SOCSO cases: Effective compensation needed

The Consumers’ Association of Penang (CAP) applauds the Human Resource Minister, YB Datuk Dr S.
Subramaniam for highlighting the fact that workers are losing out on SOCSO claims because doctors do
not link diseases and health problems to the job.

The problem of serious under-reporting of occupational diseases had also been highlighted by our former
Human Resource Minister, Datuk Seri Dr. Fong Chan Onn.

Sadly, it is not only doctors that let down workers. SOCSO can be equally guilty. We have cases where
Socso’s medical board has approved the workers benefit only to have it later rejected by Socso’s medical
appellate board. Does SOCSO not trust is own medical board?

There are also workers whose claims are rejected because they were filed more than one year after the
accident. These are illiterate workers who are unaware of the SOCSO benefits available. By the time they
find out from friends of friends it is more than 12 months.

Though Socso’s regulations allows it to extend the time limit for filing claims, it does not exercise it often
enough.

One worker could not file a claim within the required time as he was in prison. When he was released, his
claim was rejected by 3 Socso branches before he finally succeeded. We have another case where the
worker is in a vegetative state and the wife filed for disability benefit on his behalf. The claim was rejected
because it was filed after the 12 months time limit. The wife did not do so earlier was because she was
ignorant about the benefit.

Socso should not “rob” deserving workers of their benefits.

The number of work-related diseases, including cancer, skin ailments and respiratory illnesses has
increased. Thousands of workers will miss out on medical treatment, compensation and possible disability
benefits because of the failure to diagnose illnesses linked to occupations as such.

Based on British standards that there would be one case of occupational disease for every industrial
accident occurring, this would mean that Malaysia should have about 60,000 workers registering
occupational illnesses per year. Malaysia is only recording an average of about 200 to 300 occupational
diseases annually.

At the end of 2005, Datuk Seri Dr Fong Chan Onn had expressed disappointment at the poor performance
of doctors on the SOCSO panel and wanted them to accord workers their rightful benefits. Dr Fong
highlighted the insufficient numbers of doctors qualified in occupational health and safety throughout the
country. It is obvious that no progress has been made.

CAP calls on the authorities to take immediate action to correct the situation.
Employers must be mandated to provide a safe and healthy working environment. This includes the use,
handling, storing and transporting of chemicals or machinery; and the education, training and supervision
of workers on health and safety measures. Stiff penalties should be imposed on those employers who
default.

Among the work-related conditions that can afflict employees are asthma, back trouble, heavy metal
poisoning (e.g. lead poisoning), skin diseases, asbestosis and mesothelioma (for workers handling
asbestos), silicosis (for workers exposed to silica), cancers of the lung, bladder and nose, bronchitis, birth
defects (affecting the unborn child), and carpal tunnel syndrome (computer workers, etc.)

Reproductive hazards are one area that has not been given much attention. These hazards can be defined
as “substances or agents that affect the reproductive health of women or men or the ability of couples to
have healthy children”. Exposure to radiation, cigarette smoke, alcohol or alcohol-based products, and
certain chemicals and drugs are some examples of reproductive hazards.

The whole system of handling workers with occupational illnesses needs to be reviewed. A Socso study
has already found that many employers were reluctant to notify Socso of occupational diseases for fear of
visits by authorities, closure of operations, stop-work orders, and sealing of equipment. Employees
themselves do not report such illnesses for fear of dismissal of discrimination by employers.

Panel doctors are expected to detect and report work-related diseases but this system also has its
drawbacks. Firstly, there are insufficient doctors trained in the field of occupational diseases.

Secondly, the present system requires a panel doctor to secure a contract with the management or the
employer. In fact, it can be said that the doctor compromises his professional independence the moment
he secures this contract. He has to ensure that he retains the contract in subsequent years. To be able to
do so, he needs to maintain a good relationship with the management. Diagnosing a too high number of
occupation-related diseases from a particular company is not expected to boost good relations with the
management and can jeopardize a panel doctor’s position.

Furthermore, to be placed on a company’s panel, doctors may compete among themselves to reduce the
cost of medical treatment. These low costs may compromise the quality of treatment.

As an alternative to a panel made up of individual private clinics, Socso could fund Occupational Health
Units in all government hospitals. Workers can access these units if they are suffering from an occupation-
related disease and need treatment. Socso claims can be evaluated and processed using a standard
system throughout the country.

Training for more doctors in the field of occupational diseases also needs to be expedited.

