Labor
Content
COVERAGE AND LIABILITY
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Coverage of Employee’s Compensation Law
1. All ERs, public or private
2. All EEs, public or private, including:
a. Casual
b. Emergency
c. Temporary or substitute EEs
d. Filipinos employed abroad, subj to
regulations by ECC
e. AFP members
EE’s Coverage – up to 60y/o or over 60, if he had been paying
SSS/GSIS contributions prior to age 60 and has not been
compulsorily retired
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Effectivity Date of Coverage
ER – from the 1st day of operation
EE – from the 1st day of ENT
Registration - required for each ER and his EEs
Art 172. LIMITATIONS OF LIABILITY
GR: ECL is intended to assist innocent victims of ENT
accident or work-related illness.
: Self-inflicted/self-courted contingencies
1. Intoxication/drunkenness– being under the influence
of intoxicating liquor to the extent that one is not
entirely himself or so that his judgment is impaired
and his act, words, or conduct is visibly impaired
2. Self-inflicted injuries – due to willful or deliberate
intent on the part of the EE to injure himself (not
merely a failure to realize the probable consequences
to himself of his foolish act)
a. Suicide or provoked death
CASE: Mabuhay Shipping Services Inc & Skippers Maritime v
NLRC
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Seaman, Sentina ran amuck or who in a state of
intoxication provoked a fight as a result of w/c he was
killed, even during the term of his ENT does not give
rise to compensation
Challenged everyone to fight with an axe, picked up and
broke a cup and hurled it to an oiler Ero who suffered
injury
ER is exempted from liability for burial expenses for a
seaman who commits suicide.
Mere death of seaman during term of his
employment does not automatically give rise to
compensation
Interorient Maritime v Pineda: a seaman who, his job contract in
Dubai having ended, was returning to the PH but, during a
stopover, wandered on the streets of Bangkok. He brandished a
knife at people, including a policeman who reacted by shooting
him dead.
Although his death was the result of his willful act, he
was found to have been suffering from mental disorder
(he was deprived of reason), and his will was impaired.
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It was a qualification/exemption from the self-inflicted
or deliberate willful act rule and the ER was held liable.
The obligations and liabilities of the ER do not end upon
the expiration of the contracted period as they are dutybound to repatriate the seaman to the point of hire to
terminate the contract of ENT.
ER should have observed some precautionary measures
and should not have allowed seaman to travel home
alone
Solidum v GSIS
Solidum was a marine assigned in Zamboanga.. While resting
after a patrol mission, he jokingly challenged his comrades to
a duel but they all ignored him. Pointing the muzzle of his
loaded rifle at his temple and saying “Bahala na,” he squeezed
the trigger, killing himself instantly.
- GSIS denied the death benefits: (1.) the contingency
did not arise out of and in the course of employment;
(2.) not performing his duties as a soldier when he
died; (3.) death was caused by his own notorious
negligence not by accident or “act of God”.
Relief designed to compensate only the working men
who are victims of work-connected injuries and other
contingencies
Estioko v GSIS
Estioko was a corporal of the Ph Army assigned in Fort
Bonifacio until his death at the age of 25. While off-duty, he
volunteered to clean another soldier’s firearm in the barracks.
In the process of cleaning it, he cocked the pistol, pointed the
barrel to his right temple and squeezed the trigger.
Unfortunately, it was loaded, and he died.The ECC ruled
against granting the compensation, stating that even though
Estioko was cleaning a pistol when he shot himself, it was not
accidental. He acted w/ notorious negligence when he tested
the firearm by firing it against his temple. As a soldier, he
should have known the basic standard safety procedures in
handling firearms.
NOT Notorious Negligence Cases
Quizon v GSIS:
Quizon was a soldier who died while testing a dynamite that
was confiscated by them. After asking permission from his
unit, he took a civilian pumpboat and proceeded towards a
nearby island. But along the way, he accidentaly ignited the
fuse, causing the dynamite to explode prematurely, instantly
killing him.
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His father’s claim for his death benefits was denied
by the GSIS: because aside from his notorious
negligence, he was not performing his duties at the
time of the accident.
HELD: Although finding negligence on the part of Quizon,
stated that it was NOT notorious. Considering the soldier’s
training on explosives as a ranger, his desire to test the
dynamite is but a natural reaction on his part to the extent that
he even ignored the advise of his colleague against his plan.
He was acting in the performance of his duties as a member of
the Ranger Training Group, and under the permission of a
superior.
Notorious Negligence – something more than
simple/contributory negligence. It signifies a deliberate
act of the employee to disregard his own personal safety.
(Not merely disobedience to rules, if there is no intention
to end his life)
3.
The action is SELECTIVE and the EE or his heirs
have a choice of availing themselves of the benefits
under the WCA or of suing in the regular courts
under the CC for higher damages from the ER by
reason of his negligence. But once election has been
exercised, the EE or his heirs are no longer free to
opt for the other remedy. The EE cannot pursue both
actions simultaneously (Pacana vs. Cebu Autobus
Comp)
RGL’s parents cannot be allowed to recover addt’l damages
under the CC. They had previously filed and had received the
compensation under WCA.
Art 174. LIABILITY OF 3RD PARTIES
Art 179 (173). EXTENT OF LIABILITY
Rules on Simultaneous Recovery
1. Simultaneous recovery under the LC and the CC cannot
be made. The action is selective and the EE may choose
to file the claim under either. But once the election is
made, the claimant cannot opt for other remedy.
2. Simultaneous recovery under the LC and the SSS can be
made. (DOJ Opinion #8) since PD 1921 has lifted the
ban on simultaneous recovery.
RA7699 institutes a scheme for totalization and portability of
SS benefits. A covered worker who transfers ENT from one
sector to another or is employed in both sectors shall have his
creditable services or contributions in both Systems credited to
his service contribution record in each of the Systems and
shall be totalized for the 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
w/o totalization. Provided, however, that overlapping periods
of membership shall be credited only once for totalization.
Recovery under the WCA or under the CC
Ysmael Maritime Corp v Avelino:
RGL a licensed 2nd mate, on board a vessel owned by YMC,
perished when the vessel ran aground and sank. His parents
sued YMC for damages. YMC alleged that claimants had
already been compensated by the WCC for the same incident,
for w/c reason they are now precluded from seeking other
remedies against the same ER under the CC.
SC was confronted w/ 3 divergent opinions on the exclusivity
rule (Floresca vs Philex):
1. The injured EE or his heirs, in case of death, may
initiate an action to recover damages (not
compensation under the WCC) w/ regular courts on
the basis of negligence of the ER pursuant to the CC;
2.
Robles case: the remedy of an EE for workconnected injury/accident is exclusive in accordance
w/ Sec.5 of the WCA;
Legal Subrogation
- When the disability/death is caused by circumstances
creating a legal liability against a 3rd party, the
disabled EE or the dependents in case of his death
shall by paid by the System (SSS/GSIS as the case
may be).
- In case the benefit is paid, the System shall be
SUBROGATED to the rights of the disabled EE or
the dependents in case of his death, in accordance w/
general law.
3rd Party – one upon whom no liability could entail under the
law; one who is not an ER of the injured EE or a stranger
to the ENT relationship and who may be held liable at
common law for his negligence w/c results in an injury to
the EE
Excessive Recovery
- Where the System recovers from such 3rd party
damages in excess of those paid or allowed under the
law, such excess shall be delivered to the disabled EE
or other persons entitled thereto, after deducting the
cost of proceedings and expenses of the System.
Double Recovery
- The injured EE cannot claim payment twice for the
same injury from both the 3rd party and the System.
Art 175. DEPRIVATION OF BENEFITS
No contract, regulation or device whatsoever shall operate
to deprive the EE or his dependents of any part of the
income benefits, and medical or related services granted
under this Title.
Existing medical services being provided by the ER shall
be maintained and continued to be enjoyed by their EEs.
- Except as otherwise provided under this Title
Ch III ADMINISTRATION
Art 176. EE’s COMPENSATION COMMISSION (ECC)
Creation of EE Compensation Commission
- To initiate, rationalize and coordinate the policies of
EE’s compensation program
- Composed of
o Sec of DOLE – Chairman
4 Ex-officio members:
o GSIS Gen Mgr
o SSS Administrator
o Chairman of Ph Medical Care Commission
o Exec Dir. Of the ECC Secretariat
2 Appointive members:
o 2 members appointed by the President for a
term of 6yrs. (1 rep of the EE’s and 1 rep of
the ERs) – must have at least 5yrs
experience in WC or SS programs.
- Vice Chairman shall be alternated each yr bet the
GSIS Gen Mgr and the SSS Admin.
- Quorum: presence of 4 members
- Salary: per diem; P200 for every mtg that is actually
attended by him, exclusive of actual, ordinary and
necessary travel & representation expenses.
- Representative in absence of any Member: an official
of the institution he serves on full-time basis
- CEO of GSIS/SSS – shall be responsible for the gen
conduct of the operations and mgt functions of the
System; and for carrying out the policies of the ECC
- ECC Status – a govt corp attached to the DOLE for
policy coordination & guidance.
- ECC is the policy-making body of the EC Program
and also the appeal body.
- The decisions of either SSS/GSIS if unfavorable to
the claimant, are appealable to the ECC. Upon
appeal, the system elevates the record of the case to
the ECC for review.
The ECC has 3 Thrusts/Components:
1. PREVENTIVE THRUST – the mission is to
minimize & control hazards in the working envt. 2
agencies are involved in this program
a. Bureau of Working Conditions (BWC) of
the DOLE – inspects work premises
b. The Occupational Safety & Health Center
(OSHC) - trains safety engineers, tests
safety equipmt and undertakes research
work
- To force the observance of the legal reqmt on
occupational health & safety, the establishments
having a high rate of incidents caused by
hazards of their working envt will be liable to
25% of benefits due the claimants
2. COMPENSATIVE THRUST – the heart of the EC
Program. The ECC through the GSIS/SSS pays
benefits to govt & private sector workers who suffer
work-connected contingencies.
3. CURATIVE THRUST – the ECC does not only take
the responsibility for the benefits due the workers,
but also the treatment of sickness/injury that a worker
may suffer in line of duty as well as the rehab of
those who are disabled.
For medical services, the ECC conducts accreditation
of qualified physicians, clinics and hospitals where
EC patients may be referred to for admission and
treatment.
Rehab services consist of medical, surgical or
hospital treatment, incl. appliance.
2 Separate Funds
All revenues collected for the EC Program shall accrue to
SEPARATE SIFs established in 2 different govt entities,
namely the GSIS and the SSS.. , ECC may not
augment the SIF in one System w/ funds from the other
System.
Ch IV. CONTRIBUTIONS
Art 183. ER’s CONTRIBUTIONS
a. Beginning as of the last day of the month when an
EE’s compulsory coverage takes effect and every
month thereafter during his ENT, his ER shall
prepare to remit to the Sys a contribution equivalent
to 1% of EE’s monthly salary credit
b. Rate of contribution – reviewed periodically and,
subj to the limitations herein provided, may be
revised as the experience in risk, cost of admin, and
actual or anticipated as well as unexpected losses,
may require;
c. Contributions shall be paid in their entirety by the ER
and any contract/device for the deduction of any
portion thereof from the wages or salaries of the EEs
shall be null and void;
d. When a covered EE dies, becomes disabled or is
separated from ENT, his ER’s oblig to pay the
monthly contribution arising from that ENT shall
cease at the end of the month of contingency and
during such months that he is not receiving
wages/salary.
Art 184. GOV’T GUARANTEE
The RP guarantees the benefits prescribed under this
Title and accepts general responsibility for the solvency
of the SIF. In case of deficiency, the same shall be
covered by supplemental appropriations from the
national govt.
Amended rules on EC specifies 10 brackets of
monthly salary credits on w/c to base the 1%
contribution to ECC
The same rules provide the penalties to the ER who is
delinquent in paying ECC contributions, w/c include
imprisonment and/or fine and a 3% penalty per
month from the date the contribution falls due until
paid.
Ch. V. MEDICAL BENEFITS
1.
2.
Services
a. Medical services, appliances and supplies provided by the System immediately after an
EE contracts sickness or sustains an injury
and during the subsequent period of his
disability, as the nature of his sickness/injury
and progress of his recovery may require,
subj to the expense limitation prescribed
by ECC (Art 185)
b. Rehabilitation services
Cash Income Benefit or Pension due to:
a. Temporary total disability
b. Permanent total disability
c. Permanent partial disability
d. Death
EE is entitled to the benefits only for the ward services of an
accredited hospital and accredited physician.
