BSU-PORTIA SORORITY

a. A private employee, whether permanent,

Chapter Six temporary or provisional, who is not over 60
SOCIAL WELFARE LEGISLATION years old.
b. A domestic worker or kasambahay who has
TOPICS PER SYLLABUS rendered at least one (1) month of service.2
c. A Filipino seafarer upon the signing of the
VI.
standard contract of employment between the
SOCIAL WELFARE LEGISLATION seafarer and the manning agency which,
(P.D. 626) together with the foreign ship owner, act as
employers.
d. An employee of a foreign government,
P.D. No. 626 [December 27, 1974], amended Title II international organization or their wholly-owned
of Book IV on Employees’ Compensation and State Insurance instrumentality based in the Philippines, which
Fund of the Labor Code covering Articles 166 to 208 thereof. entered into an administrative agreement with
It took effect on January 1, 1975. the SSS for the coverage of its Filipino workers.
e. The parent, spouse or child below 21 years old of
the owner of a single proprietorship business.3
[NOTE: A more extensive discussion on the 3. COMPULSORY COVERAGE OF SELF-EMPLOYED PERSONS.
pertinent provisions introduced by P.D. No. 626 is
A self-employed person,4 regardless of trade,
found under the topic “VI. SOCIAL WELFARE
business or occupation, with an income of at least P1,000 a
LEGISLATION, D. Employee’s compensation –
month and not over 60 years old, should register with the
coverage and when compensable”, infra].
SSS. Included, but not limited to, are the following self-
employed persons:
Chapter Six a. Self-employed professionals;
SOCIAL WELFARE LEGISLATION b. Business partners, single proprietors and board
directors;
TOPICS PER SYLLABUS c. Actors, actresses, directors, scriptwriters and
A. SSS Law (R.A. No. 8282) news reporters who are not under an employer-
1. Coverage employee relationship;
2. Exclusions from coverage d. Professional athletes, coaches, trainers and
3. Benefits jockeys;
4. Beneficiaries e. Farmers and fisherfolks; and
f. Workers in the informal sector such as cigarette
vendors, watch-your-car boys, hospitality girls,
A. among others.5
SSS LAW
(R.A. No. 8282) Unless otherwise specified, all provisions of the law,
R.A. No. 8282, applicable to covered employees shall also be
applicable to the covered self-employed persons.6
1.
A self-employed person shall be both employee and
Coverage employer at the same time.7
1. COMPULSORY COVERAGE OF EMPLOYERS. 4. VOLUNTARY COVERAGE.
a. An employer or any person who uses the services 1. Separated Members
of another person in business, trade, industry or
any undertaking. A member who is separated from employment
or ceased to be self-employed/OFW/non-
A social, civic, professional, charitable and other
working spouse and would like to continue
non-profit organizations which hire the services
contributing.8
of employees are considered “employers.”
b. A foreign government, international organization 2. Overseas Filipino Workers (OFWs)
or its wholly-owned instrumentality such as an A Filipino recruited in the Philippines by a
embassy in the Philippines, may enter into an foreign-based employer for employment abroad
administrative agreement with the SSS for the or one who legitimately entered a foreign
coverage of its Filipino employees.1 country (i.e. , tourist, student) and is eventually
2. COMPULSORY COVERAGE OF EMPLOYEES. employed.9
3. Non-working spouses of SSS members
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BSU-PORTIA SORORITY
A person legally married to a currently
employed and actively paying SSS member who
devotes full time in the management of
household and family affairs may be covered on
a voluntary basis, provided there is the approval
of the working spouse. The person should never
have been a member of the SSS. The
contributions will be based on 50 percent (50%)
of the working spouse’s last posted monthly
salary credit but in no case shall it be lower than
P1,000.10
5. EFFECTIVE DATE OF COVERAGE.
For compulsory coverage:
1. For employer - Compulsory coverage of the
employer shall take effect on the first day of his
operation or on the first day he hires
employee/s. The employer is given only 30 days
from the date of employment of employee to
report the person for coverage to the SSS.11
2. For employee - Compulsory coverage of the
employee shall take effect on the first day of his
employment.12
3. For self-employed - The compulsory coverage of
the self-employed person shall take effect upon
his registration with the SSS13 or upon payment
of the first valid contribution, in case of initial
coverage.14
For voluntary coverage:
1. For an OFW – upon first payment of contribution,
in case of initial coverage.
2. For a non-working spouse – upon first payment of
contribution.
3. For a separated member – on the month he/she
resumed payment of contribution.15
6. EFFECT OF SEPARATION FROM EMPLOYMENT.
When an employee under compulsory coverage is
separated from employment, his employer’s contribution on
his account and his obligation to pay contributions arising
from that employment shall cease at the end of the month
of separation, but said employee shall be credited with all
contributions paid on his behalf and entitled to benefits
according to the provisions of this Act. He may, however,
continue to pay the total contributions to maintain his right
to full benefit.16
7. EFFECT OF INTERRUPTION OF BUSINESS OR PROFESSIONAL
INCOME.
If the self-employed realizes NO income in any
given month, he shall not be required to pay contributions
for that month. He may, however, be allowed to continue
paying contributions under the same rules and regulations
applicable to a separated employee member.17
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2.
EXCLUSIONS FROM COVERAGE
1. EXCLUDED EMPLOYER.
Government and any of its political subdivisions,
branches or instrumentalities, including corporations owned
or controlled by the Government18 with original charters.
2. EXCLUDED EMPLOYEES.
Workers whose employment or service falls under
any of the following circumstances are not covered:
(1) Employment purely casual and not for the
purpose of occupation or business of the
employer;
(2) Service performed on or in connection with
an alien vessel by an employee if he is employed
when such vessel is outside the Philippines;
(3) Service performed in the employ of the
Philippine Government or instrumentality or
agency thereof;
(4) Service performed in the employ of a foreign
government or international organization, or
their wholly-owned instrumentality: Provided,
however, That this exemption notwithstanding,
any foreign government, international
organization or their wholly-owned
instrumentality employing workers in the
Philippines or employing Filipinos outside of the
Philippines, may enter into an agreement with
the Philippine Government for the inclusion of
such employees in the SSS except those already
covered by their respective civil service
retirement systems:Provided, further, That the
terms of such agreement shall conform with the
provisions of R.A. No. 8282 on coverage and
amount of payment of contributions and
benefits: Provided, finally, That the provisions of
this Act shall be supplementary to any such
agreement; and
(5) Such other services performed by temporary
and other employees which may be excluded by
regulation of the Social Security Commission.
Employees of bona-fide independent
contractors shall not be deemed employees of
the employer engaging the service of said
contractors.19
3.
BENEFITS
1. TWO (2) MAIN CLASSIFICATIONS.
The SSS benefits may be classified as follows:
(a) Social security benefits:
1) Sickness
2) Maternity
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3) Retirement
4) Disability
5) Death and funeral.
(b) Employees’ compensation benefits.
I.
SOCIAL SECURITY BENEFITS
1. SICKNESS BENEFIT. 20
 What is the sickness benefit?
The sickness benefit is a daily cash allowance paid
for the number of days a member is unable to work due
to sickness or injury.
How does an SSS member qualify for the sickness
benefit?
1. He is unable to work due to sickness or injury and
confined either in a hospital or at home for at
least four (4) days;
2. He has paid at least three months of
contributions within the 12 month period
immediately before the semester of sickness has
been paid;
3. When all company sick leaves with pay for the
current year has been used up;
4. The employer has been notified, or, if
a separated, voluntary or self-
employed member, the SSS directly.
How much sickness benefit is a member entitled
to receive?
The amount of a member’s sickness benefit per day
is equivalent to ninety percent (90%) of the
member’s average daily salary credit.
How is the sickness benefit computed?
1. Exclude the semester of sickness.
A “semester” refers to two consecutive quarters
ending in the quarter of sickness.
A “quarter” refers to three consecutive months
ending March, June, September or December.
2. Count twelve (12) months backwards starting
from the month immediately before the
semester of sickness.
3. Identify the six (6) highest monthly salary credits
within the 12-month period.
“Monthly salary credit” means the
compensation base for contributions and
benefits related to the total earnings for the
month. (The maximum covered earnings or
compensation is P15,000 effective Jan 1, 2002) .
4. Add the six (6) highest monthly salary credits to
get the total monthly salary credit.
5. Divide the total monthly salary credits by 180
days to get the average daily salary credit.
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6. Multiply the average daily salary credit by 90
percent to get the daily sickness allowance.
7. Multiply the daily sickness allowance by approved
number of days to arrive at the amount of
benefit due.
For example, let us say that an SSS member gets
sick or injured in October 2004 for 20 days:
a. The semester of sickness would be from July
2004 to December 2004.
b. The 12-month period would be from July
2003 to June 2004 within which the six
highest monthly salary credits will be chosen.
c. Let us assume that the six highest monthly
salary credits are P15, 000 each. The total
monthly credit would be P90, 000 (P15, 000 x
6) .
d. The total monthly salary would be divided by
180 to get the average daily salary credit or
P500 (P90, 000/180) .
e. The sickness benefit due is P9,000 (P450 x 20
days) .
How many days in a year can a member avail
himself of the sickness benefit?
A member can be granted sickness benefit for
a maximum of 120 days in one calendar year. Any unused
portion of the allowable 120 days sickness benefit cannot be
carried forward and added to the total number of allowed
compensable days for the following year.
The sickness benefit shall not be paid for more than
240 days on account of the same illness. If the sickness or
injury still persists after 240 days, his claim will be considered
a disability claim.
Who should an employee notify regarding his
sickness or injury?
A member should notify the employer within five
(5) calendar days after the start of sickness or injury. The
employer, in turn, must notify the SSS of the confinement
within (5) calendar days after receipt of the notification from
the employee member.
Notification to the employer is not necessary if the
member’s confinement is in a hospital or if the member got
sick or was injured while working or was within the company
premises. In this case, the employer must notify the SSS
within five (5) calendar days from the start of the employee’s
sickness or injury while working or was within the company
premises.
What is the procedure for notification for
unemployed, self-employed and voluntary
members?
Unemployed, self-employed or voluntary-paying
members should notify the SSS directly within five (5)
calendar days after the start of confinement, unless such
confinement is in the hospital, in which case, notification
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is not necessary.
What are the effects of failure or delay in
notification?
1. If the employee notifies the employer, or the SSS,
in the case of an unemployed, self-employed or
voluntary-paying member, beyond the
prescribed 5-day period, the confinement shall
be deemed to have started not earlier than the
5th day immediately preceding the date of
notification.
2. If the employer notifies the SSS beyond the five
(5) calendar days after the receipt of the
notification from the employee, the employer
shall be reimbursed only for each day of
confinement starting from the 10th calendar day
immediately preceding the date of notification
to the SSS.
3. If the employee has given the required
notification to the employer, but the employer
fails to notify the SSS of the confinement within
the prescribed period resulting in the reduction
of the benefit or denial of the claim, the
employer shall have no right to recover the daily
sickness allowance advanced to the employee.
How would an employed member be paid his
sickness benefit?
The payment of the daily sickness allowance
is advanced by the employer every regular payday. The SSS
will then reimburse the employer of the amount legally
advanced upon receipt of satisfactory proof of such payment
and legality thereof.
The SSS will reimburse the employer only for
confinements within the one (1) year period immediately
preceding and the date the claim for benefit or
reimbursement is received by the SSS, except for
confinements in hospital (i.e. SSS receives the employer’s
reimbursement claim on Oct. 3, 2004 for the sickness period
September 23 to Oct. 14, 2003. The employer will be
reimbursed for the period Oct. 4 to 14,2003 only as Sept. 23
to Oct. 3, 2003 falls outside the prescribed one-year period
for reimbursement claim) .
How about the unemployed, self-employed or
voluntary member?
The sickness benefit will be paid directly by the SSS
to the unemployed, self-employed or voluntary members.
What is the prescribed period for filing for a
member who is confined in a hospital?
For hospital confinement, the claim for benefit
must be filed within one (1) year from the last day of
confinement from the hospital. For home confinement, the
claim for reimbursement by the employer must be filed
within one (1) year from the start of illness. Failure to file the
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claim within the prescribed period will result to denial of the
claim.
2. MATERNITY BENEFIT. 21
What is the maternity benefit?
The maternity benefit is a daily cash
allowance granted to a female member who was unable to
work due to childbirth or miscarriage.
What are the qualifications for entitlement to the
maternity benefit?
1. She has paid at least three (3) monthly
contributions within the 12-month period
immediately preceding the semester of her
childbirth or miscarriage.
2. She has given the required notification of her
pregnancy through her employer if employed, or
to the SSS if separated, voluntary or self-
employed member.22
Pregnant women, whether married or unmarried, are
entitled to maternity leave benefits.
Entitlement to maternity leave benefits is not
dependent on the civil status of the pregnant woman. Every
pregnant woman in the private sector, whether married or
unmarried, is entitled to the maternity leave benefits.23
Maternity benefits, not part of 13th month pay
computation.
Maternity benefits, like other benefits granted by the
SSS, are granted to employees in lieu of wages and therefore
may not be included in computing the employee’s 13th month
pay for the calendar year.24
Is the voluntary or self-employed member also
entitled to the maternity benefit?
Yes, A voluntary or a self-employed member is
entitled to the maternity benefit provided that she meets
the qualifying conditions.
How much is the maternity benefit?
The maternity benefit is equivalent to 100 percent of the
member’s average daily salary credit multiplied by 60
days for normal delivery or miscarriage,78 days for caesarean
section delivery.
How is the maternity benefit computed?
1. Exclude the semester of contingency (delivery or
miscarriage) .
A “semester” refers to two consecutive quarters
ending in the quarter of contingency.
A “quarter” refers to three consecutive months
ending March, June, September or December.
2. Count 12 months backwards starting from the
month immediately before the semester of
contingency.
3. Identify the six highest monthly salary credits
within the 12-month period.
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“Monthly salary credit” means the
compensation base for contributions benefits
related to the total earnings for the month.
4. Add the six highest monthly salary credits to get
the total monthly salary credit.
5. Divide the total monthly salary credit by 180 days
to get the average daily salary credit. This is
equivalent to the daily maternity allowance.
6. Multiply the daily maternity allowance by 60 (for
normal delivery or miscarriage) or 78 days (for
caesarean section delivery) to get the total
amount of maternity benefit.
