Employees Compensation and State Insurance Fund Notes September 2018

Labor Standards Notes (on SA Poquiz)
Employees Compensation and State Insurance Fund
Chapter 1
Article 172: The State shall promote and develop a tax exempt Employees Compensation Program
whereby employees and their dependents, in the event of work‐connected disability or death, may
promptly secure adequate income benefit, and medical or related benefits.
Purpose:
1. To provide security against hazards of life characteristic of the modern industrial revolution
(Accidents, illness, old age, loss of employment)
2. To aid the workers in claiming for damages, as in the absence of law on workmen's compensation, it is
difficult for a worker to bring suit against an employer.
When is employer not liable?
1. The employer exercised reasonable care in providing a safe place to work, safe tools and appliances
2. The injured worker assumed the risks common to the employment in which he is engaged
DOCTINE OF ASSUMPTION OF RISK*
If the injured worker knew of the risks of the job and still continued to work, the employer is not
responsible.
3. The injury arose because of the negligence of a co‐employee
4. The negligence of the injured worker contributed to occurrence of the accident
DOCTRINE OF CONTRIBUTORY NEGLIGENCE*
Different from Doctrine of Vicarious Liability, (Jayme vs Ynares GR 163609): the liability of the employer
for injury caused by its employees (quasi delict)
Employer's Liability Act (RA 1847) ‐ extends the liability of the employers and to render them liable in
damages for certain classes of personal injuries for which they are not liable under the NCC.
Workmen's Compensation Act (Act 3428)
‐ enacted to secure workmen and their dependents against becoming objects of charity, by making a
reasonable compensation for injuries incident to employment; enacted in June 1928, subsequently
repealed by the LC, with amendments on Title 2, Employees Compensation and State Insurance Fund
‐ Under this act, the presumption of compensability is recognized where an injury or disease arose out
of and in the course of employment, it is presumed that the claim for compensation falls within the
Jellie Casino, Labor Law 1 notes [Date] 1
provisions of the law. The employee NEED NOT present any proof of causation, but it is the employer
who should prove that the illness or injury did not arise out of or in the course of employment
Basic Features of the new Employee's Compensation Program:
1. Integration of Benefits
2. Increase in benefits
3. Prompt payment of income benefits
4. Legal services dispensed with
5. Wider Coverage
6. A more balanced rehabilitation program
PRINCIPLE OF SOCIAL SECURITY*
The commission administers and settles claims from a fund under its exclusive control, where the
employer does not intervene in the compensation process and it has no control over the payment of
benefits
Read: Orate vs CA GR 132761 ‐ discusses the doctrine of presumption of compensability
Facts: Norma Orate was employed by the Manila Bay Spinning Mills as a regular machine operator, who
contracted breast carcinoma in the course of her employment. Due to her illness, she retired at the age
of 44 and applied for employees compensation benefit with the SSS, but this was denied on the ground
that the illness is not work related. She appealed and elevated her request to the Employees
Compensation Commission which ruled that the disability due to breast cancer is not compensable
under the Employees Compensation Program because the disease is not included in the among the
occupational diseases outlined in Annex A of the Rules on Employees Compensation.
Issue: WON Orate is entitled to employees compensation benefits for disability arising from breast
carcinoma?
WON the law applicable to petitioners claim for disability benefits should be hinged under The
Labor Code (not Workmens Compensation Act)
Ruling: It is held that the applicable law applicable to the instant case is the Labor Code. For breast
carcinoma to be compensable, the claimant must prove by substantial evidence that a) that the sickness
was the result of an occupational disease listed in Annex A of the Rules on Employees Compensation or
b) if the sickness is not so listed, the risk of contracting the disease was increased by the claimants
working conditions. Here, the petitioner contends that her job as a machine operator which required
lifting of heavy objects increased the risk of her contracting breast carcinoma and her exposure to dye in
coloring threads aggravated the risk. The court ruled that bare allegations and vague excerpts of cancer
do not constitute evidence supporting her claim on causal relationship between her illness and working
condition, thus her disability is not compensable. The CA decision was reversed and set aside, and the
ECC decision was reinstated.
Related Cases:
GR NO 158268 Castor Garupa vs ECC
Ruling: The court granted petition and ordered GSIS to pay petitioner the compensation benefits. It was
ruled that inasmuch as petitioner’s disease was not listed as an occupational disease, it is incumbent
upon her to adduce substantial proof that would show the nature of her employment or working
conditions increased the risk of End stage renal disease. The evidence presented by petitioner
satisfactorily proved that the conditions of her work (resident physician) increased the likelihood of
petitioner being infected.
