Employees Compensation and

State Insurance Fund

(Title II, Book IV of the Labor Code
[PD 626]; SSS Law; GSIS Law)
 ARTICLE 172. Policy.
The State shall promote and develop a tax-
exempt employees' compensation program
whereby employees and their dependents, in
the event of work-connected disability or
death, may promptly secure adequate income
benefit, and medical or related benefits.
 Laginlin v. WCC
GR L-45785; March 21, 1988

[T]he objective of the Workmen's

Compensation Act is to secure workmen and
their dependents from becoming objects of
charity, by providing for a reasonable
compensation for such accidental calamities
as are incidental to their employment.
Compensation is a right.
 U-BIX Corp v. Bandiola
GR 157168; June 26, 2007)

As early as 1938, this Court emphasized, x xx

that labor laws have demonstrated an impetus
towards ensuring that employees are
compensated for work-related injuries. The
law has since treated such compensation as a
right, which the employees can claim, instead
of an act of charity to be given at the
employer's discretion.
 Evolution

Compensation for Compensation for

Damages for
Work Related Work Related
Negligence of
Deaths or Injuries Deaths or Injuries
Employer
(paid by employer) (paid by SIF)
 1st shift
No need to pin down anybody for negligence.

The compensation for the death , injury or

sickness is simply treated as a cost of doing
business.

But liability still rests with the employer.

 Murillo v. Mendoza
66 Phil. 689, 700. (1938)

*** injuries to workmen and employees are

to be considered no longer as results of
fault or negligence, but as the products of
the industry in which the employee is
concerned.

Compensation for such injuries is, under the

theory of such statute, like any other item in
the cost of production or transportation,
and ultimately charged to the consumer.
 2nd Shift (current law)
Potential liability rests with the SIF and not
the employer.
 Distinctions between
Act No. 3428 and P.D. No. 626
Act No. 3428 (Workmens
Compensation Act [Old Law])
Potential liability rests with
the employer.
The employer should
contest the compensation
claim within 14 days for the
date of disability or within
10 days from knowledge
thereof, otherwise, he can
no longer controvert the
claim.
PD 626 (Title II, Book IV, Labor
Code [Present Law])
Potential liability rests with
the SIF and not the
employer.
The employer is not
required to contest because
the employer will not be
made liable.
The proceedings are non-
adversarial.
 Raro v. ECC
GR 58445; April 27, 1989
Instead of an adversarial contest by the
worker or his family against the employer, we
now have a social insurance scheme where
regular premiums are paid by employers to a
trust fund and claims are paid from the trust
fund to those who can prove entitlement.
 De Jesus v. ECC
226 Phil. 33, 40-41 (1986)
The injured worker does not have to litigate his right
to compensation.
No employer opposes his claim.
The sick worker simply files a claim with a new neutral
Employees' Compensation Commission which then
determines on the basis of the employee's supporting
papers and medical evidence whether or not
compensation may be paid.
The payment of benefits is more prompt. The cost of
administration is low. The amount of death benefits
has also been doubled.
 De Jesus v. ECC
226 Phil. 33, 40-41 (1986)
On the other hand, the employer's duty is only
to pay the regular monthly premiums to the
scheme.
It does not look for insurance companies to
meet sudden demands for compensation
payments or set up its own funds to meet
these contingencies.
It does not have to defend itself from
spuriously documented or long past claims.
 Distinctions between
Act No. 3428 and P.D. No. 626
Act No. 3428 (Workmens PD 626 (Title II, Book IV, Labor
Compensation Act [Old Law]) Code [Present Law])
If the injury or disease arose No presumption of
out of and in the course of compensability.
employment, there is a
presumption of
compensability.
Employer is required to
prove that the claim is not Employee is required to
compensable. prove that claim is
compensable.
 Raro v. ECC
GR 58445; April 27, 1989
The non-adversarial nature of employees'
compensation proceedings is crucial to an
understanding of the present scheme. There is a
widespread misconception that the poor
employee is still arrayed against the might and
power of his rich corporate employer. Hence, he
must be given all kinds of favorable
presumptions. This is fallacious.
It is now the trust fund and not the employer
which suffers if benefits are paid to claimants
who are not entitled under the law.
Which law would apply?
 Gonzaga v. ECC
GR L-62287; January 31, 1984
In employees' compensation cases, the time
of inception of the illness or injury is crucial.

