In the Philippines, the primary framework for addressing workplace injuries and illnesses is the Employees’ Compensation Program (ECP). Established under Presidential Decree No. 626 (as amended), the ECP is designed to provide employees and their dependents with income augmentation, medical benefits, and rehabilitation services in the event of work-related contingencies.

1. The Governing Bodies

The ECP is implemented by the Employees’ Compensation Commission (ECC), an attached agency of the Department of Labor and Employment (DOLE). However, the administration of claims is handled by two specific systems:

Social Security System (SSS): For employees in the private sector.
Government Service Insurance System (GSIS): For employees in the public sector (government workers).

2. Coverage and Compensability

A workplace accident or injury is compensable if it meets the "Work-Connection Rule." This requires that the injury resulted from an accident arising out of and in the course of employment.

Compensable Situations:

At the Workplace: The injury occurred while the employee was performing official functions at their designated workplace.
Off-site but Official: The injury occurred while the employee was performing an order from the employer outside the normal workplace.
Going-to-and-Coming-from Rule: Injuries sustained while traveling to or from work are generally compensable, provided there was no "substantial deviation" from the usual route.
Occupational Diseases: Illnesses listed under the ECC’s "List of Occupational and Work-Related Diseases" are automatically compensable. If the disease is not listed, the employee must prove that the risk of contracting it was increased by their working conditions.

3. Types of Benefits Available

The ECP provides a comprehensive package of benefits to ensure the welfare of the worker:

Medical Benefits

This includes the reimbursement of costs for medical, surgical, and hospital services, as well as appliances (like crutches or prosthetics) and supplies necessary for recovery. There is no "ceiling" on the duration of medical benefits as long as the treatment is required by the nature of the injury.

Disability Benefits

Temporary Total Disability (TTD): Paid to employees who are unable to work for a continuous period not exceeding 120 days (extendable to 240 days if further medical treatment is required).
Permanent Partial Disability (PPD): Paid if the worker suffers a permanent loss of use of a body part (e.g., loss of a finger or sight in one eye) based on a schedule of benefits.
Permanent Total Disability (PTD): Paid in monthly pensions for life if the worker is no longer able to engage in any gainful occupation.

Death Benefits

If the work-related injury or disease results in death, the beneficiaries (usually the surviving spouse and dependent children) are entitled to a monthly income benefit and a funeral benefit.

Rehabilitation Services

This includes physical therapy, vocational training, and assistance in finding new employment for workers who suffer permanent disabilities.

4. The Step-by-Step Claim Process

Step 1: Notice to Employer

The employee or their dependents must notify the employer within five (5) days of the occurrence of the contingency (accident or start of illness). Notice is not required if the employer or their representative had actual knowledge of the event.

Step 2: Recording in the Logbook

The employer must record the incident in their EC Logbook within five days of receiving notice. Failure to maintain a logbook or record a compensable injury may result in penalties for the employer.

Step 3: Filing with the System (SSS or GSIS)

The claim must be filed at the SSS or GSIS branch nearest to the employee’s residence or workplace.

Prescriptive Period: The claim must be filed within three (3) years from the date of the accident or the onset of the illness.

Step 4: Adjudication and Payment

The SSS or GSIS will evaluate the medical records and the employer’s report. If approved, the benefits are released directly to the employee or the medical facility.

5. Exclusions: When a Claim Can Be Denied

Even if an injury happens at work, it may be deemed non-compensable if it was caused by:

Intoxication: The employee was under the influence of alcohol or prohibited drugs.
Willful Intent: The employee deliberately intended to injure themselves or another person.
Notorious Negligence: The employee displayed a flagrant and conscious indifference to consequences (e.g., explicitly ignoring safety protocols or "horseplay").

6. The Right to Appeal

If a claim is denied by the SSS or the GSIS, the claimant has the right to file a Request for Reconsideration with the same agency. If the denial is upheld, the case can be appealed to the Employees’ Compensation Commission (ECC) within 30 days of receiving the denial. Decisions of the ECC may further be appealed to the Court of Appeals.