GR No 78167 Lazo vs ECC
Ruling: The presumption of compensability and theory of aggravation was acknowledged to be
abandoned under the new labor code but highlights the liberality of the law in general in favor of the
working man as subsisting. Upholding the LC provision (Art 4) that all doubts in the implementation and
interpretation of the provisions of the LC including its implementing rules and regulations shall be
resolved in favor of labor. In the case at bar, the petitioner contended that the injuries he sustained due
to the vehicular accident on his way home from work should be construed as "arising out of or in the
course of employment thus compensable. The court ruled that there is no reason to deny compensation
for accidental injury occuring while petitioner was on his way home one hour after he had left his work
station.
Article 173 ‐ Definition of Terms
* Code ‐ Labor Code of the Philippines
* Commission ‐ Employees Compensation Commission
* SSS ‐ Social Security System
* GSIS ‐ Government Service Insurance System
* System ‐ SSS/GSIS
* Employer ‐ any person natural or juridical, employing the services of the employee
* Employee ‐ any person compulsorily covered by the GSIS (including AFP, any person employed as casual, emergency, temp, sub or
contractual)
* Person ‐ any individual, partnership, firm, association, trust, corp or legal representative thereof
* Dependents ‐ legitimate, legitimated, legally adopted or acknowledged natural child who is unmarried, not gainfully employed and not over
21, or over 21 but incapacitated
* Beneficiaries ‐ dependent spouse until he remarries, and dependent children who are primary beneficiaries; in their absence, the dependent
parents, the illegitimate children, and legitimate descendants who are the secondary beneficiaries
please see LC Article 173 >makasuka<
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CHAPTER 2
Article 178: Limitation of Liability
What is the State Insurance Fund?
State Insurance Fund is built up by the contributions of employers based on the salaries of their
employees. The injured worker does not have to litigate his right to compensation, no employer
opposes his claim.
The sick worker files a claim with ECC which then determines on the basis of the employee's supporting
papers WON compensation may be paid.
The employer;s duty is ONLY to pay the regular monthly premiums to the scheme.
With this set up that the employer does not oppose the claim for compensation, the rules of
presumption of compensability and controversion is now irrelevant
What is compensable sickness?
It is any illness listed as an occupational disease by the ECC, or any illness caused by employment,
subject to proof that the risk of contracting the same is increased by working conditions (Orate case‐
theory of increased risk)
What is occupational disease?
One which results from the nature of the employment (conditions to which all employees of a class are
subject and which produce the disease as natural incident of a particular occupation)
Characterized by:
1. Occurs in association with particular types of occupation
2. The disability due to the injurious exposure grows gradually over a period of time
Examples: Lead poisoning among minders, bends among divers, communicable disease among nurses in
direct contact with patients with such disease
Conditions for compensability of occupational disease:
1. The employee's work must involve the risk described
2. The disease was contracted as a result of the employee's exposure to the described risks
3. the disease was contracted within a period of exposure
4. There was no notorious negligence on the part of the employee
Employer who failed to provide adequate protection and safety devices: Penalized under Art 206 of LC
Employer who provided adequate protection: determination WON employee was negligent
CRUCIAL TEST OF COMPENSABILITY
There must be an existing employer‐ employee relationship which is jurisdictional foundation for
recovery of compensation under the law.
Read: Rep of the Phils vs Asia Pro Cooperative GR No. 172101
Since the existence of an EE‐ER relationship between the cooperative and its owners‐members was put
in issue and considering that the compulsory coverage of the Social Security Law is predicated on the
existence of the relationship, it behooves upon SSC to determine if there exists an EE‐ER relationship
between the cooperative and it's owners‐members.
Claims are rooted in the coverage by the system ‐ this falls under the jurisdiction of the SSC, not the
NLRC.
OLD DOCTRINE: Actual proof not necessary
Actual proof of causation is not necessary to justify compensability, only a substantial evidence of
reasonable work‐connection; the employee has the burden of proving that his illness is work related,
therefore compensable (Naval vs ECC, 199 SCRA 388)
NEW DOCTRINE: Proof necessary and required
Two approaches to cases where it cannot be proved that the risk of contracting an illness, not listed as
OD, was increased by claimant's working conditions:
1. It must be presumed that the working conditions increased the risk of contracting the ailment
2. If there is no proof of the required work connection, the disease is not compensable because the law
says so. UNLESS: it can be shown that a particular form of disease is caused by specific working
conditions such as chemical fumes.