An injury or illness which has its inception

prior to January 1, 1975 shall be governed by
the provisions of the Workmen's
Compensation Act [Old Law].
 ARTICLE 173. Definition of Terms.
(k) "Injury" means any harmful change in the human organism from
any accident arising out of and in the course of the employment.

(l) "Sickness" means any illness definitely accepted as an occupational

disease listed by the Commission, or any illness caused by
employment, subject to proof that the risk of contracting the same
is increased by working conditions.

(m) "Death" means loss of life resulting from injury or sickness.

(n)"Disability" means loss or impairment of a physical or mental

function resulting from injury or sickness.
 Compensation

Death Disability

Injury Sickness Injury Sickness

 Injury

any harmful change in the human

organism from any accident arising out
of and in the course of the
employment
accident
 Taller vda. de Nava vs. Ynchausti
Steamship Co.
57 Phil. 751.

The word accident is intended to indicate

that the act causing the injury shall be casual
or unforeseen, an act for which the injured
party is not legally responsible.
 What about an injury arising from a
deliberate act of another?
Under the foregoing definition, an assault
upon an employee may be considered as an
accident from the point of view of the latter
and for purposes of employee compensation,
even though such assault was a deliberate act
of the perpetrator.
 Taller vda. de Nava vs. Ynchausti Steamship Co.

The helmsman of a boat was engaged in hauling the ship's

cable and in coiling it on the deck of the boat preparatory
to passing it down a hatchway. He found the space
necessary for coiling the cable party occupied by a folding
bed of one of the passengers. This passenger, upon being
asked, declared his ownership of the bed. Nava expressed
his intention of pushing it out of the way and proceeded to
do so. Angered by this, the passenger exchanged hot
words with Nava, and then, with a piece of wood, jabbed
Nava at the pit of the stomach. At this point, the
passenger's brother ran up to Nava and stabbed him to
death.
The death was adjudged compensable.
 Bohol Land Transportation Co. vs. Vda. de
Mandaguit
70 Phil. 685.
The bus which Mandaguit was driving collided
with a cyclist going in the opposite direction. The
latter turned around and immediately pursued
the bus. He overtook it a few minutes later when
it stopped to take on passengers. The driver then
disembarked from the bus to wash his hands at a
drugstore nearby. The cyclist followed him there
and knifed him to death.
Compensable.
 Galicia vs. Dy Pac
G.R. No. 7402, March 25, 1941, 40 OG No. 1 (CA Case)
The employee, Pablo Carla, was asked to work in lieu of
another employee who had been suspended from work
upon request of his labor union;
while Carla was working, the suspended employee asked him to
intercede for him, but Carla refused;
an altercation resulted;
shortly thereafter the suspended employee stabbed Carla to
death.
The death was held compensable because "the injury
sustained by the deceased was caused by an accident
arising out of his employment since the evidence is clear
that the fight which resulted in the killing of the deceased
had its origin or cause in the fact that he was placed in the
job previously occupied by the assailant."
arising out of and in the course
of employment
(coverage formula which determines
compensability in injury cases)
 It has two components:
(a) arising out of employment
(b) in the course of employment
 Iloilo Dock &Engg Co. v WCC
GR L-26341, November 27, 1968
The words "arising out of" refer to the origin
or cause of the accident, and are descriptive
of its character.

While the words "in the course of" refer to the

time, place, and circumstances under which
the accident takes place.
 arising out of employment
(In re McNichols [(1913)], 215 Mass. 498, [L. R. A. 1916A, 306, 102 N. E. 697].)

. . . .It [the injury] arises out of the

employment when there is apparent to the
rational mind, upon consideration of all the
circumstances, a causal connection between
the conditions under which the work is
required to be performed and the resulting
injury.
 arising out of employment
(In re McNichols [(1913)], 215 Mass. 498, [L. R. A. 1916A, 306, 102 N. E. 697].)

