COID - Act for WRULDs

COID - Act for WRULDs

Compensation for Occupational Injuries and Diseases Act (130/1993),
as amended

Notice 498 of 2004

Circular Instruction 180 regarding the compensation of Work-Related Upper Limb
Disorders (WRULDs)

The following circular instruction is issued to clarify the compensation of
claims for work-related upper limb disorders (WRULDs) and supersedes all previous
instructions in this regard. The Compensation Commissioner’s “ Guidelines
for medical practitioners and employers on how to manage Work-Related Upper
Limb Disorders” can also be used for further reference. These guidelines
are available on the Department of Labour website ( through
the CC web page under Occupational Diseases.


WRULDs is a collective term for a group of occupational diseases that consist
of musculo-skeletal disorders caused by exposure in the workplace affecting
the muscles, tendons, nerves, blood vessels, joints and bursae of the hand,
wrist, arm and shoulder. These are syndromes associated with characteristic
symptoms and physical signs (e.g. rotator cuff syndrome, epicondylitis at the
elbow, tenosynovitis and nerve entrapments such as carpal tunnel syndrome).

Previously other terms had been used, such as repetitive strain injury (RSI),
cumulative trauma disorder (CTD), occupational overuse syndrome (OOS), occupational
cervico-brachial disorder (OCD), etc. For the purpose of this instruction the
umbrella term, work-related upper limb disorders (WRULDs), will be used.

WRULDs are caused, aggravated or precipitated by one or more of the following
risk factors, singly or in combination:

· Highly repetitive movements

· Movements requiring force

· Movements at the extremes of reach

· Static muscle loading

· Awkward sustained postures

· Contact stress (e.g. uncomfortable gripping and twisting, sharp edges
to hand tools, desk edges, etc.)

· Vibration

In terms of this instruction, upper limb musculo-skeletal disorders will be
presumed to be work-related if the nature of the work performed includes exposure
to the relevant risk factors.


The following criteria should be used to confirm the diagnosis:

· A diagnosis of WRULD by the medical practitioner

· Medical history and clinical signs indicating – site and distribution,
quality (type, character), severity (intensity, frequency, duration) and progression
of the symptoms according to the type of disorder

· Functional ability report by an occupational therapist and / or physiotherapist,
where necessary

· Occupational exposure to known risk factors and a chronological relationship
between the WRULD and the work environment.

· The confirmatory tests/investigations (e.g. x-rays, strength testing,
range of motion testing, nerve conduction tests), where appropriate.

The medical officers in the Compensation Office will determine whether the
diagnosis of WRULD was made according to acceptable medical standards.


Impairment will be determined, in accordance with the internal instructions
157 for residual impairment of the function of the muscles, tendons, joints
or nerves involved, after maximum medical improvement has been reached.


Benefits will be payable according to the Compensation for Occupational Injuries
and Diseases Act, 1993 (Act number 130 of 1993), as amended>

· Temporary total disablement

Payment for reasonable temporary or partial disablement will be made on the
basis of medical reports for as long as such disablement continues, for a period
not exceeding 24 months.

· Permanent disablement

Permanent disablement will be assessed when a Final Medical Report is received,
after a reasonable recovery period not exceeding 24 months, and failure to perform
work effectively after the appropriate course of treatment and rehabilitation.

· Medical Aid

Medical expenses shall be provided for a period of not more than 24 months
from the date of diagnosis. This period may be extended if, in the opinion of
the Director General, further medical aid will reduce the extent of the disablement.
The medical covers the costs of diagnosing a WRULD and any necessary treatment
provided by any healthcare provider. The Compensation Commissioner will decide
on the need for, the nature and the sufficiency of the medical aid supplied.


The following documentation should be submitted to the Compensation Commissioner,
or the employer individually liable, or the mutual association concerned:

W.CI.1 Employer’s Report of an Occupational Disease

W.CI.14 Notice of an Occupational Disease and Claim for Compensation

W.CI.301 First Medical Report in Respect of a Work-Related Upper Limb Disorder

All other reports that may be relevant to the diagnosis and treatment of the
condition (e.g. an ergonomic assessment supported by photographs, video clips,

W.CI.302 Progress / Final Medical Report in respect of a Work – Related
Upper Limb Disorder (WRULD)

Progress medical reports must be submitted monthly to the Compensation Commissioner

W.CI.110 Exposure History or an appropriate employment history

W.CI.6 Resumption Report (monthly as long as the case is open, even if the
employee is at work


The office of the Compensation Commissioner will consider and adjudicate upon
the liability of all claims. The medical officers in the Compensation Commissioner’s
office are responsible for the medical assessment of a claim and for the confirmation
of the acceptance or rejection of a claim.

Provincial Branches

Gauteng Limpopo Mpumalanga Kwazulu Natal Free State Western Cape Eastern Cape Northern Cape North West