INCREASED RISK THEORY
There must be a reasonable proof that the employees working condition increased his risk of contracting
the disease, or that there is a connection between his work and the cause of the disease (Refer to Castor
‐ Garupa vs ECC GR 158268)
Compensable Illness (illness that is work‐ connected, work induced or work related)
Non Compensable Illness (No work‐ illness connection can be established)
What is injury?
Any harmful change in the human organism from any accident arising out and in the course of
employment, sustained at work, at the workplace or elsewhere while executing an order of the
employer.
"In the course of employment" ‐ it takes place within the period of employment, at a place where the
employee may be and while he is fulfilling his duties or is engaged in doing something incidental thereto.
The Twenty‐Four hour doctrine:
Should not embrace all acts and circumstances, but only those that can be categorized as work related
or work‐connected. This doctrine may be applied when the claimant obtained his injuries at a time
he/she was doing an act within his duty and authority and that the injury was obtained in course of the
performance of his duty.
Read: Valeriano vs ECC, GR 136200;
Facts: Sgt. Hinoguin (and company) were orally granted permission to go to Aritao on an overnight pass
and to take their issued firearms with them as Aritao was considered as a critical place. Hinoguin and the
other two soldiers went to Dft Alibuyog's home for meal and drinks.
Dft Alibuyong, not noticing that his rifle's safety lever was on semi‐automatic, accidentally touched the
trigger, firing a single shot and hitting Sgt Hinoguin who later died a few days after the incident.
Issue: WON the death of Sgt Hinoguin is compensable and WON a soldier on active duty but on an
overnight pass is considered as not under "official functions"
Ruling: The court held that a soldier on active duty status is really on 24 hour duty and on official duty
status and is subject to military discipline and military laws 24 hours a day. He is subject to call and to
orders of his superior at all times, except when is on approved vacation leave status. In the case at bar,
Sgt Hinoguin, being on an overnight pass does not preclude the fact that he was performing "official
functions". While going to a fellow soldier's home for meal and drinks was not a specific military duty, he
was nonetheless in the course of official functions.
Compensable Injuries:
Peculiar Risks ‐ metro aide crushed to death by an automobile
Street Perils ‐ street sweeper exposed to the perils of the street
Acts of ministration ‐ personal comfort doctrine (an employee who heeded call of nature and sustained
injuries in the performance of such act is deemed compensable; acts incidental to employment
Acts of God ‐ farmer while adminstering insecticide got struck by lightning
Assualts ‐ employees squabbling resulting to assualt over work assignment
Recreational activities ‐ injuries sustained in the course of a company‐sponsored activity
Activities for the benefit of the employer ‐ employee sustained injuries while on the way to purchase
materials for the employer
Acts during emergency ‐ sustained in the course of a rescue work during an emergency arising out of
employment
COMING AND GOING RULE*
In the abscence of special circumstances, an employee injured in going to, or coming from his place of
work is excluded from the benefits of WCA. If injury sustained is in the course of going to or coming
from his place of work, while using the public streets and highways IS NOT COMPENSABLE. This is for the
reason that such injury suffered is a consquence of risk and hazards applicable to all members of the
travelling public.