For example, let us say that an SSS member
gives birth in December 2004.
a. The semester of contingency would be from
July 2004 to December 2004
b. The 12-month period before the semester of
contingency would be from July 2003 to June
2004
c. Let us assume that the six highest monthly
salary credits are P15,000 each. Thus, the
total monthly salary credit would be P90,000
(P15, 000 x 6) .
d. The daily maternity allowance would be P500
(P90,000/180) .
e. The total maternity benefit due would be P30,
000 (P500 x 60 days) for normal delivery or
P39,000 (P500 x 78) for caesarian cases.
How many deliveries are covered under existing
laws?
The maternity benefit shall be paid only for the first
four (4) deliveries or miscarriages starting May 24, 1997
when the Social Security Act of 1997 (R.A. No. 8282) took
effect.
Can a member apply for sickness benefit if she has
been paid the maternity benefit?
No. A female member cannot claim for sickness
benefit for a period of 60 days for normal delivery or
miscarriage or 78 days for caesarean delivery within which
she has been paid the maternity benefit. As a rule, no
member can be entitled to two benefits for the same period.
Is it necessary to notify the SSS of a member's
pregnancy?
Yes. As soon as a member becomes pregnant, she
must immediately notify her employer (if employed) or the
SSS (if separated/voluntary/self-employed) of such
pregnancy and the probable date of her childbirth at least 60
days from the date of conception by accomplishing SSS
FORM MAT-1 (Maternity Notification Form) and by
submitting proof of pregnancy.
The employer must, in turn, notify the SSS through
the submission of the maternity notification form and proof
of pregnancy immediately after the receipt of the
notification from the employee member.
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Failure to observe the rule on notification may
result to the denial of the maternity claim.
How would the claimant be paid the maternity
benefit?
(1) For employed members - the benefit is
advanced by the employer to the qualified
employee, in full, within 30 days from the date
of filing of the maternity leave application. The
SSS, in turn, shall immediately reimburse the
employer 100 percent of the amount of
maternity benefit advanced to the female
employee upon receipt of satisfactory proof of
such payment and legality thereof.
If the employee member gives birth or suffers
miscarriage without the required contributions
having been remitted by the employer, or the
employer fails to notify the SSS, the employer
will be required to pay to the SSS damages
equivalent to the benefits the employee would
otherwise have been entitled to.
(2) For separated/voluntary/self-employed
members - the amount of benefit is paid
directly to them by the SSS.
3. RETIREMENT BENEFIT. 25
What is the retirement benefit?
It is a cash benefit either in monthly
pension or lump sum paid to a member who can no longer
work due to old age.
Who may qualify for a retirement benefit?
1. A member who is 60 years old, separated form
employment or ceased to be self-employed, and
has paid at least 120 monthly contributions prior
to the semester of retirement.
2. A member who is 65 years old whether employed
or not and has paid at least 120 monthly
contributions prior to the semester of
retirement.
For Underground Mineworkers:
1. Has reached the age of 55 years old and is an
underground mineworker for at least 5 years
(either continuous or accumulated) prior to the
semester of retirement but whose actual date of
retirement is not earlier than March 13, 1998;
separated from employment or in the case of
self-employed, has ceased self-employment, and
has paid at least 120 monthly contributions prior
to the semester of retirement.
2. Has reached the age of 60 years old whether
employed or not.
What are the types of retirement benefits?
5
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BSU-PORTIA SORORITY
They are:
1. the monthly pension, and
2. the lump sum amount.
The monthly pension is a lifetime cash benefit paid
to a retiree who has paid at least 120 monthly contributions
to the SSS prior to the semester of retirement.
The lump sum amount is granted to a retiree who
has not paid the required 120 monthly contributions. It is
equal to the total contributionspaid by the member and by
the employer including interest.
How much monthly pension will a retiree receive?
The monthly pension depends on the members paid
contributions, including the credited years of service (CYS)
and the number of dependent minor children but not to
exceed five. The amount of monthly pension will be
the highest of:
1. the sum of P300 plus 20 percent of the average
monthly salary credit plus 2 per cent of the
average monthly salary credit for each
accredited year of service (CYS) in excess of ten
years; or
2. 40 per cent of the average monthly salary credit;
or
3. P1,200, provided that the credited years of
service (CYS) is at least 10 or more but less than
20 or P2,400, if the CYS is 20 or more. The
monthly pension is paid for not less than 60
months.
A retiree has the option to receive the first 18
monthly pension in lump sum discounted at a preferential
rate of interest to be determined by the SSS. The option
should be exercised upon filing of the first retirement claim.
Only advance payments shall be discounted on the date of
the payment. The dependents’ pension and 13th month
pensions are excluded from the 18 months lump sum
pension.
The member will receive the monthly pension on
the 19th month and every month thereafter.
What happens when the retirement pensioner
resumes employment?
The monthly pension shall be suspended upon
the re-employment or resumption of self-employed of a
retired member who is less than 65 years old. The member
shall again be subjected to compulsory coverage. At 65 year
old whether employed or not, he can already claim for
retirement benefit.
How much is the monthly pension of a member
who retires after age 60 and who has contributed
the required 120 monthly contributions?
The monthly pension shall be the higher of the
following:
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1. the monthly pension computed at the earliest
time the member could have retired had been
separated from self-employment or ceased to
be self-employed plus all adjustments thereto;
or
2. the monthly pension computed at the time when
the member actually retires.
A pensioner who retires more than once shall be
entitled to the higher of:
1. the monthly pension computed for the first
retirement claim; or
2. the re-computed monthly pension for the new
claim.
Aside from the retirement benefit, what else can a
retiree receive?
The retiree is entitled to a 13th month pension
payable every December. All retiree pensioners prior to the
effectivity of R.A. No. 787526 on March 4, 1995 are
automatically considered members of PhilHealth and he and
his legal dependents are entitled to its hospitalization
benefits. On the other hand, retirees effective March 4,1995
up to the present will be entitled to hospitalization benefits
under PhilHealth only if they have contributed 120 monthly
Medicare contributions. The counting of 120 monthly
contributions shall start in 1972, when the Medical Care Act
of 1969 started implementation.
Are the children of a retiree member entitled to
the dependent's pension?
The legitimate, legitimated, or legally adopted and
illegitimate children, conceive on or before the date of
retirement of a retiree will each receive dependents’
pension equivalent to 10 percent of the member’s monthly
pension or P250, whichever is higher.
Only five minor children, beginning from the
youngest, are entitled to the dependents’ pension. No
substitution is allowed.
If there are more than five dependents, the
legitimate, legitimated or legally adopted children shall be
preferred.
For how long will the dependent child receive his
pension?
The dependents’ pension stops when the child
reaches 21 years old, gets married, gets employed or dies.
However, the dependents’ pension is granted for life for
children who are over 21 years old, provided they are
incapacitated and incapable of self-support due to physical
or mental defect which is congenital or acquired during
minority.
What will happen to the monthly pension of a
retiree in case of death?
Upon the death of a retiree pensioner,
the primary beneficiaries as of the date of retirement shall
be entitled to 100 per cent of the monthly pension and the
dependents to the dependents’ pension.
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If the retiree pensioner dies within sixty (60)
months from the start of the monthly pension and has no
primary beneficiaries, the secondarybeneficiaries shall be
entitled to a lump sum benefit equivalent to the total
one thumb
monthly pensions corresponding to the five-year guaranteed
period excluding the dependents’ pension. one index finger
4. DISABILITY BENEFIT. 27 one middle finger
one ring finger
What is the New Disability Program?
one little finger
The new SSS Disability program is a re-designed
hearing of one ear
disability program that implements the revised manual of
hearing of both ears
disability assessment. The new program adopts the World
sight of one eye
Health Organization’s (WHO) definition of disability that
states that it is any “restriction or lack (resulting from
impairment) of ability to perform an activity in the manner
or within the range considered normal for a human being.”
What are the salient features of the new disability
program?
The re-designed disability program –
a. adopts the WHO definition of disability which is
any “restriction or lack (resulting from
impairment) of ability to perform an activity in
the manner or within the range considered
normal for a human being. ” Impairment is
defined as any loss or abnormality of
psychological, physiological, or anatomical
structure or function.
b. adopts the International Statistical
Classifications of Diseases and Related Health
problems Codes (ICD-10) .
c. includes medical and functional assessments.
d. requires annual assessment of all pensioners
except those with scheduled disabilities stated
under Section 13-A (f) of the SS Law.
What is the medical and functional assessment
under the new disability program?
Under medical assessment, nature and degree of
impairment of affected body part/system is determined
through physical examination and interview supported by
appropriate diagnostic tests; while,
under functional assessment, the capacity of the individual
to perform activities of daily living (ADL) is tested using the
Functional Independence Measure (FIM) .
Member should have 20% medical impairment to
qualify for functional assessment.
Who is qualified for disability benefit under the
new program?
A member who suffers partial or total disability with
at least one (1) monthly contribution paid to the SSS prior to
the semester of contingency is qualified.
What are some of the
permanent partial disabilities?
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A complete and permanent loss or use of any of the
following body parts and does not totally prevent a member
from engaging in any gainful occupation.
one big toe
one hand
one arm
one foot
one leg
one ear
both ears
What are some of the
permanent total disabilities?
The following fall under permanent total disability:
1. complete loss of sight of both eyes;
2. loss of two limbs at or above the ankle or wrists;
3. permanent complete paralysis of two limbs;
4. brain injury resulting to incurable imbecility or
insanity; and
5. such cases as determined and approved by the
SSS.
What are the types of disability benefits?
They are:
1. the monthly pension; and
2. the lump sum amount.
The monthly pension is a cash benefit paid to a
disabled member who has paid at least 36 monthly
contributions to the SSS prior to the semester of disability.
The lump sum amount is granted to those who
have not paid the required 36 monthly contributions.
How much is the monthly pension?
The amount of the monthly pension will be based
on the member’s number of paid contributions and the
years of membership.
The lowest monthly pension is P1,000 for members
with less than 10 credit years of service (CYS) ; P1,200 with
at least 10 CYS and P2,400 with at least 20 CYS.
Is the monthly pension for life?
Only totally and permanently disabled members will
receive a lifetime monthly pension. However, the pension
will be suspended if the pensioner recovers from the illness,
resumes employment or fails to report for annual physical
examination when notified by the SSS. The member may
request for a domiciliary or a home visit if the disability
inhibits the member from reporting for re-examination by
the SSS physician at any of SSS branch offices.
The monthly pension of a partially disabled member
is paid up to a certain number of months only according to
the degree of disability. If with deteriorating and related
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permanent partial disability, the percentage degree of
disability of previously granted claim shall be deducted from
the percentage degree of disability of the current claim.
The monthly pension is also given in a lump sum if
duration of pension is payable for less than 12 months.
How much is the lump sum amount?
For permanent total disability, the lump sum
benefit is equivalent to the monthly pension times the
number of monthly contributions paid to the SSS or twelve
(12) times the monthly pension, whichever is higher.
For permanent partial disability, the lump sum is
equivalent to the monthly pension times the number of
monthly contributions times the percentage of disability in
relation to the whole body or the monthly pension times 12
times the percentage of disability, whichever is higher.
Aside from the disability benefit, what else can a
disability pensioner receive?
In addition to the monthly pension, a supplemental
allowance of P500.00 is paid to the total or partial disability
pensioner. The allowance will provide additional financial
assistance to meet the extra needs arising from the
disability.
Total disability pensioners and their legal
dependents prior to the effectivity of R.A. 787528 on March
4, 1995 are entitled to hospitalization benefits under
PhilHealth. Total disabled pensioners upon the effectivity of
R.A. 7875 on March 4, 1995 and thereafter, are no longer
covered exceptwhen they have accumulated one hundred
twenty (120) Medicare monthly contributions and have
reached age sixty (60) .
However, those who wish to avail of PhilHealth
benefits may enroll in the Individually-Paying Program (for
voluntary/self-employed) or the Indigent Program (IP) of
PhilHealth.
Are the children of a disabled member entitled to
the dependent's pension?
The dependent legitimate, legitimated, legally
adopted and illegitimate children, conceived on or before
the date of contingency of a totally disabled pensioner will
each receive a dependent’s pension equivalent to 10 per
cent of the member’s pension or P250, whichever is higher.
Only five minor-children, beginning from the
youngest are entitled to the dependents’ pension. No
substitution is allowed. Where there are legitimate and
illegitimate minor children, the legitimated or legally
adopted ones will be preferred.
The minor children of a partially disabled pensioner
are not entitled to the dependent’s pension.
For how long will the dependent child receive his
pension?
The dependent’s pension stops when the child
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reaches 21 years old, gets married, gets employed or dies.
However, the dependent’s pension is granted for life to
children who are over 21 years old, provided, they are
incapacitated and incapable of self-support due to physical
or mental defect which is congenital or acquired during
minority.
What will happen to the monthly pension in case
the pensioner gets re-employed, resumes self-
employment, recovers from his permanent total
disability or his failure to present himself/herself
for examination upon notice by SSS?
The monthly pension of the member and the
dependent’s pension will be suspended upon the
reemployment or resumption of self-employment or the
recovery of the disabled member from permanent total
disability or failure to present himself/herself for
examination at least once a year upon notice by SSS.
What will happen to the monthly pension of a
disability pensioner in case of death?
Upon the death of the permanent total disability
pensioner, the primary beneficiaries as of the date of
disability, shall be entitled to 100 per cent of the monthly
pension and the dependents to the dependents’ pension.
If the totally disabled pensioner has no primary
beneficiaries and dies within sixty (60) months from the start
of the monthly pension, the secondary beneficiaries shall be
entitled to a lump sum benefit equivalent to the total
monthly pensions corresponding to the balance of the five-
year guaranteed period excluding the dependent’s pension.
The pension stops when a partial disability
pensioner retires or dies.
What is the prescriptive period in filing disability
claims?
The prescriptive period in the filing of disability
benefit claim is ten (10) years from the date of occurrence of
disability.
5. DEATH AND FUNERAL. 29
What is the death benefit?
It is a cash benefit either in monthly pension or
lump sum paid to the beneficiaries of a deceased member.
What are the types of death benefits?
They are:
1. the monthly pension; and
2. the lump sum amount.
