Labor Law and Social Legislation SOCIAL AND WELFARE LEGISLATION (P.D. 629)
his orders as regards the employment, except the Government and any of its political subdivisions, branches or instrumentalities, including corporations owned or controlled by the Government: Provided , That a self-employed person shall be both Ee and Er at the same time. (Sec 8[c], R.A. 8282)
Q: What is Social Legislation? A: It consists of statutes, regulations and jurisprudence that afford protection to labor, especially to working women and minors, and is in full accord with the constitutional provisions on the promotion of social justice to insure the well-being and economic security of all the people.
Q: Who is an employee? A: Any person who performs services for an Er in which either or both mental and physical efforts are used and who receives compensation for such services, where there is an Er-Ee relationship: Provided , That a self-employed person shall be both Ee and Er at the same time. (Sec. 8[d], R.A. 8282)
SOCIAL SECURITY SYSTEM LAW (R.A. 8282) Q: What is the policy objective in the enactment of the Social Security System Law? A: To establish, develop, promote and perfect a sound and viable tax-exempt social security service suitable to the needs of the people throughout the Philippines, which shall promote social justice and provide meaningful protection to members and their beneficiaries against the hazards of disability, sickness, maternity, old age, death, and other contingencies resulting in loss of income or financial burden. (Sec. 2, R.A. 8282)
Q: What is employment? A: GR: Any service performed by an Ee for his Er. XPNs: 1. Employment purely casual and not for the purpose of occupation or business of the Er; 2. Service performed on or in connection with an alien vessel by an Ee if he is employed when such vessel is outside the Phils; 3. Service performed in the employ of the Phil. Government or instrumentality or agency thereof; 4. Service performed in the employ of a foreign government or international organization, or their wholly-owned instrumentality: 5. Such other services performed by temporary and other Ees which may be excluded by regulation of the SSC. Ees of bona fide independent contractors shall not be deemed Ees of the Er engaging the services of said contractors. (Sec. 8[j], R.A. 8282)
Note: The enactment of SSS law is a legitimate exercise of the police power. It affords protection to labor and is in full accord with the constitutional mandate on the promotion of social justice [Roman Catholic Archbishop of Manila vs. SSS, G.R. No. 15045, (1961)].
Q: Are the SSS premiums considered as taxes? A: No. The funds contributed to the System belong to the members who will receive benefits, as a matter of right, whenever the hazards provided by the law occur [CMS Estate, Inc., vs. SSS, G.R. No. 26298, (1984)].
Q: What is a contingency?
Q: Are benefits received under SSS Law part of the estate of a member?
A: The retirement, death, disability, injury or sickness and maternity of the member.
A: No. Benefits receivable under the SSS Law are in the nature of a special privilege or an arrangement secured by the law pursuant to the policy of the State to provide social security to the workingman. The benefits are specifically declared not transferable and exempt from tax, legal processes and liens [SSS vs. Davac, et. al., G.R. No.21642, (1966)].
COVERAGE Q: Who are covered by SSS? A: 1.
Q: Who is an employer? A: Any person, natural or juridical, domestic or foreign, who carries into the Phils. any trade, business, industry, undertaking or activity of any kind and uses the services of another person who is under U N I V E R S I T Y
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Compulsory Coverage a. All Ees not over 60 years of age and their Ers; b. Domestic helpers whose income is not less than P 1000/month and not over 60 years of age and their Ers;
Limitations:
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c. d. e. f.
g. h.
2.
3.
Any benefit earned by the Ees under private benefit plans existing at the time of the approval of the Act shall not be discontinued, reduced or otherwise impaired; ii. Existing private plans shall be integrated with the SSS but if the Er under such plan is contributing more than what is required by this Act, he shall pay to the SSS the amount required to him, and he shall continue with his contributions less the amount paid to SSS; iii. Any changes, adjustments, modifications, eliminations or improvements in the benefits of the remaining private plan after the integration shall be subject to agreements between the Ers and the Ees concerned; and iv. The private benefit plan which the Er shall continue for his Ees shall remain under the Ers management and control unless there is an existing agreement to the contrary All self-employed – considered both an Er and Ee Professionals; Partners and single proprietors of business; Actors and actresses, directors, scriptwriters and news correspondents who do not fall within the definition of the term “Ee”; Professional athletes, coaches, trainers and jockeys; AND Individual farmers and fisherman. (Sec. 9, R.A. 8282)
Any foreign government, international organization, or their wholly-owned instrumentality employing workers in the Philippines, may enter into an agreement with the Philippine government for the inclusion of such Ees in the SSS except those already covered by their respective civil service retirement systems.
Q: Are seafarers covered by the SSS Law? A: Yes. The result of the Memorandum of Agreement entered by SSS and DOLE approved by the Social Security Commission per the Commission's Resolution No. 437, dated July 14, 1988 was that the Standard Contract of Employment to be entered into between foreign shipowners and Filipino seafarers is the instrument by which the former express their assent to the inclusion of the latter in the coverage of the Social Security Act. In other words, the extension of the coverage of the SSS to Filipino seafarers arises by virtue of the assent given in the contract of employment signed by Er and seafarer [ Ben Sta. Rita v. Court of Appeals, G.R. No. 119891, (1995 )]. Note: By extending the benefits of the Social Security Act to Filipino seafarers on board foreign vessels, the individual employment agreements entered into with the stipulation for such coverage contemplated in the DOLE-SSS Memorandum of Agreement, merely gives effect to the constitutional mandate to the State to afford protection to labor whether "local or overseas." (Ibid.)
Q: When is the compulsory coverage deemed effective? A: 1. 2. 3.
Voluntary a. Spouses who devote full time to managing the household and family affairs, unless they are also engaged in other vocation or employment which is subject to mandatory coverage ; (Sec. 9[b], R.A. 8282) b. Filipinos recruited by foreign-based Ers for employment abroad may be covered by the SSS on a voluntary basis; (Sec. 9[c], R.A. 8282) c. Ee separated from employment to maintain his right to full benefits d. Self-employed who realizes no income for a certain month
Employer – – on the first day of operation Employee – Employee – on the day of his employment Compulsory coverage of self-employed – self-employed – his registration with the SSS
upon
Q: What is the effect of separation of an employee from his employment under compulsory coverage? A: 1.
2.
3.
By agreement
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His Er’s obligation to contribute arising from that employment shall cease at the end of the month of separation, But said Ee shall be credited with all contributions paid on his behalf and entitled to benefits according to the provisions of R.A. 9282. He may, however, continue to pay the total contributions to maintain his right to full benefit. (Sec. 11, R.A. 8282)
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Labor Law and Social Legislation Note: The Note: The above provision recognizes the “once a member, always a member” rule.
A: The contribution shall be determined in accordance with Sec. 18 of the SSS Law, provided that:
Q: What is the effect of interruption of business or professional income?
1. The monthly earnings declared as the time of registration shall be considered as his monthly compensation and he shall pay for both Er and Ee contributions 2. The monthly earnings declared at the time of registration shall remain the basis of his monthly salary credit, unless another declaration of his monthly earnings was made, the latter becomes the new basis of his monthly salary credits. [Sec. 19-A, R.A. No. 8282]
A: If the self-employed member realizes no income in any given month: 1. He shall not be required to pay contributions for that month. 2. He may, however, be allowed to continue paying contributions under the same rules and regulations applicable to a separated Ee member: 3. Provided , that no retroactive payment of contributions shall be allowed other than as prescribed under Sec.22-A. (Sec. 11-A, R.A. 8282)
Q: How much is the monthly m onthly pension?
Q: What is a self-employed individual?
A: 1.
A: A self-employed person is one whose income is not derived from employment as well as those mentioned in Sec. 9-A of the law, including: 1. All self-employed professionals; 2. Partners and single proprietors of business; 3. Actors and actresses, directors, scriptwriters and news correspondents who do not fall within the definition of the term Ee in Sec. 8 of this Act; 4. Professional athletes, coaches, trainers and jockeys; and 5. Individual farmers and fishermen. [Sec. 8(s), RA 8282]
2.
