Question & AnswerQ&A (ECC AMENDED RULES ON EMPLOYEES' COMPENSATION)
Coverage is compulsory for all employers and employees, with specific provisions for employees over 60 and those covered by both GSIS and SSS.
An employer is any natural or juridical person, domestic or foreign, carrying on any trade, business, industry or activity in the Philippines using the services of another person under their orders regarding employment.
GSIS covers the public sector including the National Government and certain government corporations, while SSS covers the private sector comprising all other employers not covered by GSIS.
Employers must register with the System by filling prescribed forms. Employees are registered through their employers. Different deadlines apply depending on whether the sector is public or private and when operations started.
Employers or officials may be fined not less than P1,000 nor more than P10,000 and/or imprisoned for the duration of the violation until rectified. Employers may also be liable for lump sum benefits if coverage reports are delayed.
Injuries must arise out of and in the course of employment. Sickness must be due to occupational disease listed in Annex A or must prove increased risk due to working conditions.
Liability of the state insurance fund is exclusive in lieu of other liabilities of the employer for employee injury, sickness, disability, or death.
Employers pay monthly contributions entirely, equivalent to one percent of the employee's wages or salary, with specific salary brackets for private sector employees under SSS and a cap for GSIS employees.
Benefits include medical services, rehabilitation services, temporary total disability, permanent total disability, permanent partial disability, death benefits, and funeral benefits.
Claims must be filed within three years from the time the cause of action accrued, otherwise the right to benefits is barred.
Daily income benefit shall not be less than P10.00 nor more than P90.00 and is paid for up to 120 days, or up to 240 days if medical treatment requires extension.
Primary beneficiaries include the legitimate spouse living with the employee at the time of death and legitimate, legitimated, legally adopted or acknowledged natural children who meet eligibility requirements.
The employer must cause the employee to be brought immediately to the nearest or most accessible accredited physician or hospital for treatment.
A hospital must provide in-patient diagnostic and therapeutic services under physician supervision, maintain clinical records, have nursing services, be licensed by the Ministry of Health, meet health and safety standards, and maintain a Utilization Review Committee.
Persons committing fraud or collusion to secure benefits may be fined not less than P5,000 and imprisoned for six months to one year; harsher penalties apply for recidivists, professionals, or government employees including disqualification or dismissal.