D. Disability and Death Benefits

Employees’ Compensation Program (ECP)

The State shall promote and develop a tax-exempt ECP whereby the Ees and their dependents, in the event of work-connected disability or death, may promptly secure adequate income benefit and medical related benefits. (Art. 172, LC)

The basic features of the new program are:

• Integration of benefits;
• Increase in benefits;
• Prompt payment of income benefits;
• Legal services dispensed with;
• Wider coverage; and
• A more balanced rehabilitation program. (Poquiz, 2019)

XPNs:

• Where the employee is proceeding to or from his work on the premises of his employer;
• Where the employee is about to enter or about to leave the premises of his employer by way of the exclusive or customary means of ingress and egress also known as the Proximity Rule;
• where the employer, as an incident of the employment, provides the means of transportation to and from the place of employment. (Iloilo Dock & Engineering Co. v. Workmen's Compensation Commission, G.R. No. L-26341, 27 Nov. 1968)

NOTE: For an injury to be compensable it is not important that the cause thereof must have occurred within the place of employment. As long as the worker acted within the purview of his employment, performing an act reasonably necessary or incidental thereto, the injury sustained by reason thereof falls within the protection of the law regardless of the place of injury (Lopez v. ECC, G.R. No. 90267, 21 Dec. 1993)

Q: Rosa was granted vacation leave by her employer to spend three weeks in Africa with her family. Prior to her departure, the General Manager of the company requested her to visit the plant of a client of the company in Zimbabwe in order to derive best manufacturing practices useful to the company. She accepted the request because the errand would be important to the company and Zimbabwe was anyway in her itinerary. It appears that she contracted a serious disease during the trip. Upon her return, she filed a claim for compensation, insisting that she had contracted the disease while serving the interest of her employer.

Under the Labor Code, the sickness or death of an employee, to be compensable, must have resulted from an illness either definitely accepted as an occupational disease by the Employees' Compensation Commission, or caused by employment subject to proof that the risk of contracting the same is increased by working conditions.

Is the serious disease Rosa contracted during her trip to Africa compensable? Explain your answer. (2017 BAR)

A: For sickness and the resulting disability to be compensable, the sickness must be the result of an occupational disease listed under Annex A of the Amended Rules on Employees' Compensation with the condition set therein satisfied; otherwise, proof must be shown that the risk of contracting the disease is increased by the working condition. The burden of proof is upon Rosa. No proof was presented by Rosa to substantiate the foregoing. Moreover, it is required that the sickness and the resulting injury must have arisen out of or in the course of employment. Rosa’s vacation leave does not, by itself, bar her claim because she also undertook an employer-requested errand. On the facts given, however, she has not shown that the disease met the applicable occupational-disease conditions or that her working conditions increased her risk of contracting it. (De La Rea v. Employees' Compensation Commission, G.R. No. L-66129, 17 Jan. 1986)

Need for Definite Assessment Within 120/240 Days

The court summarized the rules regarding the company-designated physician's duty to issue a final medical assessment on the seafarer's disability grading, as follows:

• The company-designated physician must issue a final medical assessment on the seafarer's disability grading within a period of 120 days from the time the seafarer reported to him;
• If the company-designated physician fails to give his assessment within the period of 120 days, without any justifiable reason, then the seafarer's disability becomes permanent and total;
• If the company-designated physician fails to give his assessment within the 120 days with a sufficient justification (e.g., seafarer required further medical treatment or seafarer was uncooperative), then the period of diagnosis and treatment shall be extended to 240 days. The Er has the burden to prove that the company-designated physician has sufficient justification to extend the period; and
• If the company-designated physician still fails to give his assessment within the extended period of 240 days, then the seafarer's disability becomes permanent and total, regardless of any justification.

Case law states that without a valid final and definitive assessment from the company- designated physician within the 120/240-day period, the law already steps in to consider petitioner's disability as total and permanent. Thus, a temporary total disability becomes total and permanent by operation of law. (Gamboa v. Maunlad Trans., Inc., G.R. No. 232905, 20 Aug. 2018)

NOTE: A TTD lasting continuously for more than 120 days, except as otherwise provided, is considered as a total and permanent disability. The exception pertains to a situation when the sickness "still requires medical attendance beyond 120 days but not to exceed 240 days" in which case the temporary total disability period is extended up to a maximum of 240 days.

