as muchas they can. My mother, who is 73, helps me a lot but recently she developedhip and back problems and so she battles to pick up my chair and get it in and outof the car boot.”
For thisreason, Magriet requested a carrier for her wheelchair. She also asked if the Fund would be able to assist with the purchase of a vehicle for her, as sherelies completely on her mother to take her places. When Magriet contacted Rolling Inspiration she had received no response on these items.
SuzettePelser is the Managing Director of Working Knowledge International, anoccupation health medical examinations company. She explains that claims forWorkmen’s Comp differ for temporary and permanent disability compensation. “Apermanent disability claim is often paid out in a lump sum and then that personhas to survive on that amount for the rest of their life. If there are futureclaims, then the same claim number is used.” She says it is possible for aclaim to be reopened and for the Fund to pay out.
Theprocess for claims is a simple one, says Suzette, but should not beunderestimated. “Claiming from the Fund is not a quick process and can take along time. This period of time differs depending on the case as well as thelevel of the backlog at the Fund offices.” She says you can approach a companyto assist you that specialises in Workmen’s Compensation.
KlaasBerkenboseh, client relations manager of Corporate Industrial Risk Consultants(CIRC) which deals specifically with Workmen’s Compensation for big corporates,also says you can approach a specialised company to assist, but warns againstgoing to a lawyer. “When I hear that someone has gone to a lawyer, I want to gothrough the roof. A lawyer will not be able to assist you as a company thatspecialises in Workmen’s Compensation, and they will only take a percentage ofyour money.”
He is inagreement with Suzette that the process is a simple but prolonged one. “Theoffice has to guard against fraud and corruption, and this prolongs theprocess. The merit of each claim has to be determined and, unfortunately, thereare unscrupulous people out there who try to get benefit from the fund, withouthaving a real injury.” “Because of this the job of the people at the WC officeis so much harder. While they try their best, instead of just having todetermine the merits of a claim, they have to guard against fraudulent claims.”
He alsosays most people are not well informed about Workmen’s Compensation. “The manin the street is not educated on how the fund works. Many people do think that,if they have an accident during work, they can claim for millions and livewithout working forever. Not true.”
Inreality, there are a number of ways in which claims are determined and paidout. He says that the Act will not assist you in understanding this. “Apermanent disability will be measured on a scale and paid out according to thatscale. So, for example, a disability determined to be a 1 to 30% disabilitytype will pay out a different amount to a disability of a higher ranking. So a 1to 30% disability pays out a lump sum and this sum will be based on yourearnings at the time of the accident.”
According to Claims4U, permanent disabilityis compensated (following the assessment of the disability according to theschedules prescribed in the Act) as follows:
- <30% disability = (% disability/30) x 15x their monthly income. (Single lump sum payment)
- 30% disability = 15 x their monthly income. (Single lump sum payment)
- >30% disability = (0.75 x monthly income) x % disability = monthly pension until death of worker
You may object but the amount cannot be more than the pension you wouldhave received had you been 100% disabled.
The lackof understanding of how the Fund works can add to the prolonged nature of aclaim if the process is not followed correctly says Klaas. He says it isimportant to get your paperwork to the Fund Office quickly because it will taketime once it is there. “A delay in your paperwork only means you have to waitlonger. For example, in many cases, the claims are approved but the claimer hasnot logged their bank details with the Fund and then it takes more time. Justoverlooking one small step in the process creates more delays.”
Notfamiliar with Magriet’s case, Klaas could not say why her claim is taking thetime it is. “Each claim is specific to that person so, without looking at theirclaim history, I would not be able to say with confidence what the problemmight be.”
HesterHattingh handled her claim at the Department of Education in Johannesburg and a source at the Fund explained thatMagriet is classified as an Injury on Duty as she was on duty when her accidentoccurred. “We took over her medical responsibilities and act as her employer asshe is not working for the Department anymore.”
The samesource says that, while Magriet’s claim stays open her whole life, it does notmean there are not problems. “This is because, within the Fund, there existguidelines on what the Fund is allowed to pay. As such the reply to Magriet’srequest for a wheelchair was granted, but not for the amount for the wheelchairshe requested.” “Her request for a carrier and bath hoist has received noresponse to date. It is very frustrating not only for her, but also for us. Thelump sum she was paid out originally was not much and so she could not purchasethe carrier and hoist, but the Fund views it as money given to do just that.”
Magrietsays she is very grateful to Hester and the person looking after her case atthe Fund. “Both these ladies are angels and I know that they have been doingthe best they can to assist me.” She is also nervous of causing a fuss. “Idon’t want to start something that will cost me my pension, which I really cannotsurvive without but, on the other hand, I really need a new wheelchair.”
Herpredicament probably echoes those of many others who can do nothing, but waituntil their claim has been approved. Or not.
Claimingfrom Workmen’s Compensation
The Compensationfor Occupational Injuries and Diseases Act provides for “compensation fordisablement caused by occupational injuries or diseases sustained or contractedby employees in the course of their employment, or for death resulting fromsuch injuries or diseases; and to provide for matters connected therewith”. Assuch it relates to all employers;casual and full time workers who are injured, disabled or killed or become ill.
When a worker becomes ill or injured on duty, the employer needs tonotify the Department of Labour of the event by completing an Employers Report of an Occupational Disease Form.
The employee may then fill in a 'notice of an Occupational Disease and Claim for Compensation' form, and make a statement to start theclaim process to the Compensation Commissioner. Although employers are expected to report the incident and assist youwith claims it is possible to submit a claim personally.
How do you claim?
According to http://www.labour.gov.za/legislation/acts/how-tos/compensations-for-occupational-injuries-and-diseases/ (which both Suzette and Klaas recommend you look at) the following process has to be followed:
- Inform you supervisor or employer as soon as possible (verbally or in writing). Make a note of anyone who witnessed the accident. The form that needs to be completed by you is WCL 2: Notice of Accident and Claim for Compensation.
- The employer must then report the accident to the Compensation Commissioner, even if they don’t believe the worker's story, by submitting Form WCL 3: Employer's Report of Accident.
The employer must report a workplace injury within 7 days or within 14 days of finding out that the worker has an occupational disease/injury.
The employee should check that all the details on the form are correct.
- Within 14 days of seeing the worker, the doctor must fill in form WCL4 stating how serious the injury was and how long the worker is likely to be off work. This is sent to the employer who sends it to the Commissioner.
The worker does not pay for the doctor's fees. But if you want a second opinion, you will have to pay for this.
- If the injury will take a long time to heal, the doctor must send a progress report (WCL 5) to the Commissioner every month until the condition is fully stabilised. This informs the Commissioner of how long the worker is off work.
- Finally the doctor must submit a final doctor's report (WCL5) stating either that the worker is fit to go back to work or that the worker is permanently disabled. The doctor must send this form to the employer who sends it to the Commissioner.
- When the worker goes back to work, the employer must send a resumption report (WCL6) to the Commissioner.
- The worker and the employer should keep copies of all the completed forms.
- When the first doctor's report has been submitted, with the accident report, the Compensation Commissioner will consider the claim and make a decision. A claim number will also be allocated. This number should be used for all paperwork relating to a claim.
- Decisions can be appealed within 90 days by submitting form W929 to the Commissioner.
- Forms should be submitted to: Compensation Commissioner, PO Box 955, Pretoria, 0001
- You can contact the Commissioner or any Regional Office of the Department of Labour for more information and for assistance.
Disclaimer: Every attempt has been madeto ensure that the information contained in this article is correct but westrongly recommend that you speak to a professional who specialises in Workmen’sCompensation to assist you in any dealings with the Fund.