Labor Law: Book IV; Title II; Chapter VI Disability Benefits (Arts. 197 - 199)
Health, Safety and Social Welfare
Employees’ Compensation and State Insurance Fund
Chapter VI
Disability Benefits
Arts. 197 - 199
Q: What are the various kinds or degrees of disability that the Fund compensates?
Art. 197 [191]. Temporary total disability.
Under such regulations as the Commission may approve, any employee under this Title who sustains an injury or contracts sickness resulting in temporary total disability shall, for each day of such a disability or fraction thereof, be paid by the System an income benefit equivalent to ninety percent of his average daily salary credit, subject to the following conditions: the daily income benefit shall not be less than Ten Pesos nor more than Ninety Pesos, nor paid for a continuous period longer than one hundred twenty days, except as otherwise provided for in the Rules, and the System shall be notified of the injury or sickness. (As amended by Section 2, Executive Order No. 179)
The payment of such income benefit shall be in accordance with the regulations of the Commission. (As amended by Section 19, Presidential Decree No. 850)
Art. 198 [192]. Permanent total disability.
(a) Under such regulations as the Commission may approve, any employee under this Title who contracts sickness or sustains an injury resulting in his permanent total disability shall, for each month until his death, be paid by the System during such a disability, an amount equivalent to the monthly income benefit, plus ten percent thereof for each dependent child, but not exceeding five, beginning with the youngest and without substitution: Provided, That the monthly income benefit shall be the new amount of the monthly benefit for all covered pensioners, effective upon approval of this Decree.
(b) The monthly income benefit shall be guaranteed for five years, and shall be suspended if the employee is gainfully employed, or recovers from his permanent total disability, or fails to present himself for examination at least once a year upon notice by the System, except as otherwise provided for in other laws, decrees, orders or Letters of Instructions. (As amended by Section 5, Presidential Decree No. 1641)
(c) The following disabilities shall be deemed total and permanent:
- Temporary total disability lasting continuously for more than one hundred twenty days, except as otherwise provided for in the Rules;
- 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 or insanity; and
- Such cases as determined by the Medical Director of the System and approved by the Commission.
(d) The number of months of paid coverage shall be defined and approximated by a formula to be approved by the Commission.
Art. 199 [193]. Permanent partial disability.
(a) Under such regulations as the Commission may approve, any employee under this Title who contracts sickness or sustains an injury resulting in permanent partial disability shall, for each month not exceeding the period designated herein, be paid by the System during such a disability an income benefit for permanent total disability.
(b) The benefit shall be paid for not more than the period designated in the following schedules:
(c) A loss of a wrist shall be considered as a loss of the hand, and a loss of an elbow shall be considered as a loss of the arm. A loss of an ankle shall be considered as loss of a foot, and a loss of a knee shall be considered as a loss of the leg. A loss of more than one joint shall be considered as a loss of one-half of the whole finger or toe: Provided, That such a loss shall be either the functional loss of the use or physical loss of the member. (As amended by Section 7, Presidential Decree No. 1368)
(d) In case of permanent partial disability less than the total loss of the member specified in the preceding paragraph, the same monthly income benefit shall be paid for a portion of the period established for the total loss of the member in accordance with the proportion that the partial loss bears to the total loss. If the result is a decimal fraction, the same shall be rounded off to the next higher integer.
(e) In cases of simultaneous loss of more than one member or a part thereof as specified in this Article, the same monthly income benefit shall be paid for a period equivalent to the sum of the periods established for the loss of the member or the part thereof. If the result is a decimal fraction, the same shall be rounded off to the next higher integer.
(f) In cases of injuries or illnesses resulting in a permanent partial disability not listed in the preceding schedule, the benefit shall be an income benefit equivalent to the percentage of the permanent loss of the capacity to work. (As added by Section 7, Presidential Decree No. 1368)
(g) Under such regulations as the Commission may approve, the income benefit payable in case of permanent partial disability may be paid in monthly pension or in lump sum if the period covered does not exceed one year. (As added by Section 7, Presidential Decree No. 1368)
Notes:
- Art. 197 [191] - Temporary Total Disability:
- Employees with temporary total disability due to injury or sickness receive daily income benefits.
- The benefit is 90% of the average daily salary credit, with a minimum of Ten Pesos and a maximum of Ninety Pesos.
- Benefit paid for up to 120 days, subject to Rules.
- The System must be notified of the injury or sickness.
- Art. 198 [192] - Permanent Total Disability:
- (a) Monthly Income Benefit:
- Employees with permanent total disability receive a monthly income benefit until his death,
- The amount includes the standard benefit plus ten percent for each dependent child (up to five).