ECC accredited hospitals & physicians
- are NOT allowed to ask any deposit from EC
patients as requisite for admission.
- Neither are they allowed to collect any amt from
EC patients as charges for treatment.
- However, they are privileged to claim
reimbursement w/ the ECC through the System
for expenses incurred in the treatment of EC
patients (Medicines and ICU expenses are
reimbursed 100%)
Reimbursement of Medical Expenses
SIF – has the duty to provide the EE w/ such services,
appliances and supplies as the nature of his
sickness/injury and the progress of his recovery may
require BUT if the System fails to promptly furnish the
same, such services, appliances and supplies may be
acquired by the EE himself, at the expense of the
SIF/System.
EE’s R of reimbursement for medical expenses is NOT
extinguished upon his deathtransmitted to legal heirs
unless they are essentially personal in nature or the law
declares them to be so. (not only those incurred for the
primary illness but even those for its complications even
if the complications developed after the EE’s retirement)
CASE: Medical Expenses for Complications
Alvero v GSIS: Alvero was Justice of the Peace in Quezon.
He became Asst. Provincial Fiscal and then promoted to
the position of RTC Judge. He retired on Apr 8, 1984 at
the age of 63. For all his compensable ailments (PTB,
Moderately advanced w/ Pulmonary Emphysema and
Chronic Obstructive Pulmonary Disease) he was
granted:
a) temporary total disability benefits from Jan 4-19,
1984; and
b) permanent total disability benefits from Apr 8, 1984
to Dec 1988.
Not satisfied w/ this, he also requested for the
reimbursement of medical expenses incurred for Diabetes
Mellitus and Gastritis.
The System denied his request for reimbursement on the
ground that only those medical expenses of primary
therapeutic value w/c pertain to the approved illness at the
time of his separation from the service were allowed for
reimbursement. Medical expenses incurred due to
complications that appeared after he had retired from the
service and those w/c are of preventive value, (per Medical
Evaluation and Underwriting Group-GSIS policy), were
excluded. The Sys further alleged that he had alrdy availed
of permanent total disability benefits, consisting of
reimbursement of medicines, medical supplies, lab exams,
professional fees for claimed ailment as well as
hospitalization benefits.
RULING: The complications that arose from Alvero’s
primary illnesses PTB and Emphysema were brought
about by the intake of medications like steroids, antibiotics
and diuretics. For this reason, he is entitled to
reimbursement of medications used in treating the
complications, Diabetes and Gastritis (stomach ulcer)
Art 186. LIABILITY. The System shall have the authority to
choose/order a change of physician, hospital or rehab
facility for the EE, and shall NOT be liable for
compensation for any aggravation of the EE’s
injury/sickness resulting from unauthorized changes by
the EE of medical services, appliances, supplies,
hospitals, rehab facilities or physicians.
The oblig to provide medical services lasts from as
long as the EE is sick (during the “period of
disability”) of a compensable illness, and this duty is
not ended when ENT terminates.
The law does not provide a maximum either in the
amt to be paid or the time period w/in w/c such R
may be availed of by the EE. It is as much medical
expenses as may be necessary until the workconnected injury/sickness ceases, may be charged
against the SIF and are to be paid by the System.
Prevailing Rule in Compensation Cases: Acts not
containing any limitation as to the period during w/c
the ER may furnish/pay for medical, surgical, or
hospital services have been construed as imposing
liability on the ER as long as such services are
required to cure/relieve the injured EE from the effect
of his injury.
Art 187. ATTENDING PHYSICIAN. Any physician attending
an injured/sick EE shall COMPLY w/ all the regulations
of the Sys and SUBMIT reports in prescribed forms at
such time as may be required concerning his
condition/treatment. All medical info relevant to the
particular injury/sickness shall on demand be made
available to the EE or the System. No info developed in
connection w/ the treatment/examination for w/c
compensation is sought shall be considered as privileged
communication.
Art 188. REFUSAL OF EXAMINATION OR TREATMENT
– If the EE unreasonable refuses to submit to medical
exam or treatment, the Sys shall STOP the PAYMENT of
further compensation during such time as such refusal
continues. What constitutes unreasonable refusal shall be
determined by the Sys w/c may on its own initiative
determine the necessity, character and sufficiency of any
medical services furnished or to be furnished.
Art 189. FEES & OTHER CHARGES – All fees and other
charges for hospital services, medical care and
appliances including professional fees shall NOT be
higher than those prevailing in wards of hospitals for
similar services to injured/sick persons in general and
subj to the regulations of ECC. Professional fees shall
only be appreciably HIGHER than those prescribed
under the Ph Medical Care Act of 1969.
Art 190 REHABILITATION SERVICES –
a) The System shall, as soon as practicable,
ESTABLISH a continuing program for the rehab of
injured and handicapped EEs, who shall be entitled
to rehab services, w/c shall consist of medical,
surgical or hospital treatment, including appliances
if they have been handicapped by the injury, to help
them become physically independent.
b) As soon as practicable, the Sys shall establish
centers equipped and staffed to provide a balanced
program of remedial treatment, vocational
assessment and preparation designed to meet the
indiv needs of each handicapped EE to restore him
to suitable ENT, including assistance as may be
w/in its resources to help each rehabilitee to
develop his mental, vocational or social potential.
Rehabilitation Services– include a balanced program of
remedial treatment, vocational assessment and
preparations designed to meet the indiv needs of each
handicapped EE to restore him to suitable ENT, incl
assistance as may be w/in its resources to help each
rehabilitee develop his mental, vocational or social
potential.
3 Stages of Rehabilitation
a) PHYSICAL REHABILITATION – involves physical
therapy by the rehab center of the ECC-accredited
hosp, furnishing of prosthesis and appliances all paid
by the ECC
b) VOCATIONAL ASSESSMENT – involves
evaluation by guidance psychologist of the ECC and
sending to vocational school of those found ready to
reengage in gainful ENT
c) VOCATIONAL PLACEMENT – involves job
placement by ENT Service Officer to help him
become independent and gainfully employed.
Ch. VI. DISABILITY BENEFITS
Disability– does not refer to the injury nor to the pain &
suffering it has occasioned, but to the loss/impairment of
earning capacity. There is disability when there is a
loss/diminution of earning power because of actual
absence from work due to the injury or illness arising out
of and in the course of ENT.
Basis of compensation: reduction of earning power
Thus, even if an EE suffers a service-connected injury/illness
as long as he goes on working wlo any reduction
whatsoever in his earning capacity, there is no disability.
3 Distinct Categories of Disability
a. Temporary Total Disability (TTD)
b. Permanent Total Disability (PTD)
c. Permanent Partial Disability (PPD)
Total Disability– may either be temporary or permanent.
- does not mean a state of absolute helplessness,
but means disablement of an EE to earn wages
in the same kind of work, or a work of similar
nature, that he was trained for or accustomed to
perform, or any kind of work w/c a person of
his mentality and attainment could do.
- Object of compensation is to compensate the
injured laborer/EE for the actual and permanent
loss of a member of the body, or the use thereof.
Art 191. TEMPORARY TOTAL DISABILITY
Amount of Benefits: equivalent to 90% of his ave. daily
salary credit per day, subj to the ff conditions:
1. from P10-P90 for a continuous period not exceeding
120 days for the same disability, UNLESS the
injury/sickness requires more extensive treatment that
lasts beyond 120 days, but NOT to exceed 240 days
from onset of disability, in w/c case he shall be paid
benefit for TTD during the extended period.
2. The monthly income benefit shall be SUSPENDED if
the EE fails to submit a monthly medical report
certified by its attending physichan.
The maximum for daily income benefit for TTD is
INCREASED to P200 by ECC board resolution on
Oct 10, 1996, Effective Nov 1, 1996.
Period of Entitlement– the income benefit shall be paid
beginning on the 1st day of such disability. If caused by
an injury/sickness, it shall not be paid longer than 120
consecutive days, except where such injury/sickness
still requires such medical attendance beyond 120days
but not to exceed 240 days from the onset of disability, in
w/c case, the benefit for TTD shall be pd. However, the
Sys may declare the total and permanent status at any
time after 120 days of continuous TTD.
Relapse– after an EE has fully recovered as duly certified, the
period covered by any relapse, w/c results in disability
and is determined to be compensable, shall be considered
SEPARATE from the pd covered by the original
disability.
Magsaysay Maritime Corp Case: If the 120 days initial pd is
exceeded and no declaration of the worker’s fitness of
permanent disability to work is made because the
seafarer requires further medical attention, then the TTD
period may be EXTENDED up to a MAXIMUM of 240
Days, subj to the R of the ER to declare w/in this period
that a permanent partial/total disability already exists.
Art 192. PERMANENT TOTAL DISABILITY
- If as a result of the injury/sickness, the EE is
unable to perform any gainful occupation for a
continuous period for more than 240 days.
- EE shall be paid by the System per month, an
amount equivalent to the monthly income
benefit PLUS 10% thereof for each dependent
child up to 5yrs old, beginning w/ the youngest
and w/o substitution. Provided, that the
monthly income benefit shall be the new amt of
the monthly benefit for all covered pensioners,
effective upon approval of this decree
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PTDs
1.
2.
3.
4.
5.
6.
7.
The Monthly Income Benefit (MIB) shall be
guaranteed for 5yrs and shall be suspended if:
a) the EE is gainfully employed, or
b) recovers from his PTD, or
c) fails to present for examination at least
once a yr upon notice by the System
except as otherwise provided for in
other laws, decrees, orders of LOIs.
A disability acknowledged by the company as PTD
w/in the periods allowed by law (120 days,
extendible to 240 days);
Upon expiration of the maximum 240-day treatment
period w/o a declaration of either fitness to work or
the existence of a permanent disability;
Complete loss of sight of both eyes;
Loss of 2 limbs or above the ankle or wrist;
Permanent complete paralysis of 2 limbs;
Brain injury resulting in incurable imbecility or
insanity; and
Such cases determined as determined by the Medical
Director of the System and approved by the ECC.
Period of Entitlement– the full monthly income benefit shall
be paid for all compensable months of disability
Suspension of Income Benefits– under any of the FF
conditions:
a. Failure of the EE to present himself for examination
at least once a yr upon notice by the System;
b. Failure to submit a quarterly medical report certified
by the attending physician;
c. Complete or full recovery from his permanent
disability; or
d. Upon being gainfully employed
Amount of Benefits
1. In the case of SSS – Any EE entitled to PTD benefit
shall be paid by the System a Monthly Income
Benefit…
a. The # of months of paid coverage shall be
the # of monthly contributions remitted to
the System including contributions other
than for EC if paid before March 31, 1975.
The full monthly income benefit shall be
paid for all compensable months of
disability.
b. The first day preceding the semester of TTD
shall be considered for purposes of
computing the monthly income benefit for
PTD.
Amt of Benefit for Dependent Children – each
dependent child up to 5y/o, counted from the
youngest and w/o substitution, shall be entitled
to 10% of the MIB of the EE. ( n/a to causes
of action w/c accrued before May 1, 1978)
Aggregate Monthly Benefit Payable– Except the
benefit to dependent children, the aggregate
monthly benefit payable in the case of GSIS,
shall in no case exceed the monthly wage/salary
actually received by the EE as of the date of his
PTD.
Art 193. PERMANENT PARTIAL DISABILITY (PPD)– if
as a result of the injury/sickness, the EE suffers a
permanent partial loss of the use of any ff part of his
body, (for not more than the period designated):
CASES:
PTD
Orlino v ECC: Suffering from mental lapses w/c made him
unfit for work, Orlino was forced to seek early retirement
at the age of 55y/o. from that time to present, he has not
been able to work nor engage in any gainful ENT.
BODY PART
PERIOD OF EQUIVALENT
(MONTHS) & totally
RULING: HeDISABILITY
is considered permanently
1 thumb
10
disabled to work when he was incapacitated/disabled to
1 index finger
8
perform any substantial amt of labor in the line of work
1 middle finger
6
he was formerly engaged or any other kind of work to
1 ring finger
5
w/c he could be assigned. Total disability does not mean
1 little finger
3
a state of absolute helplessness, but disablement of an
1 big toe
6
EE to earn wages in the same kind of work, or a work of
Any toe
3
similar nature, that he was trained for or accustomed to
1 arm
50
perform, or any kind of work w/c a person of his
1 hand
39
mentality and attainments could do. The approval of
1 foot
31
1 leg
46
claimant’s application for optional retirement for
1 ear
10
disability, although he has not yet reached the age of
Both ears
20
compulsory retirement age, is an indication of his
Hearing of 1 ear
10
physical incap to render further efficient service.
