The computer system of the body that is supposed to compensate workers who get injured at work is not broken and is working properly though new registration procedures are more demanding, says its CEO.
Compensation Fund commissioner Vuyo Mafata was responding to the outcry of over the non-payment of claims, which prompted affected stakeholders, including medical practitioners, to last week launch the Injured Workers Action Group (IWAG).
Among the group’s members are the SA Medical and Dental Practitioners Association, SA Private Ambulance and Emergency Services Association, Occupational Therapy Association and the SA Society of Physiotherapy as well as entities that facilitate payments by the fund to practitioners and worker bodies. Service providers say that they have not been paid for six months and that their businesses are threatened with closure.
Business Day had previously reported that a letter from Mafata to health professionals, on December 8, admitted there had been problems with the site, and difficulties at the State Information Technology Agency (Sita), which hosts it.
The Compensation Fund provides compensation to employees who are injured or contract diseases through the course of their employment. It is financed by levies paid by employers.
The fund is also the legal model for the National Health Insurance (NHI) fund, which aims to pay for the health care of all South Africans similar to a state-run medical aid. Critics have raised concerns about the government administering the NHI fund.
The fund switched off its old computer system in August and replaced it with a new SAP-based system in October. Stakeholders say the new system is dysfunctional as they have difficulty logging in and getting access to it.
Mafata, employment & labour minister Thulas Nxesi and deputy minister Boitumelo Moloi attended a meeting of parliament’s employment & labour portfolio committee last Wednesday to update MPs on the performance of the fund.
Backlog of claims
DA labour spokesperson Michael Baigram raised the industry’s complaints about the backlog of claims. The meeting was attended by a throng of disgruntled stakeholders.
Baigram understood that Nxesi had undertaken to establish a commission of inquiry to investigate the problems of non-payment and non-registration, but Nxesi’s spokesperson, Sabelo Mali, denied this, pointing out that only the president can establish a commission of inquiry.
He said the proposed way forward is for Mafata to meet service providers; for the committee to visit the Compensation Fund to learn about the challenges being experienced; and for the fund to develop an action plan.
A statement by the committee said that “the minister committed his office and the department to address all the complaints from the service providers ... on a case-by-case basis”.
Mafata said in an interview on Friday that the new system had controls that were lacking in the old system in that it required that claims be submitted by an authorised person. Third parties or agents acting on behalf of employers needed a letter of authority from the employer, otherwise claims could not be submitted. Mafata suggested that a lot of the dissatisfaction with the system came from these third parties.
He said there were also a lot of unhappy people who had been stopped from fraudulently submitting claims to the fund. “The system works if you are registered as a user of the system,” he said.
Mafata noted that under the old system there were 15,000 active external users but only 2,277 in the new system who had submitted the required letter of authority.
He said the total claims paid in the current financial year from April to date amounted to R3.1bn, of which R1bn was paid in the past five months since September.
Since October 18 2019 under the new system, about R70m in benefits had been paid, about 11,000 claims had been successfully registered to date and about 134,000 invoices had been submitted. Fund employees were working through these 11,000 claims.
“The system does what it is designed to do in terms of validating controls so that we don’t have fraudulent claims, incomplete claims and inaccurate claims and incidents of overbilling and inaccurate billing by providers who have rendered services to our clients,” he said.
“When the system identifies such invoices it rejects them and sends the feedback back to employers.”
He said downtime on the computer was minimal, though load-shedding would have affected access to the internet.
Of the 1.2-million open and closed claims migrated from the old system dating back about six years, about 1.1-million had been closed or were incomplete.
About 55,000 registered by third-party agents were awaiting further information from employers. Mafata said he was developing an action plan with definite timelines to deal with these outstanding claims.
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