Pension & Disability Claims Management

What we handle

Claims work that rewards persistence, not paperwork.

Retirement funds and insurers move slowly by default. We hold the file open, follow the required process precisely, and escalate the moment a deadline is missed.

Retirement funds

Pension & provident fund claims

Death, withdrawal and retirement benefit claims across occupational and umbrella funds.

Section 37C death benefit distributions
Dependency & nomination disputes
Withdrawal and resignation payouts

Income protection

Disability benefit claims

Temporary and permanent disability claims against fund-linked and standalone insurers.

Income continuation benefit disputes
Lump-sum disability claim rejections
Medical evidence & assessment coordination

Escalation

Adjudicator & ombud complaints

Formal complaints where a fund or insurer fails to respond or rules unfavourably.

Pension Funds Adjudicator complaints
FAIS Ombud referrals
Section 30 procedural compliance

Enforcement

Litigation support

Where administrative escalation stalls, we prepare and hand off matters for legal action.

Case file preparation for counsel
High Court review applications
Fund non-compliance reporting

How a claim moves

A fixed sequence, followed exactly, every file.

Funds and insurers work to statutory timeframes. We track each one and escalate the moment it lapses.

01

Intake & file opening

We take a full claim history, identify the correct fund or insurer, and open a tracked file with a claim reference.

02

Evidence & documentation

We gather dependency records, medical reports and fund statements so the claim is lodged complete the first time.

03

Lodgement & follow-up

The claim is formally lodged, and we follow up on statutory deadlines rather than waiting for the fund to respond.

04

Escalation, if needed

Unresolved or disputed claims are referred to the Adjudicator, Ombud, or prepared for litigation.

05

Resolution & payout

We confirm the payment instruction and closing documentation before the file is marked resolved.

Filing a disability claim

What to expect when you submit a disability claim

Disability benefits are assessed against your ability to keep working, not just your diagnosis. Here's how that assessment works, and what to have ready.

When you're considered disabled

Two ways a claim can qualify

01

Injury or illness stops you from doing your own job, or any other role your employer could reasonably offer you given your training, education and experience. If your duties were adjusted to accommodate the condition and you've managed them well for six months or more, those adjusted duties become your new benchmark.

02

You no longer meet the minimum fitness standard required for your role under the applicable code of practice, even if you could still perform some duties.

Timing

Don't wait for the paperwork to be perfect

Notify us as soon as an extended absence, a missed fitness standard, or a "not coping" situation becomes apparent — before every form is finalised. Early notice lets us flag which medical tests or specialists will actually be needed, which avoids delay later.

6mo

Typical window to lodge full claim documentation from the date someone becomes unable to perform their own occupation. Missing it is one of the most common — and most avoidable — reasons a claim stalls.

Who does what

Four parties, one file

Employer

Starts the file

Flags the absence or capacity issue early, helps gather documentation, and lodges the claim without waiting for every form to be complete.

Employee

Provides evidence

Raises the issue with their line manager, attends the required medical assessments, and completes the claimant's sections of the claim form.

Fund

Coordinates the file

Passes the claim to the assessor as soon as it's notified, and keeps all parties informed of outstanding requirements.

Assessor

Makes the call

Reviews the medical and occupational evidence, requests anything outstanding, and issues a decision — admitted, repudiated, or reassessed on appeal.

Documentation

What we'll help you pull together

Documentary evidence

Completed lump-sum disability claim form, signed by the claimant
Copy of the claimant's ID document or passport
Leave records for the two years before the last active work date
Payslip for the last month of full, active duty

Medical evidence

Claim form sections completed by the occupational medical practitioner
Confidential medical report from the treating doctor or specialist
Supporting diagnostic test results
Current and historical fitness certificates

FAQs

Questions we're asked most

Who pays for the medical evidence?

Generally the claimant or employer, since the burden of proving inability to work sits with the employee. If the fund's assessor needs additional evidence — a second opinion, for example — to finalise the decision, that cost is usually covered separately and confirmed in writing.

What's the difference between medical boarding and occupational disability?

A treating doctor's recommendation for medical boarding is a clinical opinion. Occupational disability assessment goes further, weighing the diagnosis against the specific demands of the claimant's insured occupation under the relevant policy. A doctor's recommendation doesn't guarantee the claim will be admitted.

What counts as a pre-existing condition exclusion?

