Reference: 43675822Road Accident Fund
Duties & Responsibilities
Purpose of the job: To administer the undertakings in line with Section 17(4)(a) of the RAF Act 56 of 1996 as amended.
Key Performance Areas
Handle Claims
- Interpret the settlement, the undertaking and any limitations to determine the Funds liability for future costs to be incurred
- Scrutinize past medical expenses to determine the Funds liability for future costs to be incurred.
- Identify any differences between the final settlement and re-draft the undertaking to reflect the correct liability
- Take cognisance of all expert reports, of internal and external origin, to determine the following:
- The nexus between the costs incurred and the accident.
- The reasonability of the costs by comparing the costs incurred with the claimants personal circumstances and needs
- Communicate with experts where there is uncertainty i.r.o. costs incurred.
- Report any discrepancies to Senior
- Pre-authorise costs still to be incurred in terms of the undertaking within the mandate and in line with the medical and legal assessment
- Recommend or approve payment of the costs as per the mandate; or repudiate the costs; or request more information or refer for medical intervention.
- Refer cases to field Case Managers for further investigation.
- Determine the need for home visits and attend when required.
- Determine the need for the appointment of experts to do further assessments.
- Approve other officers payments on MIS which includes checking for duplicates and if the correct payee is being paid.
Update Claims Records
- Correct/update any change in the settlement details on the undertaking system to ensure that the liability of the Fund is accurately reflected on the system.
Manage Correspondence
- Draft legal correspondence to all external stakeholders.
Attend to Queries
- Attend to queries from internal and external stakeholders pertaining to the undertaking including the following:
-
- Liability of the Fund in terms of the undertaking.
- How to submit a claim;
- Status/progress made on the claims already submitted
- General enquiries
- Give advice to stakeholders on legal issues pertaining to undertakings
Manage Litigation
- Receive & record all litigation processes served in terms of the Undertaking
- Evaluate the documents, consider the Funds legal position with regards to the process
- Arrange for the matter to be held over, if necessary, alternatively
- Appoint an attorney for the Fund to defend the matter.
- Refer the matter for assessment to determine the Funds liability.
- Negotiate settlement with the attorney, alternatively, consider the opinions from the attorney and give clear instruction to the Funds attorneys to reach settlement
- Adhere to the time limits to prevent any wasted costs
- Attend to opinions from attorneys to ensure that the Fund is ready for trial when due.
- Report any risk to the Senior to prevent any prejudice to the Fund
- Arrange for interim disbursements to be attended to appropriately at Legal costs.
- Give proper instructions for settlement payments or payments in terms of court orders to prevent any unnecessary interest to be added.
- Arrange for the bill for costs to be referred to Legal costs to attend to and follow up on payment thereof.
- Report any actions from the Funds attorneys which is not in line with the Funds policies to the Senior.
Compile Statistics
- Keep daily stats of activities on Undertakings and related matters.
- Submit daily stats and monthly stats as required by Management.
- Keep record of statistics.
Keep Claims Records
- Maintain record of all allocated matters
- Maintain record of litigated matters
- Maintain and apply a diary system used to pend matters to be followed up
- Scrutinize incoming correspondence and maintain proper record thereof
- Maintain proper record of files requested and returned to the I/S, referred to Medical and/or Administration cell
- Keep record of private telephone calls and submit accurate telephone accounts on a monthly basis
Desired Experience & Qualification
Purpose of the job: To administer the undertakings in line with Section 17(4)(a) of the RAF Act 56 of 1996 as amended.
Key Performance Areas
Handle Claims
- Interpret the settlement, the undertaking and any limitations to determine the Funds liability for future costs to be incurred
- Scrutinize past medical expenses to determine the Funds liability for future costs to be incurred.
- Identify any differences between the final settlement and re-draft the undertaking to reflect the correct liability
- Take cognisance of all expert reports, of internal and external origin, to determine the following:
- The nexus between the costs incurred and the accident.
- The reasonability of the costs by comparing the costs incurred with the claimants personal circumstances and needs
- Communicate with experts where there is uncertainty i.r.o. costs incurred.
- Report any discrepancies to Senior
- Pre-authorise costs still to be incurred in terms of the undertaking within the mandate and in line with the medical and legal assessment
- Recommend or approve payment of the costs as per the mandate; or repudiate the costs; or request more information or refer for medical intervention.
- Refer cases to field Case Managers for further investigation.
- Determine the need for home visits and attend when required.
- Determine the need for the appointment of experts to do further assessments.
- Approve other officers payments on MIS which includes checking for duplicates and if the correct payee is being paid.
Update Claims Records
- Correct/update any change in the settlement details on the undertaking system to ensure that the liability of the Fund is accurately reflected on the system.
Manage Correspondence
- Draft legal correspondence to all external stakeholders.
Attend to Queries
- Attend to queries from internal and external stakeholders pertaining to the undertaking including the following:
-
- Liability of the Fund in terms of the undertaking.
- How to submit a claim;
- Status/progress made on the claims already submitted
- General enquiries
- Give advice to stakeholders on legal issues pertaining to undertakings
Manage Litigation
- Receive & record all litigation processes served in terms of the Undertaking
- Evaluate the documents, consider the Funds legal position with regards to the process
- Arrange for the matter to be held over, if necessary, alternatively
- Appoint an attorney for the Fund to defend the matter.
- Refer the matter for assessment to determine the Funds liability.
- Negotiate settlement with the attorney, alternatively, consider the opinions from the attorney and give clear instruction to the Funds attorneys to reach settlement
- Adhere to the time limits to prevent any wasted costs
- Attend to opinions from attorneys to ensure that the Fund is ready for trial when due.
- Report any risk to the Senior to prevent any prejudice to the Fund
- Arrange for interim disbursements to be attended to appropriately at Legal costs.
- Give proper instructions for settlement payments or payments in terms of court orders to prevent any unnecessary interest to be added.
- Arrange for the bill for costs to be referred to Legal costs to attend to and follow up on payment thereof.
- Report any actions from the Funds attorneys which is not in line with the Funds policies to the Senior.
Compile Statistics
- Keep daily stats of activities on Undertakings and related matters.
- Submit daily stats and monthly stats as required by Management.
- Keep record of statistics.
Keep Claims Records
- Maintain record of all allocated matters
- Maintain record of litigated matters
- Maintain and apply a diary system used to pend matters to be followed up
- Scrutinize incoming correspondence and maintain proper record thereof
- Maintain proper record of files requested and returned to the I/S, referred to Medical and/or Administration cell
- Keep record of private telephone calls and submit accurate telephone accounts on a monthly basis
