Issuances of the Department of Labor and Employment and its Attached Agencies

Section 1

(a) The claim for medical benefits shall be filed in a prescribed form by the accredited physician or accredited hospital directly with the System. (b) The claim for emergency services shall be filed in a prescribed form by any physician or hospital.

Section 2

The claim for income benefit shall be filed in a prescribed form by the employee, his dependents or his employer, on his behalf, directly with the System. Failure to file the claim within three years from the time the cause of action accrued, shall forever bar the right to benefits granted under these Rules. (ECC Resolution No. 2799, July 25, 1984).

Section 3

Upon the receipt of the claim, the System shall process the same and determine whether or not the injury, sickness, disability or death is compensable. When the disease or injury being claimed has been declared to be not work-connected but findings are also made that the employee has suffered or is suffering from other work-connected diseases or injuries, such incidental findings shall be evaluated by the System. (as provided under Board Resolution No. 10-05-65, April 28, 2010)

Section 4

If the supporting papers of the claim are insufficient to make proper determination, the System shall require the submission of additional proofs from the employee or his dependents, or from any office, entity or agency, public or private, or from any person, having knowledge of the contingency.

Section 5

(a) The claimant shall file with the GSIS or the SSS, as the case may be, a notice of appeal within 30 calendar days from receipt of the decision.

Section 6

Upon receipt of the notice of appeal, the GSIS or SSS shall transmit the entire records of the case to the Commission within five (5) working days from receipt thereof. (as provided under the Rules of Procedure for the Filing and Disposition of the Employees' Compensation Claims, dated July 13, 1995)