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BOX 21

1. The Labor Code introduces major changes to the law that awards compensation benefits to employees
who sustain work-connected injury or disease. What are those significant changes?

The new law discarded the concepts of presumption of compensability and aggravation to
restore what the law believes is sensible equilibrium between the employers obligation to pay
workmens compensation and the employees right to receive reparation for work-connected
death or disability.

The new law establishes a state insurance fund built up by the contribution 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. There is no notice of injury nor requirement of
controversion.

The sick worker simply files a claim with a new neutral Employees' Compensation Commission
which then determines on the basis of the employee's supporting papers and medical evidence
whether or not compensation may be paid. The payment of benefits is more prompt. The cost of
administration is low. The amount of death benefits has also been doubled.

On the other hand, the employer's duty is only to pay the regular monthly premiums to the
scheme. It does not look for insurance companies to meet sudden demands for compensation
payments or set up its own funds to meet these contingencies. It does not have to defend itself
from spuriously documented or long past claims.

The new law applies the social security principle in the handling of workmen's compensation. The
Commission administers and settles claims from a find under its exclusive control. The employer
does not intervene in the compensation process and it has no control, as in the past, over
payment of benefits. The open ended Table of Occupational Diseases requires no proof of
causation. A covered claimant suffering from an occupational disease is automatically paid
benefits.

Since there is no employer opposing or fighting a claim for compensation, the rules on
presumption of compensability and controversion cease to have importance. The lopsided
situation of an employer versus one employee, which called for equalization through the various
rules and concepts favoring the claimant, is now absent.

2. Under what circumstances is an injury considered work-connected and therefore compensable?

For the injury and the resulting disability or death be compensable, the injury must be the result of an
employment accident satisfying all of the following grounds:

(a) The employee must have been injured at the place where his work requires him to
be;

(b) The employee must have been performing his official functions; and

(c) If the injury is sustained elsewhere, the employee must have been executing an
order for the employer.

3. What kinds of diseases are compensable?


For the sickness and the resulting disability or death to be compensable, the sickness must be the result of an
occupational disease listed under Annex A of the Rules with the conditions set therein satisfied.

4. Explain the theory of increased risk.

If the ailment is not included in the list of occupational diseases, the claimant has the burden of proving that
the nature of the work increased the risk of contracting the disease.

5. What is the dual purpose doctrine?

The dual purpose doctrine allowing compensation applies where a special trip would have to be made for the
employer if the employee had not combined the service for the employer with his own going or coming trip.

The dual purpose doctrine considers as compensable an injury that an employee sustains while on a trip
undertaken for the benefit of the employer even if in the course thereof the employee pursues also a personal
purpose. (Azucena, p. 500)

6. If the cause of a disease is unknown, for example cancer, must the claimant prove that it is work-
related so as to obtain benefits under S.I.F.?

As a general rule, cancer is a disease of still unknown origin which strikes people in all walks of life, employed
or unemployed. Unless it be shown that a particular form of cancer is caused by specific working conditions or
environment, one cannot conclude that it was the employment which increased the risk of contracting the
disease.

BOX 22

1. Who are the employers and employees compulsorily covered by the employees compensation
program?

ART. 168. Compulsory coverage. - Coverage in the State Insurance Fund shall be compulsory upon all
employers and their employees not over sixty (60) years of age: Provided, That an employee who is over (60)
years of age and paying contributions to qualify for the retirement or life insurance benefit administered by
the System shall be subject to compulsory coverage.

2. What is the notorious negligence that can cause denial of compensation claim?

Notorious negligence has been defined as something more than mere or simple negligence or
contributory negligence; it signifies a deliberate act of the employee to disregard his own personal safety.

3. What benefits are claimable under the EC program and under the SS law because of injury or disease?

Under the EC Program:


a. Loss of Income Benefit or Cash Benefit in cases of Temporary Total, Permanent Total or
Permanent Partial Disability
b. Medical Benefits
c. Rehabilitation Services, and
d. Carers Allowance

Under the SS Law:


a. Sickness Benefit
b. Disability Benefit

BOX 23

1. Who administers the State Insurance Fund? What is the role of the SSS?

Employees Compensation Commission (ECC) administers the State Insurance Fund.


The Philippine Social Security System (Filipino: Paseguruhan ng Kapanatagang Panlipunan, or SSS) is a social
insurance program for workers in the Philippines. It is a government agency that provides retirement and
health benefits to all enrolled employees in the Philippines.

