Claiming Compensation for Occupational Injuries or Diseases
If you are involved in an accident at work or develop an illness caused by your working conditions, then you can claim from the Compensation Fund. Here’s what you need to know.
Who can Claim?
You can claim if
- You were injured or contracted a disease while working (permanent or casual), training or completing an apprenticeship.
- You lost a family member who died on the job.
- You are a domestic worker in a boarding house.
- You are an apprentice or trainee farm worker.
- You are a worker paid by a labour agency.
You cannot claim if you are:
- A domestic worker employed at a private home.
- A member of the South African National Defence Force (there is a separate fund).
- A member of the South African Police Services (there is a separate fund).
- An outsourced employee.
- A worker who works outside South Africa for more than 12 months at a time.
Claims will only be paid if they are submitted in the correct way and on time. Claims will not be paid if:
- The claim is made more than 12 months after the accident or death, or after the disease is diagnosed.
- You are off work for three days or less.
- The accident resulted from your own wrongdoing (unless you’re seriously disabled or die in the accident, the fund will still pay compensation).
- You unreasonably refuse to have medical treatment.
Who Pays into the Fund?
Employers pay into the Compensation Fund once a month. You do not pay anything towards the fund. Employers cannot deduct money from your wages as contributions to the fund.
What Injuries and Diseases Are Covered?
The fund covers occupational diseases and workplace injuries. The working conditions and diseases caused by these conditions that are covered by the Compensation Fund are set out in Schedule 3 of the Compensation for Occupational Injuries and Diseases Act (130/1993).
You can claim for other diseases if you can prove, using medical evidence and reports, that the disease was caused by conditions at work.
What can You Claim?
You cannot claim for pain and suffering, only for loss of movement or use of your body.
The amount of compensation paid to you, depends on how much you were earning when you got injured or diagnosed. If you have stopped working by the time a disease is diagnosed, the compensation will be worked out according to what you would have been earning.
There are five kinds of compensation:
Temporary disability is when you are unable to work or cannot do all your work because of an injury or disease, but you will get better.
To claim, you need to be put off work by a doctor for more than three days. If you are put off work for longer than three days, you will get paid out for the whole time that you are unable to work (including the first three days).
If you cannot work at all, you will get paid out 75% (three-quarters) of your normal monthly or weekly wage.
If you can only do some of your work, you will still get paid some wages by your employer. The fund will pay you 75% (three-quarters) of the difference between what you got paid and what you would have been paid before the injury.
All medical expenses are also paid if the medical accounts are submitted to the Commissioner.
You can claim compensation for temporary disability for one year. This can be extended to two years, after which the Commissioner may decide that the condition is permanent and grant compensation on the basis of permanent disability.
A permanent disability is an injury or illness that you will never recover from, for example, losing an eye. The seriousness of the disability will determine whether you’ll never be able to work again or whether you’ll find work more difficult.
Disabilities are rated from 100% to 1% depending on the seriousness. For example, a 100% would be the loss of both your hands or the loss of your sight. The loss of your small toe is a 1% disability.
Your doctor will write a medical report about the disability. The Commissioner and various other doctors will then decide how serious the disability is.
If the disability is more than a 30% disability, you will get paid a monthly pension. The size of the pension depends on what your wages were and on the seriousness of the disability. If you have a 100% disability you will get paid 75% (three-quarters) of your wages.
If the disability is less serious, the Commissioner will work out the monthly payment.
If the disability is less than a 30% disability, you will get paid a lump sum.
The lump sum payment is a once-off payment. The monthly payment will be paid for the rest of the worker's life.
If the family member that earns money to support the family (breadwinner) was killed by an occupational injury or disease, you can claim from the fund.
The amount of compensation that you will be paid depends on your relationship to the person who died. The total amount paid to the family cannot be more than the pension the dead worker would have received.
The worker's spouse and children under the age of 18 (including illegitimate, adopted and step-children) are entitled to compensation.
If there is no spouse or children, other dependents, like parents, will be paid compensation.
To claim compensation for the death of a family member, you need to provide certified copies of:
- Marriage certificate
- Children's birth certificates
- Death certificate
- Declaration by the spouse (form WCL32)
- The employer's incident report
- Funeral accounts (form WCL46)
- Details of your income and property
All the medical expenses of a worker will be paid for up to two years, from the date of the accident or the diagnosis of the disease. All medical accounts should be submitted to the Commissioner, including fees for transporting an injured employee to a hospital or to their home.
Who Pays the Claim?
The Compensation Commissioner is appointed to administer the fund and approves your claims. You’ll get money from the fund and not from your employer.
However, the employer has to pay the injured worker for the first three months after the injury was sustained. The Compensation Fund will pay the employer back.
If you’re off for more than three months, the Compensation Commissioner takes over the monthly payments.
If your employer has insurance against workplace injuries then the insurance company will pay the compensation. In these cases, claims are still made to and decided by the Compensation Commissioner.
How do You Claim?
- Inform you supervisor or employer as soon as possible (verbally or in writing). Make note of anyone who witnessed the accident.
- The form that needs to be completed is WCL 2: Notice of Accident and Claim for Compensation.
- Your employer must then report the accident to the Compensation Commissioner, even if they don’t believe your story, by submitting Form WCL 3: Employer's Report of Accident.
- The employer must report a workplace injury within seven days or within 14 days of finding out that the worker has an occupational disease.
- The employee should check that all the details on the form are correct.
- Within 14 days of seeing the worker, the doctor must fill in form WCL 4, stating how serious the injury was and how long the worker is likely to be off work. This is sent to the employer, who sends it to the Commissioner.
- You do not pay for the doctor's fees. But if you want a second opinion, you will have to pay for this.
- If the injury will take a long time to heal, the doctor must send a progress report (WCL 5) to the Commissioner every month until the condition is fully stabilised. This informs the Commissioner of how long you’ll be off work.
- Finally the doctor must submit a final doctor's report (WCL 5) stating either that you’re fit to go back to work or that you’re permanently disabled. The doctor must send this form to the employer who sends it to the Commissioner.
- When you go back to work, your employer must send a resumption report (WCL 6) to the Commissioner stating that you’re back to work and how much you were paid in compensation.
- Both you and your employer should keep copies of all the forms.
- When the first doctor's report has been submitted with the accident report, the Compensation Commissioner will consider the claim and make a decision. A claim number will also be allocated. This number should be used for all paperwork relating to a claim.
- If you disagree with the decision, they can appeal the decision within 90 days by submitting form W929 to the Commissioner.
All forms that need to be submitted to the Commission can be sent to:
PO Box 955
You can contact the Commissioner or any regional office of the Department of Labour for more information and assistance. Forms are available from:
Western Cape Office of the Department of Labour
Fourth and Sixth floors
West Bank Building
Corner Riebeeck and Long streets
Tel: 021 441 8000
Fax: 021 441 8135