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Employees' Compensation and State Insurance Fund
Employees' Compensation and State Insurance Fund
Submitted to:
Atty. Irvin Joseph Fabella
Submitted by:
Adil, Reema Fahada R.
Brito, Karen Daryl L.
Liban, Clarisse M.
Macalalad, Ma. Michaela B.
Manaloto, Abigail P
Maramag, Irish Kate B.
Reyes, Alphamilenio S.
Yusi, Jonathan Vincent U.
Employees’ Compensation (1) The public sectors comprising the
employed workers who are covered by
and State Insurance Fund
the GSIS, including the members of the
Armed Forces of the Philippines,
elective officials who are receiving
Liban, Clarisse M.
regular salary, and any person
Overview employed as casual, emergency,
temporary, substitute or contractual.
What is the Employees’ Compensation (2) The private sector comprising the
Program? (ECP) employed workers who are covered by
the SSS.
The Employees’ Compensation Program
(ECP) is a government program designed to
provide a compensation package to public Manaloto, Abigail P.
and private sector employees or their
dependents in the event of work related Coverage
sickness, injury, disability, or death.
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Protection (BFP) and Philippine Coast When can beneficiaries file for benefits
Guard. under the ECP?
It shall be determined upon the said
Are Filipinos working abroad also employee’s work-related injury, sickness,
covered by the Employees’ disability, or death.
Compensation Act?
Yes. Under the Amended Rules on
Beneficiaries
Employees’ Compensation, Filipino
employees working abroad are covered. Who are considered as beneficiaries?
They are also entitled to those benefits
enjoyed by Filipinos locally employed. Beneficiaries that may be designated may
either be: preferably the (1) Primary
beneficiaries such as the legitimate spouse
and children or in absence and in absence
When shall coverage of the employers
thereof, the (2) Secondary beneficiaries
start?
such as the legitimate parents, and
Compulsory coverage of employers shall legitimate descendants and illegitimate
take effect on the first day of his operation. children.
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In case of failure or refusal to register How much should an employer pay for
employees, the employer or responsible the contribution?
official who committed the violation shall be
For the public sector, the employer shall
punished with a fine of not less than P1,000
remit to the GSIS a monthly contribution
nor more than P10,000 and/or imprisonment
equivalent to one percent of the basic salary
for the duration of the violation or non-
or ₱100 per month per employee,
compliance or until such time that
whichever is lower.
rectification of the violation has been made,
at the discretion of the Court.
No. Under Circular No. 04-008 dated April ₱14,750 ₱15,000 and ₱30
28, 2014, No EC claim of any employee above
- over
should be rejected on the basis alone of
GSIS or SSS registration and EC
Contribution. If the contingency occurs after
30 days from employment and before the When a covered employee dies during
System receives any report for coverage employment or is separated from
about the employee or EC contribution on employment, when does the employer's
his behalf, his employer shall be liable to the obligation to pay monthly contribution
System for the lump sum equivalent of the cease?
benefits to which he or his dependents may It would cease on the last day of the month
be entitled. of contingency.
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(1) If death or permanent disability falls
within 18 months from the month of
What is the penalty for failure to remit?
coverage, it will be computed by
In case of delinquency, the employer or dividing the sum of all MSCs paid prior
responsible official who committed such to the month of death or permanent
violation shall be penalized with a fine of not disability/ number of calendar months of
less than ₱1,000 nor more than ₱10,000 coverage in the same period.
and/or imprisonment for the duration of the
violation or non-compliance or until such
time that a rectification of the violation has (2) If death or permanent disability falls
been made, that would also depend at the within the month of coverage, it is the
Court’s discretion. actual salary received during the
calendar month or its corresponding
monthly salary credit.
If any contribution is not paid to the SSS as
prescribed under the Rule V, the employer
In the case of GSIS, the AMSC is the
shall pay besides the contribution a penalty
quotient after dividing the aggregate
of 3% a month from the date of the
compensations received by the member or
contribution falls due until paid.
employee for the last three years
immediately preceding his death,
permanent disability, injury or sickness, by
What is a monthly salary credit? the number of months he received said
It is the wage base for contributions or the compensation, or three thousand pesos,
actual salary, as provided in Section 1, Rule whichever is smaller.
V of Presidential Decree 626. If earnings
are derived from more than one
employment, it shall be determined on the How is Average Daily Salary Credit
basis of the aggregate earnings from all computed?
employments, but not exceeding ₱1,000 in
The general formula in computing ADSC in
the case of SSS and ₱3,000 in the case of
the case of SSS is the result obtained by
GSIS.
dividing the sum of the six (6) highest
monthly salary credits in the 12-month
period immediately preceding the semester
How can the average monthly salary of sickness by 180.
credit be computed?
The general formula for the case of SSS is
the result obtained by dividing the sum of Exception:
MSCs in the 60-month period immediately
(1) If the injury occurs within 12 calendar
preceding the semester of death, or
permanent disability, injury, or sickness months from the month of coverage, it is
divided by number of months of coverage in the result obtained by dividing the sum
the same period. of all monthly salary credits by 30 and
by the number of months of coverage,
excluding the month of injury.