Under this test, if the injury can be seen to

have followed as a natural incident of the
work and to have been contemplated by a
reasonable person familiar with the whole
situation as a result of the exposure
occasioned by the nature of the employment,
then it arises out of the employment.
 in the course of employment
An injury is said to arise "in the course of
employment" when it takes place
within the period of employment,
at a place where the employee may reasonably
be, and
whilehe is fulfilling his duties or is engaged in
doing something incidental thereto. (IDECO,
supra)
Work connection is of primary
importance.
 Iloilo Dock &Engg Co. v WCC
GR L-26341, November 27, 1968
The two components of the coverage formula
"arising out of" and "in the course of
employment" are said to be separate tests
which must be independently satisfied; however,
it should not be forgotten that the basic concept
of compensation coverage is unitary, not dual,
and is best expressed in the word, "work-
connection," because an uncompromising
insistence on an independent application of
each of the two portions of the test can, in
certain cases, exclude clearly work-connected
injuries.
 Examples:
The death of a person employed on a public street
which happened while he was crossing the street to
go to an unsafe place to relieve himself, there being
no toilet facilities provided by his employer is
compensable. (Bellocillo v. City of Manila, GR
23422, Nov 9, 1931.)
 Examples:
The death of 2 employees occasioned by
their attempt to save the life of a co-worker is
compensable. (Estandarte v. PMAC, GR
39733, Nov 1, 1933.)
 Examples:

An accident involving an employee of a bus firm

which occurred while he was in the act of retrieving
personal belongings of a passenger outside of his
territory. (Versoza v. Arnaz, GR L-7305, Dec 15,
1953.)
 Examples:
Answering the call of nature, quenching of thirst,
satisfaction of hunger and the like while at work are
deemed incidental to employment. (Chua v.
Roman, GR L-14827, Oct 31, 1960)
 Examples:
The injury sustained by an innocent victim of
workplace horseplay is compensable.
(Simms v. Ruby Tuesday, Inc ., Record No.
091762, Va. Court of Appeals, January 13,
2011.)
In determining whether a death
or disability is compensable, are
we limited to just the immediate
cause?
For example:
B, was a teacher. She was 8-months pregnant when
she accidentally slipped and fell to the floor while
teaching. While she complained of abdominal pain
and stomach cramps, she was still able to report for
work.
After 11 days, B prematurely delivered her baby.
She, sustained vaginal lacerations which became
infected and this was declared as the cause of her
death.
Immediate Cause: Proximate Cause:
Infected vaginal lacerations. Fall sustained while
(Septicemia post partum) teaching.
Not considered as an An accident arising out of
occupational disease. and in the course of
Generally, not employment.
compensable. Compensable.
 Belarmino v. ECC
GR 90294, May 11, 1990.
The illness, septicemia post partum, which resulted in the death of
OaniaBelarmino, is admittedly not listed as an occupational disease in her
particular line of work as a classroom teacher. However, as pointed out in
the petition, her death from that ailment is compensable because an
employment accident and the conditions of her employment contributed
to its development.
The condition of the classroom floor caused Mrs. Belarmino to slip and fall
and suffer injury as a result.
The fall precipitated the onset of recurrent abdominal pains which
culminated in the premature termination of her pregnancy with tragic
consequences to her.
Her fall on the classroom floor brought about her premature delivery
which caused the development of post partum septicemia which
resulted in death. Her fall therefore was the proximate or responsible
cause that set in motion an unbroken chain of events, leading to her
demise.
 Belarmino v. ECC
GR 90294, May 11, 1990.

