ECC_ Hizon Notes

EMPLOYEES COMPENSATION PROGRAM AND

INSURANCE FUND
-program provided under Art. 172- 214 of the Labor
Code whereby a fund known as the State Insurance
Fund is established through premium payments
exacted from employers and from which employees
and their dependents in the event of work-connected
disability or death, may promptly secure adequate
income benefit, and medical or related benefits.
Characteristics
1. Tax exempt
2. Designed to ensure promptitude in the award to
employees and their dependents of adequate
income and medical or related benefits
3. Funded monthly contributions of all covered
employers
4. Compulsory on all employers and their employees
not over 60 years of age
5. Benefits of which are exclusive and in place of all
other liabilities of the employer to the employee, his
dependents or anyone otherwise entitled to receive
damages on behalf of the employee or his
dependents
6. Having its own adjudication machinery with
original exclusive jurisdiction to settle any dispute
with respect to:
a. Coverage
b. Entitlement to benefits
c. Collection and payment of contributions
d. Penalties thereon
Coverage:
Employer
a. Public sector covered by GSIS comprising the:
1. National Government
2. GOCCs
3. Philippine Tuberculosis Socirty
4. PNRC
5. Philippine Veterans Bank
b. Private sector covered by SSS
Employee
a. Public sector comprising the employed workers
who are covered by GSIS (CA 186) including:
1. AFP
2. Elective officials
3. Any person employed as casual, emergency,
temporary-substitute or contractual
b. Private sector compromising the employed
workers who are covered by SSS (RA 1161)

EMPLOYER
On the first day of operation

EMPLOYEE
On the first day of
employment

Definition of Terms (173)

Injury- Any harmful change in the human
organization from any incident arising out of and in
the course of employment
Sickness
a. Any illness definitely accepted as an occupational
disease
b. listed by the commission or
c. any illness caused by employment, subject to
proof that the risk of contracting the same is
increased by working conditions.
Examples:
a. rheumatoid arthritis and pneumonitis for
teachers
b. tuberculosis for persons nursing a person
suffering from such illness
c. anemia secondary to gastric malignancy
where the deceased was exposed to heat and
elements which ultimately weakened him
d. cancer for librarian who was exposed to dusty
books and other deleterious substances
e. senile cataract for construction workers
exposed to heat of the sun
NOTE: The Employees Compensation Commission
is empowered to determine and approve
occupational diseases and work-related illness that
may be considered compensable based on peculiar
hazards of employment
Occupational disease
a. One which results from the nature of employment,
and
b. by nature is meant conditions to which all
employees of a class are subject and
c. which produce the disease as a natural incident of
a particular occupation
d. attach to that occupation a hazard which
distinguishes it from the usual run of occupations
e. is in excess of the hazard attending the
employment in general
NOTE: Those things which science and industry
have not yet learned how to eliminate.
Every plant of the same industry is alike constantly
exposed to the danger of contracting a particular
disease.

theory of increased risk

Effective date of Coverage (176)

ECC_ Hizon Notes

-It includes any illness caused by employment,

subject to proof that the risk of contracting the same
is increased by working conditions.
The quantum of proof for the compensation:
-Substantial proof of work connection and not a
direct causal relation
1. medical history
2. record
3. physicians report
NOTE: Proof of actual cause of the ailment is not
necessary. There should, however, be proof that
shows reasonable connection between:
a. the work of the deceased
b. cause of his death
The proof must be substantial and real and not
merely apparent; for the duty to prove workcausation or work aggravation imposed by existing
law is real, not merely apparel.
Direct causal relation is not required. It is enough
that the hypothesis on which the workmens claim is
based is probable
NOTE: Medical opinion to the contrary can be
disregarded where there is some basis in the facts
for inferring work-connection
The test of evidence of the relation of the
disease: probability and not certainty.
Cancer is an occupational disease, in certain
cases.
NOTE: Although rectal cancer is not listed as an
occupational disease there is ample proof that the
risk of contracting the same was increased, if not
caused, by the working conditions prevailing in the
employers premises.
Hansens disease or leprosy compensable is
compensable provided the illness is traceable to
employment.
The claimant is required to present proof of
reasonable causal relation or aggravation where
the cause or origin of the disease is still
unknown.
This is because, if a disease not intended by law to
be compensated is inadvertently included, the
integrity of the State Insurance Fund is endangered.
NOTE: Compassion for the victims of diseases not
covered by law ignores the need to show a greater
concern for the trust fund to which the tens of
millions of workers and their families look for
compensation whenever accidents, disease or death
occur. Raro v. EEC & GSIS