Read: Iloilo Dock and Engineering Co v WCC 26 SCRA 102
Exceptions:*
1. Where the employee is proceeding to or from his work on the premises of his employer
2. Where the employee is about to enter or about to leave the premises of his employer by using the
customary means of ingress and egress
3. Where the employee is charged while on his way to or from his place of employment or at his home,
or during his employment, with some duty OR special errand connected with his employment
4. Where the employer, as an incident, provides that the means of transportation to and from the place
of employment
** Proximity Rule (EXCEPTION TO C&G Rule)
An injury sustained off the employer's premise but while in close proximity thereto and while using a
customary means of ingress and egress is COMPENSABLE
PRINCIPLE OF EXCLUSION
The employee or his dependents are not entitled to compensation for injury, sickness, disability or
death occasioned by:
1. Intoxication ‐ must be proved that the person is EXTREMELY DRUNK, such that the state of
intoxication renders one incapacitated to follow his occupation; Intoxication must be the proximate
cause of, and not merely contributory cause to his death or injury (Nitura v ECC GR 89217)
‐ the burden lies on him who raises drunkenness as a defense (Marlow Navigation Phils v Heirs
of Ganal GR 220168)
There must be concurrence of the following:
* There must be proof of actual intoxication
* The intoxication must be extreme so the employee is incapacitated from substantially engaging in
employment and performance of his task
* must be the proximate cause of the injury or death
* must not only be the proximate cause but the employment thereof must not be a contributing cause
NITURA v ECC GR 89217
Facts: Deceased Pfc Regino Nitura was in military service since October 1978, and was assigned to the D
Coy 44th Inf, stationed at Basagan, Katipunan, Zmbo del Norte. On March 02, 1986, he was instructed to
go to Dipolog City, and on his way back to camp, he passed, crossed and fell from a hanging wooden
bridge connecting Basagan and Dipolog. He hit his head on a stony portion of the ground and died due
to cardio‐respiratory arrest resulting from the traumatic fall. Petitioner mother claimed for
compensation which was denied on the grounds that the accident/disability/death was not a result of
an accident arising out of and in the course of employment; elevated to the ECC, which was also denied.
ECC also stressed that employee acted with notorious negligence, for he was already intoxicated and he
still proceeded to attend the dance party and with full knowledge that crossing the bridge is risky.
Issue: WON the death of Pfc Regino Nitura is compensable
Ruling: The court held that the petition was impressed with merit. In the case at bar, it is not proved
that there is a showing of notorious negligence for there is no intention that can be attributed to the
injured/deceased to end his life. Furthermore, the state of drunkenness was proved that such
intoxication was so extreme that it rendered PFC Nitura incapacitated to follow his occupation nor was it
proved that the intoxication was the proximate cause of death. The court ruled in favor of the
petitioner, granting the claim payable to the heirs of PFC Nitura.
2. Self ‐ inflicted injuries ‐ if the injuries are done with a willful intent to injure or kill one's self or
another; covered also is when an employee suffers injuries in the course of an ensuing struggle while he
unlawfully assaults or inflicts injury upon a person (Exception to this exception: when the employee
caused such injury at a time his will must have been impaired, or he has been deprived full use of his
reason ‐ insane acts were not done willfully) READ: GR 115497
When is suicide considered not a bar to compensation?*
* When it results from insanity resulting from compensable injury or disease
* When it occurs during a delirium resulting from compensable injury or disease
* When it flows from an uncontrollable impulse arising from compensable injury or disease
3. Notorious negligence ‐ more than simple or contributory negligence; the employee deliberately
disregarded his own personal safety
Luzon Stevedoring Corp. vs WCC GR No. L‐37896
Issue: WON the claim for compensation benefit on account of Hayson's demise due to accidental
poisoning when he mistook oil of wintergreen for Tanduay Rhum (WON this constitutes notorious
negligence on the part of the employee)
Ruling: The court ruled that there is no notorious negligence in the part of the deceased employee. In
the case at bar, it was established that the employee was not a heavy drinker and it was not shown that
he did not drink that could have affected his state of mind. It was also established that there was no
incident pointing to the fact the deceased was so despondent that he wanted to end his life. The court
held that to constitute notorious negligence, it must be shown that the act of the deceased entirely
wants in care as to raise the presumption that he was conscious of probable consequences of his
carelessness and indifferent to the danger of injury to himself or other persons. It must be equivalent to
the doing of an intentional wrong. Here, the deceased's attituted constitutes merely simple negligence.
The decision under review is affirmed.
Article 179: Extent of Liability
Whenever other laws provide similar benefits for the same contingency, the employee who qualifies for
the benefits shall have the option to CHOOSE the law under which benefits will be paid to him. If the law
choses for benefits lesser than those provided by the LC, he shall be entitled only to the difference.
Benefits excluded by the State Insurance Fund:
1. Gratuity benefits
2. Retirement, disability, sickness and death benefits under SSS
3. Life insurance, disability, and retirement benefits under GSIS
4. Gratuities and pensions of every personnel for deaths and disabilities incurred in line of duty
5. Medical benefits administered by Philhealth
6. Other benefits granted by other laws
Note: the option granted to an injured worker is selective: either he avails the benefits of WCA/LC or of
suing in the regular courts under the CC, for higher damages the employer by reason of his negligence.