However, for the company-designated physician to avail of the extended 240-day period, he must first perform some significant act to justify an extension; otherwise, the seafarer's disability shall be conclusively presumed to be permanent and total. (Talaroc v. Arpaphil Corporation, et. al., G.R. No. 223731, 30 Aug. 2017)

Reckoning Date of the Three-Year Prescriptive Period

• Sickness – from the time the Ee lost his earning capacity. NOTE: The three (3) years have to be counted from the time the Ee lost his earning capacity, not from the time the illness was discovered. (ECC v. Sanico, G.R. No. 134028, 17 Dec. 1999)
• Injury – from the time it was sustained.
• Death – from the time of death of the covered Ee. (Sec. 6(a), Rule VII, Amended Rules on EC)

DISABILITY BENEFITS

Disability refers to the loss or impairment of a physical or mental function resulting from injury or sickness. (Art. 173(n), LC)

The purpose of the law in providing benefits to the injured or sick Ee during temporary disability is to compensate him for what he might have earned during the period while his injury or sickness is being medically treated. (Chan, 2019)

Minimum Pension

• At least 10 credited years of service - P1,200.00
• At least 20 credited years of service - P2,400.00

Dependent’s Pension [Secs. 12-A, 13, and 13-A]

Payable on account of:

• Death,
• Permanent total disability, or
• Retirement

Kinds of Disability

There are three (3) kinds of disability benefits under the Labor Code:

• Temporary total disability (Art. 197, LC)
• Permanent total disability (Art. 198, LC)
• Permanent partial disability (Art. 199, LC)

NOTE: The compensation for the disabilities is not mutually exclusive. For instance, recovery of compensation for temporary total disability or permanent partial disability shall not preclude recovery for permanent total disability. (Chan, 2019)

Guidelines in Cases Where a Seafarer Claiming Disability Benefits Requests for a Third Doctor Referral (part 1 of 2)

• A seafarer who receives a contrary medical finding from his/her doctor must send to the employer, within a reasonable period, a written request to refer the conflicting medical findings to a third doctor, to be mutually agreed upon by the parties, and whose findings shall be final and binding between the parties;
• The written request must be accompanied by or must indicate the contents of the medical report from his/her doctor. Otherwise, the written request shall be considered invalid and as if none had been requested;
• In case there was no valid request for a third doctor referral from the seafarer, the Er may opt to ignore the request or to refuse to assent, either verbal or written, to such request without violating the pertinent provision of the POEA-SEC; NOTE: if a complaint is subsequently filed by the seafarer against the Er before the labor tribunal, and the parties, after a directive from the LA pursuant to NLRC En Banc Resolution No. 008-14, fail to secure the services of a third doctor, the labor tribunals shall hold the findings of the company-designated physician final and binding. XPN: unless the same is found to be biased (i.e., lacking in scientific basis or unsupported by the medical records of the seafarer). In such a case, the inherent merits of the respective medical findings shall be considered by the tribunals or court. NOTE: If, however, the parties were able to secure the services of a third doctor during mandatory conference, the latter’s assessment of the seafarer’s medical condition should be considered final and binding.
• In case of a valid written request from the seafarer for a third doctor referral, the Er must, within 10 days from receipt, send a written reply stating that the procedure shall be initiated by the employer. After a positive response from the employer, the parties are given a period of 15 days to secure the services of a third doctor and an additional period of 30 days for the third doctor to submit his/her assessment. The assessment of the third doctor shall be final and binding; NOTE: In case, however, the parties fail to mutually agree as to the third doctor, a complaint for disability benefits may be filed by the seafarer against the employer. The labor tribunals shall then consider and peruse the inherent merits of the respective medical findings of the parties’ doctors before making a conclusion as to the condition of the seafarer.
• If, however, the Er ignores the written request of the seafarer, or sends a written reply to the seafarer refusing to initiate the referral to a third doctor procedure, or sends a written reply giving its assent to the request beyond 10 days from receipt of the written request of the seafarer, the Er is considered in violation of the POEA-SEC. The seafarer may now institute a complaint against his or her employer;
• Upon the filing of the complaint and during the mandatory conference, the LA shall give the parties a period of 15 days to secure the services of a third doctor and an additional period of 30 days for the third doctor to submit his/her reassessment;
• If the services of a third doctor were not secured on account of the employer’s refusal to give heed to the LA’s request or due to the failure of the parties to mutually agree as to the third doctor, the labor tribunals should make conclusive between the parties the findings of the seafarer’s physician of choice, unless the same is clearly biased, i.e., lacking in scientific basis or unsupported by the medical records of the seafarer. In such a case, the inherent merits of the respective medical findings and the totality of evidence shall be considered by the labor tribunals or courts; NOTE: If, however, the failure to refer the seafarer’s condition to a third doctor after directive from the LA was due to the fault of the seafarer, then the labor tribunals and the courts should make conclusive between the parties the findings of the company- designated physician, except when the company-designated physician’s medical conclusion is found to have been issued with a clear bias in favor of the employer (i.e., lacking in scientific basis, or unsupported by the medical records of the seafarer) as held in Dionio v. Trans-Global Maritime Agency Inc. (G.R. No. 217362, 19 Nov. 2018). When such exception applies, the inherent merits of the respective medical findings shall be considered by the tribunals or court.
• If, despite the employer’s failure to respond to the seafarer’s valid request for a third doctor, the parties, during mandatory conference, were able to secure the services of a third doctor, and the latter was able to make a reassessment on the seafarer’s condition, the third doctor’s findings should be final and binding between the parties. In such a case, the employer’s refusal to respond to the seafarer’s valid request for a third doctor referral should be considered immaterial. (Bunayog v. Foscon Shipment, Inc., G.R. No. 253480, 04 May 2023)

