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INTERNATIONAL ORGANIZATION FOR MIGRATION

Doc Title: Compensation Plan


Doc Type: Instruction
Character: Compliance with this instruction is mandatory
Doc No.: IN/95 Rev 1
Doc Owner: HRM

INSTRUCTION

Date of Entry into Force: 28 October 2010

Replaces: This Instruction modifies IN/95 dated January 2009.


Status: Active
Summary: The purpose of this instruction is to reflect few modifications and clarifications,
on Compensation Plan contributions, the importance of including the CP clause
in the contract and assessment of occupational accidents.
Keywords: Compensation Plan insurance (CP), CP benefits, CP entitlements, CP
reimbursement of medical expenses
File Control No.: IN/95 Rev.1

Location: http://mnlfnetapps.as.iom.net:7010/filenetaccess/viewDocument.do?controlNo=IN/0095

Initiated: HRM
Coordinated: OHU & LEG
Authorized: DRM & DGO
Distribution: All Missions Worldwide, All Departments at HQ

-1-

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INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM)


COMPENSATION PLAN (CP)
In the event of an occupational accident or illness occurring to staff members during the period of
their service with the Organization, the Compensation Plan provides:

for payment of salary benefits in the case of temporary incapacity to work for a period not
exceeding 2 years from the date of the accident or the beginning of the illness;

when applicable, for permanent total or partial disability indemnities; and

benefits in case of death.

The Compensation Plan is also a group insurance which reimburses:


Medical expenses incurred because of an occupational accident or illness for a period not
exceeding five years from the date of the accident or the beginning of the illness;
Medical expenses incurred because of a non-occupational accident or non-occupational
illness, up to a maximum amount of CHF 15,000.-, which occurs/begins while on authorized
duty travel outside the country of the established duty station. This provision applies only for
local employees who are not covered by the Medical Service Plan (MSP), interns and escorts.
The insurance benefits outlined in this document cover occupational accidents and illnesses and
apply to all staff in active service of the Organization in Switzerland or in the field, including
temporary personnel, who are under short term contract and who do not hold contract subject to Staff
Regulations and Rules for Officials or Staff Regulations and Rules for Employees in Switzerland.
The following are the requirements in order to receive the benefits outlined in the document. All
forms must be sent to the Medical Officer of the Health & Insurance Medical Unit (HIM) Manila:

Notification of accidents and occupational illnesses should be received in Manila no later than
8 days following the accident or the beginning of the illness suspected to be occupational;

Initial report shall be sent as soon as possible after the accident or the beginning of the illness;

Progress report from the attending physician shall be submitted monthly to the HIM Manila;

Final report from the attending physician shall be submitted to the HIM Manila on complete
recovery (if there is no invalidity), or when assessment of invalidity is possible, but not later than
two years from the date of the occupational accident or the beginning of the occupational illness.

scs doc: A03 CP instruction / 2010

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COMPENSATION PLAN (CP)


Table of Contents

Chapter 1: CONDITIONS OF PARTICIPATION AND ELIGIBILITY

Paragraph no.

1.
2.
3.
4.

DEFINITION OF STAFF MEMBER


COMPULSORY PARTICIPATION
CESSATION OF PARTICIPATION
SPECIAL LEAVE AND SUSPENSION FROM DUTY

Chapter 2: DEFINITION OF SALARY AND PREMIUM CONTRIBUTION

Paragraph no.

5. DEFINITION OF SALARY
6. TOTAL COST OF PARTICIPATION

Chapter 3: BENEFITS

Section 1:

GENERAL INFORMATION

Paragraph no.

Section 2:

AMOUNT OF REIMBURSEMENT AND INDEMNITIES

Paragraph no.

Section 3:

7. GEOGRAPHICAL COVERAGE
8. REQUIREMENTS FOR NOTIFICATION AND REPORTING

9. OCCUPATIONAL ACCIDENT/ILLNESS
10. NON-OCCUPATIONAL ACCIDENT/ILLNESS
11. REIMBURSEMENT OF MEDICAL EXPENSES IN CASE OF
OCCUPATIONAL ACCIDENT/ILLNESS
12. REIMBURSEMENT OF MEDICAL EXPENSES IN CASE OF NONOCCUPATIONAL ACCIDENT/ILLNESS
13. DISABILTIY INDEMNITIES
14. DEATH INDEMNITY

EXCLUSIONS / OTHER INFORMATION

Paragraph no.

