compensability report

8/11/2019 Compensability Report

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SEC.1, RULE III, PD No. 626

GROUNDS:

a. For the injury and the resulting disability or death to be compensable,the injury must be the result of accident arising out of and in the course of

the employment

b. For the sickness and the resulting disability or death to be

compensable, the sickness must be the result of an occupational diseaselisted under Annex A of these Rules with the conditions set therein

satisfied, otherwise, proof must be shown that the risk of contracting the

disease is increased by the working conditions.

c. Only injury or sickness that occurred on or after January 1, 1975 and

the resulting disability or death shall be compensable under these Rules.



ANNEX A

For an occupational disease and the resulting disability or death to be

compensable, all of the following conditions must be satisfied:

1. The employee's work must involve the risks described herein;

2. The disease was contracted as a result of the employee's exposure tothe described risks;

3. The disease was contracted within a period of exposure and under

such other factors necessary to contract it;

4. There was no notorious negligence on the part of the employee.



GSIS V. GABRIEL

(GR No.130379, June 21, 1999)

GSIS: denied the claim because

a. esophageal cancer is not listed as an

occupational disease under Annex A of PDNo. 626

b. there is no showing that claimants’ duties

involve risk of contracting the above illness.

ECC: denied the motion

CA: reversed the decision of ECC



GSIS V. GABRIEL

(GR No.130379, June 21, 1999)

• ISSUE: Whether the resulting death of prosecutor from hislast illness is compensable under PD No. 626, as

amended.

• SC: The cardiac arrest causing sudden death was caused

primarily by myocardial infraction rather than by

esophageal cancer.… even if esophageal cancer is not compensable, there can

be no question that coronary artery disease or atherosclerotic

heart disease is compensable.

“the incidence of a listed occupational disease whether or not

associated with a non-listed ailment is enough basis for

requiring compensation” (GSIS v. CA)



VALERIANO V. ECC(GR No. 136200,June 8, 2000)

• Celerino Valeriano was employed as a fire truck driverassigned at the San Juan Fire Station

• On July 3, 1985, petitioner met a friend by the name

of Alexander Agawin. They decided to proceed to

Bonanza Restaurant in EDSA, for dinner.• Owner-type jeepney they were riding in figured in a

head-on collision with another vehicle at the

intersection of N. Domingo and Broadway streets in

Q.C.

• Petitioner was thrown out of the vehicle and wasseverely injured. He was brought to the hospital for

several treatments.

• On Sept. 16, 1985, he filed a claim for income

benefits under PD 626 with GSIS.




GSIS: Opposed on the ground that the injuries hesustained did not directly arise or result from the

nature of his work.

ECC: Under the present compensation law, injury

and the resulting disability or death is compensableif the injury resulted from an accident arising out of

and in the course of employment.

- This condition is found wanting in the case. The

accident the appellant met occurred outside of histime and place of work. Neither was appellant

performing his official duties as a fireman at the time

of the accident.




CA: Agreed with the finding of the ECC that petitioner’sinjuries and disability were not compensable,

emphasizing that they were not work-connected

Petitioner’s Contention:

- Invoke 24 hours duty doctrine (Hinoguin vs. ECC) claiming that his position is akin to that of a military

man, and that the exigency of his job as a fireman

requires a constant observance of his duties, as such

he can be considered to have been “on call” when he

met the accident.ISSUES:

- Whether petitioner’s injuries are work- connected

- Whether petitioner fireman, like soldiers, can be

presumed to be on 24- hour duty




SC:

For the injury and the resulting disability to be

compensable, they must have necessarily resulted from an

accident arising out of and in the course of employment.

For injury to be compensable , the standard of “work-

connection” must be substantially satisfied. The injury andthe resulting disability sustained by reason of employment are

compensable regardless of the place where the injured

occurred, if it can be proven that at the time of the injury, the

employee was acting within the purview of his employment

and performing an act reasonably necessary or incidentalthereto.

