Chapter III
ADMINISTRATION
Article 176. Employees’
Compensation Commission.
To initiate, rationalize, and coordinate
the policies of the employees’ compensation program, the Employees’
Compensation Commission is hereby created to be composed of five ex-officio
members, namely: the Secretary of Labor and Employment as Chairman, the GSIS
General Manager, the SSS Administrator, the Chairman of the Philippine Medical
Care Commission, and the Executive Director of the ECC Secretariat, and two
appointive members, one of whom shall represent the employees and the other,
the employers, to be appointed by the President of the Philippines for a term
of six years. The appointive member shall have at least five years experience
in workmen’s compensation or social security programs. All vacancies shall be
filled for the unexpired term only. (As amended by Section 19 [c], Executive
Order No. 126)
The Vice Chairman of the Commission shall
be alternated each year between the GSIS General Manager and the SSS
Administrator. The presence of four members shall constitute a quorum. Each
member shall receive a per diem of two hundred pesos for every meeting that is
actually attended by him, exclusive of actual, ordinary and necessary travel
and representation expenses. In his absence, any member may designate an
official of the institution he serves on full-time basis as his representative
to act in his behalf. (As amended by Section 2, Presidential Decree No. 1368)
The general conduct of the operations and
management functions of the GSIS or SSS under this Title shall be vested in its
respective chief executive officers, who shall be immediately responsible for
carrying out the policies of the Commission.
The Commission shall have the status and
category of a government corporation, and it is hereby deemed attached to the
Department of Labor and Employment for policy coordination and guidance. (As
amended by Section 2, Presidential Decree No. 1368)
Article 177. Powers and
duties. The Commission shall have the following powers and duties:
To assess and fix a rate of contribution
from all employers;
To determine the rate of contribution
payable by an employer whose records show a high frequency of work accidents or
occupational diseases due to failure by the said employer to observe adequate
safety measures;
To approve rules and regulations
governing the processing of claims and the settlement of disputes arising
therefrom as prescribed by the System;
To initiate policies and programs toward
adequate occupational health and safety and accident prevention in the working
environment, rehabilitation other than those provided for under Article 190
hereof, and other related programs and activities, and to appropriate funds
therefor; (As amended by Section 3, Presidential Decree No. 1368)
To make the necessary actuarial studies
and calculations concerning the grant of constant help and income benefits for
permanent disability or death and the rationalization of the benefits for
permanent disability and death under the Title with benefits payable by the
System for similar contingencies: Provided, That the Commission may upgrade
benefits and add new ones subject to approval of the President: and Provided,
further, That the actuarial stability of the State Insurance Fund shall be
guaranteed: Provided, finally, That such increases in benefits shall not
require any increases in contribution, except as provided for in paragraph (b)
hereof; (As amended by Section 3, Presidential Decree No. 1641)
To appoint the personnel of its staff,
subject to civil service law and rules, but exempt from WAPCO law and
regulations;
To adopt annually a budget of
expenditures of the Commission and its staff chargeable against the State
Insurance Fund: Provided, That the SSS and GSIS shall advance on a quarterly
basis, the remittances of allotment of the loading fund for the Commission’s
operational expenses based on its annual budget as duly approved by the
Department of Budget and Management; (As amended by Section 3, Presidential
Decree No. 1921)
To have the power to administer oath and
affirmation, and to issue subpoena and subpoena duces tecum in connection with
any question or issue arising from appealed cases under this Title;
To sue and be sued in court;
To acquire property, real or personal,
which may be necessary or expedient for the attainment of the purposes of this
Title;
To enter into agreements or contracts for
such services and as may be needed for the proper, efficient and stable
administration of the program;
To perform such other acts as it may deem
appropriate for the attainment of the purposes of the Commission and proper
enforcement of the provisions of this Title. (As amended by Section 18,
Presidential Decree No. 850)
Article 178. Management of
funds. All revenues collected by the System under this Title shall be
deposited, invested, administered and disbursed in the same manner and under
the same conditions, requirements and safeguards as provided by Republic Act
Numbered eleven hundred sixty-one, as amended, with regard to such other funds
as are thereunder being paid to or collected by the SSS and GSIS, respectively:
Provided, That the Commission, SSS and GSIS may disburse each year not more
than twelve percent of the contribution and investment earnings collected for
operational expenses, including occupational health and safety programs,
incidental to the carrying out of this Title.
