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COMPENSATION FOR OCCUPATIONAL INJURIES AND DISEASES ACT, 130 OF 1993 AS AMENDED (COIDA). DEPARTMENT OF LABOUR: COMPENSATION FUND PRESENTATION TO THE SELECT COMMITTEE FOR LABOUR ON 26 AUGUST 2009. Social insurance within the social security system in South Africa. - PowerPoint PPT Presentation
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COMPENSATION FOR COMPENSATION FOR OCCUPATIONAL INJURIES AND OCCUPATIONAL INJURIES AND
DISEASES ACT, 130 OF 1993 AS DISEASES ACT, 130 OF 1993 AS AMENDED (COIDA)AMENDED (COIDA)
DEPARTMENT OF LABOUR: DEPARTMENT OF LABOUR: COMPENSATION FUNDCOMPENSATION FUND
PRESENTATION TO THE SELECT PRESENTATION TO THE SELECT COMMITTEE FOR LABOUR ON 26 COMMITTEE FOR LABOUR ON 26
AUGUST 2009AUGUST 2009
THE COMPENSATION FUNDTHE COMPENSATION FUND
Social insurance within the social security system in South Social insurance within the social security system in South Africa.Africa.
Administered under the Compensation for Occupational Administered under the Compensation for Occupational Injuries and Diseases Act, 130 of 1993 as amended in 1997. Injuries and Diseases Act, 130 of 1993 as amended in 1997.
Public Entity in the Department of Labour.Public Entity in the Department of Labour. The Director-General is the accounting officerThe Director-General is the accounting officer The Compensation Commissioner (DDG) reports to the The Compensation Commissioner (DDG) reports to the
DG.DG. Generates revenue from employers’ annual contributions-Generates revenue from employers’ annual contributions-
employers register with the Fund and report accidentsemployers register with the Fund and report accidents..
Compensation BoardCompensation Board
CF Board is a statutory body- comprises organised CF Board is a statutory body- comprises organised business, organised labour, government and medical business, organised labour, government and medical experts.experts.
Advises Minister of Labour on policy matters, Advises Minister of Labour on policy matters, amendments to the Act, annual increases in benefits, amendments to the Act, annual increases in benefits, appointment of assessors.appointment of assessors.
Director-General can request the board to investigate any Director-General can request the board to investigate any issues.issues.
Legislative framework and policiesLegislative framework and policies
Constitution Act, 108 of 1996Constitution Act, 108 of 1996 Compensation for Occupational Injuries and Diseases Act Compensation for Occupational Injuries and Diseases Act
130 of 1993 as amended.130 of 1993 as amended. COIDA regulations.COIDA regulations. Recognition of Customary Marriages ActRecognition of Customary Marriages Act Public Service Act.Public Service Act. Public Finance Management ActPublic Finance Management Act DPSA guidelines on COIDADPSA guidelines on COIDA COIDA policies on occupational diseases and injuriesCOIDA policies on occupational diseases and injuries
Business operations of the fundBusiness operations of the fund
Employers are classified according to nature of operations.Employers are classified according to nature of operations. Assessments are based on the risk profile of employer.Assessments are based on the risk profile of employer. Generates revenue from employers’ annual contributions-Generates revenue from employers’ annual contributions-
Employees do not contribute.Employees do not contribute.
• COID Act operates on a no fault principleCOID Act operates on a no fault principle Recourse for employees- section 56 increased Recourse for employees- section 56 increased
compensation for negligence by employer.compensation for negligence by employer. Section 91 objections-heard by a tribunal.Section 91 objections-heard by a tribunal.
section 22 covers employees on ‘willful misconduct’section 22 covers employees on ‘willful misconduct’
Operations continued…Operations continued…
Employers may request transfer to mutual associationsEmployers may request transfer to mutual associations Two Mutual associations operate under license from the Minister Two Mutual associations operate under license from the Minister
of Labour to process COIDA claims.of Labour to process COIDA claims. Minister sets conditions for Mutual Associations e.g security Minister sets conditions for Mutual Associations e.g security
guarantees.guarantees. The DG determines provisional settlements to monitor mutual The DG determines provisional settlements to monitor mutual
associations.associations. Rand Mutual operates in the mining industryRand Mutual operates in the mining industry FEMA operates in the construction industry.FEMA operates in the construction industry. Government departments are exempted from annual Government departments are exempted from annual
contributions-their claims are adjudicated by the Fund.contributions-their claims are adjudicated by the Fund.
COIDA Benefits structureCOIDA Benefits structure
Permanent disablements (PD) are scheduled in Permanent disablements (PD) are scheduled in Schedule 2 and 3 of the COID Act-Schedule 2 and 3 of the COID Act-
Unscheduled PD are those not in the Act (Brain Unscheduled PD are those not in the Act (Brain injuries, multiple injuries, internal injuries)- PD is injuries, multiple injuries, internal injuries)- PD is determined by in house medical officers.determined by in house medical officers.
