The Social Security System or SSS provides disability benefits to members who are unable to work due to sickness or injury. This financial assistance can be a lifeline for Filipinos who are facing difficulties during this vulnerable time. In this guide, we will discuss the requirements, process and other key details regarding SSS disability benefits in the Philippines.
What is SSS Disability Benefit?
The Social Security System (SSS) in the Philippines provides financial assistance to members who suffer from total or partial permanent disability. The amount and type of disability benefit depends on the member’s contribution history.
Cash Benefits Offered
- Monthly Disability Pension – Members who have paid at least 36 monthly SSS contributions before the semester of disability qualify for this regular monthly payment.
- Lump Sum – If a member has less than 36 contributions or the approved disability period is less than one year, they receive a one-time lump sum payment.
Additional Benefits for Pensioners
Monthly disability pensioners can also receive:
- 500 peso monthly supplemental allowance
- 1,150 peso additional monthly benefit started in 2017
- 13th month pension every December
- PhilHealth covers hospitalization benefits for the following:
1) SSS members who were granted total disability pensions and their dependents before the implementation of RA 7875 on March 4, 1995.
2) SSS members who received total disability pensions and their dependents after RA 7875 was enacted on March 4, 1995. This is applicable if they are at least 60 years old and have made 120 monthly Medicare contributions.
What are the Types of SSS Disability Benefits?
The SSS offers three main types of disability benefits:
Total Disability Benefit
This is for members who are permanently disqualified from performing any kind of work due to a sickness or injury. The member should have at least 1 month of SSS contributions prior to the semester of disability.
Partial Disability Benefit
For members still capable of work but requires vocational rehabilitation to find suitable employment. At least 12 monthly SSS contributions are required prior to the semester of disability. The monthly disability pension varies based on the assessed degree of disability.
Temporary Disability Benefit
For members who are unable to work for a limited period of time due to sickness or injury. At least 3 monthly SSS contributions are required within the 12-month period before the semester of disability. The benefit is a daily cash allowance for a maximum of 120 days in a single calendar year.
What are the Requirements for SSS Disability Benefits?
To qualify for disability benefits, the SSS member should meet the following requirements:
- Must be diagnosed with a sickness or injury resulting in inability to work.
- Has paid the required number of monthly SSS contributions prior to the semester of disability.
- Submission of notification of sickness or injury within 5 years from the date of disability.
- Is certified by an SSS-accredited physician and reviewed by SSS-authorized physicians.
The following documents must also be submitted upon filing the disability claim:
- Disability claim application form.
- Medical certificate containing clinical abstract and diagnosis.
- Attending physician’s statement detailing prognosis, treatment and estimated duration.
- Complete medical records such as tests, lab results and medications.
Additional documents may be required by SSS to support the disability claim.
What is the Disability Assessment and Evaluation?
The SSS conducts a rigorous evaluation process to determine a member’s eligibility for disability benefits. Here are the key steps:
- Notification Period – The sickness or injury should be declared to SSS within 5 years from occurrence.
- Initial Assessment – Attending physician will determine if the member is totally/partially disabled using physical exams, medical tests and work capacity assessments.
- Confirmatory Assessment – An SSS-accredited physician will confirm if the member’s condition satisfies the requirements for the claimed disability type and benefit duration.
- Impairment Evaluation – For partial/total permanent disability, the degree of impairment and complete disqualification from work will be evaluated.
- Review – The claim will be assessed by SSS authorized-physicians who can recommend approval or denial of disability benefits.
The whole process ensures appropriate qualification standards are met before granting disability claims. The evaluation steps may take 2-3 months on average.
How Much are the Monthly SSS Disability Pensions?
The amount of monthly pension is influenced by the duration of a person’s affiliation with the SSS and their contributions made prior to becoming disabled:
- Below 10 years – PHP 1,000 at least
- 10 years or more – PHP 1,200 at minimum
- 20 years or more – PHP 2,400 at minimum
When considering supplementary support and extra advantages, the complete monthly pension could potentially surpass PHP 2,850.
How Long can Disability Pensions be Received?
For permanent total disability, the member can receive the monthly disability pension for life unless disqualified or deceased.
Partial disability pensions are also for life but subject to periodic re-evaluation of disability severity. The disability pension stops once the impairment rating drops below 31%.
Temporary disability benefits have a limited duration of 120 days within a calendar year. For job-related sickness/injury, 100% daily allowance is paid by the employer for the first 4 days then SSS pays 90% for the next 116 days.
What is the Process for Filing SSS Disability Claims?
Follow these steps when filing for SSS disability benefits:
- Notify SSS – Inform SSS of your sickness/injury within 5 years of occurrence through written notice.
- Get Medical Documents – Obtain medical certificate, clinical records, tests and attending physician’s statement.
- File Claim Application – Fill out the SSS disability claim form and submit with supporting documents to the SSS branch.
- Attend Physician Evaluation – Go through the assessment and confirmatory evaluation by accredited SSS physicians. Submit additional documents if needed.
- Claim Approval/Denial – Monitor your claim status. Check reasons if denied. File an appeal if warranted.
- Receive Benefits – If approved, follow procedures to set up benefit payments through bank, checks or over-the-counter.
The entire application process may take 2-6 months depending on claim complexity.
What are the Prescriptive Periods for SSS Disability Benefits?
There are limitations on the period within which the SSS disability claim should be filed:
- Sickness – Notification and filing should be within 3 years from the date of sickness.
- Injury – Notification and filing should be within 5 years from the date of injury.
- Death of member – The primary beneficiaries should file within 5 years from the date of member’s death.
Failure to notify and file within these periods makes the claim ineligible for benefits unless SSS finds justifiable reasons for late filing.
Can Disability Decisions Be Appealed or Re-evaluated?
If the SSS claim is denied, the applicant will be informed of the reasons such as insufficient SSS contributions, late notification or filing, no qualifying disability, etc.
The applicant can file a request for reconsideration within 30 days of benefit disapproval to submit additional documents, correct inaccurate information or address other issues cited.
For re-evaluation of disability grading by the SSS, a request can be filed after 6 months from the date of the last evaluation. This may be warranted if the medical condition has worsened as proven by updated medical certificates and tests.
How is the Disability Benefit Paid?
The Social Security System (SSS) provides monthly disability pensions and lump sum benefits to its qualified members. These benefits are distributed through 25 partner banks across the Philippines.
Some of the major banks that distribute SSS disability funds include Asia United Bank (AUB), China Bank, Development Bank of the Philippines (DBP), Land Bank of the Philippines (Landbank), Philippine National Bank (PNB), Philippine Savings Bank (PSBank), Rizal Commercial Banking Corporation (RCBC), Security Bank, and Union Bank.
If you already have a savings account with one of the accredited banks, the SSS can deposit your monthly disability pension directly into that account.
Otherwise, you will need to open an account with one of their partner banks and provide the bank with the Letter of Introduction (LOI) given to you by the SSS. This allows the SSS to properly deposit your funds each month.
Key Takeaways on SSS Disability Benefits
The SSS disability benefit provides essential income replacement for Filipinos unable to work due to sickness or injury.
Understanding the program’s requirements, process and limitations is crucial to avail of this support. Monitoring your claim and being ready to appeal decisions is also important.
Overall, the disability benefit helps ensure the welfare of SSS members and their families during difficult times.