RMA is licenced by the Minister of Labour to administer claims in terms of the Compensation for Occupational Injuries and Diseases Act (COIDA) for Class IV (Mining), Class XIII (Iron, steel, artificial limbs, galvanising, garage and metals) and related industries. The Compensation Fund is responsible for overseeing the compliance of RMA regarding all the requirements of COIDA.
COIDA, 130 of 1993, as amended regulates how and when employees who have been injured at work or who have contracted an illness or disease in the workplace are compensated and clearly sets out the legal requirements for tariffs, compensation and the limitations for workers’ claims.
COIDA provides for medical examination and treatment, disability certification and compensation. Similarly, when an employee has died as a result of injuries sustained in the workplace or an occupational disease, the dependants of the deceased employee may qualify for benefits.
COIDA covers the following employees (whether permanently or casually employed):
- Those who were injured in an accident at work;
- Those who contracted an occupational disease or illness at work;
- Those who died from a workplace accident or occupational disease.
Compensation is calculated as a percentage of the employee’s earnings at the time the injury occurred or the disease was diagnosed.
Employers must report the injury/illness to RMA in order for the employee to receive benefits from RMA, provided RMA has accepted liability for the claim. The employee may be entitled to receive compensation for medical treatment, temporary total disablement and permanent disablement in the form of lump sums, disability pensions or funeral and fatal benefits to the family in the case of an employee’s death.
COIDA defines the term accident as “an event which occurred out of and in the course of an employee’s employment and resulted in personal injury, illness or the death of the employee”.
Occupational diseases are stipulated under section 65 of COIDA as “any disease that has arisen out of and in the course of employment”. This presumes that if the employee is exposed to the risk factor, the scheduled disease is the result of that exposure, unless proven otherwise.
In addition to COID benefits, RMA identified a need for a range of value added insurance products to offer clients. These products, which fill the gaps not covered by COIDA, include:
- Commuting Journey Policy (CJP)
- Augmentation Policy
- RMA Funeral Policy
- Group Personal Accident Cover
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Commuting Journey Policy
The Commuting Journey Policy (CJP) covers the death or injury of an employee while travelling to and from work on a reasonably direct route.
Benefits include medical treatment, disability and life cover. Terms and conditions apply.
Augmentation is a top up cover of the COID benefit ensuring that staff receiving compensation receive the right level of benefits for their income.
The Augmentation policy also offers specific additional cover, including:
- Sports Cover
- Hostel Hazard Cover
RMA Funeral Policy
The funeral benefit covers the insured employee and his family in the event of death, no matter the cause of death.
Group Personal Accident (GPA) Cover
GPA offers cover in the event of a non-work related accident such as motor vehicle accidents, hijackings or assault etc. Benefits include cover for temporary total disablement, permanent disablement or death.
Should you require information on any of the above products, please contact us on 0860 222 132 or email@example.com.
RMA has an integrated, high-powered IT system for the administration, adjudication and processing of compensation claims. The system is supported by sound business processes and workflows. It encompasses all the necessary components to ensure a secure, controlled and efficient system to meet and support a business’s processing needs and requirements. To read our IT solutions brochure, click here.
RMA’s system was developed specifically for the administration of compensation claims and has thus integration and automation of the following functional areas:
- Claims adjudication
- Pension adjudication
- Employer management
- Financial management
- Medical management
- Electronic document management
- Electronic submission of claims by employers
- Electronic submission of earnings declarations by employers
The system has the capability to maintain policies and premiums, generate policy quotations and invoices, maintain policy benefits, administer claims, adjudicate claims, process claim benefit payments, maintain and generate medical treatment pre-authorisation, process medical invoices including tariff validations and pre-authorisation, and maintain and process pension payments. The system has a built-in ICD10 code medical costing, and temporary and permanent disability and maximum medical improvement (MMI) estimation models. The system is enabled for workflow and electronic document management and integrates directly with the financial/general ledger system. It is built on a three tier architecture and is web-enabled, making it scalable and easily accessible by the end user.
The effect of this integrated system is the efficient collection of premiums, speedy resolution of claims, better management information system and improved service delivery.
The competency level of staff in the enhancing and supporting of IT systems is high and continues to be developed on an on-going basis through training and development.
RMA’s IT system has enabled RMA to remain at the cutting-edge of adjudications of compensation claims. The company continues to seek and develop new ways of providing better service through appropriate adoption and use of technology.
Having been built around the COIDA legislation it was a perfect fit for the Compensation Fund’s own claims management process. In August 2014 the Compensation Fund commenced with the adjudication of claims using the RMA system, renamed by the Fund as Umehluko.