THE FEDERATED EMPLOYERS' MUTUAL ASSURANCE COMPANY

GUIDE IN RESPECT OF CLAIMS
   

Who is an employee?

Any person who has entered into a contract of service with an employer. The service contract can be in writing, expressed or implied and applies to temporary, permanent and under aged workers and is defined in section 1 of the Act.

This Act is not applicable to domestic employees employed as such in a private household.


Who is an employer?

Any person including the State, who employs an employee.


What is an Occupational Injury (ACCIDENT)

It is an occurrence of which a date, time and place can be determined
that arises out of and in the course of an employee's employment and
resulting in personal injury.


Which Occupational Injuries (ACCIDENTS) must be reported?

All occupational injuries or alleged occupational injuries that entail medical expenses and/or
absence from work for more than three days must be
reported within seven days in the prescribed manner.

The delay to report an accident or alleged accident is a criminal
offence. The Commissioner may also impose a penalty on the employer
which could be the full amount of the claim.


Procedure when reporting an Occupational Injury (ACCIDENT)

Step 1: Complete EMPLOYER'S REPORT In full

 

Step 2: Sign and date form where indicated.

 

Step 3: Hand "Part B" to the injured employee before he goes for initial medical treatment and instruct him to hand "Part

B" to the medical practitioner or hospital concerned. In serious cases "Part B" must be forwarded to the medical

practitioner or hospital without delay.

 

Step 4: Complete the rest of Part A, pages 1 and 2.

 

Step 5: Forward completed form together with a First Medical Report (if available) to your

Regional office of the Federated Employers Mutual Assurance Company LTD (FEM)

With  whom you have insured your liability in terms of the compensation for occupational injuries and diseases act, 1993.

See Reverse Part B Page 1 for addresses.

 

The employer is liable for the payment of compensation for the first three months from the date of the occupational injury.

The compensation paid by the employer shall be reimbursed by the FEM.


Recording of Occupational injuries (ACCIDENTS) by the Commissioner

Upon receipt of the Employer's Report of an Occupational injury and a First Medical Report, the claim will be considered
and if liability is accepted, notification will be addressed to the employer. The claim number allocated will appear on this notification.

If liability cannot at that stage be accepted an acknowledgement will be addressed to the employer, providing the claim number allocated.

N.B. EMPLOYERS ARE REQUESTED TO QUOTE THIS NUMBER IN ALL CORRESPONDENCE WITH FEM RELATING TO OCCUPATIONAL INJURY.

This will greatly facilitate the filing of correspondence and relevant documents on
the appropriate file and will expedite finalisation of the claim.

The basic information to identify a claim is as follows:

The registered trade name and registration number as registered with FEM.

The full names and surname of the injured employee (not nicknames).

The employee's identity number/personnel number and date of birth.

The date the occupational injury was sustained.

The above mentioned information is captured on the computer and any discrepancies
can result in duplication of claims, or that documents cannot be associated with an existing claim.


What is an occupational disease

It is a disease arising out of and contracted in the course of an employee's employment and which is listed in Schedule 3 to the Act.


Procedure when reporting an Occupational Disease

An employer must within 14 days after he gained knowledge of an alleged occupational disease complete an Employer's Report of an Occupational Disease form1 and form2” and forward it to your Regional office of the Federated Employers Mutual Assurance Company LTD (FEM)

The commencement of the disease shall be the date on which the doctor first diagnosed the illness.
The occupational disease will be recorded in the same way as discussed in paragraphs 6.1-6.4.


Dispatch of further documents

Occupational Injuries (ACCIDENTS)

When the First Medical Report was not posted together with the employer's report of an occupational injury, it must be obtained without delay and submitted to FEM. In cases of prolonged absence, a Progress Medical report must be obtained monthly from the practitioner and submitted. When the employee resumes work, a Resumption Report must be completed and submitted to FEM together with the Final Medical Report.

The Employer's Report of an Occupational Injury must not be kept in abeyance awaiting the medical report.

The medical reports must not be kept in abeyance until the employee's condition has stabilized or when he has resumed work.

Fatal Occupational Injuries (ACCIDENTS)

If the accident resulted in the employee's death, documentary proof indicating the cause of death must be submitted without delay to your Regional office of the Federated Employers Mutual Assurance Company LTD (FEM).