2016/17 Employer Manual - Randmutual.co.za - Rma · licence from the Minister of labour. the RMa...

CONTENTS

SECTION 1: OVERVIEW 6What is COiD anD COiDa? 6abOut RMa 7What DOes RMa DO? 8WhO aRe the eMplOyeRs COveReD by RMa? 9SECTION 2: DEFINITIONS 12What is an OCCupatiOnal aCCiDent? 12What is an OCCupatiOnal Disease? 12WhO is an eMplOyeR? 19WhO is an eMplOyee? 20WhO is a DepenDant? 20WhO is a healthCaRe pROviDeR? 21What aRe MeDiCal eXpenses? 21SECTION 3: RETURN OF EARNINGS SUBMISSIONS AND pREMIUM pAYMENT TO RMA 22subMitting ROes anD Making payMent tO RMa 23RegisteRing With RMa’s Online seRviCes 24SECTION 4: REpORTING AN ACCIDENT AND SUBMITTING A CLAIM TO RMA 261. What is My RespOnsibility When My eMplOyee has a WORk-RelateD aCCiDent? 26

2. When shOulD i RepORt an inJuRy OR Disease? 273. What DO i neeD tO RepORt tO RMa? 294. What iF i Delay RepORting the inJuRy OR Disease tO RMa? 29

4 Rand Mutual assuRance eMployeR Manual 2016/17

5. hOW DO i RepORt an aCCiDent tO RMa? 306. hOW DO i subMit a ClaiM tO RMa? 307. hOW DO i RepORt an aCCiDent telephOniCally tO RMa? 328. What inFORMatiOn anD DOCuMentatiOn DO i neeD tO subMit With My ClaiM? 339. unDeRstanDing yOuR ClaiM nuMbeR 3410. hOW tO ClaiM FOR a Multi-peRsOn event 3511. What is ReQuiReD FOR RMa tO aCCept liability? 3512. unDeRstanDing When tO subMit MeDiCal RepORts 3513. hOW DO i hanDle a nOise inDuCeD heaRing lOss (nihl) ClaiM? 3614. hOW DO i ClaiM FOR an eMplOyee WORking abROaD? 37SECTION 5: COID BENEFITS 391. teMpORaRy tOtal DisableMent 392. peRManent DisableMent 443. Death beneFits 484. What aRe the COiD beneFits FOR 2016/17? 515. MeDiCal eXpenses 53SECTION 6: REVIEWS/AppEALS 57SECTION 7: TRAINING 581. Online systeM tRaining 582. live WebinaRs 59SECTION 8: FRAUD 60SECTION 9: CONTACT US 62RMa bRanChes 62

5Rand Mutual assuRance eMployeR Manual 2016/17


SECTION 1: OVERVIEW

the Compensation for Occupational injuries and Diseases act (COiDa), 130 of 1993 as amended, provides for compensation to employees who are injured at work, contract an occupational disease or who die as a result of their occupational injuries or diseases. COiDa permits the Minister of labour to licence a mutual association to provide COiD benefits to certain industry classes. Rand Mutual Assurance (RMA) is such a mutual association licenced to provide COID benefits. COIDA came into effect on 1 March 1994, replacing the Workman’s Compensation Act (WCa) of 1941, and has a wider scope than the previous WCa.

COIDA regulates how and when employees who have been injured at work or who have contracted an illness or disease in the workplace are compensated and clearly sets out the legal requirements for tariffs, compensation and the limitations for workers’ claims.

COID benefits provide for medical examination and treatment, disability certification and compensation. similarly, when an employee has died as a result of injuries sustained in the workplace or an occupational disease, the dependents of the deceased employee may qualify for benefits.

WhAT IS COID AND COIDA?


Rand Mutual assurance (RMa) is a mutual assurance company with a track record of more than 120 years in the administration of claims for occupational injuries and diseases according to the Compensation for Occupational Injuries and Diseases Act (COiDa), 130 of 1993, as amended.

RMA is passionate about caring for the lives of its claimants and their families. It embodies its slogan of Caring, Compassionate Compensation at every level of the organisation, from its empathetic staff to embracing good corporate citizenship. RMA’s value lies not only in its compassionate approach, but in the excellent systems and processes it has in place to ensure timeous and efficient payment of valid claims. RMA has the licence to administer the claims for both Class IV (mining) and Class XIII (iron, steel, artificial limbs, galvanising, garages, metals and related industries).

Through its market-leading IT system, RMA offers enhanced efficiencies for the administration and paperless adjudication of COiD claims. as a company that is compassionate and caring, RMA goes the extra mile to ensure that beneficiaries and their families receive the care and compensation they are entitled to when they have sustained either a work-related injury or occupational disease.

Founded on 1 June 1894, RMA is a non-profit mutual assurance company which is owned by its policy holders. RMa operates in terms of section 30 of COiDa, under licence from the Minister of labour. the RMa group also operates under both short- and long-term insurance licences issued by the Financial Services Board (FSB).

With its head office in Johannesburg and regional walk-in branches located in Carletonville, Durban, eMalahleni, Johannesburg, Klerksdorp, Pretoria, Rustenburg and Welkom, RMa has a wide footprint and is easily accessible to its clients, claimants and other stakeholders. In addition, RMA has satellite offices in Lesotho, Mthatha and Mozambique.

An active training department has an all-encompassing approach to ensuring that stakeholders have a sound knowledge of RMA’s products and processes and how to access the online service facilities.

ABOUT RMA


the core of RMa’s business is the receipt, adjudication and administration of workers’ compensation claims, including the payment of medical costs, once-off disability payments and the ongoing payment of pensions in the case of severe disability and death.

The Compensation Fund is responsible for overseeing the compliance of RMA regarding all the requirements of COIDA.

In addition to COID, RMA identified a need for a range of value added non-COID products to service its clients. These products, which are currently offered to mining industry clients through RMA Life Assurance Company Limited, include:

• Commuting Journey Policy (CJP)• Augmentation Policy• Riot & Strike Policy• Stated Benefit (Funeral) Policy• Maternity Income Protection Plan• Group Personal Accident (GPA)

WhAT DOES RMA DO?

8 RanD Mutual assuRanCe eMplOyeR Manual 2016/17


RMA has the licence to administer the claims for both Class IV (mining) and Class XIII (iron, steel, artificial limbs, galvanising, garages, metals and related industries).

class IVThese employers belong to the mining and mining related industries and have the option to be administered by either RMa or the Compensation Fund. premiums are paid to the chosen insurer and claims can only be submitted to that insurer.

Subclasses within Class IV include:

WhO ARE ThE EMpLOYERS COVERED BY RMA?

subclass Description

0400 Underground mining and/or prospecting for any kind of mineral, metal and precious or semi-precious stones where such activities are conducted by means of shafts, tunnels and winches, but excluding coal mining; mine dump contracting.

0411 Coal mining

0420 Open cast mining, including slate quarrying but excluding coal mining and quarrying elsewhere rated; recovery of diamonds from sea, al-luvial mining and/or surface workings in connection with the recov-ery of or prospecting for any kind of mineral, metal and precious or semi-precious stones; working of sand, gravel and clay pits; recovery of gold from mine dumps; working of salt pans

0440 Quarrying of stone, flint, lime, etc. including stone crushing and all other operations incidental thereto

0441 Stone crushing operations as a separate business

class XIIIThese employers belong to the iron, steel, artificial limbs, galvanising, garages, metals and related industries. Effective from 1 March 2015, it is mandatory for all employers within this class to belong to RMA as per the Government Gazette Notice 565 of 2014. all premiums must be paid to, and claims submitted to, RMa from this date.


subclass Description1300 Iron and steel production including processing and all quarrying and/

or mining as well as other operations if incidental thereto.1301 Foundry products manufacturing as a separate business; stove

manufacturing.1331 Iron button, buckle, hook, eye, hairpin and/or metal badges and

brooch manufacturing; air-gun pellet manufacturing; leaden toy and novelty manufacturing; solder manufacturing; Venetian blind manufacturing and repairing; artificial limb manufacturing and repairing; manufacturing of vehicle and other, number plates.