15. EXCLUSIONS
16. DUPLICATION OF BENEFITS
17. EXCHANGE RATES
./

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COMPENSATION PLAN (CP)


Table of Contents

Chapter 4: ADMINISTRATION
Paragraph no.

18. SUBMISSION OF COMPENSATION PLAN MEDICAL CLAIMS


19. CORRESPONDENCE WITH MANILA
20 HIGH MEDICAL BILLS
21. PROCESSING AND REIMBURSEMENT OF COMPENSATION
MEDICAL CLAIMS
22. REPORTING REQUIREMENTS FOR ACCIDENTS AND
ILLNESSES
23. ADMINISTRATION FOR FIELD OFFICES
24. FORMS

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Chapter 1

CONDITIONS OF PARTICIPATION AND ELIGIBILITY

1. DEFINITION OF STAFF MEMBER


The term Staff Member is used to define all staff in the service of the Organization at
Headquarters or in the field, including temporary personnel, who do not hold contract
subject to either Staff Regulations and Rules for Officials or Staff Regulations and Rules
for Employees in Switzerland, who are otherwise not adequately covered against
occupational accident or illness. For purposes of the Compensation Plan (CP) insurance
only, the term also applies to consultants, experts, conference personnel, interns, casual
workers, volunteers and escorts. It also applies to invitees for whom the Organization pays
full or partial daily subsistence allowance (DSA), travel costs etc., as per the
Organizations travel rules.
2. COMPULSORY PARTICIPATION
The CP insurance is mandatory for the period of contract and applies to all staff, as
described in paragraph 1 above, as of entry on duty.
2.1

The provision granting the CP coverage must be included in the contract or, in
cases where no contract is issued, indicated in an official document issued by
IOM (e.g. the letter of invitation in the case of IOM-paid invitees).

2.2

Effective Date of Admission


Provided that the employment contract has been signed by both parties and the
formalities indicated by Occupational Health Unit Geneva (OHU) or the
Medical Officer of the Health & Insurance Medical Unit (HIM) Manila have
been completed, insurance coverage begins on the first day of employment.

3. CESSATION OF PARTICIPATION
3.1

Date of Exit
The date of exit is the last day in service of the staff member.

3.2

Date When Entitlements Cease


Entitlements for participation cease following the date of exit from the
Compensation Plan insurance, except for entitlements resulting:

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3.2.1 From an occupational accident or illness which occurs/begins while the


staff member is in active service for a period not exceeding five years
from the date when the occupational accident or illness started.
3.2.2 From a non-occupational accident or a non-occupational illness which
occurs/begins while the local employee who is not covered by the
Medical Service Plan (MSP), intern or escort is on authorized duty
travel outside the country of the established duty station for a period
not exceeding two years from the date when the non-occupational
accident or non-occupational illness started, up to a maximum amount
of 15,000.-- Swiss Francs per case.

4. SPECIAL LEAVE AND SUSPENSION FROM DUTY


In the event that a staff member is granted special leave without pay, or is suspended
from duty without pay:
4.1

The coverage of the Compensation Plan insurance ceases as from the first day
of the leave.

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Chapter 2
DEFINITON OF SALARY AND PREMIUM CONTRIBUTION

5.

DEFINITION OF SALARY
5.1

Compensation Plan premiums are calculated on the basis of the staff members salary.

For calculation of temporary incapacity, permanent disability and/or the death indemnity, the
salary on the date of the occupational accident or beginning of the occupational illness is
applicable. The following salaries are to be used:
5.1.1 For officials, the pensionable salary as per Annex E to the Staff Regulations and Rules
for Officials;
5.1.2

For employees in Switzerland, the salary as per Annex G to the Staff Regulations and
Rules for Employees in Switzerland, plus the amount of language allowance to which the
employee may be entitled (family allowance is excluded);

5.1.3

For employees in the field, the yearly base salary as per the effective salary scale in the
mission, plus the amount of language allowance to which the employee may be entitled,
if applicable, plus any bonuses to which the employee has a right (family allowance is
excluded);

5.1.4

For officials and employees serving under the terms of a special contract, temporary
contract and/or all inclusive contract, etc. which provides for participation in the
Compensation Plan insurance, the amount specified in the contract;

5.1.5

For experts and consultants, holding contract which provides for participation in the
Compensation Plan insurance, the amount specified in the contract;

5.1.6

For conference staff employed temporarily, holding a contract which provides for
participation in the Compensation Plan insurance, the amount specified in the contract;

5.1.7

For interns, volunteers and non-staff escorts, the reference to salary is taken to mean a
theoretical yearly amount equivalent to 36,000.-- Swiss Francs;

5.1.8

For participants who are not insured under items 5.1.1 to 5.1.7, the reference to salary is
taken to mean a theoretical yearly amount equivalent to 72,000.-- Swiss Francs.