Claims lodged within the first year of a policy can be declined if there's evidence the condition existed before cover began. This is one of the most disputed areas of a claim, and one where the medical timeline matters most.

How long does an assessment take?

Once complete documentation is with the assessor, a decision or a request for further information typically follows within about ten working days. Payment, once a claim is admitted, generally follows on a similar timeframe.

What happens if a claim is declined?

A repudiated claim can be reassessed on request, usually by a different member of the assessment team once further supporting evidence is submitted — and can also be escalated to the relevant Ombudsman if it remains unresolved.

For employers & benefit funds

Disability and incapacity assessment and management

We assist Trustees and Employers in determining the true extent of an employee's functional limitations and associated occupational impairment, and in reaching a validation or repudiation decision that will hold up to scrutiny.

Impairment & occupational impact assessmentDetermining the true extent of an employee's functional limitations and how they translate into occupational impairment.
Claim validation guidanceGuiding Trustees and Employers through the validation or repudiation of disability claims.
Incapacity managementOngoing case management for employees moving through an incapacity process.
Functional Capacity EvaluationFCEs for existing clients and on an ad hoc basis.

Work-site analysis & job evaluationOn-site assessment of the actual physical and cognitive demands of a role.
Independent specialist medical examinationsFacilitation of IMEs with appropriately qualified specialists.
Real-time, web-based administrationTrustees and Employers can track a case's status as it progresses.
Independent assessment reportsFactual, unbiased, and fair reporting on the validity of a disability claim.

Unclaimed benefits

A benefit doesn't expire just because a fund lost touch with you.

Under the Pension Funds Act, an unclaimed benefit is any lump sum or pension payment owed to a member — or their beneficiaries — that a fund has been unable to pay out, usually because it lost contact with the person entitled to it.

Still entitled

Old membership, live benefit

If you belonged to a South African retirement fund at any point — even decades ago — a benefit may still be sitting unpaid because the fund couldn't find you. Where the fund's rules allow it, that amount can be paid into a pension or provident fund and claimed by the member or their beneficiaries.

1981Earliest fund membership we can trace a claim back to

Major types of pension claims

Five ways a benefit can be waiting for you

Divorce · pension interest

Divorce pension interest claims

Under the Divorce Act, a non-member spouse can claim a portion of their former partner's "pension interest" — calculated as the resignation benefit or retirement annuity contributions up to the date of divorce — exactly as stipulated in the divorce decree.

Death benefit · Section 37C

Death benefit claims

When a member dies, fund trustees carry a statutory duty to identify and equitably distribute the lump sum death benefit among all factual and legal dependants — a duty that overrides the terms of a traditional will.

Two-pot system

Two-pot retirement system claims

Active members can claim once per tax year against their accessible "savings pot" for emergency liquidity, while the "retirement pot" stays preserved until actual retirement age.

Withdrawal / retrenchment

Retirement, resignation & retrenchment claims

Standard withdrawal or retirement claims made when a member leaves employment or reaches retirement age, paying out as a lump sum or a structured annuity depending on the fund's rules.

Social assistance

State old age grant claims

A means-tested social assistance claim under the Social Assistance Act, available to qualifying South African residents aged 60 and older who lack adequate independent means.

Workplace injuries · COIDA

What COIDA compensation actually covers

The Compensation for Occupational Injuries and Diseases Act exists to replace lost income and cover medical costs when a workplace injury or illness leaves someone unable to work — and to support their dependants if the outcome is fatal.

Reporting deadlines

The clock starts the moment it happens

Delays at the reporting stage are one of the most common reasons a COIDA claim stalls before it's even assessed.

7d

Window for an employer to report an injury on duty once they've been notified of it.

14d

Window to report an occupational disease once the employer becomes aware of it — slightly longer, given diagnosis often takes time.

Compensation tiers

What gets paid depends on how the injury is classified

Temporary

75% of the employee's earnings at the time of the accident, paid for as long as they remain unfit for duty. The employer covers this for the first three months and reclaims it from the Fund; after that, it's claimed directly.

Permanent · ≤30%

Where permanent disability is assessed at 30% or less, the employee receives a single lump-sum payment calculated against the applicable percentage of disability.

Permanent · >30%

Above 30%, the outcome is a monthly pension for life instead of a lump sum — plus arrears backdated to the date the condition was stabilised on the final medical report.

