Opportunities

You can request replacement, refits or repairs of prosthetic/orthotic devices, but the Medical Service Provider must motivate the request and include photos of the device to be replaced or repaired; requests must be reasonable and aligned with the published policy and tariff.

Who it is for:

employees/claimants needing replacement, refits or repairs of prosthetic/orthotic devices, via their medical service provider

How to act on it:

Ask the Medical Service Provider to motivate the replacement/refit/repair request and provide photos of the device; the employee (assisted by the Medical Service Provider) completes the appropriate form for the request.

To have an orthotic or prosthetic claim processed, pre-authorization from the Compensation Fund is required for all claims, even when the devices are listed in the Government Gazette.

Who it is for:

medical service providers and claimants submitting orthotic and prosthetic claims to the Compensation Fund

How to act on it:

Submit the claim and obtain pre-authorization from the Compensation Fund; the Medical Service Provider must confirm liability has been accepted and that the service is reasonable and aligned with the published policy and tariff.

If your occupational disease or injury claim liability has been accepted, and a medical practitioner prescribes the service and the prescribed guidelines are followed, the Compensation Fund will bear the reasonable cost for the issue of orthotic and prosthetic devices.

Who it is for:

employees (claimants) under the COID Act who need orthotic and prosthetic devices after an accepted occupational injury or disease claim

How to act on it:

Ensure the service is prescribed by a medical practitioner and that the prescribed guidelines are followed; the Medical Service Provider must ensure liability for the claim has been accepted by the Compensation Fund and that pre-authorization is obtained for the claim.