Policy and Procedural Guidelines on Eligibility of Surviving Spouse to Survivorship Benefits Amid Issues on Dependency

June 26, 2014

GSIS RESOLUTION NO. 079-14

APPROVAL OF THE POLICY AND PROCEDURAL GUIDELINES ON ELIGIBILITY OF SURVIVING SPOUSE TO SURVIVORSHIP BENEFITS AMID ISSUES ON DEPENDENCY AND CONTRARY CLAIM OR INFORMATION

WHEREAS, the Policy and Procedural Guidelines on Survivorship Benefits (PPG No. 207-11) was approved under Board Resolution No. 45 dated 10 February 2011 in order to provide guidelines on the entitlements of the beneficiaries to survivorship benefits;

WHEREAS, amended policy guidelines were subsequently issued through Board Resolution No. 166 dated 14 July 2011 [PPG No. 207-11(a)] and Board Resolution No. 261 dated 15 December 2011 [PPG No. 207-11(b)] which simplified documentary requirements to be submitted by the beneficiaries or legal heirs of the deceased member or pensioner in order to facilitate the immediate processing of funeral, death or survivorship claim;

WHEREAS, GSIS has been confronted with claims for survivorship benefits involving the issue of dependency of the surviving spouse on the member as an eligibility requirement for survivorship benefits, occasioned by the separation-in-fact of the spouses;

WHEREAS, there is a need to issue additional implementing guidelines in order to provide rules for the interpretation of the eligibility of the surviving spouse to survivorship benefits with respect to the issue on dependency and the determination of the proper survivorship beneficiary, as well as to ensure the uniform implementation of the revised guidelines across the entire organization;

RESOLVED, to APPROVE and CONFIRM the Policy and Procedural Guidelines on Eligibility of Surviving Spouse to Survivorship Benefits Amid Issues of Dependency and Contrary Claim or Information, as recommended by the Senior Vice President of the Corporate Services Group and Corporate Planning Office in her Memorandum dated 9 June 2014.

A copy of the Policy and Procedural Guidelines on Eligibility of Surviving Spouse to Survivorship Benefits Amid Issues of Dependency and Contrary Claim or Information is made an integral part of this Resolution.

June 26, 2014. Board Meeting No. 11.

CERTIFIED CORRECT:

 

(SGD.) ATTY. MARIA THERESA ABESAMIS-RAAGASCorporate Secretary

CONFIRMED:

(SGD.) DANIEL L. LACSON, JR.Chairman

(SGD.) ROBERT G. VERGARAVice Chairman

(SGD.) KARINA CONSTANTINO-DAVIDTrustee

(SGD.) GREGORIO T. YUTrustee

(SGD.) ROMAN FELIPE S. REYESTrustee

(SGD.) GERALDINE MARIE BERBERABE-MARTINEZTrustee

(SGD.) MARIO J. AGUJATrustee

(SGD.) ROMEO M. ALIPTrustee

(SGD.) ELISEA G. GOZUNTrustee

(on leave)FRANCISCO T. DUQUE IIITrustee

July 8, 2014

GSIS POLICY AND PROCEDURAL GUIDELINES NO. 256-14

 

I. Background

Policy and Procedural Guidelines (PPG) No. 207-11 dated 15 February 2011 provided guidelines on the entitlements of beneficiaries to survivorship benefits. On 06 April 2011, Office Order (OO) No. 72-11 was issued to ensure the uniform interpretation and implementation of PPG No. 207-11 on Survivorship Benefits.

Subsequently, PPG No. 207-11 (a) dated 21 July 2011 and PPG No. 207-11 (b) dated 11 December 2011 were issued to provide amended policy guidelines and to simplify documentary requirements that shall be submitted by the beneficiaries or legal heirs of the deceased member or pensioner and facilitate the immediate processing of funeral, death or survivorship claim.

However, GSIS has been confronted with claims for survivorship benefits involving the issue of dependency of the surviving spouse on the member as an eligibility requirement for survivorship benefits, occasioned by the separation-in-fact of the spouses.

Hence, there is a need to adopt additional policies for the implementation of this eligibility requirement laid down by Section 2 (f) of Republic Act (RA) No. 8291.

