WCA Claims – The Procedures

When dealing with Employers, Employees and Health Care Providers, there still seems to be a lot of uncertainty relating to the correct reporting and recording procedures of work related injuries. The Compensation for Occupational Injuries and Diseases Act, Act 130 of 1993, is the governing Act that deals with occupational injuries and diseases.

The aim of the COIDA is to provide for Compensation in the case of disablement caused by occupational injuries or diseases, sustained or contracted by employees in the course of their employment, or death resulting from such injuries or disease; and to provide for matters connected therewith.

The COIDA basically prevents employees covered by the Act from suing their employers for damages in terms of common law, opting instead for WCA Claims.

WCA Claims Must Be Referred to the Employer

Anyone who employs one or more workers must register with the Compensation Fund and pay annual assessment fees. WCA Claims for employees employed in the mining and building industries must be referred to the relevant mutual associations.

Claims by employees working for individually liable employers (the state, parliament, the provincial authorities and local authorities which have been exempted from making payments to the compensation fund) must be referred to the employer.

The following steps should be followed when reporting to and lodging WCA Claims from the Compensation Fund.

WCA Claims Step 1:

An accident must be reported when an employee meets with an accident arising out of and in the course of employment resulting in a personal injury for which medical treatment is required.

Written or verbal notice of an injury at work is to be given to the employer before the completion of the shift. Good practice on the side of the employer will be to make a list of all witnesses of the accident for the investigation of the incident.

The official form that needs to be completed is W.Cl 2 – Notice of Accident and Claim for Compensation. This form should be completed whenever an employee meets with an accident out of or in course of employment that leads to personal injury or where medical treatment is required or in the case of death. It is the employer’s duty to submit the W.Cl 2 within a period of 7 days to the Compensation Commissioner.

Guidelines relating to the completion of the form:

a) Firstly, complete Part A, page 1 of the form by providing the full details, sign and date from where indicated.

b) Secondly, detach Part B (an automatic copy of Part A, page 1) by tearing it at the perforation, hand Part B to the employee and request him/her to hand it to the doctor/hospital concerned. In serious cases, “Part B” must be handed to the emergency services personnel who have responded to the emergency.

The employee making the claim must submit to a medical examination at a reasonable time and place nominated by the commissioner or mutual association concerned, or by arrangement if the employee cannot go to the office of the nominated medical practitioner.

c) Thirdly, complete Part A, page 2 of the form by providing the full details.

After the completion of the form, send the form with a certified copy of the employees ID and the first medical report (W.Cl 4) (if available) to Compensation Commissioner. The doctor should complete the W.Cl 4 form, stating how serious the injury was and how long the employee is likely to be off work. This is sent to the employer who sends it to the Commissioner.

Please note that employers are obligated to report all alleged accidents to the Compensation Commissioner, even if they don’t believe the employees report. Good practice on the employers side should included the keeping of partially completed W.Cl 2 forms as well as certified copies of all employees’ identity documents.

Employees are not responsible for the payment of medical cost. If an employee request a second doctor’s opinion, he/she will be responsible for the payment of medical cost for the second opinion.

WCA Claims Step 2:

After receiving and registering the WCA claim, the Compensation Commissioners office should forward a postcard (W.Cl.55) to the employer.

A claim number (reference number) is provided on the postcard (W.Cl.55). This number should be used for all paperwork relating to the WCA claim. When the first doctor’s report has been submitted with the accident report, the Compensation Commissioner will consider the claim and make a decision.

After the Compensation Commissioner has considered the claim a postcard (W.Cl.56) be sent to the employer. The W.Cl.56 will only be used by the Commissioner when liability is accepted for payment of the claim. Where a W.Cl.56 is not issued, it normally indicates that the Compensation Commissioner has not accepted liability for any payment.

If the worker disagrees with the decision, they can appeal the decision within 90 days by submitting form W929 to the Commissioner.

WCA Claims Step 3:

If the injury continues for a long time (prolonged absence), the medical practitioner must send a Progress Medical Report (W.Cl 5) to the Commissioner. The progress report should be submitted on a monthly basis until the condition is fully stabilised. This informs the Commissioner of how long the employee is off work.

WCA Claims Step 4:

Once the medical practitioner handling the case is satisfied that the employee is fit for duty, the practitioner will issue a Final Medical Report (W.Cl 5), which must be sent to the Compensation Commissioner. In this report the doctor states either that the worker is fit to go back to work or that the worker is permanently disabled.

The practitioner must send this form to the employer who sends it to the Commissioner.

Please note that the Progress Report and Final Medical Report are on the same form (W.Cl 5).

WCA Claims Step 5:

When the employee resumes work, a Resumption Report (W.Cl 6) must be completed and submitted to the Commissioner.

Only after every one of these forms has been submitted will the Compensation Commissioner make all of the payments and close the case.

WCA Claims Step 6:

The worker and the employer should keep copies of all the forms as it pertains to WCA Claims.

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