Mrs. Belarmino's fall was the primary injury

that arose in the course of her employment as
a classroom teacher, hence, all the medical
consequences flowing from it: her recurrent
abdominal pains, the premature delivery of
her baby, her septicemia post partum, and
death, are compensable.
 Proximate Cause
The proximate legal cause is that acting first and
producing the injury, either immediately or by setting
other events in motion, all constituting a natural and
continuous chain of events, each having a close causal
connection with its immediate predecessor, the final
event in the chain immediately effecting the injury is a
natural and probable result of the cause which first
acted, under such circumstances that the person
responsible for the first event should, as an ordinarily
prudent and intelligent person, have reasonable
ground to expect at the moment of his act or default
that an injury to some person might probably result
therefrom." (Bataclan v. Medina, 102 Phil. 181.)
 We consider the proximate cause to
determine compensability.
". . . Verily, the right to compensation extends to disability
due to disease supervening upon and proximately and
naturally resulting from a compensable injury (82 Am. Jur.
132). Where the primary injury is shown to have arisen in
the course of employment, every natural consequence
that flows from the injury likewise arises out of the
employment, unless it is the result of an independent
intervening cause attributable to claimant's own negligence
or misconduct (I Larson Workmen's Compensation Law 3-
279 [1972]). Simply stated, all the medical consequences
and sequels that flow from the primary injury are
compensable. (Enriquez v. WCC, 93 SCRA 366)
What if the injury happened
outside the workplace?
 General Rule:
Off-the-premises injuries or those occasioned by street
perils are not compensable.

It is not fair to require employers to answer even for

their employees' personal time away from work, which
the latter are free to spend of their own choosing.
Whether they choose to spend their free time in the
pursuit of safe or perilous undertakings, in the
company of friends or strangers, lovers or enemies, this
is not one area which their employers should be made
accountable for. While we have emphasized the need
to observe official work time strictly, what an employee
does on free time is beyond the employer's sphere of
inquiry. (BSEPI v. Sps. Cuaresma, GR 182978, April 7,
2009)
 Exceptions:
1. ECC Board Resolution No. 3914-A (July 5,
1988).
2. Ingress-egress or proximity rule.
3. Shuttle bus or extra-premises rule.
4. Special errand rule.
1. ECC Board Resolution No.
3914-A (July 5, 1988).
(Continuing Act and Usual Route)
 ECC Board Resolution No. 3914-A
(July 5, 1988)
I/D suffered by employees resulting from an
accident while going to or coming from the
workplace are compensable if the act of an
employee, going to or coming from the
workplace
1. Was a continuing act
that is, an employee had not been diverted
therefrom by any other activity, and
2. He/she had not departed from his/her usual
route to or from his/her workplace.
 Vanov. GSIS
GR 81327, Dec. 4, 1989

A letter carrier from the Bureau of Posts who

was driving his motorcycle with his son on a
Sunday on his way from Loay, Bohol to his
station in Tagbilaran City for his work the
following day.
Met an accident when his motorcycle skidded
as he approached a bridge resulting in his
death.
 Alanov. ECC
GR 48594, March 16, 1988

A school principal was run over by a bus while

she was waiting for a ride at a public plaza on
her way to school.
 Baldebrinv. WCC
GR L-43792, Oct 12, 1984

Petitioners left eye was hit by a pebble while

he was riding a bus on the way home.
2. Ingress-Egress or Proximity
Rule
 IDECO v. WCC
GR L-26341, Nov 27, 1968.
At about 5:02 o'clock in the afternoon of January 29, 1960, Pablo,
who was employed as a mechanic of the IDECO, while walking on
his way home, was shot to death in front of, and about 20 meters
away from, the main IDECO gate, on a private road commonly
called the IDECO road. The slayer, Martin Cordero, was not heard
to say anything before or after the killing. The motive for the crime
was and still is unknown as Cordero was himself killed before he
could be tried for Pablo's death. At the time of the killing, Pablo's
companion was Rodolfo Galopez, another employee, who, like
Pablo, had finished overtime work at 5:00 p.m. and was going
home. From the main IDECO gate to the spot where Pablo was
killed, there were four "carinderias" on the left side of the road and
two "carinderias" and a residential house on the right side. The
entire length of the road is nowhere stated in the record.
 IDECO v. WCC
GR L-26341, Nov 27, 1978.
The proximity rule exception to the general going
and coming rule is that an employee is generally
considered to be in the course of his employment
while coming to or going from his work, when,
though off the actual premises of his employer, he is
still in close proximity thereto, is proceeding diligently
at an appropriate time, by reasonable means, over
the natural, practical, customary, convenient and
recognized way of ingress, or egress either on land
under the control of the employer, or on adjacent
property with the express or implied consent of the
employer.
3. Shuttle Bus or Extra Premises
Rule
 Under the shuttle bus or extra-premises
rule, the shuttle bus or similar vehicle
provided by the employer to transport the
employees in going to and coming from the
place of work is considered an extension of
the employers work premises.
4. Special Errand Rule
 Under the special errand rule, the injury sustained by
workers on official errand beyond office hours, within
or without the premises of his employer, is considered
compensable. The reason is that he is still considered
in the performance of his work.
The special errand rule also applies to injuries
sustained by employees during recreational activities
sponsored or authorized by the employer such as
intramurals, ball games, golf games, fishing trips, field
trips, outings, picnics or participation in social clubs or
organizations.
 Enao v. ECC
(GR L-46046, April 5, 1985.)
The injury sustained by an employee who was
ambushed while on the way to purchase school
materials is compensable as the same arose out of
and in the course of employment even if the
incident happened after working hours.
5. If the motive is work
connected.
 Luzon Stevedoring
GR L-27588, April 28, 1969.