Hearing of both ears
50
Vicente v ECC: The test of w/n an EE suffers from PTD (as
Sight of 1 eye
25
defined above). In the case at bar, Vicente’s PTD is
established by several factors & circumstances. Pet’s
Amount of Benefits– a MIB for the # of months indicated. If
app for optional retirementon the basis of his ailments
the indicated # of months exceeds 12, the income benefit
had been approved. Considering that he was only 45 y/o
shall be paid in monthly pension; otherwise, the System
when he retired and still entitled, under good behavior,
may pay income benefit in lump sum or in monthly
to 20 more yrs in service, the approval of his optional
pension.
retirement app proves he was no longer fit to continue
his ENT. For optional retirement is allowed only upon
Effect of Gainful ENT– for PPD, a covered EE shall continue
proof that the EE-applicant is already physically incap to
to receive the benefits, even if he is gainfully employed
render sound and efficient service.
and receiving his wages/salary
PTD
Invariably results in an
EE’s loss of work or
inability to perform his
usual work
PPD
Occurs when an EE loses
the use of any particular
anatomical part of his body
w/c disables him to
continue w/ his former
work
TEST of PTD: a showing of the capacity of the EE to continue
performing his work notwithstanding the disability he
incurred. Thus, if by reason of the injury/sickness the EE
is unable to perform his customary job for more than 120
days and he does not come w/in the coverage of what
constitutes TTD, then the said EE undoubtedly suffers
from PTD regardless of whether or not he loses the use
of any part of his body.
Conversion from PPD to PTD
GSIS v CA and Balais: EE suddenly experienced chills,
followed by loss of consciousness. She was diagnosed to
be suffering from Subarachnoid Hemorrhage Secondary
to Ruptured Aneurysm. After undergoing craniotomy, she
was finally discharged. Despite her operation, the EE, a
cashier of the NHA, could not perform her duties as
efficiently as she did before her illness. This forced her to
retire at the age of 62 and filed a claim for disability
benefits.
GSIS granted her TTD benefits and subsequently, PPD
benefits for 9 months starting from her retirement.
She requested GSIS for the conversion of the
classification of PPD to PTD, but GSIS denied her
request and informed her that her condition did not
satisfy the criteria for PTD.
RULING: While it is true that the degree of the EE’s
physical condition at the time of her retirement was not
considered as PTD, yet it cannot be denied that her
condition subsequently worsened after her head
operation and consequent retirement. A person’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 w/c at first was considered to be
temporary may later on become permanent or one who
suffers partial disability becomes totally and
permanently disabled from the same cause.
Jurisprudence likewise show that disability is intimately
related to one’s earning capacity. The court construed
PTD as the “lack of ability to follow continuously some
substantially gainful occupation w/o serious discomfort
or pain and w/o material injury/danger to life. And there
is nothing in the law that prohibits the conversion of
PPD to PTD benefit if it is shown that the EE’s ailment
qualifies as such.
Is Earning Capacity “IMPAIRED” if earning is higher
after the injury?
Central Azucarera Don Pedro v WC Commissioner: EE’s
alleged new ENT after receiving compensation for a
PPD, has a higher salary.
RULING: Even supposing it to be true, that fact would
not in itself necessarily affect the laborer’s claim for
compensation for a PPD. An injured laborer’s incap for
work is not to be measured solely by the wages he
receives, or his earning after the injury, since the amt of
such wages/earnings may be affected by various
extraneous matters/factors. As noted in the American
Law Reports, there are a number of possible
explanations of the fact that an EE receives higher
wages after an injury than what he earned before may
still have suffered an impairment of earning capacity:
thus, it may indicate:
a) That the EE is the beneficiary of a mere gratuity
and does not actually ‘earn’ his wages;
b) That the EE, by education & training, has fitted
himself for more renumerative ENT;
c) That the EE works longer hrs than he did before
his injury, his hourly renumeration having
increased;
d) That a general change in wage scales has taken
place for the type of work or in the industry;
e) That the new wages are intended as an
inducement to him to refrain from pursuing a
clam;
f) That the EE, before his injury, was younger or a
minor;
g) That the ENT in w/c the EE was employed after
the injury was of uncertain duration.
Should the Previous Compensation for Lesser Disability be
Deducted?
Knoxville Knitting Mills v Galyon: The EE who has lost 3
fingers on his left hand, 19 yrs before he entered the
service of the ER involved in the case, lost his left hand
in an industrial accident while performing his duties as
the latter’s EE. He sought to recover for the loss of the
hand, but the ER contended that the value of the 3
fingers previously lost should be deducted.
US SC RULING: Deduction is prohibited because there
is no law allowing for such deduction.
Ph SC jurispridence: To offset the undue
hardship/injustice that may, at times be caused to the ER,
in consequence of the strict/literal interpretation of the
law, the ff ALTERNATIVES have been resorted to:
a) An insurance secured by the ER to protect
him/his business from the resulting loss; or
b) An amendment of the law, to provide for a
deduction of the compensation formerly paid
(Apportionment Statute).
Ch VII. DEATH BENEFITS
Amount of Benefits
The System shall pay to the primary beneficiaries upon the
death of the covered EE an amt equal to his monthly
income benefit, PLUS 10% thereof for each dependent
child up to 5y/o, beginning w/ the youngest, and w/o
substitution.
If the EE has no primary beneficiary, the Sys shall pay to
his Secondary beneficiaries the monthly income benefit
up to 60 months.
Minimum Death Benefit: at least P15K
Duration – guaranteed for 5yrs.
Death of a Covered EE who is under PTD – 80% of the
MIB
His dependents: dependents’ pension, PROVIDED:
a) The marriage must have been validly subsisting
at the time of the disability;
b) If he has no primary beneficiary, the Sys shall
pay to his secondary beneficiaries the monthly
pension, excluding the dependents’ pension, of
the remaining balance of the 5-yr guaranteed
period;
c) The minimum death benefit is at least P15k
Funeral Benefit– P3k to be paid upon the death of a covered
EE or PTD pensioner
Dependents as enumerated by Art 167(i):
1. legitimate, legitimated, legally adopted or
acknowledged natural child who is unmarried, not
gainfully employed, and not over 21y/o; OR over
21y/o provided he is incapacitated an incapable of
self-support due to a physical/mental defect w/c is
congenital or acquired during minority;
2. the legitimate spouse living w/ the EE;
3. the parents of said EE wholly dependent upon him
for regular support.
Dependency– does not mean absolute dependency for the
necessities of life, but rather, that the dependent looked
up to and relied on the contribution of the decedent in
whole or in part, as a means of supporting and
maintaining herself in accordance w/ her station in life.
(A person ma be dependent, accdg to this view, although
able to maintain himself w/o any assistance from the
decedent)
Test of Dependency– is not merely whether the contributions
were necessary to bare subsistence; dependency may
exist although the dependent could have subsisted w/o
the assistance he received, if such contributions were
relied on by claimant for his means of living as
determined by his position in life.
- One need NOT be actually a part of the
decedent’s household in order to be a dependent. There
may be dependency notwithstanding the EE did not work
steadily or was absent from the home at the time of his
accidental death, and notwithstanding the EE’s unlawful
acts or his statement in his app for ENT that he had no
dependents.
Rule: Support furnished to the claimant coupled w/ a reliance
thereon establishes dependency. The test of dependency
is NOT whether the claimants could support life w/o
contributions, but whether they depend on such
contributions as part of their income or means of living.
Spouse as Dependent– a marriage must exist, even if the
spouse is “gainfully employed”, so long as there is still
financial need for support.
Vda de Macabenta v Davao Stevedore Terminal Co: When
the decedent met the vehicular accident, the claimantwidow was not yet married to the decedent although they
had already been living together as H&W for the past 3
months. However, on the day following the accident, they
got married at the hospital where the deceased was
hospitalized up to his death.
RULING: It is true that the marriage took place after the
fatal accident, but there was no question that at the time
of his death, she was married to him. She, therefore,
comes entirely w/in the letter of the law. And the child
also falls w/in the meaning of dependent.
2 Wives as Claimants– ECC is empowered by law to resolve
disputes in compensation claims. It should be noted
however, that ECC may act as referee and arbitrator bet
the 2 claimants and help them reach a mutually
acceptable compromise settlement.
2 Muslim Wives– they are both entitled to compensation
benefits. Under the Muslim law, a Muslim male may
have more than 1 wife but not more than 4 at a time. And
they are considered primary beneficiaries.
ECC’s Suppletory Rules w/ regard to Distribution of the
MIB to the qualified beneficiaries:
1. MIB shall be shared equally by all primary
beneficiaries incl dependent children, wo were not
considered in the determination of the dependent
pension. Upon emancipation or otherwise disqual to
entitlement to the dependent pension of a dependent
child, only 10% shall be deducted from the benefits
and the remaining income benefits shall once again
be divided equally by the qualified primary benefits;
2. If there are no primary beneficiaries, their secondary
beneficiaries shall also share equally in the MIB.
Separated Spouse– may be held entitled to compensation
benefits if the separation occurred owing to any of the ff
circumstances:
a. Refusal of the covered EE to continue living w/ the
surviving spouse; or the EE’s abandonment of the
said spouse, w/o just cause;
b. Attempt of the covered EE against the life of the
surviving spouse, common child/children of spouse;
c. Commission of an act of sexual abuse against the
surviving spouse, common child/children or
child/children of the spouse by the covered EE;
d. The covered EE’s recurrent commission of physical
violence, or grossly abusive conduct, against the
surviving spouse, common child/children or child/ren
of the spouse;
e. The covered EE’s infliction of physical violence, or
imposition of moral duress, to compel the surviving
spouse, common child/ren or child/ren of the spouse
to change their religious or political affiliation;
f. Attempt of the covered EE to corrupt, or induce the
surviving spouse common child/ren or child/ren of
the spouse to engage in prostitution, or to make them
connive w/ the EE in such an act of corruption or
inducement;
g. Drug addiction or habitual alcoholism of the covered
EE;
h. Lesbianism or homosexuality of the covered EE;
i. Contraction of bigamous M by the covered EE,
whether in the PH or abroad;
j. Sexual infidelity or perversion of the covered EE;
k. The covered EE’s act of allowing the surviving
spouse, common child/ren or child/ren of the spouse
to be subjected to acts of lasciviousness; and
l. The covered EE’s contraction of serious, STD extramaritally.
Parents as Dependents
If the deceased EE is the adulterous child of the wife,
the H cannot claim as dependent of said deceased EE,
in the same manner that he is not duty-bound to
support said deceased EE.
Since abandonment of the child by the parent is cause
for the ceasing of the oblig of the former to support
the latter, no matter how financially desperate is the
situation of said parent, it follows that he cannot
claim as a dependent in a compensation case where
the deceased EE is an abandoned child.
Death Benefit and Beneficiaries
Death benefit are paid in form of cash monthly pension:
a. For life to the primary beneficiaries, guaranteed for
5yrs;
b. For not more than 60months to the secondary
beneficiaries, in case there are no primary
beneficiaries;
c. In no case shall the total benefit be less than P15k
The Beneficiaries are:
1. Primary Beneficiaries
a. Dependent spouse until s/he remarries;
b. Dependent children (legitimate, legitimated,
natural-born or legally adopted);
2. Secondary Beneficiaries
a. Illegitimate children and legitimate
descendants;
b. Parents, grandparents, grandchildren
The amt of income benefits shall be equivalent to the MIB
under PTD and PPD.
Under ECC Rules, the death benefit shall accrue to the
Employee’s Compensation Fund if the deceased EE has
no beneficiaries at the time of his death.
Death Benefit after Retirement
Manuzon v ECC: Generally, the term “covered EEs” refers
to an EE who at the time of his death is still an EE
covered by the GSIS/SSS. On the other hand, the IRR of
the ECC states that to be entitled to death benefits, the
EE need not be an actual EE of the public/private sector
at the time of his death; he can be a retired EE whose
retirement was brought about by permanent disability.
