REPUBLIC ACT NO.

8282

AN ACT FURTHER STRENGTHENING THE SOCIAL SECURITY SYSTEM THEREBY

AMENDING FOR THIS PURPOSE, REPUBLIC ACT NO. 1161, AS AMENDED,
OTHERWISE KNOWN AS THE SOCIAL SECURITY LAW.

SECTION 1. Republic Act No. 1161, as amended, otherwise known as the

Social Security Law, is hereby further amended to read as follows:

SECTION 1. Short Title. This Act shall be known as the Social Security Act of
1997.

SEC. 2. Declaration of Policy. It is the policy of the Republic of the Philippines to

establish, develop, promote and perfect a sound and viable tax-exempt
social security service suitable to the needs of the people throughout the
Philippines which shall promote social justice and provide meaningful
protection to members and their beneficiaries against the hazards of
disability, sickness, maternity, old age, death, and other contingencies
resulting in loss of income or financial burden. Towards this end, the
State shall endeavor to extend social security protection to workers and
their beneficiaries.

SEC. 3. Social Security System. (a) To carry out the purposes of this Act, the Social
Security System, hereinafter referred to as SSS, a corporate body, with principal place
of business in Metro Manila, Philippines is hereby created. The SSS shall be directed
and controlled by a Social Security Commission, hereinafter referred to as
Commission, composed of the Secretary of Labor and Employment or his duly
designated undersecretary, the SSS president and seven (7) appointive members, three
(3) of whom shall represent the workers group, at least one of whom shall be a woman;
three (3), the employers group, at least one (1) of whom shall be a woman; and one (1),
the general public whose representative shall have adequate knowledge and
experience regarding social security, to be appointed by the President of the
Philippines. Xxx xxx

(b) xxx xxx

(c) xxx xxxx

SEC. 8. Terms Defined. For purposes of this Act, the following terms shall, unless
the context indicates otherwise, have the following meanings:

(a) SSS The Social Security System created by this Act.

(b) Commission - The Social Security Commission as herein created.

(c) Employer- Any person, natural or juridical, domestic or foreign, who carries on in
the Philippines any trade, business, industry, undertaking, or activity of any kind and
uses the services of another person who is under his orders as regards the
employment, except the Government and any of its political subdivisions, branches or
instrumentalities, including corporations owned or controlled by the Government:
Provided, That a self-employed person shall be both employee and employer at the
same time.

(d) Employee Any person who performs services for an employer in which either or
both mental or physical efforts are used and who receives compensation for such
services, where there is an employer-employee relationship: Provided, That a self-
employed person shall be both employee and employer at the same time.

(e) Dependents - The dependents shall be the following:

(1) The legal spouse entitled by law to receive support from the member;

(2) The legitimate, legitimated or legally adopted, and illegitimate child who is
unmarried, not gainfully employed, and has not reached twenty-one (21) years of
age, or if over twenty-one (21) years of age, he is congenitally or while still a
minor has been permanently incapacitated and incapable of self-support,
physically or mentally; and

(3) The parent who is receiving regular support from the member.

(f) Compensation - All actual remuneration for employment, including the mandated
cost-of-living allowance, as well as the cash value of any remuneration paid in any
medium other than cash except that part of the remuneration in excess of the maximum
salary credit as provided under Section Eighteen of this Act.

(g) Monthly salary credit - The compensation base for contributions and benefits as
indicated in the schedule in Section Eighteen of this Act.

(h) Monthly - The period from one end of the last payroll period of the preceding month
to the end of the last payroll period of the current month if compensation is on hourly,
daily or weekly basis; if on any other basis, monthly shall mean a period of one (1)
month.

(i) Contribution The amount paid to the SSS by and on behalf of the members in
accordance with Section Eighteen of this Act.

(j) Employment - Any service performed by an employee for his employer except:
(1) Employment purely casual and not for the purpose of occupation or business of the
employer;

(2) Service performed on or in connection with an alien vessel by an employee if he is

employed when such vessel is outside the Philippines;

(3) Service performed in the employ of the Philippine Government or instrumentality or

agency thereof;

(4) Service performed in the employ of a foreign government or international

organization, or their wholly-owned instrumentality: Provided, however, That this
exemption notwithstanding, any foreign government, international organization or their
wholly-owned instrumentality employing workers in the Philippines or employing
Filipinos outside of the Philippines, may enter into an agreement with the Philippine
Government for the inclusion of such employees in the SSS except those already
covered by their respective civil service retirement systems: Provided, further, That the
terms of such agreement shall conform with the provisions of this Act on coverage and
amount of payment of contributions and benefits: Provided, finally, That the provisions
of this Act shall be supplementary to any such agreement; and

(5) Such other services performed by temporary and other employees which may be
excluded by regulation of the Commission. Employees of bona fide independent
contractors shall not be deemed employees of the employer engaging the service of
said contractors.

(k) Beneficiaries - The dependent spouse until he or she remarries, the

dependent legitimate, legitimated or legally adopted, and illegitimate children,
who shall be the primary beneficiaries of the member: Provided, That the
dependent illegitimate children shall be entitled to fifty percent (50%) of the share
of the legitimate, legitimated or legally adopted children: Provided, further, That
in the absence of the dependent legitimate, legitimated children of the member,
his/her dependent illegitimate children shall be entitled to one hundred percent
(100%) of the benefits. In their absence, the dependent parents who shall be the
secondary beneficiaries of the member. In the absence of all the foregoing, any
other person designated by the member as his/her secondary beneficiary.

(l) Contingency - The retirement, death, disability, injury or sickness and maternity of
the member.

(m) Average monthly salary credit The result obtained by dividing the sum of the
last sixty (60) monthly salary credits immediately preceding the semester of contingency
by sixty (60), or the result obtained by dividing the sum of all the monthly salary credits
paid prior to the semester of contingency by the number of monthly contributions paid in
the same period, whichever is greater: Provided, That the injury or sickness which
caused the disability shall be deemed as the permanent disability for the purpose of
computing the average monthly salary credit.
(n) Average daily salary credit - The result obtained by dividing the sum of the six (6)
highest monthly salary credits in the twelve-month period immediately preceding the
semester of contingency by one hundred eighty (180).

(o) Semester A period of two (2) consecutive quarters ending in the quarter of
contingency.

(p) Quarter - A period of three (3) consecutive calendar months ending on the last day
of March, June, September and December.

(q) Credited years of service - For a member covered prior to January nineteen
hundred and eighty five (1985) minus the calendar year of coverage plus the number of
calendar years in which six (6) or more contributions have been paid from January
nineteen hundred and eighty five (1985) up to the calendar year containing the
semester prior to the contingency. For a member covered in or after January nineteen
hundred and eighty five (1985), the number of calendar years in which six (6) or more
contributions have been paid from the year of coverage up to the calendar year
containing the semester prior to the contingency: Provided, That the Commission may
provide for a different number of contributions in a calendar year for it to be considered
as a credited year of service.

(r) Member The worker who is covered under Section Nine and Section Nine-A of
this Act.

(s) Self-employed - Any person whose income is not derived from employment, as
defined under this Act, as well as those workers enumerated in Section Nine-A hereof.

(t) Net earnings - Net income before income taxes plus non-cash charges such as
depreciation and depletion appearing in the regular financial statement of the issuing or
assuming institution.

(u) Fixed charges Recurring expense such as amortization of debt discount or

rentals for leased properties, including interest on funded and unfunded debt.

SEC. 9. Coverage. - (a) Coverage in the SSS shall be compulsory upon all
employees not over sixty (60) years of age and their employers: Provided, That in
the case of domestic helpers, their monthly income shall not be less than One
thousand pesos (P1,000.00) a month: Provided, further, That any benefit already
earned by the employees under private benefit plans existing at the time of the approval
of this Act shall not be discontinued, reduced or otherwise impaired: Provided, further,
That private plans which are existing and in force at the time of compulsory coverage
shall be integrated with the plan of the SSS in such a way where the employers
contribution to his private plan is more than that required of him in this Act, he shall pay
to the SSS only the contribution required of him and he shall continue his contribution to
such private plan less his contribution to the SSS so that the employers total
contribution to his benefit plan and to the SSS shall be the same as his contribution to
his private benefit plan before the compulsory coverage: Provided, further, That any
changes, adjustments, modifications, eliminations or improvements in the benefits to be
available under the remaining private plan, which may be necessary to adopt by reason
of the reduced contributions thereto as a result of the integration, shall be subject to
agreements between the employers and employees concerned: Provided, further, That
the private benefit plan which the employer shall continue for his employees shall
remain under the employers management and control unless there is an existing
agreement to the contrary: Provided, finally, That nothing in this Act shall be construed
as a limitation on the right of employers and employees to agree on and adopt benefits
which are over and above those provided under this Act.

(b) Spouses who devote full time to managing the household and family affairs,
unless they are also engaged in other vocation or employment which is subject to
mandatory coverage, may be covered by the SSS on a voluntary basis.

(c) Filipinos recruited by foreign-based employers for employment abroad may

be covered by the SSS on a voluntary basis.

SEC. 9-A. Compulsory Coverage of the Self-Employed. Coverage in the SSS

shall also be compulsory upon such self-employed persons as may be determined
by the Commission under such rules and regulations as it may prescribe, including but
not limited to the following:

1. All self-employed professionals;

2. Partners and single proprietors of businesses;

3. Actors and actresses, directors, scriptwriters and news correspondents who

do not fall within the definition of the term employee in Section 8 (d) of this Act;

4. Professional athletes, coaches, trainers and jockeys; and

5. Individual farmers and fishermen.

Unless otherwise specified herein, all provisions of this Act applicable to

covered employees shall also be applicable to the covered self-employed
persons.

SEC. 10. Effective Date of Coverage. Compulsory coverage of the employer

shall take effect on the first day of his operation and that of the employee on the
day of his employment: Provided, That the compulsory coverage of the self-employed
person shall take effect upon his registration with the SSS.

SEC. 11. Effect of Separation from Employment. When an employee under

compulsory coverage is separated from employment, his employers contribution on his
account and his obligation to pay contributions arising from that employment shall cease
at the end of the month of separation, but said employee shall be credited with all
contributions paid on his behalf and entitled to benefits according to the provisions of
this Act. He may, however, continue to pay the total contributions to maintain his right to
full benefit.

SEC. 11-A. Effect of Interruption of Business or Professional Income. - If the self-

employed realizes no income in any given month, he shall not be required to pay
contributions for that month. He may, however, be allowed to continue paying
contributions under the same rules and regulations applicable to a separated employee
member: Provided, That no retroactive payment of contributions shall be allowed other
than as prescribed under Section Twenty-two-A hereof.

SEC. 12. Monthly Pension.

SEC. 12-A. Dependents Pension.

SEC. 12-B. Retirement Benefits.

SEC. 13. Death Benefits.

SEC. 13-A. Permanent Disability Benefits..

SEC. 13-B. Funeral Benefit.

SEC. 14. Sickness Benefit.

SEC. 14-A. Maternity Leave Benefit.

SEC. 15. Non-Transferability of Benefits. - The SSS shall promptly pay the benefits
provided in this Act to such persons as may be entitled thereto in accordance with the
provisions of this Act: Provided, That the SSS shall pay the retirement benefits on the
day of contingency to qualified members who have submitted the necessary documents
at least six (6) months before: Provided, further, That the beneficiary who is a national
of a foreign country which does not extend benefits to a Filipino beneficiary residing in
the Philippines, or which is not recognized by the Philippines, shall not be entitled to
receive any benefit under this Act: Provided, further, That notwithstanding the foregoing,
where the best interest of the SSS will be served, the Commission may direct payments
without regard to nationality or country of residence: Provided, further, That if the
recipient is a minor or a person incapable of administering his own affairs, the
Commission shall appoint a representative under such terms and conditions as it may
deem proper: Provided, further, That such appointment shall not be necessary in case
the recipient is under the custody of or living with the parents or spouse of the member
in which case the benefits shall be paid to such parents or spouse, as representative
payee of the recipient. Such benefits are not transferable and no power of attorney or
other document executed by those entitled thereto in favor of any agent, attorney or any
other person for the collection thereof on their behalf shall be recognized, except when
they are physically unable to collect personally such benefits: Provided, further, That in
case of death benefits, if no beneficiary qualifies under this Act, said benefits shall be
paid to the legal heirs in accordance with the law of succession.

SEC. 16. Exemption from Tax, Legal Process and Lien. All laws to the contrary
notwithstanding, the SSS and all its assets and properties, all contributions collected
and all accruals thereto and income or investment earnings therefrom as well as all
supplies, equipment, papers or documents shall be exempt from any tax, assessment,
fee, charge, or customs or import duty; and all benefit payments made by the SSS shall
likewise be exempt from all kinds of taxes, fees or charges, and shall not liable to
attachments, garnishments, levy or seizure by or under any legal or equitable process
whatsoever, either before or after receipt by the person or persons entitled thereto,
except to pay any debt of the member to the SSS. No tax measure of whatever nature
enacted shall apply to the SSS, unless it expressly revokes the declared policy of the
State in Section 2 hereof granting tax-exemption to the SSS. Any tax assessment
imposed against the SSS shall be null and void. (As amended by Sec. 9, P. D. No. 24,
S. 1972; and Sec. 14, P. D. No. 735, S. 1975).

SEC. 20. Government Contribution. - As the contribution of the Government to the

operation of the SSS, Congress shall annually appropriate out of any funds in the
National Treasury not otherwise appropriated, the necessary sum or sums to
meet the estimated expenses of the SSS for each ensuing year. In addition to this
contribution, Congress shall appropriate from time to time such sum or sums as may be
needed to assure the maintenance of an adequate working balance of the funds of the
SSS as disclosed by suitable periodic actuarial studies to be made of the operations of
the SSS.

SEC. 21. Government Guarantee. The benefits prescribed in this Act shall not be
diminished and to guarantee said benefits the Government of the Republic of the
Philippines accepts general responsibility for the solvency of the SSS.

SEC. 22. Remittance of Contributions. (a) The contributions imposed in the

preceding Section shall be remitted to the SSS within the first ten (10) days of each
calendar month following the month for which they are applicable or within such time as
the Commission may prescribe. Every employer required to deduct and to remit such
contributions shall be liable for their payment and if any contribution is not paid to the
SSS as herein prescribed, he shall pay besides the contribution a penalty thereon of
three percent (3%) per month from the date the contribution falls due until paid. If
deemed expedient and advisable by the Commission, the collection and remittance of
contributions shall be made quarterly or semi-annually in advance, the contributions
payable by the employees to be advanced by their respective employers: Provided,
That upon separation of an employee, any contribution so paid in advance but not due
shall be credited or refunded to his employer.

(b) The contributions payable under this Act in cases where an employer refuses or
neglects to pay the same shall be collected by the SSS in the same manner as taxes
are made collectible under the National Internal Revenue Code, as amended. Failure or
refusal of the employer to pay or remit the contributions herein prescribed shall not
prejudice the right of the covered employee to the benefits of the coverage.

The right to institute the necessary action against the employer may be commenced
within twenty (20) years from the time the delinquency is known or the assessment is
made by the SSS, or from the time the benefit accrues, as the case may be.

(c) Should any person, natural or juridical, default in any payment of contributions, the
Commission may also collect the same in either of the following ways:

1. By an action in court, which shall hear and dispose of the case in preference to any
other civil action; or

2. By issuing a warrant to the Sheriff of any province or city commanding him to levy
upon and sell any real and personal property of the debtor. The Sheriffs sale by virtue
of said warrant shall be governed by the same procedure prescribed for executions
against property upon judgments by a court of record.

(d) The last complete record of monthly contributions paid by the employer or the
average of the monthly contributions paid during the past three (3) years as of the date
of filing of the action for collection shall be presumed to be the monthly contributions
payable by and due from the employer to the SSS for each of the unpaid month, unless
contradicted and overcome by other evidence: Provided, That the SSS shall not be
barred from determining and collecting the true and correct contributions due the SSS
even after full payment pursuant to this paragraph, nor shall the employer be relieved of
his liability under Section Twenty-eight of this Act.

SEC. 22-A. Remittance of Contributions of Self-Employed Member.

SEC. 23. Method of Collection and Payment.

SEC. 24. Employment Records and Reports.

SEC. 24-A. Report and Registration of the Self-Employed Member.

SEC. 25. Deposits and Disbursements.

SEC. 26. Investment of Reserve Funds.

SEC. 26-A. Fund Managers.

SEC. 26-B. Mortgagor Insurance Account..

SEC. 27. Records and Reports.

SEC. 28. Penal Clause. - (a) Whoever, for the purpose of causing any payment to be
made under this Act, or under an agreement thereunder, where none is authorized to be
paid, shall make or cause to be made false statement or representation as to any
compensation paid or received or whoever makes or causes to be made any false
statement of a material fact in any claim for any benefit payable under this Act, or
application for loan with the SSS, or whoever makes or causes to be made any false
statement, representation, affidavit or document in connection with such claim or loan,
shall suffer the penalties provided for in Article One hundred seventy-two of the Revised
Penal Code.

(b) Whoever shall obtain or receive any money or check under this Act or any
agreement thereunder, without being entitled thereto with intent to defraud any member,
employer or the SSS, shall be fined not less than Five thousand pesos (P5,000.00) nor
more than Twenty thousand pesos (P20,000.00) and imprisoned for not less than six (6)
years and one (1) day nor more than twelve (12) years.

(c) Whoever buys, sells, offers for sale, uses, transfers or takes or gives in exchange,
or pledges or gives in pledge, except as authorized in this Act or in regulations made
pursuant thereto, any stamp, coupon, ticket, book or other device, prescribed pursuant
to Section Twenty-three hereof by the Commission for the collection or payment of
contributions required herein, shall be fined not less than Five thousand pesos
(P5,000.00) nor more than Twenty thousand pesos (P20,000.00), or imprisoned for not
less than six (6) years and one (1) day nor more than twelve (12) years, or both, at the
discretion of the court.

(d) Whoever, with intent to defraud, alters, forges, makes or counterfeits any stamp,
coupon, ticket, book or other device prescribed by the Commission for the collection or
payment of any contribution required herein, or uses, sells, lends, or has in his
possession any such altered, forged or counterfeited materials, or makes, uses, sells or
has in his possession any such altered, forged, material in imitation of the material used
in the manufacture of such stamp, coupon, ticket, book or other device, shall be fined
not less than Five thousand pesos (P5,000.00) non more than Twenty thousand pesos
(P20,000.00) or imprisoned for not less than six years (6) and one (1) day nor more
than twelve (12) years, or both, at the discretion of the court.

(e) Whoever fails or refuses to comply with the provisions of this Act or with the rules
and regulations promulgated by the Commission, shall be punished by a fine of not less
than Five thousand pesos (P5,000.00) nor more than Twenty thousand pesos
(P20,000.00), or imprisonment for not less than six (6) years and one (1) day nor more
than twelve (12) years, or both, at the discretion of the court: Provided, That where the
violation consists in failure or refusal to register employees or himself, in case of the
covered self-employed or to deduct contributions from the employees compensation
and remit the same to the SSS, the penalty shall be a fine of not less Five thousand
pesos (P5,000.00) nor more than Twenty thousand pesos (P20,000.00) and
imprisonment for not less than six (6) years and one (1) day nor more than twelve (12)
years.
(f) If the act or omission penalized by this Act be committed by an association,
partnership, corporation or any other institution, its managing head, directors or partners
shall be liable for the penalties provided in this Act for the offense.

(g) Any employee of the SSS who receives or keeps funds or property belonging,
payable or deliverable to the SSS and who shall appropriate the same, or shall take or
misappropriate, or shall consent, or through abandonment or negligence, shall permit
any other person to take such property or funds, wholly or partially, or shall otherwise be
guilty of misappropriation of such funds or property, shall suffer the penalties provided in
Article Two hundred seventeen of the Revised Penal Code.

(h) Any employer who, after deducting the monthly contributions or loan amortizations
from his employees compensation, fails to remit the said deduction to the SSS within
thirty (30) days from the date they became due, shall be presumed to have
misappropriated such contributions or loan amortizations and shall suffer the penalties
provided in Article Three hundred fifteen of the Revised Penal Code.

(i) Criminal action arising from a violation of the provisions of this Act may be
commenced by the SSS or the employee concerned either under this Act or in
appropriate cases under the Revised Penal Code: Provided, That such criminal action
may be filed by the SSS in the city or municipality where the SSS office is located, if the
violation was committed within its territorial jurisdiction or in Metro Manila, at the option
of the SSS.

SEC. 29. Government Aid. - The establishment of the SSS shall not disqualify the
members and employers from receiving such government assistance, financial or
otherwise, as may be provided.

SEC. 30. Transitory Clause. - Any employer who is delinquent or has not remitted all
contributions due and payable to the SSS may, within six (6) months from the effectivity
of this Act, remit said contributions or submit a proposal to pay the same in installment
within a period of not more than twelve (12) months from the effectivity of this Act
without incurring the prescribed penalty, subject to the implementing rules and
regulations which the Commission may prescribe: Provided, That the employer submits
the corresponding collection lists together with the remittance or proposal to pay in
installments: Provided, further, That in case the employer fails to remit contributions
within the six-month grace period or defaults in the payment of any amortization
provided the approved proposal, the prescribed penalty shall be imposed from the time
the contributions first became due as provided in Section 22 (a) hereof.

SEC. 2. Separability Clause.

SEC. 3. Repealing Clause.

SEC. 4. Effectivity Clause.

Approved: May 01, 1997
INTRODUCTION

The concept of social security evolved from an age-old search of man for protection against poverty,
which
breeds grave social ills that not only threaten his survival but also erode his sense of human dignity. It,
therefore,
becomes the duty of the State to operate a mechanism that would provide such protection to its people.
Legislative History
On January 26, 1948, Pres. Manuel A. Roxas proposed a bill seeking to establish a social security
system for
wage earners and low-salaried employees. This was recommended to Congress in his State of the Nation
Address.
After the death of President Roxas, Pres. Elpidio Quirino created the Social Security Study Commission
on July
7, 1948. The creation of the Commission was his first official act upon his assumption to office. Based on
the
report of the Study Commission, a draft of the Social Security Act was submitted to Congress.
In 1954, Rep. Floro Crisologo, Senators Cipriano Primicias and Manuel Briones introduced bills based on
the
report of the Social Security Study Commission in the House of Representatives and in the Senate.
These bills
were consolidated and enacted into Republic Act (RA) 1161, better known as the Social Security Act of
1954.
However, business and labor groups objected to the Social Security Act resulting in a deferment of its
implementation.
In 1957, amendatory bills were presented in Congress. These bills were the bases of RA 1792, which
amended
the original Social Security Act.
On September 1, 1957, the Social Security Act of 1954 or the Social Security Law (SS Law) was finally
implemented, marking a significant milestone in the social security program.
Thus, with the implementation of the SS law, the government also adopted the social insurance approach
to
social security, covering the employed segment of the labor force in the private sector. In 1993,
household
helpers earning at least P1,000 were included in the compulsory coverage of employees.
In 1980, some groups of self-employed persons were also required to contribute to the social security
fund from
which benefits are paid upon the occurrence of a contingency provided by law. Self-employed farmers
and
fisherfolks were included in the program in 1992, while workers in the informal sector earning at least
P1,000 a
month such as ambulant vendors and watch-your-car boys, were covered in 1995.
The Social Security System (SSS) administers social security protection to workers in the private sector.
On the other hand, the Government Service Insurance System (GSIS) takes care of workers in the public
sector.
The SSS administers two programs namely:
1. The Social Security Program; and
2. The Employees Compensation Program (EC)
Social Security provides replacement income for workers in times of death, disability, sickness, maternity
and old
age.
On May 1, 1997, Pres. Fidel V. Ramos signed RA 8282, further strengthening the SSS. Also known as
the Social
Security Act of 1997, it amended RA 1161, providing for better benefit packages, expansion of coverage,
flexibility of investments, stiffer penalties for violators of the law, condonation of penalties of delinquent
employers and the establishment of a voluntary provident fund for members.
The EC program, started in 1975, provides double compensation effective June 1984 to the worker when
the
illness, death, or accident occurs during work-related activities. EC benefits are granted only to members
with
employers.
SSS used to administer the Medicare program for hospitalization and other medical needs of the private
sector
workers; and the Government Service Insurance System (GSIS), for the public sector workers. However,
with the
passage of Republic Act 7875 or the National Health Insurance Act of 1995, the SSS and GSIS
transferred the
administration of the Medicare program to the Philippine Health Insurance Corporation (PhilHealth) for an
integrated and comprehensive approach to health development effective July 1999.
SSS retirement, death, and total disability pensioners prior to the effectivity of RA 7875 on March 4, 1995
are
entitled to hospitalization benefits under Phil-Health. Pensioners upon the effectivity of RA 7875 on March
4,
1995 and thereafter are no longer covered except when they meet the qualification requirements set by
PhilHealth.