The monthly pension is granted only to
the primary beneficiaries of a deceased member who had
paid 36 monthly contributions before the semester of death.
The lump sum is the amount granted to
the primary beneficiaries of a deceased member who had
paid less than 36 monthly contributions before the semester
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of death. The secondary beneficiaries shall be entitled to
a lump sum benefit.
How much is the monthly pension?
The monthly pension depends on the member’s
paid contributions, including the credited years of service
(CYS) and the number of dependent minor children but not
to exceed five (5) .
The amount of monthly pension will be the
highest of:
1. the sum of P300 plus 20 percent of the average
monthly salary credit plus two percent of the
average monthly salary credit for each credited
year of service (CYS) in excess of 10 years; or
2. 40 percent of the average monthly salary credit;
or
3. P1,000 if the member had less than 10 credited
years of service (CYS) ; P1,200 if with at least 10
CYS; or P2,400 if with at least 20 CYS. The
monthly pension is paid for not less than 60
months.
If the deceased member is survived by legitimate,
legitimated, or legally adopted and illegitimate
children, how is the monthly pension divided?
If a deceased member is survived by less than five
(5) minor legitimate, legitimated, or legally adopted children,
the illegitimate minor children will be entitled to 50
percent of the share of the legitimate, legitimated or legally
adopted children in the basic pension and 100 percent of the
dependents' pension.
In cases where there are no legitimate, legitimated,
or legally adopted children, the illegitimate minor children
shall be entitled to 100 percent of the basic pension.
How much is the lump sum death benefit?
The primary beneficiaries of a deceased member
who has paid less than 36 monthly contributions shall be
entitled to lump sum benefit which shall be the higher of:
1) monthly pension times the number of monthly
contributions paid prior to the semester of
death; or
2) twelve (12) times the monthly pension.
The secondary beneficiaries of the deceased
member shall be entitled to a lump sum benefit equivalent
to:
a. 36 times the monthly pension; if the member
has paid at least 36 monthly contributions prior
to the semester of death; or
b. monthly pension times the number of monthly
contributions paid or twelve (12) times the
monthly pension, whichever is higher, if the
member has paid less than 36 monthly
contributions prior to the semester of death.
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Is there anything else a deceased member's
beneficiaries can avail of?
Yes, the deceased member’s beneficiaries are
entitled to a 13th month pension payable every December
and the funeral benefit, which is paid to whoever,
shouldered the funeral expenses of the deceased member.
Survivorship pensioners prior to the effectivity of
R.A. 787530 on March 4, 1995 are also entitled to
hospitalization benefits under PhilHealth. They need to
register under PhilHealth and must submit a DDR print-out
indicating the type of claim is survivorship in nature and the
effectivity date of pension or a copy of Death/Survivorship
Certification issued by the SSS indicating the effectivity of the
pension shall be submitted to PhilHealth.
Survivorship pensioners under the effectivity of RA
7875 on March 4, 1995 and thereafter, are no longer
covered. However, those who wish to avail of PhilHealth
benefits may enroll in the Individually-Paying Program (for
voluntary/self-employed) or the Indigent Program (IP) of
PhilHealth.
If the deceased member has not paid any single
contribution, are the beneficiaries still entitled to
the death and funeral benefits?
The primary or secondary beneficiaries of a
deceased employee-member, who had no contribution
payment at all and who was reported for coverage shall be
entitled to funeral benefit only.
Are the children of a deceased member entitled to
the dependents' pension?
The dependent legitimate, legitimated, legally
adopted or illegitimate children, conceived on or before the
date of death of a deceased will each receive a dependents’
pension equivalent to 10 percent of the members’ monthly
pension or P250, whichever is higher.
Only five (5) minor children, beginning from the
youngest, are entitled to the dependents’ pension. No
substitution is allowed.
Where there are more than five (5) legitimate and
illegitimate minor children, the legitimate shall be preferred.
For how long will the dependent child receive his
pension?
The dependents’ pension stops when the child
reaches 21 years old, gets married, gets employed or dies.
However, the dependents’ pension is granted for life to
children who are over 21 years old, provided they are
incapacitated and incapable of self-support due to physical
or mental defect which is congenital and acquired during
minority.
What is the funeral grant?
A funeral grant of P20,000 (effective September 1,
2000) is given to whoever pays the burial expenses of the
9
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BSU-PORTIA SORORITY
deceased member or pensioner.
4.
BENEFICIARIES
1. PRIMARY BENEFICIARIES.
The following are primary beneficiaries:
1. The dependent spouse until he or
remarries;
2. The dependent legitimate, legitimated or legally
adopted, and illegitimate children who are not
yet 21 years of age.
The dependent illegitimate children shall be
entitled to 50% of the share of the legitimate,
legitimated or legally adopted children.
However, in the absence of the dependent
legitimate, legitimated children of the member,
his/her dependent illegitimate children shall be
entitled to 100% of the benefits
2. SECONDARY BENEFICIARIES.
The following are secondary beneficiaries:
1. The dependent parents, in the absence of
the primary beneficiaries.
2. Any other person designated by the member as
his/her secondary beneficiary, in the absence
of all the foregoing primary beneficiaries and
dependent parents.
II.
EMPLOYEES’ COMPENSATION BENEFITS
This is the second class of benefits under the SSS
Law, the first being the social security benefits discussed
above. For purposes of discussing this topic in an orderly
fashion, the same shall be presented under the topic “D.
Employee’s compensation – coverage and when
compensable”, infra.
------------oOo------------
Chapter Six
SOCIAL WELFARE LEGISLATION
TOPICS PER SYLLABUS
B. GSIS Law (R.A. No. 8291)
1. Coverage
2. Exclusions from coverage
3. Benefits
4. Beneficiaries
B.
10
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GSIS LAW
(R.A. No. 8291) 1
1.
COVERAGE
1. COMPULSORY MEMBERSHIP IN THE GSIS. 2
1. All government personnel, whether elective or
she
appointive, irrespective of status of appointment, provided
they are receiving fixed monthly compensation and have not
reached the mandatory retirement age of 65 years, are
compulsorily covered as members of the GSIS and shall be
required to pay contributions.3
2. However, employees who have reached the
retirement age of 65 or more shall also be covered, subject
to the following rules:
An employee who is already beyond the mandatory
retirement age of 65 shall be compulsorily covered and be
required to pay both the life and retirement premiums under
the following situations:
a. An elective official who at the time of election to
public office is below 65 years of age and will be
65 years or more at the end of his term of office,
including the period/s of his re-election to public
office thereafter without interruption.
b. Appointive officials who, before reaching the
mandatory age of 65, are appointed to
government position by the President of the
Republic of the Philippines and shall remain in
government service at age beyond 65.4
c. Contractual employees including casuals and
other employees with an employee-government
agency relationship are also compulsorily
covered, provided they are receiving fixed
monthly compensation and rendering the
required number of working hours for the
month.5
2. CLASSES OF MEMBERSHIP.
Membership in the GSIS is classified either
by type or status of membership.6
As to type of members, there are regular and
special members:
(a) Regular Members – are those employed by the
government of the Republic of the Philippines,
national or local, legislative bodies,
government-owned and controlled
corporations (GOCC) with original charters,
government financial institutions (GFIs) ,
except uniformed personnel of the Armed
Forces of the Philippines, the Philippine
National Police, Bureau of Jail Management
and Penology (BJMP) and Bureau of Fire
Protection (BFP) , who are required by law to
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BSU-PORTIA SORORITY

remit regular monthly contributions to the BENEFITS

GSIS.
1. KINDS OF BENEFITS.
(b) Special Members – are constitutional
The following are the benefits under the GSIS Law:
commissioners, members of the judiciary,
including those with equivalent ranks, who are (a) Compulsory Life Insurance Benefits under the
required by law to remit regular monthly Life Endowment Policy (LEP)
contributions for life insurance policies to the (b) Compulsory Life Insurance Benefits under the
GSIS in order to answer for their life insurance Enhanced Life Policy (ELP)
benefits defined under RA 8291.7 (c) Retirement Benefits
(d) Separation Benefit
As to status of membership, there are active and
(e) Unemployment Benefit
inactive members.
(f) Disability Benefits
(a) Active member – refers to a member of the (g) Survivorship Benefits
GSIS, whether regular or special, who is still (h) Funeral Benefits
in the government service and together with
the government agency to which he belongs,
is required to pay the monthly contribution. 2. COMPULSORY LIFE INSURANCE BENEFITS UNDER THE LIFE
ENDOWMENT POLICY (LEP) 16
(b) Inactive member – a member who is
separated from the service either by A member under this policy may be entitled to any
resignation, retirement, disability, dismissal of the following benefits, depending on the circumstances:
from the service, retrenchment or, who is a) Maturity benefits, which is the face amount
deemed retired from the service under this payable to the member upon maturity of the
Act.8 policy.
3. EFFECTIVITY OF MEMBERSHIP. b) Cash Surrender Value, which is earned values
The effective date of membership shall be the date during the term of the insurance payable to the
of the member’s assumption to duty on his original member when he is separated from the service
appointment or election to public office.9 before maturity date of the policy or when he is
considered as a case of PTD.
4. EFFECT OF SEPARATION FROM THE SERVICE.
c) Death Benefit, which is the face value of the
A member separated from the service shall policy payable to designated
continue to be a member, and shall be entitled to whatever beneficiary/beneficiaries or legal heirs, in the
benefits he has qualified to in the event of any contingency absence of the former, upon the death of a
compensable under the GSIS Law.10 member.
2. d) Accidental Death Benefit (ADB) is an additional
benefit equivalent to the amount of Death
EXCLUSIONS FROM COVERAGE Benefit when the member dies by accident. In
1. EXCLUSION FROM COMPULSORY COVERAGE OF GSIS this connection, proof must be presented to
LAW. 11 sufficiently establish that the cause of the
member’s death is accidental.
The following employees are excluded from
compulsory coverage: e) The right to present sufficient proof to show
that death was accidental shall prescribe if the
(a) Uniformed personnel of the Armed Forces of the claim for ADB is filed four (4) years after the
Philippines (AFP) , Philippine National Police death of the member.
(PNP), Bureau of Fire Protection (BFP) and
Bureau of Jail Management and Penology f) Cash Dividend. A policyholder is entitled to
(BJMP) ;12 dividends subject to the guidelines as approved
(b) Barangay and Sanggunian Officials who are not by the GSIS Board. This is not a guaranteed
receiving fixed monthly compensation; 13 benefit.17
(c) Contractual Employees who are not receiving 3. COMPULSORY LIFE INSURANCE BENEFITS UNDER THE
fixed monthly compensation;14 and ENHANCED LIFE POLICY (ELP) . 18
(d) Employees who do not have monthly regular A member under this policy may be entitled to any
hours of work and are not receiving fixed of the following benefits, depending on the circumstances:
monthly compensation.15
1. Death Benefit equivalent to the latest annual
3. salary multiplied by amount of insurance (AOI)
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SOCLEG
BSU-PORTIA SORORITY
factor which is 1.5 or 18 times the current
monthly salary of the member or as determined
by the GSIS, payable to the legal heirs, less all
outstanding obligations of the member in
accordance with the CLIP.
2. Termination Value. The policy earns a
Termination Value during the life of the policy
computed from the percentage of life insurance
premiums actually remitted and paid to GSIS.
Termination value is equivalent to a
percentage of monthly life insurance
premiums as determined by the GSIS, due and
paid in full, either by direct remittance or
through an APL facility.
The accumulated termination value will grow
at such rate as determined by the Actuary.
The termination value shall be paid to the
member upon his separation from the
government service less all indebtedness of
the member with the GSIS in accordance with
CLIP.
3. Cash Dividend. A policyholder is entitled to
dividends, subject to the guidelines as approved
by the GSIS Board. This is not a guaranteed
benefit.19
4. RETIREMENT BENEFITS. 20
The retirement benefit consists of a monthly
pension which is computed based on years of creditable
service and Average Monthly Compensation (AMC) for the
last 3 years.
a. Eligibility.
The member:
1. has rendered at least Fifteen (15) years of
service;
2. is at least Sixty (60) years of age; and
3. is not receiving a monthly pension benefit from
permanent total disability.21
b. Retirement Benefit Options.
A retiring member has the following options:
(1) Five (5) year lump sum equivalent to sixty (60)
months of the basic monthly pension (BMP) , subject to
qualification requirements, less all outstanding obligations of
the member in accordance with the Claims and Loans
Interdependency Policy (CLIP) , plus an old-age pension
benefit equal to the BMP payable for life, starting on the first
day of the month following the expiration of the five year
guaranteed period; or
(2) A cash payment benefit equivalent to eighteen
(18) times of the BMP, subject to qualification requirements,
less all outstanding obligations of the member in accordance
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with the CLIP, plus monthly pension for life payable on the
first month following the date of retirement.22
c. Conversion in the mode of retirement.
Conversion in the mode of retirement from R.A. No.
8291 to any other retirement laws and vice versa
administered by the GSIS shall not be allowed.
Those who became GSIS members prior to the
implementation of R.A. No. 8291 shall have the option to
retire under PD 1146, RA 660, or RA 1616, subject to
eligibility. 23
d. Change of retirement benefit option under RA
8291.
Change of retirement benefit option from eighteen
(18) months cash payment plus immediate pension to five
(5) year lump sum, or vice versa, shall not be allowed. The
GSIS shall process the claim for retirement benefits based on
the member’s records in the GSIS database.24
e. Processing of retirement benefits of members
who died while their claims are being processed.
For those qualified for retirement benefits:
1. If the deceased member opted for five year lump
sum benefit as indicated in his/her claim for
retirement application, his legal heirs shall be
entitled to five-year lump sum benefit
equivalent to sixty (60) months basic monthly
pension (BMP) . However, the survivorship
pension to qualified primary beneficiaries, if any,
shall be granted after the end of the 5-year
guaranteed period, but filing of claim for
survivorship benefit should be done before the
end of the 4-year prescription period.
2. If the deceased member opted for immediate
pension as indicated in his/her claim for
retirement benefit his legal heirs shall be
entitled to retirement benefits equivalent to
eighteen (18) months of BMP, plus accrued
pension, if any, up to the date of death of the
retiree. The corresponding survivorship pension
shall be paid to the qualified primary
beneficiaries, if any, and shall be computed from
the date of death of the retiree, subject to filing
of claim.