Q: In July 2011, Ville, a seafarer, underwent a Pre-Employment Medical Examination (PEME) wherein he was declared as fit for work. Upon the expiration of his contract on March 2012, Ville disembarked from the vessel. Upon his arrival in the Philippines, he did not report that he was experiencing any illness or injury. On March 2012, Ville underwent another PEME as a prerequisite for another deployment. In said PEME, he disclosed for the first time that he has a history of high blood pressure or hypertension and has been taking medication. The results of the PEME indicated that Ville had Coronary Artery Disease. Hence, he was declared "Unfit for Sea Duty.” Under the impression that he contracted the illness while on board Adrian Maersk, Ville filed a Complaint on 03 May 2012 against the respondents for reimbursement of medical expenses and sickness allowance, payment of total and permanent disability benefits, moral and exemplary damages, attorney's fees plus legal interest. Is Ville correct?

A: NO. A contract between an Er and a seafarer ceases upon its completion, when the seafarer signs off from the vessel and arrives at the point of hire." Indeed, "the employment of seafarers and its incidents are governed by the contracts they sign every time they are hired or re-hired. These contracts have the force of law between the parties as long as their stipulations are not contrary to law, morals, public order or public policy." Thus, upon Ville’s signing off from the vessel and repatriation on 01 Mar. 2012 due to the completion of his contract, his employment relationship with the respondents correspondingly ceased. Consequently, no liability should attach to the respondents for any illness or incident that may have been acquired or transpired after signing off or expiration of his contract, as in this case.

In addition, A seafarer-claimant is mandated a period of three working days within which he should submit himself to a post-employment medical examination so that the company- designated physician can promptly arrive at a medical diagnosis. Due to the express mandate on the reportorial requirement, the failure of the seafarer to comply shall result in the forfeiture of his right to claim compensation and benefits for injury and illness. Such was not followed in this case hence Ville is not entitled to any compensation or benefits. (Gerardo U. Ville v. Maersk-Filipinas Crewing, Inc. And/Or A.P. Mollera/S, G.R. No. 217879. 01 Feb. 2021, as penned by J. Hernando)

Q: PTCI hired San Juan on several occasions as Chief Cook from 24 Feb. 1992 to 15 May 2008. He was re-hired on 26 Aug. 2009 to work aboard a vessel. Prior to his embarkation, San Juan underwent a routine Pre-Employment Medical Examination where he declared that he suffered from hypertension treated with medication. He was given cardiac clearance and was certified as "fit to work" by PTCI's company- designated physicians.

