Issue 1 March Training support. offered to employers

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1 Connect Issue 1 March 2015 Class XIII Submitting medical Training support Celebrating a decade 04 reports 05 offered to employers 06 of mobile care Introducing RMA Government Gazettes, Nos and 38044, released by the Department of Labour served to inform all employers who fall within Class XIII of the transfer to Rand Mutual Assurance (RMA) in terms of section 30 of the Compensation for Occupational Injuries and Diseases Act (COIDA) from 1 March For a full list of who falls under Class XIII, refer to page 4. Rand Mutual Assurance (RMA) is a mutual assurance company with a track record of more than 120 years in the administration of claims for occupational injuries and diseases according to the Compensation for Occupational Injuries and Diseases Act (COIDA). 130 of 1993 as amended. RMA is passionate about caring for the lives of its claimants and their families. It embodies its slogan of Caring, Compassionate Compensation at every level of the organisation, from its empathetic staff to embracing good corporate citizenship. RMA s value lies not only in its compassionate approach, but in the excellent systems and processes it has in place to ensure timeous and efficient payment of valid claims. RMA has the licence to administer the claims for both Class IV (mining) and, more recently, Class XIII (iron, steel, artificial limbs, galvanising, garages, metals and related industries). Through its market-leading IT system, RMA offers enhanced efficiencies for the administration and paperless adjudication of COID claims. As a company that is compassionate and caring, RMA goes the extra mile to ensure that beneficiaries and their families receive the care and compensation they are entitled to when they have sustained either a workrelated injury or occupational disease. Founded on 1 June 1894, RMA is a non-profit mutual assurance company which is owned by its policy holders. RMA operates in terms of section 30 of COIDA, under licence from the Minister of Labour. The RMA Group also operates under both short- and longterm insurance licences issued by the Financial Services Board (FSB). The core of RMA s business is the receipt, adjudication and administration of workers compensation claims, including the payment of medical costs, once off disability payments and the ongoing payment of pensions in the case of severe disability and death. With its head office in Johannesburg and regional walk-in branches located in Carletonville, Durban, emalahleni, Johannesburg, Klerksdorp, Pretoria, Rustenburg and Welkom, RMA has a wide footprint and is easily accessible to its clients, claimants and other stakeholders. In addition, RMA has satellite offices in Lesotho, Mthatha and Mozambique. An active training department has an all-encompassing approach to ensuring that stakeholders have a sound knowledge of RMA s products and processes and how to access the online service facilities. Stress-free claiming Accidents happen, they are a fact of life, but what happens when one of your valued employees is injured, or they contract a disease as a direct result of their job? How do you ensure that they are well taken care of? RMA has more than 120 years experience in offering Caring, Compassionate Compensation and we give you the peace of mind that your employee will be well cared for through a highly efficient claims management process coupled with empathetic and compassionate staff. What do I need to report? All work related injuries on duty, regardless of the severity of the injury, need to be reported to RMA. This includes: minor lacerations contusions abrasions 01

2 According to the Compensation for Occupational Injuries and Diseases Act (COIDA), if an employee reports an accident alleged to have taken place in the workplace yet the employer is not convinced it is a work-related accident, it must still be reported to RMA. Accident: Report to RMA within 7 days of being informed of the accident Disease: Report to RMA within 14 days of being informed of the disease Not reporting accidents timeously can result in numerous challenges, including: Medical Service Providers are not paid timeously for services rendered; Temporary Total Disablement (TTD) claims not submitted timeously; Lack of medical reports; and Black listing of the injured employee. How do I submit a claim to RMA? RMA is a technology-forward company and works in a paperless environment. While RMA encourages the use of electronic claims submissions either online or via telephonic reporting, in support of its paperless environment, it has accommodated the needs of all types of employers by offering three easy to use claims submission options: 1. Quick and easy telephonic reporting through the RMA Contact Centre on ; 2. Online claims submissions through RMA s claims management module, known as C-Filing. This can be accessed via the website on by following the Information Zone Electronic Submission of Claims link (please ensure that you are registered with Online Services before submitting a claim); or 3. Paper claim scanned and ed to RMA at rmascannings@randmutual. co.za. Please only use this option if you are unable to submit your claim as per the two options above. Please follow the claims process flow below. RMA Claims Cycle STEP 1 Once the employee has reported the accident to the employer, the employer must report the accident to RMA within seven days for an injury and 14 days for a disease. This can either be done either via:»» C-Filing (RMA s claims portal): Log in via the Electronic Submission of Claims link (please ensure you have first registered with Online Services)»» Telephonic reporting: Call the Contact Centre on Please have the last four digits of your BP number handy when doing telephonic reporting. STEP 2 Employer completes an Accident or Disease Report Form and submits it to RMA via C-Filing or telephonically. Alternatively, hard copies can be scanned and ed to RMAscannings@randmutual.co.za. STEP 3 Once the employee has received medical treatment for their injury or disease, the healthcare provider/employer/employee must submit a First Medical Report to RMA within 14 days of the date of the accident. STEP 4 RMA will acknowledge and adjudicate the claim. If liability has been accepted in terms of COIDA, RMA will pay the healthcare provider to the maximum of COIDA tariffs. Healthcare provider/employer/employee must submit progress reports during treatment. STEP 5 STEP 6 Employer submits claims electronically via C-Filing for Temporary Total Disablement (TTD), also known as days off, of more than three days. These claims must be submitted with a medical report and/or sick note from the treating doctor. 02