1340 Metal tube manufacturing; metal furniture, door and/or window manufacturing; sheet metal products manufacturing as a separate business; wire, wire spring, wire rope, wire goods, fencing and/or gate manufacturing; tin container manufacturing; lead pipe manufacturing; blacksmith as a separate business (including farriers); iron bedstead manufacturing, cutlery manufacturing including repairing if undertaken by the manufacturer; scale making and repairing; cycle frame manufacturing; electro-static powder spray painting; metal spraying; derusting of metals; manufacturing of gas products, electric battery; accumulator and/or electrode manufacturing; building and/or repairing of ships (other than fibreglass, wooden or sailing ships) including repairs to ships whilst moored to the quay side or anchored in the harbour or roadstead or whilst undergoing trial runs; chain manufacturing as a separate business; aluminum products manufacturing and installation; welding as a separate business; galvanizing as a separate business; metal products manufacturing including the business of saw doctors; lighthouse and/or marine lighting engineering and metal or engineering works not otherwise classified but excluding structural steel erection or steel reinforcing operations rated under subclasses 0530 or 0532.

Subclasses within Class XIII include:


subclass Description1350 Electric cable manufacturing; manufacture of safety razor blades.

1360 Motor car assembly as a business including all operations in connection therewith.

1361 Motor garaging, including servicing and/or repairing of motor vehicles; the business of the owner of a motor graveyard or scrap yard; the business of an automotive electrician as a separate business; petrol and oil filling station; locksmithing; aircraft repairing and/or servicing as a separate business; employment of parking attendants; the business of a dealer in new/second hand motor vehicles; motor vehicle hiring if repairs are undertaken.

Note: (a)the sale of motor spare parts and/or cars etc., as well as the supply

of petrol, oil and/or air is incidental to the business of a motor garage owner whether such services are supplied on the garage premises or not.

(b)this rate also applies to a dealer in second-hand spare parts if the employer undertakes the dismantling of cars.

1363 Wagon, coach, carriage and/or motor body building as a separate business; panel beating and spraying as a separate business; motor car radiator manufacturing and repairing as a separate business


SECTION 2: DEFINITIONS

COIDA defines an occupational accident as one that arises out of and in the course of an employee’s employment and results in personal injury, illness or death of the employee. This means that an employee can claim for benefits if they are injured in an accident while they doing their work.

Occupational diseases are illnesses that are caused by substances or agents that the employee is exposed to in the workplace. It may take some time for a disease to manifest.

schedule 3 of COiDa sets out the occupational diseases that arise as a result of exposure to these agents. An employee can claim compensation if they develop occupational diseases as a result of these agents.

WhAT IS AN OCCUpATIONAL ACCIDENT?

WhAT IS AN OCCUpATIONAL DISEASE?



1. occupational diseases caused by exposure arising from work activities caused by:1.1 Chemical agents Beryllium or its compounds; cadmium or its compounds;

phosphorus or its compounds; chromium or its compounds; manganese or its compounds; arsenic or its compounds; mercury or its compounds; lead or its compounds; fluorine or its compounds; carbon disulphide; halogen derivatives of aliphatic or aromatic hydrocarbons; benzene or its homologues; nitro-and amino-derivatives of benzene or its homologues; nitroglycerine or other nitric acid esters; alcohols, glycols or ketones; asphyxiants like carbon monoxide, hydrogen sulfide, hydrogen cyanide or its derivates; acrylonitrile; oxides of nitrogen; vanadium or its compound; antimony or its compound; hexane; mineral acid; pharmaceutical agents; nickel or its compounds; thallium or its compounds; osmium or its compounds; selenium or its compounds; copper or its compounds; platinum or its compounds; tin or its compounds; zinc or its compounds; phosgene; corneal irritants like benzoquinone; ammonia; Isocyanates; pesticides; sulphur oxides; organic solvents; latex or latex-containing products; chlorine; and other chemical agents at work not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to these chemical agents arising from work activities and the disease(s) contracted by the worker.

diseases covered in schedule 3 of coIda


1.2 Diseases caused by physical agents:

1.2.1 Hearing impairment caused by noise

1.2.2 Diseases caused by vibration (vibration of muscles, tendons, bones, joints, peripheral blood vessels or peripherals nerves)

1.2.3 Diseases caused by compressed or decompressed air

1.2.4 Diseases caused by ionizing radiations1.2.5 Diseases caused by optical (ultraviolet, visible light,

infrared) radiations including laser1.2.6 Diseases caused by exposure to extreme

temperatures1.2.7 Diseases caused by other physical agents at work

not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to these physical agents arising from work activities and the disease(s) contracted by the worker.

1.3 Biological agents and infectious or parasitic diseases:

1.3.1 brucellosis1.3.2 hepatitis viruses1.3.3 Human immunodeficiency virus (HIV)1.3.4 tetanus1.3.5 tuberculosis1.3.6 Toxic or inflammatory syndromes associated with

bacterial or fungal contaminants1.3.7 Anthrax1.3.8 leptospirosis

diseases covered in schedule 3 of coIda (Continued)


2. occupational diseases by target organ system2.1. Respiratory diseases

2.1.1 Pneumoconioses caused by fibrogenic mineral dust (silicosis, anthraco-silicosis, asbestosis).

2.1.2 silicotuberclulosis pneumoconiosis caused by non-fibrogenic dust.

2.1.3 siderosis2.1.4 bronchopulmonary diseases caused by hard-metal

dust.2.1.5 bronchopulmonary diseases caused by dust of

cotton (byssinosis), flax, hemp, sisal or sugar cane (bagassosos).

2.1.6 Asthma caused by recognised sensitising agents or irritants to the work process.

2.1.7 Extrinsic allergic alveolitis caused by the inhalation of organic dusts or microbially contaminated aerosols arising from work activities.

2.1.8 Chronic obstructive pulmonary diseases caused by inhalation of coal dust, dust from stone quarries, woods dust, dust from cereals and agricultural work, dust in animal stables, dust from textiles, and paper dust, arising from work activities.

2.1.9 Diseases of the lung caused by aluminum.2.1.10 Upper airway disorders caused by recognised

sensitising agents or irritants inherent to the work process.



2.1.11 Other respiratory diseases not mentioned in the preceding items where a direct link established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the disease(s) contracted by the worker.

2.2 Skin diseases 2.2.1 Allergic contact dermatoses and contact urticaria caused by the other recognised allergy-provoking agents from work activities not included in other items.

2.2.2 irritant contact dermatoses caused by other recognised irritant agents arising from work activities not included in other items.

2.2.3 Vitiligo caused by other recognised agents arising from work activities not activities.

2.2.4 Other skin diseases caused by physical, chemical or biological agents at work not included under other items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from activities and the skin disease(s) contracted by the worker.