Q: On her way home from work, Mikaela, a machine operator in a sash factory, decided to watch a movie in a movie house. However, she is stabbed by an unknown assailant. When she filed a claim for benefits under the SSS Law, it was denied on the ground that her injury is not work-connected. Is the denial legal? Why?
The monthly pension shall be the highest of the following amounts: a. The sum of the following: i. Php 300.00; plus ii. 20% of the average monthly salary credit; plus iii. 2% of the average monthly salary credit for each credited year of service in excess of 10 years; or b. 40% of the average monthly salary credit; or c. Php 1,000.00, provided that the Monthly Pension shall in no case be paid for an aggregate amount of less than sixty (60) months (Sec. 12 [a], R.A. 8282) Minimum Pension a. Php 1,200.00 - members with at least 10 credited years of service b. Php 2, 400.00 for those with 20 credited years of service . (Sec. [b], R.A. 8282)
Q: What is an average monthly credit? A: An average monthly credit is the result obtained by: 1. Dividing the sum of the last 60 monthly salary credits immediately preceding the semester of contingency by 60; or 2. Dividing the sum of all the monthly salary credits paid prior to the semester of contingency by the number of monthly contributions paid in the same period, whichever is greater.
A: No. It is not necessary, for the enjoyment of benefits under the SSS Law that the injury is workconnected. What is important important is membership membership in the SSS and not the causal connection of the work of the Ee to his injury or sickness. Note: Note: Claims based on work-connected injuries or occupational diseases are covered by the State Insurance Fund.
Provided , that the injury or sickness which caused the disability shall be deemed as the permanent disability for the purpose of computing the average monthly salary credit.
Q: How are contributions of the self-employed to the SSS determined?
Q: What is an average daily salary credit?
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SOCIAL AND WELFARE LEGISLATION A: An average salary credit is the result obtained by dividing the sum of the 6 highest monthly salary credits in the 12-month period immediately preceding the semester of contingency by 180.
5.
Such other services performed by temporary and other Ees which may be excluded by regulation of the Commission. Ees of bona fide independent contractors shall not be deemed Ees of the Er engaging the service of said contractors.
Q: May the monthly pension be suspended? Q: A textile company hires 10 carpenters to repair the roof of its factory which was destroyed by typhoon “Bening.” Are the carpenters subject to compulsory coverage under the SSS Law? Why?
A: Yes. The monthly pension and dependents’ pension shall be suspended: 1. 2. 3.
Upon the reemployment or resumption of selfemployment; Recovery of the disabled member from his permanent total disability Failure to present himself for examination at least once a year upon notice by the SSS. [Sec. 13-A (b), RA 8282]
A: No. the employment is purely casual and not for the purpose of the occupation or business of the Er. Their engagement is occasioned by the passage of the typhoon; they are not hired on a regular basis. BENEFITS
EXCLUSIONS FROM COVERAGE
Q: What are the Benefits under the SSS Act?
Q: Enumerate the kinds of employment which are excluded from compulsory coverage under the SSS Law.
A: 1. Sickness Benefits 2. Permanent Disability Benefits 3. Maternity Leave Benefit 4. Retirement Benefit 5. Death and funeral Benefits
A: Under Section 8(j) of R.A. 1161, as amended, the following services or employments are excluded from coverage: 1. 2.
3.
4.
Q: Are the Benefits provided for in the SSS Law transferable?
Employment purely casual and not for the purpose of occupation or business of the Er; Service performed on or in connection with an alien vessel by an employee if he is employed when such vessel is outside the Philippines; Service performed in the employ of the Philippine Government or instrumentality or agency thereof; Service performed in the employ of a foreign government or international organization, or their wholly-owned instrumentality:
A: Benefits provided for in the SSS Law are not transferable and no power of attorney or other document executed by those entitled thereto in favor of any agent, attorney or any other person for the collection thereof on their behalf shall be recognized, except when they are physically unable to collect personally such benefits. (Sec.15, R.A. 1161, as amended) Q: What are the reportorial requirements of the employer and self-employed?
this exemption Provided, however, That notwithstanding, any foreign government, international organization or their wholly-owned instrumentality employing workers in the Philippines or employing Filipinos outside of the Philippines, may enter into an agreement with the Philippine Government for the inclusion of such Ees in the SSS except those already covered by their respective civil service retirement systems: Provided, further, That the terms of such agreement shall conform with the provisions of this Act on coverage and amount of payment of contributions and benefits: Provided, finally, That the provisions of this Act shall be supplementary to any such agreement; and
A: 1. Er - Report immediately to SSS the names, ages, civil status, occupations, salaries and dependents of all his covered Ees 2. Self-employed - Report to SSS within 30 days from the first day of his operation, his name, age, civil status, occupation, average monthly net income and his dependents
SICKNESS BENEFITS Q: What is sickness benefit?
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Labor Law and Social Legislation A: It is a daily allowance paid to a covered Ee who becomes sick and is confined in a hospital for more than 3 days or elsewhere with the Commission’s approval.
b.
Not paid for more than 240 days on account account of the same confinement; and Ee member shall notify his Er of the fact of his sickness or injury within 5 calendar days after the start of his confinement unless such confinement: i. is in a hospital ii. the Ee became sick or was injured while working or within the premises of the Er (notification to the Er not necessary);
c.
Q: What are the requirements to be entitled for sickness benefit? A: Under Sec. 14 of the Social Security Law, the following are the requisites for the enjoyment by a covered individual of the sickness benefits: 1.
2.
3.
4.
Note: If Note: If the member is unemployed or self-employed, he shall directly notify the SSS of his confinement within 5 calendar days after the start thereof unless such confinement is in a hospital in which case notification is also not necessary;
Payment of at least 3 monthly contributions in the 12-month period immediately preceding the semester of sickness; Sickness or injury and confinement for more than 3 days in a hospital or elsewhere with the Commission’s approval; Notice of the fact of sickness by the Ee to the Er (or to the SSS in case the member is unemployed) within 5 calendar days after the start of his confinement; and Exhaustion of sick leaves of absence with full pay to the credit of the Ee.
Where notification is necessary, confinement shall be deemed to have started not earlier than the 5th day immediately preceding the date of notification. (Sec.14 [b], R.A. 8282) Note: Note: The law does not require that sickness must be related to the duties of the beneficiaries.
Q: When will compensable confinement commence? Q: May the requirement of notification be dispensed with?
A: 1. 2.
A: Yes. Notification is not necessary when: 1. Confinement is in a hospital; or 2. The employee became sick or was injured while working or within the premises of the employer. Q: Who will pay the sickness benefits and how much is the benefit?
Q: What are the requirements in order that Er may claim reimbursement of the sickness benefit?
A: 1. The Er shall pay the Ee for each compensable confinement or fraction thereof
A: 1.
2. The SSS shall pay the member who is unemployed, self-employed or voluntary members with a daily sickness benefit equivalent to 90% of his average daily salary credit. The following requisites must be complied with in order to avail of sickness benefits: a.
2.
In no case shall the daily sickness benefit be paid longer than 120 days in 1 calendar year, nor shall any unused portion of the 120 days of sickness benefit granted be carried forward and added to the total number of compensable days allowable in the subsequent year;
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Begins on the 1st day of sickness Payment of such allowances shall be promptly made by the Er: th a. every regular payday or on the 15 and last day of each month, b. in case of direct payment by the SSS - as long as such allowances are due and payable. (Sec. 14[b], R.A. 8282)
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100% of daily benefits shall be reimbursed by SSS if the following requirements are satisfied: a. Receipt of SSS of satisfactory proof of such payment and legality thereof; b. The Er has notified the SSS of the confinement within 5 calendar days after receipt of the notification from the Ee member. Er shall be reimbursed only for each day of th confinement starting from the 10 calendar day immediately preceding the date of notification to the SSS if the notification to the SSS is made beyond 5 calendar days after receipt of the notification from the Ee member. (Sec. 14 [c], R.A. 8282)
SOCIAL AND WELFARE LEGISLATION Q: When will reimbursement be made by SSS?
b.