For an injury to be compensable, it is not

necessary that the cause therefor shall take
place within the place of employment.
If a workman is acting within the scope of his
employment, his protection "in the course of"
the employment usually continues, regardless
of the place of injury.
 Luzon Stevedoring
GR L-27588, April 28, 1969.

Thus, in one case, an employee went to the house of

the employer across the warehouse where he worked
to get a drink of water; that there, while trying to drive
away a puppy that he saw eating fish in the employer's
kitchen, he was bitten in the hand, as a result of which
he later died of hydrophobia.
The death of the employee was held compensable, on
the ground that his trip to the kitchen was occasioned
by the employer's fault in not providing adequate
drinking water at the warehouse.
Are injuries sustained while living or
lodging in employers premises
compensable?
 Board Resolution 12-01-02
(January 17, 2012)
GR: Injuries sustained by stay-in local
employees in their quarters regardless of time
of its occurrence shall be compensable.

XPNs: Intoxication, willful intention to injure

or kill himself or another, notorious
negligence.
 Are injuries sustained while
working at home compensable?
 An injury sustained by an employee while
working at home is, as a general proposition, not
compensable. More so when such work at home
is solely for the personal convenience of the
employee.
It becomes compensable when the same is in
connection with or related to the performance of
his work as dictated under the terms and
conditions of his employment contract expressly
or implicitly, or when so directed or instructed by
his employer.
Are injuries resulting from force
majeure or acts of God
compensable?
 GR: Not compensable. Acts of God such as
lightning, floods, earthquakes, typhoons and
the like which give rise to injuries cannot be
said to originate from risks associated with
employment as they may affect anybody,
employees or not.

XPN: If the employment has increased the

risk of this kind of unforeseeable harm, the
injury arising therefrom is compensable. (Ex.
The death of a ship officer due to the sinking
of his vessel because of a typhoon.)
Personal Comfort Doctrine
 ECC Board Resolution 93-08-0068
(August 5, 1993)

