Effectivity and coverage commencement
- Coverage shall be compulsory under Rule I, Section 1.
- Employer coverage takes effect on the first day of operation but not earlier than January 1, 1975 (Rule I, Section 6(a)).
- Employee coverage takes effect on the first day of employment (Rule I, Section 6(b)).
- For public sector employers:
- Employers operating before January 1, 1975 must register not later than March 31, 1975 (Rule II, Section 2(a)(1)).
- Employers operating on or after January 1, 1975 must register within one month from the first day of operation (Rule II, Section 2(a)(2)).
- Employees must be registered within one month from the date of employment (Rule II, Section 2(a)(3)).
- For private sector employers and employees:
- Employers already registered under SSS need not register again because they are automatically registered (Rule II, Section 3(a)(1)).
- Employers not yet registered must register not later than the first day of operation (Rule II, Section 3(a)(2)).
- Employees already registered need not register again because they are automatically registered (Rule II, Section 3(a)(3)).
- Employees not yet registered must register not later than the date of employment (Rule II, Section 3(a)(4)).
- Only one registration is needed for SSS, Medicare, and Employees’ Compensation (Rule II, Section 3(a)(5)).
Coverage rules: employer, employee, abroad
- Every employer is covered (Rule I, Section 2(a)).
- Every employee not over sixty (60) years of age is covered (Rule I, Section 2(b)).
- An employee over sixty (60) years of age is covered if:
- the employee had been paying contributions prior to age sixty (60) and
- the employee has not been compulsorily retired (Rule I, Section 2(c)).
- An employee who is coverable by both GSIS and SSS is compulsorily covered by both Systems (Rule I, Section 2(d)).
- “Employer” means any person, natural or juridical, domestic or foreign, carrying on in the Philippines any trade, business, industry, undertaking, or activity and using the services of another person under his orders as regards employment (Rule I, Section 3(a)).
- “Employer” belongs to:
- the public sector covered by GSIS (National Government, including GOCCs; the Philippine Tuberculosis Society; the Philippine National Red Cross; and the Philippine Veterans Bank) (Rule I, Section 3(b)(1)); or
- the private sector covered by SSS (all employers other than those defined as public sector) (Rule I, Section 3(b)(2)).
- “Employee” means any person who performs services for an employer under Rule I, Section 3 (Rule I, Section 4(a)).
- “Employee” belongs to either:
- public sector: workers covered by GSIS, including members of the Armed Forces of the Philippines, elective officials receiving regular salary, and persons employed as casual, emergency, temporary, substitute, or contractual (Rule I, Section 4(b)(1)); or
- private sector: workers covered by SSS (Rule I, Section 4(b)(2)).
- Filipinos working abroad for an employer under Rule I, Section 3 are covered and entitled to the same benefits as employees working in the Philippines (Rule I, Section 5(a)).
- Medical services for Filipinos employed abroad are paid under these Rules subject to limitations fixed in these Rules, and the Accreditation rules do not apply to these cases (Rule I, Section 5(b)).
- The notice requirement is strictly applied to claims involving employment abroad (Rule I, Section 5(c)).
- For abroad-related medical claims, authenticated medical certifications by physicians and authenticated hospital statement of accounts are acceptable bases for payment, but System standards and rates remain those provided under these Rules (Rule I, Section 5(d)).
Registration, reporting, and registration penalties
- Employers must register with the System by accomplishing the prescribed forms (Rule II, Section 1(a)).
- Employees are registered through their employer by accomplishing prescribed forms (Rule II, Section 1(b)).
- In the private sector, if an employee has not yet been registered, the employer shall report as follows:
- Newly hired employee: report not later than thirty (30) days from the date of employment (Rule II, Section 3(b)(2)).
- If the System receives a report or written communication with payment made in the employee’s name before a compensable contingency occurs, the employee is deemed duly reported (Rule II, Section 3(b)(3)).
- Penalties for violation of registration requirements:
- Failure or refusal to register employees results in a fine of not less than PHP 1,000 nor more than PHP 10,000 and/or imprisonment for the duration of the violation or non-compliance or until rectification is made, at the discretion of the Court (Rule II, Section 4(a)(1)).
- If a compensable contingency occurs after thirty (30) days from employment and before the System receives any report for coverage or EC contribution, the employer is liable for the lump sum equivalent of the benefits the employee or dependents may be entitled to (Rule II, Section 4(a)(2)).