San Juan performed hard manual labor and engaged in strenuous physical activities for 12 hours a day. He suffered fatigue, shortness of breath, and severe headaches. On 23 Jan. 2010, he signed off from the vessel and was medically repatriated to the Philippines. He was referred to the company-designated physicians, who certified on 20 Apr. 2010 and 30 Apr. 2010 that San Juan was fit for duty.

However, he was not rehired by PTCI. Hence, he filed a complaint, seeking payment of his permanent disability benefits and sickness allowance. Subsequently, he sought a second medical opinion from Dr. Pascual, who certified that he was "medically unfit to work in any capacity as seaman.”

Should the contrary findings of San Juan's own physician be upheld over the fit-to-work certifications issued by PTCI's company- designated physicians?

A: NO. Settled is the rule that when a seafarer sustains a work-related illness or injury while on board the vessel, his fitness or unfitness for work shall be determined by the company-designated physician, and that "in case of conflicting medical assessments between the company-designated physician and the seafarer's own physician, referral to a third doctor is mandatory. In the absence of a third doctor's opinion, it is the medical assessment of the company-designated physician that should prevail.”

In this case, San Juan pursued his claim without observing the laid-out procedure. Instead of setting into motion the process of selecting a third doctor, he preempted the mandated procedure by filing the instant complaint for permanent total disability benefits (Philippine Transmarine Carriers, Inc. v. Almario San Juan, G.R. No. 207511, 05 Oct. 2020, as penned by J. Hernando).

Q: Smith Bell Manning hired Esteva as a seafarer for 9 months. He underwent the prescribed medical examination and was pronounced fit to work. While he was onboard the vessel, Esteva began to suffer severe back pains. He underwent x-ray and was diagnosed with lumbar disc prolapse. According to the Injury/Illness Report, his condition required a specialist treatment and possible operation. Dr. Watson declared Esteva to have a temporary total disability and unfit for work and recommended immediate repatriation. Wilhelmsen Ship Management also wrote a letter requesting that Esteva be examined by the company-designated physician in the Philippines. Esteva returned to the Philippines and reported to his Er.

The company-designated physician, Dr. Cruz- Balbon, issued a Medical Certificate indicating that Esteva was given medications for Pott's disease, a form of tuberculosis of the spine. She prescribed that Esteva take at least one (1) year of treatment.

In the Medical Certificate, Esteva's suggested disability grading was Grade 8, with 2/3 loss of lifting power. Esteva consulted another doctor, Dr. Reyes-Paguia, who issued another Medical Certificate. Esteva consulted another doctor, Dr. Raymundo, an orthopedic surgeon. The physician issued a Medical Report which showed Esteva to be ambulatory but walking with a limp and his condition will no longer allow him to return as an able-bodied seaman.

Is Esteva entitled to total disability benefits?

A: YES. The entitlement of an overseas seafarer to disability benefits is governed by law, the employment contract, and the medical findings. Section 20(A)(3) of the 2010 POEA Standard Employment Contract provides that “…if a doctor appointed by the seafarer disagrees with the assessment, a third doctor may be agreed jointly between the Er and the seafarer. The third doctor's decision shall be final and binding on both parties.”

As the one contesting the company-designated physician's findings, it is the seafarer's duty to signify the intention to resolve the conflict through the referral to a third doctor. If the seafarer does not contest the findings and fails to refer the assessment to a third doctor, the company can insist on its disability rating even against a contrary opinion by another physician. Securing a third doctor's opinion is the duty of the Ee, who must actively or expressly request it.

Here, petitioner failed to signify his intention to resolve the conflicting assessments of the company- designated physician and his chosen physicians. Instead, he immediately filed the claim for permanent disability benefits. Clearly, petitioner failed to comply with the mandatory rule on referral to a third doctor.

Be that as it may, respondents also failed to discharge their duty. Petitioner claims that they did not inform him that the company-designated physician has already issued an assessment. Respondents did not dispute his contention that he was never furnished copies of the disability assessment, and that only after filing the Complaint did, he become aware of it.

Absent a final, definite disability assessment from a company-designated physician, the mandatory rule on a third doctor referral will not apply here.

Hence, petitioner cannot be faulted for not referring the assessment to a third doctor at the time he filed his Complaint. There was no medical assessment from a company-designated physician to contest then as it had not been timely disclosed to him.

