STATEMENT OF AUTHORITY
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 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.
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) 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.
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 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.
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 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.
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 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
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.
SECTION 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.
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 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).
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
Employer’s Contribution
SECTION 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:
Bracket
or Salary
Salary Credit
ContributionIX (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.
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 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 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 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, 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 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.
SECTION 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.
SECTION 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.
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 (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. (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 (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
SECTION 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.
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 (12) 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 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 of the wardservices 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
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) RehabilitationCenter.
An organized service of varied rehabilitation measures usually located
in one site for 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
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.
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 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 allowance 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 fifteen (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 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.
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 (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
SECTION 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.
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 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.
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.
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.
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 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.
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 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.
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. 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.
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
|
|
|
Complete and permanent loss of the use of
|
No. of Months
|
|
| 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 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 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. 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.
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 [shall]
be less than P15,000.00, 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 (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 P15,000.00If 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, July25, 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 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.
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.
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 Pesos (P3,000.00) 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 of his having borne the funeral expenses. (ECC Resolution No. 3682, July 21, 1987).
RULE XV
Beneficiaries
SECTION 1. Definition — (a) Beneficiaries shall be either primary or secondary, and determined at the time of employee’s death.
(b) The following beneficiaries shall be considered primary:
(1) The legitimate spouse living with the employee at the time of the employee’s 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 [sic]
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 [sic] 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 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 sixty (60) months and the death benefit shall not be less than
P15,000.00. (ECC Resolution No. 2799, July25, 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 five (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. Employer’s Logbook — Every employer shall
keep a logbook to record chronologically the sickness, injury, or death
of his employees, within five (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
five (5) days from due entry thereof in his logbook in a form prescribed
by the System.
SECTION 4. Visitorial Power — The employer’s logbook
prescribed in these Rules 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 five (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 fifty
percent (50%) 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 six (6)
months nor more than one (1) 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 of 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 this Rule.
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 patient’s 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 an accredited rehabilitation
facility or hospitals and accredited physicians.
(b) Non-accredited rehabilitation facilities 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 patient’s condition
requires emergency services or that an emergency has ended shall be
based on the physician’s evaluation and, when appropriate, on the
patient’s medical record and other additional data furnished by the
hospital.(d) Claims filed by non-accredited hospitals and
non-accredited physicians for payment of emergency services shall be
accompanied by a physician’s statement.(e) The physician’s 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, it the physician’s judgment, the
emergency ceased.
SECTION 6. Referral — Immediately upon knowledge by
the employer of his employee’s 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 employee’s 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
Employee’s 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 (3) 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 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 ten (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 five (5) days forward the entire record
of the case to the Commission for review.
RULE XIX
Review by the Commission
SECTION 1. Decision En Banc — Within thirty (30)
working days from receipt of an appeal case, the Commission shall review
and decide said case. Four affirmative votes shall decide the case.
However, if only a quorum 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 fifteen (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 employer’s 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 six (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 government agency, he shall in addition
to the penalty prescribed herein, be dismissed with prejudice to
re-employment in the government service.
RULE XXI
Implementing Provision
SECTION 1. Effectivity — These amended Rules and Regulations shall take effect June 1, 1987.
Adopted: 21 July 1987
|
(SGD.) FRANKLIN M. DRILON
Chairman |
(SGD.) FELICIANO R. BELMONTE
Member |
|
(SGD.) RAOUL M. INOCENTES
Member |
(SGD.) JOSE L. CUISIA, JR.
Member |
|
(SGD.) JORGE B. CONTRERAS
Member |
|
ANNEX “A”
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 employee’s work must involve the risks described herein;
2. The disease was contracted as a result of the employee’s 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 [Labor] 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 ten (10) years,
unless proven otherwise.The following diseases are considered as occupational when
contracted under working conditions involving the risks described
herein:
Occupational Diseases
Nature of Employment
1. Cancer of the epithelial lining of the bladder.
(Papilloma of the bladder)
Work involving exposure to
alphanaphthylamine, beta-naphthylamine or benzidine or any part of the
salts; and auramine or magenta.2. Cancer, epitheliomatous 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
a. Caissons disease
b. Aeroembolism
Any process carried on in compressed or rarefied air.
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
b) Brucellosis
c) Glanders
d) Rabies
e) Tuberculosis
f) Tularemia
g) Weill’s disease
h) Q. Fever or equine encephalomyelitis
i) Mite dermatitis
Work in connection with animals infected with anthrax,
handling of animal carcasses or parts of such carcasses including hides,
hoofs, and horns.Any occupation involving handling of contaminated food
and drink particularly milk, butter and cheese of infected goats and
cows.
Any occupation involving rabid dogs, or equine animals or carcasses.
Any occupation involving rabid dogs.
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,
pathologist or postmortem worker, where occupation involves working with
material which is a source of tuberculosis infection.Any occupation involving handling or rabbits, ground squirrels, mice, or other rodents.
Any occupation involving handling of rats, mice, swine, and dogs.
Any occupation involving handling of horses, cattle, and sheep, or their slaughter and meat packaging.
Any occupation involving handling of flows 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.a) Acute radiation syndrome
b) Chronic radiation syndrome
c) Glass blower’s cataract
Exposure to X-rays, ionizing particles of radium or other radioactive substance or other forms of radiant energy
Short durations of exposure to large doses of X-rays, gamma rays, alpha rays and beta rays.
Chronic overexposure to X-rays with a long latent period affecting the skin, blood, and reproductive organ.
Among furnace men, glass blowers, bakers, blacksmiths, foundry workers; these are workers exposed to infrared rays.
