Fedhealth is not responsible for the payment of medical costs arising from an accident, should a third party be liable to compensate your employee.
However, Fedhealth will assist your employee by paying his/her accident-related hospital and medical costs in terms of the benefits allowed by your employee’s option, provided the member and his/her attorney complete and sign an accident report form and undertaking.
If your employee thinks someone else is to blame for his/her injuries then your employee probably has a third party claim. Your employee should therefore contact an attorney to arrange an appointment. The first consultation with an attorney on our list is free of charge, and your employee is in no way obligated to make use of the attorney to proceed with his/her claim.
The employee and his/her next of kin will need to call the MVA department so that the accident report form can be completed and the third party claim established. It is important that the employee returns these documents as soon as possible, as payment of accident-related accounts can only be made once the MVA department has received the completed documents. These forms must be completed and returned even if no third party was involved.
Furthermore, if your employee does have a third party claim, he/she must institute a claim with the Road Accident Fund through his/her attorney. In-hospital accounts will not be paid until an indemnity is received from the attorney stating that monies paid out on the member’s behalf will be refunded to Fedhealth on the successful finalisation of the claim with the Road Accident Fund.
Please remember that all medical accounts must be submitted within four months of the end of the month of treatment. Likewise, these documents must be submitted within the prescribed period or the accounts will not be paid.
Hospitalisation expenses will be refunded from the in-hospital benefits, and day-to-day expenses will be refunded from the member’s OHEB and/or Savings Account.
Should you have any queries regarding the completion of the forms, please contact our MVA department on (012) 431 9746/ 86