In the Philippines, the legal framework for disability benefits is primarily governed by the Social Security System (SSS) for private-sector employees and the Government Service Insurance System (GSIS) for public-sector workers. Additionally, the Employees’ Compensation Commission (ECC) provides supplemental benefits if the disability is work-related.

1. Types of Disability Categories

Under Philippine law, disabilities are classified into three distinct categories, which determine the duration and amount of the benefit:

Permanent Total Disability (PTD): A condition where the member is permanently unable to work, such as total loss of sight, loss of two limbs, or incurable mental illness.
Permanent Partial Disability (PPD): A permanent loss of use of any body part (e.g., loss of a finger, one eye, or one foot) that does not prevent the member from engaging in any gainful occupation, though it may limit their capacity.
Temporary Total Disability (TTD): A condition that prevents a member from performing their work for a continuous period, but from which they are expected to recover.

2. The SSS Disability Benefit (Private Sector)

The SSS provides either a monthly pension or a lump-sum amount to members who become permanently disabled.

Qualifications

The member must have paid at least 36 monthly contributions prior to the semester of disability to qualify for a monthly pension.
If contributions are less than 36 months, the member is entitled to a lump-sum amount.
The disability must be medical in nature and validated by an SSS physician.

Computation of SSS Pension

The monthly pension is the highest of the following three formulas:

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The minimum pension: (for members with at least 10 CYS) or (for members with at least 20 CYS).

[!NOTE] A Supplemental Allowance of is added to the monthly pension to help cover medication and rehabilitation costs.

Filing Process

Medical Evaluation: Undergo a physical examination at any SSS branch.
Documentation: Submit the Disability Claim Application (SSS Form SSS-CLD-1.1), Medical Certificate (SSS Form CLD-2), and valid government IDs.
Submission: Claims can be filed online via the My.SSS portal or manually at the nearest branch.

3. The GSIS Disability Benefit (Public Sector)

Government employees are covered under Republic Act No. 8291. The GSIS provides a disability discharge benefit if a member is separated from service due to a permanent disability.

Computation of GSIS Benefit

If the member has at least 15 years of service, they are entitled to a Basic Monthly Pension (BMP) for life. If service is less than 15 years but they have at least 3 years of service, they receive a Cash Payment equivalent to ****, but not less than .

The BMP is calculated as:

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This amount shall not exceed of the AMC.

4. Employees’ Compensation (EC) Program

If the injury or sickness occurred due to and in the course of employment, the member can file an EC claim in addition to their SSS or GSIS claim. This is known as the "Double Recovery Rule" in the Philippine jurisdiction, provided the specific requirements of the ECC are met.

Key Criteria for EC Claims

The injury must have happened at the workplace, while performing official functions, or while commuting to/from work (the "Going and Coming Rule").
The sickness must be listed as an Occupational Disease by the ECC; otherwise, proof of increased risk must be established.

Computation of EC Benefits

The EC Permanent Total Disability pension is of the member’s SSS or GSIS basic monthly pension.

5. Required Documentary Evidence

For any disability claim in the Philippines, the burden of proof lies with the claimant. Essential documents include:

Clinical Records: Operating room records, discharge summaries, and laboratory results (X-ray, MRI, ECG).
Employer’s Report: (For EC claims) A certification that the accident happened during work hours.
Police Report: Required if the disability resulted from a vehicular accident or an act of violence.

6. Prescriptive Periods (Statute of Limitations)

SSS: Claims should be filed within ten (10) years from the occurrence of the disability.
GSIS: Claims must be filed within four (4) years from the onset of disability.
EC Program: Claims must be filed within three (3) years from the date of the accident or the onset of the occupational disease.

7. Appeals Process

If a claim is denied, the member has the legal right to appeal:

For SSS: Appeal to the Social Security Commission (SSC).
For GSIS: Request for Reconsideration to the GSIS Board of Trustees.
For EC: Appeal to the Employees’ Compensation Commission (ECC) within 30 days of denial. Final appeals may be elevated to the Court of Appeals.