3. In case the deceased member failed to indicate in
his/her retirement option, it shall be computed
as if he/she opted for immediate pension.
4. The proceeds of retirement benefits shall be paid
and distributed to the legal heirs in accordance
with the law on succession under the Civil Code
of the Philippines.25
For those not qualified for retirement benefits, the
GSIS shall determine if he/she is qualified to other applicable
benefits under R.A. 8291 or such other laws administered by
the GSIS.26
BSU-CHAPTER
BSU-PORTIA SORORITY
f. Effects of re-employment.
When a retired/separated member is re-employed
or reinstated in the service, his/her previous services
credited at the time of his/her retirement/separation for
which a corresponding benefit had been awarded, shall be
excluded in the computation of service. In effect, he/she
shall be considered a new entrant.
However, for those who retired prior to the
enactment of R.A. 8291, the previous services of a
retired/separated member may be added in the
computation of his creditable services (subject to premium-
based policy) upon subsequent retirement under R.A. 8291
only when both conditions are met: (a) the retiree re-
entered government service before June 24, 1997; and (b)
the total amount of benefit previously received, if any,
including the prescribed interest was refunded to GSIS on or
before March 2, 2006.27
g. Basis of computation of total service.
Total Length of Service (TLS) is the number of years
in government service regardless of status of employment,
with or without premium contributions.
For purposes of computing the total length of
service under part-time status of employment, services shall
be converted to their full-time equivalent using forty-hour
week and fifty two-week a year as basis.28
h. Computation of creditable service.
The computation of creditable service for the
purpose of determining the amount of benefits payable shall
include the period or periods of service with the required
premium contributions.29
i. Computation of Average Monthly Compensation
(AMC) .
The AMC shall be computed on the basis of the
average salary of the member for the last 36 months of
creditable service immediately preceding his retirement or
separation.
The basis for computing the AMC of a separated or
retired member requesting for computation of benefits shall
be the prevailing policy on AMC at the time the claim is
being processed.30
j. Computation of Revalued Monthly Compensation.
AMC plus Seven Hundred Pesos (P700.00) .31
k. Computation of Basic Monthly Pension.
The formula for computing the BMP may be
adjusted subject to the approval of the Board upon the
recommendation by the President and General Manager.
As a general rule, the BMP shall only be computed
for those members or dependents/heirs of members who
are eligible to receive benefits under this law. It shall be
computed on the basis of a percentage of the RAMC at the
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SOCLEG
rate of 2.5% for every year of creditable service, but in no
case shall it exceed 90% of the AMC of the member.
The formula for computing BMP shall be: BMP =
RAMC x (2.5% x RCS) 32
l. Adjustment/Increase in pension.
Periodic adjustments of the monthly pension of all
existing pensioners shall be done on the basis of what is
sustainable and prudent for the GSIS as recommended by its
Actuary and approved by the Board.33
m. Policies affecting pension administration.
1. Regardless of the date of retirement, the monthly
pension shall commence on the 1st day of the month
following the month of retirement.
2. Annual Renewal of Active Status (ARAS) of Old
Age and Survivorship Pensioners is required on their birth
month every year.
3. Effects of non-renewal of active status as
pensioner:
a. Suspension of payment of monthly pension;
b. Non-entitlement to cash gift if status is
suspended at the time of declaration;
c. Non-entitlement to pension increases if status
is suspended at the time of declaration.34
5. SEPARATION BENEFIT. 35
Separation benefit Is either one of the following:
1. For those members who are separated from
service and who have at least 3 years of service but less than
15 years shall be entitled to cash payment equivalent to
100% of the member’s AMC for each year of creditable
service, but not less than P12,000.00, payable upon reaching
age 60, or upon his separation if he is already 60 years of age
at the time of separation.36
2. A cash payment equivalent to eighteen (18) times
the basic monthly pension payable at the time of resignation
or separation, provided the member resigns or separates
from the service after he has rendered at least 15 years of
service and is below 60 years of age, plus an old-age pension
benefit equal to the basic monthly pension payable monthly
for life upon reaching the age of sixty (60) .37
3. Reckoning Date of Separation of Uniformed PNP,
BJMP and BFP Personnel shall be February 1, 1996. The
computation of benefit shall be based on their basic monthly
salary (premium-based) when they ceased to be members of
the GSIS.38
4. Processing of separation benefit of members who
died while their claims are being processed:
1. If the member dies during the pendency of his
claim for separation benefit and he has rendered at least 15
years of creditable service, his legal heirs shall be entitled to
receive cash payment equivalent to eighteen (18) times the
basic monthly pension, plus accrued BMP, if any, up to the
13
BSU-CHAPTER
BSU-PORTIA SORORITY
date of death of the member. Thereafter, the primary
beneficiaries shall be entitled to survivorship pension.39
2. If the member dies during the pendency of his
claim for separation benefit and he has rendered less than
15 years of creditable service, his legal heirs shall be entitled
to cash payment equivalent to one hundred percent (100%)
of AMC for each year of creditable service, but not less than
Twelve Thousand Pesos (P12,000.00) .40
6. UNEMPLOYMENT BENEFIT. 41
a. Conditions for entitlement to unemployment
benefit.
A member shall be entitled to the unemployment
benefits if the following conditions are met:
1. he/she was a permanent employee at time of
separation;
2. his/her separation was involuntary due to the
abolition of his/her office or position resulting
from reorganization; and
3. he/she has been paying the required premium
contributions for at least one (1) year but less
than 15 years prior to separation.42
b. Amount, duration and payment of unemployment
benefit.
The amount of unemployment benefit is equivalent
to 50% of the AMC and shall be paid in accordance with the
Schedule provided in the Implementing Rules of this Act
(R.A. No. 8291) .43
7. DISABILITY BENEFITS. 44
a. Meaning.
Disability refers to any loss or impairment of the
normal functions of the physical and/or mental faculties of a
member, which permanently or temporarily prevents him to
continue with his work or engage in any other gainful
occupation resulting in the loss of income.45
b. Basis of reckoning.
The corresponding disability benefits for each kind
of disability shall be granted to a member based on
the duration of incapacity to work and actual loss of
income. 46
c. Kinds of disability.
There are three (3) kinds of disability which shall be
determined by the GSIS based on established medical
standards:
• Permanent Total Disability
• Permanent Partial Disability
• Temporary Total Disability47
d. Policies governing disability benefits.
1. Permanent Total Disability (PTD) – disability due
to injury or disease causing complete, irreversible and
permanent incapacity that will permanently disable a
14
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member to work or to engage in any gainful occupation
resulting to loss of income.
The following disabilities shall be deemed total and
permanent:
a. complete loss of sight for both eyes;
b. loss of two limbs at or above the ankle or wrists;
c. permanent complete paralysis of two limbs;
d. brain injury resulting in incurable imbecility or
insanity; and
e. such other cases as may be determined and
approved by the GSIS.48
2. Permanent Partial Disability (PPD) – arises due to
the complete and permanent loss of the use of any of the
following resulting to the disability to work for a limited
period of time:
1. any finger 2. any toe 3. one arm; 4. one hand; 5.
one foot; 6. one leg; 7. one or both ears; 8. hearing
of one or both ears; 9. sight of one eye; 10. such
other cases as may be determined and approved by
the GSIS.49
3. Temporary Total Disability (TTD) – accrues or
arises when the impaired physical and/or mental faculties
can be rehabilitated and/or restored to their normal
functions, but such disability shall result in temporary
incapacity to work or to engage in any gainful occupation.50
e. Disability or injury not covered.
Any disability or injury as a result of, or due to grave
misconduct, participation in riots, gross and inexcusable
negligence, under the influence of drugs or alcohol or willful
intention to injure or kill himself or another, shall not be
compensable.51
f. Actual loss of income.
The actual loss of income shall refer to the number
of days when a member went on leave of absence without
pay (LWOP) reckoned immediately from the date of
commencement of disability and for the duration of
entitlement thereto, based on medical evaluation. Any
LWOP incurred after the duration of entitlement to the
benefit shall not be compensable.52
g. Entitlement in case of two or more different
contingencies.
If the member has two or more different
contingencies during the same period of benefit entitlement,
he shall be compensated only once for the overlapping
periods.53
h. Exclusions by reason of P.D. 626.
All injuries, disabilities, illnesses and all other
infirmities compensable under P.D. 626 shall not be
compensable under this Act (R.A. 8291) .54
i. Suspension of benefit.
Any applicable disability benefit shall be suspended
when he/she:
a. is re-employed; or
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BSU-PORTIA SORORITY
b. recovers from his/her disability as determined by
the GSIS, whose decision shall be final and
binding; or
c. fails to present himself for medical examination
when required by GSIS; or
d. is receiving any other pension either from GSIS or
another local or foreign institution or
organization.55
j. Computation of Benefit.
1. Permanent Total Disability (PTD) . - A member
who becomes permanently and totally disabled shall be
entitled to the monthly income benefits for life equivalent to
the basic monthly pension (BMP) effective from the date of
disability.56
2. Permanent Partial Disability (PPD) . - The period of
entitlement to PPD benefit shall be determined after due
medical evaluation; but such period of entitlement to the
benefit shall not exceed 12 months for the same
contingency. Only the leave of absence/s without pay
incurred during the period of entitlement, duly certified by
the authorized officer of the agency where he is employed,
shall be compensable. The amount of PPD benefit shall be
computed by dividing the BMP by 30 days and multiplying
the quotient by the number of compensable calendar days
of leave of absence without pay (LWOP) .57
3. Temporary Total Disability (TTD) . - The period of
entitlement to TTD benefit shall be determined after due
medical evaluation and proof of actual loss of work resulting
in loss of income by way of the incurred actual number of
days of leave of absence/s without pay duly certified by the
authorized officer of the agency where he is employed; but
such period of entitlement to the benefit shall not exceed
120 days in one calendar year. However, if the disability
requires more extensive treatment that lasts beyond 120
days, the payment of the TTD may be extended by the GSIS
but not to exceed a total of 240 days.
Only the leave of absence/s without pay incurred
during the period of entitlement shall be compensable.
Entitlement, however, shall start from the fourth day of the
disability.
The amount of TTD benefit shall be computed by
multiplying 75% of the daily salary of the member by the
number of days of disability based on the medical evaluation
but not to exceed 240 days for the same contingency.
However, the computed daily salary shall not be less than
seventy pesos (P70.00) but not to exceed P340.00 per day.58
4. For the purpose of computing the corresponding
benefit of inactive members for each kind of disability, the
BMP, with respect to PTD and PPD, and daily salary, with
respect to TTD, shall be computed as of the time of
separation from GSIS.59
k. Conditions for Entitlement.
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1. Permanent Total Disability (PTD) - A member who
becomes permanently and totally disabled shall be entitled
to the PTD benefits when:
a. he/she is in the service at the time of disability; or
b. if separated from the service, he has paid at least
thirty six (36) months contributions within the
five year (5) period immediately preceding
his/her disability; or has paid a total of at least
one hundred eighty (180) months contributions
prior to his/her disability;
Provided, however, that the following conditions
shall be met:
• he/she is gainfully employed prior to the
commencement of disability resulting in loss of
income as evidenced by any incontrovertible
proof thereof;
• he/she is not a registered member of any social
insurance institution; and
• he/she is not receiving any other pension either
from GSIS or another local or foreign institution
or organization.60
In addition to the monthly income benefits for life,
a cash payment equivalent to eighteen (18) times his/her
basic monthly pension (BMP) , shall be paid to a member
who was in the service at the time of his/her permanent
total disability and who has paid a total of one hundred
eighty (180) monthly contributions.61
A separated member who has at least three (3)
years of service and becomes permanently and totally
disabled but has not paid a total of at least one hundred
eighty (180) monthly contributions prior to his/her disability
shall be entitled only to cash payment equivalent to one
hundred percent (100%) of his/her average monthly
compensation for each year of service with paid
contributions but not less than twelve thousand pesos
(P12,000.00).62
2. Permanent Partial Disability (PPD) . - A member
whose disability is partial shall be entitled to the PPD benefit
when:
a. he/she is in the service at the time of disability; or
b. if separated from the service, he has paid at least
thirty six (36) months contributions within the
five (5) year period immediately preceding
his/her disability; or has paid a total of at least
one hundred eighty (180) months contributions
prior to his/her disability; Provided, however,
that the following conditions shall be met:
• he/she is gainfully employed prior to the
commencement of disability resulting in loss
of income as evidenced by any
incontrovertible proof thereof;
• he/she is not a registered member of any
social insurance institution; and
15
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BSU-PORTIA SORORITY
• he/she is not receiving any other pension
either from GSIS or another local or foreign
institution or organization.63
3. Temporary Total Disability (TTD) . - A member
shall be entitled to the TTD benefit when:
a. he/she is in the service at the time of disability; or
b. if separated from the service, he has paid at least
thirty six (36) months contributions within the
five (5) year period immediately preceding
his/her disability; or has paid a total of at least
one hundred eighty (180) months contributions
prior to his/her disability; Provided, however,
that the following conditions shall be met:
• he/she is gainfully employed prior to the
commencement of disability resulting in loss
of income as evidenced by any
incontrovertible proof thereof;
• he/she is not a registered member of any
social insurance institution; and
• he/she is not receiving any other pension
either from GSIS or another local or foreign
institution or organization.64
The payment of TTD benefit may be extended by
the GSIS up to a maximum of two hundred forty (240) days,
subject to medical evaluation.65
l. Forfeiture of disability benefits.
All the foregoing provisions notwithstanding, any
member who is enjoying disability benefits shall
automatically forfeit his/her right to the continued
enjoyment thereof if he/she refuses or deliberately fails to:
a. have himself/herself medically treated by a
physician when required by the GSIS; or
b. take the prescribed medications ; or
c. have himself/herself confined in a hospital
without justifiable reason, when such
confinement is required by the GSIS; or
d. avail himself/herself of such rehabilitation
facilities as may be duly recommended by the
GSIS and made available for him/her; or
e. observe such precautionary and/or preventive
measures as prescribed by a physician or
expressly required of him/her to prevent the
aggravation or continuance of his/her disability.
However, upon compliance with the requirements,
his/her benefits shall be resumed if he/she is still qualified.66
8. SURVIVORSHIP BENEFITS. 67
a. Survivorship benefits upon death of member or
pensioner.