Article 179. Investment of
funds. Provisions of existing laws to the contrary notwithstanding,
all revenues as are not needed to meet current operational expenses under this
Title shall be accumulated in a fund to be known as the State Insurance Fund,
which shall be used exclusively for payment of the benefits under this Title,
and no amount thereof shall be used for any other purpose. All amounts accruing
to the State Insurance Fund, which is hereby established in the SSS and GSIS,
respectively, shall be deposited with any authorized depository bank approved
by the Commission, or invested with due and prudent regard for the liquidity
needs of the System. (As amended by Section 4, Presidential Decree No. 1368)
Article 180. Settlement of
claims. The System shall have original and exclusive jurisdiction to
settle any dispute arising from this Title with respect to coverage,
entitlement to benefits, collection and payment of contributions and penalties
thereon, or any other matter related thereto, subject to appeal to the
Commission, which shall decide appealed cases within twenty (20) working days
from the submission of the evidence.
Article 181. Review. Decisions,
orders or resolutions of the Commission may be reviewed on certiorari by the
Supreme Court on question of law upon petition of an aggrieved party within ten
(10) days from notice thereof.
Article 182. Enforcement of
decisions.
Any decision, order or resolution of the
Commission shall become final and executory if no appeal is taken therefrom
within ten (10) days from notice thereof. All awards granted by the Commission
in cases appealed from decisions of the System shall be effected within fifteen
days from receipt of notice.
In all other cases, decisions, orders and
resolutions of the Commission which have become final and executory shall be
enforced and executed in the same manner as decisions of the Court of First
Instance, and the Commission shall have the power to issue to the city or
provincial sheriff or to the sheriff whom it may appoint, such writs of
execution as may be necessary for the enforcement of such decisions, orders or
resolutions, and any person who shall fail or refuse to comply therewith shall,
upon application by the Commission, be punished by the proper court for
contempt.
Chapter IV
CONTRIBUTIONS
Article 183. Employers’
contributions.
Under such regulations as the System may
prescribe, beginning as of the last day of the month when an employee’s
compulsory coverage takes effect and every month thereafter during his
employment, his employer shall prepare to remit to the System a contribution
equivalent to one percent of his monthly salary credit.
The rate of contribution shall be reviewed
periodically and subject to the limitations herein provided, may be revised as
the experience in risk, cost of administration and actual or anticipated as
well as unexpected losses, may require.
Contributions under this Title shall be
paid in their entirety by the employer and any contract or device for the
deductions of any portion thereof from the wages or salaries of the employees
shall be null and void.
When a covered employee dies, becomes
disabled or is separated from employment, his employer’s obligation to pay the
monthly contribution arising from that employment shall cease at the end of the
month of contingency and during such months that he is not receiving wages or
salary.
Article 184. Government
guarantee. The Republic of the Philippines guarantees the benefits
prescribed under this Title, and accepts general responsibility for the
solvency of the State Insurance Fund. In case of any deficiency, the same shall
be covered by supplemental appropriations from the national government.
Chapter V
MEDICAL BENEFITS
Article 185. Medical
services. Immediately after an employee contracts sickness or sustains
an injury, he shall be provided by the System during the subsequent period of
his disability with such medical services and appliances as the nature of his
sickness or injury and progress of his recovery may require, subject to the
expense limitation prescribed by the Commission.
Article 186. Liability. The
System shall have the authority to choose or order a change of physician,
hospital or rehabilitation facility for the employee, and shall not be liable
for compensation for any aggravation of the employee’s injury or sickness
resulting from unauthorized changes by the employee of medical services,
appliances, supplies, hospitals, rehabilitation facilities or physicians.