If the outcome is fatal

Dependants' pension

Spouse

Paid for life

A surviving spouse — married under civil law, civil union, or customary law, or a registered life partner — receives a pension for as long as they live, regardless of remarriage.

Children

Paid until 18

Children under 18 qualify automatically. The pension can be extended past 18 if the child is still at school or tertiary study, or has a disability that prevents them earning an income.

Disputing a decision

Objections have a hard deadline too

Anyone affected by a Compensation Commissioner's decision can object to it — but the objection has to be lodged on the prescribed form, signed by the objector, and within the statutory window. Miss it, and the right to object falls away.

180d

Time allowed to lodge a formal objection from the date of the Commissioner's decision, before escalating to a tribunal hearing and, if needed, the High Court.

Legal framework

Health Risk Management intervention has to hold up legally.

Effective intervention is consistent, objective, fair, and equitable. A liberal, far-reaching Constitution sits over all of it, raising the performance bar for both fund and employer.

01 Labour Relations Act 66 of 1995
02 Public Service Act of 1994
03 Basic Conditions of Employment Act 75 of 1997
04 Employment Equity Act 55 of 1998
05 Code of Good Practice
06 Public Service Co-ordinating Bargaining and Industrial Council Agreements

A key distinction

Impairment is not the same as disability

Impairment

A deviation from expected function

A medically identifiable deviation from the functional capabilities expected of an average healthy individual — hearing loss, reduced eyesight, poor lung function, a psychiatric disorder, restricted joint motion. On its own, an impairment is not a disability, and doesn't automatically render someone unfit for work.

Occupational disability

Impairment that limits the job

Where a medical specialist's identified impairment is shown, by a multi-disciplinary Health Risk Manager, to create a handicap that prevents the person performing a task or occupation — or limits how they can perform it.

Assessing an individual's impairment and determining its real impact on job functionality is a specific professional skill. It calls for clinical expertise, occupational insight, and a working command of the legal framework above — which is precisely where our Health Risk Managers are engaged.

Insights·31 July 2024

Workplace injuries and disability claims within SA's legislative framework

A workplace injury rarely stays contained to the person it happens to. It reaches into households and communities, and the laws meant to soften that impact only work if the people affected can actually navigate them.

Three laws, one intent

Workplace safety, compensation for work-related injuries, and the financial protection offered by long-term insurance are governed by three separate pieces of South African legislation. Understanding how they interact — and where each one's responsibility ends — is essential for both employees and the employers who owe them a duty of care.

COIDA

Compensation for Occupational Injuries and Diseases Act

Requires compensation where a workplace injury or illness causes incapacity or death. The Compensation Commissioner administers the fund that employers contribute to on employees' behalf.

OHSA

Occupational Health and Safety Act

Places a shared duty on employers and employees to keep the workplace safe — through risk assessments, safety controls, and ongoing compliance with health and safety standards.

LTIA

Long-term Insurance Act

Governs the disability insurance policies that pay financial benefits to policyholders left disabled by an occupational injury or disease.

Why access remains the hard part

COIDA sets out the entitlement, but entitlement and access aren't the same thing. Administrative complexity and uneven access to healthcare mean many South African workers face a slow, difficult path to the benefits they're owed — often at the exact point in their lives when they can least afford the delay.

The cost beyond the claim

A disabling workplace injury rarely stops at lost income. It can mean ongoing medical and rehabilitation costs, growing reliance on family or community support, and financial strain that outlasts the injury itself.

Strengthening the legislative framework, raising awareness of it, and making the claims process fairer are the practical steps toward a workplace culture that protects both worker and employer.

Why PDCM

We work the file until it closes.

Pension and disability claims fail most often from silence — a fund that never confirms receipt, an insurer that never schedules an assessment. Our role is to keep every file moving and to know exactly which statutory lever to pull when it stops. PDCM works directly with fund administrators, group risk insurers, the Pension Funds Adjudicator and the FAIS Ombud on behalf of members, beneficiaries and their families across South Africa.

37C

Death benefit expertise

37D

Deduction disputes

30d

Fund response tracked

1:1

Dedicated file handlers

Start a claim

Tell us what happened. We'll open the file.

There's no cost to have a claim assessed. We'll confirm within one working day whether we can take it on.

Every pension and disability claim deserves a file number, not a runaround.

Claim progress