Industrial health nurses could be stationed in the bigger organizations or in any organization that carries
out hazardous operations. This should be mandatory and strictly enforced.

Some international companies keep records of their workers – their health history and the risks that they
have been exposed to during the course of their work. Such keeping of records should be made a legal
requirement here in Malaysia.

Press Statement – 27 February, 2009

BENEFITS?

(BERITA MARCH ISSUE)

Dato’ Dr Khoo Kah Lin

MMA President 2007-2009

On 26 February 2009, it was reported that Human Resource Minister Datuk Dr S Subramaniam

said that “Ignorant doctors have ‘robbed’ thousands of workers of Social Security Organization -

Socso aid and pensions. He went on further to say that in other countries, thousands of workers

filed for such claims yearly but here, we receive 300 to 400. Our doctors are unable to link

many diseases and health problems to the job”.

There were many complaints from workers to this statement accusing Socso to be the stumbling

block to approval of payments. In response to this, few days latter he went on and said that four

out of five applicants for disability pensions from the Socso do not qualify for it. Human

Resources Minister Datuk Dr S. Subramaniam in his clarification also said this was because

applicants misunderstood the function of the organisation. The issue facing Socso now is that

many people apply for disability pension nearing the retirement age of 55 years, as they will not

have any income, and use this as a routine pension scheme which it is not."The decision to

award disability pensions is based on the report of a panel of doctors who examine the

applicant, and if the panel found they were qualified due to loss of 60 per cent of bodily

functions Socso would award the pension”, he said after meeting clients at the Socso office

here today
These two statements by the minister over a couple of days highlight the uncertainty and

confusion that exists among employers, workers, unions, doctors and Socso authorities on the

regulations governing the scope of health diseases and payments of compensation to affected

workers. It has noted that Malaysian employees take an average of 4.2 days of medical leave in

a year, higher than the average in many other countries. Ironically, however, the number of

work-related illnesses reported nationwide appears too low for the worker population. Based on

statistical analysis and projections, Malaysia should have about 60,000 workers registering

occupational illnesses every year, but now, there is only an average 300 to 400 annually.

Disappointingly, this is not a new development that has just recently caught the attention of the

authorities. This irregularity had in fact been highlighted from as far back as six years ago by

then previous minister.

Many companies have selected panel clinics for their employees and this should have provided

both the company and the clinic to work together to provide the employees a comprehensive

health programme. Unfortunately the companies probably of economic consideration have not

often taken this opportunity to bring to notice to the Socso the prevailing situation. Companies at

times have even pressurised the doctors in the panel to be extra cautious in their reporting, of

high number of occupation-related diseases so as not to jeopardize the panel clinic’s position.

It has been highlighted by many on the weaknesses and drawbacks of the current system.

Many employers were reluctant to notify Socso of occupational diseases for fear of visits by

authorities, closure of operations, stop-work orders and sealing of equipment. Employees

themselves do not report such illnesses for fear of dismissal of discrimination by employers.
The Malaysian trade union congress in its statement said that it. It isn't only ignorant doctors

who are "robbing" workers of their Social Security Organisation aid and disability pensions.

Unions said Socso itself sometimes denied workers' claims by appealing the findings of its

medical panels. The union also added that awareness of occupational hazards was "still low" among the
200 unions under MTUC. "MTUC runs about six health and safety courses every

year. Sadly, only about 160 members turn up."

The panel of doctors serving the industries is knowledgeable in detecting diseases aggravated

or caused by workplace hazards but there seem many limitations and obstacles for the worker

to receive his just compensation. It is time all the stakeholders hold a meeting to iron out the

differences and make the implementation of the compensation process rightful and efficient.

The Social Security Organization is an organization set up to administer, enforce and implement

the Employees' Social Security Act, 1969 and the Employees' Social Security (General)

Regulations 1971.The Social Security Organization provides social security protection by social

insurance including medical and cash benefits, provision of artificial aids and rehabilitation to

employees to reduce the sufferings and to provide financial guarantees and protection to the

family. SOCSO is the abbreviation for Social Security Organization. It is commonly known in the

Malay term as PERKESO or Pertubuhan Keselamatan Sosial.

An employee employed under a contract of service or apprenticeship and earning a monthly

wages of RM3,000 and below must compulsorily register and contribute to SOCSO regardless

of the employment status whether it is permanent, temporary or casual in nature. An employee

must be registered with the SOCSO irrespective of the age.

SOCSO only covers Malaysian workers and permanent residents. As a result, foreign workers
are protected under the Workmen's Compensation Act 1952.