Article 187. Attending
physician. Any physician attending an injured or sick employee shall
comply with all the regulations of the System and submit reports in prescribed
forms at such time as may be required concerning his condition or treatment.
All medical information relevant to the particular injury or sickness shall, on
demand, be made available to the employee or the System. No information
developed in connection with treatment or examination for which compensation is
sought shall be considered as privileged communication.
Article 188. Refusal of
examination or treatment. If the employee unreasonably refuses to
submit to medical examination or treatment, the System shall stop the payment
of further compensation during such time as such refusal continues. What
constitutes an unreasonable refusal shall be determined by the System which
may, on its own initiative, determine the necessity, character and sufficiency
of any medical services furnished or to be furnished.
Article 189. Fees and other
charges. All fees and other charges for hospital services, medical
care and appliances, including professional fees, shall not be higher than
those prevailing in wards of hospitals for similar services to injured or sick
persons in general and shall be subject to the regulations of the Commission.
Professional fees shall only be appreciably higher than those prescribed under
Republic Act Numbered sixty-one hundred eleven, as amended, otherwise known as
the Philippine Medical Care Act of 1969.
Article 190. Rehabilitation
services.
The System shall, as soon as practicable,
establish a continuing program, for the rehabilitation of injured and
handicapped employees who shall be entitled to rehabilitation services, which
shall consist of medical, surgical or hospital treatment, including appliances
if they have been handicapped by the injury, to help them become physically
independent.
As soon as practicable, the System shall
establish centers equipped and staffed to provide a balanced program of
remedial treatment, vocational assessment and preparation designed to meet the
individual needs of each handicapped employee to restore him to suitable
employment, including assistance as may be within its resources, to help each
rehabilitee to develop his mental, vocational or social potential.
Chapter VI
DISABILITY BENEFITS
Article 191. Temporary
total disability.
Under such regulations as the Commission
may approve, any employee under this Title who sustains an injury or contracts
sickness resulting in temporary total disability shall, for each day of such a
disability or fraction thereof, be paid by the System an income benefit
equivalent to ninety percent of his average daily salary credit, subject to the
following conditions: the daily income benefit shall not be less than Ten Pesos
nor more than Ninety Pesos, nor paid for a continuous period longer than one
hundred twenty days, except as otherwise provided for in the Rules, and the
System shall be notified of the injury or sickness. (As amended by Section 2,
Executive Order No. 179)
The payment of such income benefit shall
be in accordance with the regulations of the Commission. (As amended by Section
19, Presidential Decree No. 850)
Article 192. Permanent
total disability.
Under such regulations as the Commission
may approve, any employee under this Title who contracts sickness or sustains
an injury resulting in his permanent total disability shall, for each month
until his death, be paid by the System during such a disability, an amount
equivalent to the monthly income benefit, plus ten percent thereof for each
dependent child, but not exceeding five, beginning with the youngest and
without substitution: Provided, That the monthly income benefit shall be the
new amount of the monthly benefit for all covered pensioners, effective upon
approval of this Decree.
The monthly income benefit shall be
guaranteed for five years, and shall be suspended if the employee is gainfully
employed, or recovers from his permanent total disability, or fails to present
himself for examination at least once a year upon notice by the System, except
as otherwise provided for in other laws, decrees, orders or Letters of
Instructions. (As amended by Section 5, Presidential Decree No. 1641)
The following disabilities shall be
deemed total and permanent:
Temporary total disability lasting
continuously for more than one hundred twenty days, except as otherwise
provided for in the Rules;
Complete loss of sight of both eyes;
Loss of two limbs at or above the ankle
or wrist;
Permanent complete paralysis of two
limbs;
Brain injury resulting in incurable
imbecility or insanity; and
Such cases as determined by the Medical
Director of the System and approved by the Commission.
