WORKER'S COMPENSATION: SUBSIDIARY LEGISLATION
(previously "WORKMEN'S COMPENSATION")

INDEX TO SUBSIDIARY LEGISLATION

Workmen's Compensation (Forms) Regulations

Workmen's Compensation (Prescribed Occupations and Periods) Regulations

Worker's Compensation (Rates and related Costs) Regulations

WORKER'S COMPENSATION (FORMS) REGULATIONS

 

(under section 53)

 

(28th November, 2001)

 

ARRANGEMENT OF REGULATIONS

 

   REGULATION

 

 

 

   1.   Citation

 

   2.   Notice to leave neighbourhood

 

   3.   Form of list of earnings

 

   4.   Report of results of medical examination

 

   5.   Computation of compensation in fatal cases and form thereof

 

   6.   Computation of compensation in cases of incapacity and form thereof

 

   7.   Application to vary order

 

   8.   Form of acknowledgement

 

   9.   Form of certificate of insurance

 

   10.   Form of notification of cancellation of policy

 

   11.   Form of notice of injury

 

   12.   Form of injury and disease report

 

   13.   Attendance upon medical practitioner

 

   14.   Form of agreement as to compensation

 

   15.   Application to cancel agreement as to compensation

 

   16.   Payment of compensation by instalments

 

   17.   Insurer or employer to make certain returns to Commissioner and form thereof

 

   18.   Medical certificate

 

   19.   Prescribed limits for medical expenses and related costs

 

 

 

      First Schedule

 

      Second Schedule

 

      Third Schedule

 

      Fourth Schedule

 

      Fifth Schedule

 

      Sixth Schedule

 

      Seventh Schedule

 

      Eighth Schedule

 

      Ninth Schedule

 

      Tenth Schedule

 

      Eleventh Schedule

 

      Twelfth Schedule

 

      Thirteenth Schedule

 

      Fourteenth Schedule

 

      Fifteenth Schedule

 

      Sixteenth Schedule

 

      Seventeenth Schedule

 

 

S.I. 70, 2001.

 

1.   Citation

   These Regulations may be cited as the Worker's Compensation (Forms) Regulations.

 

2.   Notice to leave neighbourhood

   The notice of intention to leave the neighbourhood required by section 17(5) of the Act to be given by a worker to the employer shall be in the form set out in the First Schedule.

 

3.   Form of list of earnings

   The list of earnings required by section 18(6) of the Act to be furnished by the employer upon the request of the worker or any duly authorized person acting on his behalf under the Act shall be in the form set out in the Second Schedule.

 

4.   Report of results of medical examination

   The results of a medical examination by a medical practitioner under section 10(1) shall be reported in the form set out in the Third Schedule.

 

5.   Computation of compensation in fatal cases and form thereof

   (1) Where a worker dies leaving a dependant, or dependants, wholly or partially dependent upon his earnings, in circumstances in which compensation is payable, the amount of compensation to be paid to such dependant, or allocated between such dependants, in terms, of section 13 of the Act, shall be 48 months' earnings, less the reasonable expenses for the burial of the deceased worker payable in terms of sub-regulation (3).

   (2) Where, in terms of sub-regulation (1), there is more than one dependant entitled to receive compensation, the Commissioner shall determine the degree of dependency of each dependant, and shall allocate the compensation between such dependants, pro rata the degree of dependency of each dependant.

   (3) The reasonable expenses for the burial of the deceased worker shall be payable from the 48 months' earnings prescribed by sub-regulation (1).

   (4) The computation of compensation payable in terms of this regulation shall be in the form set out in the Fourth Schedule.

 

6.   Computation of compensation in cases of incapacity and form thereof

   (1) Where permanent total incapacity results from injury to a worker in circumstances in which compensation is payable the amount of compensation payable, under section 15 of the Act, shall be 60 months' compensation.

   (2) Where permanent partial incapacity results from injury to a worker in circumstances in which compensation is payable the amount of compensation payable, under section 16 of the Act, shall be 60 months' compensation multiplied by the percentage of the worker's incapacity.

   (3) Where temporary incapacity, whether total or partial, results from injury to a worker in circumstances in which compensation is payable the amount of the periodical payments, referred to in section 17(1) of the Act, shall be, or shall be at a rate proportionate to, a monthly payment of two-thirds of the difference between the monthly earnings which the worker was earning at the time of the accident and the monthly earnings which he is earning (or is capable of earning in some suitable employment or business) after the accident.

   (4) The computation of compensation payable in terms of this regulation shall be in the form set out in the Fifth Schedule.

 

7.   Application to vary order

   An application under section 20(2) of the Act to vary an order made thereunder as to the distribution of compensation shall be in the form set out in the Sixth Schedule.

 

8.   Form of acknowledgement

   The acknowledgement to be provided by the Commissioner in respect of any money deposited with him or other security furnished under section 31(3) of the Act shall be in the form set out in the Seventh Schedule.

 

9.   Form of certificate of insurance

   The certificate of insurance required by section 32 of the Act to be issued and delivered by the insurer to the employer shall be in the form set out in the Eighth Schedule.

 

10.   Form of notification of cancellation of policy

   Where a policy issued pursuant to this Act is cancelled in any of the circumstances described by section 34(1) of the Act, the insurer shall notify the Commissioner of the cancellation, within 14 days beginning with the day when such cancellation became effective, in the form set out in the Ninth Schedule.

