COID claims do not need to be painful

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Dave Honeyman | Managing Executive: Accident and Health/Motor | SHA Specialist Underwriters | mail me|


Claiming from the Compensation for Occupational Injuries and Diseases (COID) fund for workplace injuries is viewed by many business owners as a needlessly difficult and time-consuming process.

A survey we conducted showed that 49% of businesses that submitted claims to COID in the last three years, experienced long delays. The vast majority of these companies paid for medical treatment upfront, and nearly a quarter of them reported sustaining notable financial losses resulting from an incident.

Complex reporting

Reporting an on site injury can indeed be complicated, and a response from COID can take anything between 6 to 12 months. Understandably, this has led some companies to eschew the claims process altogether, in an attempt to avoid wasting further admin hours on what would appear to be a lost cause.

The first thing to note is that the paperwork required by COID after an incident, can be extensive. This is often the first stumbling block for a business, since incorrect or incomplete paperwork sent to COID, will understandably result in the claim being delayed.

If the business understands the claims process, and incident reports and claims are filed correctly, the fund should be able to reimburse any up-front costs much sooner. The employer needs to ensure that the incident reports are as detailed as possible, and that all supporting documentation such as doctor’s reports and up-front medical bills are included.

Secondly, they need to ensure that the submitted paperwork is actually being processed, in case the claim needs to be resubmitted. It has happened in the past that businesses waste several months before finding out that their paperwork had been thrown out for being incomplete.

Not claiming

Having discussed COID claims with a number of clients over the past year, we have found that a number of clients have decided to stop submitting COID claims and just pay the medical accounts for their employees.

Liability exposure

It should be noted that not claiming from COID could expose the client to massive liabilities.

Aside from being a legal requirement, a business that pays for the medical treatment of an injured employee and does not submit a claim to COID, essentially takes responsibility for all future costs related to that injury.

An injury such as a broken or fractured limb has the potential to develop hundreds of thousands of rand in complications months (or even years) down the line. COID was specifically created to address this risk, which is why it covers the immediate and future costs of reported injuries.

Taking the time to understand the requirements of COID will ensure that they protect themselves against unnecessary costs and protect the best interests and well-being of their employees.

Broker opportunity

In our 2019 survey, our findings show that over half of insurance brokers were unaware of the difficulties their clients are experiencing with COID claims.

There is an opportunity for brokers to discuss the benefits of a personal accident policy, which can provide cover for potential shortfalls in COID cover and protect the business and employee against financial loss. Some personal accident policies offer access to WorkCover as an add-on, which gives the employer access to professional assistance with providers who deal exclusively with issues like workman’s compensation and road accident claims.

These service providers can assist with the completion of documents and submission of COID claims, and ensure that the claims are processed timeously. Having an expert on hand that can follow up on COID claims can effectively reduce the wait time considerably.


 

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