Module 3: Toxicology - Section 7: Legal Aspects

TOX 7.2: COIDA Introductory Notes

INTRODUCTION:

The Compensation for Occupational Injuries and Diseases Act, (Act 30 of 1993), is central to occupational medicine practice. It replaced the Workmen’s Compensation Act of 1941, but is still known widely as "WCA".

Compensation is regarded with ambivalence by medical and nursing professionals and by employers. It is seen by some as a way of getting something for nothing by exaggerating injury or ill health. Others see an excessive enphasis on compensation as diverting effort from prevention of occupational injuries and diseases.

Why is compensation so important?

Workers:

The system provides for treatment for injuries at work, including emergency treatment, in the private sector, freeing the worker from anxiety about payment and enabling access to higher quality care than may be available in the state services. It also provides wage replacement (at 75% of the wage) for time off temporarily due to an occupational injury or disease. This means that the worker does not have to use up sick leave. Employers are also obliged to keep paying this wage level for the first 3 months of any time off - and claim this back from the Compensation Fund. (After three months, the employee has to wait for payments directly from the Compensation Fund. We find that not infrequently, employers do not make these payments and the employee is not aware of his/her rights).

In the case of permanent impairment leading to disability, the system provides from some income replacement, although this is usually at a low level. Finally, in the extreme cases, there is assistance with funeral expenses.

In return for this insurance cover, workers give up their right to sue their employer in civil law. The partial exception is where the worker can prove negligence - in such cases, he or she can claim "extra compensation" (in terms of Section 56 of the Act).

How does the system work for workers? Probably reasonably well for injuries on duty reported to employers in larger workplaces, but less well for smaller workplaces or situations where the opportunity to report it. Dismally for occupational diseases.

Employers:

For employers it provides a no-fault insurance scheme for occupational injuries and diseases, i.e. relieves them of civil liability. (But see point about Section 56 negligence above)

If it works well, the system should ensure good treatment, rehabilitation and early return to work of injured or ill employees.

There is an industry rating for premiums so that general companies in a particular sector pay the same fraction of their wage bill. Individual employers with a poor claims record may, however, have their premiums loaded.

Are there incentive to prevent injuries or diseases other than loading of premiums? The Act allows for merit rebates for good claims performance on a three year cycle, but these have been criticised for being too late to influence behaviour.

Medical profession:

Medical practitioners who elect to accept and treat COIDA cases are paid a tariff generally above "medical aid" rates, although somewhere below the South African Medical Association (SAMA) rates. For some practitioners treatment of injuries on duty is a good source of income. Problems with practitioners usually centres around late or non-payment by the Commissioner of medical bills.

The COIDA system breaks down almost completely for occupational diseases. Since the Commissioner takes years to resolve claims, private practitioners generally will not carry the bills. Also, the system will pay out only if the claim is finally accepted. Investigations done to exclude an occupational disease are thus not covered.

For assistance with occupational disease claims, workers are dependent on workplace clinics staffed by knowledgeable practitioners, specialised public sector clinics (Johannesburg, Cape Town and Durban) or NGOs.

Occupational Health (Nurse) Practitioners:

Administration of COIDA claims may be an incentive for a workplace occupational health service and is generally carried out by the occupational health practitioner.

What skills does the occupational medicine practitioner need with regard to COIDA?

1. You should be able to complete the medical part of an injury claim from start to finish, including advising the employer of his/her responsibilities.
2. You should be able to complete the medical part of an occupational disease claim from start to finish, as above. This includes a good knowledge of the Third Schedule and the ability to complete claims for noise induced hearing loss, musculoskeletal disease, dermatitis, respiratory disease, etc.
3. You should be able to advise the employee on his/her rights including the right to be paid for the first three months, objections and additional compensation.
4. It would be useful to be able to contribute to a management information system for recording, monitoring and trying to reduce occupational injury and disease (other than by "minimising" reporting, of course).

Postgraduate Diploma in Occupational Health (DOH) - Modules 3: Occupational Medicine & Toxicology (Basic) by Profs Mohamed Jeebhay and Rodney Ehrlich, Health Sciences UCT is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 South Africa License. Major contributors: Mohamed Jeebhay, Rodney Ehrlich, Jonny Myers, Leslie London, Sophie Kisting, Rajen Naidoo, Saloshni Naidoo. Source available from here. For any updates to the material, or more permissions beyond the scope of this license, please email healthoer@uct.ac.za or visit www.healthedu.uct.ac.za. Last updated Jan 2007.
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