 

11.   Form of notice of injury

   Where the notice of injury required to be given by section 8 of the Act -

 

   (a)   is given in writing, it shall be in the form set out in the Tenth Schedule; or

 

   (b)   is given orally, it shall provide the same information as if it had been in writing.

 

12.   Form of injury and disease report

   The report of an injury and disease required by section 9(1) of the Act to be made by the employer shall be in the form set out in the Eleventh Schedule.

 

13.   Attendance upon medical practitioner

   When a worker is required by section 10(1) of the Act to submit himself for examination by a medical practitioner, the time and place at which the worker is required to attend upon the medical practitioner in pursuance of section 10(2) of the Act shall be notified to him in the form set out in the Twelfth Schedule.

 

14.   Form of agreement as to compensation

   An agreement made under section 38(1) of the Act by the employer and worker as to the compensation to be paid by the employer shall be in the form set out in the Thirteenth Schedule.

 

15.   Application to cancel agreement as to compensation

   An application made under section 38(4) of the Act for the cancellation of an agreement made under section 38(1) of the Act, by the employer and worker as to the compensation to be paid by the employer, shall be in the form set out in the Fourteenth Schedule.

 

16.   Payment of compensation by instalments

   A requirement addressed to the Commissioner under section 49 of the Act, that any compensation payable to a worker shall be paid by instalments, shall be in the form set out in the Fifteenth Schedule.

 

17.   Insurer or employer to make certain returns to Commissioner and form thereof

   (1) The insurer or, where he has had recourse to section 31(3) of the Act, the employer shall make a return to the Commissioner-

 

   (a)   in respect of the period beginning at the commencement of the Act and ending on 31st December, immediately following that commencement; and

 

   (b)    thereafter, in respect of every period of 12 months ending 31st December, within 30 days immediately after the end of each such period.

   (2) Every return made under this regulation shall be in the appropriate form set out in the Sixteenth Schedule.

 

18.   Medical certificate

   The certificate granted by a medical practitioner under section 21 of the Act in respect of incapacity or death caused by a scheduled disease shall be in the appropriate form set out in the Seventeenth Schedule.

 

19.   Prescribed limits for medical expenses and related costs

   The employer shall, in addition to any compensation payable under regulations 5 and 6, defray such reasonable expenses incurred by a worker as required under section -

 

   (a)   28(1)(a) of the Act, in respect of medical, surgical, dental and hospital treatment, skilled nursing services and the supply of medicines, to an amount not less than P75 000;

 

   (b)   28(1)(b) of the Act, in respect of the supply, fitting, maintenance, repair and normal renewal of any artificial appliance, limb, apparatus or mechanical aid, to an amount not less than P10 000; and

 

   (c)   28(1)(c) of the Act, in respect of reasonable transport charges incurred in transporting the worker to and from a place where facilities for examination and treatment or assessment are available, if such transport is certified to be necessary by the medical practitioner in charge of the case, to an amount not less than P1 500.

FIRST SCHEDULE

 

(Regulation 2)

BL FORM 43/01
NOTICE OF WORKER'S INTENTION TO LEAVE NEIGHBOURHOOD
OF EMPLOYMENT

 

WORKER'S COMPENSATION ACT
(Cap. 47:03)
(Section 17(5))

 

 

 

Notice to employer 

 

Full name of employer ........................................................................................................ 

Full address of employer: 

 

..........................................................................................................................................
..........................................................................................................................................
.......................................................................................................................................... 

Description of injury giving rise to periodical payments of compensation and circumstances in which injury suffered: 

..........................................................................................................................................
..........................................................................................................................................
.......................................................................................................................................... 

Amount of periodical payment currently being made: P........................................................... 

Date of first payment:........................................................................................................... 

Interval of periodical payments: weekly/ fortnightly/ monthly
(Delete as applicable

Having the intention of leaving the neighbourhood of my employment at the time of suffering the injury in respect of which compensation is currently being paid for the purpose of residing elsewhere, I hereby apply- 

   for redemption of the periodical payments referred to above by payment to me of a lump sum/


   for continuance of the periodical payments referred to above. 

(Delete as applicable

 

Date: ....................................    

Signature of worker: .................................... 

   Employer's endorsement of application 

I approve the above application and- 

   in redemption of the periodical payments referred to above offer the applicant a lump sum of P............................................................................................................................... 

   offer to continue the periodical payments referred to above at the applicant's new place of residence. 

(Delete as applicable) 

Date: ............................................. 

Signature:..................................................
(of employer or person acting on employer's behalf) 

Worker's acceptance of employer's offer 

I hereby accept - 

 

   the offer of a lump sum of P.................................................................. in redemption of the periodical payments referred to above/ 

   the offer to continue the periodical payments referred to above at my new place of residence and undertake to make such place of residence known to my employer forthwith. 

(Delete as applicable

 

Date: ............................................. 

Signature of worker:........................................... 

   Reference to Commissioner 

 

Being unable to agree as to the redemption of the periodical payments referred to above or their continuation in the changed circumstances, I hereby apply for a decision on the matter. 

Date: ........................................... 

Signature:.................................... 

(of employer or person acting on employer's behalf/worker) 

(Delete as applicable

 

   Decision of commissioner 

   IN EXERCISE of the powers conferred on me by section 17(5) of the Act, I hereby order- 

the payment of a lump sum of Pula.................................*
in redemption of the periodical payments referred to above/ 

continuation of the periodical payments referred to above at the worker's new place's of residence.


(Delete as applicable

Date: ............................................. 

Signature of Commissioner: ...................................

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