COVERAGE
Who are covered under the SSS?
Compulsory Coverage
1. Coverage of Employees
a) A private employee, whether permanent, temporary or provisional, who is not over 60 years old.
b) A household-helper earning at least P1,000 a month is compulsorily covered starting Sept. 1, 1993.
A household-helper is any person who renders domestic or household services exclusively to a
household
employer such as driver, gardener, cook, governess, and other similar occupations, who is not a member
of the
family of the household employer (HR) or his/her spouse.
c) A Filipino seafarer upon actual deployment by the manning agency which, together with the foreign
ship
owner, act as employers.
d) An employee of a foreign government, international organization or their wholly-owned instrumentality
based in the Philippines, which entered into an administrative agreement with the SSS for the coverage of
its
Filipino workers.
2. Coverage of Employers
a) An employer, or any person who uses the services of another person in business, trade, industry or
any
undertaking.
A social, civic, professional, charitable and other non-profit organization which hire the services of
employees are considered employers.
b) A foreign government, international organization or its wholly-owned instrumentality such as embassy
in
the Philippines, may enter into an administrative agreement with the SSS for the coverage of its Filipino
employees.
3. Coverage of Self-Employed Persons
A self-employed person, regardless of trade, business or occupation, with an income of at least P1,000 a
month
and not over 60 years old, should register with the SSS. Included, but not limited to the following are
selfemployed
persons:
a) self-employed professionals;
b) partners, single proprietors of businesses and board directors of corporations duly registered with
appropriate government agencies;
c) actors, actresses, directors, scriptwriters and news correspondents who do not fall within the definition
of the term employee;
d) professional athletes, coaches, trainers and jockeys;
e) farmers and fisherfolks; and
f) workers in the informal sector such as sidewalk vendors, ambulant vendors, watch-your-car-boys, and
those similarly situated.
Voluntary Coverage
1. Coverage of Separated Members
A member who is separated from employment or ceased to be self-employed/OFW/non- working spouse
and would like to continue paying his/her contributions.
2. Coverage of Overseas Filipino Workers (OFWs)
A Filipino recruited in the Philippines by a foreign-based employer for employment abroad;
having a source of income in a foreign country; and permanent resident in a foreign country.
3. Coverage of Non-Working Spouses of SSS Members
A person legally married to a currently employed and actively paying SSS member who devotes full time
in the management of household and family affairs may be covered on a voluntary basis provided there is
the approval of the working spouse. The person should never have been a member of the SSS. The
contributions will be based on 50 percent of the working spouses last posted monthly salary credit but in
no case shall it be lower than P1,000.
When does the coverage of members take effect?
Effectivity of Compulsory Coverage
1. For an employee- on the first day of employment
2. For an employer- on the first day the employer hires their first employee/s.
The employer is given 30 days from the date of employment of employee to report the person for
coverage to
the SSS thru the Employment Report (SS Form R-1A).
3. For self-employed persons upon payment of the first valid contribution, in case of initial coverage.
Effectivity of Voluntary Coverage
1. For an overseas Filipino worker- upon first payment of contribution, in case of initial coverage.
2. For a non-working spouse- upon first payment of contribution.
3. For a separated member- on the month the person resumed payment of contribution.
EMPLOYEES COMPENSATION BENEFITS
The Employees Compensation (EC) program aims to assist workers who suffer work-connected sickness
or
injury resulting in disability or death.
Who are covered under the EC program?
All SSS-registered employers and their employees are compulsorily covered under the program.
Employers and employees registered in the SSS need not register again under EC.
How much is the monthly contribution?
Only the employer is required to remit monthly EC contributions on behalf of the employees. Effective
January 1,
2007, the required contribution is P10 for those with monthly salary credits (MSC) of less than P15,000.
For
those with MSC of P15,000, the required contribution is P30. (Please refer to SSS contribution schedule.)
How long is an employer obliged to pay for the EC contributions of the employee?
For as long as the employee works for him/her, the employer is obliged to pay EC contributions.
The obligation of the employer ceases when an employee is separated from employment or, if the
employee dies
during employment.
When a covered employee becomes disabled during employment, the employers obligation to pay the
monthly
contribution arising from the employment will be suspended during such months that the employee is not
receiving salary or wages.
What are the benefits under the EC program?
Benefits under the Employees Compensation program are in the form of income benefits or services and
consist
of the following:
1. Medical services, appliances and supplies provided to the afflicted member beginning on the first day
of
injury or sickness, during the subsequent period of his disability and as the progress of his recovery may
require
subject to the expense limitation prescribed by the EC Commission.
These benefits, however, are limited to the ward services only of an accredited hospital and physician.
Ward services consist of all the services an in-patient would ordinarily receive in a hospital.
2. Rehabilitation Services
Rehabilitation is the process by which there is provided a balanced program of remedial treatment,
vocational assessment and preparation designed to meet the individual needs of each handicapped
employee to restore
him to suitable employment, including assistance as may be within its resources to help each
handicapped
employee to develop his mental, vocational or social potential.
3. Income cash benefit for:
a) Temporary total disability or sickness. An income cash benefit equivalent to 90 percent of the
average daily salary credit with a minimum of P10 and a maximum of P200 (effective November 1, 1996).
It is payable for a period not longer than 120 consecutive days except where such injury or sickness still
requires
medical attendance beyond 120 days but not to exceed 240 days. However, the System may declare the
total
and permanent status at any time after 120 days of continuous temporary total disability as may be
warranted by
the degree of actual loss or impairment of physical or mental functions of the members. The employer
shall be
liable for the benefit if such illness or injury occurred before the employee is duly reported for coverage to
the
System.
This benefit is advanced by the employer every regular payday. The amount legally paid by the employer
is
reimbursed 100 percent by the SSS in the form of cheque or thru the bank.
b) Permanent total disability (loss of two limbs at or above the ankle or wrists, permanent complete
paralysis of two limbs etc.). This benefit is a monthly pension paid for as long as the sick or injured worker
lives
plus 10 percent for each of the five dependent children beginning with the youngest child and without
substitution.
The monthly pension shall be guaranteed for five years and shall be suspended if the employee is
gainfully
employed, recovers from permanent total disability, or fails to present himself/herself for examination at
least
once a year upon notice by the SSS or fails to submit a quarterly medical report certified by the attending
physician as required under Section 5, Rule IV of the EC Law.
Beginning January 1, 1991, a permanent total or permanent partial disability pensioner is also given a
supplemental allowance in addition to the monthly pension. This allowance is an additional financial
assistance
to meet the extra needs due to the disability. Effective May 1, 1993, the supplemental allowance is P575
a
month.
Upon the death of an EC permanent total disability pensioner, the SSS will pay to the primary
beneficiaries 80
percent of the monthly pension regardless of the cause of death. In addition, the dependents will be paid
the
dependents pension. If the deceased pensioner has no primary beneficiaries, the SSS will pay to the
secondary
beneficiaries the remaining balance of the five-year guaranteed period, excluding the dependents
pension.

c) Permanent partial disability (loss of one thumb, one arm, one index finger, one leg, etc.). A monthly
pension is provided to the member equivalent to the pension for permanent total disability but limited to
the
number of months designated by law for a particular disability.
However, if the period of permanent partial disability pension is less than a year, the benefit may be paid
in lump
sum.
d) Death. A monthly pension is provided to the deceased members primary beneficiaries, plus 10
percent
of such benefit for each of the dependent children, subject to some limitations. In the absence of primary
beneficiaries, the secondary beneficiaries are entitled to the monthly pension but not to exceed 60
months.
Under the EC program, a funeral benefit of P10,000 will also be paid to any person who actually
shouldered the
burial expenses of the deceased member.
What are the qualifications for EC benefits?
1. Employees should be duly reported to the SSS;
2. Employees sickness, injury or death is work-connected; and
3. The SSS has been duly notified of such sickness, injury or death.
Under what condition can an injury, sickness or death be compensable under EC?
A sickness, injury, disability or death resulting from an employment accident is compensable if:
1. The employee is injured at the workplace;
2. The employee is performing official functions; and
3. If the injury is sustained elsewhere, the employee is executing an order for the employer.
Under what conditions can an injury, sickness or death be deemed not compensable under EC?
No compensation will be allowed to an employee or the dependents if the injury, sickness, disability or
death is
due to:
1. Intoxication;
2. Willful intention to injure or kill oneself or another; or
3. Notorious negligence.
What should an employee do to file for an EC claim?
The employer should be notified of the members sickness, injury or death within five (5) days from the
occurrence of the contingency. Notice is not necessary if the contingency occurred during working hours,
at the
place of work and with the knowledge of the employer or representative.

On the other hand, what should the employer do upon the employees submission of notice?
Pursuant to Section 2 Rule XVI - Employers Records and Notices of PD 626 or the Employees
Compensation
Law, all employers are required to keep a logbook to record chronologically the sickness, injury or death
of their
employees setting forth therein their names, dates and places of contingency and absences. Entries in
the
logbook shall be made within five (5) days from notice of knowledge of the occurrence of the contingency.
Within
five (5) days after entry in the logbook, the employer shall report to the SSS those contingencies it deems
to be
work-connected.
All entries in the employers logbook shall be made by the employer or any of the authorized officials after
verification of the contingencies or the employees absences for a period of a day or more. Upon request
by the
System, the employer shall furnish the necessary certificate regarding information about any contingency
appearing in the logbook, citing the entry number, page number and date. Such logbook shall be made
available
for inspection to the duly authorized representative of the System.
What will happen if the employer fails to record the sickness, injury or death of any of the
employees in
the logbook?
Failure of the employer to keep a logbook or to give false information or withhold material information
already in possession shall make the employer liable for fifty percent (50%) of the lump sum equivalent of
the
income benefit to which the employee may be found to be entitled, the payment of which shall accrue to
the
State Insurance Fund.
In case of payment of benefits for any claim which is later determined to be fraudulent and the employer
is found to be a party to the fraud, such employer shall reimburse the System the full amount of the
compensation paid.
Who are the legal dependents of a member?
The primary beneficiaries of a member are the:
1. legitimate spouse living with the employee at the time of death until he/she remarries; and the
2. legitimate, legitimated, legally adopted or acknowledged natural children, who are unmarried, not
gainfully employed, not over 21 years of age, or over 21 years of age, provided that they are
incapacitated and
incapable of self-support due to physical or mental disability which is congenital or acquired during
minority;
provided further, that a dependent acknowledged natural child shall be considered as a primary
beneficiary only
when there are no other dependent children who are qualified and eligible for monthly income benefit;
provided
finally, that if there are two or more acknowledged natural children, they shall be counted from the
youngest and
without substitution, but not exceeding five (ECC Resolution No. 2799, July 25, 1984).
The secondary beneficiaries are the:
1. legitimate parents wholly dependent upon the employee for regular support;
2. the legitimate descendants and illegitimate children who are unmarried, not gainfully employed, and not
over 21 years of age, or over 21 years of age provided they are incapacitated and incapable of self-
support due
to physical or mental disability which is congenital or acquired during minority.
What will happen to the monthly death pension if the member has no primary and secondary
beneficiaries?
If the deceased member has no primary and secondary beneficiaries at the time of death, the benefit will
accrue
to the EC fund.

MEMBER LOAN
SSS was mandated primarily to give social security protection to its members. However, it has also
provided its
members with short-term loan programs from which they can borrow for personal purposes.
SALARY LOAN
The Social Security Commission, under Resolution No. 669 dated 10 December 2003, approved the
revised guidelines on salary loans granting.
What is a salary loan?
It is a loan intended to meet the members short-term credit need.
Who may qualify for a salary loan?
1. An employed, currently paying self-employed or voluntary member (SE/VM) who has six (6) posted
monthly contributions for the last 12 months prior to the month of filing of application.
For a one-month loan, the member-borrower must have 36 posted monthly contributions prior to the
month of
filing of application.
For a two-month loan, the member-borrower must have 72 posted monthly contributions prior to the
month of
filing of application.
2. If the member-borrower is employed, the employer must be updated in contributions and loan
remittances.
3. The member-borrower must be updated/current in the payment of other member loans, which include
educational, stock investment, Members Assistance for the Development of Entrepreneurship (MADE) &
housing loans granted under the Unified Housing Loan Program (UHLP) or direct from SSS.
4. The member-borrower has not been granted final benefit (total permanent disability, retirement and
death).
5. The member-borrower must be under sixty-five (65) years of age at the time of application. (Effective
12
January 2006 per SSC. Res. No. 434 dated 09 November 2005).
6. The member-borrower has not been disqualified due to fraud committed against the SSS.
How much is the loanable amount?
A one-month salary loan is equivalent to the average of the members latest 12 monthly salary credits
posted.
What are the duties and responsibilities of SSS employee-members?

An SSS member should:

1. secure their SS numbers;

2. ensure that they are reported for coverage under the SSS by their employers;
3. pay their monthly share of contributions and ensure that these contributions are remitted
to the SSS by their employers;
4. ensure that SSS Form R3s (Contributions Collection Lists) where their name are
included, are submitted to the SSS by their employers;
5. pay their monthly loan amortization, if any, thru salary deduction and to ensure that these
payments are remitted to the SSS by their employers;
6. update or correct their personal records with the SSS by submitting a duly filled-up SSS
Form E-4 (Members Data Amendment) and supporting document/s to avoid delays in
the processing of benefit claims; and
7. be conscious of changes and improvements in SSS policies and benefit structure.

What are the duties and responsibilities of an SSS employer-member?

An employer is obliged to:

1. require the presentation of the SS number of a prospective employee;

2. report all employees for SS coverage within thirty (30) days from the date of
employment by submitting an accomplished SSS Form R-1A (Employment Report ) at
the nearest SSS office;
3. deduct from the employees the monthly SS contributions based on the schedule of
contributions; pay their share of contributions including Employees Compensation (EC)
and remit these contributions to the SSS or accredited banks within the first the (10)
calendar days following the month when said contributions are due and applicable.
4. Submit a summary of all employees contributions thru SSS Form R-3s (Contribution
Collection List) together with a copy of the Special Bank Receipt (SBR) and SSS Form
R-5 ( Payment Return Form) within 10 days after the applicable quarter;

An employer may also participate in the SSSNet, a computer service using the electronic
data interchange technology, designed to hasten the posting of employees contributions
for faster processing and availment of benefits and loan privileges.

Or, the employer may opt to participate in the R3 Tape/Diskette Project which allows the
submission of the monthly summary of employees contribution thru a computer tape or
diskette. This system is a better alternative to manual reporting as its minimizes encoding
errors and processing time.
5. issue official receipts and maintain official records of employment and deductions for all
contributions subtracted from their employees every month or indicate such deductions
from the employees pay envelopes;

A household employer should submit an accomplished SSS Form R-3 (Contributions

 Collection List) and indicate in the appropriate box as a household employer. Submit this
together with the SSS Form R5s at the nearest SSS office. Household employers may
enroll in the Auto-Debit Arrangement System which allows the one-time enrollment of
the employers bank account for the automatic payment of monthly SSS contributions
and loan repayments. This arrangement is open at the United Coconut Planters Bank,
Equitable-PCI Bank, Bank of the Philippine Islands, Metropolitan Bank and Trust Co.,
Philippine National Bank; Asia Trust Bank; Philippine Savings Bank; Development Bank
of the Philippines; and more bank soon.
6. remit to the SSS all salary, educational, stocks investment or privatization loan
amortization of their employees and submit an accomplished SSS Form ML-1 (Monthly
Salary/Calamity/Emergency/Stock Investment Loan Payment Return) to any of the
SSS accredited banks within the first ten (10) calendar days following the month when
said amortizations are due and applicable;

7. submit a summary of all employees loan amortization thru an accomplished SSS Form
ML-2 (Collection List) with copies of the SBRs and SSS Form ML-1 on or before the
tenth day following the applicable month to the nearest branch;

An employer may also participate in the Salary Loan Repayment Tape/Diskette project
which allows the submission of the monthly summary of employees loan repayment thru
a computer tape or diskette. This system provides employers with convenience and
hastens the posting of members loan repayments.

8. advance SS and EC sickness benefits due their employees once these are approved by the
SSS;

9. advance SS maternity benefits due to qualified female employees;

10. file for reimbursement for all legally advanced sickness and maternity benefits;

11. keep their employees updated on the changes in SSS policies and increases in their
benefits;

12. ensure that all forms submitted are properly and accurately accomplished;

13. inform SSS of any change in company address, business name or temporary/permanent
cessation of business operations through the submission of a duly notarized SSS Form R-
8 ( Employer Data Change Request);

14. submit annually an updated SSS Form L-501 (Specimen Signature Card); and,

15. certify SSS-related documents for the employees when required for purposes of their
claims.

What are the duties and responsibilities of a voluntary/self-employed member?

Self-employed/voluntary members should:

 1. pay their monthly contributions using SSS Form RS-5 (Contributions Payment Return
Form) monthly in accordance with the prescribed schedule;

Beginning 01 January 2004, self-employed and voluntary members, including OFWs

may change their MSC monthly. The change may be by one or two salary brackets
without requiring the submission of documents to prove their earnings. In case the change
will result to an MSC of lower than P5, 000.00, or where the change will result to more
than the present MSC, a Declaration of Earnings must be submitted to support the new
earnings. However, if the age of the member is 55 years or older and the present MSC is
more than P10, 000.00, the allowed increase is only one salary bracket regardless of
whether the supporting documents are submitted or not.

For Overseas Filipino Workers (OFWs), the minimum MSC was increased from P3,
000.00 to P5, 000.00, or beginning 01 January 2004

2. update or correct their personal records with the SSS by submitting a duly filled-up SSS
Form E-4 (Members Data Amendment) with supporting documents.

be conscious of changes and improvements in SSS policies and benefit structure.

Self-employed and voluntary members may enroll in the Auto-Debit Arrangement

System which allows the one-time enrollment of the employers bank account for the
automatic payment of monthly SSS contributions and loan repayments. This arrangement
is open at the United Coconut Planters Bank, Equitable/PCI Bank, Bank of the Philippine
Islands, Metropolitan Bank and Trust Co., Philippine National Bank, Asia Trust Bank,
Philippine Savings Bank, Development Bank of the Philippines; and more banks soon.

Social Security Benefits

What is the sickness benefit?

The sickness benefit is a daily cash allowance paid for the number of days a member is
unable to work due to sickness or injury.

How does an SSS member qualify for the sickness benefit?

1. unable to work due to sickness or injury and confined either in a hospital or at

home for at least four days;
2. at least three months of contributions within the 12 month period immediately
before the semester of sickness has been paid;
3. all company sick leaves with pay for the current year has been used up;
4. the employer has been notified, or, if a separated, voluntary or self-employed
member, the SSS directly.
 How much sickness benefit is a member entitled to
receive?

The amount of a members sickness benefit per day is

equivalent to ninety percent (90%) of the members average
daily salary credit.

How is the sickness benefit computed?

1. Exclude the semester of sickness.

A semester refers to two consecutive quarters ending in

the quarter of sickness.
A quarter refers to three consecutive months ending
March, June, September or December.
2. Count 12 months backwards starting from
the month immediately before the semester of sickness.
3. Identify the six highest monthly salary credits within the 12-month period.

Monthly salary credit means the compensation base for contributions and
benefits related to the total earnings for the month. (The maximum covered
earnings or compensation is P15,000 effective Jan 1, 2002).

Please refer to the following table:

Range of Monthly
Compensation Salary Credit
1,000 - 1,249.99 1,000
1,250 - 1,749.99 1,500
1,750 - 2,249.99 2,000
2,250 - 2,749.99 2,500
2,750 - 3,249.99 3,000
3,250 - 3,749.99 3,500
3,750 - 4,249.99 4,000
4,250 - 4,749.99 4,500
4,750 - 5,249.99 5,000
5,250 - 5,749.99 5,500
5,750 - 6,249.99 6,000
6,250 - 6,749.99 6,500
6,750 - 7,249.99 7,000
7,250 - 7,749.99 7,500
7,750 - 8,249.99 8,000
8,250 - 8,749.99 8,500
8,750 - 9,249.99 9,000
 9,250 - 9,749.99 9,500
9,750 - 10,249.99 10,000
10,250 - 10,749.99 10,500
10,750 - 11,249.99 11,000
11,250 - 11,749.99 11,500
11,750 - 12,249.99 12,000
12,250 - 12,749.99 12,500
12,750 - 13,249.99 13,000
13,250 - 13,749.99 13,500
13,750 - 14,249.99 14,000
14,250 - 14,749.99 14,500
14,750 - O V E R 15,000

4. Add the six highest monthly salary credits to get the total monthly salary credit.
5. Divide the total monthly salary credits by 180 days to get the average daily salary
credit.
6. Multiply the average daily salary credit by 90 percent to get the daily sickness
allowance.
7. Multiply the daily sickness allowance by approved number of days to arrive at the
amount of benefit due.

For example, let us say that an SSS member gets sick or injured in October 2004 for 20
days:

a. The semester of sickness would be from July 2004 to December 2004.

b. The 12-month period would be from July 2003 to June 2004 within which the six
highest monthly salary credits will be chosen.
c. Let us assume that the six highest monthly salary credits are P15, 000 each. The
total monthly credit would be P90, 000 (P15, 000 x 6).
d. The total monthly salary would be divided by 180 to get the average daily salary
credit or P500 (P90, 000/180).
e. The sickness benefit due is P9,000 (P450 x 20 days).

How many days in a year can a member avail himself of the sickness benefit?

A member can be granted sickness benefit for a maximum of 120 days in one calendar
year. Any unused portion of the allowable 120 days sickness benefit cannot be carried
forward and added to the total number of allowed compensable days for the following
year.
 The sickness benefit shall not be paid for more than 240 days on account of the same
illness. If the sickness or injury still persists after 240 days, his claim will be considered a
disability claim.

Who should an employee notify regarding his sickness or injury?

A member should notify the employer within five (5) calendar days after the start of
sickness or injury. The employer, in turn, must notify the SSS of the confinement within
(5) calendar days after receipt of the notification from the employee member.

Notification to the employer is not necessary if the members confinement is in a hospital

or if the member got sick or was injured while working or was within the company
premises. In this case, the employer must notify the SSS within five (5) calendar days
from the start of the employees sickness or injury while working or was within the
company premises.

What is the procedure for notification for unemployed, self-employed and voluntary
members?

Unemployed, self-employed or voluntary paying members should notify the SSS directly
within five (5) calendar days after the start of confinement, unless such confinement is in
the hospital,in which case, notification is not necessary.

What are the effects of failure or delay in notification?

1. If the employee notifies the employer, or the SSS, in the case of an unemployed,
self-employed or voluntary paying member, beyond the prescribed five-day
period, the confinement shall be deemed to have started not earlier than the fifth
day immediately preceding the date of notification.
2. If the employer notifies the SSS beyond the five (5) calendar days after the receipt
of the notification from the employee, the employer shall be reimbursed only for
each day of confinement starting from the 10th calendar day immediately
preceding the date of notification to the SSS.
3. If the employee has given the required notification to the employer, but the
employer fails to notify the SSS of the confinement within the prescribed period
resulting in the reduction of the benefit or denial of the claim, the employer shall
have no right to recover the daily sickness allowance advanced to the employee.

How would an employed member be paid his sickness benefit?

The payment of the daily sickness allowance is advanced by the employer every regular
payday. The SSS will then reimburse the employer of the amount legally advanced upon
receipt of satisfactory proof of such payment and legality thereof.
 The SSS will reimburse the employer only for confinements within the one year period
immediately preceding and the date the claim for benefit or reimbursement is received by
the SSS, except for confinements in hospital (i.e. SSS receives the employers
reimbursement claim on Oct. 3, 2004 for the sickness period September 23 to Oct. 14,
2003. The employer will be reimbursed for the period Oct. 4 to 14,2003 only as Sept. 23
to Oct. 3, 2003 falls outside the prescribed one-year period for reimbursement claim.

How about the unemployed, self-employed or voluntary member?

The sickness benefit will be paid directly by the SSS to the unemployed, self-employed
or voluntary members.

What is the prescribed period of filing for a member who is confined in a hospital?

For hospital confinement, the claim for benefit must be filed within one (1) year from the
last day of confinement from the hospital. For home confinement, the claim for
reimbursement by the employer must be filed within one (1) year from the start of illness.
Failure to file the claim within the prescribed period will result to denial of the claim.

What forms are needed in filing for sickness benefit?

1. For the employed member

a. SSS Form CLD-9N (Sickness Notification).
For the employer
b. SSS Form B-304 (Sickness Benefit Reimbursement Application).
2. For the unemployed/self-employed/voluntary member
a. SSS Form CLD-9A (Sickness Benefit Claim for Unemployed/Self-
employed/Voluntary Members)
b. SSS Form MMD-102 (Medical Certificate)
3. Other documents:

a. For unemployed members

Certification from last employer showing the effective date of separation

from employment or notice of the companys closure/strike or certification
from the Department of Labor and Employment that the employee or
employer has a pending labor case.
Certification that no advance payment was granted, if the date of
separation form employment is within the confinement period being
applied for.
Presentation of the SS Digitized ID/SSS Form E-6 (acknowledgment stub)
with 2 valid Ids, one of which with the recent photo. To ensure receipt of
benefits by members, authorized company representatives who file
sickness benefit claims shall present the members SS digitized ID or E-6
(acknowledgement stub) with two valid Ids (at least one with photo). This
 requirement is in addition to the presentation by the company
representatives own SSS digitized ID and blue card.

Where does the member file his claim for sickness benefit?

For the employed/separated member - claims may be filed at the nearest SSS office.
However, processing will be done at the branch where the employer and employee
records are based.

For the voluntary/self-employed member - claims may be filed at the SSS office nearest
the members residence. However, processing will be done at the branch where the record
is based.

What is the New Disability Program?

The new SSS Disability program is a re-designed disability program that implements the
revised manual of disability assessment. The new program adopts the World Health
Organizations (WHO) definition of disability that states as any restriction or lack
(resulting from impairment) of ability to perform an activity in the manner or within the
range considered normal for a human being.

What is the main objective of the new disability program?

The re-designed program aims to ensure that the right cash benefit for disability is paid to
truly deserving members.

What are the salient features of the new disability program?

The re-designed disability program

adopts the WHO definition of disability which is any restriction or lack (resulting from
impairment) of ability to perform an activity in the manner or within the range considered
normal for a human being. Impairment is defined as any loss or abnormality of
psychological, physiological, or anatomical structure or function.
adopts the International Statistical Classifications of Diseases and Related Health
problems Codes (ICD-10).
includes medical and functional assessments.
requires annual assessment of all pensioners except those with scheduled disabilities
stated under Section 13-A (f) of the SS Law.

What is the medical and functional assessment under the new disability program?

Under the medical assessment, nature and degree of impairment of affected body
part/system is determined through physical examination and interview supported by appropriate
diagnostic tests. While, under functional assessment, the capacity of the individual to perform
activities of daily living (ADL) is tested using the Functional Independence Measure (FIM).
 Member should have 20% medical impairment to qualify for functional assessment.

Who is qualified for disability benefit under the new program?

A member who suffers partial or total disability with at least one monthly contribution paid
to the SSS prior to the semester of contingency is qualified.

Aside from the disability benefit, what else can a disability pensioner receive?

In addition to the monthly pension, a supplemental allowance of P500.00 is

paid to the total or partial disability pensioner. The allowance will provide
additional financial assistance to meet the extra needs arising from the
disability.

Total disability pensioners and their legal dependents prior to the effectivity of
R.A. 7875 on March 4, 1995 are entitled to hospitalization benefits under
PhilHealth. A copy of DDR Print-out indicating the type of claim is disability
in nature and the effectivity date of pension or a Copy of Disability-Pensioner
Certification, shall be submitted. Total disabled pensioners upon the effectivity
of R.A. 7875 on March 4, 1995 and thereafter, are no longer covered except
when they have accumulated one hundred twenty (120) Medicare monthly
contributions and have reached age sixty (60).

However, those who wish to avail of PhilHealth benefits may enroll in the
Individually-Paying Program (for voluntary/self-employed) or the Indigent
Program (IP) of PhilHealth.

Are the children of a disabled member entitled to the dependent's pension?

The dependent legitimate, legitimated, legally adopted and illegitimate

children, conceived on or before the date of contingency of a totally disabled
pensioner will each receive a dependents pension equivalent to 10 per cent of
the members pension or P250, whichever is higher.

Only five minor-children, beginning from the youngest are entitled to the
dependents pension. No substitution is allowed. Where there are legitimate and
illegitimate minor children, the legitimated or legally adopted ones will be
preferred.

The minor children of a partially disabled pensioner are not entitled to the
dependents pension.

For how long will the dependent child receive his pension?
 The dependents pension stops when the child reaches 21 years old, gets
married, gets employed or dies. However, the dependents pension is granted
for life to children who are over 21 years old, provided, they are incapacitated
and incapable of self-support due to physical or mental defect which is
congenital or acquired during minority.