- The monthly benefit is recalculated for all covered pensioners upon approval of the Decree.
- (b) Guarantee and Suspension:
- The monthly benefit is guaranteed for five years.
- Benefits will be suspended if the employee :
- gains employment,
- recovers from the disability, or
- fails to attend the annual examination as required by the System.
- Exceptions apply based on other laws, decrees, orders, or Letters of Instructions.
- (c) Total and Permanent Disabilities:
- Temporary total disability lasting continuously for more than 120 days (except as specified in the Rules).
- Complete loss of sight in both eyes.
- Loss of two limbs at or above the ankle or wrist.
- Permanent complete paralysis of two limbs.
- Brain injury leading to incurable imbecility or insanity.
- Cases determined by the Medical Director and approved by the Commission.
- (d) Coverage Duration:
- The number of months of paid coverage will be determined by a formula approved by the Commission, defining and approximating the coverage duration.
- Art. 199 [193] - Permanent Partial Disability:
- (a) Monthly Income Benefit for Permanent Partial Disability
- Employees with permanent partial disability due to sickness or injury receive a monthly income benefit.
- The benefit is provided for a period specified in the regulations approved by the Commission.
- (b) Benefit Duration Based on Specific Losses:
- Benefits are defined by specific losses:
- (c) Loss and Functional Limitation:
- Loss of a wrist = Loss of the hand
- Loss of an elbow = Loss of the arm
- Loss of an ankle = Loss of a foot
- Loss of a knee = Loss of the leg.
- Loss of more than one joint = loss of one-half of the whole finger or toe:
- Such a loss shall be either the functional loss of the use or physical loss of the member.
- (d) Partial Loss:
- When the permanent partial disability is less than the total loss specified, benefits are paid based on the proportion of the partial loss to the total loss.
- Any decimal fraction is rounded up to the next higher integer.
- (e) Simultaneous Loss:
- If an individual experiences simultaneous loss of multiple body parts, benefits are calculated for each loss period, and these periods are summed.
- Decimal fractions are rounded up to the next higher integer.
- (f) Unlisted Disabilities:
- In cases of permanent partial disabilities not listed, benefits are determined based on the percentage of the permanent loss of the capacity to work.
- The calculation is added by Section 7, Presidential Decree No. 1368.
- (g) Payment Options:
- Regulations allow the income benefit for permanent partial disability to be paid in monthly pension or as a lump sum, provided the period covered does not exceed one year.
- The choice between monthly pension and lump sum payment is subject to Commission approval.
Notes:
- Nothing in the law that prohibits the conversion of permanent partial disability benefit to permanent total disability benefit if it is shown that the employees ailment qualifies as such.
- Furthermore, the grant of permanent total disability benefit to an employee who was initially compensated for permanent partial disability but is found to be suffering from permanent total disability would not be prejudicial to the government to give it reason to deny the claim.
- The Court has in fact allowed in the past the conversion of permanent partial disability benefit to permanent total disability benefit These rulings are consistent with the primary purpose of PD 626, that is, to provide meaningful protection to the working class against the hazards of disability, illness and other contingencies resulting in the loss of income, as well as the Constitutional mandate to afford full protection to labor. (Austria vs. Court of Appeals, G.R. No. 146636. August 12, 2002)
Austria vs. Court of Appeals, G.R. No. 146636. August 12, 2002
- Pablo A. Austria worked as a bag piler at Central Azucarera de Tarlac .
- His duties included carrying and piling sacks of refined sugar, relocating and moving stockpiles, assisting in production weighing, cleaning the warehouse, and doing other related work.
- In 1994, petitioner started experiencing severe back pain.
- Petitioner filed a claim for compensation benefits under PD 626 due to his osteoarthritis.
- SSS: Granted permanent partial disability benefits.
- Petitioner requested the conversion of his permanent partial disability benefit to permanent total disability benefit,
- SSS and ECC: Denied the claim based on clinical records and the lack of progression in his illness.
- CA: Dismissed the petition, stating that the law does not allow the conversion of permanent partial disability to permanent total disability.
WoN the Honorable Court of Appeals erred in denying the claim for additional benefits in favor of the petitioner and not allowing the conversion of his (petitioner) permanent partial disability to permanent total disability. YES
Disability is intimately related to ones earning capacity. It should be understood less on its medical significance but more on the loss of earning capacity.Total disability does not require that the employee be absolutely disabled, or totally paralyzed. What is necessary is that the injury must be such that she cannot pursue her usual work and earn therefrom.
