Monday, November 25, 2013

MALAYSIA:::SOCSO accident insurance scheme benefits

Are you a subscriber to SOCSO, but not sure what you get out of it? Let LabourBulletin4Workers guide explain some of the benefits you might receive. Depending on the type of scheme you are subscribed to, there are different benefits.

Employment Injury Insurance Scheme — benefits

Medical Benefit
Employees who suffer from workplace accidents or occupational diseases are entitled to free treatment at SOCSO panel clinics or government clinics/hospital.

To apply and receive medical benefits for the first time, the following documents must be completed and submitted to a SOCSO panel clinic:

• Form 21 (accident report) or Form PKS 68 or PKS 69 (occupational disease report) or;

• Identification letter from employer; and

• Form 10 (claims form).

For treatments received from a clinic which is not a SOCSO panel, the employer or employee can submit an application for reimbursement payment to the relevant SOCSO office for approval subject to rates determined by SOCSO.

To apply and receive the reimbursement payment, the following documents must be completed and submitted to a SOCSO office:

• Form PKS (P) 24 (reimbursement travel claims form);

• Form PKS (P) 26 (reimbursement payment (general) claim report);

• Original receipt for treatment;

• A copy of the appointment card; and

• A copy of the medical report (if any).

Permanent Disablement
This is a benefit payment paid to employees who suffer from permanent disabilities due to workplace injuries, regardless of ability to continue working. The benefit rate will be 90% of the daily wage of the employee (as per previous SOCSO contribution rate) from a minimum of RM10 to a maximum of RM88.50 per day.

The insured employee must submit a written application to the relevant SOCSO office for reference to the Medical Board. Please include the following documents:

• Application form;

• A copy of identity card;

• Medical report (from hospital/ clinic which treated him/her);

• Form 10 (claim form);

• Form PKS (F) 1 (statement of wages/ contribution details); and

• A copy of the employee’s savings account passbook for direct payment of benefits.

How benefit is paid — The case will be referred to the Medical Board for disability assessment. The decision of the assessment will be notified to the insured employee.

If the permanent disablement is assessed at 20% or less loss of earning potential, the employee can claim the benefit in the form of a lump sum payment. If it exceeds 20% loss of earning potential, the benefit will be made in monthly payments. However, the employee can request that one-fifth of the benefit in a lump sum, while the balance is paid as a monthly pension for life.

The insured employee may continue to work while receiving this permanent disability benefit. If the insured employee or SOCSO is not satisfied with the decision of the Medical Board, an appeal can be made to the Medical Appeals Board within 90 days from the date notification to the insured employee.

Constant Attendant Allowance
This allowance is paid to an employee who is suffering from permanent total disablement (ie 100% loss of earning capacity), and is so severely incapacitated that he constantly requires the personal attendance of another person. The allowance is equal to 40% of the rate of permanent total disablement benefit subject to a maximum of RM500 a month.

Eligibility for this allowance is determined by the SOCSO Medical Board or the Medical Appeals Board and the payment is made directly to the recipient of the benefit.

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