EMPLOYEES COMPENSATION AND STATE INSURANCE FUND PURPOSE Provide compensation for disability or death resulting from occupational

injuries or diseases or accidental injury or death of employee. It is for the benefit if the injured employees and not for the injured employers. POLICY OF THE STATE 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. (Art. 166, LC, Art. 164, P.D. 626) WORKMENS COMPENSATION A general and comprehensive term applied to those laws providing for compensation for loss resulting from the injury, disablement or death of a workman through industrial accident, casualty or disease. DEFINITIONS Employer - means any person, natural or juridical, employing the services of the employee. Employee - means any person compulsorily covered by the GSIS under Commonwealth Act Numbered One hundred eighty-six, as amended, including the members of the Armed Forces of the Philippines, and any

person employed as casual, emergency, temporary, substitute or contractual, or any person compulsorily covered by the SSS under Republic Act Numbered Eleven hundred sixtyone, as amended. Person- means any individual, partnership, firm, association, trust, corporation or legal representative thereof. Dependent- means the legitimate, legitimated or legally adopted or acknowledged natural child who is unmarried, not gainfully employed, and not over twenty-one (21) years of age or over twenty-one (21) years of age provided he is incapacitated and incapable of self-support due to a physical or mental defect which is congenital or acquired during minority; the legitimate spouse living with the employee and the parents of said employee wholly dependent upon him for regular support. Beneficiaries- mean 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.

Injury- means any harmful change in the human organism from any accident arising out of and in the course of the employment. Sickness- means any illness definitely accepted as an occupational disease listed by the Commission, or any illness caused by employment subject to proof that the risk of contracting the same is increased by working conditions. For this purpose, the Commission is empowered to determine and approve occupational diseases and work-related illnesses that may be considered compensable based on peculiar hazards of employment. Death- means loss of life resulting from injury or sickness. Disability- means loss or impairment of a physical or mental function resulting from injury or sickness. [Article 167 (f), (g), (h), (I), (j), (k), (l), (m), (n)] COVERAGE The employees compensation law applies to: Compulsory Coverage (Art. 168, LC) a. All employers, public or private b. Employees not over 60 years old c. Employees over 60 years old provided that they are paying contribution to SSS/GSIS. d. Filipino employees employed abroad subject to prescribed ECC regulations (Art. 169, LC)

Notes: Compulsory Coverage of the employer shall take effect on the first day of his operation, and that of the employee, on the date of his employment. (Art. 170, LC) Each employer and his employees shall register with the System in accordance with its regulations. (Art. 171, LC) on

violation has been made, at the Court's discretion. (Sec. 3, Amended Rules on Employees Compensation) The Government guarantees the benefits prescribed under this Title, and accepts general responsibility for the solvency of the State Insurance Fund. In case of any deficiency, the same shall be covered by supplemental appropriations from the national government. (Art. 184, LC) COMPENSABILITY FORMULA INJURY Under the Article 167 (k) of the Labor Code, INJURY means any harmful change in the human organism from any accident arising out of and in the course of the employment. The two components of the coverage formula are: a. Arising out of b. In the course of employment Notes: For the injury and the resulting disability or death to be compensable, the injury must be the result of accident arising out of and in the course of employment. The injury must not be due to the employees intoxication, willful intention to injure or kill himself or another, notorious negligence or as otherwise provided by Law. (Art. 172, LC) Employment includes not only the actual doing of work but also a reasonable margin of time and space necessary to be used

in passing to and from the place where the work is to be done, where the latter is expressly or impliedly included in the terms of employment COMPENSABILITY RULE Rule III, Section 1 of the Amended Rules on Employees' Compensation enumerates the grounds for compensability of injury resulting in disability or death of an employee, as follows: Section 1. Grounds (a) For the injury and the resulting disability or death to be compensable, the injury must be the result of an employment accident satisfying all of the following conditions: (1) The employee must have been injured at the place where his work requires him to be; (2) The employee must have been performing his official functions; and (3) If the injury is sustained elsewhere, the employee must have been executing an order for the employer.

