In this section, notwithstanding the differences between these entities, for the sake of brevity, unfit, incapacitated and disabled will be regarded as synonymous.

Step 1: Decide whether temporary or permanent (duration):

This decision is largely dependent on whether or not the disorder is treatable under optimal conditions. Unfortunately, many factors influence this including the reality that some conditions are treatable but the optimal medical treatment is not available for various reasons (financial, geographic or even cultural) if a remedial medical treatment is available, the condition should be regarded as temporary.

Sometimes, a remedial medical treatment is not required, such as in cases when the disability simply requires a prolonged period of recovery without specific intervention after which time normal function will be restored. This is usually the case in situations such as severe orthopaedic injuries at the end of their active rehabilitation phase. Normal physical capability might only be restored many months after active rehabilitation has been discontinued. Whilst the period of recovery is often difficult to predict in medicine, estimates are useful for company management, who are involved in human resource planning. Often an estimation of weeks or months is sufficient. By convention a period of disability for longer than two years is regarded as permanent.

Step 2: Is it total or partial (extent)?

Where the disability is partial, the following issues should be addressed:

• Can the affected employee be re-deployed in an alternative effective occupation, even if this means a reduction in income? Where available, the pension provident fund should be approached for a "top-up" of the reduced income. This is a favourable option for the insurance fund, as it constitutes a far lesser cost than a payout for total disability.
• If not, can the affected employee be re-trained to meet the requirements of an alternative effective occupation?
• If none of the above, can the employee’s occupation (or any other occupation) be reasonably adjusted to accommodate the disability, which affects the relevant employee? This could include:
  
  
  • engineered adjustments, such as re-designed work area (ramps, etc.), re-designed work station (alterations to surface height).
  • administrative adjustments, such a reductions in hours of work (such as a "5-8ths" post), or restricted duties.

Note that an employer is not obliged to create a new post for the incapacitated employee, even for work-related illness. If any of the answers to these questions are Yes, then the logical sequence follows. If not, and the employer cannot leave the post unfilled for a longer period because of operational necessity, the employee is regarded as incapacitated and unsuitable for continued employment in the relevant occupation, and dismissal may be considered. The next step (Step 3) then follows.

Step 3: Return to work, rehabilitation and re-integration:

After steps 1 and 2, a more detailed look at the process of returning to work is required, whether this be to the employees’ original occupation, or an alternative. This return could be, in ideal circumstances, a return to normal work without any adjustments. However, where the employee has an impairment rendering him/her unable to return to normal work it is a requirement that the company either makes available appropriate rehabilitation or to find alternative work or to make reasonable adjustments to the work available. This suggests interplay between the employee, (with his/her impairment), and the employer (with available work options).

At this phase of the "return to work" sequence, the role of the physiotherapist, occupational therapist and biokinetician is essential for an optimal outcome. A detailed treatise on rehabilitation options is not appropriate in this document - suffice to say it is a remediation tool, which begins early and continues until such time as the residual function is optimised.

Rehabilitation generally begins whilst the affected person is under medical treatment (even as early as whilst the employee is still in hospital). It is all about the restoration of optimal function, given the circumstances of the impairment. Programmes follow different courses, including complex psychomotor skills training, and restoration of fine motor control, gross motor strength, and mechanical range of motion. An important element of rehabilitation, particularly regarding employees involved in major accidents, is aimed at minimising the psychological effects of the injury. Work readiness is generally a function of physical capability and emotional readiness. Sometimes intervention measures may be psychological, such as for employees with post-traumatic stress disorder. This is sometimes identified by an unexplained delay in return to physical readiness.

In working circumstances in which the working conditions are particularly hostile, such as in the underground mining environment, the return to work process should not be too hasty. Some mining complexes have the advantage of simulated underground environments, where rehabilitating employees can be re-integrated to the underground environment in a safe and controlled manner. Structured incremental task requirements are given to the participants of the programme and their progress is monitored and scored. As their performance improves so does their confidence in their ability to return to work. Protracted recovery times are identified readily and the appropriate intervention measures can be implemented without delay.

Step 4: Are there are benefits or entitlements available to the affected employee (compensation or disability award)?

These entitlements come in various forms. For employees with occupational injuries or illnesses, there is a statutory entitlement, which is provided for under the Compensation for Occupational Injuries and Diseases Act (COIDA), administered by the Department of Labour. For employees of mines, quarries, and "Works", they are also covered by the Occupational Diseases in Mines and Works Act (ODMWA), administered by the Department of Health. This mechanism is activated by means of the relevant reports, which are submitted to the relevant authority.

Affected employees who are not covered by statutory compensation mechanisms have the following further options to be considered:

• Permanent disability application from a private insurance company.
• Access to provident fund entitlements proportionate to the affected person’s contributions.
• Ex-gratia award made at the discretion of the company.

These three options are dependent upon what benefits or entitlements are available. The most beneficial of these is a permanent disability award, which is subject to the provisions of the relevant insurance product.

Note that in some cases both statutory and private arrangements may apply.

Point to Ponder:

Point 1: The examining doctor does not make the decision regarding disability.

It should be emphasised to the relevant affected employee that this is an application for a permanent disability payout and is subject to the decision of the insurer (including statutory funds, such as the Compensation Commissioner). At no stage should the responsible medical practitioner lead the employee to believe what the final outcome of the application will be. This sometimes leads to unreasonable expectations and drastic disappointment.

Point 2: The insurer, not the company, generally makes the payments.

A relationship should be established between the employee, the employer and the responsible medical practitioner that this is a combined effort in order to obtain the maximum possible benefit on behalf of the employee. All too often the employee is under the impression that it is the company that provides the payout and makes the decision regarding illegibility for the award. This should be clarified and it should be understood that all three are combining their efforts in this application to the insurance company.

Point 3: The pay-out is subject to the provisions of the insurance product purchased by the employer.

Various insurance products exist in the market. These vary in complexity and in their provisions. The worst of these is the product that provides only for employees with permanent disabilities that render them totally unemployable in the marketplace. This is a cheap group insurance product, previously widely purchased by companies, but which, fortunately, is seen less frequently today.

A preferred option is cover for disability to perform specific work, such as the work in which the employee was involved when the disability occurred. This insurance product makes available a sum of money that the affected employee can use whilst re-engaging a new type of work. This provides a sort of "bridging finance" for a change of career. Some insurance companies also insist on a periodic review of the affected person in order to establish that they are indeed permanently disabled. This may take the form of a medical review every two years to establish whether or not some form of rehabilitation programme might not enable the affected employee to return to effective employment, thereby releasing the insurance company of its obligation of continued payments, as well as restoring the affected person to normal active life (a kind of win-win situation).

Provident fund payouts follow a less complicated course. When the decision is reached that the employee is no longer employable, the provident fund is notified and the relevant entitlements are requested.

The ex-gratia award to which is referred above, is an optional payout, which is made at the discretion of the company, by the company, to the employee. This is a kind of "golden handshake", a reward for good work, to employees who have been financially disadvantaged by their circumstances.