ASISA INTEGRAL
6. Puntos fuertes de Asisa Frente a la competencia
Workmen’s Compensation – a general and
comprehensive term applied to those laws providing for compensation for loss resulting from the injury,
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disablement or death of a workman through industrial accident, casualty or disease
Compensation – money relief offered according to
the scale established under the statute as differentiated from compensatory damages recoverable in an action at law for breach of contract or for tort WORKMEN’S COMPENSATION ACT (WCA) EMPLOYEES COMPENSATION LAW (ECL) Presumption of compensability No presumption of compensability Presumption of aggravation No presumption of aggravation There is a need for the
employer to controvert the claim within 14 days otherwise he is deemed to have waived the right
No need for the employer to controvert the claim Payment of compensation is made by the employer Payment of compensation is made by the SSS/GSIS through the State Insurance Fund. The employer’s obligation is to pay his counter contribution to the SSS
Injury – any harmful change in the human organism
from any accident arising out of and in the course of employment
Conditions for Injury to be Compensable
1. The employee must have been injured at the place where the work required him to be
2. The employee must have been performing his official functions
3. If the injury is sustained elsewhere, the employee must have been executing an order of the employer
4. The injury was not due to the employee’s intoxication, willful intention to injure or kill himself or another, or notorious negligence
Injuries incurred by a health worker while doing overtime work shall be considered work-connected
Sickness – any illness accepted as an occupational
disease listed by the Commission or any illness caused by the employment subject to proof that the risk of contracting the same is increased by the working conditions
Conditions for Occupational Disease and Resulting Disability or Death to be Compensable
1. Employee’s work must involve the risk described therein
2. the disease was contracted as a result of the employee’s exposure to the described risks 3. the disease was contracted within the period of
exposure and other such factors necessary to contract it
4. 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:
1. 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.
2. 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 therefrom 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. c. EXTRA PREMISES RULE – the company
which provides the means of transportation in going to, or coming from the place of work, is liable to the injury sustained by the employees while on board said means of transportation
d. 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
e. 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
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f. SPECIAL ENGAGEMENT RULE – covers field trips, outings, intramurals, and picnics when initiated and sanctioned by the employer
g. 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
Compulsory Coverage – ECL applies to all
employers, and to all employees, public or private including casual, emergency, temporary, or substitute employees
An employee over 60 yrs of age and paying contributions to qualify for the retirement or life insurance benefit administered by the system shall be subject to compulsory coverage.
Effective Date of Coverage – the employer is
covered from the first day of operation and the employee from first day of employment
Limits of Liability
No compensation if the injury, death or disability is the result of the employee’s:
1. intoxication
2. willful intention to injure or kill himself or another 3. notorious negligence – deliberate act of the
employee in disregard to his own personal safety 4. otherwise provided by the Labor Code
Death through Suicide GR: not compensable Exceptions:
1. by agreement of the parties
2. if the suicide/death is caused by work-related or compensable illness or disease
Rules on Simultaneous Recovery
1. 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.
2. Simultaneous recovery under the Labor Code and the SSS can be made.
State Insurance Fund – all covered employers are
required to remit to a common fund 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
Disability Categories
1. 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
2. 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
3. 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
1. 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 2. legitimate spouse living with the employee 3. parents of said employee wholly dependent upon
him for regular support
Benefits
1. for life to the primary beneficiaries, guaranteed for 5 years
2. for not more than 60 mos. to the secondary beneficiaries in case there are no primary beneficiaries
3. in no case shall the total benefit be less than P15,000.
Beneficiaries
A. PRIMARY
1. Dependent spouse until he/she remarries 2. Dependent children (legitimate, legitimated,
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B. SECONDARY
1. Illegitimate children and legitimate descendants
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