Under the Amended Rules Employees Compensation

Covered Persons a. Persons compulsorily covered by GSIS or SSS b. Those employed as casual, emergency, temporary, substitute or contractual employees c. Members of the AFP EMPLOYERS CONTRIBUTIONS (FUNDING) All covered employers are required to remit a monthly contribution equivalent to 1% of the monthly salary credit of every covered employee. The employee pays no contribution to the fund. Any agreement to contrary is prohibited. (Art. 183, LC) In case of delinquency, the employer who committed the violation shall be punished with a fine of not less than P1, 000 or no more than P10, 000 and/or imprisonment for the duration of the violation or non-compliance or until such time that a rectification of the

For Bar Purposes: Coverage and When Compensable INJURY - any harmful change in the human organism from any accident arising out of and in the course of the employment

OCCUPATIONAL DISEASE one which results from the nature of employment. By nature is meant conditions to which all employees of a class are subject and which produce the disease as a natural incident of a particular occupation. To be Compensable: a. b. Employees work must involve the risk described therein The disease was contracted as a result of the employees exposure to the described risks The disease was contracted within a period of exposure and under such factors necessary to contract it There was no notorious negligence on the part of the employee

Death loss of life resulting from injury or sickness Disability loss or impairment of a physical or mental function resulting from injury or sickness Direct Premises Rule GR: The accident should have occurred at the place of work to be compensable. Exceptions: INGRESS-EGRESS / PROXIMITY RULE when the injury is sustained when the employee is proceeding to or from his work on the premises of the employer, the injury is compensable. GOING TO OR COMING FROM WORK when the injury is sustained when the employee is proceeding to or from his work on the premises of the employer, the injury is compensable. a. The act of the employee of going to, or coming from, the work place, must have been a continuing act, that is, he had not been diverted there from by any other activity and he had not departed from his usual route to, or from, his workplace; and b. An employee on a special errand must have been official and in connection with his work. EXTRA PREMISES RULE the company which provides the means of transportation in going

To be Compensable: (a) For the injury and the resulting disability or death to be compensable, the injury must be the result of an employment accident satisfying all of the following conditions: (1) The employee must have been injured at the place where his work requires him to be; (2) The employee must have been performing his official functions; and (3) If the injury is sustained elsewhere, the employee must have been executing an order for the employer. (Rule III, Section 1 of the Amended Rules on Employees' Compensation)

c.

d.

Rule III, Section 1 of the Amended Rules on Employees' Compensation also provides that: 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 these Rules with the conditions set therein satisfied; otherwise, proof must be shown that the risk of contracting the disease is increased by the working conditions. Only injury or sickness that occurred on or after January 1, 1975 and the resulting disability or death shall be compensable under these Rules.

SICKNESS - means any illness definitely accepted as an occupational disease listed by the Commission, or any illness caused by employment subject to proof that the risk of contracting the same is increased by working conditions.

to, or coming from the place of work, is liable to the injury sustained by the employees while on board said means of transportation SPECIAL ERRAND RULE injury sustained outside the company premises is compensable if his being out is covered by an office order or a locator slip or a pass for official business DUAL PURPOSE DOCTRINE allows compensation 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 going or coming trip SPECIAL ENGAGEMENT RULE covers field trips, outings, intramurals, and picnics when initiated and sanctioned by the employer POSITIONAL AND LOCAL RISKS DOCTRINE if an employee by reason of his duties is exposed to a special or peculiar danger from the elements, that is, one greater than that to which other persons in the community are exposed and an unexpected injury occurs, the injury is compensable Death through Suicide General Rule: not compensable Exceptions: a. by agreement of the parties b. if the suicide/death is caused by work-related or c. compensable illness or disease Rules on Simultaneous Recovery Simultaneous recovery under the Labor Code and the Civil Code cannot be made. The action is

selective and the employee may either choose to file the claim under either. But once the election is made, the claimant cannot opt for the other remedy. Simultaneous recovery under the Labor Code and the SSS can be made.

Disability Categories TEMPORARY TOTAL 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 PERMANENT TOTAL 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 PERMANENT PARTIAL - if as a result of the injury or sickness, the employee suffers a permanent partial loss of the use of any part of his body Death Benefits The System shall pay to the primary beneficiaries upon the death of the covered employee an amount equal to his monthly income benefit, plus 10% thereof for each dependent child, but not exceeding 5, beginning with the youngest, and without substitution. The income benefit shall be guaranteed for 5 years. Dependent Legitimate, legitimated, and legally adopted or acknowledged natural child

who is unmarried, not gainfully employed and not over 21 years of age or over 21 years of age, provided he is incapable of self-support due to a physical or mental defect which is congenital or acquired during minority legitimate spouse living with the employee parents of said employee wholly dependent upon him for regular support

Benefits for life to the primary beneficiaries, guaranteed for 5 years for not more than 60 mos. to the secondary beneficiaries in case there are no primary beneficiaries in no case shall the total benefit be less than P15,000. Beneficiaries A. PRIMARY Dependent spouse until he/she remarries Dependent children (legitimate, legitimated, natural born or legally adopted) B. SECONDARY Illegitimate children and legitimate descendants Parents, grandparents, grandchildren