Applying the foregoing standards, we find petitioner entitled to permanent total disability benefit under the law. Petitioner has been employed as bag piler for twenty (20) years at the Central Azucarera de Tarlac. His duties require him to carry heavy loads of refined sugar and to perform other manual work. Since his work obviously taxes so much on his back, his illness which affects his lumbar spine renders him incapable of doing his usual work as bag piler. Hence, his disability to perform his regular duties may be considered total and permanent.
Nothing in the law that prohibits the conversion of permanent partial disability benefit to permanent total disability benefit if it is shown that the employees ailment qualifies as such. Furthermore, the grant of permanent total disability benefit to an employee who was initially compensated for permanent partial disability but is found to be suffering from permanent total disability would not be prejudicial to the government to give it reason to deny the claim.
RULE X - TEMPORARY TOTAL DISABILITY
SECTION 1. Condition to entitlement.
An employee shall be entitled to an income benefit for temporary total disability if all of the following conditions are satisfied:
(1) He has been duly reported to the System;
(2) He sustains the temporary total disability as a result of the injury or sickness, and
(3) The System has been duly notified of the injury or sickness which caused his disability.
His employer shall be liable for the benefit if such illness or injury occurred before the employee is duly reported for coverage to the System.
SECTION 2. Period of entitlement.
(a) The income benefit shall be paid beginning on the first day of such disability. If caused by an injury or sickness it shall not be paid longer than 120 consecutive days except where such injury or sickness still requires medical attendance beyond 120 days but not to exceed 240 days from onset of disability in which case benefit for temporary total disability shall be paid.
However, the System may declare the total and permanent status at any time after 120 days of continuous temporary total disability as may be warranted by the degree of actual loss or impairment of physical or mental functions as determined by the System.
(b) After an employee has fully recovered from an illness as duly certified to by the attending physician the period covered by any relapse he suffers, or recurrence of his illness, which results in disability and is determined to be compensable, shall be considered independent of, and separate from, the period covered by the original disability. Such a period shall not be added to the period covered by his original disability in the computation of his income benefit
for temporary total disability (TTD). (ECC Resolution No. 1029, August 10, 1978).
SECTION 3. Amount of benefit.
Any employee entitled to benefit for temporary total disability shall be paid an income benefit equivalent to 90 percent of his average daily salary credit, subject to the following conditions:
(1) The daily income benefit shall not be less than P10.00 or more than P90.00 nor paid longer than 120 days for the same disability, unless the injury or sickness requires more extensive treatment that lasts beyond 120 days, but not to exceed 240 days from onset of disability, in which case he shall be paid benefit for temporary total disability during the extended period.
(2) The monthly income benefit shall be suspended if the employee fails to submit a monthly medical report certified by its attending physician as required under Sec. 5 of Rule IV hereof (Resolution No. 3682, July 21, 1987).
RULE XI - PERMANENT TOTAL DISABILITY
His employer shall be liable for the benefit if such injury or sickness occurred before the employee is duly reported for coverage to the System.
SECTION 1. Condition to entitlement.
(a) An employee shall be entitled to an income benefit for permanent total disability if all of the
following conditions are satisfied:
- He has been duly reported to the System;
- He sustains the permanent total disability as a result of injury or sickness; and
- The System has been duly notified of the injury or sickness which caused his disability.
(b) The following total disabilities shall be considered permanent:
- Temporary total disability lasting continuously for more than 120 days, except as otherwise provided for in Rule X hereof.
- 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, and
- Such cases as determined by the System and approved by the Commission.
SECTION 2. Period of entitlement.
(a) The full monthly income benefit shall be paid for all compensable months of disability.
(b) After the benefit under the Employees' Compensation shall have ceased as provided under the preceding paragraph, and if the employee is otherwise qualified for benefit for the same disability under another law administered by the System, he shall be paid a benefit in accordance with the provisions of that law. This paragraph applies to contingencies which occurred prior to May 1, 1978.
(c) Except as otherwise provided for in other laws, decrees, orders or letters of instructions, the monthly income benefit shall be guaranteed for 5 years and shall be suspended (see Annex “J”) under any of the following conditions:
- Failure to present himself for examination at least once a year upon notice by the System;
- Failure to submit a quarterly medical report certified by his attending physician as required under Sec. 5 of Rule IV hereof;
- Complete or full recovery from his permanent disability, or
- Upon being gainfully employed.
SECTION 3. Amount of benefit.
(a) In the case of the SSS:
- Any employee entitled to permanent total disability benefit shall be paid by the System a monthly income benefit as defined in Sec. 9 (a), Rule VI of these Rules.
(b) The number of months of paid coverage shall be the number of monthly contributions remitted to the System including contributions other than for Employees' Compensation if paid before March 31, 1975. The full monthly income benefit shall be paid for all compensable months of disability.
(c) The first day preceding the semester of temporary total disability shall be considered for purposes of computing the monthly income
benefit for permanent total disability.