Benefits are based on the employee’s medical Benefits are based on the employee’s medical condition to determine permanent disablement condition to determine permanent disablement (PD) -employee’s earnings and medical reports are (PD) -employee’s earnings and medical reports are imperativeimperative
Lump sum payment-below 31% PDLump sum payment-below 31% PD Monthly pension -From 31% and aboveMonthly pension -From 31% and above
Benefits-continued…Benefits-continued…
Medical expenses including- assistive devices (prosthesis).Medical expenses including- assistive devices (prosthesis). Widows pension-40%Widows pension-40% Widows lump sumWidows lump sum Children’s pension up to 18 years-60%Children’s pension up to 18 years-60% Pension commutation.Pension commutation. Temporary Total Disablement-loss of earnings(75% of Temporary Total Disablement-loss of earnings(75% of
earnings).earnings). Burial expenses.Burial expenses. Constant attendance allowanceConstant attendance allowance
RehabilitationRehabilitation
Currently, the CF does not have policy on rehabilitation and early return to Currently, the CF does not have policy on rehabilitation and early return to work work
Rehabilitation CentresRehabilitation Centres Two Centres established by the Compensation Fund in Durban Two Centres established by the Compensation Fund in Durban
and Benoni – under section 4(2)(b)and Benoni – under section 4(2)(b) Centres are private organizations but are not profit driven.Centres are private organizations but are not profit driven. Run by managers who report to the Board of Directors-CF and is Run by managers who report to the Board of Directors-CF and is
also represented in the board.also represented in the board. Funding- CF used to provide 90% funding but has since been Funding- CF used to provide 90% funding but has since been
phased out. phased out.
Business processes- high levelBusiness processes- high level
Supporting IT systemsSupporting IT systems
Axes One-Revenue and FinanceAxes One-Revenue and Finance E-Claims for processing CLAIMSE-Claims for processing CLAIMS FYI-electronic file for claimsFYI-electronic file for claims Centura systems –generates form letters for claims.Centura systems –generates form letters for claims.
FINANCIAL INFORMATIONFINANCIAL INFORMATION
Revenue generationRevenue generation
The Fund has 387 000 registered employers.The Fund has 387 000 registered employers. Raised over R3.9 billion ($500m) employer’s Raised over R3.9 billion ($500m) employer’s
annual contributions in the past financial year.annual contributions in the past financial year. Net assets amount to R 21 billion($2.7billion)- Net assets amount to R 21 billion($2.7billion)-
reserves plus pension account.reserves plus pension account.
FINANCIAL INFO. CONTFINANCIAL INFO. CONT….….
Expenditure on claimsExpenditure on claims Over 203 711 claims have been reported from 01 April 2008 to Over 203 711 claims have been reported from 01 April 2008 to
31 March 2009.31 March 2009. From a total of 815 045 medical accounts, R1,544,970,689 From a total of 815 045 medical accounts, R1,544,970,689
billion was paid by 31/03/2009.billion was paid by 31/03/2009. From a total of 327 647 compensation payments, R630 m was From a total of 327 647 compensation payments, R630 m was
paid by 31/03/2009.paid by 31/03/2009.
Distribution of medical claims Distribution of medical claims submitted for 2008/2009 financial yearsubmitted for 2008/2009 financial year
General Practitioners 27%General Practitioners 27% Private Hospitals 21%Private Hospitals 21% Diagnostic Radiology 18%Diagnostic Radiology 18% Physiotherapist 7%Physiotherapist 7% Orthopaedics 6%Orthopaedics 6% Pathology 5%Pathology 5%
Graphical distribution of Graphical distribution of medical claims submittedmedical claims submitted
Claims' Ratio/ Service Provider 2008/09
003 Accredited Bloodand Blood ProductCouriers004 Chiropractors
008 Homeopaths
009 Ambulance Services-Advanced
010 Anaesthetists
011 Ambulance Services-Intermediate
012 Dermatology
013 Ambulance Services-Basic
014 General MedicalPractice(7 digit pr no)
016 General MedicalPractice(7 digit pr no)
017 Obstetrics andGynaecology
018 Pulmonology
019 Specialist Physician
020 Gastroenterology
021 Neurology
022 Cardiology
023 Psychiatry
024 Medical Oncology
025 Neurosurgery
026 Nuclear Medicine
028 Opthalmology
030 Clinical Haemotology
031 Orthopaedics
036 Otorhinolaryngology
038 Rheumatology
039 Paediatrics
040 Paediatrics -cardiology
042 Physical Medicine
044 Plastic andReconstructive Surgery
046 Diagnostic Radiology
049 Radiography
050Radiotherapy/NuclearMedicine/Oncologist051 Surgery/Paediatricsurgery
052 Cardio ThoracicSurgery
054 Urology
055 Drug & AlcoholRehab
056 Sub-Acute Facilities
057 Group Practices
058 GroupPractices/Hospitals
059 Pathology
060 General DentalPractice
062 Mental HealthInstitutions
064 Provincial Hospitals
066 Private Hospitals('A'- Status)
068 Private Hospitals('B'- Status)
070 Private RehabHospitals(Acute)
072 Pharmacies
075 Pharmacotherapist
076 Maxillo-Facial andOral Surgery
077 Orthodontics
078 OccupationalTherapy
080 Art Therapist
082 Podiatry
083 Medical Scientist
084 optometrists
086 Optical dispensers
087 Physiotherapist
088 Masseurs
089 Orthoptists
090 Clinical Technology
