THE 4-STEP REVIEW PROCESS
This is the step-by-step process on how to request a review.
Step 1: LOGGING A REQUEST FOR REVIEW
A claimant can lodge a request to review the results of a claim (referred to as the determination) via the following channels:
- Call the Call Centre:
- a. Inside South Africa 080 1000 240
- b. Outside of South Africa 00 27 10 500 6186
- Any Lodgement Office
- Email firstname.lastname@example.org
Claimants should submit a request to review the determination 30 days from when the Trust issued it.
An individual can only make one request to review these results.
Step 2: ASSESSING THE REQUEST FOR REVIEW
The Trust will assess the request for review and assign it to either:
- The Medical Reviewing Authority (applies for reviews that relate to medical findings)
- The Certification Reviewing Authority (applies to Notices of Ineligibility issued by Lodgement Officers and Notices of Ineligibility or Certifications issued by the Trust Certification Committee).
Where additional information is required, the Trust will contact the claimant.
Step 3: REVIEWING THE REQUEST
The applicable Reviewing Authority will review the claim as per the logged dispute and make a finding. The Reviewing Authority will be made up of
independent experts who were not involved in determining the original claim outcome.
The Trust is in the process of establishing the Reviewing Authority which will commence activities soon.
All valid requests for review logged before the commencement of the Reviewing Authority will be considered once it is convened.
Step 4: COMMUNICATING THE OUTCOME OF REVIEW
Once the review is complete, the claimant will receive an SMS, notifying them of the review’s outcome. The SMS will have a link to a notice, which can be printed at any TEBA office.
The potential outcomes of a review are:
- Original determination confirmed and upheld
- Original determination changed in full or in part
Should the review result in a change of the original determination, the claimant will be informed through an SMS. The SMS will have a link to the notice of the finding, which can be printed at any TEBA office. Details of the next steps will also be provided in this notice.
The claimant will receive a notice with the outcome of the review.
The decision of the Reviewing Authority is final and cannot be disputed further.