Herman Enoch, marketing and communications manager at the Federated Employers Mutual (FEM) Assurance Company, outlines the claims procedure in cases of occupationally acquired Covid-19
The Compensation for Occupational Injuries and Diseases Act (COID Act) provides for compensation to an employee who is injured or disabled during the course of their work. Since March 2020, as a result of the Covid-19 pandemic, the Act has been expanded in a Notice to include “occupationally acquired Covid-19”.
It is applicable to a previously Covid-19-free individual who acquires the disease as a result of exposure to a confirmed case, or cases, of Covid-19 in the workplace or after an official trip to high-risk countries or areas.
A claim for occupationally acquired Covid-19 must be clearly set out as provided in sections 65 and 66 of the COID Act.
Occupationally acquired Covid-19 diagnosis relies on:
• Occupational exposure to a known source of Covid-19;
• A reliable diagnosis of Covid-19 as per the guidelines set out by the World Health Organization (WHO);
• An approved official trip and travel history to countries and/or areas of high risk for Covid-19 on work assignment;
• A presumed high-risk work environment where transmission of Covid-19 is inherently prevalent; and
• A chronological sequence between the work exposure and the development of symptoms.
An assessment of permanent impairment will be determined three months after diagnosis and when Maximum Medical Improvement (MMI) has been reached.
The degree of impairment will be evaluated based on “the complications of the Covid-19 from the affected body system(s)”.
Temporary Total Disablement (TTD):
Payment for TTD will be made for as long as such disablement continues, up to a maximum of 30 days.
Suspected and unconfirmed cases:
For self-quarantine recommended by a registered medical practitioner – in accordance with the Department of Health, WHO and International Labour Organization guidelines – the employer will be liable for remuneration for the employee for days of absence.
For confirmed cases and where the Compensation Fund or Mutual organisations, FEM and RMA have accepted liability, TTD will be paid from the date of diagnosis for a period of up to 30 days.
In an event where there are complications, the Commissioner or Mutual organisation has a right to review the case.
In a situation where there are complications, the Commissioner or Mutual organisation has a right to assess each case on merit and determine if there is any permanent disablement.
In all accepted cases of Covid-19, medical aid will be provided for a period of not more than 30 days from the date of diagnosis. If, in the opinion of the Director-General, further medical aid will reduce the extent of the disablement, this option will be considered.
The following documentation should be submitted to the Compensation Commissioner or the mutual association concerned:
• Employer’s Report of an Occupational Disease;
• Notice of an Occupational Disease and Claim for Compensation;
• Exposure and Medical Questionnaire;
• First Medical Report in respect of an Occupational Disease;
• Exposure History and/or any other appropriate employment history which may include any information that may be helpful to the Compensation Commissioner;
• A medical report on the employee’s symptoms that details the history and establishes a diagnosis of Covid-19, as well as laboratory results and chest radiographs where appropriate or any other information relevant to the claim;
• For each consultation, a Progress Medical Report;
• Final Medical Report in respect of an Occupational Disease when the employee's condition has reached MMI; and
• An affidavit by the employee if an employer cannot be traced.
Online claims must be made through the following channels, indicating the correct ICD-10 code-U07.1:
• Compensation Fund: CompEasy (www.labour.gov.za);
• Rand Mutual Assurance: CompCare (www.randmutual.co.za); or
• FEM: IMS (www.roe.fem.co.za).
Manual claims must be submitted as follows:
• Compensation Fund:
call 0860 105 350;
• Rand Mutual Assurance:
call 086 022 2132; or
• FEM: FEM-Registry@fema.co.za or
call 011 359 4300.