Thus, petitioner's failure to refer the assessment to a third doctor is not fatal to his disability claim. Hence, petitioner is entitled to total and permanent disability benefits (Esteva v. Wilhelmsen Smith Bell Manning, et al., G.R. No. 225899, 10 July 2019)

Q: Jara was hired by Orient Hope as an engine cadet on board M/V Orchid Sun. On its way to Oman, M/V Orchid Sun sank off Muscat on 12 July 2007. Jara sustained leg injuries. On 29 May 2008, the company-designated physician suggested that his disability grading is Grade 11.

On 06 Mar. 2008, Jara filed a complaint with the Labor Arbiter, insisting that he was entitled to total permanent disability benefits amounting to US$60,000.00. Is Jara entitled to permanent and total disability compensation considering that there was a Grade 11 disability grading given by the company-designated physician?

A: YES. Jara is entitled to permanent and total disability compensation despite the Grade 11 disability grading given by the company-designated physician. For his complaint filed before 06 Oct. 2008, the applicable 120-day rule governs; the company-designated physician’s failure to issue a final and definitive medical assessment within that period rendered Jara’s disability permanent and total.

In Island Overseas Transport Corporation v. Beja (G.R. No. 203115, 07 Dec. 2015), this Court clarified that: If the maritime compensation complaint was filed prior to 06 Oct. 2008, the rule on the 120-day period, during which the disability assessment should have been made in accordance with Crystal Shipping, Inc. v. Natividad (G.R. NO. 154798, 20 Oct. 2005), that is, the doctrine then prevailing before the promulgation of Vergara on 06 Oct. 2008, stands; for complaints governed by Vergara, the company-designated physician generally has 120 days to issue a final and definite assessment, extendible to 240 days only when further treatment or assessment is medically justified. (Orient Hope Agencies, Inc. v. Jara, G.R. No. 204307, 06 June 2018)

Q: After suffering an Epileptic Seizure with post- fit neurological deficit, Atraje was repatriated to the Philippines and was referred to the company-designated doctor for further medical evaluation and treatment. After completing his treatment, Atraje continued to suffer from shoulder and neck pain. Thus, he consulted an independent specialist who declared him permanently unfit to resume his duties as a seaman.

Atraje later filed a complaint for permanent and total disability benefits against his Ers. The latter argued that since Atraje failed to comply with the third doctor rule, the assessment of the company-designated doctor should prevail.

Meanwhile, the Panel of Voluntary Arbitrators noted that while Atraje initiated submitting to examination by a third doctor, there was silence on the part of his Ers. Hence, it held that Atraje could not be faulted anymore if the appointment of a third physician was deemed waived in this case.

Does non-compliance with the third doctor rule prejudice Atraje’s claim for disability benefits?

A: NO. Under Sec. 20-A(3) of the 2010 POEA-SEC, “If a doctor appointed by the seafarer disagrees with the assessment, a third doctor may be agreed jointly between the Er and the seafarer. The third doctor’s decision shall be final and binding on both parties.” The assessment refers to the declaration of fitness to work or the degree of disability, as can be gleaned from Sec. 20-A(3)(1). It presupposes that the company-designated physician came up with a valid, final, and definite assessment on the seafarer’s fitness or unfitness to work before the expiration of the 120- or 240-day period.

In this case, the third doctor-referral provision does not apply because there is no definite disability assessment from the company-designated physicians. (Magsaysay Mol Marine, Inc. v. Atraje, G.R. No. 229192, 23 July 2018)

Q. Teodoro Ventura, Jr. was employed by Crewtech Shipmanagement Philippines, Inc. as Chief Cook on board the vessel MV Maria Cristina Rizzo. Ventura complained that he was having a hard time urinating that was accompanied by lower abdominal pain. He was medically repatriated and referred to the company-designated physician who diagnosed Ventura's illnesses to be "Cystitis with Cystolithiases and Benign Prostatic Hyperplasia (BPH)," which he declared to be not work-related.

