Dr Lucas Mosidi Director: Medical Services

1

THE COMPENSATION FUNDDr Lucas Mosidi

Director: Medical Services

1

Rehabilitation, Return-to-Work (and the Law)

22

TABLE OF CONTENTS

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1 • Mandate of the Fund

2 • Vision and Mission

3 • Core Business Units

4 • Our Strategic Rehabilitation Pillars

5 • Our Case Management Approach

6 • Our Rehabilitation Logic Model

7 • Patient-centred Approach

8 • The Legislative Framework

9 • Strategic (Re) Focus

10 • Strategic Policy Framework

11 • The Coid Amendment Bill

12 • Responsibilities of Stakeholders

13 • Desired End State

MANDATE

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• Established in terms of Section 27(1)(c) of the Constitution under the Bill of Rights to provide social security and appropriate social assistance

Constitutional Mandate

• To provide compensation for disablement caused by occupational injuries or diseases sustained or contracted by employees or for death resulting from such injuries or diseases and provide for matters connected therewith.

Legislative Mandate

• The Compensation Fund is established in terms of Section 15 of the Compensation for Occupational Injuries and Diseases Act as amended

Statutory Establishment

VISION & MISSION

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Our Vision

To be a world-class provider of sustainable compensation for occupational injuries and diseases, rehabilitation and reintegration services

Our Mission

To provide efficient, quality, client-centric and accessible COID service

To sustain financial viability

To ensure an organization which takes care of the needs of its staff for effective service delivery

CORE BUSINESS UNITS

6

Insurance Underwriting and Beneficiary ServicesCOID Services

• Claims Registration and Adjudication

• Benefit Payment ( TTD, TD, CCA, Fatal Benefits, Funeral Benefits, Pensions)

• Employer Registrations

• Return of Earnings and Assessments

• Compliance and Audits

Medical Aid Medical Benefits

• Medical Services ( Policy and Regulation services)

• Medical Claims (MSP Registrations, Medical Aid, Tariff Determinations, Electronic Invoice Switching)

• Managed Care (Pre-authorisations, Case Management)

Employee Reintegration ServicesRehabilitation Services

• Vocational Rehabilitation Programmes

• Social Reintegration Programmes

• Provision of Assistive Technology

OUR STRATEGIC REHABILITATION PILLARS

7

Medical Rehabilitation

Vocational Rehabilitation

Social Reintegration

Provision of Assistive Technology

OUR CASE MANAGEMENT APPROACH

8

Injury/ Occupational

Disease

Case Management

Injury/ Disease Management

Medical Treatment

Medical Rehabilitation

Rehabilitation

Vocational Rehabilitation

Social Reintegration

Assistive Technology

Active Involvement of all Stakeholders at every stage of Care

Employers Trade Unions Employees Compensation FundMedical Service

Providers

OUR REHABILITATION LOGIC MODEL

Objective Strategy Output Outcome Performance Indicator

9

Sustainable Social Security

Managed Care Quality RehabilitationFunctional & Social

Independence% Rehabilitated &

Reintegrated

PATIENT-CENTRED APPROACH

10

Employee (Beneficiary)

Employer

Medical Service

Provider

The Fund

OHNP/OMP

THE LEGISLATIVE FRAMEWORK

11

Co

nst

itu

tio

n (

The

Bill

of

Rig

hts

) Section 27(1)(c): Everyone has the right to have access to social security, including, if they are unable to support themselves and their dependents, appropriate social assistance.

Section 27(2): The state must take reasonable legislative and other measures within its available resources, to achieve the progressive realization of each of these rights

Section 27(3): No one may be refused emergency medical treatment

Bas

ic C

on

dit

ion

s o

f Em

plo

yme

nt

Act

(B

CEA

75

of

19

97

) Section 22: Sick Leave – 36/12 cycle

Section 23: Proof of Incapacity – Sick note if absent 2 days or more

Section 24: Application to occupational accidents or diseases –Nullifies Sections 22 & 23

Section 25: Maternity Leave – 4/12

Section 26: Protection of employees before and after birth of a child- (1) No hazardous work; (2) Suitable or alternative employment on same terms for six (6) months post-natallyif (a) Night Work and (b) Reasonably Practicable

Section 83: Deeming of persons as employees

Section 87(1)(b): Code of Good Practice on the Protection of Employees during Pregnancy and after the Birth of a Child.