A: GR: SSS shall reimburse the Er or pay the unemployed member only for confinement within 1 year immediately preceding the date the claim for benefit or reimbursement is received by the SSS. XPN: Confinement in a hospital in which case the claim for benefit or reimbursement must be filed within 1 year from the last day of confinement. (Sec. 14[c], R.A. 8282)
3.
Not gainfully employed and has not reached the age of 21 years of age; or c. If over 21 years of age, he is congenitally or while still a minor has been permanently incapacitated and incapable of selfsupport, physically or mentally; and The parent who is receiving regular support from the member. [Sec. 8 (e), RA 8282]
Q: Compare death benefits with permanent total disability benefits
Q: When is the employer or the unemployed member not entitled to reimbursement?
A: A: 1. 2.
3.
Death Benefits Where the Er failed to notify the SSS of the confinement; In the case of the unemployed; where he failed to send the notice directly to the SSS except when the confinement is in a hospital; and Where the claim for reimbursement is made after 1 year from the date of confinement.
PTD Benefits Requisite
at least 36 monthly contributions Benefits payable to whom
Primary Beneficiaries
Member
Failure to make 36 monthly payments Benefits shall be in lump sum equivalent to the monthly pension times the number of monthly contributions paid to SSS or 12 times the monthly pension, whichever is higher.
PERMANENT DISABILITY BENEFITS Q: What is a permanent disability disability benefit?
Q: What is the effect of the death of the PTD pensioner?
A: It is a cash benefit paid to a member who becomes permanently disabled, either partially or totally.
A: 1. Primary beneficiaries are entitled to receive monthly pension as of the date of disability. 2. No primary beneficiaries and he dies within 60 months from the start of his monthly pension secondary beneficiaries shall be entitled to a lump sum benefit equivalent to the total monthly pensions corresponding to the balance of the 5year guaranteed period excluding the dependents’ pension. (Sec. 13-A [c], R.A. 8282)
Q: What disabilities are deemed permanent total disability? A: Under Sec. 13-A (d) of the SSS Law, the following disabilities are deemed permanent total: 1. Complete loss of sight of both eyes; 2. Loss of two limbs at or above the ankle or wrists; 3. Permanent complete paralysis of two limbs; 4. Brain injury resulting to incurable imbecility or insanity; and 5. Such cases as determined and approved by the SSS.
Q: What is the effect of retirement or death death to partial disability pension? A: Disability pension shall cease upon his retirement or death. (Sec 13-A [j], R.A. 8282)
Q: Among the persons entitled to permanent disability benefits are the dependents of the covered employee. Who are these dependent?
Q: What is the difference of compensability under the Labor Law and the Social Security Law? A: The claims are different as to their nature and purpose [Ortega vs. Social Security Commission, G.R. No. 176150, (2008)].
A: The dependents shall be the following: 1. The legal spouse entitled by law to receive support from the member; 2. The legitimate, legitimated or legally adopted and illegitimate child who is: a. Unmarried
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Labor Law and Social Legislation RETIREMENT BENEFIT
LABOR LAW
SOCIAL SECURITY LAW Purpose Governs compensability Benefits are intended to of : provide insurance or 1. work-related protection against the disabilities hazards or risks of 2. when there is loss disability, sickness, old of income due to age or death, inter alia , work-connected irrespective of whether or work- they arose from or in the aggravated injury course of the or illness. employment. Nature A disability is total and Disability may be permanent if as a result permanent total or of the injury or sickness permanent partial. the Ee is unable to perform any gainful occupation for a continuous period exceeding 120 days regardless of whether he loses the use of any of his body parts.
Q: What is a retirement benefit? benefit? A: It is a cash benefit paid to a member who can no longer work due to old age. Q: What are the types of retirement benefits? A: 1.
2.
Q: Who are entitled to retirement benefits? A: 1.
MATERNITY LEAVE BENEFIT Q: What is the maternity benefit?
Q: What are the qualifications for entitlement to the maternity benefit?
2.
She has paid at least three monthly contributions within the 12-month period immediately preceding the semester of her childbirth or miscarriage. She has given the required notification of her pregnancy through her Er if employed, or to the SSS if separated, voluntary or self-employed member.
A member who a. is at least 60 years old b. has paid at least 120 monthly contributions prior to the semester of retirement; and c. already separated from employment or has ceased to be self-employed,
2.
A member who is at least 65 years old, shall be entitled for as long as he lives to the monthly pension; (Sec 12-B [a], R.A. 8282)
3.
A member a. At least 60 years old at retirement; and b. Does not qualify for pension benefits under paragraph (a) above - entitled to a lump sum benefit equal to the total contributions paid by him and on his behalf; c. Must be separated from employment and is not continuing payment of contributions to the SSS on his own. (Sec. 12-B [b], R.A. 8282)
A: The maternity benefit is a daily cash allowance granted to a female member who was unable to work due to childbirth or miscarriage.
A: 1.
Monthly Pension - Lifetime cash benefit paid to a retiree who has paid at least 120 monthly contributions to the SSS prior to the semester of retirement. Lump Sum Amount - Granted to a retiree who has not paid the required 120 monthly contributions.
Q: What happens when the retirement pensioner is re-employed or resumes self-employment? A: The monthly pension of a retirement pensioner who resumes employment and is less than 65 years old will be suspended. He and his Er will again be subject to compulsory coverage. (Sec. 12-B [c], R.A. 8282)
Q: Is the voluntary or self-employed member also entitled to the maternity benefit? A: Yes, A voluntary or a self-employed member is entitled to the maternity benefit provided that she meets the qualifying conditions as mentioned in the preceding question.
Q: Are the children children of a retiree member entitled to the dependent's pension? A: Yes (Sec. 12[A], R.A. 8282) . However, only 5 minor children, beginning from the youngest, are entitled to
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the dependent ’s pension. No substitution is allowed. Where there are more than 5 legitimate and illegitimate children, the legitimate ones will be preferred.
Q: For how long will the dependent child receive the pension?
Q: Who are considered dependents?
A: Until the child reaches 21 years of age, gets married, gets employed and earns Php 300 a month or more, or dies.
A: 1. The legal spouse entitled by law to receive support from the member; 2. The legitimate, legitimated, or legally adopted, and illegitimate child who: a. Is unmarried, b. Not gainfully employed, and c. Has not reached 21 years of age, or if over 21 years of age, he is congenitally or while still a minor has been permanently incapacitated and incapable of self-support, physically or mentally. 3. The parent who is receiving regular support from the member.
However, the dependent's pension is granted for life to children who are over 21 years old, provided they are incapacitated and incapable of self-support due to physical or mental defect which is congenital or acquired during minority.
DEATH AND FUNERAL BENEFITS Q: When is a beneficiary entitled to death benefits? A: 1.
2.
Dependent parents In the absence of the foregoing, any other person designated by the covered employee as secondary beneficiary. [Sec. 8(k), R.A. 8282]
Q: How long shall the primary beneficiaries be entitled to the death benefits consisting of monthly pension and dependent’s pension?
Upon death of a member, if he has paid at least 36 monthly contributions prior to the semester of death: a. primary beneficiaries shall be entitled to the monthly pension; or b. If there are no primary beneficiaries, secondary beneficiaries shall be entitled to a lump sum benefit equivalent to 36 times the monthly pension. Upon death of a member If he has not paid the required 36 monthly contributions prior to the semester of death: a. Primary or secondary beneficiaries shall be entitled to a lump sum benefit equivalent to the monthly pension multiplied by the number of monthly contributions paid to the SSS: or b. 12 times the monthly pension, whichever is higher. (Sec. 13, R.A. 8282)
A: 1. Dependent spouse – entitled until he/she remarries children – entitled until: 2. Dependent children – a) They get married; b) Find gainful employment; c) Reach the age of 21 years; or d) Recover from mental or physical incapacity and can now support themselves. Q: What is the funeral benefit? A: A funeral grant equivalent to Php 12, 000.00 shall be paid, in cash or in kind , to help defray the cost of expenses upon the death of a member or retiree. (Sec. 13-B, R.A. 8282)
Q: Who are primary beneficiaries? BENEFICIARIES A: 1. 2.