3 STEP 7 RMA processes payment to employer for TTD claims. STEP 8 Employer continues to submit TTD claims for the duration of the injured employee s medical treatment. STEP 9 Once the injury has stabilised the healthcare provider compiles a final medical report including an assessment of the disability which is submitted to RMA. STEP 10 Based on the final medical report and assessment, RMA calculates the degree of permanent disablement and awards compensation in terms of COIDA. STEP 11 In the case of a fatality as a result of the injury/disease, compensation is paid to the beneficiaries in terms of COIDA. Understanding your claim number: Indicates that the claim is for a Class XIII Employee Indicates the number of people involved in the accident Indicates the policy = COID (EMP = Employee) X A EMP Accident Number RMA Member Number Year in which the accident took place What is required for RMA to accept liability? A claim is not a guarantee of payment and only once liability has been accepted by RMA will a claim be paid. The below information is needed by RMA in order for liability to be assessed: 1. RMA needs to receive a fully completed and signed accident or disease claim form. Depending on your reporting preference, the following are accepted: A pin (last four digits of your BP number) when reporting telephonically; Authentication code (received when registering for Online Services) when reporting via C-Filing; or Physical signature when reporting via paper. 2. Personal details of injured employee, including: ID Number; Cell phone number of employer; and Company Number. 3. A First Medical Report confirming the injury and that it is work-related. 4. Accident earnings: An average of six months earnings prior to the date of the accident; Basic earnings; Variable earnings; Non-variable earnings; and Section 51 earnings (where applicable). 03

4 Who falls under Class XIII? IRON, STEEL, ARTIFICIAL LIMBS, GALVANIZING, GARAGES, METALS and related industries 1300 Iron and steel production including processing and all quarrying and/or mining as well as other operations if incidental thereto Foundry products manufacturing as a separate business; stove manufacturing Iron button, buckle, hook, eye, hairpin and/or metal badges and brooch manufacturing; air-gun pellets manufacturing; leaden toy and novelty manufacturing; solder manufacturing; Venetian blind manufacturing and repairing; artificial limb manufacturing and repairing; manufacturing of vehicle and other number plates Metal tube manufacturing; metal furniture, door and/or window manufacturing; sheet metal products manufacturing as a separate business; wire, wire spring, wire rope, wire goods, fencing and/or gate manufacturing; tin container manufacturing; lead pipe manufacturing; blacksmith as a separate business (including farriers); iron bedstead manufacturing, cutlery manufacturing including repairing if undertaken by the manufacturer; scale making and repairing; cycle frame manufacturing; electro-static powder spray painting; metal spraying; derusting of metals; manufacturing of gas producers, electric battery; accumulator and/or electrode manufacturing; building and/or repairing of ships (other than fiber glass, wooden or sailing ships) including repairs to ships whilst moored to the quay side or anchored in the harbour or roadstead or whilst undergoing trial runs; chain manufacturing as a separate business; aluminum products manufacturing and installation; welding as a separate business; galvanizing as a separate business; metal products manufacturing including the business of saw doctors; lighthouse and/or marine lighting engineering and metal or engineering works not otherwise classified but excluding structural steel erection or steel reinforcing operations rated under subclasses 0530 or Electric cable manufacturing; manufacture of safety razor blades Motor cars assembly as a business including all operations in connection therewith Motor garaging, including servicing and/or repairing of motor vehicles; the business of the owner of a motor graveyard or scrap yard); the business of an automotive electrician as a separate business; petrol and oil filling station; locksmithing; aircraft repairing and/ or servicing as a separate business; employment of parking attendants; the business of a dealer in new/second hand motor vehicles; motor vehicle hiring if repairs are undertaken. Note: (a) The sale of motor spare parts and/or cars etc., as well as the supply of petrol, oil and/or air is incidental to the business of a motor garage owner whether such services are supplied on the garage premises or not. (b) This rate also applies to a dealer in second-hand spare parts if the employer undertakes the dismantling of cars Wagon, coach, carriage and/or motor body building as a separate business; panel beating and spraying as a separate business; motor car radiator manufacturing and repairing as a separate business. 04