Q: Is uraterolithiasis (presence of renal stones in

the ureter and urine stones) of a chemical
laboratory technician compensable?
A: Yes. The environment, water, or other fluid intake
and the nature of the occupation are important
factors in the development or inhibition of the
disease. GSIS v. Merlinda Pentecostes

Q: Do we still subscribe to the presumption of

compensability?
A: No, however, the present law has not ceased to
be a social legislation. The liberality of the law in
favor of the working man still prevails. Raro v. EEC
& GSIS

Q: When are cardiovascular diseases considered

as occupational?
A: Cardiovascular diseases are considered as
occupational when contracted under any of the
following conditions:
a. If the heart disease was known to have been
present during employment there must be proof that
an acute exacerbation clearly precipitated by the
unusual strain by reason of the nature of his work.
b. The strain of work that brings about an acute
attack must be of sufficient severity and must be
followed within twenty-four (24) hours by the clinical
signs of a cardiac insult to constitute causal
relationship.
c. If a person who was apparently asymptomatic
before subjecting himself to strain at work showed
signs and symptoms of cardiac injury during the
performance of his work and such symptoms and
signs persisted, it is reasonable to claim a causal
relationship
NOTE: Coronary artery disease is not compensable
where the employee was a chronic smoker.
Q: What defenses may be interposed by the
State Insurance Fund against a claim for
compensation?
A:
1. The injury is not work-connected or the sickness
was not occupational
2. (178) Disability or death was occasioned by his:
a. Intoxication
b. Willful intention to injure or kill him
c. Notorious negligence

ECC_ Hizon Notes

3. No notice of injury, sickness or death was given to

the employer
4. (207) Claim was filed beyond 3 years from the
time the cause of action accrued.

Q: Can the employee recover from the State

Insurance Fund and subsequently recover
damages in the criminal cases?
A: No. The liability of the State Insurance Fund shall
be exclusive and in place of all other liabilities of the
employer to the employee or his dependents or
anyone otherwise entitled to recover damages on
behalf of the employee or his dependents. This
includes the subsidiary liability of the employer under
the RPC.
NOTE: This will not bar recovery from:
a. Revised Administrative Code
b. RA. 1161
c. CA 186
d. RA 6111
e. RA 610
The injured employee or his heirs in case of death
have a right of selection or choice of action between
availing themselves of the workers right under the
employees compensation laws and suing in the
regular courts under the Civil Code for higher
damages. To preclude the filing of an action for
damages would be a violation of the constitutional
guarantees on social justice and protection to labor

Q: In case the injured employee or his heirs fail

to recover damages in the civil case, may they
claim from the SIF?
A: Yes. The rationale in awarding compensation
under compensation laws differs from that in giving
damages under the Civil Code. The compensation
act is based on a theory of compensation distinct
from
the
existing
theories
of
damages.
Compensation is given to mitigate the harshness
and insecurity of industrial life for the workman and
his family.
NOTE: Hence, an employer is liable whether the
negligence exists or not since the liability is created
by law. The employer will be liable as long as the
sickness or injury is work-connected even if the
death or injury is not due to the fault of the employer.
Murillo v. Mendoza

Q: If the injured or his heirs opted to claim and in

fact collected from the SIF, can they still maintain
action for damages against the employer?
A: No. While perhaps not as profitable, the smaller
indemnity obtainable through this remedy is
balanced by the claimants being relieved of the
burden of proving the causal connection between
the employers negligence and the resulting injury
and of having to establish the extent of the damage
suffered; issues that are apt to be troublesome to
establish satisfactorily. Having staked on this
remedy, at least until the prior claim is rejected by
the Compensation Commission, the claimant is
precluded from pursuing the alternative remedy.
(Art. 1711, CC)