5.2

Calculation of daily salary


The "daily salary" used to calculate indemnities is 1/360th of the annual salary, 1/30th of the
monthly salary, 1/7th of the weekly salary, or the daily salary as indicated in the contract of
employment.

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6.

TOTAL COST OF PARTICIPATION

The total cost of participation is 0.400% of salary as defined in paragraph 5 and is born in full by
the Organization.
As the CP premium is a direct cost, it should be projectized to the same project(s) and salary
expense GL code as the officials or employees salary and credited to the Staff Compensation
Plan liability account (GL code 211210) as part of the payroll process. Similarly for other
categories covered under the CP Plan, using the appropriate expense GL code: consultants,
experts, conference personnel, interns, casual workers, volunteers and escorts.

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Chapter 3
BENEFITS
Section 1:
GENERAL INFORMATION

7.

GEOGRAPHICAL COVERAGE

7.1

8.

The Compensation Plan covers staff members in any country, with no


geographical limitations.

REQUIREMENTS FOR NOTIFICATION AND REPORTING


8.1

In order to be entitled to the reimbursement of medical expenses, temporary


incapacity, permanent disability and/or the death indemnity concerning an
occupational accident and illness, participants must comply with the
administrative requirements as specified in paragraph 22.

8.2

In addition, when requested by either the Medical Officer of the


Occupational Health Unit (OHU) Geneva or the Medical Officer of the
Health & Insurance Medical Unit (HIM) Manila, all participants must:
8.2.1 Provide any information on his/her state of health, on the
circumstances of any accident and the nature of any illness, as well
as treatment;
8.2.2 Consult a certified medical doctor within eight days following the
accident or the illness and follow the treatment prescribed;
8.2.3

Authorize any attending physician to communicate all medical


information;

8.2.4

Submit all medical reports from their attending physician to the


Medical Officer of the Health & Insurance Medical Unit (HIM)
Manila or the Occupational Health Unit (OHU) Geneva; supply any
supplementary information which may be requested by the
Organization;

8.2.5

Accept to undergo any examination by a physician designated by the


Medical Officer of the Health & Insurance Medical Unit (HIM)
Manila or the Occupational Health Unit (OHU) Geneva. In case of
death an autopsy may be performed if required.

Failure to comply with the above may lead to the partial or total loss of entitlement
to the relevant benefits.

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Section 2 :
AMOUNT OF REIMBURSEMENT AND INDEMNITIES
9.

OCCUPATIONAL ACCIDENT AND OCCUPATIONAL ILLNESS

For the purpose of determining entitlement to occupational accident or illness benefits,


9.1

An occupational accident shall be taken to mean any event beyond the control of the
participant which, through the sudden action of an external force, causes a detectable
physical and/or psychological injury, if the event occurs while the participant is
performing official duties on behalf of the Organization or commuting directly to or from
work.
The Chief of Mission/Field Manager confirms the accident took place either while
performing official duties on behalf of the Organization or during commuting
directly to or from work by signing the Notification of Accident. He/she explains why
he/she believes the accident is related to work. However, classification of the accident
under occupational or non-occupational is under the responsibility of the Medical
Officer of the Health & Insurance Medical Unit (HIM) Manila or the Occupational
Health Unit (OHU).

9.2

An occupational illness shall be taken to mean a deterioration in health confirmed by a


legally qualified physician and demonstrated to be directly attributable to the type of
official duties performed by the participant on behalf of the Organization.
Regardless of where the participant is on duty, only the Medical Officer of the Health
& Insurance Medical Unit (HIM) Manila or the Occupational Health Unit (OHU) has
the authority to determine that the illness is to be considered occupational.

10.