The number of months of paid coverage
shall be defined and approximated by a formula to be approved by the
Commission.
Article 193. Permanent
partial disability.
Under such regulations as the Commission
may approve, any employee under this Title who contracts sickness or sustains
an injury resulting in permanent partial disability shall, for each month not
exceeding the period designated herein, be paid by the System during such a
disability an income benefit for permanent total disability.
The benefit shall be paid for not more
than the period designated in the following schedules:
Complete and permanent No. of Months
loss of the use of
One thumb - 10
One index finger - 8
One middle finger - 6
One ring finger - 5
One little finger - 3
One big toe - 6
One toe - 3
One arm - 50
One hand - 39
One foot - 31
One leg - 46
One ear - 10
Both ears - 20
Hearing of one ear - 10
Hearing of both ears - 50
Sight of one eye - 25
A loss of a wrist shall be considered as
a loss of the hand, and a loss of an elbow shall be considered as a loss of the
arm. A loss of an ankle shall be considered as loss of a foot, and a loss of a
knee shall be considered as a loss of the leg. A loss of more than one joint
shall be considered as a loss of one-half of the whole finger or toe: Provided,
That such a loss shall be either the functional loss of the use or physical
loss of the member. (As amended by Section 7, Presidential Decree No. 1368)
In case of permanent partial disability
less than the total loss of the member specified in the preceding paragraph,
the same monthly income benefit shall be paid for a portion of the period
established for the total loss of the member in accordance with the proportion
that the partial loss bears to the total loss. If the result is a decimal
fraction, the same shall be rounded off to the next higher integer.
In cases of simultaneous loss of more
than one member or a part thereof as specified in this Article, the same
monthly income benefit shall be paid for a period equivalent to the sum of the
periods established for the loss of the member or the part thereof. If the
result is a decimal fraction, the same shall be rounded off to the next higher
integer.
In cases of injuries or illnesses
resulting in a permanent partial disability not listed in the preceding
schedule, the benefit shall be an income benefit equivalent to the percentage
of the permanent loss of the capacity to work. (As added by Section 7, Presidential
Decree No. 1368)
Under such regulations as the Commission
may approve, the income benefit payable in case of permanent partial disability
may be paid in monthly pension or in lump sum if the period covered does not
exceed one year. (As added by Section 7, Presidential Decree No. 1368)
Chapter VII
DEATH BENEFITS
Article 194. Death.
Under such regulations as the Commission
may approve, the System shall pay to the primary beneficiaries upon the death
of the covered employee under this Title, an amount equivalent to his monthly
income benefit, plus ten percent thereof for each dependent child, but not
exceeding five, beginning with the youngest and without substitution, except as
provided for in paragraph (j) of Article 167 hereof: Provided, however, That the
monthly income benefit shall be guaranteed for five years: Provided, further,
That if he has no primary beneficiary, the System shall pay to his secondary
beneficiaries the monthly income benefit but not to exceed sixty months:
Provided, finally, That the minimum death benefit shall not be less than
fifteen thousand pesos. (As amended by Section 4, Presidential Decree No. 1921)
Under such regulations as the Commission
may approve, the System shall pay to the primary beneficiaries upon the death
of a covered employee who is under permanent total disability under this Title,
eighty percent of the monthly income benefit and his dependents to the
dependents’ pension: Provided, That the marriage must have been validly
subsisting at the time of disability: Provided, further, That if he has no
primary beneficiary, the System shall pay to his secondary beneficiaries the
monthly pension excluding the dependents’ pension, of the remaining balance of
the five-year guaranteed period: Provided, finally, That the minimum death
benefit shall not be less than fifteen thousand pesos. (As amended by Section
4, Presidential Decree No. 1921)
The monthly income benefit provided
herein shall be the new amount of the monthly income benefit for the surviving
beneficiaries upon the approval of this decree. (As amended by Section 8,
Presidential Decree No. 1368)
Funeral benefit. - A funeral benefit of
Three thousand pesos (P3,000.00) shall be paid upon the death of a covered
employee or permanently totally disabled pensioner. (As amended by Section 3,
Executive Order No. 179)
Chapter VIII
PROVISIONS COMMON TO INCOME BENEFITS
Article 195. Relationship
and dependency. All questions of relationship and dependency shall be
determined as of the time of death.
