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THE COMPENSATION FUNDDr Lucas Mosidi
Director: Medical Services
1
Rehabilitation, Return-to-Work (and the Law)
22
TABLE OF CONTENTS
2019/05/06 3
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
2019/05/06 4
• 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
2019/05/06 5
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.
THE LEGISLATIVE FRAMEWORK
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
THE LEGISLATIVE FRAMEWORK
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
THE LEGISLATIVE FRAMEWORK
14
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
2019/05/06 16
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, re- integration 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
2019/05/06 17
THE COID AMENDMENT BILL
2019/05/06 18
• 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
THE COID AMENDMENT BILL
2019/05/06 19
• 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)
THE COID AMENDMENT BILL
2019/05/06 20
• 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
21
Claim Registration & Adjudication
Early Identification of Eligible Cases
Case ManagementBenefit Management
Stakeholder Management &
Collaborative Framework
RESPONSIBILITIES OF THE EMPLOYER
22
Provide Safe Workplace
Early Reporting of Injuries
Institute RTW Programmes
Provide Suitable Accommodation
Maintain Occupational Hygiene & Medical
Surveillance Systems
RESPONSIBILITIES OF THE REHABILITATION PROFESSIONAL
23
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
2019/05/06 25
EXC
EPTIO
N
Contact Details
Dr Lucas Mosidi
Compensation Fund
Lucas.Mosidi@labour.gov.za
Tel: (012) 406 5856/5
Cell: 076 448 7248
2019/05/06 26
Thank You
Gracias
Obrigado
Ndaa..
27
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