5 Submitting medical reports You have had an injury on duty within the workplace and dutifully reported it to RMA, but now what? This is the part of the claims process when medical reports become critical. In terms of section 74 of the COID Act, a healthcare provider or chiropractor needs to submit a first medical report to RMA within 14 days of having examined an injured employee or having diagnosed an occupational disease. The provider may hand the report over to the employer or the employee who in turn needs to ensure it reaches RMA within the 14 day timeline. A First Medical Report form is available on the RMA website on If the healthcare provider is registered for RMA s online services, the medical reports can be submitted to RMA electronically via the Medical Portal. Employers are required to submit scanned copies of the medical reports through RMA s new scanning and imaging solution by scanning and ing the documents to: RMAscannings@randmutual.co.za. Should RMA require additional clinical information, the provider or chiropractor will need to submit additional medical reports as requested. If the provider fails to submit the subsequent reports, or does not supply sufficient information, RMA may defer the payment of the cost to the medical provider concerned until the report has been furnished or completed in a satisfactory manner. This cost can thus not be recovered from RMA before the report has been submitted or acceptably completed. Once the injury has stabilised, the healthcare provider completes a Final Medical Report including an assessment of the disability, which is submitted to RMA. Fees for medical aid Once RMA is satisfied with the medical reports from a healthcare provider and requires reimbursement, the treatment is paid at the rate determined by the Director-General as per section 76 of the COID Act. RMA pays at COIDA tariffs, per diem and negotiated tariffs. If no amount has been determined for a particular medical treatment, RMA will not pay more than what is deemed reasonable by the Director-General. No amount shall be recoverable from the employee or an employer other than an employer individually liable. 05

6 Understanding TTDs Temporary Total Disablement (TTD) is the payment of an employee for his days off work while injured, or while recovering from his work-related injury. TTDs are only paid if the employee is off work for more than three days, is undergoing medical treatment and has been booked off by the treating doctor either by means of a medical report or a sick note. Based on the supporting medical report or sick note, the employer pays the employee as per Schedule 4 of the COID Act. These payments should be made at regular intervals, but should not exceed one month intervals. The employer is liable for the TTD payment for the first three months from the date of the accident. Once RMA has accepted liability for the claim, the employer is reimbursed. The employer claims the money fr0m RMA by submitting TTD claims with the supporting medical report or sick note either electronically via the C-Filing claims management system (please remember that your company needs to be registered with RMA s online services for this type of claims submission), or by scanning and ing to RMAscannings@randmutual.co.za. Payment of TTDS may continue for the duration of the treatment, but should not continue for more than 24 months. TTDs continuing for more than 24 months may be considered as permanent disablement. For minimum and maximum payments, please refer to item 1 of Schedule 4 of COIDA. Training support offered to employers In an effort to ensure excellent service and assist clients through the transfer to RMA, we offer a comprehensive training solution for stakeholders to ensure a sound understanding of its products, processes and its simple, accessible online facilities. In order to ensure your training needs are sufficiently supported, we have compiled a training workshop schedule for 2015, which is listed below. To reserve a seat for any of the training sessions please complete the attached booking form and return it by to RMATraining@randmutual.co.za. Workshop Outline: Please note that only once we have received bookings can we confirm the venue to accommodate the required numbers. The training workshops run from 9am-3pm and the venue will be communicated to you closer to the scheduled training date. In addition to the training workshops, we will also be hosting weekly live member workshops via Webex. A schedule of these dates will be communicated to you shortly, together with a link that will give you access to the weekly Webex workshops. We have also made our training offerings even Workshop Outline: more accessible through two training videos that highlight RMA s products, processes and claims cycle. Please view these videos on the Information Zone link on our website ( Who should attend? Safety Officers, Payroll and HR Administrators, people responsible for compensation benefits, Medical Officers, Managers, Shop Stewards and any other person involved or with an interest in injury and diseases compensation. Employer Information Earnings C-Filing (formerly CompDiv) Workshop Outline: RMA Overview RMA Mandate RMA Products and Earnings Declarations Occupational Injuries and Diseases Employer Obligations and Penalties Document Completion and Submission General Discussion Q&A Workshop Sessions Date Area 22 April 2015 Pretoria 12 May 2015 Johannesburg 14 May 2015 Carletonville 21 May 2015 Welkom 09 June 2015 Klerksdorp 11 June 2015 KZN 09 July 2015 emalahleni 16 July 2015 Rustenburg 13 Aug 2015 Pretoria RMA Overview Section 63 o Variable & Non-Variable Earnings Section 51 o Apprentice o Employee under 26 years of age Completion of documentation General Discussion Q&A Workshop Sessions Date Area 16 April 2015 Johannesburg 13 May 2015 Free State 12 June 2015 Durban 08 Sept 2015 Johannesburg RMA Overview Introduction to C-Filing User Roles Electronic Signature Step-by-step claim submission Statement of Earnings Form Capturing of a Medical Report Capturing of Days Off Invoice General Discussion Q&A Workshop Sessions Date Area 17 April 2015 Carletonville 20 May 2015 Johannesburg 10 June 2015 Durban 11 June 2015 Rustenburg 15 July 2015 Welkom 19 Aug 2015 Johannesburg 06