2.3 Musculoskeletal disorders

2.3.1 Radial styloid tenosynovitis due to repetitive movements, forceful exertions and extreme postures of the wrist.

2.3.2 Chronic tenosynovitis of hand and wrist due to repetitive movements, forceful exertions and extreme postures of the wrist.

2.3.3 Olecranon bursitis due to prolonged pressure of the elbow region.



2.3.4 Prepatellar bursitis due to prolonged stay in kneeling position.

2.3.5 epicondylitis due to repetitive forceful work.2.3.6 Meniscus lesions following extended periods of

work in a kneeling or squatting position.2.3.7 Carpal tunnel syndrome due to extended periods

of repetitive forceful work, work involving vibration, extreme posture of the wrist, or a combination of three.

2.3.8 Other musculoskeletal disorders not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the musculoskeletal disorder(s)contracted by the worker.

2.4 Mental and behavioural disorders

2.4.1 post-traumatic stress disorder2.4.2 Other mental or behavioural disorders not

mentioned in the preceding item where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising form work activities and the mental behavioural disorder(s) contracted by the worker.




(In the application of this list the degree and type of exposure and the work or occupation involving a particular risk of exposure should be taken into account when appropriate)

3. occupational cancerCancer caused by the following agents:Asbestos; benzidine and its salts; bis-chloromethyl ether (BCME); chromium VI compounds; coal tars, coal tar pitches or soots; beta-naphthy lamine; vinyl chloride; benzene; toxic nitro and amino-derivatives of ben-zene or its homologues; lionising radiations; tar pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues of these substances; Coke oven emissions; nickel compounds; wood dust; arsenic and its compounds; beryllium and its compounds; cadmium and its compounds; erionite; ethylene oxide; hepatitis B virus (HBV) and hepatitis C virus (HCV); and cancers caused by other agents at work not mentioned in the preceding items where a direct link established scientifi-cally, or determined by methods appropriate to national conditions and practice between the exposure to these agents arising from work activities and the cancer(s) contracted by the worker.

4. other diseases4.1 Miners’ nystagmus4.2 Other specific diseases caused by occupations or

processes not mentioned in this list where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure arising from work activities and the diseases(s) contracted by the worker.


an employer is anybody who employs an employee and includes any person controlling the business of an employer.

The employer pays premiums to RMA based on the earnings paid to employees. The employer may not deduct any money from an employee’s salary or wages towards these contributions.

WhO IS AN EMpLOYER?

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Any person who is employed and works under a contract of service or is being trained as an apprentice by an employer, including learnerships. Casual employees, directors and labour broker employees are considered employees whilst they are employed for the purpose of the employer’s business.

Exceptions:

• Domestic workers employed in private households;• Members of the South African National Defence Force and South African Police

Services;• Employees who live outside of South Africa for more than 12 months at a time,

unless there is a special agreement with RMA.

the above are not considered employees by COiDa and therefore cannot claim COID benefits.

According to section 1 of COIDA, a dependant of an employee can be any one the following:

• A widow/widower who at the employee’s death was married to the employee according to civil law (provided the marriage is registered with the relevant Ministry of Home Affairs and a marriage certificate can be produced);

• A widow/widower who at the time of the employee’s death was married to the employee according to indigenous law or custom, so long as neither the husband nor wife also had an existing marriage under civil law;

• If there is no widow/widower, a person with whom the employee was living with as husband and wife at the time of the employee’s death;

• A child under the age of 18 of either the employee or his/her spouse. This includes posthumous children, step-children, adopted children and children born out of wedlock;

• A child over the age of 18 of either the employee or his/her spouse, and a parent or any person who is acting in the place of a parent, a brother, sister, half-brother,

WhO IS AN EMpLOYEE?

WhO IS A DEpENDANT?


A healthcare provider refers to anyone rendering medical care, including doctors, specialists, allied health professionals (physiotherapists, chiropractors, dieticians, biokineticists, occupational therapists etc.), psychologists, psychiatrists and others.

Medical expenses are payable to medical service providers for treatment of the occupational injuries or diseases, subject to COIDA limits. (Please refer to page 53 for more information).

WhO IS A hEALThCARE pROVIDER?

WhAT ARE MEDICAL EXpENSES?

half-sister, grandparent or a grandchild of the employee; and• A parent of the employee or any person who is acting in the place of a parent,

and who at the time of the employee’s death was wholly or partially dependent on the employee.

21RanD Mutual assuRanCe eMplOyeR Manual 2016/17


Employers must submit their return of earnings (ROEs) to RMA by 31 March each year. the penalties for non-submission are in terms of section 83(6)(b) of COiDa.

On receipt of your ROEs, RMA will auto generate an invoice for premium payment. section 86(1) of COiDa prescribes that an invoice is payable within 30 days after the date of the notice of assessment (30 days of the invoice date) or in agreed to instalments at times and on conditions as determined.

Once payment has been received and cleared, RMA will generate a Letter of Good Standing for your company.

SECTION 3: RETURN OF EARNINGS SUBMISSIONS AND PREMIUM PAYMENT TO RMA



Please follow the below process to submit your earnings to RMA.

1. online declarationsYou may complete an online declaration via our website by following the below steps (please note that you need to be registered with RMA’s online services in order to be able to submit earnings online):

Step 1: Visit the RMA website at: www.randmutual.co.za.Step 2: Click on the orange Online Services tab.Step 3: Click on the Earnings Declaration Submission link. Step 4: Click on the Online Declarations link, followed by “New Declaration”.Step 5: Upload the authentication key into the “Authentication file” field in order to submit the declarations.

Once you have submitted your online declarations you may download your invoice online as follows:

Step 6: Click on the Invoice tab, followed by “My Invoice”.

2. Manual declarations:If you are unable to submit your declarations online, you may submit as follows:

Step 1: Visit the RMA website at www.randmutual.co.zaStep 2: Click on the Downloads tab Step 3: Click on the Employer – Employer Forms linkStep 4: Download the Earnings Declaration Form Step 5: Email the completed and signed form to [email protected]

3. Vat numberRMA requires your company VAT number which can be emailed to us on [email protected].

http://http://randmutual.co.za/

http://randmutual.co.za/


Step 1: Visit the RMA website at: www.randmutual.co.za.

Step 2: Click on the orange “Online Services” tab and then the “Register for Online Services” link.

Step 3: Complete the online registration form and click “Register” once completed. Class Xiii members please use your bp number as the CF reference number.

Step 4: RMA’s system will automatically email a username, password and authentication key to your registered email address. The authentication key is used to submit the earnings declarations and claims. You will find this key as an attachment to the email which you need to save for future use by right clicking the file and clicking on “Save As” to save it in your selected folder. Please note that due to the confidentiality of the key, it will not allow you to copy and paste.

hOW DO I REGISTER WITh RMA’S ONLINE SERVICES?



it is your responsibility as an employer to always have someone available at the or-ganisation who knows what to do, who to phone and how to immediately report the accident to RMa. all employers have a duty to ensure that an employee receives immediate and appropriate treatment following an accident. RMA thus encourages employers to get to know the ambulance services, hospitals, emergency rooms and doctors in their area and to have the appropriate contact details easily accessible.

The employer should endeavour beforehand to enter into an arrangement with the healthcare providers in their area to ensure that their employees are treated without delay when involved in an accident at work.

The employer should explain and prove to the healthcare provider during these dis-cussions that they belong to RMA and that as soon as RMA has accepted liability for a claim following an accident (usually within three days), medical expenses will be paid within 10 days from the date when the required documents and medical reports were received from the employer and the healthcare provider. in order to assist employers, a letter for injured employees is available from RMA specifically for this purpose and is available on the Downloads tab of our website www.randmutual.co.za.

