A fund known as the State Insurance Fund is established through premium payments exacted from employer's. In the event of work-connected disability or death, employees and their dependents may promptly secure adequate income benefit, and medical or related benefits. Benefits of which are exclusive and in place of all other liabilities of the employer to the employee, his dependents or anyone otherwise entitled to receive damages on behalf of the employee or his dependents.
A fund known as the State Insurance Fund is established through premium payments exacted from employer's. In the event of work-connected disability or death, employees and their dependents may promptly secure adequate income benefit, and medical or related benefits. Benefits of which are exclusive and in place of all other liabilities of the employer to the employee, his dependents or anyone otherwise entitled to receive damages on behalf of the employee or his dependents.
A fund known as the State Insurance Fund is established through premium payments exacted from employer's. In the event of work-connected disability or death, employees and their dependents may promptly secure adequate income benefit, and medical or related benefits. Benefits of which are exclusive and in place of all other liabilities of the employer to the employee, his dependents or anyone otherwise entitled to receive damages on behalf of the employee or his dependents.
INSURANCE FUND -program provided under Art. 172- 214 of the Labor Code whereby a fund known as the State Insurance Fund is established through premium payments exacted from employers and from which employees and their dependents in the event of work-connected disability or death, may promptly secure adequate income benefit, and medical or related benefits. Characteristics 1. Tax exempt 2. Designed to ensure promptitude in the award to employees and their dependents of adequate income and medical or related benefits 3. Funded monthly contributions of all covered employers 4. Compulsory on all employers and their employees not over 60 years of age 5. Benefits of which are exclusive and in place of all other liabilities of the employer to the employee, his dependents or anyone otherwise entitled to receive damages on behalf of the employee or his dependents 6. Having its own adjudication machinery with original exclusive jurisdiction to settle any dispute with respect to: a. Coverage b. Entitlement to benefits c. Collection and payment of contributions d. Penalties thereon Coverage: Employer a. Public sector covered by GSIS comprising the: 1. National Government 2. GOCCs 3. Philippine Tuberculosis Socirty 4. PNRC 5. Philippine Veterans Bank b. Private sector covered by SSS Employee a. Public sector comprising the employed workers who are covered by GSIS (CA 186) including: 1. AFP 2. Elective officials 3. Any person employed as casual, emergency, temporary-substitute or contractual b. Private sector compromising the employed workers who are covered by SSS (RA 1161)
EMPLOYER On the first day of operation
EMPLOYEE On the first day of employment
Definition of Terms (173)
Injury- Any harmful change in the human organization from any incident arising out of and in the course of employment Sickness a. Any illness definitely accepted as an occupational disease b. listed by the commission or c. any illness caused by employment, subject to proof that the risk of contracting the same is increased by working conditions. Examples: a. rheumatoid arthritis and pneumonitis for teachers b. tuberculosis for persons nursing a person suffering from such illness c. anemia secondary to gastric malignancy where the deceased was exposed to heat and elements which ultimately weakened him d. cancer for librarian who was exposed to dusty books and other deleterious substances e. senile cataract for construction workers exposed to heat of the sun NOTE: The Employees Compensation Commission is empowered to determine and approve occupational diseases and work-related illness that may be considered compensable based on peculiar hazards of employment Occupational disease a. One which results from the nature of employment, and b. by nature is meant conditions to which all employees of a class are subject and c. which produce the disease as a natural incident of a particular occupation d. attach to that occupation a hazard which distinguishes it from the usual run of occupations e. is in excess of the hazard attending the employment in general NOTE: Those things which science and industry have not yet learned how to eliminate. Every plant of the same industry is alike constantly exposed to the danger of contracting a particular disease.