NON-OCCUPATIONAL ACCIDENT AND NON-OCCUPATIONAL ILLNESS


SUFFERED WHILE ON AUTHORIZED DUTY TRAVEL
10.1 For the purposes of this insurance, an illness is a deterioration in health
confirmed by a legally qualified physician. A non-occupational illness is an
illness which is not directly attributable to the official duties performed by
the staff member on behalf of the Organization.
10.2 For the purposes of this insurance, an accident is an event beyond the
control of the insured person which, through the sudden action of an
external force, causes him/her a detectable injury, be it physical or
psychological. A non-occupational accident is an accident which occurs
while the staff member is not performing official duties on behalf of the
Organization, nor commuting directly to or from work.
10.3 For the purposes of this insurance, coverage for non-occupational accident
and non-occupational illness is only available to local employees not
covered by the Medical Service Plan (MSP), interns or escorts who are on

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authorized duty travel outside the country of the established duty station and
such coverage only provides for reimbursement of medical expenses as
described in paragraph 12.
11. REIMBURSEMENT OF MEDICAL EXPENSES IN THE CASE OF AN
OCCUPATIONAL ACCIDENT OR AN OCCUPATIONAL ILLNESS
11.1

In the event of an occupational accident or an occupational illness

Reimbursement of medical expenses will be made as long as needed for a period not
exceeding five years from the date of the accident or the beginning of the illness.
The five year period is applicable to new cases of occupational accidents or occupational
illnesses occurring on or after 1 January 2009. For old cases the two years period continues to
apply.
11.2 Reimbursement at the rate of 100 per cent for all outpatient treatment, pharmaceutical and
hospital expenses;
11.3 The costs of transportation by ambulance and other means are reimbursable if the
circumstances so justify in the following cases:
a)

Emergency transport in the case of urgency to the nearest place of


treatment; an urgency is defined as a sudden and generally unexpected
event requiring an immediate action;

b)

Transport in an ambulance from the patient's home (or from the place
where the patient became ill/had an accident) to a hospital or the attending
doctor's place of practice and back, if the circumstances so justify;

c)

Transport from a medical establishment to another when the insured person


is hospitalized including the transfer to another medical establishment for
purposes of convalescence or continuation of treatment.

11.4 Claims may be submitted at the beginning and/or the end of the treatment, and/or during
the treatment. Transportation claims must be justifiable by a medical certificate, which
should be presented in advance whenever possible. It must mention place of pick up and
delivery, date, mode of transportation (seated or laying) and the need or not of medical
escort. A valid ambulance bill must also mention these details.
11.5 Reimbursement of expenses for the first purchase or repair of spectacles, hearing aids or
other orthopedic prosthetic appliances on a doctors prescription at the rate of 100 per cent
if the purchase or repair is required because of an occupational illness or an occupational
accident which causes an injury requiring treatment.
11.6 At the end of the five-year CP coverage no additional medical expenses will be covered by
the CP nor by the Medical Service Plan (MSP) for those who are covered by the MSP.

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12. REIMBURSEMENT OF MEDICAL EXPENSES IN THE CASE OF A NONOCCPATIONAL ACCIDENT OR A NON-OCCUPATIONAL ILLNESS
In the event of a non-occupational accident or a non-occupational illness suffered while on
authorized duty travel (TDY) outside the country of the established duty station (applies only
to local employees who are not covered by the Medical Service Plan (MSP), interns and
escorts). For those local employees who are covered by MSP, the MSP shall apply during the
TDY period.

12.1

Reimbursement of medical expenses

Reimbursement of medical, pharmaceutical and hospital expenses for a period not exceeding
two years from the date of the accident or the beginning of the illness, up to a maximum
amount of 15,000.-- Swiss Francs per case, at the rate of
a) 100% of expenses incurred because of a non-occupational accident.
b) 100% of expenses incurred because of a non-occupational illness.

13. DISABILITY INDEMNITIES


For calculation of temporary incapacity, permanent disability, the salary on the date of the
occupational accident or beginning of the occupational illness is applicable. (see paragraph 5)
13.1 Temporary total or partial incapacity to work
The full salary from the day following the date of the occupational accident or of the
beginning of the illness for a period not exceeding two years from that date.
Absence from duty during such period will be considered as special leave with full pay
and such leave will not be deducted from the sick leave accrual.
13.2 Permanent total disability
A lump sum of 3,000 times the participant's daily salary. Applicable to new cases of
occupational accidents or occupational illnesses occurring on or after 1 January 2008. For
old cases the previous entitlement of 2,000 times the participant's daily salary continues to
apply.
13.3 Permanent partial disability
In the case of permanent partial disability the lump sum varies in accordance with the type
and degree of disability suffered and the calculation is as follows: 3,000 times the
participant's daily salary multiplied by the percentage of the degree of disability.