The dependent spouse until he or she remarries The dependent legitimate, legitimated or legally adopted, and illegitimate children: Provided , that the dependent illegitimate children shall be entitled to 50% of the share of the legitimate, legitimated or legally adopted children.
Q: What is meant by “dependent for support”?
A: The entitlement to benefits as a primary beneficiary requires not only legitimacy but also dependence upon the member Ee [Gil v. SSC CA- GR SP. 37150, (1996)]. If a wife who is already separated de facto from her husband cannot be said to be "dependent for support" upon the husband, absent any showing to
Q: Who are secondary beneficiaries?
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Labor Law and Social Legislation the contrary. Conversely, if it is proved that the husband and wife were still living together at the time of his death, it would be safe to presume that she was dependent on the husband for support, unless it is shown that she is capable of providing for herself [SSS vs. Aguas, G.R. No. 165546, (2006)].
renovate its building. The work to be performed by these 50 people is not in connection with the purpose of the business of the factory. Hence, the employment of these 50 persons is purely casual. They are, therefore, excepted from the compulsory coverage of the SSS law.
Q: A, an SSS member was survived by his legal wife, who is not dependent upon him. He was also survived by two common-law wives with whom he had illegitimate minor children. Who among them is entitled to the benefits?
Q: How are disputes settled? A:
A: The illegitimate minor children shall be entitled to the death benefits as primary beneficiaries because the legal wife is not dependent upon the member. The SSS Law is clear that for a minor child to qualify as a “dependent” the only requirements are that he/she must be below 21 yrs. of age, not married nor gainfully employed [Signey vs. SSS, G.R. No. 173582, (2008)].
Social Security Commission (SSC)
Q: What is compensation?
CA / SC
Q: The owners of FALCON Factory, a company engaged in the assembling of automotive components, decided to have their building renovated. (50) persons, composed of engineers, architects and other construction workers, were hired by the company for this purpose. The work was estimated to be completed in 3 years. The workers contended that since the work would be completed after more than 1 year, they should be subject to compulsory coverage under the Social Security Law. Do you agree with their contention? Explain your answer fully. (2000 Bar Question)
Execution of decision
A: No. It cannot review, much less reverse, decisions rendered by courts of law as it did in the case at bar when it declared that the CFI Order was obtained through fraud and subsequently disregarded the same, making its own findings with respect to the validity of Bailon and Alice’s marriage on the one hand and the invalidity of Bailon and Teresita’s marriage on the other. In interfering with and passing upon the CFI Order, the SSC virtually acted as an appellate court. The law does not give the SSC unfettered discretion to trifle with orders of regular courts in the exercise of its authority to determine the beneficiaries of the SSS [SSS vs. Teresita Jarque Vda. De Bailon, G.R. No. 165545, (2006)].
In the problem given, Falcon Factory is a company engaged in the assembly of automotive components. The 50 persons (engineers, architects and construction workers) were hired by Falcon Factory to
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Decisions of SSC shall be appealable to: 1. CA – questions of law and fact ( Sec. 5c, R.A. 8282) 2. SC – questions of law . (Sec. 5c, R.A. 8282) SSC may, motu proprio or on motion of any interested party, issue a writ of execution to enforce any of its decisions or awards, after it has become final and executory. (Sec. 5d¸ R.A. 8282)
Q: Can the SSC validly re-evaluate the findings of the RTC, and on its own, declare the latter’s decision to be bereft of any basis?
A: No. Under Sec. 8 (j) of R.A. 1161, as amended, employment of purely casual and not for the purpose of the occupation or business of the Er is excepted from compulsory coverage. An employment is purely casual if it is not for the purpose of occupation or business of the Er.
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Note: Note: Disputes within the mandatory period of 20 days after the submission of evidence. (Sec. 5a, R.A. 8282) Decision, in the absence of appeal, shall be final and executory 15 days after date of notification. (Sec. 5b, R.A. 8282)
A: All actual remuneration for employment, including the mandated cost of living allowance, as well as the cash value of any remuneration paid in any medium other than cash except that part of the remuneration received during the month in excess of the maximum salary.
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DISPUTE SETTLEMENT Disputes involving: 1. Coverage 2. Benefits 3. Contributions 4. Penalties 5. Any other matter related thereto.
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SOCIAL AND WELFARE LEGISLATION Q: Due to the delinquency incurred by ABC Co. incurred on its premium and loan amortizations, SSS suggested settling its obligation either through instalment or through dacion en pago. ABC chose dacion en pago and offered its property situated in Baguio City. It was approved by the SSS. However, SSS refused to accept the payment unless the interest and charges will be paid. ABC then filed suit in court. SSS moved for dismissal contending that the SSC, and not regular courts, has the jurisdiction to entertain a controversy arising from the nonimplementation of a dacion en pago agreed upon by the parties as a means of settlement of ABC’s liabilities. Resolve.
2. 3. 4.
Q: Who is an employee or member? compensation while in the A: Any person, receiving compensation service of an Er, whether by election or appointment, irrespective of status of appointment, including barangay and sanggunian officials. (Sec. 2[d], R.A. 8291)
A: The law clearly vests upon the Commission jurisdiction over “disputes ari sing under this Act with respect to coverage, benefits, contributions and penalties thereon or any matter related thereto...” Dispute is defined as “a conflict or controversy.”From the allegations of the complaint, it readily appears that there is no longer any dispute with respect to ABC ’s accountability to the SSS. It had, in fact, admitted their delinquency and offered to settle them by way of dacion en pago subsequently approved by the SSS in Resolution No. 270-s. 2001. The controversy, instead, lies in the nonimplementation of the approved and agreed dacion en pago on the part of the SSS. As such, ABC filed a suit to obtain its enforcement which is, doubtless, a suit for specific performance and one incapable of pecuniary estimation beyond the competence of the Commission [SSS vs. Atlantic Gulf and Pacific Company of Manila, Inc. and Semirara Coal Corp . , , G.R. No. 175952, (2008)].
Q: What is compensation? A: The basic pay or salary received by an Ee, pursuant to his or her election or appointment, excluding per diems, bonuses, OT pay, honoraria, allowances and any other emoluments received in addition to the basic pay which are not integrated into the basic pay under existing laws. (Sec. 2[i], R.A. 8291) Q: Baradero is a member of the Sangguniang Bayan of the Municipality of La Castellana, Negros Occ. and is paid on a per diem basis. On the other hand, Belo a Vice-Governor of Capiz is in a hold over capacity and is paid on a per diem basis. Are the services rendered by Baradero and Belo on a per diem basis creditable in computing the length of service for retirement purposes? A: Yes. The traditional meaning of per diem is a reimbursement for extra expenses incurred by the public official in the performance of his duties. Under this definition the per diem is intended to cover the cost of lodging and subsistence of officers and employees when the latter are on a duty outside of their permanent station. On the other hand, a per diem could rightfully be considered a compensation or remuneration attached to an office.
GSIS LAW (R.A. 8291) Q: What are the purposes behind the enactment of the GSIS Law? A: To provide and administer the following social security benefits for government Ees: 1. 2. 3. 4. 5.
Its political subdivisions, branches, agencies, instrumentalities GOCCs, and financial institutions with original charters Constitutional Commissions and the Judiciary (Sec. 2[c], R.A. 8291)
Compulsory life insurance Optional life insurance Retirement benefits Disability benefits to work-related contingencies; and Death benefits
The per diems paid to Baradero and Belo were in the nature of compensation or remuneration for their services as Sangguniang Bayan and Vice-Governor, respectively, rather than a reimbursement for incidental expenses incurred while away from their home base.
Q: Who are considered employers under the GSIS Act?
