Approval of the Rules of Procedure of the GSIS Committee on Claims ( GSIS Resolution No. 184-14 )

November 27, 2014

November 27, 2014



WHEREAS, the GSIS Committee on Claims (CoC) was created pursuant to Section 26 of the Revised Implementing Rules and Regulations of R.A. No. 8291 in order to evaluate and resolve issues/complaints arising from any dispute in the settlement of claims with the GSIS;

WHEREAS, there is a need to prescribe rules of procedure for the CoC for proper, efficient, and orderly dispensation of claims;

RESOLVED, to APPROVE and CONFIRM the Rules of Procedure of the Committee on Claims, as proposed by the CoC in its Memorandum dated 11 November 2014.

A copy of the Rules of Procedure of the CoC is made an integral part of this Resolution.

November 27, 2014. Board Meeting No. 21.




(on leave)DANIEL L. LACSON, JR.Chairman









(on leave)FRANCISCO T. DUQUE IIITrustee

Rules of Procedure of the Committee on Claims

Pursuant to the Revised Implementing Rules and Regulations of Republic Act No. 8291 creating a Committee on Claims in the Operations Sector, the following rules are hereby adopted and shall be known as the "Rules of Procedure of the Committee on Claims."


Members of the Committee on Claims

SECTION 1. The members of the Committee on Claims (COC) are the following: DTEIaC


Senior Vice President, Operations Group

Vice Chairperson:

Senior Vice President, Operations Group


Senior Vice President, Operations Group

Senior Vice President, Other Functional Group, except the Chief Legal Counsel

Department Manager, Technical Services Department

Department Manager, Controller Group

Head of Secretariat:

Any Lawyer or Law graduate from a unit/office/department other than the Legal Services Group


Designation of Committee Members

SECTION 2. The composition of the COC shall be designated and revised by the President and General Manager (PGM).


Duties and Powers of the Chairperson

SECTION 3. The duties and responsibilities of the Chairperson are as follows:

(a) to preside over the meetings of the COC on the days and at the hours designated by it; to call the COC to order and, if there is a quorum, to order the reading of the Minutes of the preceding meeting, and, after the COC shall have acted upon it, to dispose of the matters appearing in the Agenda in accordance with the Rules;

(b) to decide all points of order;

(c) to see to it that all Decisions/Resolutions of the COC are complied with;

(d) to have general control over the meeting; and

(e) to vote in case of a tie.

SECTION 4. The Vice-Chairperson shall assume the duties and responsibilities of the Chairperson in the absence of the latter.


Duties and Responsibilities the Members

SECTION 5. The duties and responsibilities of the Members are as follows:

(a) to study and review matters included in the agenda;

(b) to attend regular and special meetings called by the Chairperson through the Secretariat;

(c) to deliberate on issues and cases raised before the COC, and ask questions, if necessary;

(d) to cast their votes on matters for resolution in accordance with Rule X on Voting; SIAEHC

(e) to sign the Resolutions issued by the COC, and to approve Minutes of the Meeting.


Duties and Responsibilities the Secretariat Head

SECTION 6. The duties and responsibilities of the Secretariat Head are as follows:

(a) to attend the meetings of the COC;

(b) to prepare the Agenda and the Minutes of Meetings;

(c) to keep records of the Minutes and discussions of the COC;

(d) to prepare and distribute the calendars and notices of meetings;

(e) to serve as custodian of all the records of the COC;

(f) to furnish copies of the Decisions/Resolutions to parties concerned;

(g) to certify all measures, orders and resolutions approved by the COC and to stamp them with its official seal which shall also be under its custody;

(h) to recommend to the COC the members of the Secretariat; and

(i) to perform other duties inherent to the office.


The Secretariat, Its Duties and Responsibilities

SECTION 7. The Secretariat shall be responsible for the following:

(a) to receive written communications for the COC and assign reference control numbers to each;

(b) to formally communicate to the Vice President concerned the date of the COC meeting when the submitted matter will be discussed;

(c) to provide all members of the COC with electronic files of the Completed Staff Work (CSW) prepared for matters included in the agenda three (3) days prior to the scheduled meeting of the COC;

(d) to inform the Vice President concerned of the COC's Decision/Resolution within the timeframe stated in Rule XV hereof;

(e) to maintain a database of all received communications, and COC Decision/Resolution;

(f) to regularly report to the COC all pending matters;

(g) to provide all Operating Units access to COC Decision/Resolution; and

(h) to perform other duties inherent to the office.