Article 196. Delinquent
contributions.
An employer who is delinquent in his
contributions shall be liable to the System for the benefits which may have
been paid by the System to his employees or their dependents, and any benefit
and expenses to which such employer is liable shall constitute a lien on all
his property, real or personal, which is hereby declared to be preferred to any
credit, except taxes. The payment by the employer of the lump sum equivalent of
such liability shall absolve him from the payment of the delinquent contribution
and penalty thereon with respect to the employee concerned.
Failure or refusal of the employer to pay
or remit the contribution herein prescribed shall not prejudice the right of
the employee or his dependents to the benefits under this Title. If the
sickness, injury, disability or death occurs before the System receives any
report of the name of his employee, the employer shall be liable to the System
for the lump sum equivalent to the benefits to which such employee or his
dependents may be entitled.
Article 197. Second
injuries. If any employee under permanent partial disability suffers
another injury which results in a compensable disability greater than the
previous injury, the State Insurance Fund shall be liable for the income
benefit of the new disability: Provided, That if the new disability is related
to the previous disability, the System shall be liable only for the difference
in income benefits.
Article 198. Assignment of
benefits. No claim for compensation under this Title is transferable
or liable to tax, attachment, garnishment, levy or seizure by or under any
legal process whatsoever, either before or after receipt by the person or
persons entitled thereto, except to pay any debt of the employee to the System.
Article 199. Earned benefits. Income
benefits shall, with respect to any period of disability, be payable in
accordance with this Title to an employee who is entitled to receive wages,
salaries or allowances for holidays, vacation or sick leaves and any other
award of benefit under a collective bargaining or other agreement.
Article 200. Safety
devices. In case the employee’s injury or death was due to the failure
of the employer to comply with any law or to install and maintain safety
devices or to take other precautions for the prevention of injury, said
employer shall pay the State Insurance Fund a penalty of twenty-five percent
(25%) of the lump sum equivalent of the income benefit payable by the System to
the employee. All employers, specially those who should have been paying a rate
of contribution higher than required of them under this Title, are enjoined to
undertake and strengthen measures for the occupational health and safety of
their employees.
Article 201. Prescriptive
period. No claim for compensation shall be given due course unless
said claim is filed with the System within three (3) years from the time the
cause of action accrued. (As amended by Section 5, Presidential Decree No.
1921)
Article 202. Erroneous
payment.
If the System in good faith pays income
benefit to a dependent who is inferior in right to another dependent or with
whom another dependent is entitled to share, such payments shall discharge the
System from liability, unless and until such other dependent notifies the
System of his claim prior to the payments.
In case of doubt as to the respective
rights of rival claimants, the System is hereby empowered to determine as to
whom payments should be made in accordance with such regulations as the
Commission may approve. If the money is payable to a minor or incompetent,
payment shall be made by the System to such person or persons as it may
consider to be best qualified to take care and dispose of the minor’s or
incompetent’s property for his benefit.
Article 203. Prohibition. No
agent, attorney or other person pursuing or in charge of the preparation or
filing of any claim for benefit under this Title shall demand or charge for his
services any fee, and any stipulation to the contrary shall be null and void.
The retention or deduction of any amount from any benefit granted under this
Title for the payment of fees for such services is prohibited. Violation of any
provision of this Article shall be punished by a fine of not less than five
hundred pesos nor more than five thousand pesos, or imprisonment for not less
than six months nor more than one year, or both, at the discretion of the
court.
Article 204. Exemption from
levy, tax, etc. All laws to the contrary notwithstanding, the State
Insurance Fund and all its assets shall be exempt from any tax, fee, charge,
levy, or customs or import duty and no law hereafter enacted shall apply to the
State Insurance Fund unless it is provided therein that the same is applicable
by expressly stating its name.
