PART II CLAIMS

3.                   Claims to be made in writing  (1) A claim for benefit shall be made in writing to the Director on the form approved by the Board for the purpose, or in such other manner, being in writing, as the Director may accept as sufficient in the circumstances of any particular case or class of cases.

 

(2)        Forms for claims shall be supplied without charge by the Board.

 

4.                   Information to be given: (1) A claimant shall furnish such certificates, documents, information and evidence for the purpose of determining the claim as are prescribed in these Regulations and the Director may require any claimant to attend at such place as the Director may specify and there to submit himself to medical or other examination by one or more medical officers, medical referees or other professional persons appointed by the Board for that purpose.

 

 

(2)                If so required by the Director, a claimant shall in particular furnish the following information concerning himself, or any person on behalf of whom he is claiming a benefit -

 

(a)    his name, date and place of birth, usual place of residence, employment or former employment and not being the claimant his relationship to the claimant:

 

(b)    in the case of a claim in respect of a wife or husband, or a widow or widower, or a claim based on the fact that the wife, husband, widow or widower is an insured person, a certificate of the marriage, together with a declaration confirming the information given at (a).

 

(3)                The Director may accept in support of claims and, in the absence of any certificate or document mentioned in the foregoing paragraphs:

 

(a)    as proof of kinship the sworn declaration of other persons or other evidence;

 

(b)    as proof of age, extracts from the baptismal records or school records or such other evidence as he considers satisfactory.

 

5.                   Date for claims: For the purpose of any claim to benefit the date of receipt of the claim at the office of the Director shall be deemed to be the date of the claim.

 

 

 

6.                   Amendment of claim: (1) If a claim is defective, when it is received by the Director, the Director may refer the claim back to the claimant and if the form is returned properly completed within one month from the date on which it is so referred the claim shall be treated as if it had been duly made in the first instance.

 

 

 

(2)                A claimant who has made a claim in accordance with these Regulations may amend the claim at any time before a decision has been given thereon, by notice in writing delivered or sent to the Director, and any claim so amended shall be treated as if it had been duly made in the first instance.

 

 

7.                   Interchange of claims: Where it appears that a claimant one benefit may be to some other benefit, the claim may be treated by the Director as a claim for that other benefit

 

 

 

8.                   Time for claiming benefits: (1) The time for claiming benefits shall be -

 

(a)    in the case of sickness benefit (unless good cause is given) not later than fifteen days from the earliest day in respect of which incapacity for work is certified.

 

(b)    in the case of maternity benefit.

 

(i)      if the benefit is claimed before confinement, not earlier than thirteen weeks beginning with the contribution week before that in which it is expected that the claimant will be confined.

 

(ii)    in any other case, within four weeks beginning with the date of confinement;

 

 

(c)    in the case of invalidity, age or survivor's benefit, within three months from the date on which, apart from satisfying the condition of making a claim, the claimant becomes entitled thereto; and

 

(d)    in the case of funeral grant, within six months from the date of death of the deceased.

 

 

(2)                Subject to paragraphs (3) and (4), a person failing to make a claim for benefit within the time prescribed shall be disqualified from receiving

 

 

(a)    in the case of sickness benefit, benefit in respect of any day more than fifteen days before the date on which incapacity for work is certified, subject to regulation 13;

 

(b)    in the case of maternity benefit, benefit in respect of any period before the beginning of the contribution week in which the claim is made;

 

(c)    in the case of invalidity, age or survivor's benefit, benefit in respect of any period more than three months before the date on which the claim is made;

 

(d)    in the case or funeral grant, the amount of the grant.

 

 

(3)                If in any case the claimant proves

 

(a)    that on a date earlier than the date on which the claim was made, apart from satisfying the condition of making a claim, he was entitled to the benefit, and

 

(b)    that throughout the period between the earlier date and the date on which the claim was made there was good cause for delay in making such claim,

 

he shall not be disqualified under paragraph (2) from receiving any benefit to which he would have been entitled if the claim had been made on the earlier date.

