Guide on how to file a Claim for Employees' Compensation Benefits at the GSISWorkers from the public sector who suffer work- connected sickness or injury, or their families in case of work- connected death, can file claims for Employees' Compensation benefits at the GSIS. These benefits are in addition to what the workers or their families are entitled to under the GSIS program or the Phil. Health program. Where is the Claim for Employees' Compensation benefits filed? A claim for Employees' Compensation benefit is filed with the GSIS.
![]() Workers from the public sector who suffer work-connected sickness or injury, or their families in case of work-connected death, can file claims for Employees. Information & Assistance Unit guide 1 I&A 1 Rev. 11/14 How to file a workers’ compensation claim form Use a claim form to report a work injury or illness to your. It is recommended that the claim should be filed at the GSIS office where the office remits its GSIS contribution for most likely it is there where the records of the worker and of his office are found. Access to the records will hasten action by the GSIS on the claim filed. It is important when filing the claim to clearly tell the GSIS 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 GSIS 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 GSIS will require that these documents 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 your protection just in case the original documents will get misplaced later on. What are these documents needed to support a Claim? There are a number of documents that the GSIS will require to support a claim for Employees' Compensation benefits. The most important of these are the certified true copy of service record or statement of service. This statement of service should indicate the position of the employee when the sickness, injury or death happened. In addition, a description of the actual duties and responsibilities performed by the employee at the time of the contingency is necessary. It is this description of the duties and responsibilities that will allow the GSIS evaluator to establish a connection between the sickness, injury and death and the employee's work and therefore grant the Employees' Compensation benefits. If the claim is due to sickness which resulted to disability or death) a pre- employment medical check- up done by the office or authorized government hospital or in its absence, a certification by the office that the employee is physically fit when hired. If the claim is due to injury which resulted to disability or death) the following documents are also necessary: a.) Injury/death occurred within the office premises. Certification under oath by Head of Office as to the circumstances surrounding the accident, viz: date, time and place of accident, and reason or purpose for being there. Time card/logbook of attendance/Daily Time Record. Affidavit of witness. Employer's report of injury/death b.) Injury/death occurred outside the office premises. Certification under oath by the Head of Office as to circumstances surrounding the accident, viz: date, time and place of accident, what employee was doing at the time of the accident, and reason or purpose for being there. Mission/Travel Order/Trip Ticket. Certificate of Appearance. Police Investigation Report. Vicinity sketch showing the distance in meters/km between the place of accident/place of destination and place of residence. Employer's report of injury/death c.) Wounded in Action (for AFP members)After battle/Encounter Report/Army Operations Center Journal. Spot Report. Hospitalization claim for payment duly accomplished and signed by authorized representative of hospital and attending physician. If the claim is for death benefits) In addition to the requirements 1, 2, & 3 the following documents are also necessary: For uniformed personnel: a.) NAPOLCOM Adjudication Award for PNP uniformed personnel. Line of Duty (LOD) Proceedings with the narrative summary for deceased AFP personnelc.) Killed in Action – Casualty report. For Primary Beneficiariesa. Death Certificateb. Marriage Contractc. Birth Certificate of minor children. For Secondary Beneficiariesa. Death certificate of deceased employeeb. Marriage contract of parentsc. Death certificate of parents, if anyd. Birth certificate of deceased employeee. Affidavit by parents of the deceased that the latter died single leaving no child/ren and that they/he/she/is wholly dependent upon deceased for support.[all of which shall be original or certified true copies issued by the National Statistics Office (NSO).]5. A certification signed by employer as to inclusive dates of leave of absence (for disability claims)6. A certified true copy of the page of the office logbook containing the entry for the particular sickness, accident or death; 7. The medical findings of the attending doctor or the hospital records; and. A certification of GSIS and Employees' Compensation premium contributions one year prior to the sickness, injury or death. Please be reminded that the above documents coming from the office should be written/printed on the office letterhead and duly signed by the HO or his/her authorized representative. With the documents in hand, how will the claimant go about filing an Employees' Compensation claim? If the above documents are already available, then the claimant can proceed to the GSIS office nearest the place of employment to file the appropriate claim. Theoretically, a claim for Employees' Compensation benefits may be filed at any GSIS branch office. But for immediate action on the claim, we recommend that the claim be filed at the GSIS branch where the office is remitting it GSIS contribution. Can a Claim be filed even if the documents are not complete? Yes. The GSIS will accept the claim even if the documents are not complete. 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 GSIS. When shall the claim be filed with the GSIS? The claim shall be filed with the GSIS branch within three years from the date of the occurrence of the contingency (sickness, injury or death). How does one proceed in filing a Claim at the GSIS branch office? To file a claim, it is important that you accomplish the necessary claim application forms found in the receiving counter of the GSIS branch office. It will help if you seek the assistance of the GSIS personnel at the receiving counter. Anyhow, the following application forms should be accomplished: 1. For sickness/Accident claims. Income Benefits Claim for Payment. Hospitalization Claim for Payment ECAttending Physician's certification. For Disability Claim. Income Benefits Claim for Payment. Hospitalization Claim for Payment ECAttending Physician's certification. For Medical Reimbursement Claim. EC Medical Reimbursement Claim Form. Attending Physician's certification. For Death Claim. Income Benefits Claim for Payment. Hospitalization Claim for Payment ECProofs of Surviving Legal Heirs and Guardianship. Attending Physician's certification. 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 a monthly disability pension. In the same manner, even after the confinement and release from hospital, the workers may require further medication and therefore can be entitled to medical reimbursements 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 GSIS, should now be submitted to the receiving counter of the GSIS branch office. It is suggested that when submitting the forms, you inquire from the concerned GSIS personnel if all the requirements have been met and what further instruction/information from the GSIS 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 GSIS, what will happen next? The application will be processed by the GSIS 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 GSIS 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 a thorough evaluation, the GSIS evaluators cannot establish a connection between the sickness, injury or death with the work of the worker, then claims will be disapproved and you will be accordingly informed. Normally, the GSIS will evaluate the claim and come up with a decision within twenty (2. If the Claim is disapproved by the GSIS branch office, what option is open to the Worker or his/her family? A Claim for Employees' Compensation benefits disapproved by the GSIS branch office may be reviewed by the GSIS' Employees' Compensation Commission, GSIS Headquarters, Financial Center, Pasay City. If the Claim is again denied by the GSIS EC Department, what shall the worker or his/her family do? A Claim for Employees' Compensation benefits disapproved by the GSIS EC Department may be appealed to the Employees' Compensation if you firmly believe that the sickness or injury was the result of work or of the working environment.
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