Prior to the expiration of the 240-day period reckoned from his repatriation, Ventura claimed that he was verbally informed by the company-designated physician that it would be his last check-up session and that subsequent consultations would be for his own account. Ventura was compelled to seek an independent physician of his choice, Dr. Tan, who declared him to be permanently disabled.

a. Temporary Total Disability (TTD)

A total disability is temporary if as a result of the injury or sickness, the Ee is unable to perform any gainful occupation for a continuous period not exceeding 120 days, or where the injury or sickness still requires medical attendance beyond 120 days but not exceed 240 days from the onset of disability. (Sec. 2(a), Rule VII, Amended Rules on EC)

Conditions for Entitlement

An Ee shall be entitled to an income benefit for temporary total disability if all the following conditions are satisfied:

• He has been duly reported to the System;
• He sustains the temporary total disability as a result of the injury or sickness; and
• The System has been duly notified of the injury or sickness which caused his disability.

NOTE: His Er shall be liable for the benefit if such illness or injury occurred before the Ee is duly reported for coverage to the System. (Sec. 1, Rule X, Amended Rules on EC)

Period of Entitlement

The income benefit equivalent to 90% of his average daily salary credit shall be paid beginning on the first day of such disability. If caused by an injury or sickness, it shall not be paid longer than 120 consecutive days except when such injury or sickness still requires medical attendance beyond 120 days but not to exceed 240 days from onset of disability, in which case, benefit shall be paid.

However, the System 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. (Sec. 2(a), Rule X, Amended Rules on EC)

NOTE: An Ee shall submit to the System 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. (Sec. 5, Rule IV, Amended Rules on EC)

Effect of Relapse of Illness

After the Ee has fully recovered from an illness as duly certified to by the attending physician, the period covered by any relapse he suffers, or recurrence of his illness, which results in disability and is determined to be compensable, shall be considered independent of, and separate from, the period covered by the original disability in the computation of his income benefit for temporary total disability. (Sec. 2(b), Rule X, Amended Rules on EC)

b. Permanent Total Disability (PTD)

A disability is total and permanent if as a result of the injury or sickness, the Ee is unable to perform any gainful occupation for a continuous period exceeding 120 days except when the disability not exceeding 240 days is declared as temporary total disability. (Sec. 2(b), Rule VII, Amended Rules on EC)

Total disability means disablement of an Ee to earn wages in the same kind of work, or work of 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. (Philippine Transmarine Carriers, Inc. v. NLRC, G.R. No. 123891, 28 Feb. 2001)

NOTE: In disability compensation, it is not the injury per se which is compensated but the incapacity to work. (Bejerano v. ECC, G.R. No. 84777, 30 Jan. 1992)

Conditions for Entitlement

An Ee is entitled to an income benefit for permanent total disability if all of the following conditions are satisfied:

• He has been duly reported to the System;
• He sustains the permanent total disability as a result of the injury or sickness; and
• The System has been duly notified of the injury or sickness which caused his disability.

NOTE: His Er shall be liable for the benefit if such illness or injury occurred before the Ee is duly reported for coverage to the System. (Rule XI, Amended Rules on EC)

Total Disabilities Deemed Permanent

The following total disabilities shall be considered permanent:

• Temporary total disability lasting continuously for more than 120 days, except as otherwise provided for temporary total disability;
• Complete loss of sight of both eyes;
• Loss of two limbs at or above the ankle or wrist;
• Permanent complete paralysis of two limbs;
• Brain injury resulting in incurable imbecility and insanity; and
• Such cases as determined by the System and approved by the Commission. (Sec. 1, Rule XI, Amended Rules on EC)

Permanent Disability Benefits

A member suffers permanent disability for reasons not due to his grave misconduct, notorious negligence, habitual intoxication, or willful intention to kill himself or another.

Period of Entitlement

The full month income benefit shall be paid for all compensable months of disability. (Sec. 2(a), Rule XI, Amended Rules on EC)

After the benefit under the EC has ceased as provided under the preceding paragraph, and if the Ee is otherwise qualified for benefit for the same disability under another law administered by the System, he shall be paid a benefit in accordance with the provisions of that law. This paragraph applies to contingencies which occurred prior 01 May 1978. (Sec. 2(b), Rule XI, Amended Rules on EC)

NOTE: Except as otherwise provided for in other laws, decrees, orders or letter of instructions, the monthly income benefit shall be guaranteed for five (5) years and shall be suspended under any of the following conditions:

• Failure to present himself for examination at least once a year upon notice by the System;
• Failure to submit a quarterly medical report certified by his attending physician;
• Complete or full recovery from his permanent disability; or
• Upon being gainfully employed. (Sec. 2(c), Rule XI, Amended Rules on EC)

Employee is:

• In service at the time of disability; or
• Even if separated, he has paid at least 36 monthly contributions within the 5- year period immediately prior to disability or has paid a total of at least 180 monthly contributions prior to disability; and
• Member is not enjoying old-age retirement benefits.