2. Does the EC Commission decide on compensation claims? Are their decisions appealable?

Art 180. The System (SSS/GSIS) shall have original and exclusive jurisdiction to settle any dispute arising from
this Title (Title II: Employees Compensation and State Insurance Fund) with respect to coverage, benefits,
collection and payment of contributions and penalties thereon, or other matter related thereto, subject to
appeal to the Commission (ECC), which shall decide appealed cases within twenty working days from
submission of the evidence.
Their decisions are appealable to the Court of Appeals, and subject to review on certiorari by the Supreme
Court.

BOX 24

1. Is it the employers or consumers that shoulder the contributions to the S.I.F.?

The employer shoulders the contribution to the SIF and remits to the System (SSS/GSIS) monthly.

BOX 25

1. What are the benefits recoverable under the EC Program?

a. Loss of Income Benefit or Cash Benefit in cases of Temporary Total, Permanent Total or
Permanent Partial Disability
b. Medical Benefits
c. Rehabilitation Services, and
d. Carers Allowance
e. Death Benefits

2. Are medical benefits payable even after ones retirement?

The obligation to provide medical services lasts for as long as the employee is sick because the liability for
medical care lasts during the period of disability. Medical attendance is owing as long as the employee is sick
of a compensable illness, and this duty is not ended when employment terminates.

BOX 26

1. What are the kinds of disability benefits under the EC program?


a. Temporary Total Disability (TTD) benefit is given to an employee who is unable to work for a
continuous period not exceeding 120 days.
b. Permanent Total Disability (PTD) benefit is given to an employee who is unable to work for more
than 240 days.
c. Permanent Partial Disability (PPD) benefit is given to a worker who losses a body part and
consequently, the loss of the use of that body part

2. When is a disability considered permanent-total?

A disability is total and permanent if a s a result of the injury or sickness the employee is unable to perform
any gainful occupation for a continuous period exceeding 120 days except as otherwise provided for in Rule X
of the ECC Rules (Azucena p. 556)

Permanent Total Disability means an incapacity to perform gainful work which is expected to be permanent.

BOX 27

1. In case an SIF-covered employee dies, who are the beneficiaries of the death benefits?

"Beneficiaries" means the dependent spouse until he/she remarries and dependent children, who are the
primary beneficiaries. In their absence, the dependent parents and subject to the restrictions imposed on
dependent children, the illegitimate children and legitimate descendants, who are the secondary
beneficiaries: Provided, That the dependent acknowledged natural child shall be considered as a primary
beneficiary when there are no other dependent children who are qualified and eligible for monthly income
benefit.

2. If there are competing claimants, who resolves the dispute?

The ECC is empowered to settle disputes in compensation claims such us competing claimants.

BOX 28

1. What are the liabilities of an employer who is delinquent in his contribution to the S.I.F.?

An employer who is delinquent in his contributions shall be liable to the System for the benefits which may
have been paid by the System to his employees or their dependents

2. What is the prescriptive period for EC claims?

Article 201. No claim for compensation shall be given due course unless said claim is filed with the System
within three years from the time the cause of action accrued.

The prescriptive period for filing compensation should be reckoned from the time the employee lost his
earning capacity, i.e., terminated from employment, due to his illness and not when the same first became
manifest. (ECC vs Sanico, GR 134028)

BOX 29

1. What steps need to be observed in filing and pursuing an EC claim?


It is required that the employee, his dependents or anybody on his behalf, should give the notice of sickness,
injury or death to the employer within 5 days from the occurrence of the contingency.

2. Under what circumstances may the notice to the employer be dispensed with?

(1) When the employee suffers the contingency within the employers premises;

(2) When the employee officially files an application for leave of absence by reason of the contingency
from which he suffers;

(3) When the employer provides medical services and/or medical supplies to the employee who suffers
from the contingency; and

(4) When the employer can be reasonably presumed to have had knowledge of the employees
contingency, in view of the following circumstances:

(4.1) The employee was performing an official function for the employer when the contingency
occurred;

(4.2) The employees contingency has been publicized through mass media outlets; or

(4.3) The specific circumstances of the occurrence of the contingency have been such that the
employer can be reasonably presumed to have readily known it soon thereafter; or

(4.4) Any other circumstances that may give rise to a reasonable presumption that the employer
has been aware of the contingency.