EMPLOYMENT INJURY INSURANCE SCHEME
Employment Injury Insurance Scheme provides protection to employees who suffer from accidents arising from work. Employment injury means personal injury to an employee caused by an accident or an occupational disease arising out of and in the course of employment in an industry to which this act applies.
COVERAGE
The Employment Injury Insurance Scheme protects employees from:
1) Accidents which occur while in the course of the work.
* Accident which occurs while working at the work place and was caused by the employee's job.
2) Accidents which occur while traveling
* On a route between his place of residence and his place of work.
* On a route between his place of work and the place where he takes his meal during any authorized recess.
* On a journey made for any reason which is directly connected to his employment. (on condition the accident does not occur during any interruption or deviation of the journey).
3) Accident during an emergency
* Accident which occurs during an emergency at the employer's premises while in the course of assisting, rescuing, or protecting other people from disasters such as a fire breakout.
4) Occupational Disease
* Disease that results from his occupation. The list of diseases and cause agent can be found in the Fifth Schedule of the Employee's Social Security Act, 1969. Examples:
Loss of hearing due to exposure to continuous excessive noise.
Respiratory diseases or industrial asthma as a result of exposure to dust for employees in sawmills, powder factories, flour mills, and others.
THE BENEFITS PROVIDED UNDER THE SCHEME
• Medical Benefit
• Temporary Disablement Benefit
• Permanent Disablement Benefit
• Constant Attendance Allowance
• Rehabilitation Benefit
• Dependent's Benefit
• Funeral Benefit
• Education Benefit
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MEDICAL BENEFIT
* Protection for employees who meet with an accident or suffers from an occupational disease. These employees are entitled to free treatment at SOCSO panel clinics or government clinics/hospital.
* The employee receiving treatment from a SOCSO panel clinic must continue the treatment there until he recovers.
* Transferring of treatment place to a government hospital can only be made if referred by the panel clinic.
* For serious injuries, treatment should be obtained at a government hospital and the employee is eligible for second class ward treatment. Specialist treatment will be provided, if required.
How to claim
To apply and receive the medical benefits for the first time, the following documents must be completed and submitted to a SOCSO panel clinic:-
• Form 21 (Accident Report)
• Form PKS 68 or PKS 69 (Occupational Disease Report) or
• Identification Letter from employer
Reimbursement Payments
For treatments received from a clinic which is not a SOCSO panel, the employer or employee can submit application for Reimbursement Payment to the relevant SOCSO office for approval subject to rates determined by SOCSO.
How to claim
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 Claim Form)
• Form PKS (P) 26 (Reimbursement Payment (General) Claim Report)
• Original receipt
• A copy of the Appointment Card
• A copy of the Medical Report (if any)
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TEMPORARY DISABLEMENT BENEFIT
Benefit To Be Paid
* This benefit is paid on employee who has been certified by a doctor to be unfit for work for not less than (4) days including the day of the accident.
* This benefit is paid for the period the employee is on medical leave. However, no benefit will be paid for the days for which the employee works and earns wages during this period.
Rate of daily benefit to be paid
80% of the average assumed daily wage.Subject to:
• A minimum of RM10.00 per day (for employees who earn less than RM10.00 per day)
• A maximum of RM78.67 per day (for employees who earn more than RM2,900.00 per month)
How to Claim
Claims can be made by submitting the following documents:-
• Form 21 (Accident Report)
• Form 10 (Claim Form)
• Doctor's Certification (Form 13) or the original copy of the Medical Certificate
• A copy of Identity Card
• Attendance Record/Punch Card/Employer Certification
• Form PKS (F) 1 (Statement of Wages/Contribution details)
For accidents which occur while commuting, please also submit the following:
• Police Report
• Sketch map of place of accident
For Occupatioal Disease claims may be made by submitting the following documents:-
• Form 68 (if the employee is still working)
• Form 69 (if the employee has stopped working)
• Original copy of the Medical Certificate (if any)
• Form 10 (if there is any medical leave)
Completed forms and documents must be submitted to the SOCSO office where the employer was registered.
Duration for Report of an Accident
The employer must report an accident within 48 hours and any report received later than 12 months will not be entertained.
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PERMANENT DISABLEMENT BENEFIT
Permanent disability is defined as a lasting disability due to an employment injury.
The employee may continue to work while receiving this benefit.
Duration of a claim
Claim must be made within 12 months from the date of final Medical Certificate issued.
Rate of daily benefit to be paid
The daily rate is 90% of the average assumed daily wage of the Insured and subject to a minimum of RM10.00 per day and a maximum of RM88.50 per day.