Nevertheless, SOCSO does not cover the following categories of persons :

• A person whose wages exceed RM3,000 a month and has never been covered before.

• Government employees.

• Domestic servants employed to work in a private dwelling house which includes a cook,

gardeners, house servants, watchman, washer woman and driver.

• Employees who have attained the age of 55 only for purposes of invalidity but if they

continue to work they should be covered under the Employment Injuries Scheme.

• Self-employed persons.

• Foreign workers.

The Social Security Organisation (SOCSO) has two types of social protection schemes –

Employment Injury Insurance Scheme and Invalidity Pension Scheme. These schemes are

classified into 2 categories :

o First category – Employment Injury Insurance Scheme and Invalidity Pension Scheme.

The contribution payment is made by both the employer and employee.

o Second category – Employment Injury Insurance Scheme only. The contribution is paid

by the employer only. An employee who is not eligible for coverage under the Invalidity

Pension Scheme is protected under this category.

These schemes provide the benefits of invalidity pension, invalidity grant, survivors’ pension,

rehabilitation, funeral benefit, constant attendance allowance and educational loan.

(commuting accident), arising out of and in the course of employment and occupational

diseases.

Doctors will have the last word in deciding whether workers are medically unfit or invalid under

the SOCSO scheme.

The process of claiming for temporary disablement benefits, each application presented for the

confirmation of work disaster and subsequently the payment of benefits should contain

documents that have been completed as follows :

o Form 21 (Accident Report)

o Form 10 (Claim Form)

o Doctor’s acknowledgment (Form 13) or original Sick Leave Certificate

o For accidents that occurred during commuting, the following documents should be

presented :

Police Report

Drafted map of the accident location

Punch card

Other supporting documents (if requested)

Step Work Process

1 SOCSO accepts the claim application

2 The application is registered through the SOCSO Automation Imaging Method

System
3 The application is checked whether complete or not

4 The request letter to request for supporting document is produced if the

application is incomplete

5 The request letter is posted to the employer and the person insured

6 The claim is closed till the supporting documents are received

7 The Investigation Officer carries out the investigation if the information is

incomplete

8 Work Disaster Recommendation is done after the document and complete

information is received

9 The Approving Officer confirms the work disaster

10 A notice is produced if confirmed it is not a work disaster

11 The claim is closed

12 Check the number of sick leave if confirmed it is a work disaster

13 Confirm work disaster without payment if the sick leave is less than 4 days

including the date of accident

14 A work disaster notice without payment is produced

15 A notice is posted to the employer and the person insured

16 The claim is closed

17 The Approving Officer approves the number of sick leaves and the calculation

rate if the sick leave is 4 days or more

18 Prepare payment voucher

19 The authorized Officer checks and signs the voucher

20 Prepare the payment cheque

21 The authorized Officer checks and signs the cheque

22 The cheque is posted to the person insured

The process of claiming for permanent disablement benefit, a written application to the

SOCSO/PERKESO office concerned for referral to the Panel of Doctors by enclosing :

o Medical report from a hospital or clinic that had provided treatment

o Form 10 (Claim Form)

o Application form o Present number and copy of the account passbook of the applicant for direct

payment to his savings account (if relevant)

Step Work Process

1 SOCSO accepts the claim application

2 Checks the application and registers

3 Runs through the application

4 Checks the salary details and contribution – PKS (F) 1 & Investigation Report –

PKS (F) 3

5 If none, takes action & recommends and approves calculation

6 Runs through the documents received

7 Updates the salary and minutes

8 If available, sends a letter informing the date of the Panel Doctor sitting & KIV

one day after the date of the Panel Doctor sitting

9 Attends the Panel Doctors’ sitting

10 Informs the decision of the Panel Doctors to the insured person

11 Checks and updates the decision of the Panel Doctors

12 If the insured person is not present, sends a letter requesting for a written cause
to the insured person

13 Runs through the cause letter produced

14 Claim is closed

15 If no assessment, sends a letter requesting the insured person to present a

complete/latest medical report

16 Runs through the letter

17 Posts a letter

18 Closes the application till feedback is received

19 If there is assessment, check the assessment percentage

20 If the assessment is 0%, the claim is closed

21 If the assessment exceeds 0%, check the consent of the person insured

22 If not approved, send an Appeal Form – PKS (P) 12

23 The claim is closed till assessment is received from the Appeal Panel of Doctors

24 Check the payment amount if agreeable with the assessment by the Panel of

Doctors

Employment Injury Insurance Scheme

To be eligible for compensation under the Employment Injury Insurance Scheme, the accident

which has brought about the amputation must be reported to PERKESO/SOCSO. The events of

accident must also be covered by PERKESO/SOCSO which means that the accident must

either be:

During Travel

1) During the journey to and from work.