II. Objectives

This PPG aims to:

A. Provide rules for the interpretation of the eligibility of surviving spouse to survivorship benefits with respect to the issue on dependency;

B. Provide guidelines on the handling of contests for survivorship benefits; and

C. Ensure uniform implementation of the revised guidelines across the entire organization.

III. Policies

A. General Policies

1. The surviving legal spouse is presumed to be dependent for support at the time of death of member or pensioner (Presumption of Dependency).

2. "Support" shall mean all forms of support to which a legal spouse is entitled to, as defined in the Family Code of the Philippines and other relevant laws.

3. The presumption of dependency may be rebutted by evidence that the spouses were separated-in-fact at the time of death of the member or pensioner.

 The submission of any of the following shall be sufficient to rebut the presumption of dependency:

a. Duly Notarized Affidavit of Two Disinterested Persons or Witnesses stating that the surviving spouse and member or pensioner were separated-in-fact at the time of death of the latter; or

b. Barangay Certificate issued under oath by the Punong Barangay of the barangay where the deceased last resided, or the Punong Barangay of the barangay where the abandoned surviving spouse is living, stating that the surviving spouse and member or pensioner were separated-in-fact at the time of death of the latter.

4. If the presumption of dependency is contested due to separation-in-fact of the spouses at the time of death of the member or pensioner, the surviving legal spouse is still considered as dependent for support under any of the following circumstances:

a. The surviving legal spouse continued to receive support from the member or pensioner despite their separation-in-fact;

b. The surviving legal spouse did not receive support on account of the refusal of the member or pensioner to do so;

c. The separation-in-fact was due to the fault of the member or pensioner; and

d. Surviving legal spouse had custody of the common legitimate children during their separation-in-fact.

5. The surviving legal spouse may submit any of the following in order to prove his or her dependency:

a. Duly Notarized Affidavit of Two Disinterested Persons or Witnesses stating the surviving spouse and member or pensioner are separated-in-fact and that notwithstanding separation, the former was dependent for support on the latter; or

b. Barangay Certificate issued under oath by the Punong Barangay of the barangay where the deceased last resided, or the Punong Barangay of the barangay where the abandoned surviving spouse is living stating that while the surviving spouse was separated-in-fact from the member or pensioner at the time of the latter's death, the surviving spouse was dependent for support on member or pensioner; or

c. Certification from the Office of the deceased member stating that upon member's instruction, a portion of the latter's salary was regularly deducted upon member's instruction and given to the surviving spouse; or

d. Affidavit of the surviving legal spouse stating he or she had custody of their common legitimate child or children during their separation-in-fact.

6. If the Claims Unit in the Central Office (CO) or Branch Office (BO) receives contrary information contesting the presumption of dependency due to the separation-in-fact of the spouses, it shall require the submission of an affidavit from the person who reported the same.

7. If, upon investigation and verification, the Claims Unit concerned finds out that there are untruthful statements in the affidavit, it shall endorse the matter to the Prosecution and Quasi-Judicial Cases Department (PQJCD), Legal Services Group (LSG) for appropriate legal action.

8. If another survivorship claim is filed, the Claims Unit concerned shall check the completeness of the documents of the said contrary claim based on existing documentary requirements for social insurance benefits and other related claims and transactions.

9. The Membership Department concerned shall suspend the survivorship pension upon:

a. receipt of the contrary claim with complete documentary requirements; or

b. confirmation/verification of contrary information after investigation.

10. After the pension has been suspended, the Claims Unit shall send letters within fifteen (15) days from suspension to the survivorship pensioner and contrary claimant or informant notifying them of the suspension of the survivorship benefits and referral of the contrary claim and/or information to the Committee on Claims (COC) for determination of the proper beneficiary or propriety of suspension.

11. The concerned Claims unit shall prepare a Completed Staff Work (CSW) endorsed by the Vice President (VP) concerned to the COC for determination of the proper beneficiary.

12. The COC shall determine the proper beneficiary in case of contrary claim or propriety of suspension in case of contrary information and provide the Claims Unit concerned with the COC resolution.

13. The proper beneficiary shall be the claimant who:

a. presented a National Statistics Office (NSO) certified Marriage Certificate with an earlier date of marriage;

b. has not remarried or cohabited or engaged in common law relationship; and

c. has been living together with the member or pensioner immediately preceding the death of the member or pensioner, or if not living together, was dependent for support on the deceased member or pensioner. 

