The new SSS Disability program is a re-designed disability program that implements the revised manual of disability assessment. The new program adopts the World Health Organization’s (WHO) definition of disability that states as any “restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.”
The re-designed program aims to ensure that the right cash benefit for disability is paid to truly deserving members.
The re-designed disability program –
- Adopts the WHO definition of disability which is any “restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.” Impairment is defined as any loss or abnormality of psychological, physiological, or anatomical structure or function.
- Adopts the International Statistical Classifications of Diseases and Related Health problems Codes (ICD-10).
- Includes medical and functional assessments.
- Requires annual assessment of all pensioners except those with scheduled disabilities stated under Section 13-A (f) of the SS Law.
Under the medical assessment, nature and degree of impairment of affected body part/system is determined through physical examination and interview supported by appropriate diagnostic tests. While, under functional assessment, the capacity of the individual to perform activities of daily living (ADL) is tested using the Functional Independence Measure (FIM).
Member should have 20% medical impairment to qualify for functional assessment.
A member who suffers partial or total disability with at least one monthly contribution paid to the SSS prior to the semester of contingency is qualified.
A complete and permanent loss or use of any of the following body parts and does not totally prevent a member from engaging in any gainful occupation.
The following fall under permanent total disability:
- Complete loss of sight of both eyes;
- Loss of two limbs at or above the ankle or wrists;
- Permanent complete paralysis of two limbs;
- Brain injury resulting to incurable imbecility or insanity; and
- Such cases as determined and approved by the SSS.
- The monthly pension; and
- The lump sum amount.
The lump sum amount is granted to those who have not paid the required 36 monthly contributions.
The amount of the monthly pension will be based on the member’s number of paid contributions and the years of membership.
The lowest monthly pension is P1,000 for members with less than 10 credit years of service (CYS); P1,200 with at least 10 CYS and P2,400 with at lest 20 CYS.
Only totally and permanently disabled members will be receive a lifetime monthly pension. However, the pension will be suspended if the pensioner recovers from the illness, resumes employment or fails to report for annual physical examination when notified by the SSS. The member may request for a domiciliary or a home visit if the disability inhibits the member from reporting for re-examination by the SSS physician at any of SSS branch offices.
The monthly pension of a partially disabled member is paid up to a certain number of months only according to the degree of disability. If with deteriorating and related permanent partial disability, the percentage degree of disability of previously granted claim shall be deducted from the percentage degree of disability of the current claim.
The monthly pension is also given in a lump sum if duration of pension is payable for less than 12 months.
The monthly pension is paid thru the member’s designated bank. He is allowed to choose the bank nearest his residence thru which he wishes to receive his pension benefits under the “Mag-impok sa Bangko” program. This became mandatory effective September 1, 1993.
A member must open a single saving account and must submit to the SSS his savings account number and a photocopy of his passbook upon filing of his application. The original copy of the passbook must be presented for authentication purposes.
Upon approval of the claim, the SSS will mail a notice-voucher to the claimant when to withdraw the benefit from the bank.
For permanent total disability, the lump sum benefit is equivalent to the monthly pension times the number of monthly contributions paid to the SSS or twelve (12) times the monthly pension, whichever is higher.
For permanent partial disability, the lump sum is equivalent to the monthly pension times the number of monthly contributions times the percentage of disability in relation to the whole body or the monthly pension times 12 times the percentage of disability, whichever is higher.
In addition to the monthly pension, a supplemental allowance of P500.00 is paid to the total or partial disability pensioner. The allowance will provide additional financial assistance to meet the extra needs arising from the disability.
Total disability pensioners and their legal dependents prior to the effectivity of R.A. 7875 on March 4, 1995 are entitled to hospitalization benefits under PhilHealth. A copy of DDR Print-out indicating the type of claim is disability in nature and the effectivity date of pension or a Copy of Disability-Pensioner Certification, shall be submitted. Total disabled pensioners upon the effectivity of R.A. 7875 on March 4, 1995 and thereafter, are no longer covered except when they have accumulated one hundred twenty (120) Medicare monthly contributions and have reached age sixty (60).
However, those who wish to avail of PhilHealth benefits may enroll in the Individually-Paying Program (for voluntary/self-employed) or the Indigent Program (IP) of PhilHealth.
The dependent legitimate, legitimated, legally adopted and illegitimate children, conceived on or before the date of contingency of a totally disabled pensioner will each receive a dependent’s pension equivalent to 10 per cent of the member’s pension or P250, whichever is higher.
Only five minor-children, beginning from the youngest are entitled to the dependents’ pension. No substitution is allowed. Where there are legitimate and illegitimate minor children, the legitimated or legally adopted ones will be preferred.
The minor children of a partially disabled pensioner are not entitled to the dependent’s pension.
The dependent’s pension stops when the child reaches 21 years old, gets married, gets employed or dies. However, the dependent’s pension is granted for life to children who are over 21 years old, provided, they are incapacitated and incapable of self-support due to physical or mental defect which is congenital or acquired during minority.
The monthly of the member and the dependent’s pension will be suspended upon the reemployment or resumption of self-employment or the recovery of the disabled member from permanent total disability or failure to present himself/herself for examination at least once a year upon notice by SSS.
Upon the death of the permanent total disability pensioner, the primary beneficiaries as of the date of disability, shall be entitled to 100 per cent of the monthly pension and the dependents to the dependents’ pension.
If the totally disabled pensioner has no primary beneficiaries and dies within sixty (60) months from the start of the monthly pension, the secondary beneficiaries shall be entitled to a lump sum benefit equivalent to the total monthly pensions corresponding to the balance of the five-year guaranteed period excluding the dependent’s pension.
The pension stops when a partial disability pensioner retires or dies.
The prescriptive period in the filing of disability benefit claim should be ten (10) years from the date of occurrence of disability.
- Disability Claim Application (SSS Form DDR-1);
- Medical Certificate (SSS Form MMD-102)
- Other documents that may be required to support the disability claim such as clinical and laboratory tests results, x-ray; and hospital records.
- SSS digitized ID or E-6 (acknowledgement stub) with two valid IDs, one of which with recent photo.
Where can a member file his disability benefit application?
Applications forms of disability benefits are filed at the nearest SSS branch or representative office.