If the remuneration received by a public official in the performance of his duties does not constitute a mere “allowance for expenses” but appears to be his actual base pay, then no amount of categorizing the salary as a “ per diem” diem ” would take the allowances received
A: 1. National Government
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from the term service with compensation for the purpose of computing the number of years of service in government [GSIS v. CSC, G. R. Nos. 98395 and 102449, (1995)].
Q: Who are excluded from the coverage of the GSIS Law?
Q: What is the penalty in case of delayed remittance or non-remittance of contributions?
A: 1.
A: The unremitted contributions shall be charged interests as prescribed by the GSIS Board of Trustees but shall not be less than 2% simple interest per month from due date to the date of payment by the employers concerned ( Sec. 7, R.A. 8291 ).
2. 3.
4.
COVERAGE Q: State briefly the compulsory coverage of the GSIS. (2009 Bar Question)
Ees who have separate retirement schemes (members of the Judiciary, Constitutional Commissions and others similarly situated) Contractual Ees who have no Er-Ee with the agencies they serve Uniformed members of the AFP, BJMP, whose coverage by the GSIS has ceased effective June 24, 1997 Uniformed members of the PNP whose coverage by the GSIS has ceased effective February 1, 1996. (Sec. 2.4, Rule II, IRR, R.A. 8291)
Q: For the purpose of benefit entitlement, how are the members classified?
A: The following are compulsorily covered by the GSIS pursuant to Sec. 3 of RA 8291: 1. All Ees receiving compensation who have not reached the compulsory retirement age, irrespective of employment status. 2. Members of the judiciary and constitutional commissions for life insurance policy.
A: 1. Active members a. Still in the service and are paying integrated premiums. b. Covered for the entire package benefits and privileges being extended by GSIS.
Q: Who are the government Ees subject to coverage under the GSIS?
2.
A: GR: All Ees receiving compensation who have not reached the compulsory retirement age, irrespective of employment status.
Policyholders a. Covered for life insurance only b. Can avail of policy loan privilege only c. May also apply for housing loans d. Judiciary and Constitutional Commissions
3. a.
XPNs: 1. Uniformed members of the: a. AFP; and b. PNP. 2. Contractuals who have no Er and Ee relationship with the agencies they serve.
b.
Q: Who are covered by life insurance, retirement and other social security protection?
Retired Members Former active members who have retired from the service and are already enjoying the corresponding retirement benefits applied for Not entitled to any loan privilege, except stock purchase loan (Sec. 2.2, Rules II, IRR, R.A. 8291)
BENEFITS A: GR: All members of the GSIS shall have life insurance, retirement, and all other social security protections such as disability, survivorship, separation, and unemployment benefits. (Sec. 3, R.A. 8291)
Q: What are the the Benefits provided under the GSIS Act? A: 1. Separation 2. Unemployment or involuntary separation 3. Retirement 4. Permanent disability 5. Temporary disability 6. Survivorship 7. Funeral
XPNs: Members of: 1. The judiciary; and 2. Constitutional commissions Note: They Note: They shall have life insurance only.
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SOCIAL AND WELFARE LEGISLATION 8. 9.
In the case of forfeiture, the separated employee shall be entitled to receive only ½ of the cash surrender value of his insurance.
Life Insurance Such other benefits and protection as may be extended to them by the GSIS such as loans.
UNEMPLOYMENT BENEFITS
Q: Who shall be compulsorily covered with life insurance?
Q: What are the conditions for entitlement to unemployment benefits?
A: G.R.: All Ees
A: 1.
XPN: All members of the Armed Forces of the Philippines and the Philippine National Police (PNP)
2.
Q: What are the reportorial requirements of the Er? 3.
A: Er must report to GSIS the names, employment status, positions, salaries of the employee and such other matter as determined by the GSIS.
The recipient must be a permanent Ee at the time of separation; His separation was involuntary due to the abolition of his office or position resulting from reorganization; and He has been paying the contribution for at least 1 year prior to separation.
Q: What will consist consist of an unemployment unemployment benefit?
SEPARATION BENEFITS
A: It will consists of cash payment equivalent to 50% of the average monthly compensation
Q: When will a member be entitled to separation benefits?
Note: A member who has rendered at least 15 years of service will be entitled to separation benefits instead of unemployment benefits.
A: A member who has rendered a minimum of 3 years creditable service shall be entitled to separation benefit upon resignation or separation under the following terms:
RETIREMENT BENEFITS Q: What are the conditions conditions in order to be entitled entitled to Retirement Benefits?
1. A member with at least 3 years but less than 15 years: Cash payment equivalent to 100% of the AMC for every year of service the member has paid contributions: a. not less than Php 12,000.00 b. Payable upon reaching 60 years of age or upon separation, whichever comes later.
A: 1. 2. 3.
2. A membe r with less than 15 years of service and less than 60 years of age at the time of resignation or separation: a. Cash payment equivalent to 18 times the basic monthly pension (BMP), payable at the time of resignation or separation b. An old-age pension benefit equal to the basic monthly pension, payable monthly for life upon reaching the age of 60.
A member has rendered at least 15 years of service; He is at least 60 years of age at the time of retirement; and He is not receiving a monthly pension benefit from permanent total disability. (Sec. 13-A, R.A. 8291)
Q: What is the rule in case of extension of service in order to be entitled for Retirement Benefit? A: Rabor v. CSC (G.R. No. 111812, May 1995) , held that the head of the government agency concerned is vested with discretionary authority to allow or disallow extension of the service of an official or Ee who has reached 65 years old without completing the 15 years of government service. However, this discretion is to be exercise conformably with the provisions of Civil Service Memorandum Circular No. 27, series of 1990 which provides that the extension shall not exceed 1 year.
Q: What are the effects of separation separation from service with regard to membership? member separated separated from from the the service shall A: A member continue to be a member and shall be entitled to whatever benefits he has qualified to. Note: Note: A member separated for a valid cause shall automatically forfeit his benefits, unless the terms of resignation or separation provide otherwise.
Q: What is the reason for compulsory retirement?
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Labor Law and Social Legislation A: The compulsory retirement of government officials and Ees upon their reaching the age of 65 years is founded on public policy which aims by it to maintain efficiency in the government service and at the same time give to the retiring public servants the opportunity to enjoy during the remainder of their lives the recompense, for their long service and devotion to the government , in the form of a comparatively easier life, freed from the rigors of civil service discipline and the exacting demands that the nature of their work and their relations with their superiors as well as the public would impose upon them [Beronilla vs. GSIS, G.R. No. 21723, (1970)].
Q: What are the two types of permanent disability? A: 1.
2.
Q: What are the the options of the retiree with with regard to his or her retirement benefits?
Permanent Total Disability (PTD) - accrues or arises when recovery from any loss or impairment of the normal functions of the physical and/or mental faculty of a member which reduces or eliminates his capacity to continue with his current gainful occupation or engage in any other gainful occupation is medically remote. [Section 2 (q) and (s) R.A. 8291] Permanent Partial Disability (PPD) - accrues or arises upon the irrevocable loss or impairment of certain portion/s of the physical faculties, despite which the member is able to pursue a gainful occupation. (Sec. 2[u], R.A. 8291)
A: The retiree may get either of the following: Q: What are the benefits which an employee is entitled to in case of a PTD?
1. Lump sum equivalent to 6 months of the basic monthly pension (BMP) payable at the time of retirement and an old-age pension benefit equal to BMP payable for life, starting upon the expiration of the 5 years covered by the lump sum; or 2. Cash payment equivalent to 18 times his BMP and monthly pension for life payable immediately. (Sec. 13[a], R.A. 8291)
A: 1. A member is entitled to the monthly income benefit for life equivalent to the BMP when: a. He is in the service at the time of the disability or b. If separated from service c. He has paid at least 36 monthly contributions within 5 years immediately preceding his disability d. He has paid a total of at least 180 monthly contribution prior his disability e. He is not receiving old-age retirement pension benefits
PERMANENT DISABILITY BENEFITS Q: What is disability? A: Any loss or impairment of the normal functions of the physical and/or mental faculty of a member, which reduces or eliminates his/her capacity to continue with his/her current gainful occupation or engage in any other gainful occupation.
