The Employees’ Compensation (EC) benefit is a valuable program designed to assist public and private sector employees, as well as their dependents, in the event of work-related injuries, sickness, disability, or death.
The Government Service Insurance System (GSIS) administers the EC fund for public sector employees.
What is the Employees’ Compensation (EC) Benefit?
The Employees’ Compensation benefit provides various types of assistance to workers and their families when a work-related incident occurs.
These benefits include:
- Medical services, appliances, and supplies
- Rehabilitation services
- Temporary total disability benefit
- Permanent total disability benefit
- Permanent partial disability benefit
- Death benefit
- Funeral benefit
Beneficiaries
For death and funeral benefits, the beneficiaries can be classified into:
- Primary Beneficiaries:
- Legitimate spouse until remarriage.
- Dependent children (legitimate, legitimated, adopted, and illegitimate) who are below 18 years old, unmarried, not gainfully employed, or over 18 but incapacitated due to mental or physical defects.
- Secondary Beneficiaries:
- Dependent parents.
- Legitimate descendants.
Eligibility and Exceptions
Conditions for Payment
To be eligible for EC benefits, the following conditions must be met:
- The injury must result from an accident arising out of and in the course of employment.
- The sickness must be listed as an “occupational disease” or proven to be work-related.
- Disability or death must be caused by a work-connected injury or sickness.
Exceptions
No benefits will be provided if the incident is due to the employee’s:
- Intoxication or drunkenness.
- Willful intention to injure or kill themselves or another.
- Notorious negligence.
- Non-work-related activities.
List of Occupational Diseases
Some occupational diseases include:
- Papilloma of the bladder
- Cancer of various types
- Cataract
- Deafness
- Decompression sickness
- Dermatitis due to irritants and sensitizers
- Pneumoconiosis
- Malaria and schistosomiasis
- Pneumonia
- Pulmonary tuberculosis
- Essential hypertension
- Asbestosis
Prescription Period
Claims must be filed within three years from the time the cause of action accrued (ECC Resolution No. 2799, July 25, 1984).
Recent Updates on EC Benefits
- 2014: Increase of Employees’ Compensation Funeral Benefit from Php 10,000 to Php 20,000 and a 10% increase in EC pensions for private sector employees.
- 2017: Further increase in the EC funeral benefit to Php 30,000 by Executive Order No. 33 signed by President Rodrigo Duterte.
Coverage and Compensability
Who Are Covered?
- Private Sector: Workers who are compulsory members of the Social Security System (SSS) and sea-based Overseas Filipino Workers (OFWs).
- Government Sector: Employees who are GSIS members, including Armed Forces of the Philippines, elective government officials with regular salaries, and all casual, emergency, temporary, and contractual employees.
When Coverage Starts
Coverage starts on the first day of employment.
Compensability of Sickness or Injury
- Sickness: Must result from an occupational disease listed under Annex “A” of the Amended Rules on Employees’ Compensation or be proven to be work-related.
- Injury: Must result from an accident arising out of and in the course of employment.
Step-by-Step Process of Applying for GSIS EC Claim
- Gather Necessary Documents: Collect all relevant medical records, incident reports, employment records, and any other documentation that supports your claim.
- Complete the Application Form: Fill out the EC claim application form available at GSIS or download it from their website.
- Submit the Claim: File your claim at the nearest GSIS Regional Office. Ensure that all required documents are attached to avoid delays.
- Wait for Processing: The GSIS will review your claim and may request additional information if necessary.
- Notification of Decision: You will receive a notification regarding the approval or denial of your claim.
Filing Deadlines
- Sickness: File within three years from the time you were unable to work.
- Injury: File within three years from the time of the incident.
- Death: File within three years from the date of death.
Where to File
Claims can be filed at the GSIS Regional Office nearest to your place of work or residence.
Denied Claims
If your claim is denied, you may:
- Request Reconsideration: File a request with the GSIS main office.
- Appeal: If still denied, write a letter of appeal to the Employees’ Compensation Commission.
Important Considerations
Increase in EC Benefits
Recent increases in EC benefits reflect the government’s commitment to supporting workers and their families.
Always stay updated with any changes or new executive orders that might affect the benefits you are entitled to.
Documentation
Accurate and complete documentation is important.
Ensure all forms are filled out correctly, and all necessary documents are included.
Incomplete applications can result in delays or denial of your claim.
Legal and Medical Advice
Seek professional legal or medical advice if you are unsure about any aspect of your claim.
This can help ensure that you understand your rights and the procedures involved.
Community Support
Engage with support groups or community organizations that can provide assistance and information.
They can offer valuable insights and support during the claims process.
Recent Updates
ECC Lifts Suspension of 3-Year Prescriptive Period for Filing EC Claims
The Employees’ Compensation Commission (ECC) has lifted the suspension of the 3-year prescriptive period for filing Employees’ Compensation (EC) claims. This decision reinstates the 3-year time frame for individuals to file claims for compensation due to work-related contingencies, providing them with the opportunity to seek necessary benefits. The lifting of the suspension took effect on January 18, 2024, ensuring that employees have adequate time to submit their EC claims. (ECC)
GSIS Provides Disability Benefits and Pension Crediting
The Government Service Insurance System (GSIS) offers disability benefits to members who have experienced non-work-related accidents or illnesses that have resulted in loss or injury to the body. Pension is credited to the UMID or eCard of pensioners on or before the 8th of each month. To apply for disability benefits, members need to submit the required documents and undergo assessment and evaluation.
The Employees’ Compensation (EC) Program provides medical reimbursement for hospitalization, professional fees, and medicine expenses, following a reimbursement schedule. Employees must first secure approval for their EC sickness claim before proceeding to claim reimbursement at SSS or GSIS branches, where official receipts and approval documents are required for processing. The reimbursement percentage is not 100% and is subject to the EC Program’s reimbursement schedule.
Conclusion
Filing an EC claim with GSIS involves understanding the benefits, eligibility criteria, and the process involved.
By following the steps outlined in this guide and ensuring that all documentation is accurate and complete, you can navigate the claims process more effectively.
Stay informed about updates to the EC benefits and seek support when needed to ensure you and your family receive the assistance you are entitled to.