Compensability and liability limits
- For injuries to be compensable, the injury must result from an accident arising out of and in the course of employment (Rule III, Section 1(a)).
- For sickness to be compensable, the sickness must be an occupational disease listed under Annex “A” and conditions must be satisfied; otherwise, compensability requires proof that the risk of contracting the disease is increased by working conditions (Rule III, Section 1(b)).
- Occupational diseases are occupational when the nature of employment matches the descriptions in Annex “A” (Rule III, Section 2(a)).
- Employers must:
- require pre-employment examination of prospective employees (Rule III, Section 2(b));
- provide periodic medical examination to employees exposed to occupational diseases; and
- take other necessary measures (Rule III, Section 2(b)).
- Periodic medical examinations for early detection must follow the minimum standards in Annex “B” (Rule III, Section 2(c)).
- The Commission is authorized to determine and approve additional occupational diseases and work-related illnesses with specific criteria based on peculiar hazards (Rule III, Section 3).
- No compensation is allowed when the injury, sickness, disability, or death was occasioned by:
- the employee’s intoxication; or
- the employee’s willful intention to injure or kill himself or another; or
- the employee’s notorious negligence (Rule IV, Section 1).
- The State insurance fund’s liability is exclusive and in place of other employer liabilities to the employee or dependents or others entitled to damages on the employee’s behalf, unless otherwise provided (Rule IV, Section 2(a)).
- Compensation payment does not bar recovery of benefits provided for under Section 699 of the Revised Administrative Code, Commonwealth Act No. 186 (as amended), and these laws:
- Republic Act No. 6111 (as amended),
- Republic Act No. 1161 (as amended),
- Republic Act No. 4864 (as amended),
- and other laws whose benefits are administered by the System or other government agencies (Rule IV, Section 2(b)).
- If disability or death is caused by circumstances creating a legal liability against a third party:
- the disabled employee or dependents shall be paid benefits under these Rules; and
- once benefits are claimed and allowed, the System is subrogated to the rights of the disabled employee or dependents under existing laws (Rule IV, Section 3).
- The System is not liable for compensation for unauthorized changes in:
- medical services,
- appliances and supplies,
- hospitals,
- rehabilitation services, or
- physicians,
unless the employee or dependents notify the System and secure prior consent before the change (Rule IV, Section 4).
- Medical-report requirements:
- Temporary total disability recipients must submit a monthly medical report on disability certified by the attending physician, or benefits are suspended until compliance (Rule IV, Section 5(a)).
- Permanent disability (disease-related) recipients must submit a quarterly medical report certified by physician, or benefits are suspended until compliance (Rule IV, Section 5(b)).
Employer contributions: rates, remittance, and penalties
- Employer contributions are paid in their entirety by the employer; any contract or device deducting any portion from wages or salary is null and void (Rule V, Section 1).
- Public sector (GSIS) contribution:
- 1% of the actual wages or salary received as of the last day of the month,
- but not to exceed PHP 30 per employee (Rule V, Section 1(a)(1)).
- Private sector (SSS) contribution:
- 1% of monthly salary credit as of the last day of the month, following the salary-bracket employer contribution schedule in Rule V, Section 1(a)(2) (including PHP 25 salary bracket mapping to PHP 0.25, and the highest bracket “900 – over” mapping to 1,000–3,000 monthly salary credit with PHP 10.00 employer contribution).
- If a covered employee dies or is separated during employment, employer obligation to pay monthly contribution for that employment ceases on the last day of the month of the contingency (Rule V, Section 1(a)(3)).
- If a covered employee becomes disabled during employment, the employer obligation is suspended during months when the employee is not receiving salary or wages (Rule V, Section 1(a)(4)).
- No refund of contributions is allowed (Rule V, Section 1(a)(5)).
- Remittance start and schedule:
- Contributions start in January 1975 and are remitted every month thereafter while the employee has earnings.
- The initial contribution for January 1975 is remitted in February 1975, unless another arrangement is agreed by the System and employer (Rule V, Section 2).
- Penalties for contribution violations:
- Delinquent contributions make the employer liable to the System for benefits already paid to employees or dependents and for benefits and expenses the employer is liable for; those obligations constitute a preferred lien on all property over any credit except taxes (Rule V, Section 3(a)(1)).
