Medical Cost Liability

Medical costs in terms of Chapter VIII of the COIDA were recently labelled by the CC as the biggest medical scheme in South Africa. Whether this statement is technically correct as it is not registered as such, is not relevant.  The fact of the matter is that it is a huge fund with much more benefits than that of the traditional medical schemes. It provides for a much wider spectrum of benefits. Let me give a few examples:

  • When an employee meets with an “accident” the employer is legally obliged to supply transport to a hospital or doctor.  (Section 72).  The transport cost emanating from this is according to the COIDA paid by the employer.
  • According to section 73 the CC shall be liable for the medical costs for a maximum of 2 years.  Thereafter the CC shall evaluate the extent of the residual injuries and if applicable award compensation for permanent disablement.  At the same time the payment of medical costs will be terminated.

The exception to the 2 year period [subsection 73(1)] is that the CC can extend the 2 year period if the CC is of the opinion that further medical treatment will reduce the disability should the medical treatment be prolonged.
Section 74 of Chapter VIII compels the medical practitioner to submit ”     within 14 days after having for the first time examined an employee injured in an accident or 14 days after having diagnosed an occupational disease in an employee furnish a medical report to the employer concerned in the prescribed manner”.  (Usually a W Cl 4 for an occupational injury).  I hope for the sake of all concerned in the medical profession to take note of this legal obligation.  If you do not get paid do not always blame the state.  (Section 74(1).  The 14 days mean exactly what was intended…Should the CC require further medical reports from the medical officer to adjudicate a claim, no further medical fees will be payable until such time as the report is submitted.  No levies or other fees may be charged as in the case of our medical schemes.  No amount for treatment can, therefore, be recovered from the injured employee or employer (subsection 76 & 77).

Cost of medical treatment for IOD’s In South Africa.
The medical aid supplied for the treatment of injured employees in terms of the COIDA is indeed as substantial as suggested by the CC.  The CC shall before determining the medical rates first consult with the Medical Association of South, the Chiropractic Association of South Africa and the Dental Association of South Africa.  Please note that no medical fee in excess of the tariffs annually published in the Government Gazette may be recovered from the patient, the doctor or the employer. (Subsections 76 and 77).
The expenditure in connection with Medical Aid
The amounts of medical aid supplied to injured employees are according to the archives from the Dept of Labour’s website for the most recent financial years published are as follows:±
                                            R million
2006/2007                        R1,415
2007/2008                        R1,287*
2008/2009                        R1,540

* How the ±11 % decrease came about for this financial year’s figures is a mystery.  Maybe one should keep in mind one of the recent disclaimers by the Auditor General who could not express an opinion on the CC’s Annual Report.
Another worrying aspect is the fact that the ratio between the compensation and the medical costs is changing every year.  Compensation was supposed to be 60% and medical costs 40%.  The last time I had a look it was the other way round (at least).  So the CC might be correct in his assumption that workers’ compensation is the largest medical aid scheme in the RSA.  It was, however, never meant to be. Due to a lack of space, I cannot give you the historical background.
There are peculiar practices concerning outstanding medical accounts.  The failure to timely pay medical accounts has lead to debateable business practices.  As there is very little that you and I can do to rectify the situation, I would leave it there with the hope that the investigations going on will produce results.

Till next time.