Exception:
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(2) If the injury occurs within the month of For a member covered before January
coverage, it is the actual salary received 1975, nineteen hundred seventy-five minus
during the calendar month or its the calendar year of coverage, plus the
corresponding monthly salary credit number of calendar years in which six or
divided by 30. more contributions have been paid from
January 1975 up to the calendar year
containing the semester prior to the
In the case of GSIS, ADSC shall be contingency.
computed by:
(1) If the salary or wage is based on an
hourly rate, it is the hourly rate times the For a member covered in or after January
1975, the number of calendar years in
number of hours required to work during
which six or more contributions have been
the month of contingency divided by 22.
paid from the year of coverage up to the
calendar year containing the semester prior
(2) If the salary or wage is based on a daily to the contingency.
rate, it is the daily rate times the number
of days required to work per month
divided by 22. How is monthly income benefit
computed?
(3) If the salary or wage is based on a In the case of the SSS, it is the amount
monthly rate, it is the monthly rate equivalent to 115% of the sum of: the
average monthly salary credit multiplied by
divided by 22.
the replacement ratio and one and a half
percent of the average monthly salary credit
(4) If the employee has worked for less for each credited year of service in excess
than one month, his daily salary credit is of ten years: Provided, that the monthly
the actual daily wage or salary of the income benefit must not be less than P250.
monthly wage or salary divided by the It is also provided that the monthly pension
actual number of days worked during of surviving pensioners shall be increased
automatically and simultaneously to the
the month of contingency.
extent that 15% difference in monthly
income benefit between EC and GSIS, be
How can the Replacement Ratio be maintained.
computed?
In the case of the SSS, it is the sum of the
In the case of the GSIS, the monthly income
twenty percent and the quotient obtained by
benefit shall be the basic monthly pension
dividing three hundred by the sum of three
as defined in PD 1146 plus twenty percent,
hundred forty and the average monthly
but shall not be less than Php 250, nor more
salary credit.
than the actual salary at the time of
contingency.
How can credited years of service be
computed?
Manaloto, Abigail P.
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Compensability Benefits
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The medical services, appliances and vocational assessment and preparation
supplies shall be provided to the afflicted designed to meet the individual needs of
employee beginning on the first day of the each handicapped employee to restore him
injury or sickness, during the subsequent to suitable employment, including
period of his disability, and as the progress assistance as may be within its resources to
of his recovery may require, subject to the help each rehabilitee to develop his mental,
given medical reports in Section 5 of Rule vocational or social potential.
IV.
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(1) Coverage under this Rule shall be during the rehabilitation is occasioned by
voluntary. any of the following:
(2) Coverage under this Rule shall take
effect upon completion of registration.
(1) His intoxication,
(2) His willful intention to injure or kill
What are the conditions for entitlement?
himself or another;
Any employee shall be entitled to (3) His notorious negligence.
rehabilitation services, if all of the following
conditions are satisfied:
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Yusi, Jonathan Vincent U. determined to be compensable, shall be
considered independent of, and separate
Temporary total disability
from, the period covered by the original
disability.
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(1) He has been duly reported to the The monthly income benefit shall be
System; guaranteed for five years, and shall be
(2) He sustains the permanent total suspended if:
disability (1) the employee is gainfully employed;
(3) as a result of injury or sickness; and (2) recovers from his permanent total
(4) The System has been duly notified of disability, or;
the (3) fails to present himself for examination
(5) injury or sickness which caused his at least once a year upon notice by the
disability. System, except as otherwise provided
for in other laws, decrees, orders or
When does the period of entitlement Letters of Instructions.
begin?
Beginning on the first month of such How much can the dependent children
disability, but not longer than the designated get from this benefit?
number of months for such disability.
Ten percent (10%) of the monthly income of
the employee for each dependent child, but
not exceeding five, beginning with youngest
What are the disabilities deemed as total and without substitution: Provided, That the
and permanent? monthly income benefit shall be the new
amount of the monthly benefit for all
covered pensioners, effective upon approval
(1) Temporary total disability lasting of this Decree.
continuously for more than one hundred
twenty days, except as otherwise
provided for in the Rules; Brito, Karen Daryl L.
(2) Complete loss of sight of both eyes;
(3) Loss of two limbs at or above the ankle Permanent partial disability
or wrist; What is permanent partial disability?
(4) Permanent complete paralysis of two
limbs; A disability is partial and permanent if as a
(5) Brain injury resulting in incurable result of the injury or sickness the employee
suffers a permanent partial loss of the use
imbecility or insanity; and
of any part of his body.
(6) Such cases as determined by the
Medical Director of the System and What are the conditions of entitlement of
approved by the Commission. permanent partial disability?
An employee shall be entitled to an income
How much can the employee get from benefit of permanent partial disability if all of
this benefit? the following conditions are satisfied:
An employee is entitled to be paid by the (1) He has been duly reported to the
System during such a disability an amount System;
equivalent to the monthly income benefit. (2) He sustains the permanent partial
disability as a result of the injury or
sickness; and
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(3) The System has been duly notified of
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the injury or sickness which caused his
disability.
