When an employee is injured while performing their duties at work, the employee is able to access necessary specialised private medical care, given that the employer contributes to the Compensation Fund. Medical service providers then claim the fee from the Fund.
However, because of the Fund’s dysfunction and rigorous administrative processes, medical professionals often choose to cede their claims to third-party administrators in return for immediate payment at a fee charged directly to the medical provider and not the Fund.
Medical practitioners do not necessarily have the administrative capacity or expertise to navigate the complex and dysfunctional claims system. Third-party administrators have been very successful in finalising claims, often by way of legal action. It is possible that the fund is trying to prevent further adverse court findings against it, in the hope that the medical practitioners will not pursue unpaid claims.
The Portfolio Committee on Employment and Labour (The Committee) is currently hearing oral submissions related to the Amendment Bill. They have been warned that that Section 43 collapses the only element of the Fund’s process that currently functions efficiently and will have a detrimental impact on the entire value chain, including employers, injury-on-duty patients and medical service providers, even to the Fund itself.
In the end, it will be the injured workers who will suffer most, as practitioners will no longer be willing to treat them and they will be forced to pay personally or resort to public hospitals, which are already overburdened and rife with poor or non-existent service delivery.
(Source: NEASA)