What will happen to the monthly pension in case the pensioner gets re-employed,
resumes self-employment, recovers from his permanent total disability or his
failure to present himself/herself for examination upon notice by SSS?

The monthly of the member and the dependents pension will be suspended
upon the reemployment or resumption of self-employment or the recovery of
the disabled member from permanent total disability or failure to present
himself/herself for examination at least once a year upon notice by SSS.

What will happen to the monthly pension of a disability pensioner in case of

death?

Upon the death of the permanent total disability pensioner, the primary
beneficiaries as of the date of disability, shall be entitled to 100 per cent of the
monthly pension and the dependents to the dependents pension.

If the totally disabled pensioner has no primary beneficiaries and dies within
sixty (60) months from the start of the monthly pension, the secondary
beneficiaries shall be entitled to a lump sum benefit equivalent to the total
monthly pensions corresponding to the balance of the five-year guaranteed
period excluding the dependents pension.

The pension stops when a partial disability pensioner retires or dies.

What is the prescriptive period in filing disability claims?

The prescriptive period in the filing of disability benefit claim should be ten (10) years
from the date of occurance of disability.

What are the forms needed in filing for the disability benefit?

1. Disability Claim Application (SSS Form DDR-1);

2. Medical Certificate (SSS Form MMD-102)
3. Other documents that may be required to support the disability claim
such as clinical and laboratory tests results, x-ray; and hospital records.
4. SSS digitized ID or E-6 (acknowledgement stub) with two valid IDs,
one of which with recent photo.

Where can a member file his disability benefit application?

 Applications forms of disability benefits are filed at the nearest SSS branch or
representative office.
What is the retirement benefit?

It is a cash benefit either in monthly pension or lump sum paid to a member who can no
longer work due to old age.

Who may qualify for a retirement benefit?

1. A member who is 60 years old, separated form employment or ceased to be self-

employed, and has paid at least 120 monthly contributions prior to the semester of
retirement.
2. A member who is 65 years old whether employed or not and has paid at least 120
monthly contributions prior to the semester of retirement.

For Underground Mineworkers:

1. Has reached the age of 55 years old and is an underground mineworker for at least
5 years (either continuous or accumulated) prior to the semester of retirement but
whose actual date of retirement is not earlier than March 13, 1998; separated from
employment or in the case of self-employed, has ceased self-employment, and has
paid at least 120 monthly contributions prior to the semester of retirement.
2. Has reached the age of 60 years old whether employed or not.

What are the types of retirement benefits?

They are:

1. the monthly pension, and

2. the lump sum amount.

The monthly pension is a lifetime cash benefit paid to a retiree who has paid at least 120
monthly contributions to the SSS prior to the semester of retirement.

The lump sum amount is granted to a retiree who has not paid the required 120 monthly
contributions. It is equal to the total contributions paid by the member and by the
employer including interest.

How much monthly pension will a retiree receive?

The monthly pension depends on the members paid contributions, including the credited
years of service (CYS) and the number of dependent minor children but not to exceed
five. The amount of monthly pension will be the highest of:
 1. the sum of P300 plus 20 percent of the average monthly salary credit plus 2 per
cent of the average monthly salary credit for each accredited year of service
(CYS) in excess of ten years; or
2. 40 per cent of the average monthly salary credit; or
3. P1,200, provided that the credited years of service (CYS) is at least 10 or more
but less than 20 or P2,000, if the CYS is 20 or more. The monthly pension is paid
for not less than 60 months.

A retiree has the option to receive the first 18 monthly pension in lump sum discounted at
a preferential rate of interest to be determined by the SSS. The option should be exercised
upon filing of the first retirement claim. Only advance payments shall be discounted on
the date of the payment. The dependents pension and 13th month pensions are excluded
from the 18 months lump sum pension.

The member will receive the monthly pension on the 19th month and every month
thereafter.

What happens when the retirement pensioner resumes employment?

The monthly pension shall be suspended upon the re-employment or resumption of self-
employed of a retired member who is less than 65 years old. The member shall again be
subjected to compulsory coverage. At 65 year old whether employed or not, he can
already claim for retirement benefit.

How much is the monthly pension of a member who retires after age 60 and who has
contributed the required 120 monthly contributions?

The monthly pension shall be the higher of the following:

1. the monthly pension computed at the earliest time the member could have retired
had been separated from self-employment or ceased to be self-employed plus all
adjustments thereto; or
2. the monthly pension computed at the time when the member actually retires.

A pensioner who retires more than once shall be entitled to the higher of:

1. the monthly pension computed for the first retirement claim; or

2. the re-computed monthly pension for the new claim.

How is the monthly pension paid?

The monthly pension is paid thru the members designated bank. He is allowed to choose
the bank nearest his residence thru which he wishes to receive his pension benefits under
the Mag-impok sa Bangko program. This became mandatory effective September
1,1993.
 A member must open a single savings account and must submit to the SSS his savings
account number and a photocopy of his passbook upon filing of his application. The
original copy of the passbook must be presented for authentication purposes.

Upon approval of the claim, the SSS will mail a notice voucher to the claimant informing
when to withdraw the benefit from the bank.

Aside from the retirement benefit, what else can a retiree receive?

The retiree is entitled to a 13th month pension payable every December. All
retiree pensioners prior to the effectivity of RA 7875 on March 4, 1995 are
automatically considered members of PhilHealth and he and his legal
dependents are entitled to its hospitalization benefits. On the other hand,
retirees effective March 4,1995 up to the present will be entitled to
hospitalization benefits under PhilHealth only if they have contributed 120
monthly Medicare contributions. The counting of 120 monthly contributions
shall start in 1972, when the Medical Care Act of 1969 started implementation.

A copy of DDR print-out indicating the type of claim is retirement in nature

and the effectivity date of pensioner in its absence a copy of retiree-pensioner
certification issued by SSS shall be required. They need to register under
Philhealth for the issuance of a Philhealth ID card.

Are the children of a retiree member entitled to the dependent's pension?

The legitimate, legitimated, or legally adopted and illegitimate children,

conceive on or before the date of retirement of a retiree will each receive
dependents pension equivalent to 10 per cent of the members monthly
pension or P250, whichever is higher.

Only five minor children, beginning from the youngest, are entitled to the
dependents pension. No substitution is allowed.

If there are more than five dependents, the legitimate, legitimated or legally
adopted children shall be preferred.

For how long will the dependent child receive his pension?

The dependents pension stops when the child reaches 21 years old, gets
married, gets employed or dies. However, the dependents pension is granted
for life for children who are over 21 years old, provided they are incapacitated
and incapable of self-support due to physical or mental defect which is
congenital or acquired during minority.
 What will happen to the monthly pension of a retiree in case of death?

Upon the death of a retiree pensioner, the primary beneficiaries as of the date of
retirement shall be entitled to 100 per cent of the monthly pension and the
dependents to the dependents pension.

If the retiree pensioner dies within sixty (60) months from the start of the
monthly pension and has no primary beneficiaries, the secondary beneficiaries
shall be entitled to a lump sum benefit equivalent to the total monthly pensions
corresponding to the five-year guaranteed period excluding the dependents
pension.

What documents are needed in filing for a retirement benefit?

1. Retirement claim application (SSS Form DDR-1);

2. DDR Savings Account form;
3. Certificate of Separation from last employer (for members less than 65
years old);
4. Passbook (if pension);
5. Certified true copies of birth or baptismal certificate of dependent
children;
6. Certificate of cessation of business or practice of profession (for self-
employed less than 65 years old);
7. Certified true copy of Marriage certificate (if with dependent children)
8. Proofs of filiation for illegitimate dependent children; and
9. SSS digitized or E-6 (acknowledgement stub) with two valid IDs, one of
which with recent photo.

Where can a member file his retirement application?

Applications forms for retirement benefit are filed at any SSS branch or
representative office.
What is the maternity benefit?

The maternity benefit is a daily cash allowance granted to a female member who was
unable to work due to childbirth or miscarriage.

What are the qualifications for entitlement to the maternity benefit?

1. She has paid at least three monthly contributions within the 12-month period
immediately preceding the semester of her childbirth or miscarriage.
2. She has given the required notification of her pregnancy through her employer if
employed, or to the SSS if separated, voluntary or self-employed member.

Is the voluntary or self-employed member also entitled to the maternity benefit?

 Yes, A voluntary or a self-employed member is entitled to the maternity benefit provided
that she meets the qualifying conditions.

How much is the maternity benefit?

The maternity benefit is equivalent to 100 per cent of the members average daily salary
credit multiplied by 60 days for normal delivery or miscarriage, 78 days for caesarean
section delivery.

How is the maternity benefit computed?

1. Exclude the semester of contingency (delivery or miscarriage).

A semester refers to two consecutive quarters ending in the quarter of

contingency.
A quarter refers to three consecutive months ending March, June, September
or December.
2. Count 12 months backwards starting from the month immediately before the
semester of contingency.
3. Identify the six highest monthly salary credits within the 12-month period.

Monthly salary credit means the compensation base for contributions benefits
related to the total earnings for the month. Please refer to the table below.

Range of Monthly
Compensation Salary Credit
1,000 - 1,249.99 1,000
1,250 - 1,749.99 1,500
1,750 - 2,249.99 2,000
2,250 - 2,749.99 2,500
2,750 - 3,249.99 3,000
3,250 - 3,749.99 3,500
3,750 - 4,249.99 4,000
4,250 - 4,749.99 4,500
4,750 - 5,249.99 5,000
5,250 - 5,749.99 5,500
5,750 - 6,249.99 6,000
6,250 - 6,749.99 6,500
6,750 - 7,249.99 7,000
7,250 - 7,749.99 7,500
7,750 - 8,249.99 8,000
8,250 - 8,749.99 8,500
8,750 - 9,249.99 9,000
 9,250 - 9,749.99 9,500
9,750 - 10,249.99 10,000
10,250 - 10,749.99 10,500
10,750 - 11,249.99 11,000
11,250 - 11,749.99 11,500
11,750 - 12,249.99 12,000
12,250 - 12,749.99 12,500
12,750 - 13,249.99 13,000
13,250 - 13,749.99 13,500
13,750 - 14,249.99 14,000
14,250 - 14,749.99 14,500
14,750 - O V E R 15,000

4. Add the six highest monthly salary credits to get the total monthly salary credit.
5. Divide the total monthly salary credit by 180 days to get the average daily salary
credit. This is equivalent to the daily maternity allowance.
6. Multiply the daily maternity allowance by 60 (for normal delivery or miscarriage)
or 78 days (for caesarean section delivery) to get the total amount of maternity
benefit.

For example, let us say that an SSS member gives birth in December 2004.

a. The semester of contingency would be from July 2004 to December 2004

b. The 12-month period before the semester of contingency would be from July
2003 to June 2004
c. Let us assume that the six highest monthly salary credits are P15,000 each. Thus,
the total monthly salary credit would be P90,000 (P15, 000 x 6).
d. The daily maternity allowance would be P500 (P90,000/180).
e. The total maternity benefit due would be P30, 000 (P500 x 60 days) for normal
delivery or P39,000 (P500 x 78) for caesarian cases.

f.

How many deliveries are covered under existing laws?

The maternity benefit shall be paid only for the first four (4) deliveries or miscarriages
starting May 24, 1997 when the Social Security Act of 1997 (RA8282) took effect.

Can a member apply for sickness benefit if she has been paid the maternity benefit?

No. A female member cannot claim for sickness benefit for a period of 60 days for
normal delivery or miscarriage or 78 days for caesarean delivery within which she has
 been paid the maternity benefit. As a rule, no member can be entitled to two benefits for
the same period.

Is it necessary to notify the SSS of a member's pregnancy?

Yes. As soon as a member becomes pregnant, she must immediately notify her employer
(if employed) or the SSS (if separated/voluntary/self-employed) of such pregnancy and
the probable date of her childbirth at least 60 days from the date of conception by
accomplishing SSS FORM MAT-1 (Maternity Notification Form) and by submitting
proof of pregnancy.

The employer must, in turn, notify the SSS through the submission of the maternity
notification form and proof of pregnancy immediately after the receipt of the notification
from the employee member.

Failure to observe the rule on notification may result to the denial of the maternity claim.

How would the claimant be paid the maternity benefit?

For employed members - the benefit is advanced by the employer to the qualified
employee, in full, within 30 days from the date of filing of the maternity leave
application. The SSS, in turn, shall immediately reimburse the employer 100 percent of
the amount of maternity benefit advanced to the female employee upon receipt of
satisfactory proof of such payment and legality thereof.

If the employee member gives birth or suffers miscarriage without the required
contributions having been remitted by the employer, or the employer fails to notify the
SSS, the employer will be required to pay to the SSS damages equivalent to the benefits
the employee would otherwise have been entitled to.

For separated/voluntary/self-employed members - the amount of benefit is paid directly

to them by the SSS.
 What is the death benefit?

It is a cash benefit either in monthly pension or lump sum

paid to the beneficiaries of a deceased member.

Who are the beneficiaries of a deceased member?

The primary beneficiaries are the legitimate dependent

spouse until the person remarries and the dependent
legitimate, legitimated, or legally adopted, and illegitimate
children of the member who are not yet 21 years old. In the
absence of primary beneficiaries, the dependent parents
shall be the secondary beneficiaries. In their absence, any
other person designated by the member as beneficiary in
the members record.

What are the types of death benefits?

They are:

1. the monthly pension; and

2. the lump sum amount.

The monthly pension is granted only to the primary beneficiaries of a deceased member
who had paid 36 monthly contributions before the semester of death.

The lump sum is the amount granted to the primary beneficiaries of a deceased member
who had paid less than 36 monthly contributions before the semester of death. The
secondary beneficiaries shall be entitled to a lump sum benefit.

How much is the monthly pension?

The monthly pension depends on the members paid contributions, including the credited
yeas of service (CYS) and the number of dependent minor children but not to exceed
five.

The amount of monthly pension will be the highest of:

1. the sum of P300 plus 20 percent of the average monthly salary credit plus
two percent of the average monthly salary credit for each credited year of
service (CYS) in excess of 10 years; or
2. 40 percent of the average monthly salary credit; or
3. P1,000 if the member had less than 10 credited years of service (CYS);
P1,200 if with at least 10 CYS; or P2,400 if with at least 20 CYS. The
monthly pension is paid for not less than 60 months.
If the deceased member is survived by legitimate, legitimated, or legally adopted and
illegitimate children, how is the monthly pension divided?

If a deceased member is survived by less than five minor legitimate, legitimated, or

legally adopted children, the illegitimate minor children will be entitled to 50 percent of
the share of the legitimate, legitimated or legally adopted children in the basic pension
and 100 percent of the dependents' pension.

In cases where there are no legitimate, legitimated, or legally adopted children, the
illegitimate minor children shall be entitled to 100 percent of the basic pension.

How is the monthly pension paid?

The monthly pension is paid thru the beneficiarys designated bank. The beneficiary is
allowed to choose the bank nearest his residence thru which he wishes to receive his
pension benefits under the Mag-impok sa Bangko program. This became mandatory
effective September 1, 1993.

The beneficiary must open a single savings account and must submit to the SSS his
saving account number and a photocopy of his passbook upon filing of application. The
original passbook must be presented for authentication purposes.

Upon approval of the claim, the SSS will mail a notice voucher to the beneficiary
informing him when to withdraw his benefit from the bank.

How much is the lump sum death benefit?

The primary beneficiaries of a deceased member who has paid less than 36 monthly
contributions shall be entitled to lump sum benefit which shall be the higher of:

monthly pension times the number of monthly contributions paid prior to the
semester of death; or
twelve (12) times the monthly pension.

The secondary beneficiaries of the deceased member shall be entitled to a lump sum benefit
equivalent to:

36 times the monthly pension; if the member has paid at least 36 monthly
contributions prior to the semester of death; or
monthly pension times the number of monthly contributions paid or twelve (12)
times the monthly pension, whichever is higher, if the member has paid less than
36 monthly contributions prior to the semester of death.

Is there anything else a deceased member's beneficiaries can avail of?

Yes, the deceased members beneficiaries are entitled to a 13th month pension payable
 every December and the funeral benefit, which is paid to whoever, shouldered the
funeral expenses of the deceased member.

Survivorship pensioners prior to the effectivity of RA 7875 on March 4, 1995 are also
entitled to hospitalization benefits under PhilHealth. They need to register under
PhilHealth and must submit a DDR print-out indicating the type of claim is survivorship
in nature and the effectivity date of pension or a copy of Death/Survivorship
Certification issued by the SSS indicating the effectivity of the pension shall be
submitted to PhilHealth.

Survivorship pensioners under the effectivity of RA 7875 on March 4, 1995 and thereafter, are
no longer covered. However, those who wish to avail of PhilHealth benefits may enroll in the
Individually - Paying Program (for voluntary/self-employed) or the Indigent Program (IP) of
PhilHealth.

If the deceased member has not paid any single contribution, are the beneficiaries
still entitled to the death and funeral benefits?

The primary or secondary beneficiaries of a deceased employee-member, who

had no contribution payment at all and who was reported for coverage shall be
entitled to funeral benefit only.

Are the children of a deceased member entitled to the dependents' pension?

The dependent legitimate, legitimated, legally adopted or illegitimate children,

conceived on or before the date of death of a deceased will each receive a
dependents pension equivalent to 10 percent of the members monthly pension
or P250, whichever is higher.

Only five minor children, beginning from the youngest, are entitled to the
dependents pension. No substitution is allowed.

Where there are more than five (5) legitimate and illegitimate minor children,
the legitimate shall be preferred.

For how long will the dependent child receive his pension?

The dependents pension stops when the child reaches 21 years old, gets
married, gets employed or dies. However, the dependents pension is granted
for life to children who are over 21 years old, provided they are incapacitated
and incapable of self-support due to physical or mental defect which is
congenital and acquired during minority.

What is the funeral grant?

 A funeral grant of P20,000 (effective September 1, 2000) is given to whoever
pays the burial expenses of the deceased member or pensioner.

What are the documents needed in filing death and funeral claims?

For Death claim

1. Death claim application (SSS DDR-1)

2. Filers affidavit
3. DDR Savings Account Form
4. Passbook (for Pension)
5. Report of Death (if cause of death is work-connected)
6. SSS Form CLD 13A (Affidavit for Death Claim, if claimant is a
secondary beneficiary)
7. SSS Form CLD 13 (Joint affidavit, if claimant is a legal heir)
8. Photo of filer and valid IDs
9. If married, marriage certificate of the deceased and birth certificates of
minor children (duly certified by the Local Civil Registrar)
10. If single, the deceased members birth certificate and marriage
certificate of the parents (duly certified by the Local Civil Registrar)

Note: Other papers may be required as they are found to be necessary during
the processing of the claim.

For Funeral claim

1. Claim for Funeral Benefit (SSS Form BPN-103)

2. Death certificate duly certified by the local Civil Registrar
3. Receipt of payment issued by the funeral parlor
4. Affidavit of funeral expenses
5. Report of Death (if cause of death is work-connected)
6. Photo of filer and valid IDs

Original or certified true copies of the supporting documents should be

presented during the filing of the claim.

Where does the beneficiary file for the funeral or death benefit?

Application forms for funeral/death benefit can be filed at any SSS branch or
representative office.
ANNEX A

Employees'Compensation
And State Insurance Fund
(with Implementing Rules)
Presidential Decree No. 626
(As Amended)
1998 EDITION
TABLE OF CONTENTS
Presidential Decree No. 626, as amended
Chapter I - Policy and Definitions
Chapter II - Coverage and Liability
Chapter III - Administration
Chapter IV - Contributions
Chapter V - Medical Benefits
Chapter VI - Disability Benefits
Chapter VII - Death Benefits
Chapter VIII - Provitions Common to Income Benefits
Chapter IX - Records, Reports and Penal Provisions
Implementating Rules
Statement of Authority
Rule I - Coverage
Rule II - Registration
Rule III - Compensability
Rule IV - Liability
Rule V - Employer's Contribution
Rule VI - Definitions Related to Credited Earnings
Rule VII - Benefits
Rule VIII - Medical Services, Appliances and Supplies
Rule IX - Rehabilitation Services
Rule X - Temporary Total Disability
Rule XI - Permanent Total Disability
Rule XII - Permanent Partial Disability
Rule XIII - Death
Rule XIV - Funeral Benefit
Rule XV - Beneficiaries
Rule XVI - Employer's Records and Notices
Rule XVII - Accreditation
Rule XVIII - Settlement of Claims
Rule XIX - Review by the Commission
Rule XX - Penalties
Rule XXI - Implementing Provision
Annex "A" Occupational Diseases
Annex "B" Prescribed Minimum Standards for Periodic Medical Examinations Designed for the Early
Detection of
Occupational Diseases
Annex "C" Medical Benefits
Annex "D" Suppletory Rules
Annex "E" Policy Issuances
Annex "F" Rules of Procedures for the Filing and Disposition of Employees' Compensation Claims
MALACAANG
Manila
PRESIDENTIAL DECREE NO. 626
(As amended by PD 850, PD 865-A, PD 891, PD 1368, PD 1641, PD 1692, PD 1921, EO 126 and EO 179)
FURTHER AMENDING CERTAIN ARTICLES OF PRESIDENTIAL DECREE No. 442 ENTITLED
"LABOR
CODE OF THE PHILIPPINES."
WHEREAS, Presidential Decree No. 570-A amends certain provisions of Presidential Decree No. 442,
otherwise known as the Labor Code of the Philippines, and Presidential Decree No. 608 extends the
effectivity of
Title II of Book IV onEmployees' Compensation and State Insurance Fund and Title III of Book IV on
Medicare
of the same Code to January 1, 1975;
WHEREAS, pending the effectivity of said Titles, the Social Security System, Government Service
Insurance System, Philippine Medical Care Commission, and the Department of Labor have utilized the
transition
period for intensive study and consultations with labor organizations, employer's organizations, and civic,
professional and technical associations, representing the various sectors of the economy;
WHEREAS, as a result of such discussion and consultations, it has been found necessary to make
adjustments in the text of the Labor Code to initiate, rationalize and coordinate the grant of benefits with
the
broad objectives of the Code consistent with the overriding priority of development;
NOW, THEREFORE, I, FERDINAND E. MARCOS, President of the Philippines, by virtue of the
powers vested in me by the Constitution as Commander-in-Chief of all the Armed Forces of the
Philippines and
pursuant to Proclamation No. 1081 dated September 21, 1972, as amended, do hereby order and decree:
SECTION 1. Title II of Book IV on Employees' Compensation and State Insurance Fund of the Labor
Code of the Philippines is hereby amended to read as follows:

