December 1, 2014

GSIS POLICY AND PROCEDURAL GUIDELINES NO. 271-14

 

I. Background/Rationale

On 14 February 2013, the Board approved Policy and Procedural Guidelines No. 225-13 (Constructive Filing of Retirement) through BR No. 14 as the System's response to the growing cases of disapproved retirement claims resulting from endorsement by the agencies of the retiring members of such claims after the occurrence of the death of the said members.

The adoption of PPG 225-13 facilitated the provision of corresponding benefits due retiring members who unfortunately died prior to the approval of their retirement claims. It also provided corrective measures for disapproved retirement claims due to sudden death of claimants prior to the approval and release of their benefits.

However, PPG 225-13 does not cover applications for permanent total disability (PTD) retirement claims as laid down in PPG No. 216-12 [Guidelines for Permanent Total Disability (PTD) Claims under RA 8291] approved by the Board on 12 July 2012 through BR No. 113.

The adoption of the amended policy on constructive filing of application for retirement benefits will provide guidelines for all Operating Units Concerned (OUCs) in the processing and settlement of such claims including PTD retirement.

II. Objectives

A. To provide policies and procedures in the processing and settlement of all applications for retirement claims including PTD benefits under RA 8291.

B. To establish and maintain responsibility and accountability among all government agencies in handling all applications for retirement claims.

III. Policies

A. Coverage

Constructive Filing is an assumption that an application for retirement benefit claim of a deceased member is deemed filed with the System provided such application is actually filed with the retiring member's agency prior to his or her death.

Constructive filing shall be assumed in applications for optional retirement and PTD benefits that remain in the possession of the applicant's/member's agency even after the occurrence of his or her death. SDAcaT

B. Conditions for Application of Constructive Filing

1. For optional retirement:

a. To establish the date of actual filing of the application with the agency, the following supporting documents shall be required:

1) Original copy of the retiring member's resignation letter or equivalent document with acknowledgment receipt by the Human Resources (HR) officer;

2) A certified true copy of request for clearance for the purpose of retirement duly signed by the applicant; and

3) An original copy of sworn statement disclosing the actual date of filing of retirement application by the deceased retiring member with the agency, to be executed by the Head of the HR unit or Department.

b. An application for retirement filed by a member with his or her last employer or agency shall be considered filed with the GSIS provided that the application shall be endorsed to the System not more than thirty (30) days from date of filing of the application by the member with the agency.

 However, if the application for retirement was endorsed to GSIS beyond thirty (30) days, a notarized explanation or affidavit shall be executed by the HR officer and concerned officials stating the reason for the delay in filing.

c. The retiring member shall not qualify under constructive filing if he or she dies prior to the effective date of retirement. He or she shall be considered an active member at the time of his or her death.

2. For applications for PTD benefits, the following conditions must be fulfilled in addition to those enumerated under Section III.B.1 (a) to (b):

a. Submission of PTD applications together with supporting documents under Section IV.A.3 of PPG 216-1 that are dated and were received by the agency prior to the member's death;

b. After the medical evaluation process (excluding the physical examination under Section IV.D.3.c of PPG 216-12) the following conditions are established:

1) Injury or illness is complete, irreversible and permanent;

2) No reasonable or foreseeable probability of recovery based on current medical literature;

3) State of irreversible changes (body organs and systemic functions) are already established and supported by medical evidence; and

4) Associated symptoms are progressive and totally debilitating.

c. The medical evaluator/reviewer may require submission of other corroborative documents. DCHaTc

C. Information Drive

The Corporate Communications Office (CCO) shall prepare the necessary information materials to communicate this PPG and its implementation to all GSIS executives, employees, members and government agencies.

D. Procedural Guidelines

The detailed procedures to be included in the Manual of Operations of the operating units concerned (OUC) shall adhere to the following general guidelines:

