Review Process
A claimant can lodge a request to review the results of a claim (referred to as the determination) by contacting the Trust. The Disputes Process shows the four steps to follow.
THE 4-STEP DISPUTES PROCESS
This is the step-by-step process on how to request a review.
Step 1: LOGGING A DISPUTE
A claimant can log a request for a review of the outcome of a claim (referred to as the determination) through the following channels:
• The Call Centre:
a. Inside South Africa 080 1000 240
b. Outside of South Africa 00 27 10 500 6186
• Any Lodgement Office
• Email disputes@tshiamisotrust.com
IMPORTANT:
Disputes can only be logged within 120 days from which the Trust issued the disputed determination to the claimant.
Step 2: ASSESSING THE DISPUTE
The Trust will assess the request for review and assign it to either:
• The Medical Reviewing Authority (applies to disputes that relate to medical findings)
or;
• The Certification Reviewing Authority (applies to disputes not related to medical findings, including benefit amounts,
notices of ineligibility and service records).
IMPORTANT:
Where additional information is required, the Trust will contact the claimant.
Step 3: REVIEWING THE DISPUTE
The Reviewing Authority is made up of independent experts who were not involved in determining the original
claim outcome.
IMPORTANT:
If the claim does not meet the requirements of the Trust Deed, it will remain ineligible.
Step 4: COMMUNICATING THE OUTCOME
Once the review is complete, the claimant will receive an SMS, notifying them of the outcome. The SMS will have a link to a notice, which can be viewed on their phone or 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, and the claim will continue from the point at which the original determination was made, with the substituted finding.
IMPORTANT:
The decision of the Reviewing Authority is final and binding and cannot be disputed further.