Financial Considerations

It is crucial to understand that for the rest of your life you will need to budget and plan for expenses relating to your prosthetic leg. The important thing is not to give up when confronted by red tape and other obstacles, and to persist in seeking the treatment you need.

The cost of a prosthetic leg

Do not rush into a decision, but take your time and investigate all your options – in other words, be well informed – before you appoint a prosthetist to design your prosthetic leg. It is important to ask why the prosthetist makes a specific recommendation so that you can understand exactly why he or she recommends certain components for you, and what you will be paying for. Once you understand this clearly, you will also be able to understand the differences between quotes from different prosthetists, and ultimately compare apples with apples.

Be clear about the financial arrangements and what you are paying for before you start working with a prosthetist.

Typically, the cost of a prosthetic leg can be divided into the following three categories:

1. The manufacturing or labour part consists of designing and manufacturing the socket, and aligning and assembling the components correctly to ensure the complete system works as intended. The more complicated the shape of your residual limb and the more health complications you may have, such as scar tissue, the more time and expertise will be required to manufacture your prosthesis.

2. The cost of all the mechanical components, such as the prosthetic foot, which the prosthetist purchases from prosthetic device manufacturers such as Össur. The key factor driving costs here is the prices of the specific components that the prosthetist recommends for you. It is only possible to estimate the price of your complete prosthetic leg once the prosthetist has listed the components that are recommended for you.

3. Recurring costs: Once you have received your prosthesis and regained your mobility, your prosthesis will have to be adjusted periodically as your residual limb may change shape and volume over time. The mechanical components will also wear out over time, depending on various factors such as how well you look after your prosthesis. You can expect to replace the mechanical components approximately every five years.

It is not possible to estimate a ‘standard price’ for this part of the process, because there is no ‘standard residual limb’.

Reimbursement options

Depending on the cause of the amputation, your prosthesis and prosthetic rehabilitation are likely to be financed through the following avenues:

1. Medical Aid

If you are a member of a medical aid, you should enquire about the benefits available as soon as possible, so that you can insist on getting the right treatment early on in your rehabilitation. There are so many different medical aid plans and options that navigating your way through the process can be quite intimidating. Our advice is to get help – and an experienced prosthetist can be just the person you need to guide you through the administrative process required to get a medical aid to authorise payment for your treatment.


Medical aid members via Prosthetic Benefits, Prescribed Minimum Benefits (PMB) and Ex gratia.

1. Prosthetic Benefits: Most medical aid schemes have a prosthetic (external medical device) benefit. The benefit amount depends on the medical aid and the specific plan within the medical aid. If your medical aid prosthetic benefit is insufficient, you can enquire about PMB.

2. PMB: This is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. This includes:

• Any emergency medical condition.

• A limited set of ±270 medical conditions (which includes amputation).

• 25 chronic conditions.

3. Ex gratia: In special circumstances, medical aids would consider an (Ex gratia) contribution outside of their official benefit level. With a detailed motivation and supporting arguments the ex gratia committee of the medical aid can decide to increase the benefit contribution on compassionate terms. This is often a “once-off” contribution.


Depending on the medical aid, your prosthetist can enquire on your behalf with the medical aid what your available prosthetic benefit is. Be persistent when dealing with your medical aid, and don’t automatically accept it if the fund refuses your first request for a specific prosthesis. Don’t assume that your medical aid simply doesn’t want to help you, but realise that the people making the decisions about payment have a responsibility to pay only for treatments with proven health benefits. If the medical aid benefit is low and insufficient to cover all the costs for the prosthetic rehabilitation, the patient would need to contribute to the balance of the costs.


Medical treatment, rehabilitation and the prosthesis.

Necessary documents

Letters from your prosthetist and doctor clearly explaining the health benefits to you of getting a certain prosthetic component often succeed when a case is reviewed by the medical aid:

1. Benefit: Quotation from prosthetist sent to your medical aid on your behalf. Wait for pre-authorisation.

2. PMB: Your medical aid will provide the documents that need to be completed by you and your prosthetist. Feedback is usually given within 60 days.