1. For Processing of Optional Retirement

	Activity	Responsible Unit/Person
				CO	BO
1.	Submit retirement application together with	Retiring	Retiring
	the supporting documents.	Member's	Member's
				Agency	Agency
2.	Receive and evaluate application and other	Frontline	FSD
	required documents.	Services
				Division
	2.1	If complete, stamp "received" on the	(FSD)
		application, proceed to Activity 3.
	2.2	If incomplete, return application and advice
		the Liaison Officer (LO) to comply with the
		requirements.
3.	Log into the Transaction Monitoring System
	(TMS). Indicate in the "remarks" portion that
	the member is already deceased.
4.	Scan received documents and attach to TMS.
	Forward to Claims Unit.
5.	Determine the date of death of the member.	Claims Unit	Claims Unit
	1.1	If member dies on or after the effective
		date of retirement from government
		service, proceed to activity 6.
	1.2	If a member dies prior to the effective
		date of retirement from government
		service, he or she shall be considered as
		an active member at the time of death
		and will not qualify under constructive
		filing. Notice shall be sent to his or her
		survivors or legal heirs informing them of
		their option(s).
6.	Determine the mode of retirement chosen by	Claims Unit	Claims Unit
	member.
	1.1	If member indicated the retirement option,
		evaluate qualification to chosen mode of
		retirement:
		a.	If eligible, proceed to Activity 7.
		b.	If not eligible, disapprove application
			and inform surviving legal heirs of
			such disapproval and the benefits the
			deceased member is entitled to.
	1.2	If member failed to indicate retirement
		option, compute the retirement benefit
		based an 18 months plus immediate
		pension. Proceed to Activity 7.
7.	Forward TMS to Membership for records	Membership	Membership
	updating.	Claims Unit	Claims Unit
8.	Update records and return TMS to Claims.
9.	Update TMS, forward documents to Accounts	AMD	AMD
	Management Division (AMD) for reconciliation.
10.	Reconcile account and return TMS to Claims	Claims Unit	Claims Unit
	Unit.
11.	Process claim.
12.	Prepare Disbursement Voucher (DV) payable
	to legal heirs.
13.	Forward TMS and DV for signature of	Authorized	Authorized
	authorized signatories.	Signatories	Signatories
14.	Sign DV and return TMS and DV to Check
	Printing and Releasing Unit (CPRU) for	CPRU	FSD
	CO/FSD-Cashier for BO.		(Cashier)
15.	Print check. Forward TMS and check to	Authorized	Authorized
	Authorized Signatories.	Signatories	Signatories
16.	Sign check. Return TMS and signed check to	CPRU	FSD
	CPRU (CO)/FSD-Cashier (BO).		(Cashier)
17.	Release check to payee subject to
	presentation of requirements. Close TMS.

 End of Process

2. For Processing of PTD Retirement

	Activity	Responsible Unit/Person
			CO	BO
1.	Submit PTD retirement application together	Retiring	Retiring
	with the supporting documents.	Member's	Member's
			Agency	Agency
2.	Receive and evaluate application and other	FSD	FSD
	required documents.
	2.1	If complete, stamp "received" on the
		application, log to TMS and proceed to
		Activity 3.
	2.2	If incomplete, return application and
		advice the Liaison Officer (LO) to
		comply with the requirements.
3.	Forward TMS and transmit the application with
	the supporting documents to the concerned
	Medical Evaluator for review.
4.	Receive and validate submitted documents.	Medical	Medical
	Require submission of other corroborative	Evaluator	Evaluator
	documents to prove the member's illness, if
	necessary.
5.	Evaluate the claim and determine whether
	or not the claimant is eligible for PTD benefits.
	Prepare a Disability Evaluation Sheet (DES).
6.	Forward the DES and TMS to the designated
	Medical Reviewer.
7.	Thoroughly review the medical evaluation	Medical	Medical
	and recommend the approval or denial of the	Reviewer	Reviewer
	claim.
8.	Submit to SVP concerned the DES with the
	corresponding recommendation based on the
	thorough review of the medical evaluation.
9.	Evaluate and approve or disapprove PTD	SVP	SVP
	claim.	Concerned	Concerned
10.	Forward PTD claim documents to the two (2)
	other SVPs for peer review.
11.	Assess PTD claim and return to SVP	Peer SVPs
	concerned with comments.
12.	Decide whether to maintain approval or	SVP	SVP
	disapproval of the PTD claim, considering the	Concerned	Concerned
	inputs by other SVPs. Transmit documents to
	Medical Reviewer.
13.	Log approved or disapproved claim in the	Medical	Medical
	monitoring tool. Forward approved or	Reviewer	Reviewer
	disapproved PTD claim and TMS to Claims
	Unit (CO)/FSD (BO).
14.	Determine instruction of the SVP.	Claims Unit	FSD
	14.1	If approved, process payment of PTD
		claim. Proceed to Activity 15.
	14.2	If disapproved, inform legal heirs or
		beneficiaries in writing. Forward
		documents to Records Management
		Department (RMD) for storage.
15.	Process claim.
16.	Prepare Disbursement Voucher (DV) payable
	to legal heirs.
17.	Forward TMS and DV for signature of
	authorized signatories.
18.	Sign DV and return TMS and DV to CPRU for	Authorized	Authorized
	CO/FSD-Cashier for BO.	Signatories	Signatories
19.	Print check. Forward TMS and check to	CPRU	FSD
	Authorized Signatories.		(Cashier)
20.	Sign check. Return TMS and signed check	Authorized	Authorized
	to CPRU (CO)/FSD-Cashier (BO).	Signatories	Signatories
21.	Release check to payee subject to	CPRU	FSD
	presentation of requirements. Close TMS.		(Cashier)

 End of Process

This PPG shall supersede PPG 225-13 (Constructive Filing of Retirement) and supplement PPG 216-12 (Guidelines for PTD Claims under RA 8291).

This PPG shall take effect immediately.

(SGD.) ROBERT G. VERGARAPresident and General ManagerGovernment Service Insurance System

Published in The Philippine Star on February 21, 2015.