theory of increased risk
Effective date of Coverage (176)
ECC_ Hizon Notes
-It includes any illness caused by employment,
subject to proof that the risk of contracting the same is increased by working conditions. The quantum of proof for the compensation: -Substantial proof of work connection and not a direct causal relation 1. medical history 2. record 3. physicians report NOTE: Proof of actual cause of the ailment is not necessary. There should, however, be proof that shows reasonable connection between: a. the work of the deceased b. cause of his death The proof must be substantial and real and not merely apparent; for the duty to prove workcausation or work aggravation imposed by existing law is real, not merely apparel. Direct causal relation is not required. It is enough that the hypothesis on which the workmens claim is based is probable NOTE: Medical opinion to the contrary can be disregarded where there is some basis in the facts for inferring work-connection The test of evidence of the relation of the disease: probability and not certainty. Cancer is an occupational disease, in certain cases. NOTE: Although rectal cancer is not listed as an occupational disease there is ample proof that the risk of contracting the same was increased, if not caused, by the working conditions prevailing in the employers premises. Hansens disease or leprosy compensable is compensable provided the illness is traceable to employment. The claimant is required to present proof of reasonable causal relation or aggravation where the cause or origin of the disease is still unknown. This is because, if a disease not intended by law to be compensated is inadvertently included, the integrity of the State Insurance Fund is endangered. NOTE: Compassion for the victims of diseases not covered by law ignores the need to show a greater concern for the trust fund to which the tens of millions of workers and their families look for compensation whenever accidents, disease or death occur. Raro v. EEC & GSIS
Q: Is uraterolithiasis (presence of renal stones in
the ureter and urine stones) of a chemical laboratory technician compensable? A: Yes. The environment, water, or other fluid intake and the nature of the occupation are important factors in the development or inhibition of the disease. GSIS v. Merlinda Pentecostes
Q: Do we still subscribe to the presumption of
compensability? A: No, however, the present law has not ceased to be a social legislation. The liberality of the law in favor of the working man still prevails. Raro v. EEC & GSIS
Q: When are cardiovascular diseases considered
as occupational? A: Cardiovascular diseases are considered as occupational when contracted under 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 clearly precipitated by the unusual strain by reason 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 subjecting himself 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 NOTE: Coronary artery disease is not compensable where the employee was a chronic smoker. Q: What defenses may be interposed by the State Insurance Fund against a claim for compensation? A: 1. The injury is not work-connected or the sickness was not occupational 2. (178) Disability or death was occasioned by his: a. Intoxication b. Willful intention to injure or kill him c. Notorious negligence
ECC_ Hizon Notes
3. No notice of injury, sickness or death was given to
the employer 4. (207) Claim was filed beyond 3 years from the time the cause of action accrued.
Q: Can the employee recover from the State
Insurance Fund and subsequently recover damages in the criminal cases? A: No. 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 recover damages on behalf of the employee or his dependents. This includes the subsidiary liability of the employer under the RPC. NOTE: This will not bar recovery from: a. Revised Administrative Code b. RA. 1161 c. CA 186 d. RA 6111 e. RA 610 The injured employee or his heirs in case of death have a right of selection or choice of action between availing themselves of the workers right under the employees compensation laws and suing in the regular courts under the Civil Code for higher damages. To preclude the filing of an action for damages would be a violation of the constitutional guarantees on social justice and protection to labor
Q: In case the injured employee or his heirs fail
to recover damages in the civil case, may they claim from the SIF? A: Yes. The rationale in awarding compensation under compensation laws differs from that in giving damages under the Civil Code. The compensation act is based on a theory of compensation distinct from the existing theories of damages. Compensation is given to mitigate the harshness and insecurity of industrial life for the workman and his family. NOTE: Hence, an employer is liable whether the negligence exists or not since the liability is created by law. The employer will be liable as long as the sickness or injury is work-connected even if the death or injury is not due to the fault of the employer. Murillo v. Mendoza
Q: If the injured or his heirs opted to claim and in
fact collected from the SIF, can they still maintain action for damages against the employer? A: No. While perhaps not as profitable, the smaller indemnity obtainable through this remedy is balanced by the claimants being relieved of the burden of proving the causal connection between the employers negligence and the resulting injury and of having to establish the extent of the damage suffered; issues that are apt to be troublesome to establish satisfactorily. Having staked on this remedy, at least until the prior claim is rejected by the Compensation Commission, the claimant is precluded from pursuing the alternative remedy. (Art. 1711, CC)