- If the employer pays the lump sum equivalent of such liability, the employer is absolved from paying delinquent contributions due and payable during the calendar year of the contingency and penalty for the concerned employee, but the employer remains subject to criminal liability (Rule V, Section 3(a)(2)).
- Delinquency results in a fine of not less than PHP 1,000 nor more than PHP 10,000 and/or imprisonment for the duration of the violation or non-compliance or until rectification, at the Court’s discretion (Rule V, Section 3(a)(3)).
- If any contribution is not paid to SSS as prescribed, in addition to the contribution the employer must pay a penalty of three percent (3%) a month from the date the contribution falls due until paid (Rule V, Section 3(a)(4)).
- Under ECC Resolution No. 1243 dated January 18, 1979, the System pays employees or dependents all benefits due them under PD 626 (as amended) without prejudice to proceed against the erring employer (Rule V, Section 3, Note).
Credited earnings definitions and benefit formulas
- Time periods:
- A “quarter” is three consecutive calendar months ending on March 31, June 30, September 30, or December 31 (Rule VI, Section 1).
- A “semester” is two consecutive quarters ending in the quarter of contingency (Rule VI, Section 2).
- “Monthly salary credit” is the wage base/actual salary under Rule V, Section 1, computed on aggregate earnings from multiple employments, but not exceeding PHP 1,000 for SSS and PHP 3,000 for GSIS (Rule VI, Section 3).
- “Wages or salary” for benefit computation refers to:
- monthly remuneration under Republic Act No. 1161 (as amended) for SSS and
- monthly remuneration under Presidential Decree No. 1146 (as amended) for GSIS,
except the part in excess of Three Thousand Pesos (Rule VI, Section 4).
- Average monthly salary credit (SSS):
- computed by dividing the sum of monthly salary credits in the 60-month period immediately preceding the semester of death/permanent disability/injury/sickness by the number of months of coverage, with special rules when death/permanent disability occurs within 18 months from month of coverage or within the month of coverage (Rule VI, Section 5(a)(1)-(2)).
- The day of injury or sickness that caused disability is the reckoning date for computing average monthly salary credit (Rule VI, Section 5(b)).
- Average monthly salary credit (GSIS) is the quotient of:
- aggregate compensations received in the last three years immediately preceding death/permanent disability/injury/sickness divided by the number of months of receipt, or three thousand pesos, whichever is smaller (Rule VI, Section 5(c)).
- Average daily salary credit (SSS):
- sum of six (6) highest monthly salary credits in the 12-month period preceding the semester of sickness divided by 180, with special computations for injuries within 12 calendar months and within the month of coverage (Rule VI, Section 6(a)(1)-(2)).
- Average daily salary credit (GSIS) depends on salary basis:
- hourly: hourly rate × hours required divided by 22;
- daily: daily rate × days required divided by 22;
- monthly: monthly rate divided by 22;
- if worked less than one month: actual daily wage or salary divided by actual days worked in the month of contingency (Rule VI, Section 6(b)(1)-(4)).
- Replacement ratio (SSS):
- 20% plus the quotient of 300 divided by (340 + average monthly salary by credit) (Rule VI, Section 7).
- Credited years of service:
- for members covered prior to January 1975: 1975 minus calendar year of coverage plus number of calendar years with six or more contributions from January 1975 up to the calendar year containing the semester prior to contingency (Rule VI, Section 8);
- for members covered in or after January 1975: number of calendar years with six or more contributions from the year of coverage up to the calendar year containing the semester prior to contingency (Rule VI, Section 8).
- Monthly income benefit:
- (SSS) monthly income benefit equals 115% of:
- average monthly salary credit × replacement ratio and
- 1.5% (one and a half percent) of average monthly salary credit for each credited year of service in excess of ten years,
- but not less than PHP 250, and automatic maintenance of specified 15% and 20% differences between EC and SS and between EC and GSIS (LOI 1286) (Rule VI, Section 9(a)).
- (GSIS) monthly income benefit equals the basic monthly pension under PD 1146 plus 20% thereof, but not less than PHP 250 nor more than actual salary at the time of contingency (Rule VI, Section 9(b)).
