Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Scale of Fees

Annual Increase in Medical Tariffs for Medical Service Providers - 2026

Private Hospital Gazette 2026

General Information

5. Overview of the COID Claims Process
Purchase cart Previous page Return to chapter overview Next page

 

•All claims lodged in the prescribed manner with the Compensation Fund are subjected to the following process:

 

a.New claims are registered by the Employers with the Compensation Fund in the prescribed manner. Details and progress of the claim can be viewed on the online processing system for registered users of the system.

 

b.Proof of identity is required through the submission of a copy of an identity document/card, will be required for a claim to be registered with the Compensation Fund. In the case of foreign nationals, the proof of identity (passport) must be certified.

 

c.All supporting documentation submitted to the Compensation Fund must reflect the identity and claim numbers of the employee.

 

d.Once an incident is reported to the Fund a claims number will be allocated to acknowledge receipt, but this does not imply acceptance of liability for the claim.

 

e.On acceptance of liability for claims in terms of the COID Act, all reasonable medical expenses, arising from the related medical condition shall be paid to medical service providers, and in accordance to approved tariffs, billing rules and procedures as published in the medical tariff gazettes of the Compensation Fund.

 

f.If a claim is repudiated in terms of the COID Act, medical expenses, will not be payable. The employer and the employee will be informed of this decision, and the injured employee will be liable for payment of medical costs incurred.

 

g.In the event of insufficient claim information being made available to the Compensation Fund, the claim will be rejected until the outstanding information is submitted and liability can be determined.

 

h.Manner of payment of medical benefits for Compensation Fund claims, where liability has been accepted (adjudicated) on or after 1 April 2025.
•All medical invoices for accepted claims must be submitted, in the prescribed manner within 36 months of the date of acceptance of liability.
•And or within 36 months from the date of service, which ever may apply.
•Medical invoices received after said time frame will be considered as late submission of invoices and may be rejected.

 

i.All service providers should be registered on the Compensation Fund claims processing system to capture medical invoices and medical reports for medical services rendered.

 

j.Submission of medical reports and invoices is permitted solely for claims where liability has been accepted by the Compensation Fund and where payment of reasonable medical expenses is authorised.