Have you filed for your SSS sickness benefit yet? Here’s what you need to know.
Because of the pandemic, working from home is now part of the new normal. However, this new setup has blurred the lines and created some confusion when it comes to employee benefits and claims.
For example, are you allowed to claim a sickness benefit if you got sick while working from home? What if you got Covid-19 while commuting to work?
In a previous interview, Employees’ Compensation Commission Executive Director Stella Zipagan-Banawis clarified some questions that you might be asking related to working from home and filing sickness benefit claims.
Can you file for sickness benefit when you get Covid-19 while working from home?
According to Banawis, the ECC only covers injury benefits for employees who are working from home. But Covid-19 is not classified as an injury but as a form of illness. So, as a result, work-from-home employees cannot file for Covid-related sickness benefits when working from home.
“Kapag nakuha nila sa bahay (iyong Covid-19), hindi siya entitled na makakuha ng Covid-19 benefits,” said the director. “Sa work-from-home, ang compensable ay injury, not illnesses.”
However, they are still entitled to sick leaves from their company and file for sickness benefits if they got sick for more than 4 days.
“Yong kanilang makukuhang benepisyo ay ‘yong tinatawag na sickness benefits, kung hindi sila nakapasok ng ilang araw mayroon silang daily allowance na ang maximum of P450 per day,” said Banawis.
Image by Freepik
What if I get Covid-19 in the office?
Employees who contracted COVID-19 in the workplace could avail of the benefits from the Social Security System and the Government Service Insurance System, an official of the Employees Compensation Commission said Friday.
Labor Department earlier said COVID-19 is now a compensable illness under the Employee Compensation Program if acquired in the workplace or in tasks related to a worker’s job.
“Kapag nakuha sa workplace, hindi sa bahay, or nakuha niya habang papunta siya sa opisina niya, ‘yon ay compensable as long as they can evaluate and validate that it’s work-related,” said Banawis.
In addition, medical reimbursements are also available for out-of-pocket expenses related to hospitalization, said the director. And for those claimants or SSS members who died of the disease, their beneficiaries can claim death pension or survivorship pension as well as funeral benefits, she added.
Forms are available for download online and claims are also “expedited” which, in theory, should be processed within 20 working days, Banawis said.
Furthermore, for the work-from-home set-up, injuries incurred at home, which is now considered the workplace, are also now compensable. Banawis, however, clarified that only work-related injuries are entitled to compensation.
Since the start of the first Covid-19 lockdown in March 2020, a lot of companies have implemented alternate work arrangements to prevent the spread of the disease.
With those clarifications in mind, you can now learn about what you need to do to claim your sickness benefit from SSS.
Step-by-step guide on filing and claiming SSS sickness benefits
Process of applying for your sickness benefit claim
1. Filing
Application for sickness benefit may be filed by the member and employee at any SSS branch that is most convenient to them.
sss sickness benefit requirements for employed
What should an employee do to file for a sickness benefit claim?
The employer should be notified of the member’s sickness, within five days from the day the member was sick. It is not important if the sickness happened during working hours. Here’s a copy of the Sickness Notification form.
The processing time for Sickness Benefit is within 10 to 30 working days. However, this may be extended depending on the verification of submitted documents, subject to its existing guidelines.
(However, as mentioned, PCC has given SSS a mandate to expedite Covid-19-related cases.)
What are the implications of late filing?
If you fail to submit your documents at a given time, your sickness claim application may be denied.
For example, the member notifies the SSS beyond the suggested five-day period, the confinement will start late than the 5th day followed by the date of notification.
2. Fill up the Social Security System (SSS) sickness benefit application form.
SSS sickness benefit. | Image from iStock
You may download the Sickness Benefit Application form here. Make sure you file all the details correctly.
3. Prepare your documents.
sss sickness benefit requirements for employed
What are the requirements?
