Compsol stops prepaying Doctors

Financial ruin threatens medical practitioners as the largest company handling Compensation Fund claims has suspended its prefunding services because of the fund’s failure to make payments.

CompSol’s temporary withdrawal of its prepayment services means the medical practitioners including doctors, radiographers and occupational therapists who are among its clients, will have to wait a long time for payment for their services provided to injured or ill workers.

CompSol handles 40%-60% of all medical claims against the fund.

Some medical practitioners concentrate solely on occupational cases and will be hit hard by the company’s decision not to pay them in advance of the fund paying out the compensation.

South African Medical Association chairman Mzusiki Grootboom said yesterday medical practitioners were already refusing to attend to “injured-on-duty” cases. This would force injured workers to go to overburdened state hospitals.

“Despite promises of improvement, the Compensation Fund’s payment system has ground to a halt,” Dr Grootboom said.

The medical association and Solidarity trade union have submitted complaints to Public Protector Thuli Madonsela.

Hope that the situation would improve was renewed by Labour Minister Mildred Oliphant’s comments in her recent budget vote speech and by her department’s director-general, Thobile Lamati, in a briefing to Parliament’s labour portfolio committee.

Ms Oliphant said the fund had introduced an electronic claims management system, Umehluko, which cut out manual processing.

“Umehluko has, within a short space of time, brought about demonstrable improvements in the processes of assessing and paying claims, albeit with some teething problems,” Ms Oliphant said.

“As service providers become more familiar with the system, teething problems will be minimal,” she said.

Mr Lamati gave the assurance to MPs last month that a backlog of 231,000 outstanding claims, totalling about R23bn, would be cleared by the end of June.

However, CompSol MD Fritz Luttich told clients in a letter last week that the Umehluko computer system “has virtually ground to a halt due to its dysfunctionality and incapacity to process and pay the volume of claims and medical accounts in SA”.

The poor turnaround times in claim adjudication and payment had persisted for the past nine months, Mr Luttich said.

“The injury-on-duty environment has dramatically changed for the worse with the new Umehluko system. The current situation at the fund is not sustainable and must be changed at all costs.”

He said the computer system incorrectly rejected legitimate medical claims, was incapable of registering new claims and did not acknowledge valid preauthorisations that the fund had granted. It was unable to pay accounts that had been approved for payment.

He said CompSol would continue to administer claims and medical accounts but would be unable to prefund any accounts for at least the next six to eight weeks because it was carrying “vast amounts” of prefunded accounts for its clients.

CompSol has obtained more than 10 court judgments against the Compensation Fund, and the High Court in Pretoria has appointed a judge to ensure the company’s claims are dealt with.

Dr Grootboom and Democratic Alliance labour spokesman Ian Ollis remarked that the Compensation Fund had repeatedly, over many years, promised improvements that had never materialised.

“Our studies show that things right now are in a terrible mess. The fact that CompSol has withdrawn its prefunding facility points to a worsening of the situation,” Mr Ollis said.

The head of Solidarity’s occupational health and safety unit, Paul Mardon, said that since the introduction of Umehluko things had ground to a halt and payments were not being made.

by Linda Ensor, 12 May 2015, 05:57

Business Day 12 May 2015

Incoming search terms:

  • prepaying doctors (4)
  • content (2)
  • fritz luttich (1)