- (SSS) monthly income benefit equals 115% of:
Benefits: types, disability classification, and prescriptive period
- Employees’ compensation benefits are provided as income or services, consisting of:
- medical services, appliances and supplies;
- rehabilitation services;
- temporary total disability benefit;
- permanent total disability benefit;
- permanent partial disability benefit;
- death benefit; and
- funeral benefit (Rule VII, Section 1).
- Disability definitions:
- total disability is temporary if unable to perform any gainful occupation for a continuous period not exceeding 120 days, except as otherwise provided in Rule X;
- total and permanent disability is inability for a continuous period exceeding 120 days, except as otherwise provided in Rule X;
- partial and permanent disability is permanent partial loss of the use of any part of the body (Rule VII, Section 2(a)-(c)).
- Compensation covers the disability or death resulting from injury or sickness via cash payments, not the injury or sickness itself, except in permanent partial disability (Rule VII, Section 3).
- For permanent partial disability, if the income-benefit period does not exceed 12 months, the System may pay in lump sum or monthly pension; otherwise, it is paid in monthly pension (Rule VII, Section 3-A).
- Injury or sickness is compensable by medical services, appliances, supplies, and rehabilitation services (Rule VII, Section 4).
- No contract, regulation, or device may deprive employees or dependents of any part of income benefits or medical/related services, except as provided under these Rules, and existing medical services provided by the employer must be maintained (Rule VII, Section 5).
- Claims prescriptive period:
- No compensation claim is given due course unless filed with the System within three years from the time the cause of action accrues (Rule VII, Section 6).
Medical services and limits on payment
- Entitlement to medical services, appliances, and supplies requires that the employee:
- has been duly reported to the System;
- sustains an injury or contracts sickness; and
- the System has been duly notified of the injury or sickness (Rule VIII, Section 1(a)-(3)).
- Medical services begin on the first day of injury or sickness, continue during the subsequent disability period, and continue as recovery progress may require, subject to expense limitations in Annex “C” and subject to Rule IV, Section 5 (Rule VIII, Section 2).
- Extent of medical entitlement:
- entitlement is limited to ward services of an accredited hospital and accredited physician;
- if the employee chooses better accommodations, the employee bears the excess over benefits provided under Annex “C” (Rule VIII, Section 3(a)).
- “Ward” means a hospital room that can accommodate six or more patients (Rule VIII, Section 3(a)).
- Hospitals must provide all medicines/drugs/supplies necessary for treatment at a cost not exceeding retail prices in local drug stores (Rule VIII, Section 3(b)).
- Payments are made directly to providers in amounts prevailing in the community for similar services or under the schedule in Annex “C”, whichever is less (Rule VIII, Section 3(c)).
Rehabilitation: voluntary coverage and rules
- Rehabilitation coverage is voluntary (Rule IX, Section 2(a)).
- Rehabilitation coverage takes effect upon completion of registration (Rule IX, Section 2(b)).
- Entitlement to rehabilitation services requires that the employee:
- has been reported to the System;
- sustains permanent disability as a result of compensable injury or sickness as defined in these Rules; and
- has not been placed in suitable employment (Rule IX, Section 3(1)-(3)).
- Rehabilitation services are provided during the disability period unless suspended or terminated under:
- upon suitable employment;
- suspension or termination by the Rehabilitation Center;
- self-termination (Rule IX, Section 4(1)-(3)).
- Rehabilitation services consist of:
- medical-surgical management;
- hospitalization;
- necessary appliances and supplies;
- vocational training; and
- assistance for placement,
and may include transportation allowance, lunch, and dormitory allowances in appropriate cases (Rule IX, Section 5).
- Rehabilitation centers:
- A Workers Rehabilitation Center Complex is established, and other rehabilitation centers or services may be established based on needs of occupationally disabled employees from private or public sector (Rule IX, Section 6).
- Accreditation for rehabilitation:
- Hospitals accredited under Rule XVII and rehabilitation facilities/vocational/training centers and their personnel accredited by the Philippine Academy of Rehabilitation Medicine (PARM) may apply for accreditation (Rule IX, Section 7).
- System liability limitations during rehabilitation follow exclusions based on:
- intoxication;
- willful intention to injure or kill oneself or another; or
- notorious negligence (Rule IX, Section 8).
- Suspension, termination, and appeal:
- the student-rehabilitee may be suspended or terminated upon adequate and duly proven causes and upon recommendation of the rehabilitation counselor;
- decisions may be appealed within fifteen (15) days from notice to the Governing Board, whose decision is final and executory (Rule IX, Section 9(a)-(b)).