EMPLOYEES' COMPENSATION
AND
STATE INSURANCE FUND
CHAPTER I
POLICY AND DEFINITIONS
ART. 166. Policy. - The State shall promote and develop a tax-exempt employees' compensation
program whereby employees and their dependents, in the event of work-connected disability or death,
may
promptly secure adequate income benefit, and medical or related benefits.
ART. 167. Definition of terms. - As used in this Title unless the context indicates otherwise:
(a) "Code" means the Labor Code of the Philippines instituted under Presidential Decree numbered four
hundred forty-two, as amended.
(b) "Commission" means the Employees' Compensation Commission created under this Title.
(c) "SSS" means the Social Security System created under Republic Act numbered eleven hundred
sixtyone,
as amended.
(d) "GSIS" means the Government Service Insurance System created under Commonwealth Act
numbered one hundred eighty-six, as amended.
(e) "System" means the SSS or GSIS, as the case may be.
(f) "Employer" means any person, natural or juridical, employing the services of the employee.
(g) "Employee" means any persons compulsorily covered by the GSIS under Commonwealth Act
numbered one hundred eighty-six, as amended, including members of the Armed Forces of the
Philippines, and
any person employed as casual, emergency, temporary, substitute or contractual; or any person
compulsorily
covered by SSS under Republic act numbered eleven hundred sixty-one, as amended.
(h) "Person" means any individual, partnership, firm, association, trust, corporation or legal
representative thereof.
"(i) 'Dependents' means the legitimate, legitimated, legally adopted or acknowledged natural child who
is unmarried, not gainfully employed, and not over twenty-one years of age or over twenty-one years of
age
provided he is incapacitated and incapable of self-support due to a physical or mental defect which is
congenital
or acquired during minority; the legitimate spouse living with the employee; and the parents of said
employee
wholly dependent upon him for regular support." (As amended by Sec. I, P.D. 1921).
"(j) 'Beneficiaries' means the dependent spouse until he remarries and dependent children, who are the
primary beneficiaries. In their absence, the dependent parents and subject to the restrictions imposed on
dependent children, the illegitimate children and legitimate descendants who are the secondary
beneficiaries;
Provided, that the dependent acknowledged natural child shall be considered as a primary beneficiary
when
there are no other dependent children who are qualified and eligible for monthly income benefit." (As
amended
by Sec. I, P.D. 1921).
"(k) 'Injury' means any harmful change in the human organism from any accident arising out of and in
the course of employment." (As amended by Sec. I, P.D. 1921).
(l) "Sickness" means any illness definitely accepted as an occupational disease listed by the
Commission, or any illness caused by employment, subject to proof that the risk of contracting the same
is
increased by working conditions. For this purpose, the Commission is empowered to determine and
approve
occupational diseases and work-related illness that may be considered compensable based on peculiar
hazards
of employment. (As amended by Sec. I, P.D. 1368).
(m) "Death" means loss of life resulting from injury or sickness.
(n) "Disability" means loss or impairment of a physical or mental function resulting from injury or
sickness.
(o) "Compensation" means all payments made under this Title for income benefits and medical or
related benefits.
(p) "Income benefit" means all payments made under this Title to the employee or his dependents.
(q) "Medical benefit" means all payments made under this Title to the providers of medical care,
rehabilitation services and hospital care.
(r) "Related benefit" means all payments made under this Title for appliances and supplies.
(s) "Appliances" means crutches, artificial aids and other similar devices.
(t) "Supplies" means medicines and other medical, dental or surgical items.
(u) "Hospital" means any medical facility, government or private, authorized by law, an active member
in good standing of the Philippine Hospital Association and accredited by the Commission.
(v) "Physician" means any doctor of medicine duly licensed to practice in the Philippines, an active
member in good standing of the Philippine Medical Association and accredited by the Commission.
(w) "Wages" or "Salary", insofar as they refer to the computation of benefits, means the monthly
remuneration as defined in Republic Act No. 1161, as amended, for SSS and Presidential Decree No.
1146, as
amended, for GSIS, respectively, except that part in excess of Three Thousand Pesos." (As amended by
Sec. I,
E.O. 179)
(x) "Monthly salary credit" means the wage or the salary base for contributions as provided in Republic
Act numbered eleven hundred sixty-one, as amended, or the wages or salary.
(y) "Average monthly salary credit" in the case of the SSS means the result obtained by dividing the
sum of the monthly salary credits in the sixty-month period immediately preceding the semester of death
or
permanent disability by sixty, except where the month of death or permanent disability, falls within
eighteen
calendar months from the month of coverage, in which case it is the result obtained by dividing the sum
of all
monthly salary credits paid prior to the month of the contingency by the total number of calendar months
of
coverage in the same period. (As amended by Sec. 1, P.D. 1368).
(z) "Average daily salary credit" in the case of the SSS means the result obtained by dividing the sum of
the six highest monthly salary credits in the twelve-month period immediately preceding the semester of
sickness or injury by one hundred eighty, except where the month of injury falls within the twelve
calendar
months from the first month of coverage, in which case it is the result obtained by dividing the sum of all
monthly salary credits by thirty times the number of calendar months of coverage in the same period.
In the case of the GSIS, the average daily salary credit shall be the actual daily salary or wage or the
monthly salary or wage divided by the actual number of working days of the month of contingency. (As
amended by Sec. 1, P.D. 891).
(aa) "Quarter" means a period of three consecutive months ending on the last day of March, June,
September, and December.
(bb) " Semester" means a period of two consecutive quarters ending in the quarter of death, permanent
disability, injury or sickness. (As amended by Sec. 1, P.D. 891).
(cc) "Replacement ratio" - The sum of twenty percent and the quotient obtained by dividing three
hundred by the sum of three hundred forty and the average monthly salary credit. (As amended by Sec.
1, P.D.
1641).
(dd) "Credited years of service" - For a member covered prior to January 1975, nineteen hundred
seventy five minus the calendar year of coverage, plus the number of calendar years in which six or more
contributions have been paid from January 1975 up to the calendar year containing the semester prior to
the
contingency. (As amended by Sec 1, P.D. 1641).
(ee) "Monthly income benefit" means the amount equivalent to one hundred fifteen percent of the sum
of:
The average monthly salary credit multiplied by the replacement ratio; and
One and a half percent of the average monthly salary credit for each credited year of service in excess
of ten years;
Provided, That the monthly income benefit shall in no case be less than two hundred fifty pesos. (As
amended by Sec. 1, P.D. 1921).
CHAPTER II
COVERAGE AND LIABILITY
ART. 168. Compulsory coverage. - Coverage in the State Insurance Fund shall be compulsory upon
all employers and their employees not over sixty years of age; Provided, That an employee who is over
sixty
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. (As amended by Sec. 16, P.D. 850).
ART. 169. Foreign employment. - The Commission shall ensure adequate coverage of Filipino
employees employed abroad, subject to regulations as it may prescribe.
ART. 170. Effective date of coverage. - Compulsory coverage of the employer during the effectivity
of this Title shall take effect on the first day of his operation, and that of the employee, on the date of his
employment.
ART. 171. Registration. - Each employer and his employees shall register with the System in
accordance with its regulations.
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.
ART. 173. Extent of liability. - Unless otherwise provided, the liability of the State Insurance Fund
under this Title shall be exclusive and in place of all other liabilities of the employer to the employee, his
dependents or anyone otherwise entitled to receive damages on behalf of the employee or his
dependents. The
payment of compensation under this Title shall not bar the recovery of benefits as provided for in Section
699 of
the Revised Administrative Code, Republic Act numbered eleven hundred sixty-one, as amended,
Commonwealth Act numbered one hundred eighty-six, as amended, Republic Act numbered sixty-one
hundred
eleven, as amended, Republic Act numbered six hundred ten, as amended, Republic Act numbered forty-
eight
hundred sixty-four, as amended, and other laws whose benefits are administered by the System, or by
other
agencies of the government. (As amended by Sec. 2, P.D. 1921).
ART. 174. Liability of third parties.
(a) When the disability or death is caused by circumstances creating a legal liability against a third
party, the disabled employee or the dependents in case of his death shall be paid by the System under
this Title.
In case benefit is paid under this Title, the System shall be subrogated to the rights of the disabled
employee or
the dependents in case of his death, in accordance with the general law.
(b) Where the System recovers from such third party damages in excess of those paid or allowed under
this Title, such excess shall be delivered to the disabled employee or other persons entitled hereto, after
deducting the cost of proceedings and expenses of the System. (As amended by Sec. 17, P.D. 850).
ART. 175. Deprivation of benefits. - Except as otherwise provided under this Title, no contract,
regulation or device whatsoever shall operate to deprive the employee or his dependents of any part of
the
income benefits, and medical or related services granted under this Title. Existing medical services being
provided by the employer shall be maintained and continued to be enjoyed by their employees.
CHAPTER III
ADMINISTRATION
ART. 176. Employees' Compensation Commission.
(a) To initiate, rationalize and coordinate the policies of the employees' compensation program, the
Employees' Compensation Commission is hereby created to be composed of five ex-officio members,
namely:
the Secretary of Labor and Employment as Chairman, the GSIS General Manager, the SSS Administrator,
the
Chairman of the Philippine Medical Care Commission, and the Executive Director of the ECC Secretariat,
and two
appointive members, one of whom shall represent the employees and the other, the employers, to be
appointed
by the President of the Philippines for a term of six years. The appointive member shall have at least five
years
experience in workmen's compensation or social security programs. All vacancies shall be filled for the
unexpired
term only. (As amended by Sec. 19(c), E.O. 126).
(b) The Vice Chairman of the Commission shall be alternated each year between the GSIS General
Manager and the SSS Administrator. The presence of four Members shall constitute a quorum. Each
Member
shall receive a per diem of two hundred pesos for every meeting that is actually attended by him,
exclusive of
actual, ordinary and necessary travel and representation expenses. In his absence, any Member may
designate
an official of the institution he serves on full-time basis as his representative to act in his behalf. (As
amended
by Sec. 2, P.D. 1368).
(c) The general conduct of the operations and management functions of the GSIS or SSS under this
Title shall be vested in its respective chief executive officer, who shall be immediately responsible for
carrying
out the policies of the Commission.
(d) The Commission shall have the status and category of a government corporation, and it is hereby
deemed attached to the Department of Labor for policy coordination and guidance. (As amended by Sec.
2, P.D.
1368).
ART. 177. Powers and duties. - The Commission shall have the following powers and duties:
(a) To assess and fix a rate of contribution from all employers;
(b) To determine the rate of contribution payable by an employer whose records show a high frequency
of work accidents or occupational disease due to failure by the said employer to observe adequate safety
measures;
(c) To approve rules and regulations governing the processing of claims and the settlement of disputes
arising therefrom as prescribed by the System;
(d) To initiate policies and programs toward adequate occupational health and safety and accident
prevention in the working environment, rehabilitation other than those provided for under Art. 190
hereof, and
other related programs and activities, and to appropriate funds therefor. (As amended by Sec. 3, P.D.
1368).
(e) To make the necessary actuarial studies and calculations concerning the grant of constant help and
income benefits for permanent disability or death, and the rationalization of the benefits for permanent
disability
and death under the Title with benefits payable by the System for similar contingencies; Provided; That
the
Commission may upgrade benefits and add new ones subject to approval of the President; and
Provided,
Further, That the actuarial stability of the State Insurance Fund shall be guaranteed; Provided,
Finally, that
such increases in benefits shall not require any increases in contribution, except as provided for in
paragraph (b)
hereof. (As amended by Sec. 3, P.D. 1641).
(f) To appoint the personnel of its staff, subject to civil service law and rules, but exempt from WAPCO
law and regulations;
(g) To adopt annually a budget of expenditures of the Commission and its staff chargeable against the
State Insurance Fund: Provided, that the SSS and GSIS shall advance on a quarterly basis the
remittances of
allotment of the loading fund for this Commission's operational expenses based on its annual budget as
duly
approved by the Ministry of Budget and Management. (As amended by Sec. 3, P.D. 1921).
(h) To have the power to administer oath and affirmation, and to issue subpoena and subpoena
duces tecum in connection with any question or issue arising from appealed cases under this Title.
(i) To sue and be sued in court;
(j) To acquire property, real or personal, which may be necessary or expedient for the attainment of the
purposes of this Title;
(k) To enter into agreements or contracts for such services or aid as may be needed for the proper,
efficient and stable administration of the program;
(l) To perform such other acts as it may deem appropriate for the attainment of the purposes of the
Commission and proper enforcement of the provisions of this Title. (As amended by Sec. 18, P.D.850).
ART. 178. Management of funds. - All revenues collected by the System under this Title shall be
deposited, invested, administered and disbursed in the same manner and under the same conditions,
requirements and safeguards as provided by Republic Act numbered eleven hundred sixty-one, as
amended,
and Commonwealth Act numbered one hundred eighty-six, as amended, with regard to such other funds
as are
thereunder being paid to or collected by the SSS and GSIS, respectively: Provided, that the Commission,
SSS
and GSIS may disburse each year not more than twelve percent of the contributions and investment
earnings
collected for operational expenses, including occupational health and safety programs, incidental to the
carrying
out of this Title.
ART. 179. Investment of funds. - Provisions of existing laws to the contrary notwithstanding, all
revenues as are not needed to meet current operational expenses under this Title shall be accumulated in
a
fund to be known as the State Insurance Fund, which shall be used exclusively for payment of the
benefits
under this Title, and no amount thereof shall be used for any other purpose. All amounts accruing to the
State
Insurance Fund, which is hereby established in the SSS and GSIS, respectively, shall be deposited with
any
authorized depository bank approved by the Commission, or invested with due and prudent regard for
the
liquidity needs of the System. (As amended by Sec. 4, P.D. 1368).
ART. 180. Settlement of claims. - The System shall have original and exclusive jurisdiction to settle
any dispute arising from this Title with respect to coverage, entitlement to benefits, collection and
payment of
contributions and penalties thereon, or any other matter related thereto, subject to appeal to the
Commission,
which shall decide appealed cases within twenty working days from the submission of the evidence.
ART. 181. Review. - Decisions, orders or resolutions of the Commission may be reviewed on certiorari
by the Supreme Court on questions of law upon petition of an aggrieved party within ten days from
notice
thereof.
ART. 182. Enforcement of decisions.
(a) Any decision, order or resolution of the Commission shall become final and executory if no appeal is
taken therefrom within ten days from notice thereof. All awards granted by the Commission in cases
appealed
from decisions of the System shall be effected within fifteen days from receipt of notice.
(b) In all other cases, decisions, orders and resolutions of the Commission which have become final and
executory shall be enforced and executed in the same manner as decisions of the Court of First Instance,
and
the Commission shall have the power to issue to the city or provincial sheriff or to the sheriff whom it
may
appoint such writs of execution as may be necessary for the enforcement of such decisions, orders or
resolutions, and any person who shall fail or refuse to comply therewith shall, upon application by the
Commission, be punished by the proper court for contempt.
CHAPTER IV
CONTRIBUTIONS
ART. 183. Employer's contributions.
(a) Under such regulations as the System may prescribe, beginning as of the last day of the month
when an employee's compulsory coverage takes effect and every month thereafter during his
employment, his
employer shall prepare to remit to the System a contribution equivalent to one percent of his monthly
salary
credit.
(b) The rate of contribution shall be reviewed periodically and, subject to the limitations herein
provided, may be revised as the experience in risk, cost of administration, and actual or anticipated as
well as
unexpected losses, may require.
(c) Contributions under this Title shall be paid in their entirety by the employer and any contract or
device for the deduction of any portion thereof from the wages or salaries of the employees shall be null
and
void.
(d) When a covered employee dies, becomes disabled or is separated from employment, his employer's
obligation to pay the monthly contribution arising from that employment shall cease at the end of the
month of
contingency and during such months that he is not receiving wages or salary.
ART. 184. Government guarantee. - The Republic of the Philippines guarantees the benefits under
this Title, and accepts general responsibility for the solvency of the State Insurance Fund. In case of any
deficiency, the same shall covered by supplemental appropriations from the national government.
CHAPTER V
MEDICAL BENEFITS
ART. 185. Medical services. - Immediately after an employee contracts sickness or sustains an
injury, he shall be provided by the System during the subsequent period of his disability with such
medical
services and appliances as the nature of his sickness or injury and progress of his recovery may require,
subject
to the expense limitation prescribed by the Commission.
ART. 186. Liability. - The System shall have the authority to choose or order a change of physician,
hospital or rehabilitation facility for the employee, and shall not be liable for compensation for any
aggravation
of the employee's injury or sickness resulting from unauthorized changes by the employee of medical
services,
appliances, supplies, hospitals, rehabilitation facilities or physicians.
ART. 187. Attending Physician. - Any physician attending an injured or sick employee shall comply
with all the regulations of the System and submit reports in prescribed forms at such time as may be
required
concerning his condition or treatment. All medical information relevant to the particular injury or sickness
shall
on demand be made available to the employee or the System. No information developed in connection
with
treatment or examination for which compensation is sought shall be considered as privileged
communication.
ART. 188. Refusal of examination or treatment. - If the employee unreasonably refuses to submit
to medical examination or treatment, the System shall stop the payment of further compensation during
such
time as such refusal continues. What constitutes an unreasonable refusal shall be determined by the
System
which may on its own initiative determine the necessity, character and sufficiency of any medical services
furnished or to be furnished.
ART. 189. Fees and other charges. - All fees and other charges for hospital services, medical care
and appliances excluding professional fees shall not be higher than those prevailing in wards of hospitals
for
similar services to injured or sick persons in general and shall be subject to the regulations of the
Commission.
Professional fees shall only be appreciably higher than those prescribed under Republic Act numbered
sixty-one
hundred eleven, as amended, otherwise known as the Philippine Medical Care Act of 1969.
ART. 190. Rehabilitation services.
(a) The System shall, as soon as practicable, establish a continuing program for the rehabilitation of
injured and handicapped employees, who shall be entitled to rehabilitation services, which shall consist of
medical, surgical or hospital treatment, including appliances if they have been handicapped by the injury,
to help
them become physically independent.
(b) As soon as practicable, the System shall establish centers equipped and staffed to provide a
balanced program of remedial treatment, vocational assessment and preparation designed to meet the
individual needs of each handicapped employee to restore him to suitable employment, including
assistance as
may be within its resources to help each rehabilitee to develop his mental, vocational or social potential.
CHAPTER VI
DISABILITY BENEFITS
ART. 191. Temporary total disability.
(a) Under such regulations as the Commission may approve, any employee under this Title who
sustains an injury or contracts sickness resulting in temporary total disability shall for each day of such a
disability or fraction thereof be paid by the System an income benefit equivalent to ninety percent of his
average
daily salary credit, subject to the following conditions: The daily income benefit shall not be less than Ten
Pesos
nor more than Ninety Pesos, nor paid for a continuous period longer than one hundred twenty days,
except as
otherwise provided for in the Rules, and the System shall be notified of the injury or sickness. (As
amended by
Sec. 2, E.O. 179).
(b) The monthly income benefit shall be in accordance with the regulations of the Commission. (As
amended by Sec. 19, P.D. 850).
ART. 192. Permanent total disability.
(a) Under such regulations as the Commission may approve, any employee under this Title who
contracts sickness or sustains an injury resulting in his permanent total disability shall, for each month
until his
death, be paid by the System during such a disability, an amount equivalent to the monthly income
benefit, plus
ten percent thereof for each dependent child, but not exceeding five, beginning with youngest and
without
substitution: Provided, That the monthly income benefit shall be the new amount of the monthly benefit
for all
covered pensioners, effective upon approval of this Decree.
(b) The monthly income benefit shall be guaranteed for five years, and shall be suspended if the
employee is gainfully employed, or recovers from his permanent total disability, or fails to present himself
for
examination at least once a year upon notice by the System, except as otherwise provided for in other
laws,
decrees, orders or Letters of Instructions. (As amended by Sec. 5, P.D. 1641).
(c) The following disabilities shall be deemed total and permanent:
(1) Temporary total disability lasting continuously for more than one hundred twenty days,
except as otherwise provided for in the Rules;
(2) Complete loss of sight of both eyes;
(3) Loss of two limbs at or above the ankle or wrist;
(4) Permanent complete paralysis of two limbs;
(5) Brain injury resulting in incurable imbecility or insanity; and
(6) Such cases as determined by the Medical Director of the System and approved by the
Commission.
(d) The number of months of paid coverage shall be defined and approximated by a formula to be
approved by the Commission.
ART. 193. Permanent partial disability.
(a) Under such regulation as the Commission may approve, any employee under this Title who
contracts sickness or sustains an injury resulting in permanent partial disability shall for each month not
exceeding the period designated herein be paid by the System during such a disability an income benefit
equivalent to the income benefit for permanent total disability.
(b) The benefit shall be paid for not more than the period designated in the following schedule:
Complete and permanent loss of the use of
One thumb 10
One index finger 8
One middle finger 6
One ring finger 5
One little finger 3
One big toe 6
Any toe 3
One arm 50
One hand 39
One foot 31
One leg 46
One ear 10
Both ears 20
Hearing of one ear 10
Hearing of both ears 50
Sight of one eye 25
(c) A loss of a wrist shall be considered as a loss of the hand, and a loss of an elbow shall be
considered as a loss of the arm. A loss of an ankle shall be considered as a loss of the foot, and a loss of
a knee
shall be considered as a loss of the leg. A loss of more than one joint shall be considered as a loss of the
whole
finger or toe, and a loss of only the first joint shall be considered as a loss of one-half of the whole finger
or toe:
Provided, That such a loss shall be either the functional loss of the use or physical loss of the member.
(As
amended by Sec. 7, P.D. 1368).
(d) In case of permanent partial disability less than the total loss of the member specified in the
preceding paragraph, the same monthly income benefit shall be paid for a portion of the period
established for
the total loss of the member in accordance with the proportion that the partial loss bears to the total loss.
If the
result is a decimal fraction, the same shall be rounded off to the next higher integer.
(e) In cases of simultaneous loss of more than one member or a part thereof as specified in this Article,
the same monthly income benefit shall be paid for a period equivalent to the sum of the periods
established for
the loss of the member or a part thereof. If the result is a decimal fraction, the same shall be rounded off
to the
next higher integer.
(f) In cases of injuries or illnesses resulting in a permanent partial disability not listed in the preceding
schedule, the benefit shall be an income benefit equivalent to the percentage of the permanent loss of
the
capacity for work. (As amended by Sec. 7, P.D. 1368).
(g) Under such regulations as the Commission may approve, the income benefit payable in case of
permanent partial disability may be paid in monthly pension or in lumpsum if the period covered does not
exceed one year. (As added by Sec. 7, P.D. 1368).
CHAPTER VII
DEATH BENEFITS
ART. 194. Death.
(a) Under such regulations as the Commission may approve, the System shall pay to the primary
beneficiaries upon the death of the covered employee under this Title an amount equivalent to his
monthly
income benefit, plus ten percent thereof for each dependent child, but not exceeding five, beginning with
the
youngest and without substitution, except as provided for in paragraph (j) of Article 167 hereof:
Provided,
However, That the monthly income benefit shall be guaranteed for five years: Provided, Further, That
if he
has no primary beneficiary, the System shall pay to his secondary beneficiaries the monthly income
benefit but
not to exceed sixty months: Provided, Finally, That the minimum death benefit shall not be less than
fifteen
thousand pesos. (As amended by Sec. 4, P.D. 1921).
(b) Under such regulations as the Commission may approve, the System shall pay to the primary
beneficiaries upon the death of a covered employee who is under permanent total disability under this
Title,
eighty percent of the monthly income benefit and his dependents to the dependents pension; Provided,
That
the marriage must have been validly subsisting at the time of disability: Provided, Further, That if he
has no
primary beneficiary, the System shall pay to his secondary beneficiaries the monthly pension excluding
the
dependents pension, of the remaining balance of the five-year guaranteed period: Provided, Finally, That
the
minimum death benefit shall not be less than fifteen thousand pesos. (As amended by Sec. 4, P.D. 1921).
(c) The monthly income benefit provided herein shall be the new amount of the monthly income benefit
for the surviving beneficiaries upon the Approval of this decree. (As amended by Sec. 8, P.D. 1368).
(d) Funeral Benefit. - A funeral benefit of Three Thousand Pesos (P3,000.00) shall be paid upon the
death of a covered employee or permanently totally disabled pensioner. (As amended by Sec. 3,
E.O.179).
Note: ECC Resolution No. 92 - 07 - 0032, dated July 8, 1992 increased the funeral benefit for the private sector to eight thousand pesos
(P8,000.00)
effective May 1, 1992.
CHAPTER VIII
PROVISIONS COMMON TO INCOME BENEFITS
ART. 195. Relationship and dependency. - All questions of relationship and dependency shall be
determined as of the time of death.
ART. 196. Delinquent contributions.
(a) An employer who is delinquent in his contributions shall be liable to the System for the benefits
which may have been paid by the System to his employees or their dependents, and any benefit and
expenses
to which such employer is liable shall constitute a lien on all his property, real or personal which is hereby
declared to be preferred to any credit, except taxes. The payment by the employer of the lump sum
equivalent
of such liability shall absolve him from the payment of the delinquent contributions and penalty thereon
with
respect to the employee concerned.
(b) Failure or refusal of the employer to pay or remit the contributions herein prescribed shall not
prejudice the right of the employee or his dependents to the benefits under this Title. If the sickness,
injury,
disability or death occurs before the System receives any report of the name of his employee, the
employer shall
be liable to the System for the lump sum equivalent to the benefits to which such employee or his
dependents
may be entitled.
ART. 197. Second injuries. - If any employee under permanent partial disability suffers another
injury which results in a compensable disability greater than the previous injury, the State Insurance
Fund shall
be liable for the income benefit of the new disability: Provided, That if the new disability is related to
the
previous disability, the System shall be liable only for the difference in income benefits.
ART. 198. Assignment of benefits. - No claim for compensation under this Title shall be
compensable is transferable, or liable to tax, attachment, garnishment, levy or seizure by or under any
legal
process whatsoever, either before or after receipt by the person or persons entitled thereto, except to
pay any
debt of the employee to the System.
ART. 199. Earned benefits. - Income benefits shall, with respect to any period of disability, be
payable in accordance with this Title to an employee who is entitled to receive wages, salaries or
allowance for
holidays, vacation or sick leaves and any award of benefit under a collective bargaining or other
agreement.
ART. 200. Safety devices. - In case the employees injury or death was due to the failure of the
employer to comply with any law, or to install and maintain safety devices, or take other precautions for
the
prevention of injury, said employer shall pay to the State Insurance Fund a penalty of twenty-five percent
of the
lump sum equivalent of the income benefit payable by the System to the employee. All employers,
especially
those who should have been paying a rate of contribution higher than that required of them under this
Title, are
enjoined to undertake and strengthen measures for the occupational health and safety of their
employees.
ART. 201. Prescriptive period. - No claim for compensation shall be given due course unless said
claim is filed with the System within three years from the time the cause of action accrued. (As amended
by
Sec. 5. P.D. 1921).
ART. 202. Erroneous payment.
(a) If the System in good faith pays income benefit to a dependent who is inferior in right to another
dependent or with whom another dependent is entitled to share, such payment shall discharge the
System from
liability, unless and until such other dependent notifies the System of his claim prior to the payments.
(b) In case of doubt as to the respective rights of rival claimants, the System is hereby empowered to
determine as to whom payments should be made in accordance with such regulations as the Commission
may
approve. If the money is payable to a minor or incompetent, payment shall be made by the System to
such
person or persons as it may consider to be best qualified to take care and dispose of the minors or
incompetents property for his benefit.
ART. 203. Prohibition. - No agent, attorney or other person pursuing or in charge of the preparation
or filing of any claim for benefit under this Title shall demand or charge for his services any fee, and any
stipulation to the contrary shall be null and void. The retention or deduction of any amount from any
benefit
granted under this Title for the payment of fees of such services is prohibited. Violation of any provision
of this
Article shall be punished by a fine of not less than five hundred pesos nor more than five thousand pesos,
or
imprisonment for not less than six months nor more than one year, or both, at the discretion of the court.
ART. 204. Exemption from levy, tax, etc. - All laws to the contrary notwithstanding, the State
Insurance Fund and all its assets shall be exempt from any tax, fee, charge, levy, or customs or import
duty,
and no law hereafter enacted shall apply to the State Insurance Fund unless it is provided therein that
the same
is applicable by expressly stating its name.
CHAPTER IX
RECORDS, REPORTS AND PENAL PROVISIONS
ART. 205. Record of death or disability.
(a) All employers shall keep a logbook to record chronologically the sickness, injury or death of their
employees, setting forth therein their names, dates and places of the contingency, nature of the
contingency
and absences. Entries in the logbook shall be made within five days from notice or knowledge of the
occurrence
of the contingency. Within five days after entry in the logbook, the employer shall report to the System
only
those contingencies he deems to be work-connected.
(b) All entries in the employers logbook shall be made by the employer or any of his authorized official
after verification of the contingencies or the employees absences for a period of a day or more. Upon
request
by the System, the employer shall furnish the necessary certificate regarding information about any
contingency
appearing in the logbook, citing the entry number, page number and date. Such logbook shall be made
available
for inspection to the duly authorized representative of the System.
(c) Should any employer fail to record in the logbook an actual sickness, injury or death of any of his
employees within the period prescribed herein, give false information or withhold material information
already in
his possession, he shall be held liable for fifty percent of the lump sum equivalent of the income benefit
to which
the employee may be found to be entitled, the payment of which shall accrue to the State Insurance
Fund.
(d) In case of payment of benefits for any claim which is later determined to be fraudulent and the
employer is found to be a party to the fraud, such employer shall reimburse to the System the full
amount of
the compensation paid.
ART. 206. Notice of sickness, injury or death. - Notice of sickness, injury or death shall be given
to the employer by the employee or by his dependents or anybody on his behalf within five days from the
occurrence of the contingency. No notice to the employer shall be required if the contingency is known to
the
employer or his agents or representatives.
ART. 207. Penal provisions.
(a) The penal provision of Republic Act numbered eleven hundred sixty-one, as amended, and
Commonwealth Act numbered one hundred eighty-six, as amended, with regard to the funds as are
thereunder
being paid to, collected or disbursed by the System, shall be applicable to the collection, administration
and
disbursement of the Funds under this Title. The penal provisions on coverage shall also be applicable.
(b) Any person, who for the purpose of securing entitlement to any benefit or payment under this Title
or the issuance of any certificate or document for any purpose connected with this Title, whether for him
or for
some other person, commits fraud, collusion, falsification, misrepresentation of facts or any other kind of
anomaly shall be punished with a fine of not less than five hundred pesos nor more than five thousand
pesos
and an imprisonment for not less than six months nor more than one year, at the discretion of the court.
(c) If the act penalized by this Article is committed by any person who has been or is employed by the
Commission or System, or a recidivist, the imprisonment shall not be less than one year; if committed by
a
lawyer, physician or other professional, he shall in addition to the penalty prescribed herein be
disqualified from
the practice of his profession; and if committed by any official, employee or personnel of the Commission,
System or any government agency, he shall in addition to the penalty prescribed herein be dismissed
with
prejudice to reemployment in the government service.
ART. 208. Applicability. - This Title shall apply only to injury, sickness, disability or death occurring
on or after January 1, 1975.
ART. 208-A. Repeal of Laws. - All existing laws, Presidential Decrees and Letter of Instructions
which are inconsistent with or contrary to this Decree, are hereby repealed: Provided, That in the case
of the
GSIS, condition for entitlement to benefits shall be governed by the Labor Code, as amended: Provided,
However, That the formulas for the computation of benefits, as well as the contribution base, shall be
those
provided for under Commonwealth Act numbered one hundred eighty-six, as amended by Presidential
Decree
No. 1146, plus twenty percent thereof. (As amended by Sec. 7, P.D. 1641).
SECTION 2. Title III of Book IV on Medicare of the same Code is hereby amended to read as follows:
ART. 209. Medical Care. - The Philippine Medical Care Plan shall be implemented as provided under
Republic Act numbered sixty-one hundred eleven, as amended.
SECTION 3. Article 292 of Title II of Book VII on Prescription of Offenses and Claims of the same code
is hereby amended to read as follows:
ART. 292. Money claims. - All money claims arising from employer-employee relations accruing
during the effectivity of this Code shall be filed within three (3) years from the time the cause of action
accrued;
otherwise, they shall be forever barred.
All money claims accruing prior to the effectivity of this Code shall be filed with the appropriate entities
established under this Code within one year from the date of such effectivity, and shall be processed or
determined in accordance with the implementing rules and regulations of the Code; otherwise, they shall
be
forever barred.
Workmens compensation claims accruing prior to the effectivity of this Code and during the period from
November 1, 1974 up to December 31, 1974, shall be filed with the appropriate regional offices of the
Department of Labor not later than March 31, 1975; otherwise, they shall be forever barred. these claims
shall
be processed and adjudicated in accordance with the law and rules at the time their causes of action
accrued.
(As amended by P.D. 570-A).
SECTION 4. Article 297 of Title III of Book VII on Transitory and Final Provisions of the same Code is
hereby amended to read as follows:
ART. 297. Termination of Workmens Compensation Program. - The Bureau of Workmens
Compensation, the Workmens Compensation Commission and the Workmens Compensation Units in the
regional offices of the Department of Labor shall continue to exercise the functions and the respective
jurisdictions over workmens compensation cases vested upon them by Act No. 3428 as amended,
otherwise
known as the Workmens Compensation Act, until March 31, 1976. Likewise, the term of office of
incumbent
members of the Workmens Compensation Commission, including its chairman and any commissioner
deemed
retired as of December 31, 1975, as well as the present employees and officials of the Bureau of
Workmens
Compensation, Workmens Compensation Commission and the Workmens Compensation Units shall
continue up
to that date. Thereafter, said Offices shall be abolished and all officials and personnel thereof shall be
transferred to and mandatorily absorbed by the Department of Labor, subject to Presidential Decree No.
6,
Letters of Instructions No. 14 and 14-A and the Civil Service Law and rules.
Such amount as may be necessary to cover the operational expenses of the Bureau of Workmens
Compensation, the Workmens Compensation Commission, and the Workmens Compensation Unit,
including the
salaries of incumbent personnel for the period up to March 31, 1976 shall be appropriated from the
unprogrammed funds of the Department of Labor. (As amended by P.D. 570-A and Sec. 1, P.D. 865-A).
SECTION 5. Article 300 of Title III of Book VII on Transitory and Final Provisions of the same Code is
hereby amended to read as follows:
ART. 300. Disposition of pending cases. - All cases pending before the Court of Industrial Relations
and the National Labor Relations Commission established under Presidential Decree No. 21 on the date of
effectivity of this Code shall be transferred to and processed by the corresponding labor relations division
or the
National Labor Relations Commission created under this Code having cognizance of the same in
accordance with
the procedure laid down herein and its implementing rules and regulations. Cases on labor relations on
appeal
with the Secretary of Labor or the Office of the President of the Philippines as of the date of effectivity of
this
Code shall remain under their respective jurisdictions and shall be decided in accordance with law, rules
and
regulations in force at the time of appeal.
All workmens compensation cases pending before the Workmens Compensation Units in the regional
offices of the Department of Labor and those pending before the Workmens Compensation Commission
as of
March 31, 1975, shall be processed and adjudicated in accordance with the law, rules and procedure
existing
prior to the effectivity of the Employees Compensation and State Insurance Fund. (As amended by P.D.
570-A).
SECTION 6. The numbers of the Articles of the same Code shall be amended by renumbering them
consecutively beginning with Art. 1.
SECTION 7. This Decree shall take effect on January 1, 1975.
Done in the City of Manila, this 27th day of December, in the Year of our Lord, Nineteen Hundred
Seventy Four.
(Sgd.) FERDINAND E. MARCOS
President
Republic of the Philippines
Note: PD 570-A took effect on November 1, 1974. PD 626 was signed by the President on December 27, 1974 and took effect on January
1, 1975.
PD 850 took effect on December 16, 1975.
PD 865-A took effect on December 31, 1975.
PD 891 took effect on February 9, 1976.
PD 1368 took effect on May 1, 1978.
PD 1641 took effect on January 1, 1980.
PD 1692 took effect on May 1, 1980.
PD 1921 took effect on June 1, 1984.
EO 179 took effect on June 1, 1987.
ANNEX B
Amended Rules
on
Employees' Compensation
STATEMENT OF AUTHORITY
By virtue of the powers vested upon the Employees Compensation Commission under the Labor Code
of the Philippines, the following Rules are hereby adopted to implement the provisions of Title II, Book IV
of this
Code.
RULE I - COVERAGE
SECTION 1. Nature. - Coverage shall be compulsory.
SECTION 2. Scope.
(a) Every employer shall be covered.
(b) Every employee not over 60 years of age shall be covered.
(c) An employee over 60 years of age shall be covered if he had been paying contributions to the
System prior to age 60 and has not been compulsorily retired.
(d) An employee who is coverable by both the GSIS and SSS shall be compulsorily covered by both
Systems.
SECTION 3. Employer.
(a) The term shall mean any person, natural or juridical, domestic or foreign, who carries on in the
Philippines any trade, business, industry, undertaking or activity of any kind and uses the services of
another
person who is under his orders as regards the employment.
(b) An employer shall belong to either:
(1) The public sector covered by the GSIS, comprising the National Government, including
government-owned or controlled corporations, the Philippine Tuberculosis Society, the Philippine National
Red
Cross and the Philippine Veterans Bank; or
(2) The private sector covered by the SSS, comprising all employers other than those defined in
the immediately preceding paragraph.
SECTION 4. Employee.
(a) The term shall mean any person who performs services for an employer as defined in Section 3
hereof.
(b) employee shall belong to either:
(1) The public sectors comprising the employed workers who are covered by the GSIS,
including the members of the Armed Forces of the Philippines, elective officials who are receiving regular
salary,
and any person employed as casual, emergency, temporary, substitute or contractual.
(2) The private sector comprising the employed workers who are covered by the SSS.
SECTION 5. Foreign employment.
(a) Filipinos working abroad in the service of an employer as defined in Section 3 hereof shall be
covered by the System, and entitled to the same benefits as are provided for employees working in the
Philippines.
(b) Medical services, including appliances and supplies for Filipinos employed abroad rendered or
provided in such place of employment, shall be paid in accordance with, and subject to the limitations
fixed in,
these Rules; provided that the Rules on Accreditation shall not apply in these cases.
(c) The notice requirement under these Rules shall not be strictly applied.
(d) Medical certifications of physicians, and statement of accounts of hospitals, when duly
authenticated, are acceptable as basis for payment, provided that the standard and rates payable by the
System
shall be those provided for under these Rules.
SECTION 6. Effectivity.
(a) Coverage of employers shall take effect on the first day of operation but not earlier than January 1,
1975.
(b) Coverage of employees shall take effect on the first day of employment.
RULE II - REGISTRATION
SECTION 1. Requirement.
(a) Every employer shall register with the System by accomplishing the prescribed forms.
(b) Every employee shall be registered with the System through his employer by accomplishing the
prescribed forms.
SECTION 2. GSIS. - The following guidelines shall apply to the public sector.
(1) Every employer operating before January 1, 1975 shall register not later than March 31, 1975;
(2) Every employer operating on or after January 1, 1975 shall register within one month from the first
day of operation, and
(3) Every employee shall be registered through his employer within one month from the date of
employment.
SECTION 3. SSS.
(a) The following guidelines shall apply to the private sector:
(1) Every employer already registered need not register again, for he is automatically
registered;
(2) Every employer not yet registered shall register not later than the first day of operation;
(3) Every employee already registered need not register again, for he is automatically
registered.
(4) Every employee not yet registered shall register not later than the date of employment; and
(5) Only one registration is needed for SSS, Medicare and Employees Compensation.
(b) In case the employee has not yet been registered, he shall be reported by his employer according to
the following guidelines:
(1) Every employer already registered need not register again, for he is automatically
registered.
(2) Every newly hired employee shall be reported by his employer not later than 30 days from
the date of employment; and
(3) Every employee shall be deemed as having been duly reported for coverage if the System
has received a written communication about him from his employer or an EC contribution paid in his
name by
his employer, before a compensable contingency occurs.
SECTION 4. Penalty. - Any violation under this Rule shall be penalized as follows:
(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 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.
RULE III - COMPENSABILITY
SECTION 1. Grounds.
(a) For the injury and the resulting disability or death to be compensable, the injury must be the result
of accident arising out of and in the course of the employment. (ECC Resolution No. 2799, July 25, 1984).
(b) For the sickness and the resulting disability or death to be compensable, the sickness must be the
result of an occupational disease listed under Annex A of these Rules with the conditions set therein
satisfied,
otherwise, proof must be shown that the risk of contracting the disease is increased by the working
conditions.
(c) Only injury or sickness that occurred on or after January 1, 1975 and the resulting disability or death
shall be compensable under these Rules.
SECTION 2. Occupational diseases.
(a) The diseases listed in Annex A of these Rules are occupational when the nature of employment is
as described therein.
(b) The employer shall require pre-employment examination of all prospective employees; provide
periodic medical examination to employees who are exposed to occupational diseases and take such
other
measures as may be necessary.
(c) The periodic medical examination for the early detection of occupational diseases shall be in
accordance with the minimum standards prescribed in Annex B hereof.
SECTION 3. Authority of the Commission. - The Commission is hereby authorized to determine
and approve additional occupational diseases and work-related illnesses with specific criteria based on
peculiar
hazards of employment.
RULE IV - LIABILITY
SECTION 1. Limitation. - No compensation shall be allowed to the employee or his dependents when
the injury, sickness, disability or death was occasioned by any of the following:
(1) his intoxication;
(2) his willful intention to injure or kill himself or another; or
(3) his notorious negligence.
SECTION 2. Extent of Liability.
(a) Unless otherwise provided, the liability of the State Insurance Fund, shall be exclusive and in place
of all other liabilities of the employer to the employee or his dependents or anyone otherwise entitled to
receive
damages on behalf of the employee or his dependents.
(b) The payment of compensation under this Title shall not bar the recovery of benefits as provided for
in Section 699 of the Revised Administrative Code, Commonwealth Act numbered 186, as amended,
Republic
Act numbered eleven hundred sixty one, as amended, Republic Act numbered six hundred ten, as
amended,
Republic Act numbered forty-eight hundred sixty-four, as amended, and other laws whose benefits are
administered by the System or by other agencies of the government. (ECC Resolution No. 2799, July 25,
1984).
SECTION 3. Third parties. - When disability or death is caused by circumstances creating a legal
liability against a third party, the disabled employee or the dependents in case of his death shall be paid
benefit
from the System under these Rules. In case benefit is claimed and allowed under these Rules, the
System shall
be subrogated to the rights of the disabled employee or the dependents in case of his death in
accordance with
existing laws.
SECTION 4. Unauthorized changes. - The System shall not be liable for compensation for
unauthorized changes in medical services, appliances, supplies, hospitals, rehabilitation services or
physicians.
Should there be any reason for such changes, the employee or his dependents shall notify the System
and
secure its prior consent before the change may be effected.
SECTION 5. Medical reports.
(a) An employee enjoying temporary total disability benefits shall submit to the System a monthly
medical report on his disability certified by his attending physician, otherwise his benefit shall be
suspended until
such time that he complies with this requirement.
(b) An employee enjoying permanent disability benefit where the disability resulted from a disease shall
submit to the System a quarterly medical report on his disability certified by his physician, otherwise his
benefit
shall be suspended until such time that he complies with his requirement.
RULE V - EMPLOYERS CONTRIBUTION
SECTION 1. Rate and amount. - Subject to the following conditions, contributions under this Rules
shall be paid in their entirety by the employer and any contract or device for the deduction of any portion
thereof from the wages or salary of the employees shall be null and void:
(1) For a covered employee in the public sector, his employer shall remit to the GSIS a monthly
contribution equivalent to one percent of the actual wages or salary received by him as of the last day of
the
month but not to exceed P30 per employee. (ECC Resolution No. 1451 dated December 27, 1979).
(2) For a covered employee in the private sector, his employer shall remit to the SSS a monthly
contribution equivalent to one percent of his monthly salary credit as of the last day of the month, in
accordance
with the following schedule:
Salary Bracket Range of Wage or Salary Monthly Salary
Credit
Employer's
Contribution
I P 1 - P 49.99 P 25 P 0.25
II 50 - 99.99 75 0.75
III 100 - 149.99 125 1.25
IV 150 - 199.99 175 1.75
V 200 - 249.99 225 2.25
VI 250 - 349.99 300 3.00
VII 350 - 499.99 425 4.25
VIII 500 - 699.99 600 6.00
(3) When a covered employee dies during employment, or is separated from employment, his
employers obligation to pay the monthly contribution arising from that employment shall cease on the
last day
of the month of contingency.
(4) When a covered employee becomes disabled during employment, his employers obligation to pay
the monthly contribution arising from that employment shall be suspended during such months that he is
not
receiving salary or wages.
(5) No refund of contribution shall be allowed under these Rules.
SECTION 2. Remittance. - Contributions shall start in January 1975 and every month thereafter for
as long as the employee has earnings. The initial contribution for the month of January 1975 shall be
remitted
by the employer to the System in February 1975, unless some other arrangement has been agreed by
the
System and the employer.
SECTION 3. Penalty. - Any violation of the provisions on contribution under these Rules shall be
penalized as follows:
(1) Any employer who is delinquent in his contributions shall be liable to the System for the benefits
which may have been paid to his employees or their dependents, and any benefit and expenses to which
such
employer is liable shall constitute a preferred lien on all his property, real or personal, over any credit
except
taxes:
(2) The payment by the employer of the lump sum equivalent of such liability shall absolve him from
the payment of the delinquent contributions due and payable during the calendar year of the contingency
and
penalty thereon with respect to the employee concerned, but said employer shall be subject to criminal
liability;
(3) In case of such delinquency 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 a rectification of the violation has been made, at
the
Courts discretion;
(4) If any contribution is not paid to the SSS as prescribed under these Rules, the employer shall pay
besides the contribution a penalty thereon of 3 percent a month from the date of the contribution falls
due until
paid.
Note: Under ECC Resolution No. 1243 dated Jan. 18, 1979, the System shall pay the employee or his dependents all
benefits due them under PD 626, as amended, without prejudice on its part to proceed against the erring employer.
RULE VI - DEFINITIONS RELATED TO CREDITED EARNINGS
SECTION 1. Quarter. - A period of three consecutive calendar months ending on the last day of
March, June, September and December.
SECTION 2. Semester. - A period of two consecutive quarters ending in the quarter of contingency.
SECTION 3. Monthly salary credit. - The wage base for contributions or the actual salary, as
provided in Section 1 of Rule V hereof. If earnings are derived from more than one employment, it shall
be
determined on the basis of the aggregate earnings from all employments, but not exceeding P1,000 in
the case
of SSS and P3,000 in the case of GSIS.
SECTION 4. Wages or Salary. - Insofar as they refer to the computation of benefits, means the
monthly remuneration as defined in Republic Act No. 1161, as amended, for SSS and Presidential Decree
No.
1146, as amended, for GSIS, respectively, except that part in excess of Three Thousand Pesos. (ECC
Resolution
No. 3682, Dated July 21, 1987).
SECTION 5. Average monthly salary credit.
(a) In the case of the SSS, it is the result obtained by dividing the sum of the monthly salary credits in
the 60-month period immediately preceding the semester of death, or permanent disability, injury or
sickness,
by the number of months of coverage in the same period, except:
(1) Where death or permanent disability falls within 18 months from the month of coverage, it
is the result obtained by dividing the sum of all monthly salary credits paid prior to the month of death or
permanent disability by the number of calendar months of coverage in the same period, and
(2) Where death or permanent disability falls within the month of coverage, it is the actual
salary received during the calendar month or its corresponding monthly salary credit.
(b) The day of injury or sickness which caused the disability shall be vested as the reckoning date for
the purpose of computing the average monthly salary credit.
(c) In the case of the GSIS, the average monthly salary credit is the quotient after dividing the
aggregate compensations received by the member or employee for the last three years immediately
preceding
his death, permanent disability, injury or sickness, by the number of months he received said
compensation, or
three thousand pesos, whichever is smaller.
SECTION 6. Average daily salary credit.
(a) In the case of the SSS, it is the result obtained by dividing the sum of the 6 highest monthly salary
credits in the 12-month period immediately preceding the semester of sickness by 180, except for the
following
cases:
(1) Where the injury falls within 12 calendar months from the month of coverage, it is the
result obtained by dividing the sum of all monthly salary credits by 30 and by the number of months of
coverage, excluding the month of injury; and
(2) Where the injury falls within the month of coverage, it is the actual salary received during
the calendar month or its corresponding monthly salary credit divided by 30.
(b) In the case of the GSIS, the average daily salary credit shall be determined as follows:
(1) If the salary or wage is based on an hourly rate, it is the hourly rate times the number of
hours required to work during the month of contingency divided by 22.
(2) If the salary or wage is based on a daily rate, it is the daily rate times the number of days
required to work per month divided by 22.
(3) If the salary or wage is based on a monthly rate, it is the monthly rate divided by 22.
(4) If the employee has worked for less than one month, his daily salary credit is the actual
daily wage or salary of the monthly wage or salary divided by the actual number of days worked during
the
month of contingency.
SECTION 7. Replacement ratio. - In the case of the SSS, it is the sum of the twenty percent and the
quotient obtained by dividing three hundred by the sum of three hundred forty and the average monthly
salary
credit.
SECTION 8. Credited years of service. - For a member covered prior to January 1975, nineteen
hundred seventy five minus the calendar year of coverage, plus the number of calendar years in which
six or
more contributions have been paid from January 1975 up to the calendar year containing the semester
prior to
the contingency. For a member covered in or after January 1975, the number of calendar years in which
six or
more contributions have been paid from the year of coverage up to the calendar year containing the
semester
prior to the contingency.
SECTION 9. Monthly income benefit.
(a) In the case of the SSS, it is the amount equivalent to one hundred fifteen percent of the sum of:
The average monthly salary credit multiplied by the replacement ratio and one and a half percent of the
average monthly salary credit for each credited year of service in excess of ten years: Provided, That
the
monthly income benefit shall in no case be less than P250. Provided, However, That the monthly
pension of
surviving pensioners shall be increased automatically and simultaneously to the extent that 15%
difference in
monthly income benefit between EC and GSIS, be maintained. (LOI 1286) (ECC Resolution No. 2799, July
25,
1984).
(b) In the case of the GSIS, the monthly income benefit shall be the basic monthly pension as defined
in PD 1146 plus twenty percent thereof, but shall not be less than P250, nor more than the actual salary
at the
time of contingency. (ECC Resolution No. 2799, July 25, 1984).
RULE VII - BENEFITS
SECTION 1. Types of benefits. - The benefits under Employees Compensation are in the form of
income or services, and consist of the following:
(1) Medical services, appliances and supplies;
(2) Rehabilitation services;
(3) Temporary total disability benefit;
(4) Permanent total disability benefit;
(5) Permanent partial disability benefit;
(6) Death benefit; and
(7) Funeral benefit.
SECTION 2. Disability.
(a) A total disability is temporary if as a result of the injury or sickness the employee is unable to
perform any gainful occupation for a continuous period not exceeding 120 days, except as otherwise
provided
for in Rule X of these Rules.
(b) A disability is total and permanent if as a result of the injury or sickness the employee is unable to
perform any gainful occupation for a continuous period exceeding 120 days, except as otherwise
provided for in
Rule X of these Rules.
(c) A disability is partial and permanent if as a result of the injury or sickness the employee suffers a
permanent partial loss of the use of any part of his body.
SECTION 3. Income benefit. - The disability or death resulting from the injury or sickness is
compensable by cash payments, and not the injury or sickness itself, except in the case of permanent
partial
disability.
SECTION 3-A. Income benefit for permanent partial disability. - In the case where the period
covered for payment of income benefit for permanent partial disability does not exceed twelve months,
the
System may pay in lump sum or in monthly pension, otherwise income benefit shall be paid in monthly
pension.
SECTION 4. Services. - The injury or sickness is compensable by medical services, appliances,
supplies and rehabilitation services.
SECTION 5. Deprivation. - No contract, regulation or device whatsoever shall operate to deprive the
employee or his dependents of any part of the income benefits, and medical or related services, except
as
provided under these Rules. Existing medical services being provided by the employer shall be maintained
and
continued to be enjoyed by his employees.
SECTION 6. Prescriptive period. - No claim for compensation shall be given due course unless said
claim is filed with the System within three years from the time the cause of action accrued. (ECC
Resolution No.
2799, July 25, 1984).
RULE VIII - MEDICAL SERVICES, APPLIANCES AND SUPPLIES
SECTION 1. Condition to entitlement. - Any employee shall be entitled to such medical services,
appliances and supplies as the nature of his disability and the progress of his recovery may require,
subject to
the expense limitation as contained in Annex "C" hereof, if all of the following conditions are satisfied.
(1) He has been duly reported to the System;
(2) He sustains an injury or contracts sickness; and
(3) The System has been duly notified of the injury or sickness.
SECTION 2. Period of Entitlement. - The medical services, appliances and supplies shall be
provided to the afflicted employee beginning on the first day of the injury or sickness, during the
subsequent
period of his disability, and as the progress of his recovery may require, subject to Section 5 of Rule IV.
SECTION 3. Extent of Services.
(a) The employee is entitled to the benefits only for the ward services of an accredited hospital and
accredited physician. However, if the employee chooses accommodations better than ward services the
excess
of the total amount of expenses incurred over the benefits provided under Annex "C" hereof, shall be
borne by
the employee. For this purpose, "ward" means a hospital room that can accommodate 6 or more
patients.
(b) The hospital shall provide all the medicines, drugs or supplies necessary for the treatment of the
employee at a cost not exceeding the retail prices prevailing in local drug stores.
(c) Payments shall be made directly to the providers of such services in such amount as are prevailing
in the community for similar services or provided under the schedule set forth in Annex "C" of these
Rules,
whichever is less.
RULE IX - REHABILITATION SERVICES
SECTION 1. Definition of terms. - As used in this Rule unless otherwise indicated by the context,
the following definition of terms are hereby adopted.
(a) Rehabilitation - The process by which there is provided a balanced program of remedial
treatment, vocational assessment and preparation designed to meet the individual needs of each
handicapped
employee to restore him to suitable employment, including assistance as may be within its resources to
help
each rehabilitee to develop his mental, vocational or social potential.
(b) Rehabilitee - A disabled individual undergoing rehabilitation (student-rehabilitee or trainee) or who
has finished a prescribed course in rehabilitation in which he is known as a graduate rehabilitee or
trainee.
(c) Rehabilitation Center - An organized service of varied rehabilitation measures usually located in
one site for the rehabilitation of disabled individuals. (Example: the WRCC-the Center).
(d) Rehabilitation Facility - An organized service offering one or more types of service for the
rehabilitation of the handicapped individual.
(e) Governing Board - For this purpose, the Workers Rehabilitation Center Complex shall receive
policy guidance from and shall be under the general management of, the Employees' Compensation
Commission, which is hereby constituted as its Governing Board.
Whenever necessary, the Governing Board may create an Advisory Council that shall act as a
Consultative and Advisory Body, to be composed of representatives from the National Commission on
Rehabilitation, the Ministry of Health, the Institute of Public Health of the University of the Philippines,
and such
other specialized association and organizations on rehabilitation as may be needed.
(f) Placement Officer - A person practicing the allied medical profession or discipline specialized in
psychology of the handicapped and whose responsibility is to personally advise and guide the disabled
individual
to acceptance into a job.
(g) Suitable Employment - Remunerative occupation giving the rehabilitee earning at least equal to
the statutory minimum wage.
SECTION 2. Nature and effectivity of coverage.
(a) Coverage under this Rule shall be voluntary.
(b) Coverage under this Rule shall take effect upon completion of registration.
SECTION 3. Condition to entitlement. - Any employee shall be entitled to rehabilitation services, if
all of the following conditions are satisfied:
(1) He has been reported to the System;
(2) He sustains a permanent disability as a result of a compensable injury or sickness as a defined in
these Rules;
(3) He has not been placed in suitable employment.
SECTION 4. Period of entitlement. - Rehabilitation services shall be provided during the period of
the disability unless such services are suspended or terminated under any of the following conditions:
(1) Upon suitable employment;
(2) Upon suspension or termination of such services by the Rehabilitation Center;
(3) By self-termination.
SECTION 5. Extent of services. - Rehabilitation services shall consist of medical-surgical
management, hospitalization, necessary appliances and supplies, vocational training and assistance for
placement. (Transportation allowances between place of residence and the rehabilitation facility, lunch,
and
dormitory allowances in appropriate cases may be included in the extent of services).
SECTION 6. Rehabilitation Centers. - There shall be established a Workers Rehabilitation Center
Complex, and such other rehabilitation centers or services as the needs of occupationally disabled
employees,
whether from private or public sector, may require.
SECTION 7. Accreditation of Rehabilitation Facilities. - Hospitals accredited under Rule XVII of
these Rules; rehabilitation facilities, vocational and training centers and their personnel participating in
the work
of rehabilitation accredited by the Philippine Academy of Rehabilitation Medicine (PARM) may apply for
accreditation.
SECTION 8. Liability limitations. - The System shall not be legally responsible when the injury,
sickness, disability or death during the rehabilitation is occasioned by any of the following:
(1) His intoxication,
(2) His willful intention to injure or kill himself or another;
(3) His notorious negligence.
SECTION 9. Suspension, termination and appeal.
(a) Grounds - For adequate and duly proven causes and upon recommendation of the rehabilitation
counselor, the student-rehabilitee may be suspended or terminated by the Center.
(b) Appeal - The decision of the Center may be appealed within 15 days from notice thereof to the
Governing Board whose decision shall be final and executory.
SECTION 10. Placement. - Arrangement for placement of the rehabilitee shall be an integral part of
the rehabilitation program.
SECTION 11. Participation of the System. - As incentive to the participating employers in the onthe-
job training and possible employment of the rehabilitee, the System may enter into agreement with the
employer to participate in the payment of wages of the placed rehabilitee as follows:
(1) 50% of the wages for the first two weeks after the start of the on-the-job training;
(2) 25% of the wages for the third and fourth weeks of the on-the-job training;
(3) 10% of the wages for the fifth and sixth weeks of the on-the-job training;
(4) 0% of the wages for the rest of the period of the on-the-job training.
SECTION 12. Reports. - Reports to the Governing Board on the progress of activities of rehabilitation
program shall be submitted by the Center once every 3 months as often as necessary.
RULE X - TEMPORARY TOTAL DISABILITY
SECTION 1. Condition to entitlement. - An employee shall be entitled to an income benefit for
temporary total disability if all of the following conditions are satisfied:
(1) He has been duly reported to the System;
(2) He sustains the temporary total disability as a result of the injury or sickness, and
(3) The System has been duly notified of the injury or sickness which caused his disability.
His employer shall be liable for the benefit if such illness or injury occurred before the employee is duly
reported for coverage to the System.
SECTION 2. Period of entitlement.
(a) The income benefit shall be paid beginning on the first day of such disability. If caused by an injury
or sickness it shall not be paid longer than 120 consecutive days except where such injury or sickness still
requires medical attendance beyond 120 days but not to exceed 240 days from onset of disability in
which case
benefit for temporary total disability shall be paid. However, the System may declare the total and
permanent
status at any time after 120 days of continuous temporary total disability as may be warranted by the
degree of
actual loss or impairment of physical or mental functions as determined by the System.
(b) After an employee has fully recovered from an illness as duly certified to by the attending physician
the period covered by any relapse he suffers, or recurrence of his illness, which results in disability and is
determined to be compensable, shall be considered independent of, and separate from, the period
covered by
the original disability. Such a period shall not be added to the period covered by his original disability in
the
computation of his income benefit for temporary total disability (TTD). (ECC Resolution No. 1029, August
10,
1978).
SECTION 3. Amount of benefit. - Any employee entitled to benefit for temporary total disability shall
be paid an income benefit equivalent to 90 percent of his average daily salary credit, subject to the
following
conditions:
(1) The daily income benefit shall not be less than P10.00 or more than P90.00 nor paid longer than
120 days for the same disability, unless the injury or sickness requires more extensive treatment that
lasts
beyond 120 days, but not to exceed 240 days from onset of disability, in which case he shall be paid
benefit for
temporary total disability during the extended period.
(2) The monthly income benefit shall be suspended if the employee fails to submit a monthly medical
report certified by its attending physician as required under Sec. 5 of Rule IV hereof.(Resolution No.
3682, July
21, 1987).
RULE XI - PERMANENT TOTAL DISABILITY
SECTION 1. Condition to entitlement.
(a) An employee shall be entitled to an income benefit for permanent total disability if all of the
following conditions are satisfied:
(1) He has been duly reported to the System;
(2) He sustains the permanent total disability as a result of injury or sickness; and
(3) The System has been duly notified of the injury or sickness which caused his disability.
His employer shall be liable for the benefit if such injury or sickness occurred before the employee is
duly reported for coverage to the System.
(b) The following total disabilities shall be considered permanent:
(1) Temporary total disability lasting continuously for more than 120 days, except as otherwise
provided for in Rule X hereof.
(2) Complete loss of sight of both eyes;
(3) Loss of two limbs at or above the ankle or wrist;
(4) Permanent complete paralysis of two limbs.
(5) Brain injury resulting in incurable imbecility and insanity, and
(6) Such cases as determined by the System and approved by the Commission.
SECTION 2. Period of entitlement.
(a) The full monthly income benefit shall be paid for all compensable months of disability.
(b) After the benefit under the Employees' Compensation shall have ceased as provided under the
preceding paragraph, and if the employee is otherwise qualified for benefit for the same disability under
another
law administered by the System, he shall be paid a benefit in accordance with the provisions of that law.
This
paragraph applies to contingencies which occurred prior to May 1, 1978.
(c) Except as otherwise provided for in other laws, decrees, orders or letters of instructions, the
monthly income benefit shall be guaranteed for 5 years and shall be suspended under any of the
following
conditions:
(1) Failure to present himself for examination at least once a year upon notice by the System;
(2) Failure to submit a quarterly medical report certified by his attending physician as required
under Sec. 5 of Rule IV hereof;
(3) Complete or full recovery from his permanent disability, or
(4) Upon being gainfully employed.
SECTION 3. Amount of benefit.
(a) In the case of the SSS:
(1) Any employee entitled to permanent total disability benefit shall be paid by the System a
monthly income benefit as defined in Sec. 9 (a), Rule VI of these Rules.
(a) The number of months of paid coverage shall be the number of monthly
contributions remitted to the System including contributions other than for Employees' Compensation if
paid
before March 31, 1975. The full monthly income benefit shall be paid for all compensable months of
disability.
(b) The first day preceding the semester of temporary total disability shall be
considered for purposes of computing the monthly income benefit for permanent total disability.
SECTION 4. Amount of benefit for dependent children.
(a) Each dependent child, but not exceeding five, counted from the youngest and without substitution,
shall be entitled to 10 percent of the monthly income benefit of the employee. These Rules shall not
apply to
causes of action which accrued before May 1, 1978.
SECTION 5. Entitlement to the new income benefit under PD 1641.
(a) The new amount of the monthly income benefit computed under these amended Rules shall be
applicable to all contingencies occurring on or after January 1, 1980. However, for contingencies which
occurred
before May 1, 1978, the limitation of P12, 000 or 5 years, whichever comes first, shall be enforced.
In the case of the SSS, the present monthly income benefit of current pensioners shall be increased by
20 percent effective January 1, 1980.
In case of the GSIS, the monthly income benefit of current pensioners shall be adjusted and
recomputed to reflect the 20 percent increase over the benefit under PD 1146 effective January 1, 1980.
SECTION 6. Aggregate monthly benefit payable. - Except the benefit to dependent children under
Section 4 of this Rule, the aggregate monthly benefit payable, in the case of the GSIS, shall in no case
exceed
the monthly wage or salary actually received by the employee as of the date of his permanent total
disability.
(ECC Resolution No. 2819, August 9, 1984).
RULE XII - PERMANENT PARTIAL DISABILITY
SECTION 1. Condition to entitlement.
(a) An employee shall be entitled to an income benefit of permanent partial disability if all of the
following conditions are satisfied:
(1) He has been duly reported to the System;
(2) He sustains the permanent partial disability as a result of the injury or sickness; and
(3) The System has been duly notified of the injury or sickness which caused his disability.
His employer shall be liable for the benefit if such injury or sickness occurred before the employee is
duly reported for coverage to the System.
(b) For purposes of entitlement to income benefits for permanent partial disability, a covered employee
shall continue to receive the benefits provided thereunder even if he is gainfully employed and receiving
his
wages or salary.
SECTION 2. Period of entitlement.
(a) The income benefit shall be paid beginning on the first month of such disability, but not longer than
the designated number of months in the following schedule:
Complete and
permanent loss of the
use of
No. of Months
One thumb 10
One index finger 8
One middle finger 6
One ring finger 5
One little finger 3
One big toe 6
Any toe 3
One arm 50
One hand 39
One foot 31
One leg 46
One ear 10
Both ears 20
Hearing of one ear 10
Hearing of both ears 50
Sight of one eye 25
(b) A loss of a wrist shall be considered a loss of the hand, and a loss of an elbow shall be considered a
loss of the arm; a loss of an ankle shall be considered a loss of the foot, and a loss of a knee shall be
considered
a loss of the leg, a loss of more than one joint shall be considered a loss of the whole finger or toe, and a
loss of
only the first joint shall be considered a loss of one-half of the whole finger or toe. Other permanent
partial
disabilities shall be determined by the Medical Officer of the System.
(c) The degree of permanent disability shall be equivalent to the ratio that the designated number of
compensability bears to 75.
SECTION 3. Amount of benefit.
(a) Any employee entitled to permanent partial disability benefit shall be paid by the System a monthly
income benefit for the number of months indicated in Section 2 hereof. If the indicated number of
months
exceed twelve, the income benefit shall be paid in monthly pension; otherwise, the System may pay
income
benefit in lump sum or in monthly pension.
(b) In case of permanent partial disability less than the total loss of the member, the same monthly
income shall be paid for a portion of the period established for the total loss of the member in
accordance with
the proportion that the partial loss bears to the total loss. If the result is a decimal fraction, the same
shall be
rounded off to the next higher integer.
(c) In case of simultaneous loss of more than one member or a part thereof, the same monthly income
shall be paid for a period equivalent to the sum of the periods established for the loss of the member or
part
thereof but not exceeding 75. If the result is a decimal fraction, the same shall be rounded off to the
higher
integer.
(d) The new amount of the monthly income benefit computed under these amended Rules shall be
applicable to all contingencies occurring on or after January 1, 1980. However, for contingencies which
occurred
before May 1, 1978, the limitation of P12, 000 or 5 years, whichever comes first, shall be enforced.
In the case of the SSS, the present monthly income benefit of current pensioners shall be increased by
20 percent effective January 1, 1980.
In the case of the GSIS, the monthly income benefits of current pensioners shall be adjusted and
recomputed to reflect the 20 percent increase over the benefit under PD 1146 effective January 1, 1980.
SECTION 4. Unlisted injuries and illnesses.
(a) In cases of injuries or illnesses not listed in the schedule under Section 2 hereof, the benefit shall be
an income benefit equivalent to the percentage of the permanent loss of the capacity for work. (Non-
Scheduled
Disabilities).
RULE XIII - DEATH
SECTION 1. Condition to entitlement.
(a) The beneficiaries of a deceased employee shall be entitled to an income benefit if all of the following
conditions are satisfied:
(1) The employee has been duly reported to the System;
(2) He died as a result of an injury or sickness; and
(3) The System has been duly notified of his death, as well as the injury or sickness which
caused his death. His employer shall be liable for the benefit if such death occurred before the employee
is duly
reported for coverage to the System.
(b) If the employee has been receiving monthly income benefit for permanent total disability at the time
of his death, the surviving spouse must show that the marriage has been validly subsisting at the time of
his
disability.
SECTION 2. Period of entitlement.
A. For Primary Beneficiaries:
(a) The income benefit shall be paid beginning at the month of death and shall continue to be
paid for as long as the beneficiaries are entitled thereto.
(b) The monthly income benefit shall be guaranteed for five years which in no case shall be
less than fifteen thousand pesos (P15, 000.00). Thereafter, the beneficiaries shall be paid the monthly
income
benefit for as long as they are entitled thereto. (ECC Resolution No. 2799, July 25, 1984).
B. For Secondary Beneficiaries:
(a) The income benefit shall be sixty (60) times the monthly income benefit of a primary
beneficiary which in no case be less than P 15,000.00, which shall likewise be paid in monthly pension.
(ECC
Resolution No. 2799, July 25, 1984).
SECTION 3. Amount of benefit.
(a) In the case of primary beneficiaries, the monthly income benefit shall be equivalent to the monthly
income benefit for permanent total disability, which shall be guaranteed for five years, increased by ten
percent
for each dependent child but not exceeding 5, beginning with the youngest and without substitution:
Provided
That, The aggregate monthly benefit payable in the case of the GSIS shall in no case exceed the
monthly wage
or salary actually received by the employee at the time of his death; and Provided Further, That the
minimum
income benefit shall not be less than Fifteen Thousand Pesos (P15,000.00). The death benefit shall be
paid
during the entire period for which they are entitled thereto.
If the employee has been receiving income benefits for permanent total disability at the time of his
death, the primary beneficiaries shall be paid the monthly income benefit equivalent to eighty percent
plus the
dependent's pension equivalent to 10 percent thereof for every dependent child but not exceeding five
counted
from the youngest and without substitution.
(b) In the case of secondary beneficiaries, the income benefit is payable in monthly pension which shall
not exceed the period of 60 months and the aggregate income benefit shall not be less than P15, 000.00.
If the employee has been receiving monthly income benefit for permanent total disability at the time of
his death, the secondary beneficiaries shall be paid the monthly pension, excluding the dependent's
pension of
the remaining balance of the five year guaranteed period. (ECC Resolution No. 2799, July 25, 1984).
SECTION 4. Entitlement to the new income benefit under PD 1641. - The new amount of the
monthly income benefit computed under these amended Rules shall be applicable to all contingencies
occurring
on or after January 1, 1980. However, for contingencies which occurred before May 1, 1978, the
limitation of
P12, 000 or 5 years, whichever comes first, shall be enforced.
In the case of the SSS, the present monthly income benefit of current pensioners shall be increased by
20 percent effective January 1, 1980.
In the case of the GSIS, the monthly income benefit of the current pensioners shall be adjusted and
recomputed to reflect the 20 percent increase over the benefit under PD 1146 effective January 1, 1980.
SECTION 5. - The new amount of lump sum benefit computed under these Amended Rules shall be
applicable to all contingencies occurring on or after May 1, 1980, otherwise entitlement thereto shall be
governed by the immediately preceding Section.
RULE XIV - FUNERAL BENEFIT
SECTION 1. Entitlement to funeral benefit. - A funeral benefit of Three Thousand (P3,000.00)
Pesos shall be paid upon the death of a covered employee or permanently totally disabled pensioner to
one of
the following:
(a) the surviving spouse; or
(b) the legitimate child who spent for the funeral services; or
(c) any other person who can show incontrovertible proof or proof of his having borne the funeral
expenses. (ECC Resolution No. 3682, July 21, 1987).
Note: ECC Res. No. 92-07-0032, dated July 8, 1992 increased the funeral benefit to private sector to eight thousand
pesos
(P8,000) effective May 1, 1992.
RULE XV - BENEFICIARIES
SECTION 1. Definition.
(a) Beneficiaries shall be either primary or secondary, and determined at the time of employees death.
(b) The following beneficiaries shall be considered primary:
(1) The legitimate spouse living with the employee at the time of the employees death until he
remarries; and
(2) Legitimate, legitimated, legally adopted or acknowledged natural children, who are
unmarried not gainfully employed, not over 21 years of age, or over 21 years of age provided that he is
incapacitated and incapable of self - support due to physical or mental defect which is congenital or
acquired
during minority; Provided, further, that a dependent acknowledged natural child shall be considered as a
primary beneficiary only when there are no other dependent children who are qualified and eligible for
monthly
income benefit; provided finally, that if there are two or more acknowledged natural children, they shall
be
counted from the youngest and without substitution, but not exceeding five. (ECC Resolution No. 2799,
July 25,
1984).
(c) The following beneficiaries shall be considered secondary:
(1) The legitimate parents wholly dependent upon the employee for regular support;
(2) The legitimate descendants and illegitimate children who are unmarried, not gainfully
employed, and not over 21 years of age, or over 21 years of age provided that he is incapacitated and
incapable
of self- support due to physical or mental defect which is congenital or acquired during minority.
SECTION 2. Priority.
(a) Primary beneficiaries shall have priority claim to death benefit over secondary beneficiaries.
Whenever there are primary beneficiaries, no death benefit shall be paid to his secondary beneficiaries.
(b) If the deceased employee has no primary beneficiaries at the time of his death, the death benefit
shall be paid to his secondary beneficiaries.
(c) If the deceased employee has no beneficiaries at the time of his death, the death benefit shall
accrue to the Employees Compensation fund.
SECTION 3. - Primary beneficiaries shall be entitled to a monthly income benefit. In their absence, the
secondary beneficiaries shall be entitled to a monthly income benefit not to exceed 60 months and the
death
benefit shall not be less than P15,000.00. (ECC Resolution No. 2799 dated July 25, 1984).
RULE XVI - EMPLOYERS RECORDS AND NOTICES
SECTION 1. Notice by employee. - The notice of sickness, injury or death shall be given to the
employer by the employee, his dependents or anybody on his behalf, within 5 days from the occurrence
of the
contingency. Said notice is not necessary where the employer or his representative already had
knowledge
thereof, or the contingency occurred during working hours at the work place.
SECTION 2. Employers logbook. - Every employer shall keep a logbook to record chronologically
the sickness, injury or death of his employees, within 5 days from due notice thereof.
SECTION 3. Notice by employer. - The notice of sickness, injury or death for cases which the
employer deems to be work-connected shall be submitted to the System by the employer within 5 days
from
due entry thereof in his logbook in a form prescribed by the System.
SECTION 4. Visitorial power. - The employers logbook shall be made available for inspection to any
duly authorized representative of the System during working hours.
SECTION 5. Penalty. - Any employer who fails to record in his logbook the sickness, injury or death
of any of his employees within 5 days from knowledge or receipt of due notice thereof as prescribed
herein,
gives false information or withholds material information already in his possession, shall be liable to 50
percent
of the lump sum equivalent of the income benefit to which the employee may be found to be entitled
and/ or a
fine of not less than P500 nor more than P5,000 and imprisonment for not less than 6 months or more
than one
year, at the discretion of the Court. The sum paid by the employer under this Section shall accrue to the
Employees Compensation fund of the System.
RULE XVII - ACCREDITATION
SECTION 1. Minimum requirements for accreditation.
(a) A physician may be accredited for purposes of the Employees Compensation Program upon his
application if he is a doctor of medicine duly licensed to practice in the Philippines and an active member
in
good standing of the Philippine Medical Association.
(b) A hospital may likewise be accredited upon application if:
(1) it is an institution primarily engaged in providing to in - patients, by or under the
supervision of physicians, diagnostic and therapeutic services for their medical diagnosis, treatment and
care;
(2) it is adequately equipped with facilities for physicians to treat injured or sick persons;
(3) it maintains clinical records on all patients;
(4) it has by-laws concerning its medical staff;
(5) it provides 24-hour nursing services by itself or is supervised by a registered professional
nurse; and has a licensed practical nurse or registered professional nurse on duty at all times;
(6) it requires that every patient must be under the care of a physician;
(7) it is licensed by the Bureau of Medical Services of the Ministry of Health;
(8) it meets the health and safety requirements of the Ministry of Health and Ministry of Labor;
(9) it maintains a utilization review committee as provided for in Section 3 of this Rule; and
(10) it is a member in good standing of the Philippine Hospital Association.
(c) A rehabilitation facility may be accredited upon application if:
(1) it is an institution engaged in providing to in - patients, by or under the supervision of
physicians (specialized in rehabilitation medicine, in neurology, or in neuro-surgery, or in internal
medicine, or in
orthopedic surgery), diagnostic or therapeutic services in rehabilitation practice;
(2) it is adequately equipped with facilities for physical medicine rehabilitation (PMR);
(3) it maintains clinical records on all patients;
(4) it has by-laws concerning its medical staff;
(5) it requires that every patient must be under the care of a physician;
(6) it is licensed by the Bureau of Medical Services of the Ministry of Health;
(7) it meets the health and safety requirements of the Ministry of Health and Ministry of Labor
and Employment; and
(8) it maintains a Utilization Review Committee as provided for in Section 3 of the Rules.
(d) The above requirements may be modified by the Commission from time to time as circumstances
may warrant.
SECTION 2. Conditions on accredited hospitals or rehabilitation facilities and physicians or
rehabilitation specialists.
(a) An accredited hospital or rehabilitation facility binds itself:
(1) not to collect from the patient any amount for ward services;
(2) to provide adequate services on a non-discriminating basis;
(3) to limit charges for ward rates approved by the Commission, including, but not limited to,
laboratory ward rates, laboratory facilities, x-rays, stools, drugs, medical attendance and the Relative
Value
Scale (RVS) for surgical procedures, etc.;
(4) to abide by these rules on accreditation;
(5) to have its house rules conform to the requirements of the Commission;
(6) to subject its facilities to inspection at any time by duly authorized representatives of
the Commission or the System.
(b) An accredited physician binds himself:
(1) not to collect from the patient any amount for ward services,
(2) to provide adequate services on a non-discriminating basis; and
(3) to abide by these rules on accreditation.
SECTION 3. Utilization review.
(a) Every hospital or rehabilitation facility shall have a Utilization Review Committee, composed of at
least two physicians or rehabilitation specialists, to help assure the most effective use of rehabilitation
facilities,
hospitals and services by reviewing admissions each day on a sample basis and all long stay cases.
(b) The Committee shall decide in every specific case being reviewed, whether or not care in a hospital
is medically necessary. In every case, the Committee shall discuss its findings with the patients doctor
before
making a decision.
(c) The Committee shall advise in writing the patient, his doctor and the hospital of its decision only if it
has been decided that care in a hospital is not medically necessary, in which case no payment for room
and
board shall be made by the System.
SECTION 4. Coverage of services.
(a) Payment for services shall ordinarily be made only to accredited rehabilitation facility or hospitals
and accredited physicians.
(b) Non-accredited rehabilitation facility or hospitals and non-accredited physicians shall be paid only for
emergency services. No payment can be made to them for services rendered after the emergency has
ended.
SECTION 5. Emergency services.
(a) Those services which are necessary to prevent the death or serious impairment of the health of the
individual, and which necessitate the use of the most accessible hospital available and equipped to
furnish such
services.
(b) An emergency no longer exists when it becomes safe from a medical standpoint to move the patient
to an accredited hospital, or to discharge him whichever occurs first.
(c) The determination that the patients condition requires emergency services or that an emergency
has ended shall be based on the physicians evaluation and, when appropriate, on the patients medical
record
and other additional data furnished by the hospital.
(d) Claims filed by non-accredited hospital and non-accredited physicians for payment of emergency
services shall be accompanied by a physicians statement.
(e) The physicians statement shall describe the nature of the emergency, furnish relevant clinical
information about the condition of the patient, and state that the services rendered were necessary to
prevent
the death of the individual or the serious impairment of the health. A bare statement that an emergency
existed
is not sufficient.
(f) In addition, when in-patient services are involved, the statement shall include the date when, in the
physicians judgment, the emergency ceased.
SECTION 6. Referral. - Immediately upon knowledge by the employer of his employees injury or
sickness at the work place, he shall, in addition to the medical and dental facilities which the pertinent
provisions
of the Code and these Rules on Accreditation may require him to furnish, cause the employee to be
brought by
the fastest available means of transportation to the duly accredited physician or hospital nearest or most
accessible to the employees place of work.
SECTION 7. Violation of conditions and requirements, penalties.
(a) An accredited hospital or physician shall be disaccredited for violation of any of the conditions and
requirements under Section 1 and 2 hereof without prejudice to the imposition of penalties under Rule
XIX if
applicable or to any other penalty which the Commission may impose.
(b) The cancellation or invalidation of accreditation of a physician or hospital shall be effective on the
date of notice of the disaccreditation.
(c) In case of disaccreditation, the physician or the hospital shall carry the disqualification wherever its
physical identity is found. Mere change of legal personality shall not defeat the disqualification imposed.
(d) Disaccreditation shall be lifted only on application and upon showing of good cause and effective
upon approval by the Commission. As soon as accreditation is duly restored, the hospital or physician
concerned
shall be allowed to participate in the Employees Compensation Program.
RULE XVIII - SETTLEMENT OF CLAIMS
SECTION 1. Services.
(a) The claim for medical benefits shall be filed in a prescribed form by the accredited physician or
accredited hospital directly with the System.
(b) The claim for emergency services shall be filed in a prescribed form by any physician or hospital.
SECTION 2. Income benefit. - The claim for income benefit shall be filed in a prescribed form by the
employee, his dependents or his employer, on his behalf, directly with the System. Failure to file the
claim within
three years from the time the cause of action accrued, shall forever bar the right to benefits granted
under
these Rules. (ECC Resolution No. 2799, July 25, 1984).
SECTION 3. Adjudication. - Upon the receipt of the claim, the System shall process the same and
determine whether or not the injury, sickness, disability or death is compensable.
SECTION 4. Additional requirements. - If the supporting papers of the claim are insufficient to
make proper determination, the System shall require the submission of additional proofs from the
employee or
his dependents, or from any office, entity or agency, public or private, or from any person, having
knowledge of
the contingency.
SECTION 5. Appeal. - Within 10 days from receipt of the letter of denial or the affirmation of the
denial, as the case may be, the claimant shall inform the System in writing of his desire to appeal the
decision of
the System. Upon receipt of such appeal, the System shall within 5 days forward the entire record of the
case to
the Commission for review.
Note: Period of appeal was increased from ten (10) to thirty (30) daysby rule IV.1 of Suppletory Rules.
RULE XIX - REVIEW BY THE COMMISSION
SECTION 1. Decision en banc. - Within 20 working days from receipt of an appealed case, the
Commission shall review and decide said case. Four affirmative votes shall decide the case. However, if
only a
qourum of four members are present, 3 affirmative votes shall decide the case. No motion for
reconsideration of
the decision or resolution of the Commission en banc shall be entertained.
SECTION 2. Payment of awards. - Decisions, orders, or resolutions of the Commission en banc
awarding compensation shall be complied with by the System within 15 days from receipt of the notice
thereof.
SECTION 3. Other decisions. - In all other cases involving payments to be made by the employer,
decisions, orders and resolutions of the Commission en banc which have become final and executory
shall be
enforced and executed in the same manner as decisions of the Court of First Instance, and the
Commission shall
have the power to issue to the City or Provincial Sheriff or to the Sheriff it may appoint, such writs of
execution
as may be necessary for the enforcement of such decisions, orders or resolutions.
SECTION 4. Failure to comply. - Any person or persons who fail or refuse to comply with the writ of
execution issued by the Commission shall be punished for contempt by the proper court. In the case of a
corporation, trust, firm, partnership, association or any other entity, the manager or officer-in-charge
when the
offense was committed, shall be responsible.
RULE XX - PENALTIES
SECTION 1. Penalty for failure to install and maintain safety devices, etc. - The System shall
determine for purposes of imposing the penalty provided in Art. 200 of the Code, whether the employees
sickness, injury or death was due to the failure of the employer to comply with any health and safety law,
or
failure to install and maintain safety devices in accordance with standards set by the Commission, or take
other
precautions for the prevention of the sickness, injury or death. The requisite standards shall be set by the
Commission within 6 months after the effectivity of these Rules.
SECTION 2. Penal provisions.
(a) The penal provisions of R.A. 1161, as amended, and C.A. 186, as amended, with regard to the
funds as are thereunder being paid to, collected or disbursed by the System shall be applicable to the
collection,
administration and disbursement of Employees Compensation fund of the System. The penal provisions
on
coverage shall also be applicable.
(b) Any person who, for the purposes of securing entitlement to any benefit or payment under these
Rules or the issuance of any certificate or document for any purpose whether for him or for some other
persons,
commits fraud, collusion, falsification, misrepresentation of facts or any other kind of anomaly shall be
punished
with a fine of not less than P5,000 and imprisonment for not less than 6 months nor more than one year,
at the
discretion of the court.
(c) If the act penalized is committed by any person who has been or is employed by the Commission or
System or a recidivist, the imprisonment shall not be less than one year; if committed by a lawyer,
physician, or
other professional, he shall in addition to the penalty prescribed herein be disqualified from the practice
of his
profession; and if committed by an official, employee or personnel of the Commission, System or any
other
government agency, he shall in addition to the penalty prescribed herein, be dismissed with prejudice to
reemployment
in the government service.
RULE XXI - IMPLEMENTING PROVISION
SECTION 1. Effectivity. - These amended Rules and Regulations shall take effect June 1, 1987.
APPROVED: July 21, 1987
(Sgd.) FRANKLIN M. DRILON
Chairman
(Sgd.) FELICIANO R. BELMONTE
Member
(Sgd.) RAOUL M. INOCENTES
Member
(Sgd.) JOSE L. CUISIA, JR.
Member
(Sgd.) ALFREDO R. A. BENGZON
Member
(Sgd.) JORGE B. CONTRERAS
Member
ANNEX C
OCCUPATIONAL DISEASES
For an occupational disease and the resulting disability or death to be compensable, all of the following
conditions must be satisfied:
(1) The employees work must involve the risks described herein;
(2) The disease was contracted as a result of the employees exposure to the described risks;
(3) The disease was contracted within a period of exposure and under such other factors necessary to
contract it;
(4) There was no notorious negligence on the part of the employee.
The employer who has failed to provide adequate protection and safety devices shall be subject to the
penalty imposed by Article 200 of the Code. Where he has provided adequate protective and safety
devices,
there shall be a determination as to whether or not the employee has been notoriously negligent.
Silicosis, asbestosis and byssinosis shall not be compensable if the exposure to the described risks is
less than 10 years, unless proven otherwise.
The following diseases are considered as occupational when contracted under working conditions
involving the risks described herein:
LIST OF OCCUPATIONAL AND COMPENSABLE DISEASES
Occupational Diseases Nature of Employment
1. Cancer of the epithelial lining of the bladder.
(Papilloma o the bladder).
Work involving exposure to
alphanaphthylamine, beta-naphthylamin or
benzidine or any part of the salts; and
auramine or magenta.
2. Cancer, epithellomatous or ulceration of the
skin or of the corneal surface of the eye due
to tar, pitch, bitumen, mineral oil or paraffin,
or any compound product or residue of any
of these substances.
The use of handling of, or exposure to tar;
pitch, bitumen, mineral oil (including paraffin)
soot or any compound product or residue of
any of these substances.
3. Cataract produced by exposure to the glare
of, or rays from molten glass or molten or red
hot metal.
Frequent and prolonged exposure to the glare
of or rays from molten glass or red hot metal.
4. Deafness Any industrial operation having excessive noise
particularly in the higher frequencies.
5. Decompression sickness Any process carried on in compressed or
rarefied air.
(a) Caissons disease
(b) Aeroembolism Any process carried on in rarefied air.
6. Dermatitis due to irritants and sensitizers The use or handling of chemical agents which
are skin irritants and sensitizers.
7. Infections
(a) Anthrax Work in connection with animals infected with
anthrax, handling of animal carcasses or parts
of such carcasses including hides, hoofs, and
horns.
(b) Brucellosis Any occupation involving handling of
contaminated food and drink particularly milk,
butter and cheese of infected goats and cows.
(c) Glanders Any occupation involving rabid dogs, or equine
animals or carcasses.
(d) Rabies Any occupation involving rabid dogs.
(e) Tuberculosis Any occupation involving close and frequent
contact with a source or sources of
tuberculosis infection by reason of
employment: (a) in the medical treatment or
nursing of a person or persons suffering from
tuberculosis, (b) as a laboratory worker,
pathologists or post-mortem worker, where
occupation involves working with material
which is a source of tuberculosis infection.
(f) Tularemia Any occupation involving handling of rabbits,
ground squirrels, mice or other rodents.
(g) Weill's disease Any occupation involving handling of rats,
mice, swine and dogs.
(h) Q. Fever or equine encephalomyelitis Any occupation, involving handling of horses,
cattle and sheep, or their slaughter and meat
packing.
(I) Mite dermatitis Any occupation involving handling of owls or
pigeons.
8. Ionizing radiation disease, inflammation,
ulceration or malignant disease of skin or
subcutaneous tissues of the bones or
leukemia, or anemia of the aplastic type due
to x-rays, ionizing particle, radium or other
radioactive substances.
Exposure to X-rays, ionizing particles of radium
or other radioactive substances or other forms
of radiant energy.
(a) Acute radiation syndrome Short duration of exposure to large doses of Xrays,
gamma rays, alpha rays and beta rays.
(b) Chronic radiation syndrome Chronic over-exposure to X-rays with a long
latent period affecting the skin, blood and
reproductive organ.
(c) Glass Blowers cataract Among furnace men, glass blowers, baker,
blacksmith, foundry workers. These are
workers exposed to infrared rays.
9. Poisoning and its sequelae caused by:
(a) Ammoni All work involving exposure of the risk
concerned.
(b) Arsenic or its toxic compound All work involving exposure to the risk
concerned.
(c) Benzene or its toxic homologues, nitro
and aminotoxic derivatives of benzene or its
homologue
All work involving exposure to the risk
concerned.
(d) Beryllium or its toxic compounds All work involving exposure to the risk
concerned.
(e) Brass, zinc or nickel All work involving exposure to the risk
concerned.
(f) Carbon dioxide All work involving exposure to the risk
concerned.
(g) Carbon bisulfide All work involving exposure to the risk
concerned.
(h) Carbon monoxid All work involving exposure to the risk
concerned.
(I) Chlorine All work involving exposure to the risk
concerned.
(j) Chrome or its toxic compunds All work involving exposure to the risk
concerned.
(k) Dimitrophenol or its homologue All work involving exposure to the risk
concerned.
(l) Halogen derivatives of hydrocarbo of the
aliphatic series
All work involving exposure to the risk
concerned.
(m) Lead or its toxic compounds All work involving exposure to the risk
concerned.
(n) Manganese or its toxic compounds All work involving exposure to the risk
concerned.
(o) Mercury or its toxic compounds All work involving exposure to the risk
concerned.
(p) Nitrous fumes All work involving exposure to the risk
concerned.
(q) Phosgene All work involving exposure to the risk
concerned.
(r) Phosphorus or its toxic compounds All work involving exposure to the risk
concerned.
(s) Sulfur dioxide All work involving exposure to the risk
concerned.
10. Pneumoconiosis
(a) Coal miner's Exposure to coal dust.
(b) Bysinosis Exposure to cotton dust causing weavers
cough or mill fever.
(c) Bagassosis Exposure to sugar cane dust.
(d) Psittacosis Any occupation involving handling of parrots,
parakeets and other species of birds.
11. Diseases caused by abnormalities in
temperature and humidity.
Any occupation involving exposure to
excessive heat or cold.
(a) Heat stroke/cramps/exhaustion Any occupation involving exposure to
excessive heat.
(b) Chilblain/frostbite/freezing Any occupation involving exposure to
excessive cold.
(c) Immersion foot/general hypothermia Any occupation involving exposure to
excessive cold.
12. Vascular disturbance in the upper extremities
due to continuous vibration from pneumatic
tools or power drills, riveting machines or
hammers.
Any occupation causing repeated motions,
vibrations and pressure of upper extremities.
13. Viral Hepatitis* Among workers in close and frequent contact
with (a) human blood products and with (b) a
source of viral hepatitis by reason of
employment in the medical treatment or
nursing of a person or persons suffering from
viral hepatitis, or in a service ancillary to such
treatment or nursing.
14. Poisoning by cadmium* Among workers in battery factories, who are
exposed to cadmium fumes.
15. Leukemia and lymphoma* Among operating room personnel due to
exposure to anesthetics.
16. Cancer of stomach and other lymphatic and
blood forming vessels; nasal cavity and
sinuses.*
Among woodworkers, wood products industry
carpenters, loggers and employees in pulp and
paper mills and plywood mills.
17. Cancer of the lungs, liver and brain* Among vinyl chloride workers, plastic workers.
18. CARDIO-VASCULAR DISEASES. ** Any of the following conditions
a. If the heart disease was known to have been present during employment, there must be proof that an acute exacerbation was clearly
precipitated by the unusual strain by reasons of the nature of his/her/her work.
The strain of work that brings about an cute attack must be of sufficient severity and must be
followed within 24 hours by the clinical signs of a cardiac insult to constitute causal relationship.
If a person who was apparently asymptomatic before being subjected to strain at work showed
signs and symptoms of cardiac injury during the performance of his/her/her work and such
symptoms and signs persisted, it is reasonable to claim a causal relationship.

19. CEREBRO VASCULAR ACCIDENTS.** All of the following conditions

a. There must be a his/hertory, which should be proved, or trauma at work (to the head specially)
due to unusual and extraordinary physical or mental strain or event, or undue exposure to
noxious gases in industry.
b. There must be a direct connection between the trauma or exertion in the course of the
employment and the workers collapse.
c. If the trauma or exertion then and there caused a brain hemorrhage, the injury may be
considered as arising from work.
20. MALARIA AND SCHISTOSOMIASIS.** All of the following conditions
a. Through the knowledge of the respective incubation periods of the different types of the
diseases, the physician determining the causal relationship between the employment and the
illness or malaria or schis/hertosomiasis should be able to tell whether the disease of the
afflicted employee manifested itself while he/she was so employed.
b. Compensability should be based on the principle of greater risk of acquiring the disease in the
place of work than in the place of usual residence of the afflicted worker.
c. The place of work of employment has to be verified as a malarial or schis/hertosomal work
area.
21. PNEUMONIA.** All of the following conditions
a. There must be an honest and definite his/hertory of wetting and chilling during the course of
employment and also, of injury to the chest wall with or without rib fracture, or substances in
the place of work.
b. There must be direct connection between the offending agent or event and the workers illness.
c. The signs of consolidation should appear soon ( within a few hours) and the symptoms of initial
chilling and fever should at least be 24 hours after injury or exposure.
d. The patient must manifest any of the following symptoms within a few days of the accident: (1)
severe chill and fever; (2) headache and pain, agonizing in character, in the side of the body;
(3) short, dry, painful cough with blood tinged expectoration; and (4) physical signs of
consolidation, with fine rales.
22. HERNIA.** All of the following conditions
a. The hernia should be of recent origin.
b. Its appearance was accompanied by pain, discoloration and evidence of a tearing of the
tissues.
c. The disease was immediately preceded by undue or severe strain arising out of and in the
course of employment.
d. A protrusion of mass should appear in the area immediately following the alleged strain.
23. BRONCHIAL ASTHMA.** All of the following conditions
a. There is no evidence of his/hertory of asthma before employment.
b. The allergen is present in the working environment.
c. Sensitivity test to allergens in the working environment should yield positive results.
d. A provocative test should show positive results.
24. OSTEOARTHRITIS.***
Any occupation involving: (a) joint strain from carrying heavy loads, or unduly heavy physical labor, as
among laborers and mechanics; (b) minor or major injuries to the joint; (c) excessive use or constant
strenuous usage of a particular joint, as among sportsmen, particularly those who have engaged in the
more active sports activities; (d) extreme temperature changes (humidity, heat and cold exposures);
and (e) faulty work posture or use of vibratory tools.
25. VIRAL ENCEPHALITIS.***
Any occupation involving: (a) contact with an infected person, as in areas of poor sanitation, with high
density of schoolchildren, who are the most frequent virus spreaders; (b) rural exposure, primarily in
picnics, camping activities, fishing or hunting in, or adjacent to, woods or subtropical vegetations, or as
among agricultural or forest workers; and (c) contact with other sources of infection, such as birds and
animals, as among veterinarians and abattoir workers.
26. PEPTIC ULCER.***
Any occupation involving prolonged emotional, or physical stress, as among professional people,
transport workers and the like.
27. PULMONARY TUBERSULOSIS.***
In addition to working conditions already listed under P.D. 626, as amended, any occupation involving
constant exposure to harmful substances in the working environment, in the form of gases, fumes,
vapors and dust, as in chemical and textile factories; overwork or fatigue; and exposure to rapid
variations in temperature, high degrees of humidity and bad weather conditions.
28. VIRAL HEPATITIS.***
In addition to working conditions already listed under P.D. 626, as amended, any occupation involving:
exposure to a source of infection through ingestion of water, milk, or other foods contaminated with
hepatitis virus; Provided that the physician determining the causal relationship between the
employment and the illness should be able to indicate whether the disease of the afflicted worker
manifested itself while he/she was so employed, knowing the incubation period thereof.
29. ESSENTIAL HYPERTENSION.****
Hypertension classified as primary or essential is considered compensable if it causes impairment of
function of body organs like kidneys, heart, eyes and brain, resulting in permanent disability; Provided
that, the following documents substantiate it: (a) chest X-ray report, (b) ECG report (c) blood chemistry
report, (d) funduscopy report, and (e) C-T scan.
30. ASBESTOSIS***** All of the following conditions
a. The employee must have been exposed to Asbestos dust in the work place, as duly certified to
by the employer, or by a medical institution or competent medical practitioner acceptable to, or
accredited by the System;
b. The chest X-ray report of the employee must show findings of asbestos, or asbestos related
disease, E.G., pleural plaques, pleural; thickening, effusion, neoplasm and interstitial fibrosis;
and
c. In case the ailment is discovered after the employees retirement/separation from the service,
the claim thereof must be filed with the System within three (3) years from discovery.
* Approved under ECC Resolution No. 247-A, Dated April 13, 1977.
** Approved under Resolution No. 432, Dated July 20, 1977. Although not considered occupational
diseases, they are nevertheless work-related and thus compensable too.
*** Approved under ECC Resolution No. 1676, Dated January 29, 1981.
**** Approved under ECC Resolution No. 92-07-0031, Dated July 8, 1992
***** Approved under ECC Resolution No. 96-08-0372, Dated August 1, 1996

ANNEX D
PRESCRIBED MINIMUM STANDARDS FOR PERIODIC MEDICAL EXAMINATIONS DESIGNED
FOR
THE EARLY DETECTION OF OCCUPATIONAL DISEASES
A. When the risk exists as to exposure to any of the occupational hazards enumerated in the "List of
Occupational Diseases," employers shall require his employees to undergo:
(1) A periodic medical examination to be carried out at intervals, and in accordance with the conditions,
outlined in 2 and 3 below;
(2) Periodic examinations at intervals of 3 months or less if workers are exposed to the following:
(a) Bensense (Benzol) or the nitro or amino-derivatives of benzene or its homologues.
(b) Ionizing radiations.
(c) Organic phosphorus insecticides, where the interval may be much shorter (as in spraying).
(3) Periodic examinations at intervals not exceeding 6 months in cases of exposure to the following:
(a) Lead or its toxic compounds
(b) Mercury or its toxic compounds
(c) Manganese or its toxic compounds
(d) Chromium or its toxic compounds
(e) Carbon disulfide
(4) Periodic examinations at intervals not exceeding one year in cases of all other exposure enumerated
in the "List of Occupational Diseases and not covered under 2 or 3 above.
(5) Under special circumstances medical examinations be repeated at intervals shorter than specified
under 3 and 4 as recommended by the authorized medical officers.
B. The medical examination shall be as complete as possible, but shall primarily be directed towards the
early
detection of occupational diseases. This necessitates that certain aspects of the examination be stressed
in
certain types of exposures:
(1) Examination of urine and urinary bladder in workers exposed to alphanaphtylamine,
betanaphtylamine or benzidine or any of their salts, and suramine or magenta.
(2) Examination of the skin and eyes in workers exposed to tar, pitch, bitumen, mineral oil, paraffin or
soot or any compound, product or residue of any of these substances.
(3) Examination of the eyes in workers exposed to infrared rays from molten metal, red hot metal or
molten glass.
(4) Examination of the skin in workers exposed to skin irritants and sensitizers.
(5) Audiometric examinations in workers exposed to excessive noise, particularly in the higher
frequencies.
(6) Examination of the skin, eyes and blood in workers exposed to ionizing radiations.
(7) Examination of the gastro-intestinal and nervous systems, blood, skin, mucous membranes and
lungs in workers exposed to toxic compounds of arsenic.
(8) Examination of the blood in workers exposed to benzene or the nitro or amino derivatives of
benzene or its homologues.
(9) Examination of the skin and lungs in cases of exposure to beryllium.
(10 Examination of the skin and respiratory tract in workers exposed to nickel, chromium or their toxic
compounds.
(11) Examination of the nervous system, eyes, blood and skin in workers exposed to carbon disulfide.
(12) Examination of the blood in workers exposed to carbon monoxide.
(13) Examination of the eyes and respiratory tract in workers exposed to chlorine or sulfur dioxide.
(14) Examination of the liver and kidney in workers exposed to dinitro phenol and its homologues.
(15) Examination of the skin, liver, kidneys and gastro-intestinal and nervous systems in workers
exposed in halogen derivates of aliphatic hydrocarbons.
(16) Examination of the blood, urine, gastro-intestinal and neuro-muscular systems in workers exposed
to lead or its toxic compounds.
(17) Examination of the lungs and nervous system in workers exposed to manganese or its toxic
compounds.
(18) Examination of the nervous and gastro-intestinal systems, the kidneys and eyes in workers
exposed to mercury and its toxic compounds.
(19) Examination of the bones, especially the lower jaw in workers exposed to phosphorus, and the
choline-esterase activity in workers exposed to organic phosphate insecticides.
(20) Examination of the lungs in workers exposed to risk of tuberculosis infection, silica dust, asbestos
and cotton dust.
(21) Examination of the presence of peripheral vascular disturbance in workers exposed to vibrating
tools.
C. Results of medical examinations shall be reported in a prescribed form which indicates the dates of
examinations, results and recommended action.
D. Cases of occupational diseases discovered shall be reported by the employer to the System in a
prescribed
form.
ANNEX E
MEDICAL BENEFITS
A. Medical services
(a) An employee who sustains an injury or contracts sickness shall be entitled to:
(1) Ward services during confinement in an accredited hospital;
(2) The subsequent domiciliary care by an accredited physician; and
(3) Medicines.
(b) Ambulatory services in an accredited hospital shall be allowed only in case of injury.
B. Ward services
(a) They cover all of the services an in-patient would ordinarily receive in a hospital such as:
(1) Bed in a ward (6 beds in a room);
(2) All meals, including special diets,
(3) Regular nursing services;
(4) Medicines furnished by the hospital;
(5) Laboratory services such as blood and urine tests;
(6) Radiology service such as X-rays,
(7) Medical supplies such as splints and casts,
(8) Use of appliances and equipment furnished by the hospital such as wheelchair, crutches
and braces;
(9) Anesthetic services;
(10) Operating room charges,
(11) Surgery; and
(12) Doctor's services.
(b) Ward services do not include:
(1) The extra charge for more comfortable accommodations such as private and semi-private
rooms;
(2) Personal comfort or convenience such as charges for the use of a telephone, radio or
television;
(3) Private duty nurses;
(c) If a patient receives services more expensive than ward services, payment by the System shall be
made only for the ward services. However, private or semi-private room accommodations when medically
necessary because the contagious disease or his condition requires him to be isolated, or there is no
available
ward bed and the emergency nature of the injury or disease requires him to be immediately
accommodated,
shall be paid by the System after satisfying itself as to the reasonableness thereof, and at no cost
whatsoever to
the patient. The continued accommodation of the patient in a private or semi-private room when a ward
bed is
available and the emergency or contagion no longer exists shall be paid by the System as ward services.
(d) Only necessary and relevant services shall be paid by the System. Laboratory and/or radiology
services and medicines shall be kept to a level considered by the physician reasonably necessary and
relevant to
the particular illness or injury.
C. Hospital confinement
(a) The benefits for each day of confinement in an accredited hospital shall be only for ward services.
(b) The benefit in case of injury shall not exceed the actual cost of ward services in an accredited
hospital.
(c) The benefit in case of sickness shall not exceed the actual cost of ward services in an accredited
hospital equipped with facilities necessary for the treatment of the disease.
(d) Confinement shall be counted in units of a full day, with the day of admission counted as a full day
but not the day of discharge.
D. Medical attendance - For medical attendance extended to injured or sick employees, an accredited
physician shall be paid a medical benefit no to exceed P100.00 for the first visit and P80.00 for each
subsequent
visit if he or she is a general practitioner. If he or she is a specialist, he or she will be paid P150.00 for
the first
visit and P100.00 for each subsequent visit. (This rule shall apply only to private sector. For the public
sector,
the old rate shall be maintained.)
E. Surgical expense benefit
(a) A qualified employee who has undergone a surgical procedure in an accredited hospital shall be
entitled to a surgical expense benefit, which shall consist of:
(1) A surgeon's fee according to the ECC Relative Value Study
(ECC Res. No. 94, dated April 14, 1976, as amended by Res. No. 1554 dated June 26,1980, Res. No. 2113 dated
July 15,
1982 and Res. No. 2656 dated March 15,1984).
(2) An anesthesiologist's fee ordinarily not exceeding one-third of the surgeon's fee.
(b) The surgeon's fee shall be paid to the surgeon who performed the operation, and the
anesthesiologist's fee to the anesthesiologist, subject to the following conditions:
(1) Only one surgeon shall be paid for each operation;
(2) Only one anesthesiologist, if any shall be paid for each operation; and
(3) Local anesthesia, other than regional nerve block anesthesia, shall not be compensable.
(c) The operating room fee shall be paid by the System only for surgical procedure done in the
operating-diagnostic therapy room complex of the accredited hospital.
ANNEX F
SUPPLETORY RULES
I. DISTRIBUTION OF MONTHLY INCOME BENEFITS
1. Monthly income benefits shall be shared equally by all the primary beneficiaries including dependent
children who were not considered in the determination of dependent pensions. Upon emancipation or
otherwise
disqualification to entitlement to the dependent pension of a dependent child, only (10%) percent shall
be
deducted from the benefits, and the remaining income benefits, shall once again be divided equally by
the
qualified primary beneficiaries.
2. If there are no primary beneficiaries, the secondary beneficiaries shall also share equally in the
monthly income benefits.
II. BENEFITS UPON THE DEATH OF A PENSIONER
1. Provisions of paragraph (b), Article 194 of PD442, as amended, shall apply to death occurring on or
after January 1, 1980, regardless of the date of the onset of the permanent total disability.
2. Upon the death of a pensioner, as mentioned in paragraph (b) of Article 194, eighty (80%) percent
of the monthly income benefit and the dependents pension shall be paid to the primary beneficiaries
regardless
of the cause of death.
3. This provision does not apply to cases where a member under permanent partial disability dies
during the period where he is receiving monthly income benefits for permanent partial disability.
4. Upon the death of a pensioner who is survived by secondary beneficiaries, the latter are entitled only
to the balance of the five - (5) year guarantee period, provided that the total amount of compensation
benefits
for the five - year period shall not be less than fifteen thousand (P15,000.00) pesos, but if the member
under
permanent total disability dies after the five - year guarantee period, secondary beneficiaries are no
longer
entitled to any benefits.
III. PRESCRIPTIVE PERIOD
1. Notice in any form by the employee or employer to the Systems of any compensable contingency
within three (3) years from the accrual of the cause of action suspends the running of the prescriptive
period.
2. If the employee notified the employer of the compensable contingency or in those cases where
notice is no longer required, and the employer failed to notify the Systems as required by law, the
claimant is
entitled only to fifty (50) percent of the monthly income benefits to be paid by the employer, if he failed
to file
his claim within three (3) years but the benefits shall be paid in advance by the System after which the
amount
so paid shall be reimbursed by the employer.
3. The rule on Constructive Filing under ECC Resolution No. 2127, shall not apply to contingencies
whose causes of action accrued on or after June 1, 1984.
4. The new prescriptive period of three (3) years shall benefit those pending cases which were filed
within three (3) years, provided the one (1) year prescriptive period has not yet elapsed as of
June1,1984.
IV. APPEAL FROM THE DECISIONS OF THE SYSTEMS
1. Within thirty (30) days from receipt of the letter of denial or the affirmation of denial, as the case
may be, the claimant shall inform the System in writing of his desire to appeal, otherwise the decision of
the
System shall become final. Upon receipt of such appeal, the System shall within five (5) days forward the
entire
record of the case to the Commission for review.
However, when a judgment or order is entered through fraud, accident, mistake, excusable negligence
or analogous circumstances, claimant may file a petition with the System praying that the judgment be
set aside
within the time and in the manner prescribed under Section 3, Rule 38 of the Revised Rules of Court.
V. REPEALING CLAUSE AND EFFECTIVITY
1. All Rules or Regulations which are inconsistent with this Suppletory Rules are deemed repealed and
superseded.
2. This Suppletory Rules shall take effect upon approval by the Commission.
APPROVED UNANIMOUSLY.
March 23,1990
The foregoing Suppletory Rules were adopted by the Employees' Compensation Commission in its resolution 90-03-
0022, passed during its 6th Regular Meeting, Series of 1990, held on March 23,1990 at Fourth Floor, Employees'
Compensation Commission Building, 355 Sen. Gil J. Puyat Avenue, Makati, Metro Manila.
ANNEX G
POLICY ISSUANCES
A. "Presumptive Compensability" for AFP members and Policemen
WHEREAS, because of certain serious peace and order problems of the country, more particularly the
insurgency
problems, it has become generally perceptible that on account of the nature of their work, members of
the
Armed Forces of the Philippines (AFP) have become "marked men" insofar as insurgents and other
lawless
elements are concerned and are, therefore, killed by such insurgents at every opportunity;
On motion of Hon. Hector B. Inductivo, member-designate of the Employees' Compensation Commission
(ECC)Board of Commissioners, that the member-designate representing the Government Service
Insurance
System (GSIS), namely, Hon. Amante R. Rimando, duly seconded.
This Board, resolves, as it hereby resolves, to approve the adoption of a policy that the moment an AFP
member
suffers a contingency, the presumption is that it is because of the nature of his work; provided that the
evidentiary details of his injury, or death, are clearly established through duly issued medical certificates
on his
injury or injuries, or death, by the attending physician or duly authorized representatives of the hospital
where
he is brought for medical treatment; and
This Board resolves, as it hereby resolves finally, that a copy of this resolution be duly provided the
Systems, the
AFP, and all other concerned institutions, agencies or parties, for their information and proper guidance.
Approved and confirmed: July 5,1988.
B. "Going to and coming from the place of work" rule.
RESOLUTION 3914-A
WHEREAS, in several regular meetings that the Employees' Compensation Commission (ECC) Board of
Commissioners has held since 1987, the Board has taken cognizance of the need to come up with a new,
operative principle to underpin an updated, definitive, fair and just policy aimed at causing the provision
of
benefits to employees or covered members, who suffer injury or die in accidents, while they are in route
to, or
coming from, the workplace; and
WHEREAS, during the 11th regular meeting of the ECC Board of Commissioners, series of 1988, held on
July
5,1988, The Board developed the general agreement that whether an accident wherein an employee
suffers an
injury or dies, occurs proximate to, or not, to his workplace, the assumption or operating principle is that
such
an employee will not meet an accident and get injured or die, if he is not going to or coming from work,
or he
does not carry out an official directive of his office or superiors in connection with his work;
On motion of Hon. Hector R. Inductivo, member-designate representing theSocial Security System (SSS),
that
Hon. Amante R. Rimando, member-designate representing the Government Service Insurance System
(GSIS),
duly seconded,
This Commission resolves, as it hereby resolves, to approve as a policy that an injury or death of a
covered
member in an accident while he is going to, or coming from, the workplace, shall henceforth be duly
considered
compensable in the purview of PD 626, as amended, and its approved, amended implementing rules,
provided
that the following conditions shall be established definitively:
1. The act of the employee going to, or coming from, the workplace, must have been a continuing act,
that is, he had not been diverted therefrom by any other activity, and he had not departed from his usual
route
to, or from, his workplace; and
2. Re: an employee on special errand, the special errand must have been official and in connection with
his work; and
This Commission resolves, as it hereby resolves, that the foregoing approved, updated criteria be duly
incorporated into pertinent provisions of PD 626, as amended, and its approved, amended implementing
rules;
and
This Commission resolves, as it hereby resolves finally, that a copy of this resolution be duly furnished
the SSS
and the GSIS, and all other concerned institutions, agencies or parties, for their information and proper
guidance.
Approved and confirmed: July 5, 1988
C. Policy on Military on Pass:
BOARD RESOLUTION 03-020014
"The governing Board of the Employees Compensation Commission (ECC), having subjected to
penultimate
scrutiny and critique a duly approved, revised set of definitive guidelines on compensability of disability or
death
resulting from illnesses or injuries members of the military suffered, while they were 'on pass' or 'on
leave';
"On motion duly seconded,
"Resolved, that effective immediately, the following guidelines shall be observed in adjudging the
compensability
of disability or death of members of the military resulting from illnesses or injuries they suffered, while
they
were 'on pass' or 'on leave':
"1. In the following circumstances, the disability or death of a member of the military is held
compensable:
1.1. While the soldier was on pass for a period not exceeding seventy-two (72) hours. If the soldier
was unable to report himself or herself back for duty from a duly authorized pass within the 72-hour
period, it
must have been for some legitimate, and valid reasons, such as, fortuitious events or force majeure;
provided
that no unjustified or reasonable deviation from the condition for which the pass had been issued had
been
committed;
1.2. While the soldier was on rest and recreation, which is considered part of the soldier's military
activities, after the soldier had gone on actual combat duty, as duly certified to by the proper
commanding
officer concerned; and
1.3. While the soldier was on academic leave, provided that the particular field of study had been
approved and paid for by the military, or other agencies the military had sanctioned officially;
"2. The disability or death of a soldier in the following circumstances is deemed not compensable:
2.1. While the soldier was on furlough or on leave, he or she is considered absent from military
duties;
2.2. While the soldier was on sick, convalescent, or compassionate leave, except when the leave
had been due to work-connected illnesses or injuries;
2.3. While the soldier was on maternity, paternity or graduation leave; and
2.4. When the soldier is considered on "AWOL" status;
"3. The judgment of compensability apropos to the foregoing cases is subject to the general limitations
provided
for in Article 172 of the Labor Code of the Philippines, as amended; specifically, that the disability or
death had
not been occassioned by intoxication, notorious negligence and willful intention of the soldier to kill
himself, or
another. Moreover, the sickness or injury should not have arisen from participation or involvement in a
criminal
offense, whether consummated or not; and
"4. The aforecited guidelines notwithstanding, the disability or death of the soldier is also subject to the
policy
on "presumptive compensability" governing contingencies of members of the Armed Forces of the
Republic of
the Philippines (AFP), as contained in Board Resolution 3906, ECC, dated July 1988; and
"Resolved, Finally,, that a copy of this issuance be furnished all concerned institutions, agencies or
parties, for
their information and proper guidance.
Unanimously approved: Makati, Metro Manila, 11 February 1993."
D. Policy on Prescription, Permanent Total Disability, Increased Risk, Progression
(Deterioration)
of Illness or Injury, Presumptive Death, Personal Comfort Doctrine and Definition of
Excepting
Circumstances:
BOARD RESOLUTION 93-08-0068
RESOLVED, THAT the following policy instructions 01-93 of the Employees' Compensation Commission
(ECC) be
approved effective immediately:
To insure proper implementation of Title II, Book IV, on Employees' Compensation and State Insurance
Fund of
the Labor Code of the Philippines, as amended, and its approved implementing Rules and Regulations
concerning the processing and adjudication of employees' compensation (EC) cases, the following rules
and
regulations are hereby issued for the guidance of all concerned:
1. PRESCRIPTION
1.1. As a general rule, no claim for compensation shall be given due course, unless said claim is filed
with the System within three (3) years from the time the cause of action accrued: Provided, however,
that any
claim filed with the System for any contingency that may be held compensable under the Employees'
Compensation Program (ECP) shall be considered as the EC claim itself;
1.2. "Cause of Action" refers to a work-related disability or death. The three year prescriptive period
shall be reckoned from the onset of disability, or date of death and
1.3. In case where one is declared presumptively dead, the three (3) year limitation for filing the claim
shall be counted from the date the missing person was officially declared to be presumptively dead;
2. PERMANENT TOTAL DISABILITY (PTD):
2.1. As a rule, a sickness or injury requiring prolonged treatment shall be deemed temporary total for a
period of not more than one hundred twenty days (120) days; thereafter, if disability still persists, the
grant of
temporary total disability (TTD) benefits shall be continued up to a maximum of (240) days. Thereafter, if
the
claimant is still sick and unable to report for work as established by proper medical examination, his
disability
shall be considered permanent and total; and
2.2. If the employee retires or otherwise is separated from employment after the first 120 days of
temporary total disability (TTD), but before 240 days, he may present himself to the System for another
physical
and medical examination, to determine if he is entitled to additional benefits;
3. INCREASED RISK:
3.1. There is increased risk if the illness is caused or precipitated by factors inherent in the employees'
nature of work and working conditions. It does not include aggravation of a pre-existing illness; and
3.2. To establish compensability of the claim under the increased risk theory, the claimant must show
proof of work-connection. The degree of proof required is merely substantial evidence as a reasonable
mind
may accept as adequate to support a conclusion;
4. PROGRESSION (DETERIORATION) OF ILLNESS OR INJURY:
4.1. Where the primary illness or injury is shown to have arisen in the course of employment, every
natural consequence that flows from the illness or injury shall be deemed employment-related; and
4.2. Upon the death of a covered member during the period he was receiving permanent partial
disability (PPD) benefits, the remainder of his PPD benefits shall be paid to his primary beneficiaries.
However,
the beneficiaries shall be entitled to the same benefits enjoyed by the beneficiaries of a PTD pensioner
upon his
death: Provided, That, the cause of death was the same illness or injury for which he was awarded PPD
benefits;
5. PRESUMPTIVE DEATH:
5.1. If one is declared presumptively dead after he had been reported missing for sometime, payment
of death benefits shall be reckoned from the date he was declared presumptively dead by proper
authority, in
accordance with law; except when the declaration of death specified another date, in such a case,
payment of
death benefits shall start from the latter date; and
5.2. In spite of the fact that the body of a missing person had not been recovered, and that no burial
activities had been undertaken, the beneficiaries shall still be entitled to funeral benefits, as provided for
under
the law; and
6. PERSONAL COMFORT DOCTRINE:
6.1. Acts performed by an employee within the time and space limits of his employment, to minister to
personal comfort, such as satisfaction of his thirst, hunger or other physical demands, or to protect
himself
fromexcessive cold, shall be deemed incidental to his employment and injuries the employee suffered in
the
performance of such acts shall be considered compensable and arising out of and in the course of
employment.
7. EXCEPTING CIRCUMSTANCES:
7.1. Intoxication
Intoxication refers to a persons condition in being under the 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;
7.2. Notorious Negligence
Notorious negligence is something more than mere or simple negligence. It signifies a
deliberate act of the employee to disregard his own safety, or ignore established warning or precaution;
and
7.3. Willful Intent to Injure or Kill Oneself or Another
This contemplates a deliberate intent on the part of the employee to inflict injuries on himself
or another; and
Resolved, finally, that this Board Resolution be duly circularized immediately not only to the administering
agencies of the Employees Compensation Program (ECP) for the private sector and the public sector,
namely,
the Social Security System (SSS) and the Government Service Insurance System (GSIS), but to the
general
public as well, for guidance of all concerned.
Unanimously approved: Quezon City, Metro Manila, 05 August 1993.
E. Policy on the Reimbursement of Hospital Expenses for Service-Connected Ailments of
Hypertensive Cardiovascular Disease and Cardiovascular Accident:
BOARD RESOLUTION 96-09-0397
As duly provided for in Rule VIII (B) of the ECC Charter (Presidential Decree 626, as amended), the
Administering Agencies of the Employees Compensation Program for the private sector and the public
service,
namely, the Social Security System and the Government Service Insurance System, shall reimburse to a
hospital,
wherein an employee, who has suffered from work-related ailment or diseases is confined, all the
medicines,
drugs or supplies deemed justifiably necessary for the treatment of the employees medical condition at a
cost
not exceeding retail prices; and
In a meeting of 4th September 1996, the 1st Special Working Group of Commissioners, with the
Technical
Review Committee, ECC, unanimously recommended to this Commission the approval of the
reimbursement by
the System of claims filed by Employees Compensation patients for expenses they have incurred in the
purchase of medicines considered necessary to lower their serum lipid levels, as a result of their
serviceconnected
ailments of hypertensive cardiovascular disease and cardiovascular accident;
On motion duly made and seconded,
Resolved, that, a recommendation of the 1st Special Working Group of Commissioners, with the
Technical
Review Committee, on the approval of the reimbursement by the System of claims of EC patients, who
suffer
from a work-related HCVD and CVA, for expenses they have incurred in the purchase of medicines
considered
justifiably necessary to lower their serum lipid levels, be approved, effective 1st April 1996;
Unanimously approved in Makati City, Metro Manila, 12th September 1996.
F. Policy on the Increase in the Maximum Ceiling for Daily Income Benefits for Temporary
Total
Disability from Ninety Pesos to Two Hundred Pesos, effective 1st November 1996:
BOARD RESOLUTION 96-10-0429
Whereas, The reserves of the State Insurance fund under the Administering Agency of the Employees
Compensation Program for the private sector, namely, the Social Security System, have been registered
to have
grown to FOURTEEN BILLION FIVE HUNDRED SIXTY-FOUR MILLION SEVEN HUNDRED ONE
THOUSAND TWO HUNDRED EIGHTY-SEVEN PESOS (PhP14, 564,701,287.00) as of 31st March
1996,
owing to the prudent and judicious management thereof by the System since the inception and
operationalization of the Program in January 1975;
Whereas, The plowing back of the reserves of the SIF in liberalized benefits to workers who get sick or
injured,
or die arising out of and in the course of employment constitutes an operative principle in this
Commissions
discharge of its quasi-judicial and policy-making functions on employees compensation;
Whereas, This Commission is duly concerned that for certain reasons, it has been eight years ago since
the
ECC pegged the daily income benefit at not less than Ten Pesos (PhP 10.00), nor more than Ninety Pesos
(PhP
90.00), nor paid longer than 120 days (Board Resolution 3682 of 7th July 1987). This cognizance takes
into
account a pervasive clamor of covered members under both the SSS and the Administering Agency of the
said
Program for the public service, namely, the Government Service Insurance System, for the institution of
realistic,
unitary increases in the daily income benefit and certain other EC benefits;
Whereas, In a memorandum of 11th April 1996, Hon. RENATO C. VALENCIA, Administrator, SSS, and
concurrently Member of the Board, ECC, duly recommended to this Commission, inter alia, the upward
revision
of the EC maximum daily income benefit for temporary total disability from NINETY PESOS (PhP
90.00) to
TWO HUNDRED PESOS (PhP 200.00). This is to keep it at par with the ceiling of social security
benefits for
non-work-related contingencies;
Whereas, As contained in a Position Paper of 15th May 1996 on the aforecited proposal, the Employers
Confederation of the Philippines, through its President, Hon. MIGUEL B. VARELA, concurrently Member
of the
Board, ECC, declared that the ECOP x x x fully supports the proposal indorsed by the Social Security
System
increasing the EC benefits due to workers on condition that this will not entail additional contributions
from the
Employers x x x x x ;
Whereas, This Commission takes into account also that the proposed increase in the maximum ceiling
for daily
income benefits for TTD will not require an increase in premium contributions of employers to the SIF for
and in
behalf of their employees. And neither will it have an adverse impact on the stability, liquidity and
viability of the
SIF reserves under the SSS; and
Whereas, In general, organized labor has always batted for the enhancement of benefits for workers;
and in
particular, the Labor Advisory Consultative Council, as duly relayed to this Commission by Hon.
VLADIMIR R.
TUPAZ, Secretary General of the Trade Union of the Philippines and Allied Services, and Concurrent
Member,
ECC, representing Employees, formally made known in a recent meeting it held that LACC fully supports
the
aforecited proposal as endorsed by the SSS; and
Whereas, Article 177 (e) of the ECC Charter (Presidential Decree 626, as Amended, a.k.a. Title II, Book
IV, on
Employees Compensation and State Insurance Fund, of the Labor Code of the Philippines, as Amended),
provides thus:
x x x The Commission may upgrade benefits and add new ones subject to the approval of
the
President; and Provided, Further, that the actuarial stability of the State Insurance Fund
shall be
guaranteed; Provided, Finally, that such increases in benefits shall not require any increases
in
contribution, except as provided for in Paragraph (b) hereof. (As amended by Sec. 3, P.D.
1641) x x
x;
On motion duly made and seconded,
Resolved, As it hereby Resolved, That, The increase in the maximum ceiling for daily income benefits
for
Temporary Total Disability from NINETY PESOS (PhP 90.00) to TWO HUNDRED PESOS (PhP
200.00)
under Administering Agency of the Employees Compensation Program for the private sector, the Social
Security
System, be approved, effective 1st November 1996; and That, such an increase will not entail an upward
revision of premium contributions of employers to the State Insurance fund for and in behalf of their
employees;
and
Resolved, Further, That, This Board Resolution and supporting documents thereof be transmitted to
the
Office of the President soonest, for approval; and that copies thereof be furnished the SSS and the GSIS,
the
ECOP and all other concerned Institutions, Agencies or Parties, for their information and appropriate
action.
Unanimously approved in Makati City, Metro Manila, 10th October 1996.
G. Policy On Surviving Spouse
BOARD RESOLUTION NO. 97-09-0500
Pursuant to the provision of the Labor Code on protection and welfare of workers and their legal
beneficiaries,
the Secretariat of the Employees Compensation Commission, had formally sought the liberalization of the
implementation of Section I (B) (1), Rule XV, of the ECC Charter (Presidential Decree 626, as amended,
a.k.a.
Title II, Book IV, on Employees Compensation and State Insurance Fund) i.e., considering that
thereunder, the
surviving spouse of a covered employee is held entitled to Employees Compensation benefits only cases
the
spouse is found living with the employee at the time of the latters death; and
Further thereto, during the 16th regular meeting of the Governing Board, ECC, convoked on 4th
September
1997, the Board duly discussed the validation of a recommendation of the Secretariat contained in a
memorandum of 2nd September 1997, that payment of EC benefits to a surviving spouse, who is legally
separated or separated de facto from the deceased covered employee, be given due course based on a
set of
guidelines;
On motion duly made and seconded,
Resolved, as it is hereby resolved, that, the adoption of a policy that the surviving spouse found to be
not living
with the covered employee at the time the employee died be held entitled to Employees Compensation
benefits
under Section I (B) (1), Rule IV, Of the ECC Charter, be approved, provided, that the separation occurred
owing
to any of the following circumstances:
1. Refusal of the covered employee to continue living wth the surviving spouse; or the employees
abandonment of the said spouse, without justifiable or valid cause;
2. Attempt of the covered employee against the life of the surviving spouse, common child/children of
the spouse:
3. Commission of an act of sexual abuse against the surviving spouse, common child/children or
child/children of the spouse by the covered employee;
4. The covered employees recurrent commission of physical violence, or grossly, abusive conduct,
against the surviving spouse, common child/children or child/children of the spouse;
5. The covered employees infliction of physical violence, or imposition of moral duress, to compel the
surviving spouse, common child/children or child/children of the spouse to change their religious or
political
affiliation;
6. Attempt of the covered employee to corrupt, or induce the surviving spouse, common child/children
or child/children of the spouse to engage in prostitution, or to make them connive with the employee in
such an
act of corruption or inducement;
7. Drug addiction or habitual alcoholism of the covered employee;
8. Lesbianism or homosexuality of the covered employee;
9. Contraction of bigamous marriages by the covered employee, whether in the Philippines or abroad;
10. Sexual infidelity or perversion of the covered employee;
11. The covered employees act of allowing the surviving spouse, common child/children or
child/children of the spouse to be subjected to acts of lasciviousness; and
12. The covered employees contraction of serious, sexually transmitted disease extra-maritally; and
Resolved, Further, that a copy of this Board Resolution be furnished all concerned institutions, agencies
or
parties, for their information and proper guidance.
Approved in Makati City, Metro Manila, 4th September 1997.
ANNEX H
RULES OF PROCEDURE FOR THE FILING AND DISPOSITION OF THE EMPLOYEES
COMPENSATION
CLAIMS
WHEREAS, the existing Rules of Procedure need updating and simplification to meet the need of
claimants, dependents, and beneficiaries under existing and changing conditions;
WHEREAS, these simplified and updated Rules will achieve the objective of the Employees
Compensation Law, and will assist parties in obtaining prompt, expeditious and inexpensive settlement of
their
claims;
WHEREAS, these Rules will improve the administration and enforcement of the Employees
Compensation and State Insurance Fund Law;
NOW THEREFORE, the Commission hereby adopts and promulgates the following rules:
RULE 1. TITLE AND CONSTRUCTION
Section 1. Title. - These rules shall be known and cited as the Rules of Procedure for the Adjudication
of Employees Compensation Claims.
Section 2. Construction and interpretation. - These rules of procedure shall be liberally construed
to promote the objective of the Law on Employees Compensation and State Insurance Fund, (hereinafter
referred to as the Law) to assist the parties in obtaining just, prompt, expeditious and inexpensive
settlement of
their claims.
RULE 2. JURISDICTION
Section 1. Jurisdiction.
(a) Original and Exclusive. The Government Service Insurance System (hereinafter referred to as
GSIS) in case of the public sector and the Social Security System (hereinafter referred to as SSS) in case
of the
private sector, shall have original and exclusive jurisdiction to settle any dispute arising from the Law and
its
Implementing Rules and Regulations with respect to coverage, entitlement to benefits, collection and
payment
of contributions and penalties thereon or any other matter related thereto.
(b) Appellate. The Employees Compensation Commission (hereinafter referred to as the Commission)
shall have appellate jurisdiction over all awards and decisions, orders or resolutions of the GSIS and SSS.
RULE 3. FILING OF CLAIM
Section 1. Who may file. - The covered employee, his dependents or the beneficiaries defined by law
or, in case of their absence or incapacity, their duly authorized representative may file an appropriate
claim with
the GSIS in case of the public sector or the SSS in case of the private sector.
Section 2. What to file. - Claims for benefits may be filed for any or a combination of the following:
1. Disability Benefit
(a) Permanent Total Disability (PTD) Benefit
(b) Permanent Partial Disability (PPD) Benefit
(c) Temporary Total Disability (TTD) Benefit
2. Death Benefit
3. Funeral Benefit
4. Medical Services
5. Rehabilitation Services
Section 3. Where to file. - Claims of employees in the public sector shall be filed with the GSIS and
those of the private sector with the SSS.
Section 4. When to file.
(a) Benefit claims shall be filed with the GSIS or the SSS within three (3) years from the date of
the occurrence of the contingency (sickness, injury, disability or death).
(b) Claims filed beyond the 3-year prescriptive period may still be given due course, provided
that:
1. A claim was filed for Medicare, retirement with disability, burial, death claims, or life
(disability) insurance, with the GSIS within three (3) years from the occurrence of the contingency.
2. In the case of the private sector employees, a claim for Medicare, sickness, burial,
disability or death was filed within three (3) years from the occurrence of the contingency.
3. In any of the foregoing cases, the employees compensation claim shall be filed with
the GSIS or the SSS within a reasonable time as provided by law.
RULE 4. PROCEDURE IN THE SYSTEM
Section 1. Form of application. - All claims shall be filed using the prescribed forms furnished by
either the GSIS or the SSS, and endorsed by the employer or his duly authorized representative together
with
the following supporting documents:
1. Claim for disability benefits
(a) Sickness resulting to disability
(1) Updated service record
(2) Statement of duties and responsibilities
(3) Hospital record of confinement;
(4) Official receipts in payment of hospital bills, professional fees and medicines
purchased from the drugstore;
(b) Injury resulting to disability
(1) Updated service record
(2) Statement of duties and responsibilities
(3) Police investigation report, employers report of injury, death/casualty (for civilian
employees) spot report, Investigation Report and or report of proceedings before Line of Duty Board (for
AFP
members)
(4) Mission or Travel Order, when applicable;
(5) Hospital receipts in payment of hospital bills, professional fees and medicines
purchased from drugstore.
2. Claim for Death Benefits
(1) Updated service record
(2) Statement of duties and responsibilities
(3) Police investigation report or employers report of injury, death or casualty (for civilian
employees) spot report and/or report of proceedings before Line of Duty Board (for AFP members), when
applicable;
(4) Mission or Travel Order, when applicable;
(5) Hospital record of confinement
(6) Official receipts in payment of hospital bills, professional fees and medicines purchased
from a drugstore;
(7) Death certificate issued by the Local Civil Registrar or National Statistics Office ( NSO ), and
(8) Declaration of presumptive death by competent authority.
3. The GSIS or the SSS may require the submission of other supporting documents if the supporting
papers of the claim are insufficient to make a proper adjudication of the claim.
Section 2. Adjudication. - The GSIS and SSS shall adjudicate the claim within twenty (20) calendar
days from the submission of all required documents and shall render a decision either denying or
awarding
compensation benefits.
Section 3. Notice of Award or Decision. - The claimant shall be notified in writing by the GSIS or
the SSS of its award or decision on the action taken on his claim.
The award or decision of the GSIS or SSS shall include the following:
1. Facts of the case
2. Issue or issues involved
3. Applicable laws or rules, and
4. Conclusion(s) and reason(s) therefor.
The claimant shall also be informed of his right to appeal in accordance with Title II of Book IV of the
Labor Code and its Implementing Rules and Regulations and that the decision shall become final and
executory
if no appeal or motion for reconsideration is filed within the reglementary period.
Section 4. Motion for Reconsideration. - The claimant shall file with the GSIS or the SSS, as the
case may be, only one motion for reconsideration within ten (10) calendar days from receipt of the
decision.
When a motion for reconsideration is denied by the GSIS or the SSS, the claimant may appeal to the
Commission within thirty (30) calendar days from the receipt of the decision or the notice of denial of the
motion for reconsideration.
RULE 5. APPEAL
Section 1. Period of Appeal. - The claimant shall file with the GSIS or the SSS, as the case may be, a
notice of appeal within thirty (30) calendar days from receipt of the decision.
Section 2. Grounds. - The appeal may be entertained only on any of the following grounds:
(a) if serious errors in the finding of facts are raised which, if not corrected, would cause grave
irreparable damage or injury to the appellant,
(b) if there is a prima facie evidence of abuse of discretion on the part of the System, and
(c) if made purely on question of law.
Section 3. Requisites for Perfection of Appeal. - The appeal shall be filed within the reglementary
period as provided in Section 1 of this Rule, stating the grounds relied upon and the arguments in
support
thereof, and the relief prayed for.
A mere notice of appeal without complying with the other requisite aforestated shall not stop the
running of the period for perfecting an appeal.
Section 4. Transmittal of the Record In Case of Appeal. - Upon receipt of the notice of appeal,
the GSIS or SSS shall transmit the entire records of the case to the Commission within five (5) working
days
from receipt thereof. The transmittal letter must include the date of the:
(a) Filing of the claimants application,
(b) Decision of GSIS or SSS,
(c) Receipt by the claimant of the decision of the GSIS or the SSS,
(d) Claimants motion for reconsideration,
(e) Decision of the GSIS or SSS on the motion for reconsideration,
(f) Receipt by the claimant of the GSIS or SSS decision on the motion for reconsideration;
(g) Claimants notice of appeal with the GSIS or SSS, and
(h) Transmittal of the records to the ECC.
Section 5. Docket and Assignment of Cases. - Appealed cases from the GSIS and SSS duly
received by the Commission shall be docketed and assigned to legal and medical officers, as the case
may be,
for evaluation and review.
Section 6. Evaluation and Recommendation. - Cases involving legal issues shall be assigned to the
Legal Division for proper legal evaluation. Cases involving medical issues shall be assigned to the Medical
Division for proper medical evaluation.
In either case, the evaluation shall be in a duly prescribed outline form and from which a draft decision
shall be based.
Section 7. Submission to the Technical Review Committee (TRC). - The evaluation shall be
submitted to the Technical Review Committee (TRC) for its consideration and recommendation.
Section 8. Action of the TRC. - The TRC shall review the evaluation and elevate the same to the
Commission.
Section 9. Action by the Commission. - Upon submission of the draft decision, the Commission may
approve, deny or modify the evaluation and recommendation of the TRC.
Section 10. Content of Decisions, Resolutions and Orders. - Decisions, resolutions, or orders
issued by the Commission shall be clear and concise, and shall include a brief statement of:
(a) The facts of the case,
(b) The issue or issues involved,
(c) The applicable laws or rules, and
(d) The conclusion(s) and /or reason(s) of the action taken, and
(e) The benefits granted, if any.
Section 11. Form and Notice of Decision. - All decisions, resolutions or orders duly approved by the
Commission shall be signed and issued by the Executive Director or his duly authorized representative.
All parties concerned shall be given written notice of the decision rendered by the Commission.
No motion for reconsideration of the decision, resolution or order of the Commission shall be allowed.
Appeals to the Court of Appeals shall be filed within fifteen (15) days from receipt of the notice thereof,
and shall be governed by the Rules of Court.
RULE 6. FINAL PROVISIONS
Section 1. Repealing Clause. - Upon the effectivity of these Rules of Procedure for the Adjudication
of Employees Compensation Claims, all resolutions, orders, memoranda and circulars which are
inconsistent
with these rules are hereby repealed or modified accordingly.
Section 2. Effectivity Clause. - These rules shall take effect fifteen (15) days after the completion of
its publication in a newspaper of general circulation.*
Done in the City of Makati this 13th day of July 1995.**
* Published on Sept. 6, 1995
** Effectivity: Sept. 21, 1995
Copyright 2000 Employees' Compensation Commission