Acts performed by an employee within the time

and space limits of his/her employment to
minister to personal comfort, such as satisfaction
of his/her thirst, hunger or other physical
demands, or to protect himself from excessive
cold, shall be deemed incidental to his
employment and any injuries the employee
suffered in the performance of such acts shall be
considered compensable as having arisen out of
or in the course of employment.
Assaults motivated by personal
reasons.
Assault compensable even if motive is
personal in the ff instances:
Policemen and Soldiers
 Hinoguin v. ECC
(GR 84307, April 17, 1989)
It may be noted in this connection that a soldier on active duty status is
really on 24 hours a day official duty status and is subject to military
discipline and military law 24 hours a day. He is subject to call and to the
orders of his superior officers at all times, 7 days a week, except, of
course, when he is on vacation leave status (which Sgt. Hinoguin was not).
Thus, we think that the work-connected character of Sgt. Hinoguin's injury
and death was not effectively precluded by the simple circumstance that
he was on an overnight pass to go to the home of Dft. Alibuyog, a soldier
under his own command. Sgt. Hinoguin did not effectively cease
performing "official functions" because he was granted a pass. While
going to a fellow soldier's home for a few hours for a meal and some
drinks was not a specific military duty, he was nonetheless in the course of
performance of official functions. Indeed, it appears to us that a soldier
should be presumed to be on official duty unless he is shown to have
clearly and unequivocally put aside that status or condition temporarily
by, e.g., going on an approved vacation leave.
 GSIS v. CA
(GR 128524, April 20, 1999)
From the foregoing cases, it can be gleaned that
the Court did not justify its grant of death
benefits merely on account of the rule that
soldiers or policemen, as the case may be, are
virtually working round-the-clock.
Note that the Court likewise attempted in each
case to find a reasonable nexus between the
absence of the deceased from his assigned place
of work and the incident that led to his death.
 GSIS v. CA
(GR 128524, April 20, 1999)
In Hinoguin, the connection between his absence from
the camp where he was assigned and the place where
he was accidentally shot was the permission duly
given to him and his companions by the camp
commander to go on overnight pass.
According to the Court, "a place which soldiers have
secured lawful permission cannot be very different,
legally speaking, from a place where they are required
to go by their commanding officer" and, hence, the
deceased is to be considered as still in the performance
of his official functions.
 GSIS v. CA
(GR 128524, April 20, 1999)
The same thing can be said of Nitura where
the deceased had to go outside of his station
on permission and directive by his superior
officerto check on several personnel of his
command who were then attending a dance
party.
 GSIS v. CA
(GR 128524, April 20, 1999)
As for P/Sgt. Alvaran in the Employees'
Compensation Commission case, although he was
not given any directive or permission by a
superior officer to be at the Mandaluyong Police
Station, his presence there was nonetheless
justified by the peacekeeping nature of the
matter he was attending to at the time that he
was attacked and shot to death, that is, bringing
his son to the police station to answer for a
crime, a basic duty which any policeman is
expected and ought to perform.
 GSIS v. CA
(GR 128524, April 20, 1999)
In the absence of such prior authority as in
the cases of Hinoguin and Nitura, or
peacekeeping nature of the act attended to
by the policeman at the time he died even
without the explicit permission or directive of
a superior officer, as in the case of P/Sgt.
Alvaran, there is no justification for holding
that SPO2 Alegre met the requisites set forth
in the ECC guidelines.
Art. 178. Limitation of liability.
The State Insurance Fund shall be
liable for compensation to the
employee or his dependents, except
when the disability or death was
occasioned by the employee's
intoxication, willful intention to
injure or kill himself or another,
notorious negligence, or
otherwise provided under this
Title.
 Intoxication
Refers to a persons condition of being under the
influence of liquor or prohibited drugs to the extent
that his acts, words or conduct are impaired visibly as
to prevent him from physically and mentally engaging
in the duties of his employment.
To bar compensation, it must be shown that the
intoxication was the proximate cause of the death or
injury.
The burden of proof lies in him who raises drunkenness
as a defense against the grant of compensation.
 Willful intention to injure or kill
himself or another.
Four situations barring recovery of
compensation:
1. The employees willful intention to injure
himself.
2. The employees willful intention to kill himself.
3. The employees willful intention to injure
another
4. The employees willful intention to kill another.
 Suicide may be compensable if it results from
or is caused by insanity or delirium resulting
from a compensable disease or injury.
 Notorious negligence
Something more than mere or simple
negligence or contributory negligence; it
signifies a deliberate act of the employee to
disregard his own personal safety.
Such kind of negligence ignores warning or
precaution.
As otherwise provided under Title II of
Book IV of the Labor Code.
1. The System xxx 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. (Art. 192)

2. 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. (Art. 194)
 Sickness
any illness definitely accepted as an
occupational disease listed by the Commission,
or any illness caused by employment, subject
to proof that the risk of contracting the same is
increased by working conditions
 Sickness is compensable if:
1. It was the result of an occupational disease
under Annex A of the Amended Rules on
Employees Compensation. (Doctrine of
Occupational Disease)
2. (Though the sickness is not so listed) the risk
of contracting the disease was increased by
the claimants working conditions (Theory of
Increased Risk)
 GSIS v. Pentecostes
(GR 154385; Aug 24, 2007)
Respondent Merlita Pentecostes (Merlita) was 32 years old when she
joined the government service in 1980 as a public school elementary
teacher assigned to the remote and mountainous barangay elementary
schools of the towns of Basud, Imelda, Labo and Jose Panganiban, all in
the province of Camarines Norte.