When a member or pensioner dies, the
beneficiaries shall be entitled to the following survivorship
benefits, whichever is applicable:
16
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1. Survivorship pension consisting of:
a. the basic survivorship pension which is fifty
percent (50%) of the BMP; and
b. the dependent children’s pension equivalent to
10% of the BMP for each child but not to
exceed fifty percent (50%) of the BMP.68
2. Cash payment equivalent to eighteen (18)
months BMP; 69
3. Cash payment equivalent to one hundred
percent (100%) of the AMC for every year of service with
paid contributions but not less than Twelve Thousand Pesos
(P12,000.00) .70
b. Survivorship benefits of members in active service.
If at the time of death, a member was in the service
and has rendered at least fifteen (15) years of creditable
service:
a. his primary beneficiaries shall receive the
survivorship pension and cash payment
equivalent to 18 x the BMP; or
b. in the absence of primary beneficiaries, his
secondary beneficiaries shall receive the cash
payment equivalent to 18 x the BMP; or
c. in the absence of secondary beneficiaries, the
legal heirs shall receive the cash payment
equivalent to 18 x the BMP.71
2. If at the time of death, the member was in the
service with less than fifteen (15) years of creditable service;
his primary beneficiaries shall receive the cash payment
equivalent to 100% of the AMC for every year of creditable
service.72
c. Survivorship benefits of inactive members.
Primary beneficiaries of inactive members who
have at least 15 years of creditable service shall receive the
survivorship pension only.
1. Primary beneficiaries of inactive members who
have at least 3 years but less than 15 years of
creditable service and were less than 60 years
old at the time of death shall receive the cash
payment equivalent to 100% of the AMC for
every year of creditable service, but not less
than P12,000.00.
2. Primary beneficiaries of inactive members who
have less than 15 years of creditable service but
were at least 60 years old at the time of
separation and have received the corresponding
separation benefit, shall not be entitled to
survivorship benefits. However, if the member
has not received yet his separation benefit
within four years after his/her separation, the
primary beneficiaries shall receive the cash
benefit equivalent to 100% of the inactive
member’s AMC for every year of creditable
service, but not less than P12,000.00.73
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d. Payment of survivorship benefits.
The survivorship benefits shall be paid as follows:
1. When the dependent spouse is the only survivor,
he shall receive the basic survivorship pension;
2. When only the dependent children are the
survivors, they shall be entitled only to the
dependent children’s pension equivalent to 10%
of the BMP for every dependent child, not
exceeding five (5) , counted from the youngest
and without substitution;
3. When the survivors are the dependent spouse
and the dependent children, the dependent
spouse shall receive the basic survivorship
pension for life or until he remarries or cohabits,
and the dependent children shall receive the
dependent children’s pension.
4. When the dependent spouse and dependent
children are already receiving the basic
survivorship pension and dependent children’s
pension, respectively, any subsequent death,
emancipation or disqualification of any one of
them shall not entitle the other beneficiaries to
the forfeited share.
5. In the absence of a natural guardian, the
guardian de facto of dependent children, as well
as the physically or mentally incapacitated
dependent children, must file a Petition for
Guardianship to be able to claim the
survivorship benefits on behalf of the dependent
children.
6. When the pensioner dies within the 5-year
period after receiving the five-year lump sum,
the survivorship pension shall be paid only after
the end of the said five-year period. However,
filing of claim for survivorship benefit should be
done before the end of the 4-year prescription
period.74
e. Conditions for entitlement to survivorship
benefits.
The primary and secondary beneficiaries, except
dependent children, shall be entitled to applicable
survivorship benefits, subject to the following:
a. not engaged in any gainful occupation as defined
in Sec 2 (p) of R.A. 8291;
b. the surviving spouse and the deceased member
were living together as husband and wife;
c. not gainfully engaged in a business or economic
activity (self- employed) ;
d. employed/engaged in a business or economic
activity but receiving income less than the
minimum compensation of government
employees.
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SOCLEG
e. not receiving any other pension from the GSIS or
another local or foreign institution or
organization; and
f. In the case of the dependent spouse, payment of
the basic survivorship pension shall discontinue
when he remarries, cohabits, or engages in
common-law relationship.
The foregoing conditions, except the last one, must
be present immediately preceding the death of the member
or pensioner.75
9. FUNERAL BENEFITS. 76
a. Nature of benefit.
Funeral benefit is intended to help defray the
expenses incident to the burial and funeral of the deceased
member, pensioner or retiree under R.A. 660, R.A. 1616, P.D.
1146 and R.A. 8291.77
b. To whom payable.
It is payable to any qualified individual, in
accordance with the following order of priority:
1. Legitimate spouse,
2. Legitimate child who spent for the funeral
services, or
3. Any other person who can show incontrovertible
proof that he shouldered the funeral expenses
of the deceased.78
c. Amount of funeral benefit.
The amount of funeral benefit are as follows:
1. The prevailing amount approved by the Board of
Trustees at the time of death of the member or
pensioner.
2. For uniformed members of the PNP, BJMP and
BFP, the amount of funeral benefit is fixed at
P10,000.00.79
d. Conditions for entitlement.
Funeral benefit shall be paid upon the death of:
1. An active member; or
2. A member who has been separated from the
service with more than 15 years of creditable
service, but entitled to future separation or
retirement benefits; or
3. Old age or disability pensioner; or
4. A retiree who at the time of his retirement is at
least 60 years of age and with at least 20 years
of service but who opts to retire under R.A.
1616 on or after June 24, 1997; or
5. A member who retired under R.A. 1616 prior to
June 24, 1997 with at least twenty (20) years of
service, regardless of age.80
4.
Beneficiaries
17
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BSU-PORTIA SORORITY
1. BENEFICIARIES.
There are two (2) kinds of beneficiaries under the
GSIS Law as follows:
1. Primary beneficiaries — The legal dependent
spouse until he/she remarries and the
dependent children.
2. Secondary beneficiaries — The dependent
parents and, subject to the restrictions on
dependent children, the legitimate
descendants.81
2. DEPENDENTS.
Dependents shall be the following:
(a) the legitimate spouse dependent for support
upon the member or pensioner;
(b) the legitimate, legitimated, legally adopted child,
including the illegitimate child, who is
unmarried, not gainfully employed, not over
the age of majority, or is over the age of
majority but incapacitated and incapable of
self-support due to a mental or physical defect
acquired prior to age of majority; and
(c) the parents dependent upon the member for
support.82
Gainful Occupation — Any productive activity that
provided the member with income at least equal to the
minimum compensation of government employees.83
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Chapter Six
SOCIAL WELFARE LEGISLATION
TOPICS PER SYLLABUS
C. Limited Portability Law (R.A. No. 7699)
C.
LIMITED PORTABILITY LAW
(R.A. No. 7699) 1
1. LIMITED PORTABILITY SCHEME - TOTALIZING THE
WORKERS’ CREDITABLE SERVICES OR CONTRIBUTIONS TO
BOTH SSS AND GSIS.
a. Declared policy is to establish a unitary social
security system.
It is the declared policy of the State to institute a
scheme for totalization and portability of social security
benefits with the view of establishing within a reasonable
18
EXCLUSIVE COPY
period, a unitary social security system.2
b. Rationale.
R.A. No. 7699 was enacted to enable those from the
private sector who transfer to the government service or
from the government sector to the private sector to
combine their years of service and contributions which have
been credited with the SSS or GSIS, as the case may be, to
satisfy the required number of years of service for
entitlement to the benefits under the applicable laws.3
c. Totalization, defined.
The term “totalization” refers to the process of
adding up the periods of creditable services or contributions
under each of the Systems, SSS or GSIS, for the purpose of
eligibility and computation of benefits.4
d. Portability, defined.
On the other hand, the term “portability” refers to
the transfer of funds for the account and benefit of a worker
who transfers from one system to the other.5
e. Applicability of limited portability scheme. -
The benefits provided under R.A. No. 7699 apply to
active or inactive members of either System (GSIS/SSS) as of
the date of its effectivity on May 20, 1994.6
f. Coverage.
R.A. No. 7699 and its implementing rules apply to
all worker-members of the GSIS and/or SSS who transfer
from the public sector to the private sector or vice-versa, or
who wish to retain their membership in both Systems.7
g. Creditability and totalization of contributions and
benefits in SSS and GSIS.
Under R.A. No. 7699,8 it is enunciated that
provisions of any general or special law or rules and
regulations to the contrary notwithstanding, a covered
worker who transfers employment from one sector to
another (i. e. , from private sector to public sector, or vice
versa) , or is employed in both sectors, shall have his
creditable services or contributions in both Systems (GSIS
and SSS) credited to his service or contribution record in
each of the Systems and shall be totalized for purposes of
old-age, disability, survivorship and other benefits in case the
covered member does not qualify for such benefits in either
or both Systems without totalization provided, however, that
overlapping periods of membership shall be credited only
once for purposes of totalization.
h. Limited portability of
funds.
The processes involved in the prompt payment of money
benefits to eligible members are the joint responsibility of
the GSIS and SSS.9
The System or Systems responsible for the payment
of money benefits due a covered worker shall release the
same within fifteen (15) working days from receipt of the
claim, subject to the submission of the required documents
PORTIA SORORITY BSU-CHAPTER
SOCLEG
BSU-PORTIA SORORITY
and availability of complete employee/employer records in
the System or Systems.10
i. Totalization of contributions and benefits; how
processed.
1. Contributions.
All contributions paid by such member personally
and those that were paid by his employers to both Systems
(GSIS and SSS) shall be considered in the processing of
benefits which he can claim from either or both Systems,
provided, however, that the amount of benefits to be paid
by one System shall be in proportion to the number of
contributions actually remitted to that System.11
The term “contributions” refers to the contributions
paid by the employee or worker to either the GSIS or the SSS
on account of the worker’s membership.12
2. Creditable services or periods of contributions.
All creditable services or periods of
contributions made continuously or in the aggregate of a
worker under either of the sectors shall be added up and
considered for purposes of eligibility and computation of
benefits. (Section 1, Rule V, Rules and Regulations
Implementing Republic Act No. 7699) .
The term “creditable services” insofar as the public
sector is concerned, refers to the following:
1. All previous services rendered by an
official/employee pursuant to an appointment,
whether permanent, provisional or temporary;
2. All previous services rendered by an
official/employee pursuant to a duly-approved
appointment to a position in the Civil Service
with compensation or salary;
3. The period during which an official or employee
was on authorized sick leave of absence without
pay not exceeding one (1) year;
4. The period during which an official or employee
was out of the service as a result of illegal
termination of his services as finally decided by
the proper authorities; and
5. All previous services with compensation or salary
rendered by elective officials.13
The term “periods of contributions” for the private
sector refers to the periods during which a person renders
services for an employer with compensation or salary, and
during which contributions were paid to the SSS. A “self-
employed person” is considered an employee and employer
at the same time.14
The term “eligibility” means that the worker has
satisfied the requirements for entitlement to the benefits
provided for under R.A. No. 7699.15
3. Benefits.
All services rendered or contributions paid by a
member personally and those that were paid by the
employers to either System shall be considered in the
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SOCLEG
computation of benefits which may be claimed from either
or both Systems. However, the amount of benefits to be paid
by one System shall be in proportion to the services
rendered or periods of contributions made to that System.16
“Benefits” refer to the following:
1. Old-age benefit;
2. Disability benefit;
3. Survivorship benefit;
4. Sickness benefit;
5. Medicare benefit, provided that the member
shall claim said benefit from the System where
he was last a member; and
6. Such other benefits common to both Systems
that may be availed of through totalization.17
j. Totalization; when applicable. - Totalization applies
in the following instances:
a. if a worker is not qualified for any benefits from
both Systems; or
b. if a worker in the public sector is not qualified for
any benefits from the GSIS; or
c. if a worker in the private sector is not qualified
for any benefits from the SSS.
For purposes of computation of benefits,
totalization applies in all cases so that the contributions
made by the worker-member in both Systems shall provide
maximum benefits which otherwise will not be available. In
no case shall the contribution be lost or forfeited.18
Gamogamo v. PNOC Shipping and Transport
Corp. 19 - Following the concept of totalization, the High
Court in this casepronounced that obviously, totalization of
service credits is only resorted to when the retiree does not
qualify for benefits in either or both of the Systems. In case
the employee is qualified to receive benefits granted by the
GSIS or the SSS, as the case may be, he cannot avail of the
benefits under R.A. No. 7699.
k. Effect if worker is not qualified after totalization. -
If after totalization, the worker-member still does not
qualify for any benefit as listed in the law,20 the member will
then get whatever benefits correspond to his/her
contributions in either or both Systems.21
l. Effect if worker qualifies for benefits in both
Systems.
If a worker qualifies for benefits in both Systems,
totalization shall not apply.22
m. Processes of
totalization; joint responsibility of GSIS and SSS.
The processes of totalization of creditable services or periods
of contributions and computation of benefits provided under
R.A. No. 7699 are the joint responsibility of the GSIS and the
SSS.23
n. Effect of overlapping periods of creditable
services.
19
BSU-CHAPTER
BSU-PORTIA SORORITY
Overlapping periods of creditable services or
contributions in both Systems shall be credited only once for
purposes of totalization.24
“Overlapping of periods” refers to the periods during
which a worker simultaneously contributes to both
Systems.25
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Chapter Six
SOCIAL WELFARE LEGISLATION
TOPICS PER SYLLABUS
D. Employee’s compensation – coverage and when
compensable
D.
