By Elvin Bailey
Our records indicate that the second most valuable product available from Social Security is Sickness Benefit. It amounted to EC$6.5million for 2008 and 2009, with 37% apportioned to men and the remaining 63% claimed by women. Besides, over the years, we have seen a strong correlation between members aged 25 and 34 years and being sick – they accounted for about 30% of all payments within the recent past. Sickness benefits payments would have been higher were it not for the fact that about 5% of all claims made are disallowed; and the vast majority of those that are disallowed are sickness claims. That is not to say that these claimants are/were not sick, but they did not meet the requirements. Those requirements are set out in SRO No. 28 of 2002 and are the subject of this week’s dialogue.
First, sickness benefit is for persons who are employed at the time they take sick, even if that period of employment is called vacation. This is so because for most persons, vacation is paid for and reported to Social Security no differently than if you were at work. Furthermore, a worker who is older than 62 years old has no entitlement to sick leave because he has ceased to pay contributions and would normally be in receipt of an age benefit. That then eliminates the 2.5% of the work force contributors who fir into this category. Indeed, they do not pay contributions at all; only the 1% coverage for Employment Injury is due and payable.
Secondly, the claimant must have or have had paid into the Fund at least 26 contributions in order to qualify for consideration.
Thirdly, the claimant must have paid or have had paid at least 8 of the last 13 weeks fully paid up, that is two of the last 3 months. This is the 8 in 13 rule. There is also an 8 in 17 rule that can be applied, but even so, the 13 weeks are expected to be continuous. Almost 20% of the sickness claims that are rejected are done so based on the 8 in 13 rule.
Fourthly, the claimant must be sick, as certified by a medical practitioner. There is also a schedule of prescribed proposed diseases set out in the Fifth schedule of Regulation 41. This list does not include “sick child”. Several of the claims that are rejected are done so on this basis. A mother cannot claim a benefit on the grounds that her child is sick.
The sick person has 10 days to claim the sickness benefit. Sickness benefit can be paid for as much as 26 weeks in any one continuous period, provided that the illness is legitimized by a doctor who is authorized to practice medicine in the Federation. However, any two claims that are separated by less than 8 weeks are considered to be one continuous period of claim.
Sickness benefit is payable from the day the insured person is certified to be incapable of work, provided that the period of sickness shall not be less than 4 days.
Finally, by law, sickness benefit is payable at the rate of 65% of the average weekly wage of the person divided by six (days). Wages can either be that actually paid or credited.
The law allows for a response to all and any claims within 10 working days but by policy, Social Security prides itself on a 2 day processing period. “We keep looking up for your benefit”.
Our mission statement states that we pay the best possible benefits guaranteed by sound financial management. That’s what we do. But yet, along with the relevant ministries, we are working towards a healthier population.
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