Eligibility Requirement

36 monthly contributions prior to the semester of death.

If the member paid at least 36 monthly contributions before the semester of death, the primary beneficiaries are entitled to a monthly pension. In the absence of primary beneficiaries, the secondary beneficiaries are entitled to a lump sum equivalent to 36 times the monthly pension.

If ineligible, lump sum benefit which shall be the higher between the two:

• monthly pension x 12; or
• monthly pension x [# of monthly contributions]

c. Permanent Partial Disability (PPD)

A disability is partial and permanent if as a result of injury or sickness, the Ee suffers a permanent partial loss of the use of any part of his body. (Sec. 2(c), Rule VII, Amended Rules on EC)

NOTE: An Ee’s disability may not manifest fully at one precise moment in time but rather over a period of time. It is possible that an injury which at first considered as temporary may later become permanent, or who suffers a partial disability becomes total and permanently disabled for the same cause. (GSIS v. CA, G.R. No. 117572, 29 Jan. 1998)

Eligibility Requirement

• 36 monthly contributions prior to the semester of disability; same as death benefit; the only difference is that the pension is paid directly to the member.
• In case the permanently disabled member dies, it would be given the same treatment as a retiree dying.
• For permanent partial disability, the pension is not lifetime [e.g. loss of thumb entitles members to only 10 months of pension, while loss of arm 50 months]. It shall be paid in lump sum if the period is less than 12 months.

Conditions for Entitlement

An Ee is entitled to an income benefit for permanent partial disability if all of the following conditions are satisfied:

• He has been duly reported to the System;
• He sustains the permanent partial disability as a result of the injury or sickness; and
• The System has been duly notified of the injury or sickness which caused his disability.

NOTE: His Er shall be liable for the benefit if such illness or injury occurred before the Ee is duly reported for coverage to the System.

For purposes of entitlement to income benefits, a covered Ee shall continue to receive benefits provided thereunder even if he is gainfully employed and receiving his wages or salary. (Sec. 1(b), Rule XII, Amended Rules on EC)

Period of Entitlement

The monthly income benefit shall be paid beginning on the first month of such disability, but no longer than the designated number of months in the following schedule: (Art. 199, LC)

Source: Labor Code, Art. 199 (formerly Art. 193), par. (b), as amended.

A worker who sustained work-related injuries that resulted to functional loss and/or physical loss of any part of his body shall be granted Temporary Total Disability (TTD) and Permanent Partial Disability (PPD) benefits successively. Any earlier compensation for TTD that may have been paid to an injured worker shall not be deducted from the PPD benefit that may be later granted to him.

NOTE: Under Sec. 2(b), Rule XII, Amended Rules on Employees’ Compensation:

• Loss of a wrist shall be considered a loss of a hand;
• Loss of an elbow shall be considered a loss of the arm;
• Loss of an ankle shall be considered a loss of the foot;
• Loss of a knee shall be considered a loss of the leg;
• Loss of more than one joint shall be considered a loss of the whole finger or toe;
• Loss of only the first joint shall be considered a loss of one-half of the whole finger or toe; and
• Other permanent partial disabilities shall be determined by the Medical Officer of the System.

DEATH BENEFITS

Compensable death refers to death which is the result of a work-related injury or sickness. (Chan, 2019)

Permanent Total Disability Benefit

• Monthly income benefit for life equal to basic monthly pension (effective from date of disability);
• If member is in service at the time of disability and he has paid at least 180 monthly contributions, in addition to the monthly income benefit, he shall receive an additional cash payment of 18 times basic monthly pension.

Conditions for Entitlement

The beneficiaries of a deceased Ee shall be entitled to an income benefit if all of the following conditions are satisfied:

• The Ee has been duly reported to the System;
• He died as a result of an injury or sickness; and
• The System has been duly notified of his death as well as the injury or sickness which caused his death.