FACTS: During his ENT, the deceased suffered from a
stroke, caused by a blockage of arteries. He had to retire
because of paralysis caused by the stroke when he was an
asst professor. He died after compulsory retirement
caused by cardiovascular attack or MI. The ECC denied
the claims because the death came 4 and a half yrs after
his retirement caused by work-oriented paralysis arising
from the attack.
ECC Amended Rules: the payment of said benefit shall begin
at the month of death ‘and shall continue to be paid for as
long as the beneficiaries are entitled thereto.’ It further
states that after the guaranteed 5yrs, ‘the beneficiaries
shall be paid the MIB for as long as they are entitled
thereto.’
GSIS President Directive: suspended the payment of death
benefit beyond 5 yrs from death of a covered EE.
Ch VIII PROVISIONS COMMON TO INCOME
BENEFITS
Art 195. All questions of relationship & dependency shall be
determined as of the TIME OF DEATH.
Art 196. DELINQUENT CONTRIBUTIONS
An ER who is delinquent in his contributions shall be liable to
the Sys for benefits w/c may have been paid by the Sys
to his EEs or their dependents, and any benefit &
expenses to w/c such ER is liable shall constitute a lien
on all his property, real or personal w/c is hereby
declared to be preferred to any credit, except taxes. The
payment by the ER of the lump sum equivalent of such
liability shall absolve him from the payment of the
delinquent contribution and penalty thereon w/ respect to
the EE concerned.
Failure /refusal of the ER to pay/remit the contributions herein
prescribed shall NOT prejudice the R of the EE or his
dependents to the benefits under this Title. If the
sickness/injury/disability/death occurs before the Sys
receives any report of the name of his EE, the ER shall
be liable to the Sys for the lump sum equivalent to the
benefits to w/c such EE or his dependents may be
entitled.
Art 197. SECOND INJURIES
If any EE under PPD suffers another injury w/c results in a
compensable disability greater than the previous injury,
the SIF shall be liable for the income benefit of the new
disability, provided that if the new disability is related to
the previous disability, the Sys shall be liable only for the
difference in income benefits.
Benefits for Death of Pensioner– (Art 194(b) – death benefit
shall be paid to the beneficiaries if an EE, while
receiving PTD benefit dies. The death benefit here is
lower than that under par. (a). also, it shld be noted that
this provision does not apply to cases where a member
under PPD dies during the period he is receiving MIB
from PPD.
Art 198. ASSIGNMENT OF BENEFITS
NO claim for compensation under this Title is transferable or
liable to tax, attachment, garnishment, levy or seizure by
or under any legal process whatsoever, either before or
after receipt by the person/s entitled thereto, except to
pay any debt of the EE to the Sys. (in pursuant to Police
Power of the State)
Is the period of entitlement 5yrs only or even beyond?
Art 199. EARNED BENEFITS
Income Benefits shall, w/ respect to any period of disability,
be payable to an EE who is entitled to receive wages,
Art 194(1): The death benefit is guaranteed for 5 yrs.
salaries, or allowance for holidays, vacation or sick
leaves, and any award of benefit under a CBA or other
agreemt.
Art 200. SAFETY DEVICES
In case the EE’s injury/death was due to the failure of the ER
to comply w/ any law, or to install and maintain safety
devices, or take other precautions for the prevention of
injury, said ER shall pay to the SIF a penalty of 25% of
the lump sum equivalent of the income benefit payable
by the Sys to the EE. All ERs, esp those who shld have
been paying a rate of contribution higher than required of
them, are enjoined to undertake & strengthen measures
for the occupational health & safety of their EEs.
Art 201. PRESCRIPTIVE PERIOD
No claim for compensation shall be given due course unless
said claim is filed w/ the System w/in 3yrs from the time
the cause of action accrued.
BUT accdg to Manila Railroad Co. v Perez: Despite the 3yr prescriptive pd expressly provided by Art 201, a
compensation claim may be filed beyond this but before
the lapse of the 10th yr from accrual of the cause of
action, applying Art 1144 of the CC.
ECC v Sanico: 3yrs – have to be counted from the time the
EE lost his earning capacity, NOT from the time the
illness was discovered.
FACTS: EE was a former EE of John Gotamco & Sons
as a wood filer until he was separated from ENT due to
his sickness. He was suffering from PTB. He filed w/ the
SSS a claim for compensation benefits but was denied on
the ground of prescription.
Constructive Filing
Although the Code requires the claim to be in writing, the ff
acts have been held as equivalent to filing a claim w/ the
ER as required by the WC:
1. A verbal request for medical & hospitalization
expenses made to the corporate ER through its
treasurer;
2. Request for financial aid in behalf of the family of
the deceased worker made by the president of his
union.
Under ECC Resolution 2127 a claim is deemed to have been
filed for the purposes of prescription:
3. When the system itself receives from the concerned
EE, or his duly authorized rep/s or his ER, a written
notice giving info on the occurrence of a certain
contingency, w/c may be held compensable;
4. When a pertinent and authentic document evidencing
a particular contingency that befalls an EE is
submitted to and received by the Sys, for the purpose
of initiating payment of whatever benefits that may
duly accrue to the EE;
5. When the concerned EE, or any of his legal
beneficiaries or duly authorized rep/s files a
FORMAL CLAIM, w/ the Sys for life, retirement
and/or other insurance benefits because of disability
or death, w/c may also be held compensable.
Provided however, that in all these 3 cases, the claimant
shall be required, if necessary, to submit addt’l
supporting docs/papers to establish compensability,
otherwise, noncompliance therewith for an
unreasonably long time shall be deemed as
abandonment of claims and any subseq claims shall
be barred by laches.
Mailing Date of Claim Considered Date of Filing
Suanes v WCC: EE died. Claim for compensation was filed
2 yrs later. But the claim designated the wrong ER, who
was impleaded about 12yrs later.
RULING: Ordinarily, R to claim prescribes 10yrs from
the accrual of the claim (from death of EE), but where
the orig claim designated the wrong ER, the defense of
prescription must be rejected in the interest of
substantial justice.
Period to File Claim of Minors and the Mentally Deficient
Minors - prescribes in 10yrs from the time they reach the age
of majority.
Mentally deficient – prescribes in 10yrs from the moment a
legal guardian has been appointed
Art 225 of the FC: The mother/mother of the mentally
incapacitated child/ren, or of the dependent minor
child/ren and w/o the necessity of securing judicial
appointment as legal guardian, can file a claim for
compensation under the WCA and un under the present
law on EC for himself or herself and in behalf of those
nons sui juris.
Erroneous Payment
If the Sys, in GF pays income benefit to a dependent who is
inferior in R to another dependent or w/ whom another
dependent is entitled to share, such payment shall
discharge the Sys from liability, unless and until such
other dependent notifies the Sys of his claim prior to the
payments.
In case of doubt as to the respective Rs of rival claimants, the
Sys is hereby empowered to determine as to whom
payments shld be made in accdance w/ such regulations
as ECC may approve. If the money is payable to a
minor/incompetent, payment shall be made by the Sys to
such person/s as it may consider to be best qualified to
take care & dispose of the minor/incompetent’s property
for his benefit.
Art 203. PROHIBITION
No atty shall demand or charge for his services any fee…
-
The intent of the law is to free the award from any
liability/charge so that the claimant may enjoy/use it
to the fullest
it is the claimant who is exempt from liability for
atty’s fees. The defaulting govt agency remains liable
for atty’s fees bcoz it compelled the claimant to
employ the services of counsel by unjustly refusing
to recognize the validity of the claim.
Parties– it is not fatal to a claim for compensation that the
System was not impleaded as party respondent.
Art 204. EXEMPTION FROM LEVY, TAX, ETC.
All laws to the contrary notwithstanding, the SIF and all its
assets shall be exempt from any tax, fee, charge, levy, or
customs or import duty and no law hereafter enacted shall
apply to the SIF unless it is provided therein that the same is
applicable by expressly stating its name.
Ch IX. RECORDS, REPORTS & PENAL PROVISIONS
Art 205. RECORD OF DEATH/DISABILITY
a) All ERs shall keep a logbook to record
chronologically the sickness, injury or death of their
EEs, setting forth therein their names, dates, and
places of the contingency, nature of the contingency
and absences. Entries in the logbook shall be made
w/in 5 days from notice/knowledge of the occurrence
of the contingency. W/in 5 days after entry in the
logbook, ER shall report to the Sys only those
contingencies he deems to be work-connected.
b) All entries in the logbook shall be made by the ER or
any of his authorized officials after verification of the
contingencies or the EE’s absences for a period of a
day or more. Upon the request of the Sys, the ER
shall furnish the necessary cert regarding info about
any contingency appearing in the logbook, citing the
entry #, page # and date. Such logbook shall be made
available for inspection to the duly authorized rep of
the Sys.
c) Should any ER fail to record in the logbook an actual
sickness, injury or death of any of its EEs w/in the
period prescribed herein, give false info or withhold
material info already in his possession, he shall be
held liable for 50% of the lump sum equivalent of the
income benefit to w/c the EE may be found to be
entitled, the payment of w/c shall accrue to the SIF.
d) In case of payment of benefits for any claim w/c is
later determined to be fraudulent and the ER is found
to be a party to the fraud, such ER shall reimburse the
Sys the full amt of the compensation paid.
Art 206. NOTICE TO ER
The EE, his dependents, or anybody on his behalf, shld give
the notice of sickness, injury or death to the ER w/in
5days from the occurrence of the contingency. The
purpose is not only to establish the EE’s R to
compensation, as no claim for compensation shall be
given to the ER, but also to enable the ER to comply w/
its duty under the Rules– entering the contingency in the
logbook and of giving also due notice to the Sys if the
injury/sickness/death is deemed work-connected.
When Notice to ER NOT Needed (Under ECC Resolution
2127):
1. When the EE suffers the contingency w/in the ER’s
premises;
2. When the EE officially files an app for leave of
absence by reason of the contingency from w/c he
suffers;
3. When the ER provides medical services and/or
medical supplies to the EE;
4. When the ER can be reasonably presumed to have
knowledge of the EE’s contingency, in view of the ff
circs:
a. The EE was performing an official function
for the ER when the contingency occurred;
b. The EE’s contingency has been publicized
thru mass media;
c. The specific circs of the occurrence of the
contingency have been such that the EER
can be reasonably presumed to have readily
known it soon thereafter; and
d. Any other circs that may give rise to a
reasonable presumption that the ER has been
aware of the contingency.
Delay/failure to give the ER notice of compensable
illness/injury w/in the prescribed period does not bar a
claim for compensation IF it is shown that the latter, his
agent or rep in fact knows of such injury/illness or that
he suffered no damage by reason of such delay or lack of
notice.
Representatives– or “agents” whose knowledge is deemed
knowledge of their ER include:
1. Project engineer in charge of the work
2. Captain of the vessel in w/c the EE worked
3. Foreman
4. Asst mgr
5. Superintendent of transport oper.
Damage/prejudice– that the ER/Sys by reason of the failure to
receive the required notice, has been made less able to
resist the claim
Effect of Quitclaim– does not release the ER; it does not
result in waiver; the law does not consider as valid any
agreement to receive less compensation than what the
worker is entitled to recover
Even a compromise agreement approved by the court may be
disregarded by the NLRC in order to give protection to
labor.
Evidence – strict observance of the technical rules of evidence
is not properly demanded in WC cases (for purposes of
establishing relshp bet dependent & decedent)
Physician’s Report– the findings of the doctors & Chief of
the Medical Officer of the GSIS & ECC are not binding
on the SC as they are not considered experts.
Foreign Currency
Compensation benefits MAY be paid in foreign currency in its
equivalent in Ph currency, esp if based on the ENT
contract.
Applicable Law– in WC cases, the governing law is
determined by the date on w/c the claimant contracted
his illness. If the app for compensation does not state
when the claimant contracted the disease, the claim is
filed under PD 626, the presumption is that he contracted
the disease after the effectivity of said PD.
Title III MEDICARE
Art 209. MEDICAL CARE
RA 7875 – the National Health Insurance Act initiated the
Nat’l Health Insurance Program intending to provide
health insurance coverage and health care services for all
Filipinos.
Ph Health Insurance Corp is also created to carry out the
program
Title IV. ADULT EDUCATION
ART 210. Every ER shall render assistance in the
establishment & operation of adult education programs
for their workers and EEs as prescribed by regulations
jointly approved by DOLE and DEPED.