In 1995, Merlita was assigned to the urban town of Daet, Camarines Norte
where she retired from service on 24 April 1998 on account of her serious
malady.

While assigned at the said mountainous towns, Merlita had to walk six (6)
kilometers daily to and from the barangay elementary school where she
taught and her temporary residence in the poblacion.[4] In said
locales, Merlitas only source of drinking water came from a deep well.
Merlita frequently experienced urinary tract infections.
 GSIS v. Pentecostes
(GR 154385; Aug 24, 2007)
From 15 November 1997 to 8 December 1997, Merlita was confined at the Bicol
Medical Center in Naga City due to Chronic Renal Failure secondary to Obstructive
Uropathy Secondary to Urolithiasis. Consequently, Merlitas right kidney was
removed by way of a nephrectomy in October 1998.

Merlitasleft kidney also failed because of Nephrolithiasis (Renal Stones or

Urolithiasis). On account of her condition, she underwent hemodialysis (a
procedure where blood with the excretory products is removed and replaced with
fresh blood) two (2) times a week which is an expensive procedure done not to
cure the disease but to ease the pain, to lessen the retention of fluids, to minimize
further complications, and to lengthen the chance of survival of Merlita.

Merlitascondition constrained her to retire from service in April 1998. Her medical
examiners considered her disability as total and permanent. On account of her
illness, Merlita filed a claim with GSIS for compensation benefits which was denied
on the ground that Urolithiasis is not work-related. Merlita sought
reconsideration, but it was similarly denied. On appeal, the Employees
Compensation Commission (ECC) likewise rejected Merlitas claim,
 GSIS v. Pentecostes
(GR 154385; Aug 24, 2007)
SC: The foregoing medical reports establish that the environment (climate and
geographical location), water or fluid intake and activity are important factors in
the development or inhibition of urinary stone disease. The regularity of urination
likewise plays an important role since withholding urine for sometime may disturb
the balance.
Merlita was assigned to schools located in mountainous barangays which required
her to walk daily a considerable distance.Considering the climate, the location of
her workplace, i.e. mountainous and far-flung, and the strenuous walk she had
to daily endure, she was prone to dehydration which could have led to the
formation of urinary stones. Additionally, in said place the only available drinking
water was the water taken from the deep well which in all probability was hard
water, containing minerals which contribute to the formation of kidney stones.
Merlita could also have missed the important habit ofregular urination.
Teachers have a tendency to sit for hours on end, and to put off or postpone
emptying their bladders when it interferes with their teaching hours or
preparation of lesson plans.
Thus, while the Court concedes that the nature of Merlitas work as a teacher
does not per se ordinarily cause urolithiasis, the risk of contracting the same in this
case was aggravated by the peculiar conditions and location of her workplace,
which required her to undergo a five-day week schedule of strenuous and
protracted walking.
 Benefits

1. Medical benefits
2. Disability benefits
3. Death benefits
Medical Benefits
 Art. 191. 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.
 The obligation of the SIF to provide medical
services shall continue for as long as the
employee is sick. This duty is not ended even
if employment was terminated.