They cannot pursue both actions simultaneously
EXCEPTION:
When claimant becomes cognizant of the fact that employer has been remiss in its contractual
obligations only AFTER receiving compensation under the act. This is because had the petitioners been
aware of this fact and violation of government rules and regulations by employer, and its negligence,
claimants would have availed sought redress under the regular courts.
** Read: DM Consunji Inc v CA GR 137873
When claimant sues on the basis of supervening facts or developments occurring after he opted for the
first remedy (Marcopper Mining Corp vs Abeleda, GR L‐33851)
Article 180: Liability of Third Parties
In case the injury or death is caused by third party, the injured employee may either claim compensation
from the system under the LC OR sue for damages the third party
When the system recovers from third party the damages in excess of those paid or allowed in Title 2 of
LC, such excess shall be delivered to the injured employee after the deduction of expenses of the system
and the cost of proceeding.’
Chapter 3
Article 182: Employees Compensation Commission
Composition:
Secretary of Labor and Employment (Chairman)
Members: Exec Director of ECC, GSIS Gen. Manager, SSS Administrator, President of Philhealth
Appointive Members: Employee’s representative and Employer’s representative
** The appointive members should have at least 5 years’ experience in workmen’s compensation or
social security program
** The ECC is a government corporation, attached to the DOLE
Article 188: Powers and Duties of the ECC
1. To assess and fix a rate of contribution for all employers
2. To determine the rate of contribution payable by employer
3. To approve rules and regulations governing the processing of claims
4. To initiate policies and programs toward adequate occupational health and safety and accident
prevention in the working environment
5. TO make the necessary actuarial studies and calculations concerning the grant of help and
income benefits
6. To appoint the personnel of its staff, subject to CSC rules and guidelines
7. To adopt annually, a budget of expenditures of the Commission
8. To have the power to administer oath and affirmation and to issue subpoena
9. To sue and be sued in court
10. To acquire real or personal property, necessary or expedient of the attachment of the purposes
of this title
11. To enter into agreements or contracts
12. To perform such other acts as it may deem appropriate
** also to determine and approve additional occupational diseases and work‐related illnesses
with specific criteria
Article 184: Management of Funds
12% of the contributions and investment earnings collected‐ The amount that can be disbursed for
operational expenses by the ECC, SSS and GSIS. The limitation is set to protect the contributions to the
system for these are not public funds but TRUST funds belonging to covered members‐employees.
The State Insurance Fund should be used exclusively for payment of employee’s compensation benefits
and not for any other purposes. Can be invested with due and prudent regard for the liquidity needed
by the system
Article 186: Settlement of Claims
 Exclusive jurisdiction to settle any dispute with respect to coverage, entitlement to benefits,
collection and payment of contributions shall fall under The System.
 Appeal: The Commission, decided upon within twenty working days from the submission of
evidence
Remember:
Claims for medical benefits: filed BY the accredited physician/hospital directly with the SSS/GSIS, using
the prescribed form
Claims for income benefits: filed BY the employee, his dependents or employer in his behalf, directly
with the SSS/GSIS, using prescribed form; Must be filed within 3 years from time of cause of action
accrued.
Article 187: Reviews
Decisions, orders or resolutions of the Commission may be reviewed by Certiorari by the SC on
questions of law upon petition of an aggrieved party within TEN days from notice thereof:
Covered: Appeals from judgements or final orders of the CTS, and from awards, et al, by any quasi
judicial agency in the exercise of its quasi judicial functions
Not Covered: judgements and final orders under the LC
Where to Appeal: CA, within the period provided, whether the appeal involves questions of fact, or of
law, or mixed
Period of Appeal: 15 days from notice of the award/judgement
Only 1 motion for reconsideration shall be allowed; there must also be payment of full amount of docket
fee before the expiration of the reglementary period
How: Appeal by filing a verified petition for review in 7 legible copies; Pay to Clerk of Court of the CA
Contents of Petition: Full names of parties, concise statement of facts and issues involved, accompanied
by a clear legitimate or duplicate original of the judgement appealed from, statement of all the specific
material dates that it was filed within the reglementary period and a sworn certification against forum
shopping.
Effects: The failure of the petitioner to comply with the foregoing requirements shall be sufficient
grounds for the dismissal thereof.
