| (1) | An employee shall not be entitled to sick fund benefits— |
| (a) | for more than 130 days in any 365 day cycle, calculated from the first day in respect of which the employee is entitled to sick pay. |
| (b) | if the employer is not up to date with the Sick Benefit Fund contributions. |
| (c) | if an employee is absent from work owing to an accident or disease payable under the Compensation for Occupational Injuries and Diseases Act, 1993 except in respect of any period during which no compensation is payable. Claims in respect of injuries on duty must be submitted to the Compensation Commissioner in terms of Clause 24 of the Main collective agreement. |
[Clause 10 of Part 111 substituted by section 9(1) of Notice No. R. 389, GG44506, dated 30 April 2021]
| (d) | if an employee's absence from work is related to the abuse of alcohol or drugs, or the illegal use of substances, is incapacitated through sickness owing to own negligence or misconduct, or attempted suicide; |
| (e) | if an employee fails to observe the instruction of a medical practitioner, or has in the opinion of that practitioner aggravated the condition or retarded recovery through his or her own actions; |
| (f) | if an employee suffers from injury for which a third party is liable to pay or does pay compensation to him; |
| (g) | while he or she undergoes treatment prescribed by any person other than a registered medical practitioner/nurse. |
| (h) | if he or she fails to provide the Regional Committee with any relevant information which it may require; |
| (i) | if he or she is found by the Sick Benefit Fund Committee to be fit to resume employment or to be permanently disabled, in which event he or she shall cease to be entitled to sick pay from a date determined by the risk benefit underwriter or an expert for this purpose; and |
| (j) | in respect of absence from work due to pregnancy or giving birth; |
| (k) | if engaging in hunting, mountaineering or racing on wheels, professional sport, motor-cycling other than motor-cycling to and from the employee's normal work; |
| (I) | the performance of any unlawful act. |
| (m) | for an injury inflicted by any military or usurped power, whether or not there has been a declaration of war, or due to riots or civil commotion or engaging in fighting; |
| (n) | at any time when the amount to the credit of the Fund drops below R500,000.00 and until such time as the amount to the credit of the Fund exceeds R1000,000.00. |
| (o) | notwithstanding the aforesaid ,in the event that the credit of the Fund drops below the threshold of R500,000.00, the Fund may at its discretion immediately revoke payments and benefits only in respect of claims submitted for periods of 1 and 2 days. The Fund shall reinstate these benefits when the credit exceeds the threshold limit. |
| (p) | for claims submitted for absences for part of a day in instances of medical treatment and the claimant has not been declared unfit for duty and booked off. |
| (q) | If the Sick Benefit Fund Committee requires the member to undergo an independent medical examination at the cost to the fund and the member unreasonably refuses to undergo such an examination. |
| (r) | no Sick Fund benefits shall be payable in respect of paid public holidays specified in the Main collective agreement for the industry. |
| (2) | The fund shall be entitled to recover any amount paid to any employee— |
| (a) | In consequence of false information furnished to the Fund by or on behalf of such employee; |
| (b) | If the employee fails to notify the fund timeously of any change in circumstances which could lead to the amount of the benefits being reviewed or withdrawn, in which event the Fund may claim for the employee any amount overpaid to him; and |
| (c) | Should a member follow any remunerative occupation with any employer during the period he is in receipt of benefits. |
| (3) | Employees on leaving the industry or on becoming unemployed shall immediately cease to be entitled to sick pay benefits. |
| (4) | An appeal against a decision not to pay a claim or part of a claim must be made in writing to the Sick Benefit Fund Committee and the decision of the National Sick Benefit Fund Committee shall be binding. |