EMPLOYEE’S COMPENSATION
COVERAGE AND WHEN COMPENSABLE1
1. BACKGROUND ON THE STATE INSURANCE FUND [SIF].
a. SIF created from contributions of employers. - The
State Insurance Fund (SIF) is built up by the contributions of
employers based on the salaries of their employees as
provided under the Labor Code.
b. Two (2) separate SIFs. - There are two (2)
separate and distinct State Insurance Funds: one established
under the SSS for private sector employees; and the other,
under the GSIS for public sector employees. The
management and investment of the Funds are done
separately and distinctly by the SSS and the GSIS. It is used
exclusively for payment of the employees’ compensation
benefits and no amount thereof is authorized to be used for
any other purpose.2
c. Three (3) agencies involved in the implementation
of the ECP. - There are three (3) agencies involved in the
implementation of the Employees’ Compensation Program
(ECP) . These are: (1) The Employees’ Compensation
Commission (ECC) which is mandated to initiate, rationalize
and coordinate policies of the ECP and to review appealed
cases from (2) the Government Service Insurance System
(GSIS) and (3) the Social Security System (SSS) , the
administering agencies of the ECP.
d. Role of the GSIS and SSS. - As administering
agencies of the ECP, both GSIS and SSS are tasked to:
1. Evaluate all employees compensation (EC) claims
filed within a given period and pay the
corresponding EC benefits;
2. Collect EC premiums remitted by employers; and
3. Manage the State Insurance Fund.
20
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SOCLEG
Both the GSIS and the SSS invest the funds in
profitable ventures to generate earnings which will form part
of the State Insurance Fund (SIF) from which payments for
employees’ compensation claims are sourced.
e. Role of the ECC. -The law applies the social
security principle in the handling of workmen’s
compensation. Towards this end, the Employees’
Compensation Commission (ECC) administers and settles
claims from a fund under its exclusive control. The employer
does not intervene in the compensation process and it has
no control, as in the past, over payment of benefits. The
open-ended Table of Occupational Diseases requires no
proof of causation. A covered claimant suffering from an
occupational disease is automatically paid benefits.
f. Role of the employer. - On the part of the
employer, its duty is only to pay the regular monthly
premiums to the System (GSIS/SSS) . It does not look for
insurance companies to meet sudden demands for
compensation payments or set up its own funds to meet
those contingencies. It does not have to defend itself from
spuriously documented or long past claims.
g. Role of the employee. - The injured worker does
not have to litigate his right to compensation. There is no
notice of injury or requirement of controversion. The sick
worker is simply required to file a claim with the ECC which
determines, on the basis of the employee’s supporting
papers and medical evidence, whether or not compensation
should be paid. The payment of benefits is more prompt ad
the cost of administration is low.
The employer no longer opposes or fights a claim for
compensation by the employee. Resultantly, the lop-sided
situation of an employer against one employee is absent.3
2. SCOPE OF COVERAGE OF THE ECP.
a. General coverage. – The
following shall be covered by the Employees’ Compensation
Program (ECP) :
1. All employers;
2. Every employee not over sixty (60) years of age;
3. An employee over 60 years of age who had been
paying contributions to the System (GSIS/SSS)
prior to age sixty (60) and has not been
compulsorily retired; and
4. Any employee who is coverable by both the GSIS
and SSS and should be compulsorily covered by
both Systems.4
b. Sectors of employees covered by the ECP. - The
following sectors are covered under the ECP:
1. All public sector employees including those of
government-owned and/or controlled
corporations and local government units
covered by the GSIS;
2. All private sector employees covered by the SSS;
and
3. Overseas Filipino workers (OFWs) , namely:
BSU-CHAPTER
BSU-PORTIA SORORITY
a. Filipino seafarers compulsorily covered
under the SSS.
b. Land-based contract workers provided that
their employer, natural or juridical, is
engaged in any trade, industry or business
undertaking in the Philippines; otherwise,
they shall not be covered by the ECP.
c. Start of coverage of employees under the ECP. -
The coverage under the ECP of employees in the private and
public sectors starts on the first day of their employment.
d. Nature of coverage. - The coverage
is compulsory in nature.5
3. EMPLOYEES’ COMPENSATION BENEFITS.
The following are the benefits provided under the
Labor Code:
a. Medical Benefits6
b. Disability Benefits7
1. Temporary total disability8
2. Permanent total disability9
3. Permanent partial disability10
c. Death Benefit11
d. Funeral Benefit12
3.1. MEDICAL BENEFITS.
a. Conditions for entitlement to medical services,
appliances and supplies. - Any employee is entitled to such
medical services, appliances and supplies as the nature of his
disability and the progress of his recovery may require,
subject to the expense limitation as contained inAnnex “C” of
the Amended Rules on Employees’ Compensation, if all of the
following conditions are satisfied:
1. He has been duly reported to the System
(GSIS/SSS) ;
2. He sustains an injury or contracts sickness; and
3. The System has been duly notified of the injury or
sickness.13
b. Period of entitlement. - The medical services,
appliances and supplies are required to be provided to the
afflicted employee beginning on the first day of injury or
sickness, during the subsequent period of his disability, and
as the progress of his recovery may require.14
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.15
c. Extent of services. - The employee is entitled to
the benefits only for the ward services of an accredited
hospital and accredited physician. However, if the employee
chooses accommodations better than ward services, the
excess of the total amount of expenses incurred over the
benefits provided under Annex “C” of the Amended Rules on
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SOCLEG
Employees’ Compensation (infra) , shall be borne by the
employee.16
The hospital shall provide all the medicines, drugs or
supplies necessary for the treatment of the employee at a
cost not exceeding the retail prices prevailing in local drug
stores.17
Payments shall be made directly to the providers of
such services in such amount as are prevailing in the
community for similar services or provided under the
schedule set forth in said Annex “C,” whichever is less.18
The right of the employee to seek reimbursement
for medical expenses does not only pertain to those incurred
for the principal or primary ailment but extends to those
incurred for complications arising therefrom even if the
same occurred after the employee had already retired.
d. Loss of wages or earning capacity not required. - It
is worthy to note that Article 185 does not impose as a pre-
requisite for the grant of medical benefits, that the injured
or sick employee should show proof that he suffered loss of
wages or earning capacity as a result of such injury or
sickness. The law is clear that the injured or sick employee
is “immediately” entitled to be provided 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.19
3.2. TEMPORARY TOTAL DISABILITY.
a. Total disability, when temporary. - A total
disability is temporary if, as a result of the injury or sickness,
the employee is unable to perform any gainful occupation
for a continuous period of not exceeding 120
days, except when such disability still requires medical
attendance beyond 120 days, but not to exceed 240 days.20
If the disability is the result of an injury or sickness,
the period of compensability shall be counted from the first
day of such injury or sickness.
An employee who later had to stop working due to
a compensable illness is also entitled to temporary total
disability benefits.21
b. Conditions to entitlement in case of temporary
total disability. - An employee shall be entitled to an
income benefit for temporary total disability if all of the
following conditions are satisfied:
1. He has been duly reported to the System
(GSIS/SSS) ;
2. He sustains the temporary total disability as a
result of the injury or sickness; and
3. The System has been duly notified of the injury or
sickness which caused his disability.
His employer shall be liable for the benefit if such
illness or injury occurred before the employee is duly
reported for coverage to the System (GSIS/SSS) .22
c. When to commence payment of benefits. - The
21
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income benefit in the case of temporary total disability
should be paid beginning on the first day of such disability. If
caused by an injury or sickness, it should not be paid longer
than 120 consecutive days except where such injury or
sickness still requires medical attention beyond 120 days but
not to exceed 240 days from the onset of the disability, in
which case, benefit fortemporary total disability shall be
paid. However, the System (GSIS/SSS) may declare the total
and permanent status at any time after 120 days of
continuous temporary total disability as may be warranted
by the degree of actual loss or impairment of physical or
mental functions as determined by the System (GSIS/SSS) .23
d. Cash payment of temporary total disability
benefit. - Temporary total disability resulting from the injury
or sickness is compensable by cash payments and not the
injury or sickness itself.24
e. Income benefit for temporary total disability. - Any
employee entitled to the benefit for temporary
total disability shall be paid an income benefit equivalent to
ninety percent (90%) of his average daily salary credit as
determined by the System (GSIS/SSS) , subject to the
following conditions:
1. The income benefit shall not be more than P200.00
per day for private sector workers and P90.00 per
day for public sector employees and shall not be paid
longer than 120 days for the same disability unless
the injury or sickness requires more extensive
treatment that lasts beyond 120 days but not to
exceed 240 days from the onset of the disability, in
which case, he shall be paid benefit for temporary
total disability during the extended period.
2. The monthly income benefit shall be suspended if the
employee fails to submit a monthly medical report
certified by his attending physician as required under
the Amended Rules on Employees’ Compensation.25
An employee enjoying temporary total disability
benefits shall submit to the System (GSIS/SSS) a
monthly medical report on his disability certified by
his attending physician; otherwise, his benefit shall
be suspended until such time that he complies with
this requirement. Further, he must also submit
himself for examination upon being notified by the
System (GSIS/SSS) , at least once a year.26
3.3. PERMANENT TOTAL DISABILITY.
a. Permanent disability, defined. - “Permanent
disability” is the inability of a worker to perform his job for
more than 120 days, regardless of whether or not he loses
the use of any part of his body.27
b. Total disability, defined. - “Total disability,” on the
other hand, means disablement of an employee to earn
wages in the same kind of work, or work of a similar nature
that he was trained for, or accustomed to perform, or any
kind of work which a person of his mentality and attainment
could do.28
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Total disability is lack of ability to follow
continuously some substantial gainful occupation without
serious discomfort or pain and without material injury to
health and danger to life.29
Total disability does not mean a state of absolute
helplessness. A total disability does not require that the
employee be absolutely disabled or totally paralyzed. What
is necessary is that the injury must be such that the
employee cannot pursue his usual work and earn
therefrom.30
c. Disability, when total and permanent. - A disability
is total and permanent if, as a result of the injury or sickness,
the employee is unable to perform any gainful occupation
for a continuous period exceeding 120 days.31
Moreover, the fact that the permanently and totally
disabled employee continues to work after such disability
does not deprive him of the benefits provided under the
law.32
For what is important consideration is the inability
to do substantially all material acts necessary for the
prosecution of a gainful occupation without serious
discomfort or pain and without material injury or danger to
life. In disability compensation, it is not the injury per
se which is compensated but the incapacity to work.33
Disability is intimately related to one’s earning
capacity. The test to determine its gravity is the impairment
or loss of one’s capacity to earn and not its mere medical
significance.
Seagull Maritime Corp. v. Dee. 34 - It was held in this
case that although private respondent’s injury was
undeniably confined to his left foot only, however, the
inescapable impact of private respondent’s injury on his
capacity to work as a seaman cannot be disregarded. In their
desire to escape liability from private respondent’s rightful
claim, petitioners denigrated the fact that even if private
respondent insists on continuing to work as a seaman, no
profit-minded employer will hire him. His injury erased all
these possibilities.
GSIS v. Cadiz. 35 - It was declared in this case that
the fact that the employee did not lose the use of any part of
his body does not justify the denial of his claim for
permanent total disability.
GSIS v. CA. 36 - The High Court held here that
while permanent total disability invariably results in an
employee’s loss of work or inability to perform his usual
work, permanent partial disability occurs when an employee
loses the use of any particular anatomical part of his body
which disables him to continue with his former work. Stated
otherwise, the test of whether or not an employee suffers
from permanent total disability is the capacity of the
employee to continue performing his work notwithstanding
the disability he incurred. If by reason of the injury or
sickness he sustained, the employee is unable to perform his
customary job for more than 120 days and he does not come
within the coverage of Rule X of the Amended Rules on
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Employees Compensation (which, in a more detailed manner,
describes what constitutes temporary total disability) , then
the said employee undoubtedly suffers from a permanent
total disability regardless of whether or not he loses the use
of any part of his body. Permanent total disability does not
mean a state of absolute helplessness, but means
disablement of an employee to earn wages in the same kind
of work, or work of similar nature that he was trained for, or
any work which a person of similar mentality and attainment
could do.
d. Total disabilities considered permanent. - The
following total disabilities are considered permanent:
1. Temporary total disability lasting continuously for
more than 120 days and prevents an employee
from pursuing his usual work and earning
therefrom.37
2. Complete loss of sight of both eyes;
3. Loss of two limbs at or above the ankles or wrists;
4. Permanent and complete paralysis of two limbs;
5. Brain injury resulting in incurable imbecility or
insanity; and
6. Such cases as determined by the System
(GSIS/SSS) and approved by the ECC.38
Palisoc v. Easways Marine, Inc. 39 - The petitioner
here was unable to perform his job for more than 120 days
from the time of his repatriation which entitles him
to permanent disability benefits. Thus, even in the absence
of an official finding by a company-designated physician that
petitioner is unfit for sea duty, he is deemed to have
suffered permanent disability because of his inability to work
for more than 120 days. The Court of Appeals erred in
ruling that petitioner’s operation involving the removal of his
gallbladder is not a compensable injury, disease, or illness
under Appendix 1 of the POEA-SEC. Permanent disability
refers to the inability of a worker to perform his job for more
than 120 days, regardless of whether he loses the use of any
part of his body. What determines petitioner’s entitlement
to permanent disability benefits is his inability to work for
more than 120 days.
e. Litmus test and distinction between permanent
total disability and permanent partial disability.
In Vicente v. ECC. 40 - The Supreme Court laid down
the litmus test and distinction between Permanent Total
Disability and Permanent Partial Disability, to wit:
“[W]hile ‘permanent total
disability’ invariably results in an employee’s loss of
work or inability to perform his usual
work, ‘permanent partial disability,’ on the other
hand, occurs when an employee loses the use of
any particular anatomical part of his body which
disables him to continue with his former work.
Stated otherwise, the test of whether or not an
employee suffers from ‘permanent total disability’ is
a showing of the capacity of the employee to
continue performing his work notwithstanding the
disability he incurred. Thus, if by reason of the
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injury or sickness he sustained, the employee is
unable to perform his customary job for more than
120 days and he does not come within the coverage
of Rule X of the Amended Rules on Employees
Compensability (which, in a more detailed manner,
describes what constitutes temporary total
disability) , then the said employee undoubtedly
suffers from ‘permanent total disability’ regardless
of whether or not he loses the use of any part of his
body.” 41
f. Requisites for entitlement to income benefit for
permanent total disability. - An employee is entitled to an
income benefit forpermanent total disability if all of the
following conditions are satisfied:
1. He has been duly reported to the System
(GSIS/SSS);
2. He sustains the permanent total disability as a
result of the injury or sickness; and
3. The System has been duly notified of the injury or
sickness which caused his disability.