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The permanent total or partial disability benefit is paid when assessment of invalidity is
possible and is considered final but not later than two years from the date of the
occupational accident or the beginning of the occupational illness.

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DEATH INDEMNITY
For calculation of death indemnity, the salary on the date of the occupational accident or
beginning of the occupational illness is applicable. (see paragraph 5). Applicable to new
cases of occupational accidents or occupational illnesses occurring on or after 1 January
2008.
14.1 Participants with no dependants :

500

14.2 Participants with spouse or with one dependent child*:

times the daily salary


2,000 times the daily salary

14.3 Participants with spouse and having one dependent child*


or participants with two or more dependent children* :

3,000 times the daily salary

*By "dependent child/children", it is meant direct dependent(s) who is/are


dependent upon the participant.

Section 3:
EXCLUSION AND OTHER INFORMATION
15

EXCLUSION
In the event of accident or illness, the coverage of this insurance does not extend to expenses
related to:
15.1 Excess of alcohol, alcoholism and consumption of drugs or other toxics;
15.2 Wilful injuries or voluntary impairment to health caused on the insured person
by him/herself or by a third party with the consent of the insured person;
15.3 Injuries or impairment to health caused by radiation of any kind and in
particular from atomic radiation except in the case where such radiation is used
for radio-therapy or in the course of medical examination;
15.4 Injuries or impairment to health resulting from the active participation of the
insured person in armed conflicts, civil disorders, riots, brawls, affrays, duels,
etc.;
15.5 Injuries or impairment to health occurring during a period of voluntary military
service;

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15.6 Injuries or impairment to health resulting from intentional crime or offenses,


including attempted crime or offenses, attributable to the insured person;
15.7 Participation as a contestant in motor-vehicle or in motor-boat races, or during
training for such races;
15.8 Accidents occurring while using an aircraft, or during parachuting, if the
person insured commits a premeditated violation of existing rules and
regulations and does not possess the required license and/or official
authorizations;
15.9 Continuation or aggravation of a condition existing at the time of recruitment.

15.10 FOR THE PURPOSE OF THIS INSURANCE


a) The exclusions mentioned under items 15.1 to 15.3 above refer only to
the benefits indicated in paragraphs 11 and 12 (reimbursement of
medical expense) and paragraph 13 (temporary incapacity and
permanent disability);
b) The exclusions mentioned under items 15.4 to 15.9 above refer to all the
benefits provided by the Compensation Plan insurance.

16.

MEMBERSHIP IN OTHER SCHEME(S) AND DUPLICATION OF BENEFITS

Participants in the Compensation Plan are free to receive benefits also from another insurance
scheme, but under the following conditions:
16.1 The participant should inform the Compensation Plan Administration Manila at
CPAdminMNL@iom.int that she/he belongs to another insurance and indicate the name
of the other scheme (including the national social security).
16.2 In the case of participation in a national social security scheme towards which the
Organization also contributes, the benefits of the Compensation Plan are due only to the
extent not payable by the national scheme.
16.3 When reimbursement of medical expenses is requested from both the Compensation Plan
and another scheme, the participant must supply documentary evidence of the amount
received or expected from the other scheme. In no case shall the amount paid by the
Compensation Plan plus the amount paid by the other scheme exceed the medical expenses
incurred.
16.4 If a third party is responsible for an accident, any right of the participant to claim
reimbursement of the medical expenses from the third party or his/her insurer must be
surrendered to the Organization as a condition for reimbursement of these expenses.

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Should the third party or third party insurer reimburse the participant directly, the latter
must refund the amount to the Organization, unless s/he decides not to claim any
reimbursement from the Organization.

17.

EXCHANGE RATES

17.1

Medical claims:

Conversions are to be made at the IOM exchange rate prevailing on the date of payment.
17.2

Claims concerning indemnities for salary, disability and death:

Conversions are to be made at the IOM exchange rate prevailing on the date of the occupational
accident or on the date the occupational illness began.

