Sunday, 22 July 2018

 
Permanent Disability Benefits
 
 

The Employee may claim a disability benefit from the Permanent Disability Scheme if he / she becomes permanently and totally disabled prior to age 65, either as a result of sickness or injury, and he / she cannot do any job in the Metal Industries.

Before receiving any benefits from the Scheme it is important that all of the procedures as determined by the Labour Relations Act are carried out.

 
 
The Labour Relations Act:
 

Should an Employee become incapable of doing his / her work, the Labour Relations Act requires that: 

  • Each case is thoroughly investigated in a process that is open and transparent and understood by the Employee. 
  • The investigation is done by the Employer and is discussed with the Employee. 
  • The Employee must be provided the opportunity to present his / her case and must be allowed representation. 
  • Before the Employee lodges a claim for disability benefits, the Employer must first try to accommodate the Employee by either:
    (a) Adapting the work situation to accommodate the Employee’s impairment.
    (b) Providing the Employee with alternative employment, even at a lower salary.
  • If the disability is assessed as being temporary, an ex-gratia benefit may be awarded for a limited period. The Employer may consider a temporary placement until the Employee can return to his / her original position.
 
 
Process to be followed when making application:
 

Should the Employee become ill or become involved in an accident, he / she and the Employer must complete the following steps when applying for a disability benefit. If the Employee does not resign following his / her ceasing work, Employers should ensure that the Employee's name is retained on the Sick Pay and Retirement Fund contribution returns, even where no wages are paid during the waiting period. Employers should endeavour not to discharge an Employee until advice is received from the Scheme that a permanent disability benefit has been awarded.

 

Step 1: Make Application for Permanent Disability

  • The Medical Advisor or Doctor should examine the Employee and determine whether he / she will be eligible for a disability claim. The Employer must agree with the findings.
  • The Employer will need to investigate whether the work circumstances or duties of the Employee may be adapted to accommodate the illness or disability. If such alternative work exists, then the Employee will return to work. If not, then the claiming process will begin.
  • If the Employee's disability was caused by an accident at work, a work related illness or a motor vehicle accident, then the Employee needs to apply for COIDA or RAF benefits as well as the disability benefit.
  • The Employer must submit an application for Permanent Disability Benefits. All medical reports confirming disability, sick leave, level of education, job description and responsibilities have to be included in the application.

Step 2: Examination by the Scheme's Specialist :

  • The application will be sent to the Scheme’s medical advisors and admitted as a possible claim for further investigation in terms of the Rules of the Scheme. 
  • If the application is accepted, the Employee will be requested to undergo all necessary medical examinations and tests as prescribed by the Scheme’s medical specialists. These are paid for by the Scheme. 
  • The Scheme's medical advisors will examine the reports and results of all the examinations and tests and make recommendations to the Trustees of the Scheme. 
  • These recommendations will be reviewed at the monthly meeting of the Claims sub-Committee.

Step 3: Review by the Claims Sub – Committee

  • The Claims sub-Committee will deliberate on all the cases presented and will review each case on the medical opinions provided. They will also look at the work capabilities of the Employee to determine whether he / she can possibly be employed within the Industry in any capacity.
  • If the Claims sub-Committee approves the claim, the Employer and the Employee will receive confirmation of the Employee’s acceptance as a disabled Employee. The Employee will receive payment in the 7th month after his / her last working day.
  • After the first disability payment is made, the Employee will be required to undergo a medical examination once per year at the discretion of the Claims sub-Committee to determine the level of disability. The procedures in step 2 will be repeated.
  • If the Claims sub-Committee does not accept the claim, the procedures outlined in step 4 may be followed.

Step 4: Claim not approved by the Claims Sub – Committee: 

  • The Claims sub-Committee will advise the Employer and Employee if they have rejected the disability claim. 
  • The Employee may appeal against the decision of the Committee by submitting additional medical opinions within three months of the decision to reject the claim. 
  • The Scheme’s Medical Advisors will examine the reports and results of all the examinations and tests and make recommendations to the Trustees of the Scheme. These recommendations will be reviewed at the monthly meeting of the Claims sub- Committee. 
  • If the appeal is upheld, the procedures of step 3 will be repeated.
  • If the appeal is rejected, there will be no further right of appeal to the Claims sub- Committee.
 