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Coverage of Employee’s Compensation Law
1. All ERs, public or private
2. All EEs, public or private, including:
a. Casual
b. Emergency
c. Temporary or substitute EEs
d. Filipinos employed abroad, subj to
regulations by ECC
e. AFP members
EE’s Coverage – up to 60y/o or over 60, if he had been paying
SSS/GSIS contributions prior to age 60 and has not been
compulsorily retired
-
Effectivity Date of Coverage
ER – from the 1st day of operation
EE – from the 1st day of ENT
Registration - required for each ER and his EEs
Art 172. LIMITATIONS OF LIABILITY
GR: ECL is intended to assist innocent victims of ENT
accident or work-related illness.
: Self-inflicted/self-courted contingencies
1. Intoxication/drunkenness– being under the influence
of intoxicating liquor to the extent that one is not
entirely himself or so that his judgment is impaired
and his act, words, or conduct is visibly impaired
2. Self-inflicted injuries – due to willful or deliberate
intent on the part of the EE to injure himself (not
merely a failure to realize the probable consequences
to himself of his foolish act)
a. Suicide or provoked death
CASE: Mabuhay Shipping Services Inc & Skippers Maritime v
NLRC
-
-
-
Seaman, Sentina ran amuck or who in a state of
intoxication provoked a fight as a result of w/c he was
killed, even during the term of his ENT does not give
rise to compensation
Challenged everyone to fight with an axe, picked up and
broke a cup and hurled it to an oiler Ero who suffered
injury
ER is exempted from liability for burial expenses for a
seaman who commits suicide.
Mere death of seaman during term of his
employment does not automatically give rise to
compensation
Interorient Maritime v Pineda: a seaman who, his job contract in
Dubai having ended, was returning to the PH but, during a
stopover, wandered on the streets of Bangkok. He brandished a
knife at people, including a policeman who reacted by shooting
him dead.
Although his death was the result of his willful act, he
was found to have been suffering from mental disorder
(he was deprived of reason), and his will was impaired.
-
It was a qualification/exemption from the self-inflicted
or deliberate willful act rule and the ER was held liable.
The obligations and liabilities of the ER do not end upon
the expiration of the contracted period as they are dutybound to repatriate the seaman to the point of hire to
terminate the contract of ENT.
ER should have observed some precautionary measures
and should not have allowed seaman to travel home
alone
Solidum v GSIS
Solidum was a marine assigned in Zamboanga.. While resting
after a patrol mission, he jokingly challenged his comrades to
a duel but they all ignored him. Pointing the muzzle of his
loaded rifle at his temple and saying “Bahala na,” he squeezed
the trigger, killing himself instantly.
- GSIS denied the death benefits: (1.) the contingency
did not arise out of and in the course of employment;
(2.) not performing his duties as a soldier when he
died; (3.) death was caused by his own notorious
negligence not by accident or “act of God”.
Relief designed to compensate only the working men
who are victims of work-connected injuries and other
contingencies
Estioko v GSIS
Estioko was a corporal of the Ph Army assigned in Fort
Bonifacio until his death at the age of 25. While off-duty, he
volunteered to clean another soldier’s firearm in the barracks.
In the process of cleaning it, he cocked the pistol, pointed the
barrel to his right temple and squeezed the trigger.
Unfortunately, it was loaded, and he died.The ECC ruled
against granting the compensation, stating that even though
Estioko was cleaning a pistol when he shot himself, it was not
accidental. He acted w/ notorious negligence when he tested
the firearm by firing it against his temple. As a soldier, he
should have known the basic standard safety procedures in
handling firearms.
NOT Notorious Negligence Cases
Quizon v GSIS:
Quizon was a soldier who died while testing a dynamite that
was confiscated by them. After asking permission from his
unit, he took a civilian pumpboat and proceeded towards a
nearby island. But along the way, he accidentaly ignited the
fuse, causing the dynamite to explode prematurely, instantly
killing him.
-
His father’s claim for his death benefits was denied
by the GSIS: because aside from his notorious
negligence, he was not performing his duties at the
time of the accident.
HELD: Although finding negligence on the part of Quizon,
stated that it was NOT notorious. Considering the soldier’s
training on explosives as a ranger, his desire to test the
dynamite is but a natural reaction on his part to the extent that
he even ignored the advise of his colleague against his plan.
He was acting in the performance of his duties as a member of
the Ranger Training Group, and under the permission of a
superior.
Notorious Negligence – something more than
simple/contributory negligence. It signifies a deliberate
act of the employee to disregard his own personal safety.
(Not merely disobedience to rules, if there is no intention
to end his life)
3.
The action is SELECTIVE and the EE or his heirs
have a choice of availing themselves of the benefits
under the WCA or of suing in the regular courts
under the CC for higher damages from the ER by
reason of his negligence. But once election has been
exercised, the EE or his heirs are no longer free to
opt for the other remedy. The EE cannot pursue both
actions simultaneously (Pacana vs. Cebu Autobus
Comp)
RGL’s parents cannot be allowed to recover addt’l damages
under the CC. They had previously filed and had received the
compensation under WCA.
Art 174. LIABILITY OF 3RD PARTIES
Art 179 (173). EXTENT OF LIABILITY
Rules on Simultaneous Recovery
1. Simultaneous recovery under the LC and the CC cannot
be made. The action is selective and the EE may choose
to file the claim under either. But once the election is
made, the claimant cannot opt for other remedy.
2. Simultaneous recovery under the LC and the SSS can be
made. (DOJ Opinion #8) since PD 1921 has lifted the
ban on simultaneous recovery.
RA7699 institutes a scheme for totalization and portability of
SS benefits. A covered worker who transfers ENT from one
sector to another or is employed in both sectors shall have his
creditable services or contributions in both Systems credited to
his service contribution record in each of the Systems and
shall be totalized for the 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
w/o totalization. Provided, however, that overlapping periods
of membership shall be credited only once for totalization.
Recovery under the WCA or under the CC
Ysmael Maritime Corp v Avelino:
RGL a licensed 2nd mate, on board a vessel owned by YMC,
perished when the vessel ran aground and sank. His parents
sued YMC for damages. YMC alleged that claimants had
already been compensated by the WCC for the same incident,
for w/c reason they are now precluded from seeking other
remedies against the same ER under the CC.
SC was confronted w/ 3 divergent opinions on the exclusivity
rule (Floresca vs Philex):
1. The injured EE or his heirs, in case of death, may
initiate an action to recover damages (not
compensation under the WCC) w/ regular courts on
the basis of negligence of the ER pursuant to the CC;
2.
Robles case: the remedy of an EE for workconnected injury/accident is exclusive in accordance
w/ Sec.5 of the WCA;
Legal Subrogation
- When the disability/death is caused by circumstances
creating a legal liability against a 3rd party, the
disabled EE or the dependents in case of his death
shall by paid by the System (SSS/GSIS as the case
may be).
- In case the benefit is paid, the System shall be
SUBROGATED to the rights of the disabled EE or
the dependents in case of his death, in accordance w/
general law.
3rd Party – one upon whom no liability could entail under the
law; one who is not an ER of the injured EE or a stranger
to the ENT relationship and who may be held liable at
common law for his negligence w/c results in an injury to
the EE
Excessive Recovery
- Where the System recovers from such 3rd party
damages in excess of those paid or allowed under the
law, such excess shall be delivered to the disabled EE
or other persons entitled thereto, after deducting the
cost of proceedings and expenses of the System.
Double Recovery
- The injured EE cannot claim payment twice for the
same injury from both the 3rd party and the System.
Art 175. DEPRIVATION OF BENEFITS
No contract, regulation or device whatsoever shall operate
to deprive the EE or his dependents of any part of the
income benefits, and medical or related services granted
under this Title.
Existing medical services being provided by the ER shall
be maintained and continued to be enjoyed by their EEs.
- Except as otherwise provided under this Title
Ch III ADMINISTRATION
Art 176. EE’s COMPENSATION COMMISSION (ECC)
Creation of EE Compensation Commission
- To initiate, rationalize and coordinate the policies of
EE’s compensation program
- Composed of
o Sec of DOLE – Chairman
4 Ex-officio members:
o GSIS Gen Mgr
o SSS Administrator
o Chairman of Ph Medical Care Commission
o Exec Dir. Of the ECC Secretariat
2 Appointive members:
o 2 members appointed by the President for a
term of 6yrs. (1 rep of the EE’s and 1 rep of
the ERs) – must have at least 5yrs
experience in WC or SS programs.
- Vice Chairman shall be alternated each yr bet the
GSIS Gen Mgr and the SSS Admin.
- Quorum: presence of 4 members
- Salary: per diem; P200 for every mtg that is actually
attended by him, exclusive of actual, ordinary and
necessary travel & representation expenses.
- Representative in absence of any Member: an official
of the institution he serves on full-time basis
- CEO of GSIS/SSS – shall be responsible for the gen
conduct of the operations and mgt functions of the
System; and for carrying out the policies of the ECC
- ECC Status – a govt corp attached to the DOLE for
policy coordination & guidance.
- ECC is the policy-making body of the EC Program
and also the appeal body.
- The decisions of either SSS/GSIS if unfavorable to
the claimant, are appealable to the ECC. Upon
appeal, the system elevates the record of the case to
the ECC for review.
The ECC has 3 Thrusts/Components:
1. PREVENTIVE THRUST – the mission is to
minimize & control hazards in the working envt. 2
agencies are involved in this program
a. Bureau of Working Conditions (BWC) of
the DOLE – inspects work premises
b. The Occupational Safety & Health Center
(OSHC) - trains safety engineers, tests
safety equipmt and undertakes research
work
- To force the observance of the legal reqmt on
occupational health & safety, the establishments
having a high rate of incidents caused by
hazards of their working envt will be liable to
25% of benefits due the claimants
2. COMPENSATIVE THRUST – the heart of the EC
Program. The ECC through the GSIS/SSS pays
benefits to govt & private sector workers who suffer
work-connected contingencies.
3. CURATIVE THRUST – the ECC does not only take
the responsibility for the benefits due the workers,
but also the treatment of sickness/injury that a worker
may suffer in line of duty as well as the rehab of
those who are disabled.
For medical services, the ECC conducts accreditation
of qualified physicians, clinics and hospitals where
EC patients may be referred to for admission and
treatment.
Rehab services consist of medical, surgical or
hospital treatment, incl. appliance.
2 Separate Funds
All revenues collected for the EC Program shall accrue to
SEPARATE SIFs established in 2 different govt entities,
namely the GSIS and the SSS.. , ECC may not
augment the SIF in one System w/ funds from the other
System.
Ch IV. CONTRIBUTIONS
Art 183. ER’s CONTRIBUTIONS
a. Beginning as of the last day of the month when an
EE’s compulsory coverage takes effect and every
month thereafter during his ENT, his ER shall
prepare to remit to the Sys a contribution equivalent
to 1% of EE’s monthly salary credit
b. Rate of contribution – reviewed periodically and,
subj to the limitations herein provided, may be
revised as the experience in risk, cost of admin, and
actual or anticipated as well as unexpected losses,
may require;
c. Contributions shall be paid in their entirety by the ER
and any contract/device for the deduction of any
portion thereof from the wages or salaries of the EEs
shall be null and void;
d. When a covered EE dies, becomes disabled or is
separated from ENT, his ER’s oblig to pay the
monthly contribution arising from that ENT shall
cease at the end of the month of contingency and
during such months that he is not receiving
wages/salary.
Art 184. GOV’T GUARANTEE
The RP guarantees the benefits prescribed under this
Title and accepts general responsibility for the solvency
of the SIF. In case of deficiency, the same shall be
covered by supplemental appropriations from the
national govt.
Amended rules on EC specifies 10 brackets of
monthly salary credits on w/c to base the 1%
contribution to ECC
The same rules provide the penalties to the ER who is
delinquent in paying ECC contributions, w/c include
imprisonment and/or fine and a 3% penalty per
month from the date the contribution falls due until
paid.
Ch. V. MEDICAL BENEFITS
1.
2.
Services
a. Medical services, appliances and supplies provided by the System immediately after an
EE contracts sickness or sustains an injury
and during the subsequent period of his
disability, as the nature of his sickness/injury
and progress of his recovery may require,
subj to the expense limitation prescribed
by ECC (Art 185)
b. Rehabilitation services
Cash Income Benefit or Pension due to:
a. Temporary total disability
b. Permanent total disability
c. Permanent partial disability
d. Death
EE is entitled to the benefits only for the ward services of an
accredited hospital and accredited physician.