2. If the member does not satisfy the conditions above but has rendered at least 3- years-service, he shall be advanced the cash payment equivalent to 100% of his average monthly compensation for each year of service he has pad contributions but not less than Php 12,000.00 which should have been his separation benefit (he shall no longer receive separation benefits)
Q: What is total disability? A: Complete incapacity to continue with present employment or engage in any gainful occupation due to the loss or impairment of the normal functions of the physical and/or mental faculties of the member.
Q: What are the benefits which an employee is entitled to in case of a PPD?
Q: What are the conditions in order to be entitled for permanent disability benefits?
A: A member is entitled to cash payment in accordance with the schedule of disabilities to be prescribed by GSIS, if he satisfies the given conditions of either (1) or (2) of Sec. 16(a).
A: The permanent disability was not due to any of the following: 1. 2. 3. 4.
Q: When will the payment of these benefits be suspended?
Grave misconduct Notorious negligence Habitual intoxication Willful intention to kill himself or another
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Q: Under what conditions are the primary beneficiaries entitled to the basic monthly pension?
In case a member is re-employed; or Member recovers from disability as determined by the GSIS; or Fails to present himself for medical examination when required by the GSIS. (Sec. 16 [c], R.A. 8291)
A: Upon the death of a member, the primary beneficiaries shall be entitled to: 1.
Survivorship pension : Provided , That the deceased: a. was in the service at the time of his death; or b. if separated from the service, has rendered at least 3 years of service at the time of his death and has paid 36 monthly contributions within the five-year period immediately preceding his death; or has paid a total of at least 180 monthly contributions prior to his death; or
2.
The survivorship pension plus a cash payment equivalent to 100% of his average monthly compensation for every year of service : Provided, that the deceased was in the service at the time of his death with at least 3 years of service; or
TEMPORARY DISABILITY BENEFITS Q: When does temporary total disability arise? A: It accrues or arises when the impaired physical and/or mental faculties can be rehabilitated and/or restored to their normal functions. (Sec 2[t], R.A. 8291) Q: What benefits are given for temporary disability? A: 1.
2.
Member is entitled to 75% of his current daily compensation for each day or fraction thereof of th total disability benefit, to start at the 4 day but not exceeding 120 days in one calendar year when: a. He has exhausted all sick leaves b. CBA sick leave benefits Provided, that: i. He was in the service at time of disability; or ii. If separated, he has rendered at least 3 years of service and has paid at least 6 monthly contributions in the year preceding his disability The temporary total disability benefits shall in no case be less than P70 a day.
3. A cash payment equivalent to 100% of his average monthly compensation for each year of service he paid contributions, but not less than Php 12,000.00: Provided , that the deceased has rendered at least 3 years of service prior to his death but does not qualify for the benefits under item (1) or (2) of this paragraph. [Sec. 21 (a), R.A. 8291]
Q: After the end of the guaranteed 30 months, are the beneficiaries still entitled to any survivorship benefits? A: Yes. The survivorship pension shall be paid as follows:
Note: Note: A member cannot enjoy the temporary total disability benefit and sick leave pay simultaneously.
1.
An application for disability must be filed with the GSIS within 4 years from the date of the occurrence of the contingency.
2.
SURVIVORSHIP BENEFITS Q: Who are entitled to survivorship benefits? A: Upon the death of a member or pensioner, his beneficiaries shall be entitled to survivorship benefits. Such benefit shall consist of: 1. 2.
3.
The basic survivorship pension which is 50% of the basic monthly pension; and The dependent children’s pension not exceeding 50% of the basic monthly pension
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When the dependent spouse is the only survivor, he/she shall receive the basic survivorship pension for life or until he or she remarries; When only dependent children are the survivors, they shall be entitled to the basic survivorship pension for as long as they are qualified, plus the dependent children’s pension equivalent to 10% of the basic monthly pension for every dependent child not exceeding 5, counted from the youngest and without substitution; When the survivors are the dependent spouse and the dependent children, the dependent spouse shall receive the basic survivorship pension for life or until he/she remarries, and the dependent children shall receive the dependent children’s pension. (Sec. 21[b], R.A. 8291)
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Labor Law and Social Legislation Note: Note: The dependent children shall be entitled to the survivorship pension as long as there are dependent children and, thereafter, the surviving spouse shall receive the basic survivorship pension for life or until he or she remarries.
claim for death benefits with the GSIS? Why? (1991 Bar Question) A: The beneficiaries of a member of the GSIS are entitled to the benefits arising from the death of said member. Death benefits are called survivorship benefits under the GSIS Law. Not being a beneficiary, Bella is not entitled to receive survivorship benefits. She is not a beneficiary because she is a commonlaw wife and not a legal dependent spouse.
Q: When are secondary beneficiaries entitled to survivorship benefits? A: In the absence of primary beneficiaries, the secondary beneficiaries shall be entitled to: 1.
2.
Q: Is the cause of death of Gary (cardiac arrest due to accidental electrocution in his house) compensable? Why?
The cash payment equivalent to 100% of his average monthly compensation for each year of service he paid contributions, but not less than Php 12,000.00: Provided, That the member is in the service at the time of his death and has at least 3 years of service; or In the absence of secondary beneficiaries, the benefits under this paragraph shall be paid to his legal heirs. (Sec. 21[c], R.A. 8291)
A: Yes. To be compensable under the GSIS Law, the death need not be work connected. Q: Abraham, a policeman, was on leave for a month. While resting in their house, he heard two of his neighbors fighting with each other. Abraham rushed to the scene intending to pacify the protagonists. protagonists. However, he was shot to death by one of the protagonists. Eva Joy, a housemaid, was Abraham's surviving spouse whom he had abandoned for another woman years back. When she learned of Abraham's death, Eva Joy filed a claim with the GSIS for death benefits. However, her claim was denied because: (a) when Abraham was killed, he was on leave; and (b) she was not the dependent spouse of Abraham when he died. Resolve with reasons whether GSIS is correct in denying the claim. (2005 Bar Question)
Q: What are the benefits that the beneficiaries are entitled to upon the death of the pensioner? A: 1.
Upon the death of an old-age pensioner or a member receiving the monthly income benefit for permanent disability, the qualified beneficiaries shall be entitled to the survivorship pension. 2. When the pensioner dies within the period covered by the lump sum, the survivorship pension shall be paid only after the expiration of such period.
A: Yes, because under the law, a dependent is one who is a legitimate l egitimate spouse living with the Ee. ( Art. Art. 167 [i], LC) In the problem given, Eva Joy had been abandoned by Abraham who was then living already with another woman at the time of his death.
Q: Gary Leseng was employed as a public school teacher at the Marinduque High. On April 27, 1997, a memorandum was issued by the school principal designating Gary to prepare the model dam project, which will be the official entry of the school in the search for Outstanding Improvised Secondary Science Equipment for Teachers. Gary complied with his superior's instruction and took home the project to enable him to finish before the deadline. While working on the model dam project, he came to contact with a live wire and was electrocuted. The death certificate showed that he died of cardiac arrest due to accidental electrocution.
Moreover, Abraham was on leave when he was killed. The 24-hour duty rule does not apply when the policeman is on vacation leave [ECC v. CA, G.R. No. 121545, (1996)]. Taking together jurisprudence and the pertinent guidelines of the ECC with respect to claims for death benefits, namely: 1. 2.
Bella (Gary’s common-law wife) and Jobo (his only son) filed a claim for death benefits with the GSIS which was denied on the ground that Gary’s death did not arise out of and in the course of employment and therefore not compensable because the accident occurred in his house and not in the school premises. Is Bella entitled to file a U N I V E R S I T Y
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That the Ee must be at the place where his work requires him to be; That the Ee must have been performing his official functions; and That if the injury is sustained elsewhere, the Ee must have been executing an order for the Er, it is not difficult to understand then why Eva Joy's claim was denied by the GSIS [Tancinco v. GSIS, G.R. No. 132916, (2001)].