- Petitioner sustained the injuries after pursuing a purely

personal and social function. His injuries and consequent

disability were not work- connected and thus not

compensable.




SC: In Hinoguin and Nitura , the Court granted deathcompensation benefits to theirs heirs, as both members of the

Phil. Army.

- The concept of “workplace” cannot always literally applied

to a soldier on active duty status who, to all intents and

purposes, is on a 24-hour official duty status, subject tomilitary discipline and at the law and at the call of his

superior officers at all times, except on vacation leaves.

- In ECC v. CA, Court reviewed Hinoguin, Nitura and ECC

and noted that in each case death benefits were granted,

not just because of the principle that soldiers or policemenwere virtually working round the clock, but of the

reasonable nexus between the absence of the

deceased from his assigned place of work and the

incident causing his death.




SC:Taking together jurisprudence and pertinent guidelines

of ECC with respect to claims for death benefits:

1. That the employee must be at the place where his

work requires him to be

2. That the employee must have been performing his

official functions

3. That if the injury is sustained elsewhere, the employee

must have been executing an order for the employer.

24 hour duty doctrine cannot be applied to petitioner’s case.

- He was neither at assigned work place nor in pursuit of

orders of his superiors when he met an accident.

- He was not doing an act within his duty and authority as a

fire truck driver at the time he sustained his injuries.



GSIS V. CUANANG(GR No. 158846, June 3, 2004)

• Carmen Cuanang was formerly employed as a teacher in theDivision of City Schools, Manila. She was first appointed as

Elementary Grade Teacher, then promoted to Teacher I and

later on to Teacher II.

• Carmen served as Teacher II until she applied for early

optional retirement after completing almost 26 years ofgovernment service.

• Sept. 14-18, 1997 she was confined for Bronchial Ashma &

Pneumonia, RHD and Mitral Stenosis. She filed sickness

benefits with GSIS under PD 626. GSIS awarded her

Temporary Total Disability benefits from Nov. 14-25, 1998.

He was also granted Permanent Partial Disability benefits

for 9 months.

• She died at the age of 65 with the immediate cause of death

was determined to be Cardio Pulmonary Arrest with Acute

Myocardial Infarction as the antecent cause, and Bronchial

Asthma and Hypertension as underlying cause.




• Respondent filed with petitioner GSIS a claim for deathbenefits under PD 626.

GSIS: death was due to Myocardial Infarction is not

compensable under PD 626 since it occurred after retirement

and beyond PPD period.

ECC: affirmed the GSIS denial of respondents’ claim.The ailment Acute Myocardial Infarction cannot be

considered work- connected since it is complication of RHD

which is a result of her Rheumatic Fever acquired during

childhood

Bronchial Asthma cannot be given due course since it tookbeyond PPD period

Hypertension was developed after Cuanang’s retirement

negates compensability since it could be due to factors other

than her work.




CA: set aside ECC’s decisionThe degree of proof required under PD 626 is merely

substantial evidence. The claimant must show, at least, by

substantial evidence that the development of the disease is

brought largely by a conditions present in the nature of the job.

What the law requires is a reasonable work connection and

not direct causal connection.

ISSUE: Whether the resulting death of Carmen Cuanang is

compensable under PD 626.SC: The wife of the respondent died a year after her

retirement . Clearly, the period between her retirement and

demise was less than 1 year. A claim for benefit for such death

cannot be defeated by the mere fact of separation from

service.




There was a substantial evidence to support respondent’s claim.

- The requisite substantial evidence came from the expert

opinion of Dr. Arsenio Estreras who issued the Death

Certificate

- Expert opinion is fully supported by the facts leading toCarmen Cuanang’s deteriorating health condition and

ultimately, her death. When she joined the government

service on Oct. 1, 1972, she was in perfect health, but

condition while still in service started to worsen.

- Myocardial Infarction or known as “coronary’ is a lifethreatening condition. Predisposing factors include stress.

The collective effect of all the factors involved during her

service contributed to the deterioration of her already

precarious health.

- The respondent’s claim is GRANTED.

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