9.6 The Coverage of Employment Injury Insurance Scheme
The Employment Injury Scheme provides coverage for accidents that occur while :
9.6.1 Traveling (Commuting accident)
while traveling on a route between the place of residence or stay and the work place
while traveling between the work place and the place where the employee takes meals during any authorized recess
while traveling on a journey directly connected to work
Except for accident that occurs during a stoppage or deviation done for personal reasons, all commuting accidents are considered as employment related.
9.6.2 Arising out of and in the course of employment
Accident that happens while performing official duty at the work place which arise out of the employment.
9.6.3 Occupational diseases
An employee contracting a disease to which he is exposed to various hazards by the nature of his duty.
The list of occupational diseases is found in the Fifth Schedule of the Employees' Social Security Act 1969.
Several benefits are provided under the Employment Injury Insurance Scheme :
9.6.4 Medical Benefit
Where an employee contracts any occupational disease or meets with an accident, he is entitled to treatment at a SOCSO Panel Clinic or any government hospital or clinic.
To be eligible for free treatment, a employee or his representative is required to bring along an :
Accident Report (Form 21) or an Identification
Letter from his employer or Report of Occupational Diseases Form 68 & Form 69 (whichever is relevant)
SOCSO will settle his medical bill on behalf by paying the medical treatment provider directly.
Where the employee initially receives treatment in a SOCSO Panel Clinic, treatment must be continued at the same clinic until recovery or unless he is referred to a Government Hospital.
In the event of serious injury, the treatment should be at the nearest government hospital.
Where an employee requires in-patient treatment, he is eligible for second class ward treatment at the hospital. Where an employee requires specialist treatment, such treatment can also be provided at a government hospital.
Reimbursement for medical expenditure incurred at a non SOCSO Panel Clinic may only be submitted for consideration.
9.6.5 Temporary Disablement Benefit
An 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 is eligible for this benefit. This benefit will be paid for the period the employee is on medical leave.
The daily rate of this benefit is equivalent to 80% of the average assumed daily wage. However, the employee will be paid a minimum rate of RM10 if the daily rate is below RM10. An employee whose wage exceeds RM1,900 per month will be paid a maximum rate of RM52 per day.
9.6.6 Permanent Disablement Benefit
An employee who has been certified by a Medical Board or an Appellate Medical Board to be suffering from permanent disablement as a result of an employment injury is eligible for this benefit. Where the permanent disablement is assessed to be 100%, an employee will be paid a daily rate equivalent to 90% of the average assumed daily wage, subject to a minimum daily rate of RM10.
An employee can claim the benefit to be paid as a lump sum if the permanent disablement is assessed to be 20% or less.
However, where the assessment of the loss of earnings capacity exceeds 20%, the employee is given an option to exchange 1/5 of the daily rate of permanent disablement benefit into a lump sum payment while the balance will be paid as a monthly pension for life.
While receiving this benefit, an employee may continue to work.
9.6.7 Constant Attendance Allowance
This allowance is paid to an employee who is suffering from permanent total disablement or 100% loss of earnings capacity, and is so severely incapacitated that he constantly requires the personal attendance of another person. Subject to a maximum of RM500, the allowance is equivalent to 40% of the rate of permanent total disablement benefit.
The Medical Board or the Appellate Medical Board will determine the eligibility for this allowance and the payment will be paid directly to the recipient of the benefit.
9.6.8 Funeral Benefits
Where an employee dies as a result of an employment injury or while receiving disablement benefit, an amount of RM1,500 will be paid. Payment will be made to the eligible next-of-kin. Where there are no next-of-kin, the person who incurred the funeral expenditure will be paid the benefit. The maximum amount for the benefit is the actual amount incurred or RM1,500 whichever is lower.
9.6.9 Rehabilitation Benefit
SOCSO provides facilities for vocational and physical rehabilitation to employee who suffers from permanent disablement.
Physical rehabilitation includes physiotherapy, occupational therapy, reconstructive surgery, as well as the supply of artificial limps such as artificial leg, hand, eye and dentures and other prosthetic appliances such as wheelchairs, hearing aids, crutches, spectacles, calipers and orthopedics shoes, including their repair and replacement.
An employee who is unable to find a suitable job due to his permanent disablement, can apply to undergo vocational training in courses such as radio or television repairs, metal trade, electrical wiring, repairs of refrigerator and air-conditioner, tailoring, plumbing, typing and secretarial work.
SOCSO will bear all expenses incurred for the purpose of vocational and physical rehabilitation based on rates and conditions determined by SOCSO.
9.6.10 Dependant's Benefit
Where an employee dies as a result of an employment injury, the dependants are entitled to this benefit. Subject to a minimum rate of RM10 per day, the full daily rate of dependants' benefit is 90% of the average assumed daily wage.
Where there is no widow, widower or an eligible child, the following persons can receive the benefits if they depend wholly or partially on the employee's income at the time of his death.