Note:
A motion for reconsideration, prior to taking an appeal, is not always required. The rule of immutability
of final judgement is adhered to the necessity notwithstanding occasional errors that may result thereby
since litigation must come to an end.
Article 188: Enforcement of Decisions
The decision , order or resolution of the ECC becomes final and executory if no appeal is taken within 10
days from notice thereof.
Under Revised Admin Circular, an appeal may be taken to the CA within 15 days from notice of award,
judgement or final order of the ECC.
The commission HAS the power to issue a writ of execution necessary for the enforcement of decisions.
Chapter 4
Employer’s Contribution:
Public Sector: 1% of the actual wages or salary received as of the last day of the month, remitted to GSIS
Private Sector: 1% of his monthly salary credit as of the last day of the month, remitted to SSS
Effect of death or separation:
Employer’s obligation to pay the monthly contribution shall cease on the last day of the month of
contingency
Effect of disability:
The employer’s obligation to pay the monthly contribution arising from that employment shall be
suspended during the months that he is not receiving salary or wages.
Non Refundable: Contributions refund is not allowed
The government guarantees and accepts the general responsibility for the solvency of the State
Insurance Fund in order to insure benefits due an employee. In case of deficiency, the same can be
covered by supplemental appropriations from the national government.
Chapter 5
Scope of Medical Services:
1. Ward services during confinement in an accredited hospital
2. Subsequent domiciliary care by an accredited physician
3. Medicine
4. Ambulatory Services in an accredited hospital, in case of emergency
Conditions of entitlement:
1. He has been duly reported to the system
2. He sustains an injury or contracts a sickness
3. The system has been duly notified of the sickness and/or injury
Period of entitlement: beginning with the first day of injury/sickness, during the subsequent period of
his disability and as the progress of his recovery may require, subject to the periodic submission of a
medical report, certified by his physician
Ward – hospital room that can accommodate six or more patients
Extent of Services:
Employee is entitled only to ward services of an accredited hospital and accredited physician
IF employee chooses a better accommodation, the excess of the total amount of expenses incurred shall
be borne by the employee
EXCEPTION: When employee suffers from a contagious disease which requires him to be isolated
The hospital shall provide all the medicine, drugs, or supplies necessary for the treatment of the
employee at a cost not exceeding the retail prices in local drug stores.
Liability:
The system is not liable for compensation for unauthorized charges in medical services, appliances,
supplies, hospitals, etc. Should there be any reason for changes, the employee shall NOTIFY the system
and secure its prior consent before the change may be effected.
Attending Physician: should comply with all the regulations of the system and submit medical reports in
prescribed form
Medical information developed in connection with treatment or examination is NOT considered as
privileged communication.
Note: The system can stop the payment of compensation benefits if employee unreasonable refuses to
medical exam or treatment – UNREASONABLE REFUSAL
What is rehabilitation?
The process by which there is provided a balanced program of remedial treatment, vocational
assessment and preparation designed to meet the individual needs of each handicapped employee to
restore him to suitable employment.
This is voluntary in nature.
Entitlement to rehabilitation services.
1. He has been reported to the system
2. He sustains a permanent disability as a result of a compensable injury or sickness
3. He has not been placed in suitable employment
Rehabilitation services shall be provided during the period of disability unless suspended or terminated
under any of the following grounds: suitable employment, self‐termination or suspension of such
services by rehabilitation center.
LIMITS of System’s Liability:
System is not legally responsible when the S/I/D is occasioned by any of the following:
1. Intoxication
2. Willful intention to injure or kill himself or another
3. Notorious negligence
Chapter 6
Disability Benefits
What is Disability?
Disability means loss or impairment of a physical or mental function resulting from injury or sickness;
Not synonymous with sickness or illness.
What is Temporary Total Disability?
It is if as a result of the injury or sickness, the employee is unable to perform any gainful occupation for a
continuous period not exceeding 120 days or where the injury or sickness still requires medical
attendance beyond 120 days but not more than 240 days from the onset of disability.
When is one entitled to an income benefit for TTD?
1. The employee has been duly reported to the system
2. The employee sustains the temporary total disability as a result of the injury or sickness
3. The system has been duly notified of the injury or sickness which caused his disability.
Amount of Benefit: income benefit equivalent to 90% of his average daily salary credit, provided that
the daily income benefit shall not be less than P10.00 or P90.00 nor paid longer than 120 days for the
same disability.