His employer shall be liable for the benefit if such
injury or sickness occurred before the employee is duly
reported for coverage to the System (GSIS/SSS) .42
g. ECC Board Resolution No. 98-09-0563 [September
25, 1998]. – This enunciated the following conditions that
should be taken into account in considering disability
as permanent, in addition to the existing rules and
regulations relative to permanent total disability, and in
consonance with the Supreme Court’s pronouncement on
liberal construction in disability claims cases:
1. If the disability results to disablement of an
employee or worker to earn wages in the same
kind of work, or work of similar nature that
he/he was trained for;
2. If the disability results to disablement of an
employee or worker to earn wages in any kind
of work which a person of his mentality and
attainment could do;
3. If the disability results to the inability of an
employee or worker to do substantially all
material acts necessary to the prosecution of an
occupation for remuneration or profit in
substantially customary and usual manner;
4. If the disability results to the lack of ability of an
employee or worker to follow continuously the
same substantial gainful occupation without
serious discomfort or pain and without injury or
danger to life;
5. If an employee or worker is compelled to retire
or cease from employment before reaching the
age of compulsory retirement by reason of
work-related contingency;
6. If, after retirement, an employee or worker dies
23
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BSU-PORTIA SORORITY
within a reasonable period of time, and the
cause of his death is the disability ailment or
injury, in which event, his disability shall be
considered permanent and total;
7. If the temporary and total disability shall last
continuously for more than 120 days, except as
otherwise provided in Rule X of the existing
implementing rules and regulations of P.D. No.
626, as amended.
Garcia v. Compensation Appeals and Review Staff.43 -
The denial of permanent total disability benefits to the
claimant in this case,who was a school teacher with thirty-
eight (38) years of dedicated service, would render inutile
and meaningless, the social justice precept guaranteed by
the Constitution. The claimant is entitled not only to partial
disability but to full compensation because her illness
rendered her incapable of teaching. That claimant’s
employment had contributed even in a small degree to the
development of the disease is enough for compensability of
claim.44
h. Payment for all compensable months of disability. -
In case of permanent total disability, the full monthly
income benefits should be paid for all compensable months
of disability.45
i. Effect of cessation of grant of employees’
compensation benefits to entitlement to benefits for the
same disability in another law being administered by the
System. - After the benefit under the Employees’
Compensation Program (ECP) has ceased, and if the
employee is otherwise qualified for benefit for the same
disability under another law administered by the System
(GSIS/SSS) , he should be paid such benefit in accordance
with the provisions of that law. This rule applies to
contingencies which occurred prior to May 1, 1978.46
j. 5-year guaranteed monthly income benefits;
grounds for suspension of grant of benefits. - Except as
otherwise provided in other laws, decrees, orders or letters
of instructions, the monthly income benefit is guaranteed for
five (5) years and shall be suspended under any of the
following conditions:
1. Failure to present himself for examination at
least once a year upon notice by the System;
2. Failure to submit a quarterly medical report
certified by his attending physician as required
under Section 5, Rule IV of the Amended Rules
on Employees’ Compensation;
3. Complete or full recovery from
his permanent disability; or
4. Upon being gainfully employed.47
Said Section 5 of Rule IV of the Amended
Rules provides that an employee
enjoying permanent disability benefit where the disability
resulted from a disease should submit to the System
(GSIS/SSS) a quarterly medical report on his disability
certified by his physician; otherwise his benefit shall be
24
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SOCLEG
suspended until such time that he complies with this
requirement.
k. Cash payment of permanent total disability
benefit. - Permanent total disability resulting from the injury
or sickness is compensable by cash payments and not the
injury or sickness itself.48
l. Monthly income benefit. - Any employee entitled
to permanent total disability benefits shall be paid by the
System (GSIS/SSS) a monthly income as defined in Section 9,
Rule VI of the Amended Rules on Employees’
49
Compensation.
1. In the case of the SSS.
In the case of the SSS, the monthly income benefit
is the amount equivalent to one hundred fifteen percent
(115%) of the sum of the average monthly salary credit
multiplied by the replacement ratio and one and a half
percent (1-1/2%) of the average monthly salary credit for
each credited year of service in excess of ten (10) years;
provided, that the monthly income benefit shall in no case
be less than P250.00; provided, however, that the monthly
pension of surviving pensioners shall be increased
automatically and simultaneously to the extent that the
fifteen percent (15%) difference in monthly income benefit
between EC and SS and the twenty percent (20%) difference
in monthly income benefit between EC and GSIS, should be
maintained.50
2. In the case of the GSIS.
In the case of the GSIS, the monthly income benefit
shall be the basic monthly pension as defined in P, D. No.
1146 [May 31, 1977] plus twenty percent (20%) thereof, but
shall not be less than P250.00 nor more than the actual
salary at the time of contingency.51
m. Amount of benefit for dependent children. -
Under Section 4, Rule XI of the Amended Rules on Employees’
Compensation, it is provided that each dependent child, but
not exceeding five (5) , counted from the youngest and
without substitution, shall be entitled to ten percent (10%)
of the monthly income benefit of the employee.
The Amended Rules on Employees Compensation, however,
shall not apply to causes of action which accrued before May
1, 1978.
Except the benefit to dependent children under
said Section 4 of Rule XI of the Amended Rules on Employees’
Compensation, the aggregate monthly benefit payable, in
the case of the GSIS, shall in no case exceed the monthly
wage or salary actually received by the employee as of the
date of his permanent total disability per ECC Resolution No.
2819 dated August 9, 1984.52
3.4. PERMANENT PARTIAL DISABILITY.
a. Disability, when partial and permanent. - A
disability is partial and permanent if, as a result of the injury
or sickness, the employee suffers a permanent partial loss of
the use of any part of his body.53
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b. Requisites for entitlement. - An employee shall be one index finger - 8

entitled to an income benefit for permanent partial disability
(PPD) if all of the following conditions are satisfied: one middle finger - 6

1. He has been duly reported to the System one ring finger - 5

(GSIS/SSS) ; one little finger - 3
2. He sustains the permanent partial disability as a
result of the injury or sickness; and one big toe - 6
3. The System has been duly notified of the injury or
any toe - 3
sickness which caused his disability.
His employer shall be liable for the benefit if such one hand - 39
injury or sickness occurred before the employee is duly one arm - 50
reported for coverage to the System (GSIS/SSS).54
one foot - 31
c. Effect of gainful employment. - For purposes of
entitlement to income benefits for permanent one leg - 46
partial disability, a covered employee shall continue to
receive the benefits provided thereunder even if he is one ear - 10
gainfully employed and receiving his wage or salary.55 both ears - 20
d. Income benefit in case of permanent partial hearing of one ear - 10
disability (PPD) . - Permanent partial disability is
the exception to the rule that disability resulting from the hearing of both ears - 50
injury or sickness is compensable by cash payments and not
the injury or sickness itself.56 sight of one eye - 2560

Consequently, in the case where the period covered

for payment of income benefit for PPD does not exceed
twelve (12) months, the System (GSIS/SSS) may pay in lump
sum; otherwise the income benefit shall be paid in monthly
pension.57
In other words, if the indicated number of months
exceeds twelve (12) , the income benefit should be paid in
monthly pension; otherwise, the System may pay the income
benefit in lump sum or in monthly pension.58
Under ECC Board Resolution 93-08-0068 issued on
August 5, 1993, permanent partial disability benefit is
granted up to a maximum of two hundred forty (240) days if
the claimant's disability persist exceeding the 120-day limit.
Any employee entitled to PPD benefit shall be paid
by the System (GSIS/SSS) a monthly income benefit for the
number of months indicated inSection 2, Rule XII of
the Amended Rules on Employees’ Compensation [See
Schedule below].59
e. Schedule of income benefit payment. - Under
said Section 2, Rule XII of the Amended Rules on Employees’
Compensation, the income benefit shall be paid beginning
with the first month of such disability, but no longer than the
designated number of months in the following schedule:
Complete and Permanent
Loss
of the use of No. of
Months
one thumb - .64
10
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In case of permanent partial disability less than the
total loss of the member, the same monthly income shall be
paid for a portion of the period established for the total loss
of the member in accordance with the proportion that the
partial loss bears to the total loss. If the result is a decimal
fraction, the same shall be rounded off to the next higher
integer.61
In case of simultaneous loss of more than one
member or a part thereof, the same monthly income shall be
paid for a period equivalent to the sum of the periods
established for the loss of the member or part thereof but
not exceeding seventy-five (75) . If the result is a decimal
fraction, the same shall be rounded off to the higher
integer.62
The degree of permanent disability shall be
equivalent to the ratio that the designated number of
months of compensability bears to seventy-five (75).63
f. Consequence of loss of a part of body. - The
following rules shall apply in case of loss of a part of the
employee’s body:
1. A loss of a wrist is considered a loss of the hand;
2. A loss of an elbow is considered a loss of the arm;
3. A loss of an ankle is considered a loss of the leg;
4. A loss of more than one joint is considered a loss
of the whole finger or toe; and
5. A loss of only the first joint shall be considered a
loss of one-half of the whole finger or toe.
Other permanent partial disabilities shall be
determined by the Medical Officer of the System (GSIS/SSS)
g. Unlisted injuries and illnesses (non-scheduled
disabilities) . - In cases of injuries or illnesses not listed in
25
BSU-CHAPTER

SOCLEG
BSU-PORTIA SORORITY
the schedule underSection 2, Rule XII of the Amended Rules
on Employees’ Compensation [supra], the benefit shall be an
income benefit equivalent to the percentage of the
permanent loss of the capacity for work.65
3.5. DEATH BENEFIT.
a. Death, meaning. - Within the context of the
employees’ compensation program, the term “death” means
loss of life resulting from an injury or sickness.66
b. Compensable death. - “Compensable
death” refers to death which is the result of a work-related
injury or sickness.
c. Proof required in order for death to be
compensable. - Death compensation benefit cannot be
awarded unless there is substantial evidence showing that:
(a) The cause of the employee’s death was
reasonably connected with his work; or
(b) The sickness for which he died is an accepted
occupational disease; or
(c) His working conditions increased the risk of
contracting the disease for which he died.67
d. Income benefit in case of death. - Death resulting
from the injury or sickness is compensable by cash payments
and not the injury or sickness itself.68
The monthly income benefit provided under Article
194 of the Labor Code is the new amount of the monthly
income benefit for the surviving beneficiaries upon the
approval of P.D. No. 1368 [May 1, 1978] which introduced
amendments to Title II, Book IV of the Labor Code.69
e. Requisites for entitlement to death benefit. - The
beneficiaries of a deceased employee shall be entitled to an
income benefit if all of the following conditions are satisfied:
1. The employee had been duly reported to the
System (GSIS/SSS) ;
2. He died as a result of an injury or sickness; and
3. The System has been duly notified of his death,
as well as the injury or sickness which caused his
death.
His employer shall be liable for the benefit if such
death occurred before the employee is duly reported for
coverage to the System (GSIS/SSS).70
f. Death to be compensable must occur while in the
performance of job; exception. - Under the law on
employees’ compensation, death is compensable only when
it results from a work-connected injury or sickness.71
Lu v. WCC.72 - It was ruled in this case that the benefits
of the Workmen’s Compensation Act for the death of the
employee cannot be extended to the claimant since it did
not occur while in the performance of his duties as a
gasoline attendant.
Tolosa v. ECC,73 - It was pronounced here that the
employee’s widow is not entitled to death benefits because
her husband had stopped working when he became
26
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physically disabled to do his work at the time of his
retirement in 1975 and death on February 14, 1984, or
almost nine (9) years after, which is clearly not within
the two-year period required by the old Workmen’s
Compensation Act.
But in Manuzon v. ECC.74 - The dependents were held
entitled to the benefits from the employee’s death which
occurred about 4 ½ years after retiring from the service due
to a stroke, a cardiovascular accident caused by thrombosis.
This is so because although the death occurred after the
retirement, the cause of death, myocardial infarction, is
closely related to the cause of his compulsory retirement.
In the 2004 case of GSIS v. Cuanang,75 the employee
died a year after retirement. The Supreme Court held that
indeed, if the death which occurred almost 4 ½ years after
retirement was held to be within the coverage of the death
benefits under P.D. 626, as in the Manuzon case, with more
reason should the death which occurred within one year
after retirement be considered as covered under the same
law. A claim for benefit for such death cannot be defeated
by the mere fact of separation from service.76
g. Death of a member while under permanent partial
disability. - Upon the death of a covered member during the
period that he/she was receiving permanent partial disability
(PPD) benefits, the remainder of his PPD benefits shall be
paid to his primary beneficiaries. However, the beneficiaries
shall be entitled to the same benefits enjoyed by the
beneficiaries of a permanent total disability (PTD) pensioner
upon his death, provided that the cause of death was the
same illness or injury for which he/she was awarded PPD
benefits.
h. Additional requisites; proof of marriage. - If the
employee has been receiving monthly income benefit
for permanent total disability at the time of his death, the
surviving spouse must show that the marriage has been
validly subsisting at the time of his disability.77
i. Material date to determine the amount of death
compensation benefits. - It is well-settled that the material
date to determine the amount of death compensation
benefits is the date of the death of the employee and not
the amount provided by law at the time of payment.78
j. Period of entitlement to death benefit.
1. For primary beneficiaries.
The income benefit for primary beneficiaries shall
be paid beginning at the month of death and shall continue
to be paid for as long as the beneficiaries are entitled
thereto.
The monthly income benefit shall be guaranteed
for 5 years which in no case shall be less than P15,000.00.
Thereafter, the beneficiaries shall be paid the monthly
income benefit for as long as they are entitled thereto.79
2. For secondary beneficiaries.
The income benefit for secondary beneficiaries shall be
sixty (60) times the monthly income benefit of
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a primary beneficiary which in no case shall be less
than P15,000.00 which shall likewise be paid as monthly
pension.80
k. Presumptive death.
1. When death benefits should be paid.
Payment of death benefits shall be reckoned from
the date a worker was declared presumptively dead after
he/she had been reported missing for sometime, by proper
authority, in accordance with law; except when the
declaration of death specified another date, in such a case,
payment of death benefits shall start from the latter date.81
2. Entitlement to funeral benefits.
The beneficiaries shall be entitled to funeral
benefits as provided for under the law, even though the
body of a missing person had not been recovered and that
no burial activities had been undertaken.
l. Death benefits, not part of the estate of the
deceased.
The death benefits being paid under the law are not
part of the deceased’s estate. They are not in the nature of
inheritance. They are granted by operation of law as financial
compensation and aid for the death of the employee.
It must be noted that the dependents mentioned in
the law are not referred to as the “heirs” but rather
as “beneficiaries.” It may be further observed that the
dependents are not necessarily the “heirs” of the deceased,
as this term is understood in civil law.