14. The Claims Unit concerned, upon receipt of the COC resolution, shall send letters to the survivorship pensioner informing the latter of the results of the investigation, collection of the amount of the previously paid benefit, if warranted, and his or her right to question the same before the Board of Trustees (BOT), and the contrary claimant on the results of the investigation.

15. The survivorship benefits shall be paid to the proper beneficiary once the COC or BOT, in case an appeal is filed on the resolution of the COC, resolves the claim after investigation and review of the contrary claimant's application and supporting documents for survivorship pension.

16. The Claims Unit concerned shall submit a quarterly report to the BOT of the suspended and terminated beneficiaries of survivorship benefit.

17. The survivorship benefits erroneously paid shall be collected pursuant to existing policies on collection of overpayments.

B. Information Dissemination

The Corporate Communications Office shall prepare information materials to disseminate this PPG.

IV. Procedures

The detailed procedures to be included in the Manual of Operations of the Operating Units Concerned (OUC) shall adhere to the following general procedures.

Processing of survivorship claim shall follow the existing procedures on Survivorship Benefits. The procedures below shall only be applicable to Contrary Claim or Information.

		A.	Receipt of Application for a Contrary Claim
				Responsible Unit
			Activity	Central	Branch
				Office (CO)	Office
					(BO)
1.	Receive the application form and documentary	Customer	Frontline
	requirements from contrary claimant.	Care	Services
				(CCare)	Division
					(FSD)
2.	Check completeness of documents based on
	existing documentary requirements for social
	insurance benefits and other related claims and
	transactions.
	2.1.	If complete, scan the necessary
		documents, log in to the Transaction
		Monitoring System (TMS), and send to
		Claims. Proceed to Activity 3.
	2.2.	If incomplete, return the application and
		inform the claimant of any deficiency.
3.	Prepare Certified Instruction to Update Record	Claims
	(CIUR) signed by concerned Manager
	for the suspension of the pension record of the
	survivorship pensioner and forward the same
	and TMS to Membership Department.
4.	Suspend survivorship pension record of the	Membership Department
	survivorship pensioner. Update TMS and
	forward same to Claims.
5.	Confirm if the survivorship pension has been	Claims
	suspended.
	5.1.	If suspended, prepare letter to the:
		a.	existing survivorship pensioner
			informing him or her of the action
			taken by the GSIS as a result of the
			receipt of a contrary claim; and
		b.	contrary claimant informing him or her
			of the action taken by GSIS.
		Forward letter to Manager for signing and
		to RMD or OBM for mailing. Proceed to
		Activity 6.
	5.2.	If not suspended, return TMS to
		Membership Department. Revert to
		Activity 4.
6.	Prepare CSW to the COC to be endorsed by
	the concerned VP for determination of the
	proper beneficiary.
7.	Determine the proper beneficiary and provide	COC
	the concerned Claims unit with the COC
	resolution.
8.	Receive COC resolution on the proper	Claims
	beneficiary.
	8.1.	If the proper beneficiary is the contrary
		claimant, prepare letter to the survivorship
		pensioner to be signed by the concerned
		Manager informing him or her of the results
		of the investigation, suspension of his or her
		pension record, collection of the amount of
		the previously paid benefit and his or her
		right to question the same before the BOT.
		Forward letter to RMD or OBM for mailing.
		Proceed to Activity 9.
	8.2.	If the proper beneficiary is the survivorship
		pensioner, prepare disapproval letter to
		contrary claimant informing the claimant
		of the reason for disapproval and right to
		question the same before the BOT and
		forward to Manager for signature and to
		RMD or OBM for mailing. Proceed to
		Activity 10.
9.	Process survivorship claim of the contrary
	claimant. Prepare letter to the contrary claimant
	to be signed by the concerned Manager that his
	or her claim has been approved and survivorship
	benefit is being processed. Proceed to Activity 13.
10.	Prepare CIUR to lift suspension of the
	survivorship pensioner. Forward same and
	TMS to Membership Department.
11.	Lift suspension on the survivorship pension	Membership Department
	record of the survivorship pensioner. Update