 

(4)                Notwithstanding the provisions of sub-paragraph (3) no sum shall be paid by way of

 

(a)    sickness, maternity, invalidity, age, survivor's benefit in respect of any period more than six months before the date on which the claim therefore is duly made;

 

(b)    funeral grant, if the claim is not duly made within twelve months after the date of the death of the person in respect of whom the grant is payable.

PART III BENEFITS

 

A. Sickness Benefit

9.                   Entitlement: Subject to the provisions of these Regulations, sickness benefit shall be awarded to an insured person who is rendered incapable of work as a result of some specific disease or of bodily or mental disablement; and for this purpose an insured person shall be treated as incapable of work because he is under observation by reason of being a carrier of a disease, or of his having been in contact with a case of infectious disease.

 

 

10.               No entitlement after age sixty: No insured person shall be awarded or-paid sickness benefit on or after attaining the age of sixty years.

 

 

11.               Support of claim: A claim for sickness benefit shall be supported by a certificate of a medical practitioner in accordance with the First Schedule to these Regulations or by such other evidence as the Director may require for the purpose of establishing the incapacity of the insured person for work.

 

 

12.               Conditions to be satisfied: Sickness benefit shall be payable only if the insured person-

 

(a)    had paid not less than twenty-six weekly contributions;

 

(b)    had paid or had been credited with not less than eight weekly contributions in the period of thirteen contribution weeks immediately preceding the contribution week in which the first day of incapacity for work occurred.

 

 

13.               Commencement: An insured person who is awarded sickness benefit shall not be entitled to receive such benefit for the first three days of any continuous period of incapacity for work but only from the fourth day of any such period:

 

 

Provided that for the purpose of computing the first three days of any continuous period of incapacity for work,

 

(a)    public holidays shall be included; and

 

(b)    Sundays shall not be included.

 

 

14.               Duration: (1) Subject to the provisions of these Regulations, sickness benefit shall be paid in respect of each day (excluding Sundays) as long as incapacity for work continues, subject to a maximum of twenty-six weeks, in any one continuous period of incapacity.

 

 

(2)       Any two or more periods or incapacity for work not separated by more than eight weeks shall be treated as one continuous period of incapacity for work starting on the first day of the first week of those periods.

 

 

(3)       The daily rate of benefit payable in respect of the later period or periods under this Regulation is the daily rate of benefit paid during the first period of incapacity.

 

 

15.               Rate of benefit: (1) The weekly rate of sickness benefit shall be sixty five per centum of the sum of the insurable earnings or credits of the insured person in the thirteen contribution weeks immediately preceding the contribution week in which incapac1ty for work occurred or was deemed to have occurred, divided by thirteen.

 

 

(2)       The daily rate of sickness benefit shall be the weekly rate divided by six.

 

 

(3)       When an insured person who is not exempted from benefit under section 18 of the Act continues after the third consecutive day of sickness and while on leave to receive from his employer all or part of his wages, the weekly rate of sickness benefit to be contributed by the Fund shall be sixty five per centum of his average weekly insurable earning which amount shall form part of and not be in addition to, the amount paid by his employer.

 

 

(4)       When a claimant is entitled to receive from his employer full pay during any period of incapacity for work, the Director shall pay directly to the employer the weekly rate of sickness benefit payable by the Fund as prescribed in paragraph (3).

 

 

 

16.               Disqualification: An insured person entitled to payment of sickness benefit shall be disqualified from receiving benefit for such period as the Director may decide, but not exceeding six weeks if-

 

 

(a)    the claimant has become incapable of work through his own misconduct; or

 

 

(b)    the claimant fails, without good cause, to comply with a notice in writing by the Director requiring him to attend for and submit himself to medical or other examination; or

 

 

(c)    the claimant fails, without good cause, to observe any of the following rules of behaviour, namely

 

 

(i)      to refrain from behaviour calculated to retard his recovery, or to answer any reasonable enquiries by an officer of the Board directed to ascertaining whether he is doing so;

 

 

(ii)    not to be absent from his place of residence without leaving word as to where he may be found; or

 

 

(iii)   to do no work for which remuneration is or would ordinarily be payable.