Exception: the injury or sickness requires more extensive treatment that lasts beyond 120 days as may
be determined by the Commission
The monthly benefit shall be suspended: failure of employee to submit a monthly medical report
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What is Permanent Total Disability?
It is a disability if as a result of the injury or sickness, the employee is unable to perform any gainful
occupation for a continuous period EXCEEDING 120 days. EXCEPT: when the disability not exceeding 240
days is declared as TTD.
How to determine?
There must be a showing of the capacity of the employee to continue performing his work
notwithstanding the disability he incurred. It does not require that the employee be absolutely disabled
or totally paralyzed. What is necessary is that the injury must be such that the employee cannot pursue
her usual work and earn therefrom (Remigio v NLRC, GR No 159827)
Jurisprudence:
GR 123891:
 Disablement of employee to earn wages in the same kind of work
 Disablement of employee to earn wages in work of similar nature that he was trained or
accustomed to perform
 Disablement of employee to earn wages from any kind of work which a person of his mentality
and attainment could do
GR 84777 Bejarno v ECC
 It is the incapacity to work resulting to the impairment of one’s earning capacities
Note:
The full monthly income benefit shall be paid for all compensable months of disability, guaranteed for
five (5) years
Suspension or Termination of Benefit:
1. Failure of the employee to present himself for examination, at least once a year
2. Failure to submit a quarterly medical report certified by the attending physician
3. Complete or full recovery from the permanent disability
4. Upon being gainfully employed
What is the 120 Day period rule?
120 days‐ the seaman/employee is on temporary total disability as he is totally unable to work for this
period. May be extended to no more than 240 days, if no such other declaration is made because the
seaman needs further medical attention.
This is subject to the right of the employer to declare within this period that a permanent partial or total
disability already exists.
Refer to Magsaysay v NLRC GR No 186180
Remember: the disability need not be an illness that is incurable, or resulting from an incurable illness,
but that the employee is unable to perform his customary work for more than 120 days = this
constitutes Permanent Total Disability (Crystal Shipping Inc v Natividad, GR 154798)
What is the 240 day rule?
Disability lasting continuously for more than 120 days, except as otherwise provided in the rules are
considered as TOTAL and PERMANENT DISABILITY
The 240 day rule is the exception, where the system may declare the total and permanent disability
status at any time after 120 days of continuous temporary total disability as may be warranted by the
degree of actuall loss or impairment of physical or mental functions as determined by the system.
What is permanent partial disability?
It is partial and permanent if as a result of injury or sickness, the employee suffers a permanent partial
loss of use of any part of his body. It occurs when an employee loses the use of any particular
anatomical part of his body which disables him to continue with his former work.
Note: An employee is entitled to a conversion of his disability benefits from partial permanent to
permanent total, where the employee’s disability further deteriorated, the aggravation of his condition
arise from the same injury or disability.
Amount of Benefit: if exceeding 12 months, the income benefit shall be paid in monthly pension.
Otherwise, lump sum.
Conditions for entitlement of Death Benefit:
1. The employee should have been duly reported to the system
2. The death was the result of an injury or sickness
3. The system should have been notified of the death, as well as the I/S that caused the death
Primary Beneficiaries:
Legitimate spouse, living with employee, until he remarries
Legitimate, legitimated or legally adopted natural children, who are un married and not gainfully
employed and who are below 21 years old; if over 21 years old, incapacitated or incapable of self
support
Secondary Beneficiaries:
Legitimate parents wholly dependent upon the employee for support
Legitimate descendants and illegitimate children who are unmarried, not gainfully employed and <21
Priority: Primary beneficiaries shall priority over secondary beneficiaries;
If without primary benefifiaries, the death benefit shall be paid to his secondary
If no beneficiaries at the time of death, the death benefit shall accrue to the ECC fund
How much is the income benefit?
Equivalent to the monthly income benefit for permanent total diswability, guaranteed for 5 years,
increased by 10 percent for each dependent child, not exceeding five beginning with the youngest, and
without substitution.
What is the funeral benefit?
Paid upon the death of a covered employee or PTD pensioner to the surviving spouse, or legitimate child
who spent for the funeral services or any other person who can show incontrovertible proof of having
borne the funeral expenses.

Employees Compensation and State Insurance Fund Notes September 2018

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Employees Compensation and State Insurance Fund Notes September 2018

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Labor Standards Notes (on SA Poquiz)

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