The employer should agree with the hospital or doctor concerned how their practice will be able to identify an employee that belongs to them, and determine if an injury is work-related. this could be in the form of the printed claim form with the RMa claim number from C-Filing (please ensure it contains the employer name, employee name

1. WhAT IS MY RESpONSIBILITY WhEN MY EMpLOYEE IS INVOLVED IN A WORk-RELATED ACCIDENT?

SECTION 4: REPORTING AN ACCIDENT AND SUBMITTING A CLAIM TO RMA


and the RMA undertaking) or any other means agreed to between the employer and the healthcare provider such as a letter from the employer.

it is important to note that in terms of section 47(3)(a) of COiDa, the employer is liable for the payment of compensation for the first three months. The employer therefore remains liable for the first three months or until RMA has accepted liability.

the employee/witness must report the accident to the employer as soon as possible after it has occurred.

In turn, the employer must report the accident to RMA as follows:

1. OCCUPATIONAL INjURIES: WIThIN

2.OCCUPATIONAL DISEASES: WIThIN

OF ACCIDENT.

OF DIAGNOSIS.

2. WhEN ShOULD I REpORT AN INJURY OR DISEASE?

7 Days

14 Days


All work-related injuries on duty, regardless of the severity of the injury, need to be reported to RMA. This includes: • first aid cases• minor lacerations • contusions • abrasions

According to COIDA, if an employee reports an accident alleged to have taken place in the workplace yet the employer is not convinced it is a work-related accident, it must still be reported to RMa.

Reporting delays have a serious impact on the claiming and payment process, resulting in numerous challenges, including:• Healthcare providers not being paid timeously for services rendered. Delays

in payment could cause the healthcare provider to turn away employees (RMa patients) in future;

• Temporary Total Disablement (TTD) claims not being submitted timeously and ultimately delays in payment to claimants;

• Delays in compensation to beneficiaries of a deceased employee;• Lack of medical reports;• Black listing of the injured employee; and• Escalation of costs per claim.

According to section 44 of COIDA, if an accident is reported after 12 months of the date of the accident or diagnosis of the disease, there is NO benefit available to the injured/ill employee.

If an employee believes that the employer is not reporting the accident to RMA, they may approach RMa directly.

3. WhAT DO I NEED TO REpORT TO RMA?

4. WhAT IF I DELAY REpORTING ThE INJURY OR DISEASE TO RMA?


2. Quick and easy telephonic reporting through the RMA Contact Centre on 0860 222 132.

Please follow the below process when submitting a claim to RMA:

1. Online reporting through C-Filing (RMA’s online claims portal). In order to report an incident via C-Filing your company needs to be registered with RMA’s Online Services (see page 24 to register with online services).

5. hOW DO I REpORT AN ACCIDENT TO RMA?

6. hOW DO I SUBMIT A CLAIM TO RMA?

employer completes an accident or Disease Report Form (available at www.randmutual.co.za under the Downloads tab) and keeps on file for record purposes. Where necessary, this form can be sent with the injured employee to the healthcare provider as it incorporates all the details of the accident.

Once the employee has reported the accident to the employer, the employer must report the accident to RMa within seven days for an injury and 14 days for a disease. This can either be done either via:• C-Filing: Visit www.randmutual.co.za, click on the orange

button followed by the “Claims Submission” button. Please ensure you are registered with RMA’s Online Services (see pg 24 to register).

• Telephonic reporting: Call the Contact Centre on 0860 222 132. However, should you be reporting more than five claims a month, we encourage you to report electronically via C-Filing. Refer to pg 32 for more information on telephonic reporting.

onlIne seRVIces



Once the employee has received medical treatment for their injury or disease, the healthcare provider/employer/employee must submit a First Medical Report to RMa within 14 days of the date of the accident. all medical report forms are available on www.randmutual.co.za under the Downloads tab.

healthcare provider/employer/employee must submit progress reports during treatment.

in the case of a fatality as a result of the accident, compensation is paid to the beneficiaries in terms of COIDA.

employer continues to submit ttD claims for the duration of the injured employee’s medical treatment.

Once the injury has stabilised the healthcare provider compiles a final medical report including an assessment of the disability (where applicable) which is submitted to RMa.

Based on the final medical report and assessment, RMA calculates the degree of permanent disablement and awards compensation in terms of COiDa.

RMa processes payment to employer for ttD claims.

Employer submits claims electronically via C-Filing for Temporary Total Disablement (TTD), also known as “days off”, of more than three days. these claims must be submitted with a medical report and/or sick note from the treating doctor.

RMA will acknowledge and adjudicate the claim. If liability has been accepted in terms of COiDa, RMa will pay the healthcare provider.


Step 1: employer to call the RMa Contact Centre on 0860 222 132 within seven days for an injury and 14 days for a disease.

Step 2: have your authentication key (pin number) and member number ready to give to the Contact Centre agent.

Step 3: Employer to supply the following information:

• Name of person reporting the event• Contact number of the person reporting the

event• Name of the injured/ill employee• ID number of the injured/ill employee• Cell number of the injured/ill employee• Employee number of the injured/ill employee• Occupation of the injured/ill employee• Date of accident• Time of accident• Location of accident• Description of how the accident/disease occurred• Description and severity of the injury/disease -

please include the body part, which side of the body has been affected (right/left/back/front/multiple) and whether the injury sustained is a fracture/contusion/laceration/amputation etc.

Step 4: The contact centre agent will take your details and log a referral for a consultant to call you back in order to register the claim.

7. hOW DO I REpORT AN ACCIDENT TELEphONICALLY TO RMA?


7. hOW DO I REpORT AN ACCIDENT TELEphONICALLY TO RMA?

8. WhAT INFORMATION AND DOCUMENTATION DO I NEED TO SUBMIT WITh MY CLAIM?

Step 5: Once the claim has been submitted, the system will automatically generate a claim number, known as a personal event number (pev), which will be given to you by the contact centre agent.

Step 6: A claims assessor will contact you to acknowledge the claim and to send an acknowledgement letter.

• Declaration of accident earnings as completed on the Statement of Earnings form (available on the Downloads tab of the website) (see page 41 to understand more about accident earnings);

• Copy of ID document;• Banking details of the injured employee as incorporated in the Statement of

Earnings Form. RMA may request a letter from the bank or a bank statement for the employee at a later stage should any benefits be payable directly to the employee;

• When benefits are to be paid to the company, the claimant or their dependents, please include copies of the employee’s payslips for six months prior to the accident;

• For TTD’S, fatal and pensionable benefits – copies of the employee’s payslips for six months prior to the accident;

• In the case of TTDs, fatal and pensionable benefits, please include copies of the employee’s payslips for six months prior to the accident.

• RMA First Medical Report (must be submitted to RMA within 14 days of the healthcare provider having examined/diagnosed the injury/disease);• RMA Progress Medical Report – in the case of ongoing treatment only; and• RMA Final Medical Report – when an injured employee has reached maximum

medical improvement (MMi).• RMA may request additional supporting documentation depending on the

individual circumstances of the claim e.g. police reports in the event of a motor vehicle accident etc.

Please send all claims related supporting documents required by RMA to: [email protected]


9. UNDERSTANDING YOUR CLAIM NUMBER:

10. hOW TO CLAIM FOR A MULTI-pERSON EVENT

X/1390312/1/a0001/15/eMp

Indicates the class of the claim Indicates the type of policy. In this

instance it is a COID claim (EMp = Employee).