ECC accredited hospitals & physicians
- are NOT allowed to ask any deposit from EC
patients as requisite for admission.
- Neither are they allowed to collect any amt from
EC patients as charges for treatment.
- However, they are privileged to claim
reimbursement w/ the ECC through the System
for expenses incurred in the treatment of EC
patients (Medicines and ICU expenses are
reimbursed 100%)
Reimbursement of Medical Expenses
SIF – has the duty to provide the EE w/ such services,
appliances and supplies as the nature of his
sickness/injury and the progress of his recovery may
require BUT if the System fails to promptly furnish the
same, such services, appliances and supplies may be
acquired by the EE himself, at the expense of the
SIF/System.
EE’s R of reimbursement for medical expenses is NOT
extinguished upon his deathtransmitted to legal heirs
unless they are essentially personal in nature or the law
declares them to be so. (not only those incurred for the
primary illness but even those for its complications even
if the complications developed after the EE’s retirement)
CASE: Medical Expenses for Complications
Alvero v GSIS: Alvero was Justice of the Peace in Quezon.
He became Asst. Provincial Fiscal and then promoted to
the position of RTC Judge. He retired on Apr 8, 1984 at
the age of 63. For all his compensable ailments (PTB,
Moderately advanced w/ Pulmonary Emphysema and
Chronic Obstructive Pulmonary Disease) he was
granted:
a) temporary total disability benefits from Jan 4-19,
1984; and
b) permanent total disability benefits from Apr 8, 1984
to Dec 1988.
Not satisfied w/ this, he also requested for the
reimbursement of medical expenses incurred for Diabetes
Mellitus and Gastritis.
The System denied his request for reimbursement on the
ground that only those medical expenses of primary
therapeutic value w/c pertain to the approved illness at the
time of his separation from the service were allowed for
reimbursement. Medical expenses incurred due to
complications that appeared after he had retired from the
service and those w/c are of preventive value, (per Medical
Evaluation and Underwriting Group-GSIS policy), were
excluded. The Sys further alleged that he had alrdy availed
of permanent total disability benefits, consisting of
reimbursement of medicines, medical supplies, lab exams,
professional fees for claimed ailment as well as
hospitalization benefits.
RULING: The complications that arose from Alvero’s
primary illnesses PTB and Emphysema were brought
about by the intake of medications like steroids, antibiotics
and diuretics. For this reason, he is entitled to
reimbursement of medications used in treating the
complications, Diabetes and Gastritis (stomach ulcer)
Art 186. LIABILITY. The System shall have the authority to
choose/order a change of physician, hospital or rehab
facility for the EE, and shall NOT be liable for
compensation for any aggravation of the EE’s
injury/sickness resulting from unauthorized changes by
the EE of medical services, appliances, supplies,
hospitals, rehab facilities or physicians.
The oblig to provide medical services lasts from as
long as the EE is sick (during the “period of
disability”) of a compensable illness, and this duty is
not ended when ENT terminates.
The law does not provide a maximum either in the
amt to be paid or the time period w/in w/c such R
may be availed of by the EE. It is as much medical
expenses as may be necessary until the workconnected injury/sickness ceases, may be charged
against the SIF and are to be paid by the System.
Prevailing Rule in Compensation Cases: Acts not
containing any limitation as to the period during w/c
the ER may furnish/pay for medical, surgical, or
hospital services have been construed as imposing
liability on the ER as long as such services are
required to cure/relieve the injured EE from the effect
of his injury.
Art 187. ATTENDING PHYSICIAN. Any physician attending
an injured/sick EE shall COMPLY w/ all the regulations
of the Sys and SUBMIT reports in prescribed forms at
such time as may be required concerning his
condition/treatment. All medical info relevant to the
particular injury/sickness shall on demand be made
available to the EE or the System. No info developed in
connection w/ the treatment/examination for w/c
compensation is sought shall be considered as privileged
communication.
Art 188. REFUSAL OF EXAMINATION OR TREATMENT
– If the EE unreasonable refuses to submit to medical
exam or treatment, the Sys shall STOP the PAYMENT of
further compensation during such time as such refusal
continues. What constitutes unreasonable refusal shall be
determined by the Sys w/c may on its own initiative
determine the necessity, character and sufficiency of any
medical services furnished or to be furnished.
Art 189. FEES & OTHER CHARGES – All fees and other
charges for hospital services, medical care and
appliances including professional fees shall NOT be
higher than those prevailing in wards of hospitals for
similar services to injured/sick persons in general and
subj to the regulations of ECC. Professional fees shall
only be appreciably HIGHER than those prescribed
under the Ph Medical Care Act of 1969.
Art 190 REHABILITATION SERVICES –
a) The System shall, as soon as practicable,
ESTABLISH a continuing program for the rehab of
injured and handicapped EEs, who shall be entitled
to rehab services, w/c shall consist of medical,
surgical or hospital treatment, including appliances
if they have been handicapped by the injury, to help
them become physically independent.
b) As soon as practicable, the Sys shall establish
centers equipped and staffed to provide a balanced
program of remedial treatment, vocational
assessment and preparation designed to meet the
indiv needs of each handicapped EE to restore him
to suitable ENT, including assistance as may be
w/in its resources to help each rehabilitee to
develop his mental, vocational or social potential.
Rehabilitation Services– include a balanced program of
remedial treatment, vocational assessment and
preparations designed to meet the indiv needs of each
handicapped EE to restore him to suitable ENT, incl
assistance as may be w/in its resources to help each
rehabilitee develop his mental, vocational or social
potential.
3 Stages of Rehabilitation
a) PHYSICAL REHABILITATION – involves physical
therapy by the rehab center of the ECC-accredited
hosp, furnishing of prosthesis and appliances all paid
by the ECC
b) VOCATIONAL ASSESSMENT – involves
evaluation by guidance psychologist of the ECC and
sending to vocational school of those found ready to
reengage in gainful ENT
c) VOCATIONAL PLACEMENT – involves job
placement by ENT Service Officer to help him
become independent and gainfully employed.
Ch. VI. DISABILITY BENEFITS
Disability– does not refer to the injury nor to the pain &
suffering it has occasioned, but to the loss/impairment of
earning capacity. There is disability when there is a
loss/diminution of earning power because of actual
absence from work due to the injury or illness arising out
of and in the course of ENT.
Basis of compensation: reduction of earning power
Thus, even if an EE suffers a service-connected injury/illness
as long as he goes on working wlo any reduction
whatsoever in his earning capacity, there is no disability.
3 Distinct Categories of Disability
a. Temporary Total Disability (TTD)
b. Permanent Total Disability (PTD)
c. Permanent Partial Disability (PPD)
Total Disability– may either be temporary or permanent.
- does not mean a state of absolute helplessness,
but means disablement of an EE to earn wages
in the same kind of work, or a work of similar
nature, that he was trained for or accustomed to
perform, or any kind of work w/c a person of
his mentality and attainment could do.
- Object of compensation is to compensate the
injured laborer/EE for the actual and permanent
loss of a member of the body, or the use thereof.
Art 191. TEMPORARY TOTAL DISABILITY
Amount of Benefits: equivalent to 90% of his ave. daily
salary credit per day, subj to the ff conditions:
1. from P10-P90 for a continuous period not exceeding
120 days for the same disability, UNLESS the
injury/sickness requires more extensive treatment that
lasts beyond 120 days, but NOT to exceed 240 days
from onset of disability, in w/c case he shall be paid
benefit for TTD during the extended period.
2. The monthly income benefit shall be SUSPENDED if
the EE fails to submit a monthly medical report
certified by its attending physichan.
The maximum for daily income benefit for TTD is
INCREASED to P200 by ECC board resolution on
Oct 10, 1996, Effective Nov 1, 1996.
Period of Entitlement– the income benefit shall be paid
beginning on the 1st day of such disability. If caused by
an injury/sickness, it shall not be paid longer than 120
consecutive days, except where such injury/sickness
still requires such medical attendance beyond 120days
but not to exceed 240 days from the onset of disability, in
w/c case, the benefit for TTD shall be pd. However, the
Sys may declare the total and permanent status at any
time after 120 days of continuous TTD.
Relapse– after an EE has fully recovered as duly certified, the
period covered by any relapse, w/c results in disability
and is determined to be compensable, shall be considered
SEPARATE from the pd covered by the original
disability.
Magsaysay Maritime Corp Case: If the 120 days initial pd is
exceeded and no declaration of the worker’s fitness of
permanent disability to work is made because the
seafarer requires further medical attention, then the TTD
period may be EXTENDED up to a MAXIMUM of 240
Days, subj to the R of the ER to declare w/in this period
that a permanent partial/total disability already exists.
Art 192. PERMANENT TOTAL DISABILITY
- If as a result of the injury/sickness, the EE is
unable to perform any gainful occupation for a
continuous period for more than 240 days.
- EE shall be paid by the System per month, an
amount equivalent to the monthly income
benefit PLUS 10% thereof for each dependent
child up to 5yrs old, beginning w/ the youngest
and w/o substitution. Provided, that the
monthly income benefit shall be the new amt of
the monthly benefit for all covered pensioners,
effective upon approval of this decree
-
PTDs
1.
2.
3.
4.
5.
6.
7.
The Monthly Income Benefit (MIB) shall be
guaranteed for 5yrs and shall be suspended if:
a) the EE is gainfully employed, or
b) recovers from his PTD, or
c) fails to present for examination at least
once a yr upon notice by the System
except as otherwise provided for in
other laws, decrees, orders of LOIs.
A disability acknowledged by the company as PTD
w/in the periods allowed by law (120 days,
extendible to 240 days);
Upon expiration of the maximum 240-day treatment
period w/o a declaration of either fitness to work or
the existence of a permanent disability;
Complete loss of sight of both eyes;
Loss of 2 limbs or above the ankle or wrist;
Permanent complete paralysis of 2 limbs;
Brain injury resulting in incurable imbecility or
insanity; and
Such cases determined as determined by the Medical
Director of the System and approved by the ECC.
Period of Entitlement– the full monthly income benefit shall
be paid for all compensable months of disability
Suspension of Income Benefits– under any of the FF
conditions:
a. Failure of the EE to present himself for examination
at least once a yr upon notice by the System;
b. Failure to submit a quarterly medical report certified
by the attending physician;
c. Complete or full recovery from his permanent
disability; or
d. Upon being gainfully employed
Amount of Benefits
1. In the case of SSS – Any EE entitled to PTD benefit
shall be paid by the System a Monthly Income
Benefit…
a. The # of months of paid coverage shall be
the # of monthly contributions remitted to
the System including contributions other
than for EC if paid before March 31, 1975.
The full monthly income benefit shall be
paid for all compensable months of
disability.
b. The first day preceding the semester of TTD
shall be considered for purposes of
computing the monthly income benefit for
PTD.
Amt of Benefit for Dependent Children – each
dependent child up to 5y/o, counted from the
youngest and w/o substitution, shall be entitled
to 10% of the MIB of the EE. ( n/a to causes
of action w/c accrued before May 1, 1978)
Aggregate Monthly Benefit Payable– Except the
benefit to dependent children, the aggregate
monthly benefit payable in the case of GSIS,
shall in no case exceed the monthly wage/salary
actually received by the EE as of the date of his
PTD.
Art 193. PERMANENT PARTIAL DISABILITY (PPD)– if
as a result of the injury/sickness, the EE suffers a
permanent partial loss of the use of any ff part of his
body, (for not more than the period designated):
CASES:
PTD
Orlino v ECC: Suffering from mental lapses w/c made him
unfit for work, Orlino was forced to seek early retirement
at the age of 55y/o. from that time to present, he has not
been able to work nor engage in any gainful ENT.
BODY PART
PERIOD OF EQUIVALENT
(MONTHS) & totally
RULING: HeDISABILITY
is considered permanently
1 thumb
10
disabled to work when he was incapacitated/disabled to
1 index finger
8
perform any substantial amt of labor in the line of work
1 middle finger
6
he was formerly engaged or any other kind of work to
1 ring finger
5
w/c he could be assigned. Total disability does not mean
1 little finger
3
a state of absolute helplessness, but disablement of an
1 big toe
6
EE to earn wages in the same kind of work, or a work of
Any toe
3
similar nature, that he was trained for or accustomed to
1 arm
50
perform, or any kind of work w/c a person of his
1 hand
39
mentality and attainments could do. The approval of
1 foot
31
1 leg
46
claimant’s application for optional retirement for
1 ear
10
disability, although he has not yet reached the age of
Both ears
20
compulsory retirement age, is an indication of his
Hearing of 1 ear
10
physical incap to render further efficient service.
