Claims Management

With the advent of the new Act, Act no 10 0f 2008 the Fund now covers the cost for emergency medical treatment of all people injured in motor vehicle accidents until stabilization, followed by liability determination to decide on further liability for treatment. The focus is now on treatment, care, rehabilitation and life enhancement instead of mere compensation. Claims Management, responsible for coordinated customer welfare, therefore has a magnified role to play to realize the aspirations of the new Act.

Claims Management deals with Provider Management, Case Management (medical and social) and Claims Assessment. This article focuses on Medical Case Management.

Case Management

Case Management is a proactive victim oriented approach which aims to, without avoidable delay, reach out and assist claimants to recover from injury, restore functionality, and enhance quality of life for those permanently challenged. Soon after your claim has been accepted and an undertaking for future medical treatment has been provided by the MVA Fund your case manager will meet with you to discuss your rehabilitation plan.

Case Management Process:

Step 1: Once an accident occurs, the emergency response number (081 968 2) is dialed and
the Accident Call Service Centre picks up the call
and informs the nearest ambulance, the police and MVA Fund officer on call.
Step 2: Injured person is picked up from accident scene to nearest health care facility.
Step 3: MVA Fund serves a notice to claim within 90 days and claim form.
Step 4: Injured person is hospitalized in heath care facility for fair and reasonable treatment.
Step 5: Injuries are assessed and consensual treatment plan compiled in consultation with the doctor, claimant and family.
Step 6: Monitor treatment and condition of patient and evaluate progress.
Step 7: Compile a rehabilitation plan together with the patient upon discharge.

What is Rehabilitation?

A process of active support to help a you as an Injured Person as a result of a Motor Vehicle Accident to regain your health and independence, and therefore the ability to participate in your usual activities.

What is a Rehabilitation Plan?

This is an agreement between you and the MVA Fund, which outlines your rehabilitation path as advised by medical specialists. If you have been working prior to your accident, you and your employer and claims manager will work together to make every reasonable attempt to ensure that you return to work. If you were not employed at the time of your accident, you and your case manager will work together to make every reasonable attempt to ensure that you able to return to your pre-injury level of functioning. This plan also ensures that if you have a medical undertaking your claims manager ensure that you referred to the appropriate specialists and that the MVA Fund pays your medical costs as per the Regulated Tariffs.