The Benefits Payable by the Disability Scheme:
 

If the Employee's claim is accepted, an Employee will receive a monthly disability income equal to 75% of his / her pensionable salary.

 
Example:
 
  • Monthly Salary: R3 500.00 x 75% = R2 625.00 .
  • The payments will continue until the Employee recovers, reaches Normal Retirement Age, or dies.
  • (Please note that there is no lump sum payment.)
Important Notes:
 
If the Employee joined the Fund after reaching the age of 55 years, and becomes permanently disabled, the benefit payable will be reduced to 37.5% of monthly earnings.
 
Example:
 
R3 500.00 x 37% = R1 312.50
 
Questions and Answers
 

There may be many questions about the disability benefit, therefore we have provided a few answers. If there are any further questions, please contact the Permanent Disability Scheme on (011) 870-2000.

 
What does it mean to be permanently disabled?
 

According to the Scheme's Rules, you are “permanently disabled” if you are unable to work in any position within the Industries. There is a 6 month waiting period.

 
What benefit does the Disability Scheme provide?
 

Should you become permanently disabled and your disability claim is accepted, the Scheme will provide a monthly disability income equal to 75% of your pensionable salary. Employees joining the Scheme after age 55 only qualify for a 37,5% benefit.

 

Does the Disability Scheme provide any cash lump sum benefits?

 
No. It is important to note that the Scheme only provides a monthly income and does not pay out any lump sum cash benefits.
 

When will the monthly disability income begin?

 

Your monthly disability income will start after a six-month waiting period following your last day of work. Therefore, no benefits will be payable by the Scheme for the first six months of your disability.

However, the waiting period may be relaxed if a member is suffering from a short terminal disease.

 

What happens during the six-month waiting period?

 
In the six months before your disability income is payable, you and your Employer will be following all the claiming procedures outlined in this document. It is important that both you and your Employer ensure that all the claim forms are submitted as soon as possible after your last working day.
 

What is the COIDA and UIF benefit?

 

“COIDA” refers to the Compensation for Occupational Injuries and Diseases Act, 1993. This is a government insurance scheme that provides certain benefits should you become injured at work or should you suffer from a disease related to your work. A benefit is also payable to your family should you die as a result of your work-related injury or disease.

“UIF” refers to the Unemployment Insurance Fund, which is also a government insurance scheme. This Fund provides benefits to persons during the first six months of their unemployment due to ill health.

 

What is the RAF benefit?

 
RAF refers to the Road Accidents Fund. This Fund may pay a benefit should you be seriously injured in a motor vehicle accident.
 
Documentation to be completed and submitted by the Human Resources Official in respect of each member: 
 
What happens if I am receiving another source of income?
 
If you qualify for any other additional disability payments from an external source, for example, COIDA or RAF, the Permanent Disability Scheme's benefit will be reduced to limit your total income to 75% of your pensionable salary.
 

While your disability claim is being assessed, you will be entitled to claim benefits from the UIF and also from the Sick Pay Fund if you are a member. This will ensure that you still receive an income while you are waiting for your disability claim to be assessed.

 

DOCUMENTATION TO BE COMPLETED AND SUBMITTED BY THE HUMAN RESOURCES OFFICIAL IN RESPECT OF EACH MEMBER:

 
  • An “Application for Permanent Disability Benefits”. It must be filled in, and the Employee must sign and date it in front of a Commissioner of Oaths or a Human Resources Officer. Remember to include the banking details on the Bank Mandate form (i.e. account number and branch code).
  • An original Medical Certificate certifying that the Employee is permanently and totally unable to work at any job in the Metal Industries.
  • A Certificate of Service from the Employer.
  • Medical Examination and Report on Working Capabilities. Completed and signed by the Employee’s doctor.
  • Job description, Duties and responsibilities. To be completed and signed by the Employer.
  • A copy of the Employee’s Identity Document.