South Africans who are injured in work-related accidents are increasingly being denied treatment by doctors and pharmacists because the labour department’s Workmen’s Compensation Fund has not processed their claims for payment.
“Getting an injury while on duty is one of the worst things that can happen to someone,” said Renette Oosthuizen of the union Solidarity. Last year, Minister of Labour Membathisi Mdladlana told Parliament that, at the end of the book year, claims of R411million were outstanding. And the fund was still struggling to clear 2002’s backlog.
In terms of the Compensation for Occupational Injuries and Diseases Act, claims should be settled within two months.
Several doctors, including two orthopaedic specialists, said they were hesitant to treat patients when they had to bill the fund, a statutory insurance scheme. “A back operation costs thousands of rands,” said one East Rand specialist. “You can’t take the risk that you won’t be paid.”
Johan Bothma, executive director of the community pharmacy sector of the Pharmaceutical Society of South Africa, said there were no guarantees when dispensing medicine to compensation fund patients. “You just don’t know whether the patient is registered or whether his claim has been processed,” he said.
Payment for the medical treatment of injured employees makes up 51% of the fund’s expenditure on claims, including pensions. It paid out R1,95-billion last year.
Oosthuizen said the only solution was for patients to find doctors or pharmacists who had not yet “blacklisted” the fund, or to pay themselves.
Mark Bishop, group fund relations manager at Netcare, said the appointment of the new commissioner and her team had brought improvements over the past six months. The fund generally paid his company’s hospital on time, but individual doctors in the hospital and retail pharmacists working with Netcare had bigger problems.
Last February, Mdladlana fired then-commissioner Bongiwe Ncube for non-performance and hired Nerine Kahn, the department’s former labour relations head.
Department of Labour spokesperson Page Boikanyo said the compensation commissioner was aware that some medical providers were refusing to service claimants. But this was not universal, meaning that people should choose service providers who rendered services to everyone.
Boikanyo said a project has been launched to review temporary files and convert them into permanent claims by the end of this month. Provided a complete claim was submitted to the fund, processing, including payment, should take no longer than two months. But some claims took longer to finalise because of the noncompliance of employees, employers and service providers.
Yet the Pretoria High Court last year ruled that the lack of an employer’s report could no longer delay claims for compensation. Despite this, Solidarity’s Hanlie Janse van Rensburg said she had had a claim cancelled because it had not been reported.
The Act makes provision for penalties against employers who fail to report within the prescribed period, including a fine equivalent to the total amount of the claim.
‘This man is waiting for his legs’
Andries Pyper, who lives near Oudtshoorn, lost both legs and an arm in 1977 in an accident while in the service of his local council.
The Workmen’s Compensation Fund immediately approved his claim and he has been drawing a meagre pension of R500 a month from the fund ever since.
Two years ago, Pyper, who is illiterate, wanted a prosthesis. He found that his file was still classified as temporary and that, until his claim was fully processed, he was not entitled to claim the cost of artificial limbs from the fund.
His representative in Solidarity, Hanlie Janse van Rensburg, has been trying to locate Pyper’s 28-year-old file and original application, which still bears the stamp of the then Workmen’s Compensation Commissioner.
“No one can tell me why this man is still waiting for his legs. While the fund stalls, he can’t move around or help himself in any way,” she said.
Official inertia has left another victim of a workplace accident, Stanley Marsberg, in the queue for five years. Marsberg suffered head and neck injuries while on shift at a Witbank colliery in 2000, leaving him with constant shoulder spasms and reducing his mobility by 30%.
His supervisor failed to report the injury to management, meaning that no report was lodged with the fund at the time of the accident.
“Despite an affidavit from me and two witnesses, the fund has not processed my claim and, after five years, I still have a temporary file,” he said. There had been no movement, despite a high court order last year instructing the fund to process files such as his.
Marsberg, who has had a number of operations and needs constant physiotherapy, estimates his medical costs at R50 000. Much of this has come from his own pocket. — Yolandi Groenewald