	TMS and forward same to Claims.
12.	Confirm if the suspension on survivorship	Claims
	pension has been lifted.
	12.1.	If lifted, prepare letter to the survivorship
		pensioner informing him or her of the
		action taken by the GSIS as a result of the
		investigation. Forward letter to Manager
		for signing and to RMD or OBM for mailing.
		Proceed to Activity 13.
	12.2.	If not lifted, return TMS to Membership
		Department. Revert to Activity 11.
13.	Prepare and submit a quarterly report to the
	BOT on suspended and/or terminated pension
	record due to contrary claim.
			END OF PROCESS
		B.	Receipt of Contrary Information
				Responsible Unit
			Activity	Central	Branch
				Office (CO)	Office
					(BO)
1.	Receive the information, notarized affidavit and	Customer	Frontline
	supporting documents, if any, that the	Care	Services
	survivorship pensioner is separated from and/or	(CCare)	Division
	is not dependent for support on the deceased		(FSD)
	member.
2.	Scan the necessary documents, log in to the
	Transaction Monitoring System (TMS), and
	send to Claims.
3.	Validate contrary information based on	Claims
	documents submitted and home visit.
	3.1.	If contrary information can be validated
		based on documents submitted and home
		visit, proceed to Activity 4.
	3.2.	If contrary information cannot be validated
		based on documents submitted and home
		visit, require additional proofs from the
		contrary informant. Revert to Activity 1
		upon submission of additional proofs.
4.	Determine if contrary information has been
	validated.
	4.1	If information is accurate, prepare Certified
		Instruction to Update Record (CIUR) signed
		by concerned Manager for the suspension
		of the pension record of the survivorship
		pensioner and forward same and TMS to
		Membership Department. Proceed to
		Activity 5.
	4.2	If information in the notarized affidavit has
		untruthful statements, endorse the matter to
		PQJCD, LSG for appropriate legal action.
5.	Suspend survivorship pension record of the	Membership Department
	survivorship pensioner upon validation of the
	contrary information. Update TMS and forward
	same to Claims.
6.	Confirm if the survivorship pension has been	Claims
	suspended.
	6.1	If suspended, prepare letter to the:
		a.	existing survivorship pensioner
			informing him or her of the results of
			the validated contrary information,
			suspension of his or her pension record,
			and requesting him or her to comment
			and submit evidence; and
		b.	contrary informant informing him or
			her of the action taken by GSIS.
		Forward letter to Manager for signing and
		RMD or OBM for mailing. Proceed to
		Activity 7.
	6.2	If not suspended, return TMS to Membership
		Department. Revert to Activity 5.
7.	Receive letter and/or comments from
	survivorship pensioner. Prepare CSW to the
	COC to be signed by the concerned VP for
	resolution.
8.	Determine validity of information and provide	COC
	concerned Claims Unit a copy of the resolution.
9.	Receive COC resolution on the propriety of	Claims
	suspension of the pension record.
	9.1	If suspension of the pension record was
		deemed valid and with merit by the COC,
		Proceed to Activity 13.
	9.2	If suspension of the pension record was
		deemed not valid and/or without merit by the
		COC, prepare disapproval letter to contrary
		informant informing the latter of the reason
		for disapproval and right to question the same
		before the BOT and forward to Manager for
		signature and to RMD or OBM for mailing.
		Proceed to Activity 10.
10.	Prepare CIUR to lift suspension of the	Claims
	survivorship pensioner. Forward same and TMS
	to Membership Department.
11.	Lift suspension on the survivorship pension	Membership Department
	record of the survivorship pensioner. Update
	TMS and forward same to Claims.
12.	Confirm if the suspension on survivorship	Claims
	pension has been lifted.
	12.1	If lifted, prepare letter to the survivorship
		pensioner informing him or her of the
		action taken by the GSIS as a result of the
		investigation. Forward letter to Manager
		for signing and to RMD or OBM for mailing.
		Proceed to Activity 13.
	12.2	If not lifted, return TMS to Membership
		Department. Revert to Activity 11.
13.	Prepare and submit a quarterly report to the
	BOT on suspended and/or terminated pension
	record due to contrary information.
			END OF PROCESS

This PPG shall take effect immediately on the date indicated below.

Date Signed: July 8, 2014.

 

(SGD.) ROBERT G. VERGARAPresident and General Manager