3) On a journey made for any reason which is directly connected to his employment.

At Work Place

Accidents occurring while working at the work places which arise out of and in the course of

employment.

The insured amputee is eligible for:

Medical Benefit

Temporary Disablement Benefit

Permanent Disablement Benefit Rehabilitation Benefit

Other general benefits under the Employment Injuries Insurance Scheme are:

Constant Attendance Allowance

Dependent’s Benefit

Survivor’s Pension

Education Benefit

Medical Benefit

Workers are eligible for medical benefits in which the medical expenses, e.g. treatment,

hospitalisation and medications will be borne by PERKESO/SOCSO.

Temporary Disablement Benefit

This benefit is for workers who are still on medical leave.

Procedure:
The insured or anyone acting on his behalf must report the accident verbally or in written form to

the employer.

The insured or anyone acting on his behalf will need to lodge a police report and forward a copy

of the police report to the employer.

Employer must then hand the documents listed below to the nearest PERKESO/SOCSO

branch:

Copy of police report

Laporan Kemalangan (Form 21)

Sketch of the location of the accident

Attendance card

Other related documents

The insured or anyone acting on his behalf must hand the following documents to the nearest

PERKESO/SOCSO branch:

Form 10 (Claim form)

Doctor’s certification (Form 13) OR Medical Certificate

Permanent Disablement Benefit

This benefit is usually given after the period of medical leave, which signifies that the disability is

permanent. This makes the worker eligible for a sum which is calculated based on the

percentage of impairment as determined by a group of doctors appointed by PERKESO.

A written application must be sent to the nearest PERKESO/SOCSO branch for reference to the

Medical Board or Special Medical Board with the following documents:

Medical report from the hospital or clinic that has rendered treatment

Claim form (Form 10)

Application form

Copy of savings book and account number from a designated bank for purposes of direct

payment to savings account

Rehabilitation Benefit

Rehabilitation services, for example, physiotherapy and occupational therapy are provided free

to all workers who have permanent impairment. All other necessary aids like wheelchairs and

orthosis are also provided free including repair and maintenance.

Application for a prosthesis:

To apply for a prosthesis, a doctor’s recommendation is needed by the PERKESO/SOCSO

branch where the application is made.

The PERKESO/SOCSO branch will then forward the recommendation for prosthesis to the

PERKESO/SOCSO Headquarters which will then assign a prothetist to the worker.

A date and location to see the prosthetist will be fixed and informed to the worker by

PERKESO/SOCSO. The worker will then see the prosthetist on the fixed date for prosthesis

measurement and later, prosthetic fitting.

Invalidity Pension Scheme

For a PERKESO contributor who has undergone amputation due to non-work-related causes,

e.g. amputation due to diabetic foot or peripheral arterial disease, he or she is not eligible for the

Employment Injury Insurance Scheme.

What he or she is eligible for is the Pension Scheme which covers for any impairment due to

chronic diseases for example diabetes mellitus, ischaemic heart disease, etc.

The benefits under the Invalidity Pension Scheme are:

Invalidity Pension

Invalidity Grant

Constant Attendance Allowance

Survivor’s Pension

Rehabilitation

Education Loan

(Source : PERKESO website – www.perkeso.gov.my)

Email Facebook 6K

BUTTERWORTH: Single mothers should not hire middlemen to apply for

Socso chief executive Dr Soh Chee Seng said the organisation had received
several reports that unscrupulous people were offering help to single mothers to
apply for pension and other benefits entitled to them.

“Some of them even offered low-cost homes and speedy approval for Socso
applications with a fee. We advise single mothers to go straight to our counters
and make enquiries from our officers as we are there to help them.

“We do not want single mothers to be cheated of their money that is meant for
them and their children’s future ,” he said after closing a seminar for 70 single
mothers at the Socso office in Seberang Jaya here on Saturday.

Dr Soh said the seminar was aimed at providing information to single mothers on
how to get help from the various government agencies and departments.

He said Socso received more than 3,000 applications from single mothers to
participate in the seminar but was unable to accommodate them as they wanted
to focus on a smaller group at each seminar.

The seminar is organised jointly with the National Population and Family
Development Board that provided speakers and motivators.