Question & AnswerQ&A (GSIS Resolution NO. 113)
A member who suffers permanent disability for reasons not due to grave misconduct, notorious negligence, habitual intoxication, or willful intention to kill himself/herself or another is entitled to PTD benefits under Section 15 of RA No. 8291, subject to conditions in Section 16.
PTD is defined as an injury or disease causing complete, irreversible, and permanent incapacity that permanently disables a member to work or engage in the same occupation, resulting in loss of income.
Permanent and total disabilities include: complete loss of sight of both eyes; loss of two limbs at or above the ankle or wrist; permanent complete paralysis of two limbs; brain injury resulting in incurable imbecility, insanity, or physical incapacitation; and other cases determined by the GSIS Board of Trustees.
The injury or illness must be complete, irreversible, and permanent; have no reasonable chance of recovery; show irreversible changes supported by medical evidence; include progressive and debilitating symptoms; and prevent the claimant from engaging in occupation or earning the same income.
A claimant must submit service records, certificates of leaves (with and without pay) including leave balance, and daily time records for the past three months certified by the agency's Human Resources office.
Benefits may be suspended if the claimant is reemployed but does not inform GSIS; if the claimant earns at least the same income as before disability; if medical evaluation shows recovery; or if the claimant fails to present self for medical examination without valid reason.
Medical Evaluators and Medical Reviewers designated by the Senior Vice Presidents of Luzon, NCR, and VisMin Groups are responsible for evaluating and reviewing PTD claims.
Appeal must be filed within 60 days from receipt of notice to the Committee on Claims (COC). The COC's decision may be appealed to the Board of Trustees within 60 days of receiving the COC's resolution.
Erring officers or employees may be subject to disciplinary actions under Section 46(b) of the Administrative Code of 1987, Section 38 of Presidential Decree No. 1146, and the Revised Rules on Administrative Cases in the Civil Service.
The processing time for PTD claims shall be sixty (60) days from submission of complete requirements.