Accident Number

RMA MemberNumber

Year in which the accident took place

Indicates the number of people involved in the accident.


a multi-person event is an accident in which a number of people are injured or contract a disease in the workplace.

For example, if 50 people are injured in one event, when reporting such a case to RMA, the employer need only report this as one event and only needs to describe the event once, and then link the 50 employees to that one event in the claim number. each employee will have an independent claim but the event will encompass all injured employees.

in other words, there will be 50 claim numbers and each of the 50 employees will have their own unique claim number, as follows:

employee 1 – claim number: X/1491234/1/F0007/2015/eMpemployee 2 – claim number: X/1491234/2/F0007/2015/eMp

(Continues as above for all 50 employees)

employee 49 – claim number: X/1491234/49/F0007/2015/eMpemployee 50 – claim number: X/1491234/50/F0007/2015/eMp


11. WhAT IS REQUIRED FOR RMA TO ACCEpT LIABILITY? A claim is not a guarantee of payment and only once liability has been accepted by RMa will a claim be paid. the below information is needed by RMa in order for liability to be assessed:

• Report the claim electronically via C-Filing or by telephonic reporting. Depending on your reporting preference, the following are accepted:

o A pin (authentication key or member number) for telephonic reporting; or o Authentication key (received when registering for Online Services) when

reporting via C-Filing.

• Personal details of injured employee, including: o ID Number; o Cell phone number of employee; and o Company number.

• A First Medical Report confirming the injury and how it relates to the work of the employee.

• Accident earnings: (see page 41 to find out more about accident earnings)o An average of six months earnings prior to the date of the accident (Please

provide payslips for six months or a relevant payroll printout for the six months when requested);

o Basic earnings; o Variable earnings; o Non-variable earnings; and o Section 51 earnings (where applicable).

12. UNDERSTANDING WhEN TO SUBMIT MEDICAL REpORTSPlease refer to page 54 for information on submitting medical reports. All medical report forms are available from www.randmutual.co.za under the Downloads tab.


13. hOW DO I hANDLE A NOISE INDUCED hEARING LOSS (NIhL) CLAIM?

In terms of COIDA, an employee or their employer must prove:• the degree of hearing loss by means of a diagnostic audiogram;• that the employee is exposed to excessive noise in the workplace. The employee /

employer must prove that the noise is greater than 85 decibels over an eight hour day or 40 hour week. The higher the intensity of the sound, the less exposure time is needed for NIHL to occur;

• when the employee first started working in a noise zone by means of the initial screening audiogram i.e. the baseline audiogram (which could have been performed at a previous employer) or when the employee first started working for the employer i.e. entry audiogram; and

• that the type of hearing loss is due to noise exposure and not the various other causes of hearing loss as confirmed in a medical report.

What documents do I need to submit to RMA for NIHL claims?

• Two diagnostic audiograms conducted on the same day with a reasonable break between the two audiograms. These should only be conducted after 24 hours of the employee having been removed from the noisy environment;

• The baseline audiogram;• Attestation of proof of identity completed by the Audiologist or ear, nose and throat

(ENT) specialist with an attached copy of an ID or passport;• A full record of service, documenting the noise level exposure for each of the

employee’s occupations or positions during his/ her working career – if the employee has not been exposed to noise, this should also be recorded as such;

• Medical report compiled by the occupational medical practitioner – this is the doctor responsible for the occupational health examinations of the company’s employees; and

• If the percentage hearing loss is greater than 30%, the employee is to be seen by an ENT specialist. The ENT specialist is to include in the first medical report the full medical history of the employee, such as treatment with ototoxic drugs, ear surgery and otitis media.


14. hOW DO I CLAIM FOR AN EMpLOYEE WORkING ABROAD?

in terms of section 23 of the Compensation for Occupational injuries and Diseases act (COiDa), employees ordinarily employed within south africa but who are injured while temporarily employed outside of the country are covered as if the accident happened within the country.

Based on the above, the employee will be covered by RMA if the following criteria are met:• the injured employee was temporarily employed outside the country;• the injured employee was not working beyond the borders of South Africa for a

continuous period of 12 months or more; • the company’s business operates chiefly in South Africa ;and• the employee is ordinarily employed in south africa.

The compensation amount for the injured employee will be based on the earnings they would have received had they remained in south africa.

the employer will need to cover all medical costs incurred by the employee while outside of the country. these costs will be reimbursed by RMa upon proof of payment and RMA accepting liability for the claim. Medical costs will be reimbursed at South African COIDA tariff rates.

We request that you keep a record of all medical documents relating to treatment of the injured employee. this especially important if the employee is repatriated back to south africa for further treatment, and for costs to be reimbursed to you if liability is accepted by RMa.

The employer must notify RMA of any existing employees working outside the borders of South Africa by completing and submitting a Record of Employee/s working in a foreign country form to RMA. This form is available on the Downloads tab of the RMA website at www.randmutual.co.za. This form must be accompanied by a copy of the employee’s contract of employment as Annexure 1, detailing the working arrangements whilst the employee is working outside of the country. The form and contract must be emailed to [email protected]


The Record of Employee/s working in a foreign country form must include the following minimum details:Name of the employee;Identity number;Employee number;Date employed;Job description;Employee earnings; andThe period the employee is due to be working outside of the country, including start and return dates.

please inform RMa if the company has taken out any additional injury on duty (iOD) insurance cover. The disclosure must include:Name of the insurer;Policy schedule; andCover period.

need an additional solution?

If your company regularly sends employees on international assignments, talk to us as RMA can partner with you to find a customised solution best suited to your company. The solution may fall outside of the scope of COID benefits but will ensure that your risks are minimised and employees are protected while working abroad.



There are four main types of COID benefits that can be claimed under COIDA:

• Temporary Total Disablement (TTD)• Permanent disablement• Death• Medical expenses

SECTION 5: COID BENEFITS

temporary total Disablement (ttD), also known as a temporary income replacement benefit, is the payment of an employee for his days off work while injured, or while recovering from his work-related disease. TTDs are paid if:

• the employee is off work for more than three consecutive days;• is undergoing medical treatment; and • has been booked off by the treating doctor either by means of a medical report or

a sick note for more than three consecutive days.

Based on the supporting medical report or sick note, the employer pays the employee as per Schedule 4 of COIDA. These payments should be made at regular intervals, but should not exceed one month intervals. The employer is liable for the TTD payment for the first three months from the date of the accident. Once RMA has accepted liability for the claim, the employer is reimbursed for related payments made during the first three month period.

The employer claims from RMA by submitting TTD claims with the supporting medical report or sick note either electronically via the C-Filing claims management system (please remember that your company needs to be registered with RMA’s online services for this type of claims submission), or by scanning and emailing to [email protected].

1. TEMpORARY TOTAL DISABLEMENT: COIDA SECTION 47 (DAYS OFF)


in accordance with COiDa, an injured/ill employee does not receive their full lost earnings during their absence from work due to injury/illness, however, TTD payments are tax-free.

