CLAIMS

FILE A CLAIM

If you are injured on the job, you should complete the form
Employee Claim (C-61) as soon as possible to ensure your
benefits are not delayed or interrupted. You must also notify your
employer in writing of when, where and how you were injured or
became ill.

If you have questions about filing an Employee Claim (Form C-62),

email claims@compensationinsure.co.za and a claims
representative will assist you. You will be notified by mail of any
action regarding your claim

DEATH CLAIMS

When an injured worker has passed away at work or due to an

existing work injury/illness, the next of kin should file a Claim for
Compensation in Death Case (C-63 form) along with the appropriate
documentation,

The Proof of Burial and Funeral Expenses by Undertaker (Form C-

65) would be completed by the funeral home.

A TIMELINE FOR YOUR CLAIM

Medical treatment: Get medical care immediately.See your doctor

within 24 hours after the injury
Wage replacement: If your case is accepted, you will be paid within
30 days of the incident. If your case is disputed, you will have a
hearing to determine your claim.
IF YOUR CLAIM IS DISPUTED
Occasionally, insurers dispute claims. The insurer may not agree
that you had a work-related injury, or assert that it didn’t insure your
employer and or you were not covered for the specific claim, or give
another reason. If your claim is disputed, the Claims division will
hold a hearing, review your medical records, wages, and other
evidence and testimony. The outcome thereof will determine the
issue and any benefit award.
You or your employer’s may appeal that decision, in writing, within
30 days of the filing date. Compensation Insures Claims Division
reviews the appeal and will agree, change it or reject it. They may
also ask for more hearings.
IF A HEARING OCCURS
Benefits are frequently paid automatically. However, sometimes
hearings are needed to resolve issues. If a hearing is needed, you’ll
receive a notice from the Claims Division advising you of the reason,
location, date and time of the hearing. It’s important to review all
mail you receive the insurer and respond timeously. Keep copies for
your records.
HELP IS AVAILABLE
Sometimes you need help getting back to work.Your employer may
have alternative or light duty assignments so you can work while you
recuperate. If you are experiencing family or financial problems as a
resultof your injury, or want guidance on returning to work,
Compensation Insure has return-to-work counselors and social
workers who can help you email us at
help@compensationinsure.co.za to learn about these services.
 CLAIMS Q & A
Q. What does my next – of – kin / dependent do if I pass away while
collecting workers' compensation benefits?

A. Notify our claims division immediately on

claims@compensationinsure.co.za and submit a copy of the death certificate
and complete the Proof of Burial and Funeral Expenses by Undertaker (Form
C-64) completed by the funeral home.

Q. would my next – of – kin / dependent continue to receive

compensation benefits due to me?

A. In most cases benefits may stop. The widow/widower must file for a
compensation death claim form showing medical proof that the injured
worker's death was related to the established work injury. If the death claim is
found compensable, payments may resume retroactive to the date of death.

Q. What does my next – of – kin / dependent do if my death relates to

work injury? 

A. File for a Compensation death claim by completing a Claim for

Compensation in Death Case (C-62 Form) with the appropriate
documentation. You will also need to file the Proof of Death by Physician Last
in Attendance on Deceased (C-64 Form) and, if you have it, medical evidence
from the last treating physician stating how the death is causally related to the
original work injury/illness.

Q. What if the beneficiary was killed at work and has no dependents; are
there benefits payable for at least funeral expenses to his/her parents?

A. Parents who were not dependent on the deceased would be eligible for a
no-dependency award if there is no spouse, children, or other dependent
family members. They would also be eligible for paid funeral expenses, up to
the maximum allowed under the cover

Remember: You must file a claim within two years of the accident
or within two years after you knew or should have known that a
contracted disease was due to the nature of your employment.