Why SSS member’s disability claim was denied

This is regarding the complaint (Letters, 2/23/13) of Esmeraldo C. Mariano about his permanent total disability (PTD) claim, which was denied by the Social Security System in Tarlac.

According to SSS Tarlac, Mariano’s appeal for his PTD claim was endorsed to the Employees’ Compensation Commission (ECC) after it was denied at their end. However, as per Employees Compensation Commission Board Resolution No. 03-12-1038 dated Dec. 11, 2003, the same was denied for lack of merit.

Based on the resolution promulgated by the ECC, Mariano’s claim lacks basis since his condition is not one of those that falls under the classifications of PTD as provided in paragraphs (c), (1), (2), (3), (4), (5), (6) of Section 192 of Presidential Decree 626, or The Amended Rules on Employees Compensation.

The above-mentioned rules provide that only the following criteria are acceptable for PTD cases:

1. Temporary disability lasting continuously for more than 120 days except as otherwise provided for in the rules;

2. Complete loss of sight of both eyes;

3. Loss of two limbs at or above the ankles or wrists;

4. Permanent complete paralysis of two limbs;

5. Brain injury resulting in incurable imbecility or insanity; and

6. Such cases as determined by the medical director of the System and approved by the Commission.

In Mariano’s case, the medical record shows that there was no progression of his ailment, Herniated Disk Disease, which he suffered when he accidentally slipped and fell while he was assisting in the repair of a belt conveyor. Also, his condition is not one of the criteria for him to be granted the PTD benefits.

Mariano was notified by the ECC regarding their decision and was informed that an appeal for reconsideration of the resolution should be made to the Court of Appeals within 15 days from the receipt of the notice as provided in Administrative Circular No. 1-95 (Revised Circular No. 1-91). Otherwise, such resolution will become final and executory as provided in Article 182 of the Labor Code of the Philippines (as amended by PD 626).

Before Mariano filed for PTD claim, he had already been granted a 30-month compensation by the SSS for his Herniated Disk Disease, his work-related ailment.

—MARISSU G. BUGANTE,

vice president,

public affairs and events division,

Social Security System