12

Lab

ou

r R

elat

ion

s A

ct (

LRA

66

o

f 1

99

5) Section 185: Right to not be

unfairly dismissed or subjected to Unfair Labour Practice

Section 186(1): Meaning of Dismissal

Section 186(2): Meaning of Unfair Labour Practice

Section 187: Automatically Unfair Dismissals: (1)(e): Pregnancy, intended pregnancy or any reason related to pregnancy; (1)(f): race, gender, sex, ……disability,etc.

Section 200A(4): Code of Good Practice on Who Is an Employee?

Section 133: Dispute resolution through Commission (CCMA)

Emp

loym

ent

Equ

ity

Act

(EE

A

55

of

19

98

) Section 5: Employer to promote equal opportunity and eliminate unfair discrimination in all policies and practice

Section 6 (1): Prohibition of unfair discrimination on the basis of disability

Section 7(1): Prohibition of Medical testing

Section 8: Prohibition of psychological testing

Section 9: Employee includes applicant of employment

Section 15: Affirmative action measures 2(a) identify and eliminate employment barriers 2(c) reasonable accommodation of designated groups

(3) Preferential treatment of designated groups


13

Occ

up

atio

nal

Hea

lth

& S

afet

y A

ct (

OH

SA 8

5 o

f 1

99

3) Section 3(1): Employer to ensure

first aid treatment in case of injury or emergency

Section 8(1): Employer to provide and maintain safe working environment

Section 8(2)(b-d): Employer to identify, assess, evaluate and mitigate occupational hazards

Section 14 (a): Responsibility of employee towards health & safety; (c) abide by lawful instruction; (e) immediate reporting of injuries

Sections 24 & 25: Employer to ensure reporting of all work-related injuries and occupational diseases

Min

e H

ealt

h &

Saf

ety

Act

(M

HSA

29

of

19

96

) Section 5: Employer to maintain healthy and safe mine environment

Section 11: Employer to assess and respond to risk

Section 12: Employer to conduct occupational hygiene measurements

Section 13: Employer to establish system of medical surveillance,; read in conjunction with Sections 14 – 20.

Section 22: Employees’ duties for health and safety

Section 23: Employees’ right to leave dangerous working place

Section 54: Inspector’s power to deal with dangerous conditions

Section 55: Inspector’s power to order compliance

Section 86: Negligent act or omission


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Co

mp

ensa

tio

n f

or

Occ

up

atio

nal

Inju

ries

&

Dis

ease

s A

ct (

CO

IDA

13

0 o

f 1

99

3) Section 22: Right to Compensation;

read in conjunction with Sections 38 – 41.

Section 26: Special circumstances in which the Director-General may refuse award

Section 28: Employee requiring constant help

Section 29: Liability for payment of compensation

Section 42: Employee to submit to medical examination

Section 44: Prescription

Section 45: Consideration of claim; read in conjunction with Sections 47 – 49.

Section 56: Increased compensation due to negligence of employer

Co

mp

ensa

tio

n f

or

Occ

up

atio

nal

Inju

ries

&

Dis

ease

s A

ct (

CO

DA

13

0 o

f 1

99

3-

con

t.) Section 66: Presumption regarding

cause of occupational disease; read in conjunction with Sections 65 & 68.

Section 73: Medical expenses; read in conjunction with Sections 72 & 74.

Section 75: Director-General to decide on need for, and nature and sufficiency of, medical aid.

Section 76: Fees for medical aid; read in conjunction with Sections 77 & 78.

Section 79: Consultation of representative medical authorities by Director-General.

Section 85: Variation of tariff of assessment

Section 90: Review of decisions by Director-General

Section 91: Objections and appeal against decisions of Director-General

STRATEGIC (RE)FOCUS

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Grow Social Safety Net

Improve Claims Turnaround Times

Active Case Management

Rehabilitation & RTW

Disability Management

Disability

Management

Rehab

& RTW

Active Case

Management

Improve

Claim TAT

Grow Social

Safety Net

Current Focus Business Process Reengineering Future Focus

STRATEGIC POLICY FRAMEWORK

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Ensure enabling legislation

Driven by CF in accordance with its RR/RTW Policy Framework and COIDA

Aligned to the vision and strategic objective of the Fund

Responsive to the call of the NDP Vision 2030 to create an inclusive social protection system

Developed in collaboration with all stakeholders

With the ultimate aim of addressing the needs of the most vulnerable (injured/diseased employees)

Outlines the rights, roles and responsibilities of all stakeholders

Puts special emphasis on the need for health promotion and disease and injury prevention

Encourages evidence-based methodologies and best practice across the board

Based on a biopsychosocial approach which takes into account medical, psychological and social aspects

THE COID AMENDMENT BILL

To amend the Compensation for Occupational Injuries and Diseases Act, 130 of 1993 so as to substitute, insert, delete and repeal certain

sections and definitions; to provide coverage for domestic employees, to provide for rehabilitation, reintegration and return to work of occupationally injured and diseased employees; to regulate

the use of health care services; to provide for the reopening of claims; to provide for criminal and administrative penalties; to

regulate compliance and enforcement, to provide for no fault based compensation system and to provide for matters connected

therewith.