SOCIAL AND WELFARE LEGISLATION Q: When does compulsory life insurance coverage take effect?
In the present case, Abraham was resting at his house when the incident happened; thus, he was not at the place where his work required him to be. Although at the time of his death Abraham was performing a police function, it cannot be said that his death occurred elsewhere other than the place where he was supposed to be because he was executing an order for his Er.
A: All Ees including the members of the Judiciary and the Constitutional Commissioners except for Members of the AFP, the PNP, BFP and BJMP, shall, under such terms and conditions as may be promulgated by the GSIS, be compulsorily covered with life insurance, which shall automatically take effect as follows:
FUNERAL BENEFITS 1.
Q: What comprises the Funeral Benefit? A: The funeral benefit, in the amount Php 20,000, which is intended to defray the expenses incident to the burial and funeral of the deceased member, pensioner, or retiree under R.A. 660, R.A. 1616, P.D. 1146, and R.A. 8291. It is payable to the members of the family of the deceased, in the order which they appear: 1. Legitimate spouse 2. Legitimate child who spent for the funeral services, or 3. any other person who can show unquestionable proof of his having borne the funeral expenses of the deceased.
2.
3.
Q: When may a member obtain optional Life Insurance coverage? A: 1.
Q: When will it be paid? A: Upon the death of : 1. 2.
An active member A member who has been separated from the service but is entitled to future separation or retirement benefits 3. A member who is a pensioner (excluding survivorship pensioners) 4. A retiree who is at the time of his retirement was of pensionable age, at least 60 years old, who opted to retire under RA 1616 ( An act further amending Sec.12, C.A. 186, as amended, by prescribing two other modes of retirement and for other purposes ).
2.
A member may at any time apply for himself and/or his dependents an insurance and/or preneed coverage embracing: a. Life b. Memorial plans c. Health d. Education e. Hospitalization f. Other plans as maybe designed by GSIS Any Er may apply for group insurance coverage for its Ees.
Q: What is the prescriptive period to claim the benefits? A: GR: 4 years from the date of contingency XPNs: Life insurance and retirement (Sec. 28, R.A. 8291)
LIFE INSURANCE Q: What are the classes of life insurance coverage under the GSIS Law? A: 1. 2.
Those employed after the effectivity of this Act, their insurance shall take effect on the date of their employment; For those whose insurance will mature after the effectivity of this Act, their insurance shall be deemed renewed on the day following the maturity or expiry date of their insurance; For those without any life insurance as of the effectivity of this Act, their insurance shall take effect following said effectivity.
Q: May a member enjoy the benefits provided for in the Revised GSIS Act simultaneous with similar benefits provided under other laws for the same contingency?
Compulsory Life Insurance Optional Life Insurance
A: Whenever other laws provide similar benefits for the same contingencies covered by this Act, the member who qualifies to the benefits shall have the option to choose which benefits will be paid to him.
Note: The plans may be endowment or ordinary life.
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Labor Law and Social Legislation However, if the benefits provided by the law chosen are less than the benefits provided under this Act, the GSIS shall pay only the difference. (Sec. 55, R.A. 8291)
This is advantageous to the SSS and GSIS members for purposes of death, disability or retirement benefits. In the event the Ees transfer from the private sector to the public sector, or vice-versa, their creditable employment services and contributions are carried over and transferred as well.
BENEFICIARIES Q: Who are the considered beneficiaries?
EMPLOYEES’ COMPENSATION A: 1. Primary beneficiaries a. The legal dependent spouse until he/she remarries, and b. The dependent children (Sec. 2[g] , R.A. 8291) 2.
Q: Discuss briefly the Employees’ Compensation Program. A: It is the program provided for in Arts. 166 to 208 of the LC whereby a fund known as the State Insurance Fund is established through premium payments exacted from Ers and from which the Ees and their dependents in the event of work-connected disability or death, may promptly secure adequate income benefit, and medical or related benefits.
Secondary beneficiaries a. The dependent parents, and b. Subject to the restrictions on dependent children, the legitimate descendants (Sec. 2[h] , R.A. 8291)
COVERAGE Q: Who are considered dependents? dependents? A: 1. 2.
3.
Q: Who are subject to coverage under the Employees’ Compensation Program? Legitimate spouse dependent for support upon the member or pensioner; Legitimate, legitimated, legally adopted child, including the illegitimate child, a. who is unmarried, b. not gainfully employed, c. not over the age of majority, or if over the age of majority, incapacitated and incapable of self-support due to a mental or physical defect acquired prior to age of majority; and Parents dependent upon the member for support. ( Sec. 2[f])
A: Ers and their Ees not over 60 years of age are subject to compulsory coverage under this program. The Er may belong to either the: 1. Public sector covered by the GSIS, comprising the National Government, including GOCCs, Philippine Tuberculosis Society, the Philippine National Red Cross, and the Philippine Veterans Bank; and 2. Private sector covered by the SSS, comprising all Ers other than those defined in the immediately preceding paragraph.
LIMITED PORTABILITY LAW (R.A. 7699) The Ee may belong to either the: 1. Public sector comprising the employed workers who are covered by the GSIS, including the members of the AFP, elective officials who are receiving regular salary and any person employed as casual emergency, temporary, substitute or contractual; 2. Private sector comprising the employed workers who are covered by the SSS.
Q: What is the Limited Portability Rule? A: A covered worker who transfers employment from one sector to another or is employed on both sectors, shall have creditable services or contributions on both Systems credited to his service or contribution record in each of the Systems and shall be totalized for purposes of old-age, disability, survivorship, and other benefits in either or both Systems. (Sec. 3, R.A. 7699)
Q: When does compulsory coverage take effect?
All contributions paid by such member personally, and those that were paid by his employers to both Systems shall be considered in the processing of benefits which he can claim from either or both Systems. (Sec. 4, R.A. 7699)
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Employer – – on the first day of operation Employee – Employee – on the day of his employment
Q: What is an occupational disease?
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SOCIAL AND WELFARE LEGISLATION A: One which results from the nature of the employment, and by nature is meant conditions which all Ees of a class are subject and which produce the disease as a natural incident of a particular occupation, and attach to that occupation a hazard which distinguishes it from the usual run of occupations and is in excess of the hazard attending the employment in general
2.
3. 4.
To be occupational, the disease must be one wholly due to causes and conditions which are normal and constantly present and characteristic of the particular occupation.
Note: Notorious negligence is equivalent to gross negligence; it is something more than mere carelessness or lack of foresight.
Q: Abraham Dino works as a delivery man in a construction supply establishment owned by Abraham Julius. One day, while Dino was making reports on his delivery, he had an altercation with Julius; irked by the disrespectful attitude of Dino, Julius pulled out his gun and shot Dino, hitting him in the spinal column and paralyzing him completely. Julius was prosecuted for the act.
Q: What is compensable sickness? A: It means any illness definitely accepted as an occupational disease listed by the Commission or any illness caused by employment, subject to proof that the risk of contracting the same is increased by working conditions. (Art. 167(l), LC) Q: Discuss briefly the theory of Increased Risk.
1.
A: The term “ sickness” as defined in Art . 167(l) of the LC is a recognition of the theory of increased risk. To establish compensability under the same, the claimant must show substantial proof of workconnection, but what is required is merely a reasonable work-connection and not a direct causal relation. Proof of actual cause of the ailment is not necessary. The test of evidence of relation of the disease with the employment is probability and not certainty [Jimenez v. Employees’ Compensation Commission, G.R. No. L-58176, (1984); Panotes vs. ECC, G.R. No. L-64802, (1984)].
2.
A: 1.
2.
Q: May an illness not listed by the Employees ’ Compensation Commission as an occupational disease be compensable? A: Where the illness is not listed by the Employees ’ Compensation Commission as an occupational disease, it must be established that the risk of contracting the same is increased by working conditions.
Is the disability suffered by Abraham Dino compensable? If Abraham Dino recovers compensation from the SIF, can he still recover from Abraham Julius damages in the criminal case? Why?