Should your company be covered by RMA’s Augmentation policy, which is a top up cover of the COID benefit, this takes effect if the employee earns above the COID maximum payment as stipulated above, to a maximum payment of R416 667 per month.

ttd payment scenarios

a. Monthly paid employee

Formula: Accident earnings x 75% ÷ 30.3333 x days off = TTDs

Example: Accident Earnings = R10 000

R10 000 x 75% = R7 500 ÷ 30.3333 = R247.25 x 30 Days Off = R7 417.59

Formula: Fortnightly rate x 2.1666 x 75% ÷ 30.3333 x the number of days off = TTDs

Example: Fortnightly rate = R5 000

R5 000 x 2.1666 = R10 833 x 75% = R8 124.75 ÷ 30.3333 = R267.84 x 30 Days Off = R8035.47

b. Fortnightly paid employee


Formula: Weekly rate x 4.0 X 75% ÷ 30.3333 x the number of days off = ttds

Example: Weekly rate = R1 500

R1 500 x 4.0 = R6 000 x 75% = R4 500 ÷ 30.3333 = R148.35 x 30 Days Off = R4 450.55

Formula: Hourly rate x number of hours worked x 75% ÷ 30.3333 x the num-ber of days off = TTDs

Example: Hourly rate = R40.00

R40 x 320 hours worked = R12 800 x 75% = R9 600 ÷ 30.3333 = R316.48 x 30 Days Off = R9494.51

c. Weekly paid employee

d. Hourly paid employee

What is the duration of ttd payments?TTDs are paid from day four and can continue up to one year (12 months), depending on the extent of the injury or disease. Once the employee has returned to work or has received compensation, TTDs can no longer be claimed. If the injury/disease continues beyond 12 months, RMa will reassess the claim and the possibility of continuing payment. However, TTDs continuing for more than two years (24 months) may be considered permanent disablement.

B. What are accident earnings?

Earnings are a key component in the compensation process. They are used to determine compensation for ttDs, permanent disablement and to compensate dependents in the event of the employee’s death.

Section 63 of COIDA sets out which earnings are to be used for purposes of compensation. Variable and non-variable earnings must be reduced to a monthly amount when submitting claims.


Which earnings are included and excluded?

1. Earnings include:• The monthly earnings paid by the employer;• Food or quarters supplied by the employer;• Overtime payments for regular work that is ordinarily performed; and• Any allowance of a regular and constant nature.

2. Earnings exclude:• Payment for intermittent overtime;• Payment for non-recurrent occasional services;• Amounts paid by an employer to an employee to cover any special expenses; and• Ex-gratia payments whether by the employer or any other person.

What are variable and non-variable earnings?

1. non-variable earnings:

These are consistent earnings and include:• the employee’s basic salary;• any housing allowances; and• any annual or incentive bonuses.

It is important here to note that:

(i) If the employee’s basic salary fluctuates, or is increased during the six month period that has already been declared, then an average must be calculated for the six months’ basic salary.

(ii) the annual bonus and/or incentive bonus (if applicable) must be divided by the number of months for which it is payable. For example if it is paid annually then it must be divided by 12.

If it is paid biannually, then it must be divided by six, or if per quarter then by three. this is then the amount that is declared per month.


For example:

This is the amount placed in the annual bonus field when completing the accident/disease report form or section 51 forms.

2. Variable earnings

These are less consistent earnings and constitute the cumulative allowances the employee received during the six months before the accident. These allowances can be for overtime worked, production bonuses and attendance bonuses etc. the cumulative amount is then divided by six to determine the amount to be declared as variable earnings.

earnings declaration compensation for an employee in training or under the age of 26

If the employee is under the age of 26 or working as an apprentice at the time of the accident, it falls under section 51 of COIDA, and the earnings are calculated on future earning potential.

In the case of an apprentice, the calculations are based on the earnings of a recently qualified person or a person in the same occupation, trade or profession with five years’ experience, whichever is more favourable to the employee.

Similarly, in the case of an employee under the age of 26, his/her earnings are based on the earnings that a person of 26 years would normally have been entitled to if performing the same work as the employee at the time of the accident.

Alternatively, the calculations are based on the earnings of an employee in the same occupation, trade or profession with five years’ experience, whichever calculation is more favourable to the employee.

Annual bonus: R5000 ÷ 12 = R416,66


a. luMp suM payMent: coIda sectIon 49

Permanent Disablement awards from 1% to 30% are paid in the form of a lump sum. The lump sum amount that is paid to the injured employee is based on the degree (percentage) of permanent disablement. This is calculated once the injured employee has been assessed and the Final Medical Report has been submitted to RMa. the percentage of permanent disablement is set out in Schedule 2 of COIDA.

permanent disablement percentages as per schedule 2 of coIda

2. pERMANENT DISABLEMENT

injury % permanent disablement

loss of two limbs 100Loss of both hands, or of all fingers and both thumbs 100Total loss of sight 100total paralysis 100Injuries resulting in employee being permanently bedridden 100Any other injury causing permanent total disablement 100loss of arm at shoulder 65loss of arm between elbow and shoulder 65loss of arm at elbow 55loss of arm between wrist and elbow 55loss of hand at wrist 50Loss of four fingers and thumb of one hand 50Loss of four fingers 40Loss of thumb: both phalanges 25

one phalanx 15



Loss of index finger: three phalanges 10two phalanges 8one phalanx 5

Loss of middle finger: three phalanges 8two phalanges 6one phalanx 4

Loss of ring finger: three phalanges 6two phalanges 5one phalanx 3

Loss of little finger: three phalanges 4two phalanges 3one phalanx 2

Loss of metacarpals: first, second or third (additional)

4

fourth or fifth (additional) 2Loss of leg: at hip 70

between knee and hip 45 to 70below knee 35 to 45

Loss of toes: all 15big, both phalanges 7big, one phalanx 3toes other than big toes:four toes 7three toes 5two toes 3one toe 1

permanent disablement percentages as per schedule 2 of coIda (Continued)



Loss of eye: whole eye 30sight 30sight except perception of light

30

Loss of hearing: both ears 50one ear 7

Please also note the following:• Total permanent loss of the use of a limb is treated as the loss of the limb. • Any injury to the left arm or hand and, in the case of a left-handed employee, to the

right arm or hand, may at the discretion of RMA be rated at 90%.• If there are two or more injuries, the sum of the percentages for these injuries may

be increased, at the discretion of RMa.

How to calculate a pd lump sum

The formula to calculate a PD lump sum is as follows:

permanent disablement percentages as per schedule 2 of coIda (Continued)

Multiply the employee’s accident earnings by 15Multiply by the disability %

Divide the answer by 30

Accident Earnings: R9 500R9500 x 15 = R142 500R142 500 x 10 = R1 425 000(the “10” indicates the percentage value of the permanent disablement)

R1 425 000 ÷ 30 = R47 500

Formula: Accident earnings x 15 x disability % ÷ 30 = PD lump sum

For example:


B. peRManent dIsaBleMent pensIon: coIda sectIon 49

section 49 of COiDa prescribes a monthly disablement pension for all permanent disablement (PD) awards greater than 30%. The monthly pension is payable for the life of the disabled employee.

How to calculate a pd pension (31%-100%)

the formula to calculate a monthly pD pension for employees with an injury between 31% and 100% is as follows:

For example:

R3 562.50 is the normal pension amount RMa will pay to the injured employee on a monthly basis for his life.

if the employee is unable to perform essential life activities without the constant help of another person as a result of their disablement from the accident, they are paid an additional constant attendance allowance. This is a fixed monthly amount as stipulated by COiDa.

