QuestionsQuestions (PRESIDENTIAL DECREE NO. 626)
The State shall promote and develop a tax-exempt employees’ compensation program so that employees and their dependents may promptly secure adequate income benefits in the event of work-connected disability or death, and medical or related benefits.
An employee is any person compulsorily covered by the GSIS (including members of the AFP) and any person employed as casual, emergency, temporary, substitute, or contractual, or any person compulsorily covered by the SSS—depending on the controlling system.
Dependents include the legitimate, legitimated, or legally adopted unmarried child not gainfully employed and not over 18, or over 18 but not over 21 if enrolled in school, or over 21 if congenitally incapacitated and incapable of self-support physically or mentally; the legitimate spouse living with the employee; and legitimate parents wholly dependent on the employee for regular support.
Injury is any harmful change in the human organism sustained at work during working hours at the workplace or elsewhere while executing an order for the employer. Sickness is an illness accepted as occupational disease listed by the Commission, or any illness caused by employment subject to proof that the risk is increased by working conditions. Death is loss of life resulting from injury or sickness.
Coverage in the State Insurance Fund is compulsory upon all employers and their employees not over 60 years of age; however, an employee over 60 who is paying contributions to qualify for retirement or life insurance benefits administered by the System remains subject to compulsory coverage.
If an employee is both covered by the SSS and GSIS, only the employee’s employment with the latter shall be considered for purposes of coverage.
Compulsory coverage of the employer takes effect on the first day of his operation during the effectivity of the Title; coverage of the employee takes effect on the date of his employment.
Unless otherwise provided, the State Insurance Fund’s liability is exclusive and in place of all other liabilities of the employer to the employee or dependents for the same disability or death; payment under this Title bars recovery of certain benefits under specified laws administered by SSS/GSIS during the period of such payment for the same contingency.
It has four ex-officio members: the Secretary of Labor (Chairman), GSIS Manager, SSS Administrator, Chairman of the Philippine Medical Care Commission, plus two appointive members (one representing employees, one representing employers) appointed by the President for a term of six years; all vacancies are filled for the unexpired term.
Examples: assess and fix employers’ contribution rates; adjust contribution rates for high-frequency accidents/diseases due to lack of safety; approve rules on processing claims and settling disputes; initiate occupational health and safety/accident-prevention programs; conduct actuarial studies for benefit calculations; appoint staff; adopt an annual budget; issue subpoenas; sue and be sued; and perform acts for enforcement of the Title.
All revenues collected under this Title shall be deposited, invested, administered, and disbursed in the same manner and with the same safeguards as SSS/GSIS funds under their enabling laws, with the Commission/SSS/GSIS allowed to disburse each year up to 12% of contributions and investment earnings for operational expenses, including occupational health and safety programs.
Surplus revenues not needed for current operational expenses are accumulated in the State Insurance Fund used exclusively for payment of benefits under the Title; no amount of it shall be used for any other purpose.
The System has original and exclusive jurisdiction to settle disputes related to coverage, entitlement to benefits, collection/payment of contributions and penalties, and other matters related thereto; decisions on appeal to the Commission must be decided within 20 working days from submission of evidence.
Money claims arising during the effectivity of the Code must be filed within three (3) years from accrual; claims accruing prior to effectivity must be filed within one year from date of effectivity; and workmen’s compensation claims pending prior to effectivity and from Nov. 1–Dec. 31, 1974 must be filed with appropriate Labor Department regional offices no later than March 31, 1975.
Cases pending before the Workmen’s Compensation Units and those pending before the Workmen’s Compensation Commission as of March 31, 1975 are to be processed and adjudicated under the law, rules, and procedure existing prior to the effectivity of the Employees’ Compensation and State Insurance Fund Title.