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Claims Management

The actual claims process

 

•    Claim forms are received by Customer Service Officers and a letter acknowledging receipt of the claim is dispatched to claimants also notifying them of their claim number.
•    Files assessed by Claim Assessors. If necessary they might;
o    Send the file to the Fund Investigations Department to collect more evidence;
o    Ask the Claimant to provide more information;
o    Arrange for the claimant to be examined by relevant medical experts.
•    If all the information is there, the Claim Assessors will first determine if the Fund is liable or if there exixts legal limitations in respect of the claim at hand.
o    If the Fund is not liable, a letter of repudiation is sent to the claimant.
o    If the Fund is liable, the amount of compensation is then determined, taking into consideration the extent to which claimant has contributed to the occurrence of the accident. An offer is then made and dispatched to the claimant.
•    The claimant then indicates his/her acceptance in writing and upon receipt of such written acceptance, the Fund issues a crossed cheque in favour of the claimant and dispatches it to the claimant by registered mail.
•    There are times where the claimant disputes the repudiation or amount of the compensation. In those situations the Fund encourages the claimant to engage in a dialogue with the Fund substantiating his objection instead of rushing off court. The Fund has at times reviewed its final determination in favour of the claimant. Where the claimant is still dissatisfied after the dialogue he may approach the courts for redress of his complaint.
•    All claims and resultant offers or repudiations are assessed and signed by two Claim assessors, one junior and one senior. This is in order to ensure fair and equitable assessment of claims and to prevent corruption.


WHAT TO EXPECT AFTER SIGNING A DISCHARGE CERTIFICATE

•    The claimants Welfare Officer then ensures that claimants utilize those portions of their offers set aside for their future support, medical treatment and other rehabilitation purposes. It is the responsibility of the Claimant to approach the Fund and provide information regarding his/her intended treatment visits.

How long does it take to process a claim?

The length and time depends of the type of the claim at hand. Please refer to the Service Standards Charter for more information on how long different claims will take.

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