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This refers to circumstances where an employee with health issues requires important decisions (“judgements”) to be made, impacting their work.
Three scenarios that may warrant the opinion of an occupational medicine specialist include:
An employee is medically fit to work when the employee has no physical or mental impairments that adversely impact the employee’s ability to perform the inherent task requirements of the job safely, and to the required standard, within the working conditions associated with the job.
See illustrative image below:
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An occupational disease is an impairment of the normal structure or function of a body part or system that is manifested by symptoms and/or signs, and which is attributed to (caused by) exposure to a workplace hazard, either entirely or in part.
Since the COIDA amendments took effect on 23 January 2026, post-traumatic stress disorder (PTSD) has been expressly recognised as an occupational disease.
These causal links may be:
To determine the presence of an occupational disease, consider: (this step is called case investigation and is conducted by the OH team)
If a clinical diagnosis of an occupational disease is made, the following must happen:
The employer must initiate an incident investigation, the purpose being to determine the root cause for the incident, so as to implement corrective actions (a legal requirement)!
If the incident investigation confirms the presence of an occupational disease, line management shall seek ways to reduce the exposures by implementing the hierarchy of controls, as applicable – namely:
OHN shall initiate measures to identify employees from similar exposure profiles that may also have acquired the occupational disease.
The medical team shall communicate the results of the medical screen to:
All three of these are required by law (sections 24 and 25 of the OHS Act, and regulation 8(4) of the General Administrative Regulations).
If a compensable disease is diagnosed, the OHN & OMP shall complete the forms required for submission to the Compensation Commissioner. These include the following basic set (others are applicable depending upon the circumstances):
The OHN shall coordinate the submission of these forms to the COID offices.
Under the amended COIDA, notifications and claims go to the Compensation Commissioner, and the period for lodging a claim is now three years (previously 12 months). Late reporting now attracts administrative penalties, so timely submission matters.
The OMP shall conduct a “return to work assessment” on the affected employee before their return to work. This is done cognisant of the requirements of the job to which the employee is returning, ensuring they are fit for duty, thereby not endangering their own or others’ health and safety.
The amended COIDA now makes rehabilitation and return to work a statutory obligation (Chapter VIIA), supported by new regulations on return-to-work and rehabilitation programmes. Employers need a documented process, not an informal one.
This step ends with a return to work fitness assessment, to ensure that the employee with an occupational disease is suitable to return to their previous job.
Employee care:
Occupational disease reporting:
The diagram below summarises the legal triggers for action and reporting for the most common occupational disease, noise-induced hearing loss, updated for the Noise Exposure Regulations, 2024 and SANS 10083:2023.
I provide independent specialist opinions on complex cases of fitness to work, possible occupational disease, and incapacity or disability, including cases where the medical evidence or the process followed is disputed. I review the records against the inherent requirements of the job, assess the employee where needed, and give a clear, reasoned report that employers, employees, treating doctors and, where necessary, the Compensation Fund or an arbitration can rely on.