SECTION 4. Amount of benefit for dependent children.
(a) Each dependent child, but not exceeding five, counted from the youngest and without substitution, shall be entitled to 10 percent of the monthly income benefit of the employee. These Rules shall not apply to causes of action which accrued before May 1, 1978.
SECTION 5. Entitlement to the new income benefit under PD 1641.
(a) The new amount of the monthly income benefit computed under these amended Rules shall be applicable to all contingencies occurring on or after January 1, 1980. However, for contingencies which occurred before May 1, 1978, the limitation of P12, 000 or 5 years, whichever comes first, shall be enforced.
In the case of the SSS, the present monthly income benefit of current pensioners shall be increased by 20 percent effective January 1, 1980.
In case of the GSIS, the monthly income benefit of current pensioners shall be adjusted and recomputed to reflect the 20 percent increase over the benefit under PD 1146 effective January 1, 1980.
SECTION 6. Aggregate monthly benefit payable
Except the benefit to dependent children under Section 4 of this Rule, the aggregate monthly benefit payable, in the case of the GSIS, shall in no case exceed the monthly wage or salary actually received by the employee as of the date of his permanent total disability. (ECC Resolution No. 2819, August 9, 1984).
RULE XII - PERMANENT PARTIAL DISABILITY
SECTION 1. Condition to entitlement.
(a) An employee shall be entitled to an income benefit of permanent partial disability if all of the following conditions are satisfied:
- He has been duly reported to the System;
- He sustains the permanent partial disability as a result of the injury or sickness; and
- The System has been duly notified of the injury or sickness which caused his disability.
His employer shall be liable for the benefit if such injury or sickness occurred before the employee is duly reported for coverage to the System.
(b) For purposes of entitlement to income benefits for permanent partial disability, a covered employee shall continue to receive the benefits provided thereunder even if he is gainfully employed and receiving his wages or salary.
SECTION 2. Period of entitlement.
(a) The income benefit shall be paid beginning on the first month of such disability, but not longer than the designated number of months in the following schedule:
A worker who sustained work-related injuries that resulted to functional loss and/or physical loss of any part of his body shall be granted Temporary Total Disability (TTD) and Permanent Partial Disability (PPD) benefits successively.
Any earlier compensation for TTD that may have been paid to an injured worker shall not be deducted from the PPD benefit that may be later granted to him. (as provided under Board Resolution No. 10-09- 114, September 2, 2010)
(b) A loss of a wrist shall be considered a loss of the hand, and a loss of an elbow shall be considered a loss of the arm; a loss of an ankle shall be considered a loss of the foot, and a loss of a knee shall be considered a loss of the leg, a loss of more than one joint shall be considered a loss of the whole finger or toe, and a loss of only the first joint shall be considered a loss of one-half of the whole finger or toe. Other permanent partial disabilities shall be determined by the Medical Officer of the System.
(c) The degree of permanent disability shall be equivalent to the ratio that the designated number of compensability bears to 75.
SECTION 3. Amount of benefit.
(a) Any employee entitled to permanent partial disability benefit shall be paid by the System a monthly income benefit for the number of months indicated in Section 2 hereof. If the indicated number of months exceed twelve, the income benefit shall be paid in monthly pension; otherwise, the System may pay income benefit in lump sum or in monthly pension.
(b) In case of permanent partial disability less than the total loss of the member, the same monthly income shall be paid for a portion of the period established for the total loss of the member in accordance with the proportion that the partial loss bears to the total loss. If the result is a decimal fraction, the same shall be rounded off to the next higher integer.
(c) In case of simultaneous loss of more than one member or a part thereof, the same monthly income shall be paid for a period equivalent to the sum of the periods established for the loss of the member or part thereof but not exceeding 75. If the result is a decimal fraction, the same shall be rounded off to the higher integer.
(d) The new amount of the monthly income benefit computed under these amended Rules shall be applicable to all contingencies occurring on or after January 1, 1980. However, for contingencies which occurred before May 1, 1978, the limitation of P12, 000 or 5 years, whichever comes first, shall be enforced.
In the case of the SSS, the present monthly income benefit of current pensioners shall be increased by 20 percent effective January 1, 1980. In the case of the GSIS, the monthly income benefits of current pensioners shall be adjusted and recomputed to reflect the 20 percent increase over the benefit under PD 1146 effective January 1, 1980.
SECTION 4. Unlisted injuries and illnesses.
(a) In cases of injuries or illnesses not listed in the schedule under Section 2 hereof, the benefit shall be an income benefit equivalent to the percentage of the permanent loss of the capacity for work. (Non-Scheduled Disabilities).
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