Medical Care

How to qualify for Medical Care

YOU MUST

OTHER REQUIREMENTS

TIME REQUIREMENT

• Have suffered an employment injury / work-related prescribed disease

• Meet all other requirements as per the Procedures for Medical Care (see summary below)

• Doctor or Medical Board's recommendation for treatment required, e.g. therapy, surgery, artificial limbs, treatment abroad

• Claim when injury occurs or when prescribed disease develops

• Expenses to be submitted no later than 3 months from the date they were incurred

• If claim is not submitted within the 3 months period, a good reason must be given by claimant.

How much and for how long is Medical Care?
Rate of Benefit Payment	Period of Benefit Payment
• Payment to be made to insured contributor and/or Employer and/or Approved Medical Provider, as per agreed Payment Schedules	• Continues, with periodic assessments by Medical Board, for as long as the patient requires medical care for the employment injury

PROCEDURES FOR MEDICAL CARE (in brief)
Injured insured contributor 's (or representative's) Responsibilities

Obtain medical attention and services from APPROVED medical providers (providers with a license issued by Social Security).
The first visit must be to an approved General Practitioner who can then refer you to an approved Specialist, if necessary.
You or your employer should pay for the first visit. The payer of the bill will be reimbursed by Social Security on presentation of receipt, if claim is approved.
Submit the medical certificate(s) on IB1 or IB8 stating nature and bodily location of injury and period of incapacity.
For your second and subsequent medical and specialist visits, you or your representative must obtain purchase order(s) from Social Security for diagnostic services, medications, laboratory examinations, etc.
If the claim is allowed, the benefit continues, with periodic assessments by the Medical Board, for as long as the patient requires medical care for the employment injury.
If the injury is proven not to be work-related or is not covered as a prescribed disease, the claim will be disallowed. The employee must then pay for any medical bills incurred.

Employers' Responsibilities

Maintain an Accident Log to record all accidents or work-related diseases allegedly suffered by your employees.
Inform Social Security on work-related accidents (or suspected diseases), immediately, via telephone, fax or by other means.
Ensure that the injured insured contributor is taken immediately to the nearest APPROVED General Practitioner for medical care; the employer is responsible for this transportation of injured contributor.
Pay for the injured person's first medical care (if employee is not able to).
If claim is allowed as Injury Benefit, employer or insured contributor will be reimbursed by Social Security, on presentation of receipts.
Facilitate investigation of the claim by Social Security Inspectors, by providing information relevant to the accident and by allowing access to witnesses to the accident.
If claim is disallowed, the employee must pay for any medical bills incurred.