Hearing of both ears
50
Vicente v ECC: The test of w/n an EE suffers from PTD (as
Sight of 1 eye
25
defined above). In the case at bar, Vicente’s PTD is
established by several factors & circumstances. Pet’s
Amount of Benefits– a MIB for the # of months indicated. If
app for optional retirementon the basis of his ailments
the indicated # of months exceeds 12, the income benefit
had been approved. Considering that he was only 45 y/o
shall be paid in monthly pension; otherwise, the System
when he retired and still entitled, under good behavior,
may pay income benefit in lump sum or in monthly
to 20 more yrs in service, the approval of his optional
pension.
retirement app proves he was no longer fit to continue
his ENT. For optional retirement is allowed only upon
Effect of Gainful ENT– for PPD, a covered EE shall continue
proof that the EE-applicant is already physically incap to
to receive the benefits, even if he is gainfully employed
render sound and efficient service.
and receiving his wages/salary
PTD
Invariably results in an
EE’s loss of work or
inability to perform his
usual work
PPD
Occurs when an EE loses
the use of any particular
anatomical part of his body
w/c disables him to
continue w/ his former
work
TEST of PTD: a showing of the capacity of the EE to continue
performing his work notwithstanding the disability he
incurred. Thus, if by reason of the injury/sickness the EE
is unable to perform his customary job for more than 120
days and he does not come w/in the coverage of what
constitutes TTD, then the said EE undoubtedly suffers
from PTD regardless of whether or not he loses the use
of any part of his body.
Conversion from PPD to PTD
GSIS v CA and Balais: EE suddenly experienced chills,
followed by loss of consciousness. She was diagnosed to
be suffering from Subarachnoid Hemorrhage Secondary
to Ruptured Aneurysm. After undergoing craniotomy, she
was finally discharged. Despite her operation, the EE, a
cashier of the NHA, could not perform her duties as
efficiently as she did before her illness. This forced her to
retire at the age of 62 and filed a claim for disability
benefits.
GSIS granted her TTD benefits and subsequently, PPD
benefits for 9 months starting from her retirement.
She requested GSIS for the conversion of the
classification of PPD to PTD, but GSIS denied her
request and informed her that her condition did not
satisfy the criteria for PTD.
RULING: While it is true that the degree of the EE’s
physical condition at the time of her retirement was not
considered as PTD, yet it cannot be denied that her
condition subsequently worsened after her head
operation and consequent retirement. A person’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 w/c at first was considered to be
temporary may later on become permanent or one who
suffers partial disability becomes totally and
permanently disabled from the same cause.
Jurisprudence likewise show that disability is intimately
related to one’s earning capacity. The court construed
PTD as the “lack of ability to follow continuously some
substantially gainful occupation w/o serious discomfort
or pain and w/o material injury/danger to life. And there
is nothing in the law that prohibits the conversion of
PPD to PTD benefit if it is shown that the EE’s ailment
qualifies as such.
Is Earning Capacity “IMPAIRED” if earning is higher
after the injury?
Central Azucarera Don Pedro v WC Commissioner: EE’s
alleged new ENT after receiving compensation for a
PPD, has a higher salary.
RULING: Even supposing it to be true, that fact would
not in itself necessarily affect the laborer’s claim for
compensation for a PPD. An injured laborer’s incap for
work is not to be measured solely by the wages he
receives, or his earning after the injury, since the amt of
such wages/earnings may be affected by various
extraneous matters/factors. As noted in the American
Law Reports, there are a number of possible
explanations of the fact that an EE receives higher
wages after an injury than what he earned before may
still have suffered an impairment of earning capacity:
thus, it may indicate:
a) That the EE is the beneficiary of a mere gratuity
and does not actually ‘earn’ his wages;
b) That the EE, by education & training, has fitted
himself for more renumerative ENT;
c) That the EE works longer hrs than he did before
his injury, his hourly renumeration having
increased;
d) That a general change in wage scales has taken
place for the type of work or in the industry;
e) That the new wages are intended as an
inducement to him to refrain from pursuing a
clam;
f) That the EE, before his injury, was younger or a
minor;
g) That the ENT in w/c the EE was employed after
the injury was of uncertain duration.
Should the Previous Compensation for Lesser Disability be
Deducted?
Knoxville Knitting Mills v Galyon: The EE who has lost 3
fingers on his left hand, 19 yrs before he entered the
service of the ER involved in the case, lost his left hand
in an industrial accident while performing his duties as
the latter’s EE. He sought to recover for the loss of the
hand, but the ER contended that the value of the 3
fingers previously lost should be deducted.
US SC RULING: Deduction is prohibited because there
is no law allowing for such deduction.
Ph SC jurispridence: To offset the undue
hardship/injustice that may, at times be caused to the ER,
in consequence of the strict/literal interpretation of the
law, the ff ALTERNATIVES have been resorted to:
a) An insurance secured by the ER to protect
him/his business from the resulting loss; or
b) An amendment of the law, to provide for a
deduction of the compensation formerly paid
(Apportionment Statute).
Ch VII. DEATH BENEFITS
Amount of Benefits
The System shall pay to the primary beneficiaries upon the
death of the covered EE an amt equal to his monthly
income benefit, PLUS 10% thereof for each dependent
child up to 5y/o, beginning w/ the youngest, and w/o
substitution.
If the EE has no primary beneficiary, the Sys shall pay to
his Secondary beneficiaries the monthly income benefit
up to 60 months.
Minimum Death Benefit: at least P15K
Duration – guaranteed for 5yrs.
Death of a Covered EE who is under PTD – 80% of the
MIB
His dependents: dependents’ pension, PROVIDED:
a) The marriage must have been validly subsisting
at the time of the disability;
b) If he has no primary beneficiary, the Sys shall
pay to his secondary beneficiaries the monthly
pension, excluding the dependents’ pension, of
the remaining balance of the 5-yr guaranteed
period;
c) The minimum death benefit is at least P15k
Funeral Benefit– P3k to be paid upon the death of a covered
EE or PTD pensioner
Dependents as enumerated by Art 167(i):
1. legitimate, legitimated, legally adopted or
acknowledged natural child who is unmarried, not
gainfully employed, and not over 21y/o; OR over
21y/o provided he is incapacitated an incapable of
self-support due to a physical/mental defect w/c is
congenital or acquired during minority;
2. the legitimate spouse living w/ the EE;
3. the parents of said EE wholly dependent upon him
for regular support.
Dependency– does not mean absolute dependency for the
necessities of life, but rather, that the dependent looked
up to and relied on the contribution of the decedent in
whole or in part, as a means of supporting and
maintaining herself in accordance w/ her station in life.
(A person ma be dependent, accdg to this view, although
able to maintain himself w/o any assistance from the
decedent)
Test of Dependency– is not merely whether the contributions
were necessary to bare subsistence; dependency may
exist although the dependent could have subsisted w/o
the assistance he received, if such contributions were
relied on by claimant for his means of living as
determined by his position in life.
- One need NOT be actually a part of the
decedent’s household in order to be a dependent. There
may be dependency notwithstanding the EE did not work
steadily or was absent from the home at the time of his
accidental death, and notwithstanding the EE’s unlawful
acts or his statement in his app for ENT that he had no
dependents.
Rule: Support furnished to the claimant coupled w/ a reliance
thereon establishes dependency. The test of dependency
is NOT whether the claimants could support life w/o
contributions, but whether they depend on such
contributions as part of their income or means of living.
Spouse as Dependent– a marriage must exist, even if the
spouse is “gainfully employed”, so long as there is still
financial need for support.
Vda de Macabenta v Davao Stevedore Terminal Co: When
the decedent met the vehicular accident, the claimantwidow was not yet married to the decedent although they
had already been living together as H&W for the past 3
months. However, on the day following the accident, they
got married at the hospital where the deceased was
hospitalized up to his death.
RULING: It is true that the marriage took place after the
fatal accident, but there was no question that at the time
of his death, she was married to him. She, therefore,
comes entirely w/in the letter of the law. And the child
also falls w/in the meaning of dependent.
2 Wives as Claimants– ECC is empowered by law to resolve
disputes in compensation claims. It should be noted
however, that ECC may act as referee and arbitrator bet
the 2 claimants and help them reach a mutually
acceptable compromise settlement.
2 Muslim Wives– they are both entitled to compensation
benefits. Under the Muslim law, a Muslim male may
have more than 1 wife but not more than 4 at a time. And
they are considered primary beneficiaries.
ECC’s Suppletory Rules w/ regard to Distribution of the
MIB to the qualified beneficiaries:
1. MIB shall be shared equally by all primary
beneficiaries incl dependent children, wo were not
considered in the determination of the dependent
pension. Upon emancipation or otherwise disqual to
entitlement to the dependent pension of a dependent
child, only 10% shall be deducted from the benefits
and the remaining income benefits shall once again
be divided equally by the qualified primary benefits;
2. If there are no primary beneficiaries, their secondary
beneficiaries shall also share equally in the MIB.
Separated Spouse– may be held entitled to compensation
benefits if the separation occurred owing to any of the ff
circumstances:
a. Refusal of the covered EE to continue living w/ the
surviving spouse; or the EE’s abandonment of the
said spouse, w/o just cause;
b. Attempt of the covered EE against the life of the
surviving spouse, common child/children of spouse;
c. Commission of an act of sexual abuse against the
surviving spouse, common child/children or
child/children of the spouse by the covered EE;
d. The covered EE’s recurrent commission of physical
violence, or grossly abusive conduct, against the
surviving spouse, common child/children or child/ren
of the spouse;
e. The covered EE’s infliction of physical violence, or
imposition of moral duress, to compel the surviving
spouse, common child/ren or child/ren of the spouse
to change their religious or political affiliation;
f. Attempt of the covered EE to corrupt, or induce the
surviving spouse common child/ren or child/ren of
the spouse to engage in prostitution, or to make them
connive w/ the EE in such an act of corruption or
inducement;
g. Drug addiction or habitual alcoholism of the covered
EE;
h. Lesbianism or homosexuality of the covered EE;
i. Contraction of bigamous M by the covered EE,
whether in the PH or abroad;
j. Sexual infidelity or perversion of the covered EE;
k. The covered EE’s act of allowing the surviving
spouse, common child/ren or child/ren of the spouse
to be subjected to acts of lasciviousness; and
l. The covered EE’s contraction of serious, STD extramaritally.
Parents as Dependents
If the deceased EE is the adulterous child of the wife,
the H cannot claim as dependent of said deceased EE,
in the same manner that he is not duty-bound to
support said deceased EE.
Since abandonment of the child by the parent is cause
for the ceasing of the oblig of the former to support
the latter, no matter how financially desperate is the
situation of said parent, it follows that he cannot
claim as a dependent in a compensation case where
the deceased EE is an abandoned child.
Death Benefit and Beneficiaries
Death benefit are paid in form of cash monthly pension:
a. For life to the primary beneficiaries, guaranteed for
5yrs;
b. For not more than 60months to the secondary
beneficiaries, in case there are no primary
beneficiaries;
c. In no case shall the total benefit be less than P15k
The Beneficiaries are:
1. Primary Beneficiaries
a. Dependent spouse until s/he remarries;
b. Dependent children (legitimate, legitimated,
natural-born or legally adopted);
2. Secondary Beneficiaries
a. Illegitimate children and legitimate
descendants;
b. Parents, grandparents, grandchildren
The amt of income benefits shall be equivalent to the MIB
under PTD and PPD.
Under ECC Rules, the death benefit shall accrue to the
Employee’s Compensation Fund if the deceased EE has
no beneficiaries at the time of his death.
Death Benefit after Retirement
Manuzon v ECC: Generally, the term “covered EEs” refers
to an EE who at the time of his death is still an EE
covered by the GSIS/SSS. On the other hand, the IRR of
the ECC states that to be entitled to death benefits, the
EE need not be an actual EE of the public/private sector
at the time of his death; he can be a retired EE whose
retirement was brought about by permanent disability.