Matters for Submission to the COC

SECTION 8. The COC shall evaluate and resolve issues/complaints arising from any dispute in the settlement of claims, such as, but not limited to the following:

(a) interpretation of an existing policy or procedure;

(b) no existing program or system to process a claim;

(c) no existing policy as basis to process a claim;

(d) appeal from an aggrieved party to a settled claim; ACETSa

(e) findings from either the Internal Audit Services Office or the Commission on Audit that are disputable;

(f) implementation of and Order from any Court, quasi-judicial body or duly authorized entity due to its being in conflict or inconsistent with existing GSIS laws, policies, rules and regulations;

(g) housing and non-life insurance related transactions which affect the settlement of social insurance claim of a member; and

(h) any other matter related to any or all of the foregoing which is necessary for their determination.

SECTION 9. The COC shall elevate matters pertaining to policy formulation or revision and submit a status report on decided claims and issues to the Board of Trustees through the PGM.

SECTION 10. The COC shall accept matters for consideration if:

(a) directly appealed by the claimant or his/her attorney in fact; or

(b) referred by the Vice President concerned; or

(c) referred by the Board of Trustees or the Office of the PGM; or

(d) referred by judicial and quasi-judicial bodies.



SECTION 11. The COC shall hold its regular meeting once a month, preferably on the last Tuesday of each month. The notice, including the agenda, place and time of the meeting shall be given three (3) days before the regular meeting.

Special meetings may be called by the Chairperson, but notice, including the agenda, place and time of the meeting, shall be given one day in advance to every member of the COC.

SECTION 12. In case a member cannot attend the meeting, he may send his representative who should have a position title not lower than the Department/Branch Manager. The presence of a representative shall not be considered in determining the existence of a quorum. The representative cannot vote on any motion.



SECTION 13. A majority of the members, including the Chairperson, shall constitute a quorum (i.e., four out of six).

SECTION 14. Should the question of lack of quorum be raised, the Chairperson, without debate, shall immediately proceed to a verification thereof by causing the reading of the roll of the members and announcing forthwith the result.



SECTION 15. The voting shall be nominal. In a nominal voting, the Secretariat Head shall call alphabetically the names of the members present and each member shall answer "yes" or "no" upon being called.

Immediately thereafter, the Secretariat Head shall inform the Chairperson about the result of the voting, and the latter forthwith shall in turn announce it to the Committee.

SECTION 16. The "yes" and "no" with the names of the members voting shall be recorded in the Minutes. aIAHcE

SECTION 17. The Chairperson shall not vote except when his vote is decisive or when his vote is necessary to break a tie between the "yes" and the "no" votes.

SECTION 18. The vote of a member who is absent from the session at the moment he is called to vote shall not be counted.

SECTION 19. No member shall be permitted to vote on any measure after the Chairperson has announced the result of the voting.

SECTION 20. Voting shall not be interrupted except on a question of quorum.

SECTION 21. A motion subject of voting shall be considered approved or disapproved if it garners a majority vote of the members of the COC present during the meeting.


Order of Business

SECTION 22. The Secretariat Head shall prepare for each meeting the Agenda in which shall be listed the following:

(a) Roll Call

(b) Reading and Approval of the Minutes of the previous meeting

(c) Pending Matters

(d) Regular Matters

(e) Other Matters


Minutes of the Meeting

SECTION 23. The COC shall keep the Minutes of its meetings which shall contain a brief and accurate account of what has taken place in every meeting.

SECTION 24. The reading of the Minutes may be dispensed with by unanimous consent, in which case the Minutes shall be deemed to have been approved.

SECTION 25. If a member finds any error in the Minutes, the reading of which was dispensed with, he shall verbally call the attention of the COC to this fact and move for its correction during the meeting.

SECTION 26. The Minutes of the meetings shall be furnished to each of the members through their individual corporate email addresses three (3) days prior to the next meeting.


Unfinished Business

SECTION 27. Unfinished business at the end of the meeting shall be taken up at the next session in the same status.


Manner of Presenting Issues, Behavior and Language

SECTION 28. Matters for deliberation shall be presented by the Vice President concerned, or his/her authorized representative, with the corresponding Completed Staff Work (CSW) and/or slide Power Point Presentation (PPT).

SECTION 29. Whenever a member wishes to speak, he shall raise his hand and request the Chairperson to allow him to speak, which consent shall be necessary before he may proceed. If various members wish to have the floor, the Chairperson shall recognize the one who first made the request.

SECTION 30. No member shall interrupt another without the latter's consent, which may not be obtained except through the Chairperson. EDCIcH

SECTION 31. Acts and language which may offend any party present during the meeting shall be avoided.