090 Unattachedoperating theatres/ Dayclinics090 Approved U O T U /Day clinics
091 Blood transfusionservices
092 Hospices
093 NursingAgencies/Home CareServices094 Speech therapy andaudiology
095 Hearing AidAucostician
Total medical payments for Total medical payments for the past three yearsthe past three years
Year Payment category Number of payments Rand Value 2006/07 Medical 886 511 R 1,430,143,788 2007/08 Medical 777 320 R 1,294,380,035 2008/09 Medical 815,045 R 1,544,970,689
Graphical presentation of Graphical presentation of payments over the past three payments over the past three
yearsyears
NUMBER OF MEDICAL ACCOUNTS PAID
720,000740,000
760,000780,000800,000
820,000840,000860,000
880,000900,000
2006/07 2007/08 2008/09
Acc. Paid
Number of compensation Number of compensation benefits for the past three yearsbenefits for the past three years
YEARYEAR NO OF PAMENTSNO OF PAMENTS RAND VALUERAND VALUE
20062006 331672331672 R655000000R655000000
20072007 335345335345 R652000000R652000000
20082008 327647327647 R630708449R630708449
Graphical presentation of Graphical presentation of compensation benefitscompensation benefits
COMPENSATION BENEFITS
331672
335345
327647
322000
324000
326000
328000
330000
332000
334000
336000
2007
NU
MB
ER
PA
ID Series2
Series1
Series3
2006 2008
Current challenges facing the Current challenges facing the
FundFund Lack of capacity for revenue generation, debt collection and Lack of capacity for revenue generation, debt collection and
Supply Chain Management.Supply Chain Management. Slow Slow settlement of claims thus eliminating backlogs.settlement of claims thus eliminating backlogs. Non and/or delays in reporting of accidents and submission of Non and/or delays in reporting of accidents and submission of
documentsdocuments Lack of adequate IT resources and InfrastructureLack of adequate IT resources and Infrastructure Disparate IT systemsDisparate IT systems Outdated business processesOutdated business processes Decentralization of functionsDecentralization of functions Audit qualifications.Audit qualifications.
Current interventionsCurrent interventions
New business processes have been developed and are pending New business processes have been developed and are pending the development of the new IT system-the development of the new IT system-
The new system is being developed in collaboration with Rand The new system is being developed in collaboration with Rand Mutual Assurance (RMA).Mutual Assurance (RMA).
- Electronic submission of claims will be possible- Electronic submission of claims will be possible - Will facilitate the final decentralization of the remaining - Will facilitate the final decentralization of the remaining
functionsfunctions - Will facilitate automation and organizational structure re-- Will facilitate automation and organizational structure re-
designdesign Organizational structure re-design- A service provider has Organizational structure re-design- A service provider has
already been procured by tender.already been procured by tender.
Current interventions cont….Current interventions cont….
The COIDA Enforcement policy was developed and is being The COIDA Enforcement policy was developed and is being implemented by provinces.implemented by provinces.
A new case management IT system is currently under A new case management IT system is currently under development by Inspection and Enforcement Servicesdevelopment by Inspection and Enforcement Services
The decentralization of claims pilot will be rolled out to 4 The decentralization of claims pilot will be rolled out to 4 provinces by 30 March 2010-Currently the pilot is running at provinces by 30 March 2010-Currently the pilot is running at Limpopo Provincial Office.Limpopo Provincial Office.
Action plans on all audit queries have been put in place and the Action plans on all audit queries have been put in place and the project will be complete by 30 March 2010.project will be complete by 30 March 2010.
Intensify communication with stakeholders in line with the current Intensify communication with stakeholders in line with the current communication strategy namely-Public Service employees communication strategy namely-Public Service employees educational campaign, reporting of accidents campaigneducational campaign, reporting of accidents campaign
Future plans/initiatives of the fundFuture plans/initiatives of the fund
New Policy OptionsNew Policy Options- Development of policy on rehabilitation and re-integration Development of policy on rehabilitation and re-integration
of an employee following an occupational injury.of an employee following an occupational injury.- Review the pension policy regarding the death of a Review the pension policy regarding the death of a
pensioner through natural causes.pensioner through natural causes.- Joint strategy with RAF on assessment of permanent Joint strategy with RAF on assessment of permanent
disablement and payment of medical aid.disablement and payment of medical aid.- Integration of COIDA with the current comprehensive Integration of COIDA with the current comprehensive
social security reforms proposals within government.social security reforms proposals within government.
THANK YOUTHANK YOU
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