Multiply the employee’s accident earnings by 75%

Multiply the above amount by the percentage of permanent disablement (in this case it is a 50% PD)

Accident Earnings: R9 500R9500 x 75% = R7 125R7 125 x 50% = R3 562.50

(the “50%” indicates the percentage of the permanent disablement)


3. DEATh BENEFITS Section 54 of COIDA determines the compensation award following the death of an employee in a work-related accident, or as a result of an occupational injury or disease.

If the employee dies, the following applies:1. If the death is due to the occupational injury/disease, a continuing fatal benefit will

be paid to the deceased employee’s dependents. Dependents are defined as per section 1 of COIDA (see definition on page 20).

2. if the employee is an RMa pensioner and if the death is not as a result of the occupational injury/disease, the pension ceases.

The following are the benefits payable in the event of a fatal claim:a) spouse’s lump sum paymentb) spouse’s monthly pensionc) Dependent children’s monthly pension/sd) Funeral benefit



if there is more than one spouse, the amount of R2 850 is divided by the number of spouses.

Formula: Accident earnings x 75% x 2 = lump sum payment

Multiply the employee’s accident earnings by 75%

Multiply the amount by 2

Accident Earnings: R9 500R9500 x 75% = R7 125R7 125 x 2 = R14 250

Multiply the employee’s accident earnings by 75%Multiply the amount by 40%

Accident Earnings: R9 500R9500 x 75% = R7 125R7 125 x 40% = R2 850 per month

Formula: Accident earnings x 75% x 40% = spouse’s monthly pension

a) Spouse’s lump sum paymentThis is a once-off lump sum payment paid to the spouse. If the deceased employee had more than one spouse married in terms of customary law, this payment is shared between the spouses.

For example (1 spouse):

if there are additional spouses, the R14 250 will be divided by the number of spouses.

b) Spouse’s pensionThe spouse’s pension is a lifelong monthly benefit of 40% of 75% of the deceased’s accident earnings.

For example (1 spouse):


c) Child/ren’s pensionThe child’s pension is a monthly benefit of 20% of 75% of the deceased’s accident earnings if there are three or less children.

For example:

This benefit is payable to each minor child until the month in which the child turns 18 years. Where there are more than three children, the 60% (i.e. 20% x 3) is divided equally by the number of children. Where employers have taken RMA’s Augmentation Policy as a separate benefit, this will take effect in cases where there are more than three children.

A child may apply to RMA for an extension beyond 18 years under the following circumstances:

• If the child is unable to earn an income due to a physical or mental disability;• If the child is still completing secondary education; or • If the child is undergoing tertiary education.

The extension of a child’s pension is discretionary and RMA will assess the merit of each case individually.

If the child dies or marries before the age of 18 years, his/her benefit will cease.

d) Funeral benefitRMA pays a fixed funeral benefit as is annually gazetted by the Minister of Labour.

Multiply the employee’s accident earnings by 75%Multiply the amount by 20%

Accident Earnings: R9 500R9500 x 75% = R7 125R7 125 x 20% = R1 425 per child per month


4. WhAT ARE ThE COID BENEFITS FOR 2016/17?

In accordance with Schedule 4 of Government Gazette No. 39683, the COID benefits from 1 April 2016 to 31 March 2017 are calculated as follows:

(i) (ii) (iii) (iv) (v) (vi) (vii)item section nature and

degree of disablement

nature of benefits

Manner of calculating benefits

Recommended maximum compensation

Recommended minimumcompensation

1. 47(1)(a) temporary total disablement

periodical payments

75% of an employee’s monthly earnings at the time of the accident.

R23 569 R3 300

2. 49(1) permanentdisablementof 30%

lump sum

15 x the monthly earnings of the employee at the time of the accident.

R263 991 R65 993

3. 49(1) permanent disablement of less than 30%

lump sum

The lump sum benefits specified in item 2 above are prorated according to the disability % up to 30%.

4. 49(1) permanent disablement of 100%

Monthly pension

75% of an employee’s monthly earnings at the time of the accident

R23 569 R3 300

5. 49(1) permanent disablement of less than 100% but more than 30%

Monthly pension

The monthly pension benefits specified in item 4 above are prorated according to the disability %, between 30% and 100%.

6. 54(1)a Fatal lump sum

twice the employee’s monthly pension that would have been payable to the employee under item 4 had he been totally disabled.

R47 138 R6 600


(i) (ii) (iii) (iv) (v) (vi) (vii)item section nature and

degree of disablement

nature of benefits

Manner of calculating benefits

Recommended maximum compensation

Recommended minimumcompensation

7. 54(1)b Fatal Monthly pension

40% of the monthly pension that would have been payable to the employee under item 4 had he been totally permanently disabled.

R9 428 R1 320

8. 54(1)c Fatal Monthly pension

20% of the monthly pension that would have been payable to the employee under item 4 had he been totally permanently disabled, to each child.

R4 714 R660

9. 54(1)(d)(ii)

Fatal lump sum

Percentage dependence as portion of R135 797 based on a standard formula.

R135 797

10. 54(2) Fatal Funeral costs

a reasonable amount for funeral costs to a maximum of R17 218 or the actual amount, whichever is the lesser.

R17 218

11. 63(1)(a) Minimum for free food and quarters

to be included in earnings

Minimum for free food R237 per month and minimum for free quarters R106 per month.

R237 per month for free food and R106 per month for free quarters

12. 28 Constant attendance allowance

Monthly allowance

Minimum amount of R1 759 per month.

R1 759


5. MEDICAL EXpENSESOnce RMA has accepted liability on a claim, all reasonable medical expenses related to the occupational injury/disease will be paid for up to two years from the date of the accident or diagnosis of the disease. These benefits are paid to a maximum of the COIDA tariff (which is updated annually on 1 April), per diem and negotiated tariffs. if no amount has been determined for a particular medical treatment, RMa will not pay more than what is deemed reasonable by the Director-general as per section 76 of COiDa.

Pre-authorisation of medical benefits

Pre-authorisation assists healthcare providers with confirmation that RMA has taken liability for the cost of treatment, and is thus a form of guaranteed payment. Pre-authorisation can only be generated, however, once the incident has been reported to RMa and liability has been accepted.

In an emergency, medical treatment should continue without pre-authorisation, which can then be obtained retrospectively.

Whilst pre-authorisation is not a pre-requisite for treatment in emergency or acute cases, it is recommended that the hospital (or healthcare provider) notifies RMA of all hospital admissions in order to assist with confirmation of RMA liability.

Re-opening of a claimAuthorisation is, however, compulsory if a claim has been finalised, but where further medical treatment is indicated or required and RMA is expected to pay the medical costs of the re-opened claim. The objective of the requested treatment should be focussed on further reducing the impairment.

In the case of a re-opening of a claim for specific treatment, the healthcare provider is required to submit a request with supporting documents to RMA which will review the merits of the request and, if valid, approve liability through the process of pre-authorisation.


Physiotherapy and Occupational Therapy pre-authorisationsNo pre-authorisation is required for the first 20 sessions with either a physiotherapist or occupational therapist. Thereafter, pre-authorisation is required together with a treatment plan. should the additional sessions not be pre-authorised, these will not be paid by RMa.

Medical reports required by RMa

A first medical report must accompany the first consultation. Thereafter, progress reports must be submitted for ongoing treatment and consultations with doctors, specialists, psychologists and psychiatrists. A progress report can cover multiple visits for up to, but not exceeding, a month. However, should there be a change in the claimant’s medical condition, an updated medical report must be submitted to RMa.

Even if pre-authorisation has been obtained, if there is no accompanying medical report, the doctor’s invoice for that service date will not be paid.