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Chapter 4
ADMINISTRATION
18.

SUBMISSION OF COMPENSATION PLAN MEDICAL CLAIMS


Medical expenses
Claims for reimbursement of medical expenses shall be submitted to the Compensation Plan
Administration Manila as soon as possible after the receipt of the bills on the form provided
for this purpose. They must be signed and dated by the participant or the person acting on
his/her behalf and supported by original receipted bills. Pharmacy receipts should be
supported by prescriptions.
If the medical expenses incurred result from an occupational accident or an
occupational illness, they must not be reimbursed/paid directly by the Organization
before submission of the notification and medical report(s).
18.1 As a rule, participants must pay their medical bills first and then claim
reimbursement from the insurance.
18.2 The following rules apply regarding the preparation of the claim:
18.2.1

Claims for reimbursement must be made on a special form annexed to this


document;

18.2.2

Supporting documents must be submitted in the original. Copies of the


prescriptions, bills or receipts will be accepted only when the originals have
been used for partial reimbursement by another insurance. In such cases,
the amount reimbursed must be indicated on the copies of the bills by the
other insurance (see paragraph 16).

18.2.3

Bills must be receipted or accompanied by proof of payment.

18.2.4

Bills and prescriptions must show clearly the patient's surname and first
name, date of treatment/purchase which must be written in by the doctor, or
hospital, never by the patient.

18.2.5

Bills must also show the following information, which must be written in
legibly by the doctor, hospital or pharmacist:
Doctors bills: the date of each visit and the nature of the services
rendered (consultation, visit, night call), as well as the detailed price
of each service; laboratory bills must indicate the date of the detailed
lab tests rendered and price for each test;
Hospital bills: the period of hospitalization, the nature of the services

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rendered and the detailed cost of each service;


Pharmacists bills accompanied by a doctor's prescription: the date of
purchase, the name(s) of the item(s) purchased and the price paid.
18.3

Participants are advised to keep for their own records a photocopy of each claim and all
the supporting documents.

18.4

Indemnities payable in the event of occupational accident or occupational illness

18.4.1

Loss of salary: If the participant has submitted the notification of occupational


accident/notification of occupational illness and medical report(s), indicating the
duration and percentage of sick leave, s/he is entitled to receive this benefit. There is
no other form to fill in.

18.4.2

Invalidity: The final medical report shall be considered as the participant's claim for
invalidity (if any).

18.4.3 Death benefits: Claims for death benefits shall be filed by the beneficiary (ies) within
six months after the date of death. There is no form for this.
19.

CORRESPONDENCE WITH MANILA


Claims and supporting documents must be submitted in the original to the Health
Claims Processing Unit HCP Manila to the attention of Compensation Plan
Administration.
19.1 Correspondence with Manila should be addressed either to the Compensation
Plan Administration Manila at CPAdminMNL@iom.int or to the Medical
Officer of the Health & Insurance Medical Unit (HIM) Manila, HIMMAC@iom.int depending on the nature of the question, administrative or
medical.
19.2 Electronic communication facilities may be used as follows:
19.2.1 Participants who use the e-mail of the Organization are invited to
address their communications for administrative matters to:
COMPENSATION PLAN Admin Manila, in the global address book.
The Medical Officer of the Health & Insurance Medical Unit HIM
Manila may be addressed by name.
19.2.2 When using Internet from a computer with no access to the global
address book, the address for administrative matters is:
CPAdminMNL@iom.int.
19.2.3 Participants are invited to address their communications for medical
matters directly to the Medical Officer. All medical documents
(medical reports, lab test, letters from physician etc) have to be sent
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confidentially by email or fax by the staff member him/herself to the


Medical Officer, and the originals have to be sent in a sealed envelope
to the attention of the Medical Officer of the Health & Insurance
Medical Unit (HIM) Manila. Medical information can either be sent
by e-mail directly to the Medical Officer of the Health & Insurance
Medical Unit (HIM) Manila HIM-MAC@iom.int or by the direct
telefax line for confidential information, no. +632 848 14 39. The
direct telephone number is: +632 848 05 61.
20. HIGH MEDICAL BILLS
20.1 Staff may request a direct settlement of the bill(s) by the Organization, when
faced with high medical expenses.
20.2 Whenever justified, and after prior approval from the Compensation Plan
Administration Manila, direct payments may be made by the field office on the
condition that claims are nevertheless submitted retroactively on the CP form with
the original supporting documents.
21.