FACTS: During his ENT, the deceased suffered from a
stroke, caused by a blockage of arteries. He had to retire
because of paralysis caused by the stroke when he was an
asst professor. He died after compulsory retirement
caused by cardiovascular attack or MI. The ECC denied
the claims because the death came 4 and a half yrs after
his retirement caused by work-oriented paralysis arising
from the attack.
ECC Amended Rules: the payment of said benefit shall begin
at the month of death ‘and shall continue to be paid for as
long as the beneficiaries are entitled thereto.’ It further
states that after the guaranteed 5yrs, ‘the beneficiaries
shall be paid the MIB for as long as they are entitled
thereto.’
GSIS President Directive: suspended the payment of death
benefit beyond 5 yrs from death of a covered EE.
Ch VIII PROVISIONS COMMON TO INCOME
BENEFITS
Art 195. All questions of relationship & dependency shall be
determined as of the TIME OF DEATH.
Art 196. DELINQUENT CONTRIBUTIONS
An ER who is delinquent in his contributions shall be liable to
the Sys for benefits w/c may have been paid by the Sys
to his EEs or their dependents, and any benefit &
expenses to w/c such ER is liable shall constitute a lien
on all his property, real or personal w/c is hereby
declared to be preferred to any credit, except taxes. The
payment by the ER of the lump sum equivalent of such
liability shall absolve him from the payment of the
delinquent contribution and penalty thereon w/ respect to
the EE concerned.
Failure /refusal of the ER to pay/remit the contributions herein
prescribed shall NOT prejudice the R of the EE or his
dependents to the benefits under this Title. If the
sickness/injury/disability/death occurs before the Sys
receives any report of the name of his EE, the ER shall
be liable to the Sys for the lump sum equivalent to the
benefits to w/c such EE or his dependents may be
entitled.
Art 197. SECOND INJURIES
If any EE under PPD suffers another injury w/c results in a
compensable disability greater than the previous injury,
the SIF shall be liable for the income benefit of the new
disability, provided that if the new disability is related to
the previous disability, the Sys shall be liable only for the
difference in income benefits.
Benefits for Death of Pensioner– (Art 194(b) – death benefit
shall be paid to the beneficiaries if an EE, while
receiving PTD benefit dies. The death benefit here is
lower than that under par. (a). also, it shld be noted that
this provision does not apply to cases where a member
under PPD dies during the period he is receiving MIB
from PPD.
Art 198. ASSIGNMENT OF BENEFITS
NO claim for compensation under this Title is transferable or
liable to tax, attachment, garnishment, levy or seizure by
or under any legal process whatsoever, either before or
after receipt by the person/s entitled thereto, except to
pay any debt of the EE to the Sys. (in pursuant to Police
Power of the State)
Is the period of entitlement 5yrs only or even beyond?
Art 199. EARNED BENEFITS
Income Benefits shall, w/ respect to any period of disability,
be payable to an EE who is entitled to receive wages,
Art 194(1): The death benefit is guaranteed for 5 yrs.
salaries, or allowance for holidays, vacation or sick
leaves, and any award of benefit under a CBA or other
agreemt.
Art 200. SAFETY DEVICES
In case the EE’s injury/death was due to the failure of the ER
to comply w/ any law, or to install and maintain safety
devices, or take other precautions for the prevention of
injury, said ER shall pay to the SIF a penalty of 25% of
the lump sum equivalent of the income benefit payable
by the Sys to the EE. All ERs, esp those who shld have
been paying a rate of contribution higher than required of
them, are enjoined to undertake & strengthen measures
for the occupational health & safety of their EEs.
Art 201. PRESCRIPTIVE PERIOD
No claim for compensation shall be given due course unless
said claim is filed w/ the System w/in 3yrs from the time
the cause of action accrued.
BUT accdg to Manila Railroad Co. v Perez: Despite the 3yr prescriptive pd expressly provided by Art 201, a
compensation claim may be filed beyond this but before
the lapse of the 10th yr from accrual of the cause of
action, applying Art 1144 of the CC.
ECC v Sanico: 3yrs – have to be counted from the time the
EE lost his earning capacity, NOT from the time the
illness was discovered.
FACTS: EE was a former EE of John Gotamco & Sons
as a wood filer until he was separated from ENT due to
his sickness. He was suffering from PTB. He filed w/ the
SSS a claim for compensation benefits but was denied on
the ground of prescription.
Constructive Filing
Although the Code requires the claim to be in writing, the ff
acts have been held as equivalent to filing a claim w/ the
ER as required by the WC:
1. A verbal request for medical & hospitalization
expenses made to the corporate ER through its
treasurer;
2. Request for financial aid in behalf of the family of
the deceased worker made by the president of his
union.
Under ECC Resolution 2127 a claim is deemed to have been
filed for the purposes of prescription:
3. When the system itself receives from the concerned
EE, or his duly authorized rep/s or his ER, a written
notice giving info on the occurrence of a certain
contingency, w/c may be held compensable;
4. When a pertinent and authentic document evidencing
a particular contingency that befalls an EE is
submitted to and received by the Sys, for the purpose
of initiating payment of whatever benefits that may
duly accrue to the EE;
5. When the concerned EE, or any of his legal
beneficiaries or duly authorized rep/s files a
FORMAL CLAIM, w/ the Sys for life, retirement
and/or other insurance benefits because of disability
or death, w/c may also be held compensable.
Provided however, that in all these 3 cases, the claimant
shall be required, if necessary, to submit addt’l
supporting docs/papers to establish compensability,
otherwise, noncompliance therewith for an
unreasonably long time shall be deemed as
abandonment of claims and any subseq claims shall
be barred by laches.
Mailing Date of Claim Considered Date of Filing
Suanes v WCC: EE died. Claim for compensation was filed
2 yrs later. But the claim designated the wrong ER, who
was impleaded about 12yrs later.
RULING: Ordinarily, R to claim prescribes 10yrs from
the accrual of the claim (from death of EE), but where
the orig claim designated the wrong ER, the defense of
prescription must be rejected in the interest of
substantial justice.
Period to File Claim of Minors and the Mentally Deficient
Minors - prescribes in 10yrs from the time they reach the age
of majority.
Mentally deficient – prescribes in 10yrs from the moment a
legal guardian has been appointed
Art 225 of the FC: The mother/mother of the mentally
incapacitated child/ren, or of the dependent minor
child/ren and w/o the necessity of securing judicial
appointment as legal guardian, can file a claim for
compensation under the WCA and un under the present
law on EC for himself or herself and in behalf of those
nons sui juris.
Erroneous Payment
If the Sys, in GF pays income benefit to a dependent who is
inferior in R to another dependent or w/ whom another
dependent is entitled to share, such payment shall
discharge the Sys from liability, unless and until such
other dependent notifies the Sys of his claim prior to the
payments.
In case of doubt as to the respective Rs of rival claimants, the
Sys is hereby empowered to determine as to whom
payments shld be made in accdance w/ such regulations
as ECC may approve. If the money is payable to a
minor/incompetent, payment shall be made by the Sys to
such person/s as it may consider to be best qualified to
take care & dispose of the minor/incompetent’s property
for his benefit.
Art 203. PROHIBITION
No atty shall demand or charge for his services any fee…
-
The intent of the law is to free the award from any
liability/charge so that the claimant may enjoy/use it
to the fullest
it is the claimant who is exempt from liability for
atty’s fees. The defaulting govt agency remains liable
for atty’s fees bcoz it compelled the claimant to
employ the services of counsel by unjustly refusing
to recognize the validity of the claim.
Parties– it is not fatal to a claim for compensation that the
System was not impleaded as party respondent.
Art 204. EXEMPTION FROM LEVY, TAX, ETC.
All laws to the contrary notwithstanding, the SIF and all its
assets shall be exempt from any tax, fee, charge, levy, or
customs or import duty and no law hereafter enacted shall
apply to the SIF unless it is provided therein that the same is
applicable by expressly stating its name.
Ch IX. RECORDS, REPORTS & PENAL PROVISIONS
Art 205. RECORD OF DEATH/DISABILITY
a) All ERs shall keep a logbook to record
chronologically the sickness, injury or death of their
EEs, setting forth therein their names, dates, and
places of the contingency, nature of the contingency
and absences. Entries in the logbook shall be made
w/in 5 days from notice/knowledge of the occurrence
of the contingency. W/in 5 days after entry in the
logbook, ER shall report to the Sys only those
contingencies he deems to be work-connected.
b) All entries in the logbook shall be made by the ER or
any of his authorized officials after verification of the
contingencies or the EE’s absences for a period of a
day or more. Upon the request of the Sys, the ER
shall furnish the necessary cert regarding info about
any contingency appearing in the logbook, citing the
entry #, page # and date. Such logbook shall be made
available for inspection to the duly authorized rep of
the Sys.
c) Should any ER fail to record in the logbook an actual
sickness, injury or death of any of its EEs w/in the
period prescribed herein, give false info or withhold
material info already in his possession, he shall be
held liable for 50% of the lump sum equivalent of the
income benefit to w/c the EE may be found to be
entitled, the payment of w/c shall accrue to the SIF.
d) In case of payment of benefits for any claim w/c is
later determined to be fraudulent and the ER is found
to be a party to the fraud, such ER shall reimburse the
Sys the full amt of the compensation paid.
Art 206. NOTICE TO ER
The EE, his dependents, or anybody on his behalf, shld give
the notice of sickness, injury or death to the ER w/in
5days from the occurrence of the contingency. The
purpose is not only to establish the EE’s R to
compensation, as no claim for compensation shall be
given to the ER, but also to enable the ER to comply w/
its duty under the Rules– entering the contingency in the
logbook and of giving also due notice to the Sys if the
injury/sickness/death is deemed work-connected.
When Notice to ER NOT Needed (Under ECC Resolution
2127):
1. When the EE suffers the contingency w/in the ER’s
premises;
2. When the EE officially files an app for leave of
absence by reason of the contingency from w/c he
suffers;
3. When the ER provides medical services and/or
medical supplies to the EE;
4. When the ER can be reasonably presumed to have
knowledge of the EE’s contingency, in view of the ff
circs:
a. The EE was performing an official function
for the ER when the contingency occurred;
b. The EE’s contingency has been publicized
thru mass media;
c. The specific circs of the occurrence of the
contingency have been such that the EER
can be reasonably presumed to have readily
known it soon thereafter; and
d. Any other circs that may give rise to a
reasonable presumption that the ER has been
aware of the contingency.
Delay/failure to give the ER notice of compensable
illness/injury w/in the prescribed period does not bar a
claim for compensation IF it is shown that the latter, his
agent or rep in fact knows of such injury/illness or that
he suffered no damage by reason of such delay or lack of
notice.
Representatives– or “agents” whose knowledge is deemed
knowledge of their ER include:
1. Project engineer in charge of the work
2. Captain of the vessel in w/c the EE worked
3. Foreman
4. Asst mgr
5. Superintendent of transport oper.
Damage/prejudice– that the ER/Sys by reason of the failure to
receive the required notice, has been made less able to
resist the claim
Effect of Quitclaim– does not release the ER; it does not
result in waiver; the law does not consider as valid any
agreement to receive less compensation than what the
worker is entitled to recover
Even a compromise agreement approved by the court may be
disregarded by the NLRC in order to give protection to
labor.
Evidence – strict observance of the technical rules of evidence
is not properly demanded in WC cases (for purposes of
establishing relshp bet dependent & decedent)
Physician’s Report– the findings of the doctors & Chief of
the Medical Officer of the GSIS & ECC are not binding
on the SC as they are not considered experts.
Foreign Currency
Compensation benefits MAY be paid in foreign currency in its
equivalent in Ph currency, esp if based on the ENT
contract.
Applicable Law– in WC cases, the governing law is
determined by the date on w/c the claimant contracted
his illness. If the app for compensation does not state
when the claimant contracted the disease, the claim is
filed under PD 626, the presumption is that he contracted
the disease after the effectivity of said PD.
Title III MEDICARE
Art 209. MEDICAL CARE
RA 7875 – the National Health Insurance Act initiated the
Nat’l Health Insurance Program intending to provide
health insurance coverage and health care services for all
Filipinos.
Ph Health Insurance Corp is also created to carry out the
program
Title IV. ADULT EDUCATION
ART 210. Every ER shall render assistance in the
establishment & operation of adult education programs
for their workers and EEs as prescribed by regulations
jointly approved by DOLE and DEPED.