• The Preamble

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• by the insertion after the definition of “Disablement" of the following definition: "‘Disability ' means for purposes of rehabilitation in terms of this Act a permanent long-term or recurring physical or mental disability which substantially limits the prospects of a person to obtain by virtue of any service employment or profession the means needed to enable that person to provide for maintenance;

Disab

ility

• "‘Rehabilitation' means measures, services and facilities also in the form of clinical, vocational and social rehabilitation provided for in Chapter VIIA of the Act provided with a view to the reintegration of employees exposed to an occupational injury or disease back into work and to enable them to attain and maintain where reasonable and practicable maximum independence, full physical, mental, social and vocational ability and full inclusion and participation in all aspects of life.

Reh

abilitatio

n


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• 26 (b) if, in the opinion of the [Director -General] Commissioner the death [was caused,] or the disablement was caused, prolonged or aggravated, by the [unreasonable refusal or wilful neglect of the] employee’s unreasonable refusing to submit to medical aid or rehabilitation programs in respect of any injury or disease, whether caused by the accident or existing before the accident. ".

Ap

po

rtion

men

t (Se

ct. 26

)

• 42 (a) by the substitution for the heading of the following heading: "Employee to submit to medical examination and rehabilitation; (b) by the insertion after subsection (1) of the following subsection: 1A An employee contemplated in subsection 1 shall if required to do so submit himself or herself to an examination for purposes of rehabilitation.

Ind

epen

de

nt

Op

inio

n (Sect. 4

2)


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• 70A. (1) Subject to the provisions of this Act the Compensation Fund may provide as the case may be facilities, services and benefits aimed at rehabilitating employees suffering from occupational injuries or diseases, to return to their work and to reduce any disability resulting from their injuries or diseases.

Reh

abilitatio

n

(Ch

apter V

IIA)

• 70A (2) The rehabilitation benefits provided in subsection 1 may consist of:

• (a) clinical rehabilitation and the provision of assistive devices for the purpose of physical and psychological recovery of the employee and to reduce any disability resulting from an occupational injury or disease;

• (b) vocational rehabilitation to assist an employee to maintain employment, obtain employment, retain or acquire vocational independence; and

• (c) social rehabilitation to assist in restoring an employee's independence and social integration to the maximum extent practicable. "

Rein

tegration

&

RTW

(Sect.16

)

RESPONSIBILITIES OF THE FUND

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Claim Registration & Adjudication

Early Identification of Eligible Cases

Case ManagementBenefit Management

Stakeholder Management &

Collaborative Framework

RESPONSIBILITIES OF THE EMPLOYER

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Provide Safe Workplace

Early Reporting of Injuries

Institute RTW Programmes

Provide Suitable Accommodation

Maintain Occupational Hygiene & Medical

Surveillance Systems

RESPONSIBILITIES OF THE REHABILITATION PROFESSIONAL

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Provide Cost-effective

Rehabilitation

Design Rehabilitation &

RTW Plans

Identify & Address RTW Barriers

Advise Employers on Suitable

Accommodation

Maintain Ethical, Evidence-based

Practice

RESPONSIBILITIES OF THE OCCUPATIONAL HEALTH & MEDICINE PROFESSIONAL (OHNP/OMP)

24

Protection & Promotion of

Employee Health

Assist in Establishment of Emergency Preparedness

Early Identification & Reporting of Deviation

from Health

Provide Expertise in Addressing Barriers in

RTW

Formulate Policies & Procedures for Effective RTW

Maintain Evidence-based OH Programmes

DESIRED END STATE

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EXC

EPTIO

N

Contact Details

Dr Lucas Mosidi

Compensation Fund

[email protected]

Tel: (012) 406 5856/5

Cell: 076 448 7248

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mailto:[email protected]

Thank You

Gracias

Obrigado

Ndaa..

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Documents

Dr Lucas Mosidi Director: Medical Services