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Dealing with disability claims

Becoming disabled or temporarily impaired is a traumatic experience for any of your employees and for your organisation it does become somewhat disruptive. Most large companies provide benefits for their employees in terms of Death or Disability. Different companies have different terms and conditions regarding the provision of such benefits.

Most Corporate Health Insurance companies don’t provide enough guidelines to both employers and employees, who are usually confused about the procedures and paperwork involved in a claim. Thus submitting a disability claim can be somewhat confusing for the employee but there are many ways in which you, as the HR practitioner or manager, can assist your employees.

How can you as HR help?

In a typical scenario the Human Resources department needs to send out documentation such as medical reports, and declarations that your employee, their line manager, and their doctor/s need to complete. These documents are generally forwarded to the employee because they are responsible for the disability claims process. However, your employee is forced to deal with the stress of adjusting to living with their disability and you as HR should be able to take over some of the documentation processing to prevent them from having to deal with small administration duties such as forwarding documents and obtaining signatures when the disability they have to deal with may be crippling and render them incapable of normal functioning. Obtaining medical reports and medical insurance records from the appropriate professionals/people in such situations is pivotal and will speed up the process for both the employer’s and employee’s benefit.

The Labour Relations Act

The Labour Relations Act, 1995, codifies a process relating to an employee’s incapacity due to ill health or injury.  In terms of this Code, an employer’s obligation can be summarised as follows:

1. An employer has to determine whether an employee is temporarily or permanently unable to work.

2. If the employee is temporarily unable to work, the employer should investigate the extent of the incapacity and alternative solutions to accommodate the employee.

3. If the incapacity is permanent, the employer should ascertain the possibility of securing alternative employment or adapting the duties or work circumstances of the employee to accommodate such employee’s disability.

4. In any investigations related to incapacity, the employee should be allowed to state their case in the course of the investigation and to be assisted by a trade union representative or a fellow employee.  

5. The degree of incapacity is relevant to the fairness of any dismissal, whether for temporary or permanent incapacity.  

6. At all times during assessments, an employer should consider:

6.1 Whether the employee is capable of performing the work;

6.2 If the employee is not capable, the extent to which the employee is able to perform the work;

6.3 The extent to which the employee’s work circumstances can be adapted to accommodate the disability or, where this is not possible, the extent to which the employee’s duties can be adapted;

6.4 The availability of any suitable alternative employment.

Expediting the process

Should your employee learn that they have become incapable of performing the majority of their duties, or has been absent from work for longer than three weeks, you as the immediate supervisor, line manager or HR must contact  your employee and make an appointment with the their doctor to provide an assessment of their ability to perform their duties. A proactive attitude toward claims management will cut costs.

The claims process must begin as early as possible. Most corporate health insurers will have a waiting period where you as the employer will have to pay your employee’s full salary from the date on which your employee becomes disabled until the disability claim is approved or rejected.

The Labour Relations Act, 1995, stipulates that the corporate health insurers will evaluate your employee’s job activities and how serious the disability is by using medical reports supplied by doctors, hospitals and/or other institutions where they were treated.

Application Approval

Once an application is approved, disability benefits are generally paid monthly, just like a salary. You as the employer will be freed from your obligation of paying your employee’s salary. Group schemes usually provide employees with between 60%-75% of their pre-disability salary.

According to the Association for Saving and Investment South Africa (ASISA), If you provide your employees with some type of disability within their group benefits, it is a waste of money for your employees to seek private income protection since they would not be able to claim on both their group benefits and private income protection. ASISA states that this will result in over insurance. When claiming disability, the idea is for an employee to maintain a similar standard of living. Claiming on multiple policies will result in a higher income, which is clearly not the purpose of disability insurance.

Becoming disabled or temporary impaired is a life-changing event for anybody. Submitting the disability claim may seem like a tedious, bureaucratic and endless process but you must understand that this is done to prevent fraud and abuse of the disability benefit. It is a sign of a great HR practitioner when you can hold your employee’s hand and guide them through the process of claiming an income after becoming disabled.