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SSS Employees' Compensation Program

What is the Employees' Compensation Program?
The Employees’ Compensation (EC) program aims to assist workers who suffer work-connected sickness or injury resulting in disability or death. The benefits under the EC program may be enjoyed simultaneously with benefits under the social security program effective June 1984.

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 EC contribution?

Only the employer is required to remit monthly EC contributions on behalf of the employees, equivalent to one per cent of the employee’s monthly salary credit. The required contribution under the current rate is P10.

How long is an employer obliged to pay for the EC contributions of his employee?

For as long as the employee works for him/her 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 employer’s 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 include:

  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 disability, and as the progress of recovery may require. 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-patients would ordinarily receive in a hospital.
  2. Rehabilitation services, consisting of medical, surgical and hospital treatment. The SSS also provides as soon as practicable, a balanced program of remedial treatment for handicapped members.
  3. Income cash benefit for:
  • Temporary total disability or sickness. An income cash benefit equivalent to 90 per cent of the average daily salary credit with a minimum of P10 and a maximum of P200 (effective Nov. 1, 1996). It is payable for a period not longer than 120 consecutive days. If the injury requires more treatment, the period may be extended up to 240 days. If it persist after this period, the injury will be considered as permanent total disability. This benefit is advanced by the employer every regular payday. The amount legally paid by the employer is reimbursed 100 per cent by the SSS in the form of cheque or thru the bank.
  • Permanent total disability (loss of two limbs, permanent complete paralysis of two limbs, etc.). This benefit is a monthly pension paid for as long as the injured lives plus 10 per cent for each of the five dependent children beginning with the youngest and without substitution. The monthly pension is guaranteed for five years but will 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. The minimum monthly income benefit is P2,000.


Beginning Jan. 1,1991, a permanent total disability pensioner is also given a supplemental allowance in addition to the monthly pension. This allowance will provide additional financial assistance to meet the extra needs arising from the disability. Effective May 1, 1993, the supplemental allowance is P575 a month. Upon the death of an EC permanent total or permanent partial disability pensioner,the SSS will pay to the primary beneficiaries 100 per cent of the monthly pension. In addition, the dependents will be paid the dependent’s 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 dependent’s pension.

  • Permanent partial disability (such as loss of one thumb, finger, leg). 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. The minimum monthly pension is P2,000. However, if the period of permanent partial disability pension is less than a year, the benefit may be paid in lump sum.
  • Death. A monthly pension is provided to the deceased member’s primary beneficiaries, plus 10 per cent of such benefit for each of five 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. The minimum monthly pension for the death benefit is P2,000. 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 conditions 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 incompensable under EC?
No compensation will be allowed to an employee or the dependents if the injury, sickness, disability or death is due to:

  1. Drunkenness;
  2. Willful intention to injure or kill himself or another; or
  3. Notorious negligence.


What should an employee do to file for an EC claim?

The employer should be notified of the member’s sickness, injury or death within five days from the occurrence of the contingency. Notice is not necessary if the contingency occured 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 employee's submission of his notice?

Pursuant to Section 2 Rule XVI - Employer’s Records and Notices of PD 626 or the Employee’s 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 employer’s logbook shall be made by the employer or any of the authorized official after verification of the contingencies or the employee’s absence 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 withold material information already in possesion shall make the employer liable for fifty per cent (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 benefit 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?

  1. Legitimate spouse living with the employee at the time of his/her death until he remarries; and the
  2. Legitimate, legitimated, legally adpoted 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 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)


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 defect which is congenital or acquires 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.

What forms are needed to file for EC claims?

For medical expenses:

  1. SSS Form B-301 (EC Medical Reimbursement Benefit Application)


For temporary total disability or sickness:

  1. EC Form B-309 (Accident/Sickness Report)
  2. EC Form B-300 (Employee’s Notification); and
  3. SSS Form B-304 (Sickness Benefit Reimbursement Application).


For disability:

  1. Claim for Disability Benefit; and
  2. SSS Form MMD-102 (Medical Certificate).


For death:

  1. BPN-105 (Report of death) and
  2. DDR-1 (Death Claim Application).


For funeral expenses:

  1. BPN-103 (Claim for funeral expenses);
  2. Death certificate of deceased member duly certified by the local Civil Registrar; and
  3. Official receipt from the funeral parlor
  4. BPN-105 (Report of death)

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


What other documents are needed for an EC death claim?
For Primary Beneficiaries:

  1. Original or certified true copy (signed by the Local Civil Registrar) of:
  • Death certificate of member;
  • Birth certificate(s) of minor children; and
  • Marriage certificate of member.


For illegitimate children
(acknowledged natural children whose parents have no legal impediment to marry)

  • Original or certified true copy (signed by the Local Civil Registrar) of:

           -  Death certificate of deceased;
           -  Birth certificate of the children; and
           -  Joint Affidavit of two disinterested persons that parent have no legal impediment to marry.

  • If minor children are orphaned, guardianship will be filed by grandparent, eldest brother or sister or any guardian. The guardian will apply for an appointment as representative payee through a competent court or the System.
NOTE:
Other papers may be required as they are found to be necessary during the processing of the claim.



For Secondary Beneficiaries:
Parents of deceased:

  • Original or certified true copy (signed by the Local Civil Registrar) of:
       -  Death certificate of deceased;
       -  Birth certificate of deceased; and
       -  Marriage certificate of parents.
  • SSS Form CLD-1.3A (Affidavit for Death Benefit Claim)


For illegitimate children
(Parents have legal impediment to marry and claims are to be filed by their guardian)

  • Original or certified true copy (signed by the local civil registrar) of:

       -  Death certificate of deceased;
       -  Death certificates of parents of deceased, if both are no longer living;
       -  Birth certificate of the children; and
       -  SSS Form CLD-1.3A (Affidavit for Death Benefit Claim).


Where are claims for the EC benefit filed?
Claims for EC benefits are filed at any SSS branch or representative office nearest the member's residence or place of work.
 



    

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