How to Claim
The Insured 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)
• Form 10 (Claim Form)
• Form PKS (F) 1 (Statement of Wages/Contribution details)
• A copy of the saving's account book for direct payment of benefits.
How the benefit is paid
The case will be refereed to the Medical Board for disability assessment. The decision of the assessment will be notified to the Insured.If the permanent disablement is assessed at 20% or less the employee can claim that the benefit in the form of a lump sum payment. If the assessment of the permanent disablement exceeds 20%, the benefit will be made in monthly payments. However, the employee can apply that1/5 of the benefit to be paid lump
sum, while the balance to be paid in monthly payments and as a monthly pension for life.
The Insured may continue to work while receiving this permanent disability benefit.
If the Insured or SOCSO is not satisfied with the decision of the Medical Board made, an appeal can be made to the Appellate Medical Board within 90 days from the date notification to the Insured.
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CONSTANT ATTENDANCE ALLOWANCE
This allowance is paid to an employee who is suffering from permanent total disablement (i.e 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/-. Eligibility for this allowance is determined by the Medical Board or the Appellate Medical Board and the payment is made directly to the recipient of the benefit.
REHABILITATION BENEFIT
Facilities for vocational and physical rehabilitation are provided free of charge by SOCSO to an employee who suffers from permanent disablement. Physical rehabilitation includes:
* Physiotherapy
* Occupational therapy
* Reconstructive surgery
* Supply of artificial limbs such as artificial leg, hand, eye and dentures
* Supply (as well as repair and replace) of other orthotic equipments such as wheelchairs, crutches, hearing aids, spectacles, calipers, and orthopedic shoes
* "Return to Work" Programme Vocational rehabilitation includes:
* Vocational training in courses such as electrical wiring, tailoring, radio/TV repairs, metal trade, refrigerator and air-conditioner repairs, plumbing, typing and secretarial work. All expenses incurred will be borne by SOCSO based on rates and conditions determined by SOCSO.
DEPENDENT'S BENEFIT
If an employee dies as a result of an employment injury, his dependents are entitled to this benefit.
Rate of daily benefit to be paid
90% of the average assumed daily wage.Subject to:
• To a minimum of RM10.00 per day (for employees who earns less than RM10.00 per day) an a maximum of RM88.50 per day.
How to Claim
If there is widow, widower or children, the claimant must submit:
• Claim Form (Form 24)
• Death Certificate of the employee*
• Birth Certificates of all the children*
• Marriage Certificate*
• Widow/widower's Identity Card (whichever relevant)*
• A copy of the savings account book of the claimant
*Please bring along the original documents for SOCSO's verification.
Allocation of the benefit
The following is the allocation of share based on priority:-
| Dependant | Divide on full daily rate | Condition |
| Widow or widower | 3/5 | Receives benefit for life even though widow or widower remarries on or after 1st May 2005 |
Children - All eligible children are entitled to receive benefit which includes natural, dependant step-child, adopted child or a child out of wedlock | 2/5 | Receives benefit up to age 21 or marriage whichever occurs studying in a institute of higher learning, he/she will receive benefit up to completion of the first Degree or marriage (whichever occurs earlier). If a child is mentally retarded or physically handicapped and is unable to support himself, the benefit will be paid as long as the child is unable to support himself. |
If the Insured dies and doesn't leave any widow or widower or children, the dependent's benefit will be paid to:
| Parents | 4/10 | Receive benefit for life |
| Brothers and sisters | 3/10 | Receive benefit up to age 21 or marriage (whichever occurs earlier) |
| Grandparents (If parents have pass) | 4/10 | Receive benefit for life |
If there is no widow, widower or eligible children, the claimant must submit:
• Claim Form (Form 24)
• Death Certificate of the employee*
• Birth Certificates of the deceased employee*
• Birth Certificates of all brothers and sisters (if relevant)*
• Identity Card of parents or guardian or grandparents (if relevant)*
• A copy of the savings account book of the claimant
*Please bring along the original documents for SOCSO's verification.
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FUNERAL BENEFIT
An amount of RM1,500 will be paid if an employee dies as a result of an employment injury or while receiving disablement benefit. Payments will be made to the eligible next of kin. If there is no next of kin, the benefit will be paid to the person who incurred the funeral expenditure. The amount paid will be the actual amount incurred or RM1,500 whichever is lower.
How to claim
To apply and receive the benefit, the following documents and their certified copies must be completed and submitted:-
• Claim Form (Form 26)
• Death Certificate*
• Other relevant documents which certifies the next of kin*
*Please bring along the original documents for SOCSO's verification