PROCESSING AND REIMBURSEMENT OF MEDICAL CLAIMS


21.1 Medical Compensation Plan claims which have been handed in to IOM offices
for dispatch to Manila will be mailed by diplomatic pouch, periodically during
the month, depending on local practice.
21.2 After approval of the claims, authorization for payment, in the form of an email message giving the claimants name and the amount due, is given to the
MHRO-payroll unit for all Officials and Employees in Switzerland and to
Manila Treasury Service (MTS) for separated Officials and Employees in
Switzerland. Authorization is given to the mission for Employees in field
missions.

22.

REPORTING REQUIREMENTS FOR ACCIDENTS AND ILLNESSES

22.1 Notification of occupational accident or occupational illness, (form annexed to this


document). All notification of occupational accidents and occupational illnesses should be
received in Manila no later than 8 days following the accident or the beginning of the
occupational illness.
22.1.1 Notifications of occupational accident or occupational illness concerning participants
whose duty station is at Headquarters, Geneva, should be addressed directly to the Health
& Insurance Medical Unit (HIM) Manila (see paragraphs 22.1.5 and 22.1.6).
22.1.2 Notifications of occupational accident or occupational illness concerning participants
whose duty station is in one of the field offices should be addressed to the Chief of
Mission/Field Manager who shall transmit them immediately to the Health & Insurance
Medical Unit (HIM) Manila (see paragraphs 22.1.5 and 22.1.6).

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22.1.3 Notification concerning non-occupational accident should be addressed directly to the


Health & Insurance Medical Unit (HIM) Manila and should mention that accident
occurred during TDY. Notification concerning non-occupational illness should be
declared by e-mail or telefax to the Health & Insurance Medical Unit (HIM) Manila and
should mention that illness occurred during TDY.
22.1.4 All medical reports concerning accident or illness should be addressed to the Health &
Insurance Medical Unit (HIM) Manila (no copy for the Compensation Plan
Administration Manila).
22.1.5 Notification of accident or occupational illness reports must be written on the two-page
form annexed to this document by the participant, or by a person acting on his/her behalf.
Extra pages may be inserted if required.
22.1.6 Notification of accident or occupational illness reports must be signed and dated on all
pages by the participant or the person acting on his/her behalf. If the notification
concerns a participant in the field, the second page of the form must also be signed and
dated by the Chief of Mission/Field Manager.
22.1.7 If the report concerns an occupational accident in the field, the Chief of Mission/Field
Manager confirms the accident took place either while the participant was
performing official duties on behalf of the Organization or during commuting
directly to or from work by signing the Notification of Accident. He/she explains
why he/she believes the accident is related to work.
22.1.8 If a third party is responsible for an accident, the participant must inform the
Compensation Plan Administration Manila of the name and address of the third party, as
well as the name and address of his/her insurer. If the third party is not insured, then the
Compensation Plan Administration Manila should be so informed by the participant.
22.1.9 Notification of accidents and occupational illnesses should be received at Manila no
later than 8 days following the accident or the beginning of the illness suspected to be
occupational. However, it is sometimes impossible to obtain all the details required
on the form provided for notification within the above-mentioned time frame. If
this is the case, an interim report must be sent (see paragraph 22.2).
22.2

Interim reports

22.2.1 Must be sent by e-mail or telefax to the Health & Insurance Medical Unit (HIM)
Manila (as explained in paragraph 22.1 above) no later than 3 days following the
occupational accident or beginning of the illness suspected to be occupational;
22.2.2 Must be sent to the Health & Insurance Medical Unit (HIM) Manila by telephone,
e-mail or telefax immediately in case of an accidental death;

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22.2.3 Must be followed by the complete notification on the form provided for that purpose
(annexed to this document) as soon as possible.
Interim reports on accidents should indicate (at least): the name of the insurance
scheme (Compensation Plan), name of the accident victim, date and place of the
accident, and a brief description of the event and injuries (keeping in mind the remark
in previous text about medical confidentiality).
Interim reports on illnesses should indicate (at least): the name of the insurance scheme
(Compensation Plan), name of the patient, date the symptoms of the illness began, a
brief description of the symptoms and indication of why the illness is suspected to be
occupational (keeping in mind the remark in previous text about medical
confidentiality).
22.3