For on-going treatment, RMA needs to be informed of the progress of the claimant’s medical condition at least once a month. Days taken off work and when the employee will resume work must be indicated as well as justification for the temporary total disablement. Supporting documents and any paid invoices must be submitted to RMa.

should the claimant consult an allied health professional (physiotherapist, chiropractor, occupational therapist, biokineticist, dietician etc.), a referral letter from the treating doctor and a medical report from the allied professional must be submitted at the beginning of the treatment and again at the end of the treatment. Once the claimant has reached Maximum Medical Improvement (MMI), the point beyond which his/her condition will neither improve nor decline, a final medical report must be submitted to RMa. this medical report will be used to assess functional loss and will determine whether the claimant should receive a permanent disablement benefit. RMA’s role and function is not to assess the employee’s fitness to return to work.


This is the responsibility of the employer, taking the inherent risks and requirements of the employee’s specific job into account.

please note that all medical report forms are available on RMa’s website www.randmutual.co.za under the Downloads tab.

are there any co-payments for medical treatment?

under no circumstances should the employee pay either a co-payment or an administration fee to the healthcare provider. should this be the case, the employer must inform RMa.

Similarly, if the employer or employee are aware of a healthcare provider charging out of tariff rates, they should inform RMA in order that we may address this individually with the relevant healthcare provider.

When will RMa not pay coId compensation?

Claims will only be paid if they are submitted in the correct way within the proper time limit.

According to COIDA, a compensation claim will not be paid if:• the claim is submitted to RMA more than 12 months after the injury or death, or

more than 12 months after the disease is diagnosed;• if the employee was off work for three days or less, TTDs and permanent disablement

may not be paid by RMA, however, medical costs will be paid;• the accident or injury is a result of an employee’s wrong doing or misconduct,

unless the employee was seriously disabled or died as a result of the accident; and• the employee unreasonably refuses to have medical treatment.



section 91 objections

Should the employee, employer or trade union representative not agree with a a decision made by RMA, section 91 of COIDA entitles the employee to lodge an objection against the decision. A section 91 objection must be lodged within 180 days of the decision made by RMa and will be heard by an independent tribunal. the objector may be appear in person at the tribunal or may be represented by a trade union or legal representative. Should the employee still not agree with the outcome of the tribunal, they may further appeal the decision in the High Court in terms of section 91(5)(a) of COiDa.

appeal process

section 56 objections

If an employee has an accident due to negligence by the employer or an employee in management, the employee may make an application for increased compensation over and above the standard compensation.

an RMa section 56 application form must be submitted to RMa within two years (24 months) of the date of the accident. RMA shall investigate the accident and make a decision regarding the alleged negligence.

employee unhappy with pD award decision by RMa

Completes an RMa section 91 objection form

independent tribunal

RMA legal department communicates tribunal outcome

SECTION 6: REVIEWS/APPEALS


SECTION 7: TRAINING

1. ONLINE SYSTEM TRAINING

RMA offers a comprehensive training solution for stakeholders to ensure a sound understanding of its products, processes and its simple, accessible online facilities.

In order to make sure that your training needs are sufficiently supported, RMA offers training workshops around the country. RMA drafts a training schedule at the beginning of each year, which is available on www.randmutual.co.za under the User Zone - Training link. However, should you require specific training for your company, please contact us on [email protected] and we will investigate the possibility of scheduling a workshop in your area. Please note, however, that a minimum of 15 people are required in order for a workshop to take place.

Alternatively, RMA offers additional training solutions to assist you, as follows:

RMA’s online learner management system allows for ease of use and can be accessed at your convenience, 24 hours a day, seven days a week.

Once you have registered with RMA’s online services (see pg 24 on how to register) you will automatically receive a link, together with your username and password, that will direct you to the log in page. Once received, please save this link as a favourite (ctrl D) for ease of future access.

Once logged in to the Learner Management System, you will have access to the following:• Online Training

o C-Filing Simulator (C-Filing is the claims management module on the RMA system)

• RMA Training videoso Employer Information Briefingo the Claims Cycle

• Training Schedule for the year


2. LIVE WEBINARSIn addition, RMA hosts “live” member workshops via Webex. These online workshops cover the following:

Member Workshop• RMA overview• RMA mandate• RMA products and earnings declarations• Occupational injuries and diseases• Employer obligations and penalties• Document completion and submission• General discussion – Q&A

c-Filing (claims management system)• RMA overview• Introduction to C-Filing (RMA’s claims management system)• User roles – electronic signature• Step-by-step claim submission• Statement of earnings form• Capturing of days off invoice• General discussion – Q&A

To participate in the webinars, please submit a RMA Webex training request form, select your preferred date and forward to [email protected]. Once RMA has received your confirmation, we will forward a link that will give you access to the relevant Webex workshop.

Please accept this link before the actual workshop in order to ensure timeous dialing into the workshop. You will also receive a guide to assist you to better navigate Webex.

Should you have any queries regarding the above, please contact us on 010 214 3179 or [email protected]


SECTION 8: FRAUDIf you suspect fraud – either by an RMA employee or by any of our clients, healthcare providers or suppliers - don’t delay, contact the anonymous RMa fraud and ethics line as soon as possible.

The RMA fraud and ethics line is managed by Deloitte through Tip-offs Anonymous and is therefore totally independent of RMA, ensuring anonymity. No one will therefore ever know who reported the fraud or the dishonest and inappropriate behaviour.

Fraud line (inside sa): 0800 21 22 56Fraud line (outside sa): +27 31 571 5734Freecall fax: 0800 00 77 88email: [email protected] Freepost address: Tip-offs Anonymous, FreePost KZN 138, Umhlanga Rocks, 4320



SECTION 9: CONTACT US

RMA Branches:

tel: 0860 222 132Fax: 0860 222 203enquiries: [email protected] document submissions: [email protected] address: P O Box 61413, Marshalltown, 2107Website: www.randmutual.co.za Got an enquiry, compliment or complaint? We want to hear from you. Please complete the feedback form under the Contact us tab on www.randmutual.co.za.

Head OfficeBDO Building, 1st Floor, 22 Wellington Road, parktown

carletonville Terenure Building,124 kaolin street,Carletonville

durban Mayfair on the lake, 3rd Floor,5 park lane, parkside,Umhlanga Rocks

Johannesburg 23 Wellington Road,parktown

Klerksdorpground Floor, Sanlam Building,President Kruger street,klerksdorp

eMalahleniunit 505 5th Floor Centre de la vie Corner beatty avenue and Woltemade street (Opposite life Cosmos hospital)eMalahleni

Maseru – lesotho (Satellite Office)TEBA Office,226 Moshoeshoe Road, industrial area,lesothoTel: (+26) 6 22 314 897

Mthatha (satellite Office) TEBA Office,9 york Road,Mthatha

pretoriapodium at Menlyn, 3rd Floor, 43 Ingersol Road,Corner lois and atterbury Roads,Menlyn

Rustenburg Montana Building,Corner loop and van alphen streets,Rustenburg

Welkom2 toermalyn street, Jan Cilliers park (Extension 7), Welkom

Xai-Xai – Mozambique (Satellite Office)bairro 6 coca missava, recinto da Wenala, casa #3Tel: (+258) 282 6990



63Rand Mutual assuRance eMployeR Manual 2016/17 63RanD Mutual assuRanCe eMplOyeR Manual 2016/17


Notes

2016/17 Employer Manual - Randmutual.co.za - Rma · licence from the Minister of labour. the RMa...

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