NOTE: His Er shall be liable for the benefit if such illness or injury occurred before the Ee is duly reported for coverage to the System.

If the Ee has been receiving monthly income benefit for PTD at the time of his death, the surviving spouse must show that the marriage has been validly subsisting at the time of his disability. In addition, the cause of death must be a complication or natural consequence of the compensated PTD. (Sec. 1, Art. XIII, Amended Rules on EC)

In Case of Death of Member

• Primary beneficiaries as of the date of disability shall be entitled to receive the monthly pension; OR
• If no primary beneficiaries and he dies within 60 months from the start of his monthly pension, his 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 dependents’ pension.

Funeral Benefits [Sec. 13-B, RA 11199]

Upon the death of a member, the person who paid the funeral expenses receives a funeral benefit of at least ₱20,000, subject to the amount set under applicable SSS rules.

I. For Primary Beneficiaries

• The monthly income benefit shall be paid beginning at the month of death and shall continue to be paid as long as the beneficiaries are entitled thereto. With respect to the surviving legitimate spouse, the qualification is that he/she has not remarried. For dependent children, the qualifications are that they must be:
• Unmarried;
• Not gainfully employed; and
• Not over 21 years of age; or, if over 21 years of age, incapable of self-support due to a physical or mental defect which is congenital or acquired during minority.
• The monthly income benefit shall be guaranteed for five (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. (Sec. 2(A), Rule XIII, Amended Rules on EC)

Permanent Partial Disability Benefit

Paid according to GSIS prescribed schedule.

Eligibility requirements

Employee must be:

• In service at the time of disability; or
• If separated, he has rendered at least 3 years of service and paid at least 6 monthly contributions in the 12-month period immediately prior to disability;
• All sick leave credits including CBA sick leaves for the current year has been used up; and
• Maximum of 120 days per 1 calendar year (maximum permissible for the same sickness and confinement is 240 days for 2 consecutive years).

II. For Secondary Beneficiaries:

The income benefit shall be 60 times the monthly income benefit of a primary beneficiary, which shall in no case be less than P15,000.00, which shall likewise be paid in monthly pension. (Sec. 2(B), Rule XIII, Amended Rules on EC)

NOTE: If the deceased has no beneficiaries at the time of his death, the death benefit shall accrue to the Ees Compensation Fund. (Sec. 2(C), Rule XIII, Amended Rules on EC)

In relation thereto, the following are the guidelines on the grant of EC death benefits to qualified wives and children beneficiaries of Muslims:

• The basic monthly pension shall be divided equally among the surviving wives;
• Upon the death or remarriage of any of the wives, her basic monthly pension shall be equally redistributed to the remaining wives; and
• The qualified dependent children not exceeding 5 beginning with the youngest and without substitution, who are entitled to dependent’s pension, shall be counted from among the collective number of children of the wives of the Muslim and not counted from the children of each wife of the Muslim. (Board Resolution No. 14-07-34, 29 July 2014)

Presumptive Death

Under ECC Circular No. 15-01-20, 20 Jan. 2015, the following are the series of events which should be considered in the grant of EC benefits:

• The word “missing” refers to unknown fate or there is no trace of whereabouts of a worker, Ee and uniformed personnel while he/she is in the performance of his/her duties during the calamities or fatal events;
• The worker, Ee or uniformed personnel was not seen or heard from after the lapse of four years from the occurrence of the incident;
• The disappearance of the worker, Ee or uniformed personnel gives rise to presumption of death; and
• The death of the worker, Ee or uniformed personnel arises out of and in the course of employment.

Temporary Disability Benefit

Entitled to 75% of the current daily compensation for every day or fraction thereof of disability or P70 whichever is higher.

Survivorship Benefits

Consists of

• The basic survivorship pension (50% of the basic monthly pension); and
• The dependent children’s pension (not exceeding fifty percent (50%) of the basic monthly pension).

Funeral Benefits

Paid upon the death of:

• An active member; or
• A member who has been separated from the service, but who may be entitled to future benefit; or
• A pensioner; or
• A retiree who at the time of his retirement was of pensionable age under this Act but who opted to retire under RA 1616.