3. Ex gratia: Detailed motivation and supporting arguments.

2. Compensation for Occupational Injuries and Diseases Act (COIDA) funding

Every employer in South Africa is required by law to make a monthly contribution to the Department of Labour Compensation Fund, whose purpose is to compensate people who have been injured at work.


COIDA applies to all employees (casual and full-time workers) who, as a result of a workplace accident or work-related disease are injured, disabled or killed. Under this act, there are different bodies:

1. Workmen's Compensation Fund (WCA) General workers

2. The Federal Employer's Mutual Assurance Company (FEM) Construction industry

3. Rand Mutual Assurance (RMA)Mining sector and iron, steel and metal industry


Occupational Injuries from WCA and FEM:

1. Report any injury to your employer immediately.

2. Take a WCA form with you for completion by the doctor and hospital staff. This, together with any other forms given to you by the doctor, must be submitted to the WCA.

3. The WCA will give you a case number, which you will use for all future claims and enquiries.

4. Follow up with your employer on the progress of the matter.

5. Once you are given a claim number, you can visit your prosthetist, who will then send an application and motivation for pre-authorisation for your prosthesis to the WCA.

Occupational Injuries from RMA:

1. Inform your employer immediately. Your employer must report the incident to RMA within 7 days from the date of the accident for all injuries, or within 14 days of diagnosis of disease.

2. Submit the necessary documents to your employer who will, in turn, need to submit these to RMA together with your claim:

  • Completed Section 51 document if you are under the age of 26 years or if you are a learner or trainee.
  • Medical reports – your first medical report must be submitted with your original claim, however, additional medical reports are required during the course of your treatment so that your progress can be tracked, particularly in the case of Temporary Total Disablement (TTDs).
  • Final assessment document.

3. Once you are given a claim number, you can visit your prosthetist, who will then send an application and motivation for pre-authorisation for your prosthesis to RMA. Please be aware that it can take several months for the WCA to respond to this request.


The COIDA tariff list used by Workman's Compensation only allows for basic prosthetic components. For higher-end components, you may need to combine this with some other reimbursement options.

Necessary documents

Your employer must send the necessary documents and your prosthetist must send an application and motivation for pre-authorisation for your prosthesis to the WCA, FEM or RMA. For more information on the topic and to view all the relevant forms please visit the Department of Labour's website: Keep in mind that if you’ve lost a limb due to an injury at work and the funds available from the Compensation Fund aren’t enough to cover the costs of a prosthetic leg with adequate functionality to allow you to return to work and become a productive employee again, your employer may very well be willing to contribute towards the shortfall.

3. Personal Injury Claims


Medical negligence

It is an unfortunate reality that negligence by medical personnel in the treatment of many diseases, conditions and injuries can result in the amputation of a limb that may have been otherwise avoidable. The following conditions may result in amputation:

• Onset of infection in hospital (non-sterile IV equipment, infection after artificial joint replacement).

• Mismanagement of infection once present.

• Misdiagnosis of vascular disease or vascular damage (in case of trauma).

• Compartment syndrome (swelling occurring within a plaster of Paris cast or brace that was applied).

General personal injury

Gunshots, dog bites or assault such as stabbing, causing severe injury that can result in eventual amputation, very often as a result of vascular damage or later onset of serious infection.

Metrorail/Transnet injuries

If you have been injured while using the South African rail network, you may have a claim against Metrorail or Transnet.


Medical negligence

If a case of negligence is suspected against a medical facility or its personnel, it is advised that the services of a medical negligence attorney are obtained. The attorney, with assistance of the relevant medical experts that will be appointed, will investigate the specific case and give a professional view on whether negligence was potentially the cause for the amputation. It should be noted that a relatively small percentage of medical negligence cases are successful as it is often difficult to prove that the alleged negligence itself caused the relevant aggravation (which in this case would be amputation) and that it would not have occurred in any case as a result of the condition, disease or injury itself.

