Compensation Fund withdraws rule to pay only medical service providers

The Compensation Fund has agreed at the last minute to withdraw a notice which would have made it compulsory for it to pay claims only into bank accounts of medical service providers who treat employees who were injured on duty. 

The rule, published by the fund in the Government Gazette on September 10, was to have applied from Friday. The rule was designed to ensure that the fund will no longer accept nominated bank accounts of agents, including third-party administrators, for claims repayment.

The fund aimed to, from October 1, only make payments into the bank accounts of medical service providers who provide the service to the injured worker.

The proposed rules have raised the ire of a number of medical service providers, including the Injured Workers' Action Group, a coalition of affected and concerned parties whose objective is the efficient functioning of the fund.

They said the fund was chronically dysfunctional.

They said one of the results of the fund's inability to fix itself was that the doctors, private hospitals, physiotherapists and other medical service providers who treat injured workers have had to wait up to two years to be paid by the fund.

It was for this reason that medical service providers use the services of professional third-party administrators - at no additional cost to employers, injured workers or the fund itself - to navigate the fund’s dysfunction and secure payment for medical services rendered to injured workers.

The issue of the proposed prohibition of the involvement of intermediaries in claims and compensation recovering processes was part of the proposed amendments to the Compensation for Occupational Injuries and Diseases (Coid) Amendment Bill.

The Bill is now under consideration  by the National Council of Provinces.

In public comments made in relation to the Coid Amendment Bill in February this year, an orthopaedic surgeon practising in Pretoria, Dr Joseph Sibanyoni, stated that he treated injury on duty (IOD) patients with trauma injuries.

“I accept all cases and do not turn these patients away.”

Sibanyoni said he treated on average 150 IOD patients a year and the monthly value of the IOD claims averages R2m a year.

“In my experience it is extremely difficult and endlessly frustrating trying to submit IOD claims and receive payment from the Compensation Fund.”

Sibanyoni said it was for this reason that he uses the services of a third party administrator.

“The benefits for me using a third party administrator include guaranteed payment for treating IODs rather than an uncertain financial wait for months, potential financial ruin after years of hard work and study to qualify and set up our practice,” Sibanyoni said.

In another submission made by Dr Moira Wilson, a physiotherapist in private practice at Milpark Hospital in Johannesburg, she said she employed eight other fulltime physios.

She said her job was to return injured patients to all activities of daily living and back to work as soon as they have recovered. Wilson said the benefits of using a third party was the guaranteed payment of IOD cases timeously and she does not have to wait months to be paid.

“Medical practices are small businesses that employ staff, and these people deserve to be paid on time and not to be at the mercy of the (Compensation Fund).”

Labour department spokesperson Musa Zondi said on Thursday that the Compensation Fund has agreed to withdraw the notice that makes it compulsory to pay into bank accounts of claimants only.

“A withdrawal notice will be published in the government gazette soon. We will be publishing a new notice to give the public an opportunity to comment on this,” Zondi said.

Zondi said the proposed rules were a risk mitigation initiative to manage risks of fraudulent claims and paying claims into bank accounts of people who are not legitimate claimants.

“To achieve this we are implementing a bank account verification system with effect from  October 1 2021, meaning all claims sent for payment will go through verification in the system.

“If there are no discrepancies between the details of (medical service provider) or claimant then the payment will go through, but if there are discrepancies, these would have to be investigated before payment,” Wilson said.

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