Medical reports

All medical reports: Initial, progress and final (forms annexed to this document) concerning
an accident or an illness should be addressed to the Health & Insurance Medical Unit (HIM)
Manila (no copy for the Compensation Plan Administration Manila).
22.3.1 Initial report
An initial report of the attending physician shall be forwarded to the Health & Insurance
Medical Unit (HIM) Manila as soon as possible after the accident or the beginning of the
illness.
22.3.2 Progress report(s)
For any treatment/absence from work lasting for more than one month, progress reports from
the attending physician shall be submitted to the Health & Insurance Medical Unit (HIM)
Manila at monthly intervals.
Definition of "degree" on forms for initial and progress reports: Degree of temporary
incapacity to work expressed in percentage. For example: Not able to work at all
(= degree of 100%); able to work half days (= degree of 50%). Please ensure that this
information is not omitted by the treating physician.
22.3.3 Final report
A final report from the attending physician shall be submitted to the Health & Insurance
Medical Unit (HIM) Manila on complete recovery (if there is no invalidity), or when
assessment of invalidity is possible, but not later than two years from the date of the
occupational accident or the beginning of the occupational illness.
Definition of "degree" on the form for the final report: Estimated degree of partial
permanent invalidity expressed in a percentage. Please ensure that this information is
not omitted by the treating physician.

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23.

ADMINISTRATION FOR FIELD OFFICES

Chiefs of Mission/Field Manager:


Authorizations required to be obtained by Chiefs of Mission/Field Manager from the
Compensation Plan Administration Manila:
23.1

Medical Expenses
As a general rule, medical expenses should be paid first by the insured person and then
claimed on the CP form provided for that purpose, supported by the original receipted bills.
Whenever justified, and after prior approval from HCP, Compensation Plan
Administration Manila, direct payments may be made by the field office on the condition
that claims are nevertheless submitted retroactively on the CP form with the original
supporting documents. Please address such requests to the Compensation Plan
Administration Manila.

23.2

No participant should suffer because s/he cannot afford to disburse the amount(s)
needed for medical care which is/are reimbursable under the terms of the CP
insurance.

Failure to submit the claim retroactively results in a financial loss for the
Organization (the amount disbursed by IOM cannot be recovered from the insurance
company without the original receipted bills).

Indemnities

Indemnity payments are subject to prior authorization from the Compensation Plan
Administration Manila
This rule applies also for the indemnity during temporary incapacity to work covering loss of
salary. These payments will be authorized upon presentation of the Notification of Accident
and relevant medical report(s) certifying that such absence is medically justified and
specifying the period(s) of incapacity to work as well as the degree (see definition of "degree"
under "Medical Reports" paragraph 22.3 above).
23.3

Accounting Codes

All amounts disbursed by the Organization (medical care, incapacity, disability and death
indemnities) should be charged to the Compensation Plan code 2355 for those missions who
do not access PRISM. For those missions who do access PRISM, amounts should be charged
to code 211540.
The salary should be coded as explained above in its entirety during periods when the staff
member is absent on a full-time basis. If the participant is working part-time because of a
partial temporary incapacity, the percentage of the salary for the time not worked should be
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coded as explained above and the other percentage to the usual salary code.
23.4

Reporting absences due to temporary incapacity to work resulting from occupational


accidents or illnesses (field offices): It is the responsibility of the Chief of Mission/Field
Manager to report to the Compensation Plan Administration Manila the absences on a
monthly basis, indicating the exact period of absence and the degree (see definition under
"Medical Reports" paragraph 22.3 above). The degree of absence should correspond to
that indicated on the medical report(s) for the period(s) concerned.
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24.

Failure to report such absences results in a financial loss for the Organization
(the salary disbursed by IOM will not be recovered from the insurance company
if unknown to the Compensation Plan Administration Manila).

FORMS
The following forms, which are annexed to this document, are also available upon
request from the Compensation Plan Administration Manila (Manila), Human
Resources Management (Geneva), and from the Chief of Mission or other designated
persons in field missions. Forms can be also downloaded from intranet HRM section.
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Notification of Accident
Notification of Occupational Illness
Initial Report of Attending Physician
Progress Report of Attending Physician
Final Report of Attending Physician
Claim for Reimbursement of Medical Expenses

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