- Placement is an integral part of the rehabilitation program (Rule IX, Section 10).
- System participation incentives to employers for on-the-job training:
- System may agree to participate in paying wages of the placed rehabilitee:
- 50% for first two weeks,
- 25% for third and fourth weeks,
- 10% for fifth and sixth weeks,
- 0% for the rest of the on-the-job training period (Rule IX, Section 11(1)-(4)).
- System may agree to participate in paying wages of the placed rehabilitee:
- Reports:
- the Center submits reports to the Governing Board on progress of rehabilitation program activities once every 3 months or as often as necessary (Rule IX, Section 12).
Temporary total disability benefit rules
- Entitlement requires that the employee:
- has been duly reported to the System;
- sustains temporary total disability due to injury/sickness; and
- the System is duly notified of the injury/sickness (Rule X, Section 1(a)(1)-(3)).
- Employer liability applies when the illness or injury occurred before the employee is duly reported for coverage to the System (Rule X, Section 1, second paragraph).
- Period of entitlement:
- income benefit begins on the first day of disability;
- it is not paid longer than 120 consecutive days;
- if medical attendance continues beyond 120 days but not beyond 240 days from onset, temporary total disability benefit is paid during the extended period (Rule X, Section 2(a)).
- The System may declare temporary total disability’s status as total and permanent at any time after 120 days of continuous temporary total disability based on degree of impairment determined by the System (Rule X, Section 2(a)).
- Relapse/recurrence rule:
- after full recovery certified by the attending physician, a relapse/recurrence disability period is treated as independent and separate; it is not added to the original temporary total disability period (Rule X, Section 2(b)).
- Amount:
- temporary total disability benefit is 90% of average daily salary credit (Rule X, Section 3(a)).
- daily income benefit limits: not less than PHP 10.00 nor more than PHP 90.00, and not longer than 120 days for the same disability unless extended treatment requires beyond 120 days up to 240 days (Rule X, Section 3(a)(1)).
- monthly income benefit is suspended if the employee fails to submit a monthly medical report certified by the attending physician as required under Rule IV, Section 5 (Rule X, Section 3(a)(2)).
Permanent total disability benefit rules
- Entitlement requires that the employee:
- has been duly reported to the System;
- sustains permanent total disability as a result of injury or sickness; and
- the System is duly notified of the injury or sickness (Rule XI, Section 1(a)(1)-(3)).
- Employer liability applies if injury or sickness occurred before the employee is duly reported (Rule XI, Section 1(a), second paragraph).
- Permanent total disability cases are considered permanent when:
- temporary total disability lasts continuously for more than 120 days (subject to Rule X);
- 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 and insanity; or
- such cases as determined by the System and approved by the Commission (Rule XI, Section 1(b)(1)-(6)).
- Period:
- full monthly income benefit is paid for all compensable months of disability (Rule XI, Section 2(a)).
- after the Employees’ Compensation benefit ceases and if qualified for another System-administered law for the same disability, benefit is paid under that other law; this paragraph applies to contingencies occurring prior to May 1, 1978 (Rule XI, Section 2(b)).
- monthly income benefit is guaranteed for five (5) years (except as otherwise provided in other laws) and is suspended upon:
- failure to present himself for examination at least once a year upon System notice;
- failure to submit a quarterly medical report certified by attending physician as required under Rule IV, Section 5;
- complete or full recovery;
- or when gainfully employed (Rule XI, Section 2(c)(1)-(4)).
- Amount for SSS:
- permanent total disability income benefit is as defined in Section 8(a), Rule VI (notwithstanding the cited section reference) (Rule XI, Section 3(a)(1)).
- Number of months of paid coverage:
- is the number of monthly contributions remitted, including contributions other than Employees’ Compensation if paid before March 31, 1975; full monthly income benefit is paid for all compensable months (Rule XI, Section 3(b)).
- The first day preceding the semester of temporary total disability is used as reckoning for computing monthly income benefit for permanent total disability (Rule XI, Section 3(c)).
- Dependent children benefit:
- each dependent child (not exceeding five (5), counted from the youngest without substitution) is entitled to 10% of the monthly income benefit (Rule XI, Section 4(a)).
- these Rules do not apply to causes of action accrued before **May 1