SECTION 32. Any party, under any circumstance, shall not use offensive or improper language against any person or institution subject of the claim.

SECTION 33. When any party, by word or deed, violates any of these rules, the Chairperson, at his own volition or at the instance of another member, may call him to order.

SECTION 34. The Committee may expel any party for disorderly behavior upon concurrence of the majority of the members present during the meeting of the COC.


Appeal to the COC

SECTION 35. Appeal from the decision of the Vice President (VP) of the Operating Unit Concerned (OUC) shall be in writing and filed by the claimant or his/her attorney-in-fact to the COC within thirty (30) days from receipt thereof. The appeal shall be filed through personal delivery or registered mail addressed to the COC.

Appeals filed with the COC shall be referred to the VP concerned for the preparation of the Completed Staff Work (CSW).


Procedure for Submission of Matters to the COC

SECTION 36. The VP concerned shall transmit the CSW to the COC Secretariat not more than ten (10) days from receipt of the notice/letter of appeal.

The CSW shall contain the following:

(a) Action Requested — The specific action being requested.

(b) Facts of the Case — Details of the processed claim, policy, issue, rule, IAS or COA findings being submitted for the Committee's consideration and/or resolution including the date that the Manager received the letter or memorandum.

(c) Relevant Laws, Policies or Rules — Specific provision of the law, policy, rule, IASO or COA findings applicable to the submitted matter.

(d) Recommendation — The recommendation of the Vice President concerned on the matter.


Time Frame for Submitted Matters

SECTION 37. Only matters submitted to the COC not later than 3 days before the scheduled meeting shall be included in the agenda.

SECTION 38. The Secretariat shall calendar the issue/case for COC deliberation not later than 30 days from receipt of the notice/letter of appeal and complete supporting documents by the Secretariat.

SECTION 39. The COC shall render its decision on issues/cases within 60 days from the last deliberation.


COC Decisions

SECTION 40. Every decision of the COC shall clearly state the facts, issue and discussion of the operational interpretation based on GSIS Charter, policies and procedural guidelines, orders and circulars, and existing laws on which the decision is based. EHTCAa

SECTION 41. COC decisions shall be signed by the members of the COC taking part in the deliberations, and certified true copies served personally or by mail to the claimant's or counsel's residence, per GSIS records, copy furnished the VP concerned.

SECTION 42. Whenever practicable, service by mail shall be by private courier. If no private courier is available in the claimant's locality, service may be done by registered mail.


Appeal to the Board of Trustees

SECTION 43. The COC shall in no case take a motion for reconsideration of a Decision/Order denying a claim.

Appeal from the COC's decision shall be filed with the Board of Trustees within 60 days from receipt thereof.


Executive Session

SECTION 44. Executive sessions shall be held whenever a member so requests it and his motion has been duly seconded.

SECTION 45. The executive sessions of the COC shall always be held behind closed doors. In such sessions, only the Secretariat and/or such other persons as may be authorized by the COC may be admitted to the meeting hall.

SECTION 46. The member who presented the motion shall then explain the reasons which he had for submitting the same.

SECTION 47. The Minutes of the executive sessions shall be recorded in a separate book.



SECTION 48. The Chairperson as well as the members and the Secretariat shall absolutely refrain from divulging any of the confidential matters taken up by the COC, and all discussions which might have taken place in connection with the said matters shall be likewise considered as strictly confidential.

SECTION 49. Any member or party who violates the provisions contained in the preceding section shall, by a vote of all the members of the Committee, be subject to disciplinary action.


Documents Filed with the COC

SECTION 50. All documents filed with the COC for consideration shall be kept and preserved by the COC Secretariat.

SECTION 51. When the documents sought to be copied or withdrawn are, in the opinion of the Chairperson, not confidential in nature, the Secretariat may issue certified copies thereof.


Amendments to or Revision of the Rules

SECTION 52. Any and all amendments and revisions to these Rules shall be recommended by COC for approval by the Board of Trustees through the PGM. EcTIDA



SECTION 53. These Rules shall take effect fifteen (15) days after filing a copy with the Office of the National Administrative Register (ONAR), and they shall govern the processing of all pending and future claims.


Transitory Provision

SECTION 54. Pending the reconstitution of the COC and its Secretariat in accordance with Rule I above, and in order to avoid delays in the resolution of complaints arising from any dispute in the settlement of claims, the existing members of COC and its Secretariat, as designated by the PGM shall continue to perform their respective functions and assume the duties and responsibilities outlined in Rules III, IV, V and VI above.