One leg 46
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(2) He died as a result of an injury or (1) He/she has not remarried.
sickness; and
(3) The System has been duly notified of his For the dependent children, the
death, as well as the injury or sickness qualifications are:
which caused his death. His employer
(1) Unmarried;
shall be liable for the benefit if such
(2) Not gainfully employed; and
death occurred before the employee is
(3) Over 21 years of age provided he/she is
duly reported for coverage to the
incapable of self-support due to a
System.
physical or mental defect which is
congenital or acquired during minority.
In addition, the cause of death must be a
complication or natural consequence of the
compensated Permanent Total Disability. Can the spouse be entitled to death
benefits even if the illness of the late
How much is the amount of benefit for employee-spouse is not listed as
primary beneficiaries? occupational disease?
The monthly income benefit shall be Yes. An illness which is admittedly not listed
equivalent to the monthly income benefit for as occupational disease can still be
permanent total disability, which shall be compensable if the death from the ailment is
guaranteed for five years, increased by ten caused by an employment accident and the
percent for each dependent child but not conditions of his employment contributed to
exceeding 5, beginning with the youngest its development. (Belarmino v. ECC, G.R.
and without substitution. No. 182978, 11 May 1990)
The income benefit shall be paid beginning To whom shall the funeral benefit be
at the month of death and shall continue to given?
be paid for as long as the beneficiaries are
entitled thereto.
(1) The surviving spouse; or
What are the requirements for primary (2) The legitimate child who spent for the
beneficiaries to be entitled?
funeral services; or
For the surviving legitimate spouse:
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(3) Any other person who can show What is a Carer’s Allowance?
incontrovertible proof or proof of his
A Carer’s Allowance is a supplemental
having borne the funeral expenses.
pension provided to an Employee who
suffers from permanent partial (PPD) or
What are conditions of entitlement for permanent total disability (PTD) as a result
EC funeral benefits? of work-related contingency arising out of
employment.
The EC funeral benefits shall be granted
after the SSS or the GSIS has declared the
following in the evaluation of claims for EC Who are covered by the Carer’s
death benefits: Allowance?
Both employees in Private and the Public
(1) Death due to sickness - causal sectors.
relationship between the death and the
working conditions of the covered
member. What are the reimbursement rates of
physicians under medical benefits of the
Carer’s allowance?
(2) Death due to injury - causal relationship
between the death and the work-related
accident.
General Specialist
Practitioners
(3) Death of EC Permanent Partial Disability
(PPD) or Permanent Total Disability A. Daily Ward Visits
(PTD) pensioner - the cause of death is
a complication or natural consequence Per day ₱400 ₱600
of previously compensated PPD or PTD.
Maximum per ₱1,600 ₱2,400
confinement
When is the period of filing in cases of
presumptive death?
B. ICU/CCU
The beneficiaries may file their claims for
EC death with funeral benefits within the Per day ₱800 ₱1,200
three-year prescriptive period from the time
the missing person has been presumed Maximum Per ₱1,600 ₱2,400
dead after the lapse of four years from the Confinement
occurrence of the incident.
Out-patient ₱400 ₱600
Consultation
Adil, Reema Fahada R
Carer’s Allowance C. Consultation for pre-procedure medical
evaluation (Out-patient and In-patient)
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Reyes, Alphamilenio S.
Routine (Per ₱800 ₱1,200
pre-procedure Record of Death or Disability
medical
evaluation)
What is an employer’s logbook?
With Medical ₱1,200 ₱1,400
An employer’s logbook contains a
Indication (Per
chronological record of sickness, injury or
pre-procedure
death of his employees. It also includes the
medical
employee’s names, dates and places of
evaluation)
contingency, nature of the contingency and
absences.
D. Intra- ₱1,200 ₱1,400
operative
Monitoring Who will record/make entries in the
logbook?
How much is the Carer’s Allowance All entries in the employer’s logbook shall
be made by the employer or any of his
1000 pesos a month for both public and authorized officials after verification of the
private sectors as mandated by E.O. No. contingencies or the employee’s absences
54. for a period of a day or more.
What is the reimbursement rate for What is the duty of the employer after
physical therapy sessions? making the entries in the logbook?
A maximum of 500 pesos per session. The employer shall report to the System
within five (5) days the contingencies he
only deems to be work-connected.
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When is notice not necessary? and/or a fine of not less than five hundred
(P500) nor more than five thousand pesos
The notice is not necessary where the
(P5,000) and imprisonment for not less than
employer or his representatives already had
six (6) months or more than one (1) year, at
knowledge thereof, or the contingency
the discretion of the Court.
occurred during work hours at the
workplace.
Prescriptive Period
Penal Provisions
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For private sector employees, the benefit is less than the benefits provided by
payment of benefits under the SSS Law the GSIS, the GSIS will only pay for the
does not bar the employee/beneficiaries difference between the benefit chosen as
from receiving benefits under the ECP, paid by the EC and the value of the GSIS
provided that the death or disability is work- benefit.
related.
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