7 Celebrating a decade of Mobile Care Mobile and limber On-site prosthetic manufacturing done on board the mobile clinic on its first foray into Malawi in Caring and compassionate RMA Chief Executive Officer, Jay Singh, communicates with a pensioner on a mobile clinic trip to Malawi in By Marissa Nel RMA, together with prosthetic partner, Marissa Nel & Associates, celebrates 10 years of caring for its disabled pensioners and completing prosthetic reviews through its mobile clinic. The mobile clinic travels into rural areas across the breadth of southern Africa, taking prosthetics to often remotely based beneficiaries who otherwise would not have access to their required level of care. Everything starts with a dream, perhaps as a thought, and so it was that 10 years ago the RMA Medical Department together with Marissa Nel & Associates had such a dream. This vision was to improve the quality of life of disabled people living in rural areas by delivering sustainable prosthetic services to their doorstep by means of a mobile prosthetic clinic. Founded on the belief that you can create miracles with a positive attitude and a dedicated team, a mobile vehicle was purchased in May A tailor-made container was built in Durban and the vehicle was delivered to East London where customised cupboards and worktops, together with a specially designed router and other equipment, was made and fitted. Due to the remote areas it would be travelling to, a generator was installed to power all machinery including an oven, hand tools and an air conditioner. Most of the equipment was designed to be removable so that a fully operational workshop could be set up outside the vehicle. Its maiden voyage to Lusikisiki, Bizana, Flagstaff and Mthatha exposed some flaws in the design that were overlooked in the original enthusiasm to get the clinic on the road, but overall it was a successful trip to the Eastern Cape with all the necessary prosthetic repairs and maintenance being conducted onsite. The initial concept for the mobile clinic was to repair prosthetics and issue sundries on-site to ensure an accessible and convenient service to pensioners. A review of the first trip, however, identified a need to further expand on this original concept to include on-site prosthetic manufacturing as part of the service. This has been successfully operational for the past 10 years. The mobile clinic was soon venturing across South African borders into Mozambique to the excitement of RMA s disabled pensioners who were delighted that they could get their prosthesis the day after being assessed. The joy and appreciation of pensioners when their new limbs were fitted was a truly rewarding experience for the team and the 07

8 smiles of appreciation further motivated the team to improve on its service delivery model. The next milestone was in early 2006 when the clinic embarked on a remarkable journey from the Eastern Cape to Gauteng, through Mozambique and Malawi. Nothing had quite prepared the team for the delays experienced at border posts, corrupt officials seeking bribes, massive potholes and non-existent roads. However, iron determination ensured that the clinic arrived in Malawi on time and serviced 131 pensioners en route. The dedicated team frequently worked through the night, often in heavy rain and challenging conditions to ensure that the pensioners were up and mobile. Subsequent to its initial forays, RMA has held numerous clinics helping many disabled pensioners across southern Africa from the Eastern Cape to KwaZulu Natal, Swaziland, Lesotho, Mozambique and Malawi. Over the past 10 years, more than prosthetic reviews were conducted how many prosthetics made?. The past decade has meant that the team has also gained further insight into the greater social needs of RMA s beneficiaries in these often remote rural areas, leading to expansion into social assistance projects for beneficiaries enrolled in the pensioners medical programme. These projects not only benefit beneficiaries, but have a broader impact on their families and communities. The vision and passion to improve the quality of life of disabled people continuously drives service enhancement to ensure that the brand message of caring, compassionate compensation is at the core of service delivery. To this end, in March 2013 RMA held a disability awareness campaign in which all staff were temporarily disabled for the day to experience how it felt to be disabled. This helped staff to learn the value of mobility and with it, an increased understanding and awareness of how RMA s pensioners are affected by their disability. What started as a rural mobile maintenance plan 10 years ago with the desire to improve on-site service has grown into a well-received, caring and compassionate service to RMA beneficiaries living in rural areas, enhancing the quality of their lives as well as their environment. Stuck in the mud One of the many challenges experienced en route into often remote rural areas. Contact RMA: Let us know what you would like to know more about in the upcoming issues of RMA Connect. Tel: contactcentre@randmutual.co.za Fax: Fraud Line: