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ANNEX "A" |
ANNEX "B" |
ANNEX "C" |
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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.
Sec.
2. Scope — (a) Every employer
shall be covered.
(b) Every
employee not over sixty (60) years of age shall be covered.
(c) An
employee over sixty (60) years of age shall be covered if he had been
paying
contributions to the System prior to age sixty (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.
Sec.
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) Any
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.
Sec.
4. Employee — (a) The term shall
mean any person who performs services for an employer as defined in
Section
3 hereof.
(b)An
employee shall belong to either:
(1) The
public sector 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.
Sec.
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 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 standards and rates payable by the System shall be those provided
for
under these Rules.
Sec.
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
Sec.
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.
Sec.
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.
Sec.
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
thirty
(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 report or written communication paid in his name
by his employer, before a compensable contingency occurs.
Sec.
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 thirty (30) days from
employment
and before the System receives any report for coverage about the
employee
or EC contribution on his behalf, his employer shall be liable to the
System
for the lump sum equivalent of the benefits to which he or his
dependents
may be entitled.
RULE
III
Compensability
Sec.
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.
Sec.
2. Occupational Diseases — (a)
The diseases listed in Annex
"A" [herein below] 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.
Sec.
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
Sec.
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.
Sec.
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 is 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 No. 186, as amended, Republic Act No. 6111, as
amended,
Republic Act No 1161, as amended, Republic Act No. 610, as amended,
Republic
Act No. 4864, 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),
Sec.
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.
Sec.
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.
Sec.
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
Employer's
Contribution
Sec.
1. Rate and Amount — Subject
to the following conditions, contributions under these 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 (1%) of his
monthly
salary credit as of the last day of the month, in accordance with the
following
schedule:
Salary Range
of Wagechan
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robles virtual law libraryEmployer's
Ichan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law libraP1 P49.99chan
robles virtual law libraryP25 P0.25
IIchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law libr50 99.99chan
robles virtual law library.....75 0.75
IIIchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law li100 149.99chan
robles virtual law library125 1.25
IVchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law li150 199.99chan
robles virtual law library175 1.75
Vchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law lib200 249.99chan
robles virtual law library225 2.25
VIchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law li250 349.99chan
robles virtual law library300 3.00
VIIchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law l350 499.99chan
robles virtual law library425 4.25
VIIIchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law 500 699.99chan
robles virtual law library600 6.00
IXchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law li700 899.99chan
robles virtual law library800 8.00
Xchan
robles virtual law librarychan robles virtual law librarychan robles
virtual
law lib900 overchan
robles virtual law library1,000-3,000 10.00
(3) When
a covered employee dies during employment, or is separated from
employment,
his employer's 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 employer's
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.
Sec.
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 employer to the System in February 1975,
unless
some other arrangement has been agreed by the System and the employer.
Sec.
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 Court's 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
three percent (3%) a month from the date 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 P.D. No.
626,
as amended, without prejudice on its part to proceed against the erring
employer).
RULE
VI
Definitions
Related to Credited Earnings
Sec.
1. Quarter — A period of three
consecutive calendar months ending on the last day of March, June,
September
and December.
Sec.
2. Semester — A period of two
consecutive quarters ending in the quarter of contingency.
Sec.
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.
Sec.
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, July 21,
1987).
Sec.
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 eighteen (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.
Sec.
6. Average Daily Salary Credit
— (a) In the case of the SSS, it is the result obtained by dividing the
sum of the six (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 or days worked during the month of contingency.
Sec.
7. Replacement Ratio — In the
case of the SSS, it is the sum of twenty percent (20%) and the quotient
obtained by dividing three hundred by the sum of three hundred forty
and
the average monthly salary by credit.
Sec.
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.
Sec.
9. Monthly Income Benefit — (a)
In the case of the SSS, it is the amount equivalent to one hundred
fifteen
percent (115%) of the sum of:
The
average monthly salary credit multiplied by the replacement ratio and
one
and a half percent (1-1/2%) 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 the fifteen percent (15%)
difference
in monthly income benefit between EC and SS and the twenty percent
(20%)
difference in monthly income benefit between EC and GSIS, be
maintained.
(L.O.I.
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 (20%) 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
Sec.
1. Types of Benefits — The benefits
under Employees' Compensation are in the form of income or services,
and
consists 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.
Sec.
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.
Sec.
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.
Sec.
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
(12) months, the System may pay in lump sum or in monthly pension,
otherwise
income benefit shall be paid in monthly pension.
Sec.
4. Services — The injury or sickness
is compensable by medical services, appliances, supplies and
rehabilitation
services.
Sec.
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.
Sec.
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
Sec.
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.
Sec.
2. Period of Entitlement — The
medical services, appliances, and supplies shall be provided to the
afflicted
employee 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 Section 5 of Rule IV.
Sec.
3. Extent of Services — (a) The
employee is entitled to the benefits only of 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 six 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
Sec.
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 rehabilitation of disabled individuals.
(E.g.:
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 associations 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 earnings at
least equal to the statutory minimum wage.
Sec.
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
Sec.
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 defined in these Rules;
(3) He
has not been placed in suitable employment.
Sec.
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.
Sec.
5. Extent of Services — Rehabilitation
services shall consist of medical-surgical management, hospitalization,
necessary appliances and supplies, vocational training, and assistance
for placement. (Transportation allowance between place of residence and
the rehabilitation facility, lunch, and dormitory allowances in
appropriate
cases may be included in the extent of services).
Sec.
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.
Sec.
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.
Sec.
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.
Sec.
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 fifteen (15) days
from
notice thereof to the Governing Board whose decision shall be final and
executory.
Sec.
10. Placement — Arrangement for
placement of the rehabilitee shall be an integral part of the
rehabilitation
program.
Sec.
11. Participation of the System
— As incentive to the participating employers in the on-the-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.
Sec.
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
Sec.
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.
Sec.
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).
Sec.
3. Amount of Benefit — Any employee
entitled to benefit for temporary total disability shall be paid an
income
benefit equivalent to 90 percent (90%) of his average daily salary
credit,
subject to the following conditions:
(1) The
daily income benefit shall not be less than P10.00 nor 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
Sec.
1. Conditions 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.
Sec.
2. Period of Entitlement — (a)
The full monthly income benefit shall be paid for all compensable
months
of disability.
(b) After
the benefit under 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 five
(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.
Sec.
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. 8 (a), [sic]
Rule
VI of these Rules.
(b) 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.
(c) 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.
Sec.
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 ten (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.
Sec.
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 twenty percent (20%) effective January 1, 1980.
In
the case of the GSIS, the monthly income benefit of current pensioners
shall be adjusted and recomputed to reflect the twenty percent (20%)
increase
over the benefit under PD 1146 effective January 1, 1980.
Sec.
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
Sec.
1. Conditions 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.
Sec.
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:
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(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.
Sec.
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 exceeds 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 twenty percent (20%) effective January 1, 1980.
In
the case of the GSIS, the monthly income benefit of current pensioners
shall be adjusted and recomputed to reflect the twenty percent (20%)
increase
over the benefit under P.D. 1146 effective January 1, 1980.
Sec.
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
Sec.
1. Conditions 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 had 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.
Sec.
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 [shall] be less than P15,000.00,
which shall likewise be paid in monthly pension (ECC Resolution No.
2799,
July 25, 1984).
Sec.
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
(10%)
for each dependent child but not exceeding five (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 (80%) plus the dependent's
pension equivalent to ten percent (10%) thereof for every dependent
child
but not exceeding five (5) 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 sixty (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).
Sec.
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 five (5) yeas,
whichever
comes first, shall be enforced.
In
the case of the SSS, the present monthly income benefit of current
pensioners
shall be increased by twenty percent (20%) effective January 1, 1980.