3.6. FUNERAL BENEFIT UNDER THE LABOR CODE.
a. Entitlement to funeral benefit. - A funeral benefit
of P3,000.00 shall be paid upon the death of a covered
employee or a permanently totally disabled pensioner to one
of the following:
1. The surviving spouse; or
2. The legitimate child who spent for the funeral
services; or
3. Any other person who can show incontrovertible
proof of his having borne the funeral expenses.82
b. Increases in the amount of funeral
benefit.
1. The amount of funeral benefit was increased from
P3,000.00 as provided in the Labor Code and its
implementing rules, to P6,000.00.83
2. Subsequently, in 1992, the amount of funeral
benefit to private sector employees was increased to
P8,000.00 effective May 1, 1992.84
3. Effective May 1, 1994, the funeral benefit was
increased to P10,000.00 for the private sector and P3,000.00
for the public sector.
c. Effect of denial of death benefit on entitlement to
funeral benefit. - The denial of the death benefit being
claimed has an adverse effect on the claim for funeral
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benefit. The Supreme Court in the case of Tolosa v.
ECC,85 held that the widow is not entitled to funeral
benefit in view of its ruling that she is not entitled to death
benefit.
4. DEPENDENCY.
a. Dependency, meaning. - The
term “dependency” does not mean absolute dependency for
the necessities of life but rather, that the dependent looked
to and relied on the contribution of the claimant, in whole or
in part, as a means of supporting and maintaining himself in
accordance with his station in life.
Under this concept, a person may be considered a
dependent although he is able to maintain himself without
any assistance from the decedent.86 For instance, the
legitimate spouse may be gainfully employed himself or
herself but he/she is considered a dependent for as long as
he/she is living with the deceased employee at the time of
the occurrence of death.
b. Test of dependency. - There is no uniform test to
ascertain dependency. What the law imposes is that the
dependency relationship should exist at the time of the
occurrence of the injury. What would be ordinary necessity
and comfort for one person may not necessarily apply to
another. However, such factors as standards of living, station
in life, the necessity and comfort required and the like, may
prove helpful in determining dependency.
Total or partial dependency is a question of fact
which may be established by appropriate evidence.
In Paragatos v. Barredo,87 the Supreme Court ruled that
based on the evidence presented, the plaintiff-parent was
partially dependent upon his son for support, taking into
account the circumstances and conditions prevailing in the
country where any amount sent by a son to his father who
lives in the rural area and who can hardly provide for the
needs of his minor children is sufficient evidence of partial
dependency.
c. Classification of dependency. - Dependency may
be classified as follows:
i. As to the amount - partial or total; or
ii. As to status - legal or actual.
1. Partial dependency.
A partial dependent is a person who has some
means or income of his own and who receives less than all of
his support from the employee. If the contributions from the
employee enable him to live in accordance with his station in
life, without which he could not live in accordance therewith,
such person is a partial dependent.
2. Total dependency.
A total dependent is one who has no means of
support and entirely depends for support upon the
contribution from the employee or one who may have an
income from other sources but the amount of which is too
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small and insignificant as would enable him to support
himself without the major support from the employee.
3. Legal dependency.
Legal dependency proceeds from the mandate or
operation of the law, irrespective of the ability of the
dependent to support himself. This type of dependency,
having been established by operation of law, is conclusive.
4. Actual dependency.
Under this type of dependency, the reasonable
expectation of continuing support appears to be the general
and important criterion to consider. An actual dependent,
therefore, is one who looked to the employee for support,
partially or wholly.
d. Specific dependents under the Labor Code.
1. Dependents provided under the Labor Code.
Under the Labor Code, the term “dependent” refers
to the following:
a. The legitimate, legitimated or legally adopted
or acknowledged natural child who is
unmarried, not gainfully employed, and not
over twenty-one (21) years of age or over
twenty-one (21) years of age provided he is
incapacitated and incapable of self-support
due to a physical or mental defect which is
congenital or acquired during minority;
b. The legitimate spouse living with the
employee; and
c. The parents of said employee wholly
dependent upon him for regular support.88
2. Children as dependents.
The children referred to as dependents under the
law are:
1. Legitimate children;
2. Legitimated children;
3. Legally-adopted children; and
4. Acknowledged natural children.
As a general rule, minor children of the deceased
employee are conclusively presumed to be dependents.
As far as children of majority age are concerned,
they should prove their dependency in accordance with the
requirements of the law. Thus, a child who is over 21 years
of age may still be considered dependent if he satisfies the
two (2) requirements as follows:
i. He is incapacitated; and
ii. Incapable of self-support due to a physical or
mental defect which is congenital or acquired
during minority.89
Under the old Workmen’s Compensation Act, as
amended, stepchildren as well as brothers and sisters of the
deceased employee are considered dependents. However,
under the Labor Code, reference to them is absent.
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Therefore, they should no longer be considered as
dependents.
As far as illegitimate children are concerned,
paragraph [i] of Article 167 of the Labor Code defining the
term “dependent” does not mention or make reference to
them as dependents. However, paragraph [j] thereof
and Section 1 [c], Rule XV of the Amended Rules on
Employees’ Compensationtreat illegitimate children
as secondary beneficiaries.
Legally-adopted children, to be considered
dependents, must have been judicially-decreed as such prior
to the occurrence of the injury and death of the deceased
employee. Without judicial pronouncement on the adoption,
as when the child was merely taken into the home and
treated as a member of the family, would not be sufficient
for purposes of entitlement to the benefits.
3. Legitimate spouse as dependent.
At the outset, it bears stressing the fact that, unlike
the old Workmen’s Compensation Act where Sections 9 and
10 thereof explicitly made a distinction
between “widow” and “widower” in terms of entitlement to
benefits, the Labor Code uses the generic
term “spouse” which may refer either to a widow (wife) or a
widower (husband) .
In order for the widowed spouse of the deceased
employee to be entitled to compensation benefits, the law
imposes the following requirements:
1. He/she is a legitimate spouse; and
2. He/she should be living with the deceased
employee at the time of death.
A widowed spouse is, as a general rule, conclusively
presumed to be a dependent when living with the deceased
at the time of the latter’s death, irrespective of whether
he/she is gainfully employed.
The only time when this conclusive presumption
does not attach is when the surviving spouse is not the
legitimate spouse or is voluntarily living apart from the
deceased employee at the time of death.
In case there are two (2) wives claiming the benefits
under the law, the Workmen’s (now Employees’)
Compensation Commission, according to the Supreme Court,
is empowered to rule on the issue of who is the legitimate
spouse who shall be awarded the benefits. The Commission
may act as referee and arbitrator to help the two (2)
claimants reach an amicable settlement.90
In case the legitimate surviving spouse was living
separately from the deceased employee at the time of
death, he/she may be treated as dependent if such
separation was necessary and justified as when the same
was caused by health or business reasons or because of the
fault of the deceased spouse. Under these situations, it is
believed that the conclusive presumption of dependency
should still apply.
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In Vda. de Makabenta v. Davao Stevedore Terminal In order for the parents of the deceased employee
Company,91 a marriage celebrated in a hospital where the to qualify as dependents, the law simply imposes one (1)
deceased employee was confined after the fatal accident requirement, i.e. , that they arewholly and not partially,
where he sustained the injury but before his death, was held dependent upon the latter for regular support. Living with
sufficient for purposes of determining the dependency of the the deceased employee is not a requirement. The conclusive
wife. For three (3) months prior to such marriage, they were presumption applicable to the other dependents is not
already living together as common-law husband and wife. followed in the case of parents. Consequently, the burden of
proof is upon such parents to prove dependency.
4. Policy on surviving spouse.
As to what is meant by “regular support,” the law
A policy92 has been enunciated as regards surviving
and the implementing rules failed to define or describe it.
spouse found not to be living with the covered employee at
However, such regularity of support which is certainly a
the time the employee died. Said surviving spouse is entitled
question of fact may be inferred from the peculiar facts of a
to employees' compensation benefits provided that the
case.
separation occurred owing to any of the following
circumstances: In Malate Taxicab v. Del Villar,93 the parents were
considered dependents despite the substantial income of
1. Refusal of the covered employee to continue
the father who is an accountant earning P300.00 per month.
living with the surviving spouse; or the
The test of dependency, according to the High Court, is not
employee's abandonment of the said spouse,
merely whether the contributions were necessary to bare
without justifiable or valid cause;
subsistence. Dependency may exist although the dependents
2. Attempt of the covered employee against the life
could have subsisted without the assistance he received, if
of the surviving spouse, common child/children
such contributions were relied on by the claimant for his
of the spouse;
means of living as determined by his position in life. So, it is
3. Commission of an act of sexual abuse against the
immaterial that claimant could have so reduced his living
surviving spouse, common child/children of the
expenses that he could have been supported independently
spouse;
from the earnings of the employee. One need not be actually
4. The covered employee's recurrent commission of
a part of the deceased employee’s household in order to be
physical violence, or grossly, abusive conduct,
a dependent. There may be dependency notwithstanding
against the surviving spouse, common
the fact that the employee did not work steadily or was
child/children of the spouse;
absent from the home at the time of his accidental death,
5. The covered employee's infliction of physical
and notwithstanding the employee’s unlawful acts or his
violence, or imposition of moral duress, to
statement in his application for employment that he had no
compel the surviving spouse, common
dependents.
child/children or child/children of the spouse to
change their religious or political affiliation; 5. BENEFICIARIES.
6. Attempt of the covered employee to corrupt or
a. Beneficiaries, defined. - The
induce the surviving spouse, common
term “beneficiaries” means the dependent spouse until
child/children or child/children of the spouse to
he/she remarries and dependent children who are
engage in prostitution, or to make them connive
the primary beneficiaries. In their absence, the dependent
with the employee in such an act of corruption
parents and subject to the restrictions imposed on
or inducement;
dependent children, the illegitimate children and legitimate
7. Drug addiction or habitual alcoholism of the
descendants, who are the secondary beneficiaries, provided
covered employee;
that the dependent acknowledged natural child shall be
8. Lesbianism or homosexuality of the covered
considered as a primary beneficiary when there are no other
employee;
dependent children who are qualified and eligible for
9. Contraction of bigamous marriages by the
monthly income benefit.94
covered employee, whether in the Philippines or
abroad; b. General classification. - Beneficiaries under the
10. Sexual infidelity or perversion of the covered Labor Code may be classified as follows:
employee;
1. Primary; or
11. The covered employee's act of allowing the
2. Secondary.95
surviving spouse, common child/ children or
child/children of the spouse to be subjected to c. Primary beneficiaries. - The following beneficiaries
acts of lasciviousness; and shall be considered primary:
12. The covered employee's contraction of serious
1. The legitimate spouse living with the employee at
sexually transmitted disease extra-maritally.
the time of the employee’s death until he/she
5. Parents of deceased employee as dependents. remarries; and

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BSU-PORTIA SORORITY

2. The legitimate, legitimated or legally adopted or Employees’ Compensation Fund.

acknowledged natural children who are
If the deceased employee has
unmarried, not gainfully employed, not over 21
no primary or secondary beneficiaries at the time of his
years of age, or over 21 years of age, provided
death, the death benefit shall accrue to the Employees’
that he is incapacitated and incapable of self-
Compensation Fund.103
support due to a physical or mental defect
which is congenital or acquired during minority. g. Benefits payable. - Primary beneficiaries shall be
A dependent acknowledged natural child shall entitled to a monthly income benefit. In their absence,
be considered as a primary beneficiary only the secondary beneficiaries shall be entitled to a monthly
when there are no other dependent children income benefit not to exceed sixty (60) months and the
who are qualified and eligible for monthly death benefit shall not be less than P15,000.00.104
income benefit. If there are two or more
h. Monthly income benefit, how distributed. - The
acknowledged natural children, they shall be
distribution of monthly income benefits shall be as
counted from the youngest and without
follows:105
substitution, but not exceeding five (5) .96
1. Monthly income benefits shall be shared equally
d. Secondary beneficiaries. - The following
by all the primary beneficiaries including
beneficiaries shall be considered secondary:
dependent children who were not considered in
1. The legitimate parents wholly dependent upon the determination of dependent pensions. Upon
the employee for support; emancipation or otherwise disqualification to
entitlement to the dependent pension of a
2. The legitimate descendants and illegitimate
dependent child, only ten percent (10%) shall be
children who are unmarried, not gainfully
deducted from the benefits and the remaining
employed and over 21 years of age, or over 21
income benefits shall, once again, be divided
years of age provided that he is incapacitated
equally by the qualified primary beneficiaries.106
and incapable of self-support due to a physical
or mental defect which is congenital or acquired 2. If there are no primary beneficiaries,
during minority.97 the secondary beneficiaries shall also share
equally in the monthly income benefits.107
e. When to determine beneficiaries. - Beneficiaries
shall be determined at the time of the employee’s death.98 i. Evidence to prove relationship and dependency. -
A marriage certificate issued by the parish priest who
Consequently, although in other
solemnized the marriage between the surviving spouse and
jurisdictions, posthumous children who died before the
the deceased is sufficient to establish marriage
employee’s death are considered as dependents,99under the
relationship.108
laws of the Philippines, they cannot, as a general rule, be so
considered since beneficiaries are determined at the time of The baptismal certificates and birth certificates of
the death of the employee. the children are also sufficient evidence to prove the
relationship of the dependents with the deceased. Strict
However, in Vda. de Makabenta v. Davao Stevedore
observance of the technical rules of evidence is not properly
Terminal Company,100 the daughter born after the death of
demanded in employees’ compensation cases.109
the employee and, therefore, a posthumous child, was
considered a legal dependent of the deceased employee.
f. Rule on priority of beneficiaries. ------------oOo------------
1. Priority of primary beneficiaries; secondary
beneficiaries excluded.
Primary beneficiaries have priority claim to death
benefits over secondary beneficiaries. Whenever there
are primary beneficiaries, no death benefit should be paid
to secondary beneficiaries.101
2. In the absence of primary beneficiaries, death
benefits should be paid to secondary beneficiaries.
If the deceased employee has
no primary beneficiaries at the time of his death, the death
benefits should be paid to his secondarybeneficiaries.102
3. In the absence of both primary and secondary
beneficiaries, death benefits shall accrue to the
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