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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.106 n.6 Cape Town Jun. 2016

http://dx.doi.org/10.7196/samj.2016.v106i6.11040 

IZINDABA

 

Occupational injuries - radiologists lose patience, sue government

 

 

In spite of a new electronic claims system and ZAR52 billion in its coffers, the Compensation Fund keeps doctors waiting for payments for up to a year -prompting 19 radiologists to sue it for ZAR121.5 million in unpaid claims this March, in what could prove a landmark case.

The Radiological Society of South Africa (RADSA) and 19 individual radiology practices are suing the labour minister over the fund's failure to process and pay out this amount in claims for services they have provided to injured workers. The litigant group represents less than a quarter of existing private radiology practices, with most using third-party agencies to collect money for them - at a cost of 20% of debt recovered. RADSA's Executive Director, Richard Tuft, says that it's iniquitous for doctors to have to forfeit a fifth of their income just to increase their chances of getting paid. Last June the biggest company handling claims on behalf of doctors, CompSol, chose to temporarily suspend its services, so difficult had its job become. The South African Medical Association (SAMA) revealed that many doctors were refusing to attend to 'injured-on-duty' cases because they had no confidence that they would be paid by the fund.

 

 

A history of unpaid claims

Compensation Commissioner Vuyo Mafata conceded that the fund has a history of unpaid claims, but said it had improved its turnaround time - now averaging 60 days - by automating processes with an electronic claims system called Umehluko. The fund had ZAR52 billion in reserves and paid claims totalling ZAR6 billion this year. 'We don't want to not pay anyone,' he said. Tuft said the average debtors' days for claims from the Compensation Fund was 350 days, compared with an average 12 - 20 days for claims from medical schemes. Repeated engagement with the fund's administrators came to nothing.

Mafata said the fund tried to engage with RADSA after becoming aware of litigation last November, but to no avail. The Department of Labour would oppose the matter, but would have preferred to resolve the matter out of court. Claims could be outstanding because there was documentation missing or because employers had failed to register the claim, as required by law, he asserted. The fund had set up a team to try to help SAMA's doctors resolve their outstanding claims, he added.

 

Chris Bateman
chrisb@hmpg.co.za

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