Guide for Filing Employees' Compensation Claims at the SSS
Workers from the private sector who suffer work-connected sickness or injury resulting in disability, or their families in case of work-connected death, may file claims for Employees' Compensation benefits at the SSS. These benefits are addition to what the workers or their families are entitled to under the SSS program or the PhilHealth program.
Where is the Claims for Employees' Compensation Benefits Filed?
A claim for Employees Compensation benefit is filed with the SSS. It is recommended that the claim should be filed at the SSS office where the company remits their SSS contributions for most likely, it is where the records of the worker and his employer or company are found. Access to the records will hasten action by the SSS on the claim filed.
It is important when filing the claim to clearly tell the SSS personnel at the receiving window that the claim is for Employees' Compensation benefits.
Are there Documents needed to support the Claim?
Yes, there are important documents that the SSS will require to support the claim. It is therefore important that you bring along these documents when filing a claim for Employees' Compensation benefits. The SSS will require that these documents (original) shall be attached to the claim application form. For your protection, it may help if you can have these documents photocopied first and have the photocopies kept on file at home. This is you protection just in case the original documents will get misplaced later on.
What are these documents needed to support the Claim?
There are a number of documents that the SSS will require to support a claim for Employees' Compensation benefits. The most important of these are:
1. A certificate of employment signed by the employer or his authorized representative. This certificate of employment should indicate the position of the worker when the sickness, injury or death happened. In addition, a description of the actual duties and responsibilities performed by the worker at the time of the contingency is necessary. It is this description of the duties and responsibilities that will allow the SSS evaluator to establish a connection between the sickness, injury or death and the worker's work and therefore grant the Employees' Compensation benefits.
2. (If the claim is for sickness benefit) a pre-employment medical check-up done by the company or in its absence, a certification by the company that the worker is physically fit when hired;
3. (If the claim is for injury benefit) an accident report signed by the worker's immediate supervisor and by the personnel manager in case the accident happened within the company premises. If an accident happened outside the company premises a record of consultation or hospital report is necessary. However, in cases of accident involving third party, a police report on the accident is necessary;
4. (If the claim is for death benefits) in addition to the above, the following documents are also necessary:
c)birth certificate of the deceased worker if single (when necessary);
d)birth certificate of children below 21 years of age
[all of which shall be certified true copies issued by the National Statistics Office (NSO).]
5.A certified true copy of the page of the company logbook containing the entry for the particular sickness or accident;
6.The medical findings of the attending doctor or the hospital records (certified true copy of the original); and
7.A certification of SSS and Employees' Compensation premium contributions one year prior to the sickness or injury.
Please be reminded that the above documents coming from the employer or the company should be written/printed on the company letterhead and duly signed by the authorized company official.
With the Documents in hand, how will the claimant go about filing an Employees' Compensation claim?
If the above documents are already available, then you can proceed to the SSS office nearest the place of employment to file the appropriate claim. Theoretically, a claim for Employees' Compensation benefits may be filed at any SSS branch office. But for the immediate action on the claim, we recommend that the claim be filed at the SSS branch where the company is remitting their SSS contribution.
Can a Claim be filed even if the Documents are not complete?
No. The SSS will not accept the claim if the documents are not complete. However, if the claimant can no longer obtain the documents necessary to substantiate his claim he must cite the reason/s for his failure to produce the said documents in a letter addressed to the SSS. The said covering letter signals to the SSS to evaluate the claim based on the available documents submitted by the claimant.
When shall the claim be filed with the SSS?
The claim shall be filed with the SSS branch within three years from the date of occurrence of the contingency (sickness, injury or death).
How does One proceed in filing a Claim at the SSS branch office?
To file a claim, it is important that you accomplish the necessary claim application forms at the receiving counter of the SSS branch office. It will help if you seek the assistance of the SSS personnel at the receiving counter. Anyhow, the following application forms should be accomplished:
2.For Death Claim
DDR Form for Death (DDR-1)
DDR Savings Account Form
Report of Death (EC Form BPN-105)
4.For Medical Reimbursement Claim (after sickness/accident/disability, death has been approved by the SSS)
EC Medical Reimbursement Benefit Application (EC Form B301)[pages 1&2]
Disability or medical reimbursement are additional benefits you can claim after the initial sickness or accident claim has been filed. This is because a worker who gets sick or is injured as a result of work can suffer some degree of disability which may not allow him to report for work temporarily or completely. In which case, for each day of absence from work, the worker is entitled to a daily income benefit. Should the disability become permanent, the worker shall be entitled to monthly
In the same manner, even after confinement and release from hospital, the worker may require further medication and therefore can be entitled to medical reimbursement for the medicines needed.
After the Forms have been accomplished, what is the next step the Worker should do?
The accomplished forms together with the necessary supporting documents required by the SSS should now be submitted to the receiving counter at the SSS branch office. It is suggested that when submitting the forms, you inquire from the concerned SSS personnel if all the requirements have been met and what further instruction/information from the SSS you may need to know. It is important that all the instruction/information are properly complied with to avoid further complication on the claim filed.
After the Filing and Acceptance of the Application Form by the SSS, what will happen next?
The application will be processed by the SSS in due time and if the sickness, injury or death is found to be work-connected then you will be accordingly informed about it and the benefits accordingly granted.
If the documents are not complete or insufficient for the SSS to come out with an objective evaluation of the claim, you will also be informed about it and maybe asked to submit additional documents. It is important that this additional requirement be complied with immediately.
If after the thorough evaluation, the SSS evaluators cannot establish a connection between the sickness, injury or death with the work of the worker, then the claim will be disapproved and you will be accordingly informed.
Normally, the SSS will evaluate the claim and come up with a decision within twenty (20) days from filing and submission of complete documents.
If the Claim is Disapproved by the SSS branch office, what option is Open to the Worker or his/her family?
A claim for Employees' Compensation benefits disapproved by the SSS branch office may be reviewed by the SSS, Medical Operations Department, East Avenue, Diliman, Quezon City.
If the Claim is again Denied by the SSS Medical Operations Department, what shall the worker or his/her family do?
A Claim for Employees' Compensation benefits disapproved by the SSS Medical Operations Department may be appealed to the Employees' Compensation Commission if you firmly believe that the sickness or injury was the result of work of the working environment. The appeal can be made in a simple letter sent to the Employees' Compensation Commission.