Disability Ben Tejana

7/26/2019 Disability Ben Tejana

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Chapter VI

DISABILITY BENEFITS

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DISABILITY BENEFITS Art. 191. Temporary total disability.

1. Under such regulations as the Commission mayapprove, any employee under this Title who sustains aninjury or contracts sickness resulting in temporary totaldisability shall, for each day of such a disability or fractionthereof, be paid by the System an income benefit

equivalent to ninety per cent of his average daily salarycredit, subject to the following conditions: the daily incomebenefit shall not be less than Ten Pesos nor more thanNinety Pesos, nor paid for a continuous period longer thanone hundred twenty days, except as otherwise provided forin the Rules, and the System shall be notified of the injuryor sickness.(As amended by Section 2, Executive Order No.179)

2. The payment of such income benefit shall be inaccordance with the regulations of the Commission. (Asamended by Section 19, Presidential Decree No. 850)

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Art. 192. Permanent total disability.

1. Under such regulations as the Commission mayapprove, any employee under this Title whocontracts sickness or sustains an injury resulting in

his permanent total disability shall, for each monthuntil his death, be paid by the System during such adisability, an amount equivalent to the monthlyincome benefit, plus ten per cent thereof for eachdependent child, but not exceeding five, beginningwith the youngest and without substitution:Provided, That the monthly income benefit shall be

the new amount of the monthly benefit for allcovered pensioners, effective upon approval of thisDecree.

2. The monthly income benefit shall be guaranteed forfive years, and shall be suspendedif the employee is

gainfully employed, or recovers from hispermanent total disability, or fails to presenthimself for examination at least once a yearuponnotice by the System, except as otherwise providedfor in other laws, decrees, orders or Letters ofInstructions. (As amended by Section 5, PresidentialDecree No. 1641)

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July 13, 1959 - petitioner started working as Accounting Clerk I at

the Budget Commission.

August 10, 1959 - transferred to the DENR, with the same

position of Accounting Clerk I.

July 1, 1989 - promoted to the position of Senior Bookkeeper of

DENR, Region IV, Manila

In 1978 - found to be suffering from Hypertensive Vascular

Disease (HVD)In 1983 - diagnosed with Coronary Artery Disease (CAD)

In 1989 - found to have Nephrolithiasis, Left, with associated

renal parenchymal disease prostatic concretions

Maniosovs. GSIS

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In 1994, found to be suffering from cardiomegaly, LV Form and

Atherosclerotic aorta; pelvo-calycealithiasis (L) and earlydegenerative changes, spine, staghorn calculi (L), cortical cyst,

and a slightly enlarged prostate gland

1/11/95 to1/20/95 - hospitalized in Batangas City after

experiencing chest heaviness, shortness of breath, and

diaphoresis. The results of his examinations showed that he was

suffering from Acute Myocardial Infarction and HVD.

1/11/95to 5/15/95- compulsorily retired from government serviceon reaching 65 years of age and after serving almost 36 years, he

no longer reported for work. His sick leave covering said period

was duly approved.

Maniosovs. GSIS

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Petitioner filed a claim for income benefits under PD 626 with the

GSIS which found his ailments work-related, hence, he wasgranted Temporary Total Disability (TTD) benefits for 2 months

covering the period from 1/11/95 to3/11/95 .

He was later granted Permanent Partial Disability (PPD) benefits

for eight (8) months covering the period from 5/15/95to 1/14/96.

Petitioner appealed for more disability benefits with the GSIS

In 1997 - was brought to the PGH several times due to Chronic

Renal Infection (CRI) 2 to Obstructive Uropathy 2 to Staghorn

Calculi (L) and Benign Prostatic Hypertrophy (BPH); Diabetes

Mellitus Nepropathy, Stage IV, and Hypertensive

Nephrosclerosis.

Maniosovs. GSIS

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Petitioner filed a claim for additional disability benefits claiming

that the ailments for which he was hospitalized several times in1997 developed from his work-related illnesses but was

disapprovedupon the ground that he was already paid the

maximum monthly income benefit for eight (8) months covering

the period from 5/15/95to 1/14/96"commensurate to the degree

of his disability at the time of his retirement from service.

