Professional Documents
Culture Documents
COMPENSATION BENEFITS available only in case work-connected disability or death arising from:
1.) INJURY 2. ILLNESS *It is not injury or illness which is compensated but the death or disability.
GOING TO AND COMING FROM RULE – As a general Rule it is excluded from compensation if injury occured
because it is not work related. EXCEPT;
1. GOING TO AND COMING FROM PLACE OF WORK DOCTRINE – Injury or death resulting from an
accident while the employee is going to, or coming from, the workplace is NOT compensable AS GENERAL
RULE EXCEPT if the ff. conditions are met:
A. Act of the employee of going to, or coming from the workplace must have been a CONTINUING ACT.
Not been diverted therefrom from any other activity and not departed from usual route. Or did not
deviate from the usual route. Activity from his usual route.
2. PROXIMITY RULE – example Enter the Gate and was accidentaly hit by a car. Compensable
3. SPECIAL ERRAND RULE - Employee is Charged some duty. Ask for special assignment. Example Teacher
was given project in the house and got accident or killed. It is COMPENSABLE if he can proved that it is work
related and must have permission or official or mandate in the office.
4. EXTRA PREMISES RULE – Means of transport, or employer gave a transportation for employees and met
an accident. COMPENSABLE.
5. SPECIAL ENGAGEMENT RULE – Injury during activity like company outing, pilgrims and other similar
activities. This is compensable.
Other exceptions:
When it is INCIDENTAL TO EMPLOYMENT: 1. Acts done in a call of nature – acts personal to the comfort of
employee 2. Performing an act benefit to the employer. 3. Done to further goodwill of employer 4. Acts in
emergencies. 5. Acts to save the property of the employer.
If the accident or injuries occured in the staff house provided by the employer. It is compensable provide that it is
express, implied related to his duties.
DUAL PURPOSE DOCTRINE – Compensable while oon the trip for the benefit of employer / personal purpose of
employee.
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Acts of God and Force Majuere – Not compesable. It is only compensable if the employee is exposed to danger or
injuriy as reasonable element that it is work related incident.
A soldier on active duty status is really on a 24-hour official duty status and is subject to military discipline
and military law 24 hours a day. He is subject to call and to the orders of his superior officers at all times, 7
days a week, except when he is on VACATION LEAVE STATUS.
Perceptible that on account of the nature of their work, policemen and limitary personnel have become
“marked men” insofar as insurgents and other lawless elements are concerned and are therefore killed by
insurgents at every opportunity.
Moment a policeman or military personnel suffers a contingency, it is presumed that it arose from the nature
of his work.
To be entitled to compensation, the standard of work-connection must still be established by substantial
evidence.
Not compensable because an employee who is on leave does not perform his usual duties.
Disability or death arising from injury by a member of the military while “on pass” for a period not exceeding
72 hours is compensable. If the soldier was unable to report himself back for duty after 72-hour period, the
disability or death is still compensable if such failure to report was due to legitimate and valid reasons such as
fortuitous event or force majeure.
**Disability or death arising from injury by a member of the military while on rest and recreation, which is considered
part of the soldier’s military activities, after having gone on actual combat duty, as certified to by the proper
commanding officer, is compensable.
Diseases which are not classified as “occupational disease” are compensable only if the claimant can prove
that the risk of contracting the disease was increased by the working conditions.
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There is increased risk if the illness is caused by or precipitated by factors inherent in the employees’ nature
of work and working conditions. It does not include aggravation of pre-existing illness.
Not require that there should be a direct causal connection between the disease and the employment. All that
is required is reasonable work-connection, which could be established by mere substantial evidence.
It is essential for the claimant to show that the development of the disease was brought largely by the
conditions present in the nature of the job.
Law does not require that the employment should be the sole factor in the growth, development and
acceleration of the illness to entitle him to compensation benefits. It is enough that his employment had
contributed, even in a small degree to the development of the disease.
Test of evidence: Probability not certainty.
When the primary illness or injury is shown to have arisen in the course of the employment, every natural
consequence that flows from the illness or injury shall be deemed employment-related, hence, compensable.
Coverage in the State Insurance Fund shall be compulsory upon all employers and their employees not over
sixty (60) years of age: Provided, That an employee who is over (60) years of age and paying contributions
to qualify for the retirement or life insurance benefit administered by the System shall be subject to
compulsory coverage.
COVERED EMPLOYEES
All employers, whether belonging to the public or private sector are covered
Public sector employers are those covered by the Government Service Insurance System (GSIS) including
GOCC, Phil. Tuberculosis Society, National Red Cross and the Phil. Veterans Bank.
Private sector employersare covered by Social Security System (SSS)
Employees not over 60 years old whether public or private sectors are covered.
Employees over 60 years old are covered if they have been paying contributions to SSS or GSIS prior to the
age of 60 and have not been compulsorily retired.
Employees coverable by both the SSS and GSIS shall be coverable by both systems.
Coverage om employers shall take effect on the 1st day of operation but nor earlier than January 1, 1975
Coverage of employees shall take effect on the first day of employment
If the SSS or GSIS has received a report or written communication about him from his employer and
Employees’ Compensation contribution paid in his name before a compensable contingency occurs.
(1) In case of failure or refusal to register employees, the employer or responsible official who committed the
violation shall be punished with a fine of not less than P1,000 nor more than P10,000 and/or imprisonment for the
duration of the violation or non-compliance or until such time that rectification of the violation has been made, at the
discretion of the Court.
(2) In case a compensable contingency occurs after thirty (30) days from employment and before the System
receives any report for coverage about the employee or EC contribution on his behalf, his employer shall be liable to
the System for the lump sum equivalent of the benefits to which he or his dependents may be entitled.
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ART. 172: LIMITATION OF LIABILITY
The State Insurance Fund shall be liable for compensation to the employee or his dependents, except when
the disability or death was occasioned by the employee’s intoxication, willful intention to injure or kill himself
or another, notorious negligence, or otherwise provided under this Title.
1. Intoxication
2. Wilful intention to injure or kill himself or another
3. Notorious negligence
INTOXICATION – Refers to a person’s condition in being under influence of liquor or prohibited drugs to the extent
that his acts, words or conduct is impaired visibly, as to prevent him from physically and mentally engaging in the
duties of his employment
To constitute a ground for denial of compensation, the degree of intoxication must be such that it rendered
the employee incapable of doing work. The accident or injury must be shown that it arose out of his drunken
condition and not because of work.
Intoxication which does not incapacitate the employee from following his occupation is not sufficient to defeat
the recovery of compensation, although intoxication may be a contributory cause to his injury.
Contemplates a deliberate intent on the part of the employee to inflict injuries to himself or another.
The resulting injury, disability or death was not caused by the employment but by the employee’s own
voluntary act.
NOTORIOUS NEGLIGENCE
Something more than mere or simple negligence or contributory negligence. It signifies a deliberate act of
the employee to disregard his own personal safety.
More than mere carelessness or lack of foresight and is tantamount to gross negligence.
To constitute ground for denial of compensation: must be shown by clear and convincing proof that it was
the cause of the injury. Disobedience to rules, orders, and/or prohibition does not per se constitute notorious
negligence, if no intention can be attributed to the injured to end his life.
Can the injured employee (or his heir in case of death), avail of the compensation benefits under LC and sue the
employer for damages under Civil Code.
NO.