How to File for SSS Sickness Benefit

Getting sick is really a blow to employees both physically and financially. Thankfully, employees who are SSS active members have the SSS Sickness Benefit to aid them in their time of need.

By definition, the sickness benefit is a daily cash allowance paid by SSS for the number of days a qualified member is unable to work due to sickness or injury. Member can file for a maximum of 120 days of sickness claim in one calendar year. If unused, this could not be carried forward nor added to the total number of allowed compensable days for the succeeding years.

Here are the qualifications to avail the Sickness Benefit:

You are unable to work due to sickness or injury and confined either in a hospital or at home for at least four (4) days
You have paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury
You have used up all current company sick leaves with pay (if any)
You have notified the employer or the SSS (if unemployed, VM or SE member) regarding your sickness or injury

If you are indeed qualified for a sickness claim, here are the following steps you need to do:

Notify your employer within five calendar days after the start of sickness or injury. In turn, our employer must notify the SSS about the confinement within five days after the receipt of the notification from the employee.

If the member was confined in a hospital or was sick or injured while working or within the company premises, the employee is not required to notify the employer. The employer now has ten calendar days from the start of the employee’s sickness/injury to notify SSS.

If a member would file the sickness claim personally, he or she should submit the following;

– Duly accomplished Sickness Notification
– Identification card/s or document/s
-Medical documents

In case of work-related claims:

Accident/Sickness Report from employer, if work-connected; and
Police Report (for vehicular accident with third party involvement), if work-related; and
Photocopy of employer’s logbook

In case of prolonged confinements or sickness, original/certified true copy of the following:

Laboratory, X-ray, ECG and other diagnostic results
Operating room/clinical records that will support diagnosis

In case of sickness that occurred while on strike/shutdown and member will file to SSS personally, submit the above-mentioned requirements together with the following:​

Certificate of Notice of Strike issued by DOLE
Certificate of Foreclosure
Certification from the DOLE that the employee or employer has a pending labor case
Certificate of Non-advancement of Payment from Employer

If filed through Company Representative, the following documents should be forwarded to SSS:

System-generated Transmittal List (TL) or System-generated Acknowledgment Letter, if filed through Electronic Notification (three copies); or Employer TL (three copies)
Member’s Sickness Notification Application
Member’s identification card/s or document/s (photocopy)
All attached medical documents and reports, if any

If filed through Company Representative, the following documents should be forwarded to SSS:

System-generated Transmittal List (TL) or System-generated Acknowledgment Letter, if filed through Electronic Notification (three copies); or Employer TL (three copies)
Member’s Sickness Notification Application
Member’s identification card/s or document/s (photocopy)
All attached medical documents and reports, if any.

 

The payment of the daily sickness allowance shall be shouldered by the employer every regular payday and shall be reimbursed by the SSS after the employer presented satisfactory proof of such payment.