MEDICAL BENEFITS UNDER
EMPLOYEE’S COMPENSATION
PROGRAM
 System shall provide employee
immediately after he contracts
sickness and during the subsequent
period of his disability and progress of
his recovery with such medical
services and appliances as the nature
of his sickness or injury, subject to
expense limitation prescribed by the
Commission
 Medical services covered are:
a. Ward services during confinement
in an accredited hospital
b. Subsequent domiciliary care by
an accredited physician
c. Medicines
d. Ambulatory services in an
accredited hospital in case of
injury
 Conditions for entitlement:
a. He has been duly reported to the
System
b. He sustains an injury or contracts
sickness; and
c. The system has been duly notified
of the injury or sickness
 Period of entitlement is from
beginning with the first day of injury or
sickness, during the subsequent
period of his disability and as the
progress of his recovery may require
 WARD- hospital room that can
accommodate 6 or more patients
 Employee is entitled only to ward
services of an accredited hospital and
accredited physician
- If he chooses an upgrade, the
excess shall be borne by the
employee
- Accommodation in private on
semi-private room may be granted
if employee suffers contagious
disease
- Hospital shall provide
medicines and supplies
necessary for treatment of
employee at cost not exceeding
retail prices prevailing in local drug
stores
 Coverage of Ward Services:
a. Bed in ward
b. All meals, including special diets
c. Regular nursing services
d. Medicines furnished by the
hospital
e. Laboratory services
f. Radiology services
g. Medical supplies
h. Use of appliances and equipment
furnished by the hospital
i. Anesthetic services
j. Operating room charges
k. Surgery
l. Doctor’s services
- Not included are:
a. Extra charge for more
comfortable accommodation
b. Personal comfort or
convenience
c. Private duty nurses
 System has authority to choose or
order change of physician, hospital or
rehabilitation for employee
 System is not liable for compensation
for any aggravation of employee’s
injury or sickness resulting from
unauthorized changes by the
employee
- If there is need for such changes,
employee or dependents shall
notify the system and secure first
its consent
 Duty of attending physician shall
comply with all regulations of the
System and submit medical reports in
prescribed forms
 Medical information not privileged in
connection with this compensation
sought
 Unreasonable refusal of employee to
submit medical examination, the
System can stop the payment of
all compensation benefits
 Fees and charges for hospital
services, medical care and
appliances shall not be higher than
 those prevailing in wards of hospitals a. Medical-surgical management,
for similar services in general hospitalization, necessary
- Professional fees shall only be appliances and supplies,
appreciably higher vocational training and assistance
 Fees and charges: for placement, transportation
a. Hospital confinement allowance, lunch and dormitory
b. Domiciliary care  Limit of System’s liability:
c. Ambulatory care (less than 24 a. Intoxication
hours) b. Willful intention to injure or kill
d. Surgical expense benefit himself or another
c. Notorious negligence
 System shall establish a continuing  System may enter into agreement
program for the rehabilitation of with employer to participate in
injured and handicapped employees payment of wages of the employed
 System shall establish centers rehabilitee on the job:
equipped and staff designed to meet a. 50% of wages for first 2 weeks
the individual needs of each after start of OJT
handicapped employee to restore him b. 25% of wages for 3rd and 4th
to suitable employment weeks of OJT
 REHABILITATION- process by which c. 10% of wages for 5th and 6th
there is provided a balanced program weeks of OJT
of remedial treatment, vocational d. 0% of wages for rest of period of
assessment and preparation OJT
designed to meet the individual needs
of each handicapped employee to
restore him to suitable employment,
including assistance as may be with
its resources to help each rehabilitee
to develop his mental, vocational or
social potentials
 Coverage of handicapped employees
in rehabilitation services program is
voluntary
 Conditions for entitlement of
rehabilitation services:
a. He has been reported to the
system
b. He sustains a permanent disability
as a result of a compensable
injury or sickness
c. He has not been placed in suitable
employment
 Rehabilitation services shall be
during the period of disability unless
suspended on the following grounds:
a. Upon suitable employment
b. By self termination
c. Upon suspension or termination of
such services by the rehabilitation
center
 Extent of services: