The ECC |
The ECP | SIF | Claims
| Case Updates | PD626
| Amended Rules | Press
Releases| Facts & Figures | Directory
|
|
|
| |
THE EMPLOYEES' COMPENSATION
PROGRAM
|
The
Employee's Compensation Program
is designed to provide public and private sector employees and their
dependents with income and other benefits in the event of a work-connected
injury, sickness, disability or death. It was created under P.D.
626 and became effective on January 1975. It assures workers of
total protection through the provision of a comprehensive benefit package
encompassing preventive occupational safety and health aspects, curative
or medical and compensatory grant, and rehabilitation of occupational
disabled workers. There
are three agencies involved in the implementation of the Employees
Compensation Program. These are: The
Employees’ Compensation Commission (ECC) which is
mandated to initiate, rationalize and coordinate policies of the
ECP and to review appealed cases from the Government
Service Insurance System (GSIS) and the Social
Security System(SSS). the administering agencies of the ECP. As administering
agencies of the ECP, both GSIS and SSS are tasked to:
Both
Systems invest the funds in profitable ventures to generate earnings which
will form part of the State Insurance Fund from where payments for
employees compensation claims are sourced. |
Who are covered under the ECP?
The
following are covered under the Employees' Compensation Program:
a.
All
public sector employees including those of government-owned or corporations and
local government units
b.
All
employees in the private sector covered by the SSS; and
c.
Filipino
Seamen compulsorily covered under the SSS. Landbased contract workers are only
subject to coverage under the ECP if their employer, natural or juridical, is
engaged in any trade, industry or business undertakings in the Philippines.
When shall coverage of employees under the ECP
start?
Employees
in the private sector and public sector are covered starting on the first day
of their employment.
What work contingencies are compensable under the
ECP?
The
following are compensated under the new ECP.
What are the forms of compensation a claimant may
received for work-related injury, sickness, disability or death?
The
compensation which a claimant may received for a work-connected injury,
sickness, disability or death are in the following forms:
·
Cash
Income Benefit - for disability or death;
·
Medical
and related services - for injury or sickness; and
·
Rehabilitation
services (in addition to monthly cash income benefit) for permanent disability.
To
be more specific, the benefits given to the employee or his dependents are in
the form of:
·
Daily
cash income benefit for temporary
total disability (TTD);
·
Monthly cash income
benefit for permanent total
disability (PTD) on a lifetime basis;
·
Monthly cash income
benefit for permanent partial
disability (PPD);
·
Monthly cash income
benefit for death, also on lifetime basis, except for benefit paid to secondary
beneficiaries, which is a monthly pension not to exceed 60 months but not less
than fifteen thousand pesos (P15,000.00);
·
Medical services,
appliances and supplies for injury or sickness;
·
Rehabilitation services
for permanent disability; and
·
Carer's allowance for
permanent disability.
When is an accident/injury compensable?
An injury is compensable if it was sustained due to an accident arising out of
and in the course of employment.
When is an accident considered to have resulted out of and in the
course of employment?
An
accident is considered to have resulted out of and in the course of employment
if:
·
it
occurred while the employee was performing his official function, at the place
where his work requires him to be, and, if elsewhere, the employee must have
been executing an order for the employer;
·
it
occurred while the employee was performing an act 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 protect himself from
excessive cold;
·
it
occurred while the employee was going to or coming from the place of work;
provided however, that there was no diversion from his usual route;
·
it
occurred while the employee was engaged in company sponsored activities, such as
field trips, picnics, intramurals, etc.; and
·
it
occurred while the employee was onboard a shuttle bus or any vehicle provided by
the company.
Any
sickness that is listed by the ECC as an "occupational disease" (View List) is
compensable
An illness
not listed as "occupational disease",
may be compensable if an employee can show an
evidence/proof that the risk of contracting such sickness was increased by the
working conditions (increased risk theory), e.i. if the illness is caused by or
precipitated by factors inherent in the employee's nature of work and working
conditions. However, this does not include aggravation of pre-existing
illness.
How can a
claimant establish compensability of a sickness under the increased risk theory?
There
is an increase risk if the illness is caused or precipitated by factors inherent
in the employees' nature of work and working conditions. To establish
compensability of a 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.
When is a disability compensable and how much income benefits may an
employee received?
A
disability is compensable if it is caused by a work-connected injury or
sickness.
INCOME
BENEFIT FOR TEMPORARY
TOTAL DISABILITY (TTD):
Income
benefit is 90% of the employee's average daily salary credit as
determined by the System. This income benefits shall not be more than P200
per day for private workers and P90 per day for government employees, and shall
not be paid longer than 120 days, unless the injury or sickness requires more
extensive treatment that lasts beyond 120 days. During this extended period, the
worker shall continue to be paid the TTD benefit but not to exceed 240 days.
The
employee has no obligation to the System while he is receiving TTD income
benefit. However, the employee should submit to the System a monthly medical
report on his disability certified by his attending physician. Failure to
do so shall cause the suspension of his income benefit until such a time when he
complies with his obligation. He must also submit himself for examination, upon
being notified by the System, at least once a year.
A
worker does not have to exhaust his leave credits before he may be entitled to
employees compensation benefits.
Should
the employee who suffered any work-connected sickness or injury still has
available leave credits, he shall, starting on the very first day of the
contingency, enjoy both his leave with pay and employees' compensation benefits
at the same time.
INCOME
BENEFIT FOR PERMANENT
PARTIAL DISABILITY (PPD):
An employee under PPD shall
be paid a monthly income benefit equal to the monthly income benefit paid for
PTD according to the schedule of payments beginning with the first month of
disability and shall continue for a period as follows:
|
Complete
and Permanent Loss of the use of: |
Number
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
other toe |
3 |
|
One
hand |
39 |
|
One
arm |
50 |
|
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 |
For the complete and
permanent loss of more than one member or part of his body at the same time,
the employee shall be paid the same amount of monthly income benefit for a
period equivalent to the SUM TOTAL of the periods established for the loss of
the individual members.
Thus, an employee who loses
his thumb (10 months) and his little finger (3 months) at the same time
shall receive the monthly income benefit for a period of 13 months.
An employee under PPD may
receive a lump sum benefit if the period of his disability does not
exceed 12 months.
An employee who is
receiving PPD income benefit and becomes or remains to be gainfully
employed shall
continue to receive his monthly income benefit for as long as he is entitled to
it.
INCOME BENEFIT
FOR PERMANENT
TOTAL DISABILITY (PTD):
An employee under PTD
shall, until his death, be paid by the System a monthly income benefit, plus 10%
thereof for each dependent child, but not exceeding five, beginning with the
youngest and without substitution.
·
For the private sector
employees, the monthly income benefit for PTD shall be 15% more than the SSS
benefit; and
·
For government
employees, the monthly income benefit is 20% more than the GSIS basic monthly
pension (BMP).
Monthly
Income Benefits (MIB)
For private sector,
the monthly income benefit is equivalent to 115% of the sum of the monthly
pension which shall be the highest of the following amounts:
a. The sum of the following:
·
Three Hundred Pesos
(Php300.00); plus
·
Twenty percent (20%) of
the average monthly salary credit; plus
·
Two percent (2%) of the
average monthly salary credit for each credited year of service in excess of ten
(10) years; or
b. Forty percent (40%) of the average monthly salary credit; or
c. Two thousand Pesos (Php 2,000.00).
For the government
sector, the monthly
income benefits is equivalent to 120% of Basic Monthly Pension (BMP) under P.D.
1146 (GSIS Law).
The BMP is equivalent to 37.5% of the revalued average monthly compensation (RAMC),
plus 2.5% thereof for every year of service in
excess of 15 years.
RAMC is equivalent to the monthly compensation (AMC), plus Php 140.00.
AMC is the quotient obtained by dividing the total compensation received
during the last three years by the number of months during which compensation
was received but in no case shall the AMC exceed Php3,000.00.
Based on the foregoing formula, a government employee who has been in the
service for 10 years and receiving at least 3,000 a month for the last three
years before permanent total disability, will receive a monthly income benefit
of Php1,413.00 under the Employees' Compensation Law.
Payment of
the Permanent Total Disability Monthly income benefit may be suspended if:
·
the employee fails to
submit his quarterly medical report;
·
he fails to present
himself for annual examination;
·
he has recovered from
his PTD; or
·
he is gainfully
employed, except or otherwise provided for in other laws or Executive Orders.
Death
is compensable when it resulted from a work-connected injury or sickness.
In
case an employee dies, his beneficiaries are entitled to receive the income
benefit. The status of the beneficiaries shall be determined at the time
of employee's death.
The
employee's beneficiaries are classified into:
|
Primary
beneficiaries
|
-
legitimate
husband or wife who is living with the employee when the employee dies,
until he or she remarries; and -
the
legitimate, legitimated, legally adopted or acknowledged natural children
who are unmarried, not gainfully employed and not over 21 years of age. To
be considered as primary beneficiary: For a legitimate, legitimated,
legally adopted or acknowledged natural child whose age is over 21, he
must have been incapacitated and incapable of self-support due to physical
or mental defect that is congenital or acquired during minority. |
|
Secondary
beneficiaries
|
-
the
legitimate parents wholly dependent upon the employee for support, and -
the
legitimate descendants and illegitimate children who are unmarried, not To
be considered as secondary beneficiary: A legitimate descendant or an
illegitimate child who is over 21 years of age must have been
incapacitated and incapable of self-support due to a physical or mental
defect that is congenital or acquired during minority.
|
|
If
there are primary and secondary beneficiaries
at the time of the employee's death, only the primary beneficiaries have
priority claim to the death benefits. No death benefits shall be given to
secondary beneficiaries whenever there are primary beneficiaries. |
|
INCOME
BENEFIT FOR DEATH
·
The
monthly income benefit of primary beneficiaries shall be equal to the monthly
income benefit paid for PTD. This shall be paid to them for as long as they are entitled
to it and guaranteed for five (5) years.
·
Primary
beneficiaries (or whoever spent for burial services) will also receive funeral
benefit.
·
If
there are dependent children, the benefit shall be increased by 10% for every
dependent child but not more than five (5) children counted from the youngest
and without substitution.
·
The
monthly income benefits shall be shared equally by all primary beneficiaries,
including the dependent children not counted among the five designated ones.
Upon disqualification of a designated child, ten percent (10%) shall be deducted
from the benefits, and the remaining amount shall once again be divided equally
by the qualified primary beneficiaries.
·
The
secondary beneficiaries may receive the death benefits only when the deceased
employee has no primary beneficiaries at the time of his death. They shall
receive a monthly pension equal to 60 times the employee's monthly income
benefit, but in no case lower than Php15,000.00. If the deceased was a pensioner
under PTD, and if he did not have primary beneficiaries at the time of his
death, the secondary beneficiaries shall be entitled only to the balance of the
five-year guaranteed period; but if the member under PTD dies after the five
year guaranteed period, secondary beneficiaries are no longer entitled to any
benefits.
·
If
there are no beneficiaries at the time of his death, the death benefits shall
become part of the State Insurance Fund.
When is an injury,
sickness, disability or death not compensable?