General personal injury

A personal injury claim would be instigated against the insurance of the individual(s)/group or organisation that are represented.

In case of a dog bite, a claim would be against the owner of the dog (or the owner's personal liability insurance). It is recommended that an experienced personal injury attorney/firm is consulted to determine if such a claim would indeed be viable and likely successful.

Metrorail/Transnet injuries

Consult with an experienced personal injury attorney to assess the viability of such a claim.


Medical negligence

Claim for medical treatment, rehabilitation, prosthesis, loss of income, etc..

General personal injury

Claim for medical treatment, rehabilitation, prosthesis, loss of income, etc..

Metrorail/Transnet injuries

Claim for medical treatment, rehabilitation, prosthesis, loss of income, etc..

4. Road Accident Fund

The Road Accident Fund provides compulsory cover to all users of South African Roads. The RAF reimburses road accident victims who were seriously injured and as a result incurred medical costs, loss of employment or income and often require long-term medical treatment, which also has financial implications


A road accident victim. If you were injured in an accident, you may have a claim for compensation against the Road Accident Fund (RAF). This includes both motor vehicle (car, motorcycle, taxi, bus, truck) and pedestrian accidents.


The RAF encourages people who have been injured in a car accident to contact them directly (, but it is generally beneficial to get a competent and experienced attorney to facilitate your claim against the RAF. In most cases, experience has shown that individuals who are represented by an attorney get better compensation as compared to direct claims handling and settlement by the Road Accident Fund itself.


In terms of amputation as a result of a road accident, the individual would be compensated in two parts:

1. A financial reimbursement for general damages.

2. An undertaking for future medical expenses.

If you succeed with your claim, you may be compensated with a lump-sum payment − but remember that the costs associated with a prosthetic leg can be substantial, so plan and budget carefully for your prosthetics needs as you go forward.

Necessary Documents

Your attorney and prosthetist can help you to get all the necessary forms, documentation and medical expert reports that would be needed to process your claim. In most cases, the prosthetist would apply for pre-authorisation on your behalf at the RAF. Once authorisation is received your prosthesis fitting and rehabilitation can start.

5. Private Funds

Individuals who do not have a medical aid and did not lose their limb as a result of a road accident or occupational injury; thus, there is no claim against the Road Accident Fund or Workman's Compensation Fund for example.


This often includes individuals who lose a limb as a result of disease, or as a result of general injury/trauma (that results in serious infection), or in cases of congenital (birth) deformity where they do not have medical aid.


Amputees and/or their families would need to pay for the prosthesis. They can also get financial support through:

  • Personal funds (such as savings, bank credit or loans, selling assets).
  • Contributions and donations from family members and friends.
  • Sponsorship (by individuals or companies).
  • Fundraising events can be very successful. Your message must be clear, so that people can see why getting the prescribed device will help you lead a productive life. You need to be able to explain exactly what the device will enable you to do and what difference it will make to your health and mobility. A letter from your prosthetist or doctor explaining the medical benefits of the specific device they are recommending will go a long way towards getting other people to understand your needs.

Medical treatment, rehabilitation and prosthesis.

6. Disability Insurance

If you have disability insurance or insurance against the risk of not being able to do your job due to illness or injury, contact your insurance broker to ask about the coverage available. In fact, it’s important for everybody to have sufficient disability cover. Most South Africans are vastly underinsured when it comes to losing a limb. A small adjustment to a person’s insurance policy can mean the difference between being able to afford a suitable prosthesis and having to make do with something inferior.

7. Public Sector

All South Africans are entitled to treatment at a government medical facility. Go to your local (closest) government clinic first. You will then be referred to a government orthotics and prosthetics centre. A prosthetist at the centre will evaluate you and suggest the appropriate treatment and components you will need for your prosthesis. Although the options available in the government sector are fewer than in the private sector, prosthetic technology is constantly improving, and components that were previously only available in the private sector are starting to filter through to public health care. The cost of your prosthesis will be determined by your income level and whether or not you receive a disability or pension grant from SASSA.