9. Poisoning and its sequelae caused by:
a) Ammonia
b) Arsenic or its toxic compound
c) Benzene or its toxic homologues; nitro and amino-toxic derivatives of benzene or its homologue
d) Beryllium or its toxic compounds
e) Brass, zinc, or nickel
f) Carbon dioxide
g) Carbon bisulfide
h) Carbon monoxide
i) Chlorine
j) Chrome or its toxic compounds
k) Dinitrophenol or its homologue
l) Halogen derivatives of hydrocarbon of the alipathic series
m) Lead or its toxic compounds
n) Manganese or its toxic compounds
o) Mercury or its toxic compounds
p) Nitrous fumes
q) Phosgene
r) Phosphorus or its toxic compounds
s) Sulphur dioxide
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
All work involving exposure to the risk concerned.
10. Pneumoconjoses
a) Coal miners
b) Byssinosis
c) Bagassosis
d) Psittacosis
Exposure to coal dust.
Exposure to cotton dust causing weavers’ cough or mill fever.
Exposure to sugar cane dust.
Any occupation involving handling or parrots, parakeets, and other species of birds.
11. Diseases caused by abnormalities in temperature and humidity
a) Heat stroke/cramps/exhaustion
b) Chilblains/frostbite/freezing
c) Immersion foot/general hypothermia
Any occupations involving exposure to excessive heat or cold.
Any occupation involving exposure to excessive heat.
Any occupation involving exposure to excessive cold.
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 quent contact with
(a) human blood products and with (b) a source of 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
[workers], 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.
The following, although not considered occupational diseases, are nevertheless [when] work-related, compensable too.
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 unusual strain by reasons of the nature of his work.b) The strain of work that brings about an acute attack must
be of sufficient severity and must be followed within twenty four (24)
hours by the clinical signs of a cardiac insult to constitute causal
relationship.c) 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 work and such symptoms and signs
persisted, it is reasonable to claim a causal relationship.
19. CEREBRO-VASCULAR ACCIDENTS. All the following conditions — a)
There must be a history, which should be proved, or trauma at work (to
the head especially) 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 worker’s 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 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 schistosomiasis should be able to tell whether the
disease of the afflicted employee manifested itself while he 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 schistosomal work area.
21. PNEUMONIA. All of the following conditions —
a) There must be an honest and definite history of
wetting and chilling during the course of employment and also, of injury
to the chest wall with or without rib fracture, or inhalation of
noxious gases, fumes, and other deleterious substances in the place of
work.b) There must be direct connection between the offending agent or event and the worker’s 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 twenty four (24) hours after the 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 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 the following conditions —
a) There is no evidence of history of asthma before employment.
b) The allergen is present in the working conditions.
c) Sensitivity test to allergens in the working environment should yield positive results.
d) A provocative test should show positive results.
24. OSTEOARTHRITIS. a) Any occupation involving: aa) joint strain
from carrying heavy loads, or unduly heavy physical labor, as among
laborers and mechanics; bb) minor or major injuries to the joint; cc)
excessive use or constant strenuous usage of a particular joint, as
among sportsmen, particularly those who have engaged in the more active
sports activities; dd) extreme temperature changes (humidity, heat, and
cold exposures); and ee) faulty work posture or use of vibratory tools.
25. VIRAL ENCEPHALITIS. Any occupation involving; aa) contact
with an infected person, as in areas of poor sanitation, with a high
density of school children, who are the most frequent virus spreaders;
bb) rural exposure, primarily in picnics, camping activities, fishing or
hunting in, or adjacent to, woods or subtropical vegetations, or as
among agricultural and forest workers; and cc) 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 TUBERCULOSIS. In addition to working conditions
already listed under PD 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 degree of humidity and bad weather conditions; and
28. VIRAL HEPATITIS. In addition to the working conditions already
listed under PD 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 was so employed, knowing the
incubation period thereof.
ANNEX “B”
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 their 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 examination at intervals of three (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 examination at intervals not exceeding six (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 (1)
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 to be
repeated at intervals shorter than specified under 3 and 4 above 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 a certain aspects of the examination
be stressed in certain types of exposures:
1. Examination of urine and urinary bladder in workers
exposed to alphanaphthylamine, betanaphthylamine or benzidine or any of
their salts, and surmise 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 examination 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 case of exposure of 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 disulphde.
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 sulphur 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
derivatives of alipathic 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 the gastro-intestinal
systems, the kidneys and eyes in workers exposed to mercury or 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 occupation diseases discovered shall be reported by the employer to the System in a prescribed form.
ANNEX “C”
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 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 Systems 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 benefit 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 diseases.(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. Domiciliary care — The benefit for the
subsequent domiciliary care by an accredited physician shall not exceed
P60 for the first visit and P50 for each subsequent visits.
E. Ambulatory services — (a) The benefit for
ambulatory care in an accredited hospital, either by (1) a physician in
his hospital/clinic, or (2) training resident in emergency shall not
exceed P60 a day, exclusive of drugs and medicines.
(b) A patient who is treated for a specific minor surgical
procedure or other treatment that keeps him in the hospital only for a
few hours (less than 24) shall be considered an ambulatory patient
regardless of the hour of admission, whether or not he used a bed, or
whether or not he remained in the hospital past midnight.
F. 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. 247
dated April 13, 1977, Res. No. 1554 dated June 26, 1980, and Res. No.
2113 dated July 15, 1982 and Res. No. 2656 dated March 15, 1984).2. An anesthesiologist’s fee ordinarily not exceeding twenty five percent (25%) 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 procedures done in the
operating-diagnostic-therapeutic room complex of the accredited
hospital.