Board Resolution No. 22-06-14
Prescribing the Definition and Extent of Physical Restoration Services for the KAGABAY Program in Connection with Rule IX (Rehabilitation Services) of the Amended Rules of the Employees’ Compensation
WHEREAS, Presidential Decree (P.D.) 626, as amended or the Law on the Employees’ Compensation Program (ECP) and the State Insurance Fund provides income, medical, rehabilitation and other benefits to workers and their families in the event of work-related illness, injury, disability or death of the former;
WHEREAS, Article 191 of P.D. 626, as amended states that after an employee contracts sickness or sustains an injury, he shall be provided by the Systems during the subsequent period of the disability with such medical services and appliances as the nature of his illness or injury may require subject to the expense limitation prescribed by the Commission;
WHEREAS, Article 196 of P.D. 626, as amended states that an injured and handicapped employees are entitled to rehabilitation services where a balanced program of remedial treatment, vocational assessment an.d preparation are designed to help them become physically independent and develop their mental, vocational and social potential;
WHEREAS, in 2002, the Employees’ Compensation Commission (ECC) initiated the Katulong at Gabay sa Manggagawang May Kapansanan (KAGABAY) providing workers with occupationally acquired disabilities with a program of skills/livelihood training, livelihood material assistance and as applicable, physical rehabilitation services and prosthesis/assistive devices;
WHEREAS, Rule IX of the Amended Rules on Employees’ Compensation provides details on the rehabilitation services under the Employees’ Compensation Program;
WHEREAS, Board Resolution No. 14-07-19 amending Rule IX on Rehabilitation services includes physical restoration (Physical/Occupational Therapy), under the Kagabay Program among others;
WHEREAS, Rehabilitation services such as physical and occupational therapy under Medical Benefits (Chapter V) of P.D. 626, as amended, are provided as long as the progress and recovery of the injured or sick worker may require;
WHEREAS, there is a need to distinguish the provision of Rehabilitation services under the ECP Medical Benefit Program and those under the KAGABAY program of the ECC;
NOW THEREFORE, ON MOTION DULY MADE AND SECONDED
This Commission RESOLVES as it hereby RESOLVED, to prescribe the distinction for the Rehabilitation services provided under the ECP Medical Benefits and under the ECC KAGABAY program (physical restoration component).
RESOLVED, that the Rehabilitation services provided under the ECP Medical Benefit program administered by the Systems are interventions included during the immediate period of treatment following the work-related injury or illness and during the period where long-term management is needed to stabilize, prevent or mitigate the progression of a permanent disability.
RESOLVED, that the Rehabilitation services under the KAGABAY is a short-term intervention designed to regain to the best extent possible the physical, cognitive and sensory functioning of the PWRD that was impaired by employment-related permanent disability in preparation to engage in an economic activity or increase his/her independence to perform activities of daily living.
RESOLVED FURTHER, that the amount allocated for Physical/Occupational Therapy sessions and diagnostics under the KAGABAY shall not exceed the maximum of Php50,000.00 for each qualified worker with occupationally acquired disability:
RESOLVED FURTHER, that if further rehabilitation services are required beyond the maximum amount, these shall be covered under the ECP Medical Benefit program administered by the Systems during the period where long-term management is needed to stabilize, prevent or mitigate the progression of a permanent disability.
RESOLVED FURTHER, that the Systems shall establish partnerships with hospitals and clinics providing Physical Rehabilitation services for the provision of PT/OT services through the Letter of Guarantee (LOG) mechanism in order to facilitate the provision of the rehabilitation services.
RESOLVED FINALLY, that this resolution shall take effect fifteen days after its publication in a newspaper of general circulation and copies be furnished to the SSS and GSIS for guidance and compliance.
APPROVED in Quezon City, this 16th day of June 2022.
(SGD.) SILVESTRE H. BELLO III
Chairperson
Department of Labor and Employment
(SGD.) RIZALDY T. CAPULONG
Member – Alternate
Social Security System
(SGD.) NORA M. MALUBAY
Member-Designate
Government Service Insurance System
(SGD) CARLITO P. ROBLE
Member
Employees’ Sector
(SGD) ANGEL L. MIRANDA, JR.
Member-Alternate
Philippine Health Insurance Corporation
(SGD) STELLA ZIPAGAN-BANAWIS
Member
Employees’ Compensation Commission – Secretariat