- Sickness Benefit Application (SBA) Form
- SSS ID/UMID card or any valid primary ID cards/documents such as:
-
- Driver’s License
- Passport
- Voter’s ID Card
- National Bureau of Investigation (NBI) Clearance
- Postal Identity Card
- Any other government-issued (secondary) ID cards/documents
- For those who contracted Covid-19 at work, here are the additional documents you need to present:
- Certificate of employment
- Certificate of RT-PCR positive result from any DOH-accredited testing facility
- Medical records if hospitalized
If the claimant is unable to file this personally, here are the things that her authorized representative should present:
- should be original of any one of the member’s authorized representative’s primary ID cards/documents.
- two secondary ID cards/documents, both with signature and at least one with photo.
Remember, for sickness/injury that happened overseas, the document from that country should be in English. It should also be notarized by Philippine embassy with authority to put statements into form made by law.
- The SSS Medical expert needs to process medical records/documents necessary for the value of the request rights.
Additional requirements for special cases
1. For Self-Employed/Voluntary Member (previously employed)
If confinement period applied for is within the period of employment or before the date of separation:
- Certificate of separation from employment with a date of separation and no advance payment was granted (it should be signed by the employer’s authorized signatory as see in the Card or SSS Form)
2. For Member Separated from Employment
If the confinement period applied is within the period of employment or prior to the date of separation:
- Certificate of separation from employment with an effective date of separation and no advance payment was granted (signed by the employer’s authorized signatory as reflected in SS Form L-501)
3. If the confinement period applied for is after the date of separation:
- Certificate of separation from employment with an effective date of separation (signed by the employer’s authorized signature reflected on the SSS form.
Certificate of separation is not required for self-employed and voluntary members (previously employed) or those separated from employment under any of the following conditions.
In which other supporting document/s shall be required to be submitted as follows:
4. If the company is on strike:
- Notice of strike duly acknowledged by the Department of Labor and Employment (DOLE); and
- Duly notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted
5. If a company has been closed:
- Notarized Affidavit issued by the member stating that no advanced payment was granted and with indicated date of separation
6. Case pending before a court regarding separation of members:
- Certification from DOLE; and
- Notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted and with indicated effective date of separation
7. Separated from employment due to absence without leave (AWOL) or with unfortunate relations with the employer:
- Notarized Affidavit of Undertaking issued by the member stating that no advanced payment was granted and with indicated effective date of separation
READ MORE
Iba’t ibang uri ng loans na makakatulong sa nagigipit na miyembro ng SSS
Processing of claiming your SSS sickness benefits
Image from iStock
The procedure of sickness benefit payment
The sickness benefit claims should be directly transferred through your UMID card or ATM card.
However, if you cannot claim through UMID or ATM, don’t worry because you can claim it through participating banks in the Philippines or through PESONet.
You can also do it through electronic wallets (E-Wallets) and any accredited remittance transfer companies (RTCs)/cash payout outlets (CPOs).
Self-employed and voluntary members, including OFWs and those separated from employment, are required to give the following details and upload proof of account in the My.SSS Facility in the SSS website:
Members will be notified by SSS through email or SMS if their sickness benefit claim is already available.
PESO Net participating banks: Bank name and account number
E-wallet: Mobile number linked to bank account number
RTC/CPO: Mobile number
Expect your benefits/claims to be made within 5 banking days from the date of settlement.
Take note that the amount you will receive will depend on your monthly contribution to SSS and how long you have been a member. You can receive up to 30,000 pesos from your sickness benefit depending on your contribution.
Other things you need to know
Who are the legal beneficiaries of a member?
Primary beneficiaries of a member are the following:
- a legal spouse living with the employee at the time of his/her death until he remarries
- a legal, or acknowledged natural children, who are unmarried, 21 years of age above and below (provided that they are incapable of self-support due to physical or mental defect)
- a dependent legal child shall be considered as a primary beneficiary.
Secondary beneficiaries are the following:
- legal parents who are dependent upon the employee for regular support.
- legal and illegitimate children who are unmarried, not employed, and 21 years of age above and below (provided that they are incapable of self-support due to physical or mental problems)
What will happen to the sickness claim if the member has no primary and secondary beneficiaries?
When the sick member has no primary and secondary beneficiaries at this time the benefit will go to the EC fund.
If you have any questions regarding your SSS sickness benefits and other claims during the pandemic, don’t hesitate to inquire from your company’s human resources officer.