A claimant who, despite his illness, continues

to work in order to avoid economic loss is
nonetheless entitled to medical benefits.
 Examples of medical benefits
Ward services, which includes:
1. Bed in a ward (6 beds/room)
2. Meals
3. Nursing services
4. Medicines provided by the hospital
5. Laboratory services
6. X-rays
7. Medical supplies
8. Use of appliances and equipment furnished by the hospital
9. Anesthetic services
10. Operating room charges
11. Surgery
12. Doctors services
Subsequent domiciliary care by an accredited physician
Medicines
 Art. 192. 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.
 Art. 193. 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.
 Art. 194. 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.
Disability Benefits
 3 kinds of disability under the Labor
Code
1. Temporary total disability
2. Permanent total disability
3. Permanent partial disability
 PPD Benefits Schedule
Complete and permanent loss of 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

One hand 39

One foot 31

One leg 46

One ear 10

Both ears 20

Hearing of one ear 10

Hearing of both ear 50

Sight of one eye 25

 loss of a wrist = loss of the hand
loss of an elbow = loss of the arm
loss of an ankle = loss of the foot
loss of a knee = loss of the leg
loss of first finger joint = loss of finger or toe
loss of 2 joints = loss of finger/toe
Death Benefits
 Primary and secondary beneficiaries.

Primary Beneficiaries Secondary Beneficiaries

Dependent spouse (until remarriage)
Dependent children (unmarried, not
Dependent parents
gainfully employed, and not over
twenty-one years of age or over the illegitimate children and
twenty-one years of age provided he is legitimate descendants
incapacitated and incapable of self-
support due to a physical or mental
defect which is congenital or acquired
during minority )
A dependent acknowledged natural
child shall be considered as a primary
beneficiary when there are no other
dependent children who are qualified
and eligible for monthly income
benefit.
 Death benefit may consist of a monthly
pension or a lump sum benefit.
The presence of primary beneficiaries
excludes secondary beneficiaries from receipt
of the benefit.
Benefit is not part of the estate of the
deceased and thus not subject to estate tax.
Funeral benefit = P12,000 (SSS); P18,000
(GSIS)
 ART. 179. Extent of liability
Unless otherwise provided, the liability of the State
Insurance Fund under this Title shall be
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.
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,
Republic Act Numbered Eleven hundred sixty-one, as
amended, Republic Act Numbered Forty-eight hundred
sixty-four as amended, and other laws whose
benefits are administered by the System or by
other agencies of the government. (As amended
by Presidential Decree No. 1921).
Choice of remedy belongs to claimant.
An employer is also liable to his employees under
Article 1711 of the Civil Code.
If the claim is made under the Labor Code, the SIF
shall be liable. If the claim is made under the
Civil Code, the employer is liable.
The choice belongs to the claimant, however, he
cannot pursue both simultaneously. Choice of
one remedy forecloses the other (at least until
the claim in the first remedy is rejected).
 ART. 180. Liability of third party/ies.
(a) When the 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 by the System under this Title. In case benefit is paid
under this Title, the System shall be subrogated to the
rights of the disabled employee or the dependents, in case
of his death, in accordance with the general law.
(b) Where the System recovers from such third party
damages in excess of those paid or allowed under this Title,
such excess shall be delivered to the disabled employee or
other persons entitled thereto, after deducting the cost of
proceedings and expenses of the System.
 No double recovery from SIF and 3rd
Party
The disabled employee or his dependents
cannot claim payment twice for the same
injury, from both the third party and the
SSS/GSIS.
 ART. 174. Compulsory
coverage.
- Coverage in the State Insurance
Fund shall be compulsory upon all
employers and their employees not
over sixty (60) years of age:
Provided, That an employee who is
over (60) years of age and paying
contributions to qualify for the
retirement or life insurance benefit
administered by the System shall be
subject to compulsory coverage.
 Effective Date of Coverage
Employer = first day of operation
Employee = date of employment.
 Liability for non-registration
Amended Rules on Employee Compensation =
Fine of P1,000 to P10,000 and/or
imprisonment for the duration of the violation
or non-compliance at the discretion of the
court.
SSS/GSIS Law = Fine of P5,000 to P20,000 and
imprisonment of 6 years and 1 day to 12
years.
 What if a contingency occurs prior to
registration?
In case a compensable contingency occurs
after 30 days from employment and before
the SSS or GSIS receives any report for
coverage about the employee, the employer
shall be liable to the SSS or GSIS for the lump
sum equivalent to the benefits to which the
employee or his dependents may be entitled.