Yes. The injury was sustained by Abraham Dino in his place of work and while in the performance of his official functions. No. Under Art. 173 of the LC, as amended by P.D. 1921, the liability of the State Insurance Fund under the Employees ’ Compensation Program shall be exclusive and in place of all other liabilities of the Er to the Ee or his dependents or anyone otherwise entitled to recover damages on behalf of the Ee or his dependents.
Q: Wilfredo, a truck driver employed by a local construction company, was injured in an accident while on assignment in one of his employer’s project in Iraq. Considering that his injury was sustained in a foreign country, is Wilfredo entitled to benefits under the Employees’ Compensation Program?
Q: What defenses may be interposed by the State Insurance Fund against a claim for compensation made by a covered Ee or his dependents?
A: Yes. Filipinos working abroad in the service of an Er, domestic or foreign, who carries on in the Philippines any trade, business, industry, undertaking or activity of any kind, are covered by the ECP. (Rule 1, Section 5, ECC Rules; Art.169, LC)
A: The following defenses may be set up: 1.
Disability or death was occasioned by the Ee’s intoxication, wilful intention to injure or kill himself or another, or his notorious negligence (Art. 172, LC) No notice of sickness, injury or death was given to the Er (Art. 206, LC) Claim was filed beyond 3 years from the time the cause of action accrued (Art. 201, LC, as amended by P.D. 1921)
Injury is not work-connected or the sickness is not occupational
Q: What is the “Going and Coming Rule”? Is this rule absolute?
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Labor Law and Social Legislation A: GR: In the absence of special circumstances, an Ee injured while going to or coming from his place of work is excluded from the benefits of Workmen’s Compensation Act.
eligible for monthly income benefit. (Art. 167, LC, as amended by Sec. I, P.D. 1921)
Q: What are the benefits which may be enjoyed under the State Insurance Fund?
XPNs: 1. Where the Ee is proceeding to or from his work on the premises of the Er; 2. Proximity Rule— Rule —where the Ee is about to enter or about to leave leave the premises of his Er by way of exclusive or customary means of ingress and egress; 3. Ee is charged, while on his way to or from hi s place of employment or at his home, or during this employment with some duty or special errand connected with his employment; and 4. Where the Er as an incident of the employment provides the means of transportation to and from the place of employment.
A: 1. Medical Benefits 2. Disability Benefits 3. Death Benefits 4. Funeral Benefits MEDICAL BENEFIT (MEDICAL SERVICES) Q: What are the conditions of entitlement to medical services? A: For an Ee to be entitled to medical services, the following conditions must be satisfied: 1. He has been duly reported to the System (SSS or GSIS); 2. He sustains a permanent disability as a result of an injury or sickness; and 3. The System has been notified of the injury or sickness which caused his disability.
Q: Who are entitled to benefits under the Employees’ Compensation Program? A: The covered Ee, his dependents, and in case of his death, his beneficiaries.
DISABILITY BENEFIT
Q: Who are the dependents of the employee?
Q: What are disability benefits?
A: 1. Legitimate, legitimated, legally adopted or acknowledged natural child who is unmarried, not gainfully employed, and not over 21 years of age or over 21 years of age provided he is incapacitated and incapable of self-support due to a physical or mental defect which is congenital or acquired during minority; 2. Legitimate spouse living with the Ee 3. Parents of said Ee wholly dependent upon him for regular support. (Art.167(i), LC, as amended by P.D. 1921)
A: They are income benefits in case of temporary total disability, permanent total disability and permanent partial disability Q: What are the disabilities that are considered total and permanent? A: The following disabilities shall be deemed total and permanent: 1. Temporary total disability lasting continuously for more than one hundred twenty days, except as otherwise provided for in the Rules; 2. Complete loss of sight of both eyes; 3. Loss of two limbs at or above the ankle or wrist; 4. Permanent complete paralysis of two limbs; 5. Brain injury resulting in incurable imbecility or insanity; and 6. Such cases as determined by the Medical Director of the System and approved by the Commission. (Art.192(c), LC)
Q: Who are included in the term beneficiaries? A: "Beneficiaries " means the dependent spouse until he remarries and dependent children, who are the primary beneficiaries. In their absence, the dependent parents and subject to the restrictions imposed on dependent children, the illegitimate children and legitimate descendants who are the secondary beneficiaries: Provided , that the dependent acknowledged natural child shall be considered as a primary beneficiary when there are no other dependent children who are qualified and
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Q: May a permanent partial disability be converted to permanent total disability after the employe e’s retirement? Why?
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SOCIAL AND WELFARE LEGISLATION A: Yes. This is in line with the social justice provision in the Constitution. A person’s disability may not manifest itself fully at one precise moment in time but rather over a period of time. And disability should not be understood more on its medical significance but on the loss of earning capacity.
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Q: May permanent total disability arise although the employees does not lose the use of any part of his body?
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A: Yes. Where the Ee is unable, by reason of the injury or sickness, to perform his customary job for more than 120 days, permanent total disability arises. [Ijares vs. CA, G.R. No. 105854, (1999)]
FUNERAL BENEFIT
DEATH BENEFIT
Q: What is the funeral benefit?
Q: What are the conditions for entitlement to death benefits?
A: A funeral benefit of Php 10, 000.00 shall be paid upon the death of a covered Ee or permanently totally disabled pensioner.
A: The beneficiaries of a deceased Ee shall be entitled to an income benefit if all of the following conditions are satisfied: 1. The Ee has been duly reported to the System; 2. He died as a result of an injury or sickness; and 3. The System has been duly notified of his death, as well as the injury or sickness which caused his death.
Q: Who are required to make contributions to the State Insurance Fund? A: Contributions under this Title shall be paid in their entirety by the Er and any contract or device for the deduction of any portion thereof from the wages or salaries of the Ees shall be null and void. (Art.183(c), LC)
Q: For how long are the primary beneficiaries entitled to the death benefits?
Q: When does the right to compensation or benefit for loss or impairment of an employe e’s earning capacity due to work-related illness or injury arise?
A: 1. Dependent Spouse— Spouse —until he or she remarries. 2. Dependent Children— Children —until they get married, or find gainful employment, or reach 21 years of age. 3. Dependent Child suffering from physical or mental defect —until such defect disappears.
A: It arises or accrues upon, and not before, the happening of the contingency. Hence, an Ee acquires no vested right to a program of compensation benefits simply because it was operative at the time he became employed [San Miguel Corporation vs. NLRC, G.R. No. 57473, (1988)].
Q: If an employee suffers disability or dies before he is duly reported for coverage to the System (SSS or GSIS), who will be liable for the benefits?
Q: Does recovery from the State Insurance Fund bar a claim for benefits under the SSS Law? Why?
A: The Er shall be liable (Sec.1, Rule X; Sec.1, Rule XI; Sec. 1, Rule XII; Sec. 1, Rule XIII; ECC Rules)
A: No, as expressly provided for in Art. 173 of the LC, payment of compensation under the State Insurance Fund shall not bar the recovery of benefits under the SSS Law, Republic Act No. 1161, as amended. Benefits under the State Insurance Fund accrue to the Ees concerned due to hazards involved and are made a burden on the employment itself. On the other hand, social security benefits are paid to SSS members by reason of their membership therein for which they contribute their money to a general fund [Ma-ao Sugar Central Co., Inc. vs. CA, G.R. No. 83491, (1990)].
Q: What are the rules regarding employer’s liability in case of death or injury?
A: 1.
If the cause was due to the Ee’s own notorious negligence, or voluntary act or drunkenness, the Er shall not be liable. If the cause was partly due to the Ee’s lack of sue care, the compensation shall be inequitably reduced. If the cause was due to the negligence of a fellow Ee, the Er and the guilty Ee shall be liable solidarily. If the cause was due to the intentional or malicious act of fellow Ee, the fellow Ee and Er are liable unless the Er exercised due diligence in selecting and supervising his Ees.
If the cause of the death or personal injury arose out of and in the course of employment, the Er is liable.
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