Chapter IX
RECORDS, REPORTS AND PENAL PROVISIONS
Article 205. Record of
death or disability.
All employers shall keep a logbook to
record chronologically the sickness, injury or death of their employees,
setting forth therein their names, dates and places of the contingency, nature
of the contingency and absences. Entries in the logbook shall be made within
five days from notice or knowledge of the occurrence of the contingency. Within
five days after entry in the logbook, the employer shall report to the System
only those contingencies he deems to be work-connected.
All entries in the employer’s logbook
shall be made by the employer or any of his authorized official after
verification of the contingencies or the employees’ absences for a period of a
day or more. Upon request by the System, the employer shall furnish the
necessary certificate regarding information about any contingency appearing in
the logbook, citing the entry number, page number and date. Such logbook shall
be made available for inspection to the duly authorized representative of the
System.
Should any employer fail to record in the
logbook an actual sickness, injury or death of any of his employees within the
period prescribed herein, give false information or withhold material
information already in his possession, he shall be held liable for fifty
percent of the lump sum equivalent of the income benefit to which the employee
may be found to be entitled, the payment of which shall accrue to the State
Insurance Fund.
In case of payment of benefits for any
claim which is later determined to be fraudulent and the employer is found to
be a party to the fraud, such employer shall reimburse the System the full
amount of the compensation paid.
Article 206. Notice of
sickness, injury or death. Notice of sickness, injury or death shall be
given to the employer by the employee or by his dependents or anybody on his
behalf within five days from the occurrence of the contingency. No notice to
the employer shall be required if the contingency is known to the employer or
his agents or representatives.
Article 207. Penal
provisions.
The penal provisions of Republic Act
Numbered Eleven Hundred Sixty-One, as amended, and Commonwealth Act Numbered
One Hundred Eighty-Six, as amended, with regard to the funds as are thereunder
being paid to, collected or disbursed by the System, shall be applicable to the
collection, administration and disbursement of the Funds under this Title. The
penal provisions on coverage shall also be applicable.
Any person who, for the purpose of
securing entitlement to any benefit or payment under this Title, or the
issuance of any certificate or document for any purpose connected with this
Title, whether for him or for some other person, commits fraud, collusion,
falsification, misrepresentation of facts or any other kind of anomaly, shall
be punished with a fine of not less than five hundred pesos nor more than five
thousand pesos and an imprisonment for not less than six months nor more than
one year, at the discretion of the court.
If the act penalized by this Article is
committed by any person who has been or is employed by the Commission or
System, or a recidivist, the imprisonment shall not be less than one year; if
committed by a lawyer, physician or other professional, he shall, in addition
to the penalty prescribed herein, be disqualified from the practice of his
profession; and if committed by any official, employee or personnel of the
Commission, System or any government agency, he shall, in addition to the
penalty prescribed herein, be dismissed with prejudice to re-employment in the
government service.
Article 208. Applicability. This
Title shall apply only to injury, sickness, disability or death occurring on or
after January 1, 1975.
Article 208-A. Repeal. All
existing laws, Presidential Decrees and Letters of Instructions which are
inconsistent with or contrary to this Decree, are hereby repealed: Provided,
That in the case of the GSIS, conditions for entitlement to benefits shall be
governed by the Labor Code, as amended: Provided, however, That the formulas
for computation of benefits, as well as the contribution base, shall be those
provided under Commonwealth Act Numbered One Hundred Eighty-Six, as amended by
Presidential Decree No. 1146, plus twenty percent thereof. (As added by Section
9, Presidential Decree No. 1368 [May 1, 1978] and subsequently amended by
Section 7, Presidential Decree No. 1641)
Title III
MEDICARE
Article 209. Medical care. The
Philippine Medical Care Plan shall be implemented as provided under Republic
Act Numbered Sixty-One Hundred Eleven, as amended.
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