CA affirmed the ruling of the GSIS, it holding that petitioner's

physical condition at the time of his retirement was not of such

nature as to satisfy the criteria set for Permanent Total Disability

(PTD). Additionally, it held that since the ailments for which

petitioner sought additional benefits developed after his

retirement, they can no longer be attributed to his former

occupation but to factors independent thereof

Maniosovs. GSIS

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Issues:1. WHETHER OR NOT PETITIONER'S AILMENTS FALLUNDER THE CATEGORY OF PERMANENT TOTAL

DISABILITY

2. WHETHER OR NOT PETITIONER'S RETIREMENT FROMSERVICE PREVENTS HIM FROM ENTITLEMENT TO

PERMANENT TOTAL DISABILITY BENEFITS

Maniosovs. GSIS

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Ruling:1. Yes, petitioners ailments fall under permanent total disability

Under Article 192 (c) of the LABOR CODE OF THE PHILIPPINES,

the following disabilities are deemed total and permanent:

(1) Temporary total disabilitylasting continuously for more thanone hundred twenty days.

Under Section 2(b), Rule VII of the Amended Rules on Employees

Compensation, "[a] disability is total and permanent if as a result

of the injury or sickness the employee is unable to perform anygainful occupation for a continuous period exceeding 120 days,

except as otherwise provided under Rule X of these Rules.

Maniosovs. GSIS

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The records show that the GSIS evaluated petitioner's Myocardial

Infarction and HVD as occupational diseases under PD 626.

Petitioner was on sick leave from 1/11/95 up to his date of

retirement on 5/15/95 or for a period of more than 120 days.

Surely, the DENR, in approving his more than 120 days leave

must have passed upon his Medical Certificate relative to his

ailments.

Petitioner's disability having lasted for more than 120 days, he isentitled to PTD benefits

Maniosovs. GSIS

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Ruling:2. No, petitioners retirement from the service does notprevent him from availing of the PTD benefits to which he is

entitled.

Benefits due an employee due to work-related sicknessshall be provided until he becomes gainfully employed, oruntil his recovery or death. None of these is present in

petitioner's case.

Maniosovs. GSIS

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3. The following disabilities shall be deemed total and permanent:

Temporary total disability lasting continuously for morethan one hundred twenty days, except as otherwiseprovided 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 theSystem and approved by the Commission.

4. The number of months of paid coverage shall be defined andapproximated by a formula to be approved by the Commission.

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Art. 193. Permanent partial disability.

1. Under such regulations as the Commissionmay approve, any employee under this Titlewho contracts sickness or sustains an injury

resulting in permanent partial disability shall,for each month not exceeding the perioddesignated herein, be paid by the Systemduring such a disability an income benefit forpermanent total disability.

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2. The benefit shall be paid for not more than the period designated in

the following schedules:

Complete and permanent No. of Monthsloss of the use ofOne thumb - 10One index finger - 8One middle finger - 6One ring finger - 5

One little finger - 3One big toe - 6One toe - 3One arm - 50One hand - 39One foot - 31One leg - 46One ear - 10Both ears - 20Hearing of one ear - 10Hearing of both ears - 50Sight of one eye - 25

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3. 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 afoot, and a loss of a knee shall be considered as a loss ofthe leg. A loss of more than one joint shall be consideredas a loss of one-half of the whole finger or toe: Provided,That such a loss shall be either the functional loss of theuse or physical loss of the member. (As amended bySection 7, Presidential Decree No. 1368)

4. In case of permanent partial disability less than the totalloss of the member specified in the precedingparagraph, the same monthly income benefit shall bepaid for a portion of the period established for the totalloss of the member in accordance with the proportion

that the partial loss bears to the total loss. If the result isa decimal fraction, the same shall be rounded off to thenext higher integer.

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5. In cases of simultaneous loss of more than one memberor a part thereof as specified in this Article, the same

monthly income benefit shall be paid for a periodequivalent to the sum of the periods established for theloss of the member or the part thereof. If the result is adecimal fraction, the same shall be rounded off to thenext higher integer.

6. In cases of injuries or illnesses resulting in a permanentpartial disability not listed in the preceding schedule, thebenefit shall be an income benefit equivalent to thepercentage of the permanent loss of the capacity towork. (As added by Section 7, Presidential Decree No.1368)

7. Under such regulations as the Commission may approve,the income benefit payable in case of permanent partialdisability may be paid in monthly pension or in lump sumif the period covered does not exceed one year. (Asadded by Section 7, Presidential Decree No. 13685

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