 

B. Maternity Benefit

17.               Entitlement: Subject to the provisions of these Regulations, maternity benefit shall be awarded to a woman who is an insured person, in respect of her pregnancy and confinement.

 

 

18.               Certificate in support of claim: A claim for maternity benefit shall be supported by a certificate of a medical practitioner or a registered midwife in accordance with the First Schedule to these Regulations or by such other evidence as the Director may accept for the purpose of establishing the pregnancy or confinement, as the case may be.

 

 

19.               Conditions to be satisfied: Maternity benefit shall be payable to a woman who has been insured for thirty weeks where not less than twenty weekly contributions have been paid by, or credited to her, during the thirty weeks immediately preceding that contribution week

 

(a)    which is six weeks before the expected week of confinement; or

 

(b)    in which occurs the day from which the allowance is claimed whichever is later.

 

 

20.               Certificate of confinement: A woman who has been awarded maternity benefit shall obtain a certificate of confinement in accordance with paragraphs 7 and 8 of the Schedule to these Regulations and send it to the Director within three weeks of confinement or, within the same period furnish the Director with such other evidence of her confinement as may be acceptable to him

 

 

21.               Duration of maternity benefit: Subject to the provisions of these Regula­tions maternity benefit shall be payable for a period starting not earlier than six weeks before the expected week of confinement and continuing until the expiration of thirteen weeks:

 

Provided always that the total period of maternity benefit payable shall not exceed thirteen weeks.

 

 

22.               Rate of benefit: (1) The weekly rate of maternity benefit shall be sixty five per centum of the sum of the insurable earnings or credits of the insured person in the thirty weeks specified in regulation 19 divided by thirty, and the daily rate shall be the weekly rate divided by six.

 

 

(2)                When an insured person during her confinement continues while on leave to receive from her employer all or part of her wages, the weekly rate of maternity benefit to be contributed by the Fund shall be sixty five per centum of her average weekly insurable earning while on leave which amount shall form part of and not be in addition to, the amount paid by the employer.

 

 

(3)                When a claimant is entitled to receive from her employer full pay during any period of absence from work, due to pregnancy, the Director shall pay directly to her employer the weekly rate of maternity benefit payable by the Fund as prescribed in paragraph (2).

 

 

23.               Maternity Grant: (1) A woman is entitled to a grant of two hundred dollars if- (click here for 2002 Amendments)

 

(a)    she has given birth to a living child; and

 

 

(b)    she or her husband has contributed to the fund for at least twenty of the thirty weeks immediately preceding the week which she gave birth.

 

 

(2)                For the purpose of this regulation the provision of section 28 (4) of the Act applies and the expression 'husband" includes a single man living in a common law relationship with a single woman with whom he resides in the same dwelling house.

 

 

(3)                The payment made by virtue of this regulation shall in respect of the hus­band's contribution be made only to one such woman.

 

 

24.               Disqualification: An insured person entitled to payment of maternity benefit shall be disqualified from receiving such benefit for such period as the Director may decide if during the period for which benefit is payable -

 

 

(a)    she engages in remunerative work;

 

 

(b)    she fails without good cause to comply with a notice in writing by the Director requiring her to furnish a medical certificate as prescribed in the Schedule or other acceptable evidence of her confinement.

 

 

25.               Incapacity from complications of confinement: The provisions of the Regulations relative to sickness benefit shall apply in relation to a case where there is incapacity for work arising from pathological complications of confinement immediately following the cessation of rights to maternity benefit:

 

 

Provided that in such a case the conditions of regulation 12 shall be applied in relation to the period immediately preceding the first day from which maternity benefit was payable.

C.         INVALIDITY BENEFIT

 

 

26.               Entitlement: Subject to the provisions of these Regulations, invalidity benefit shall be awarded to an insured person who is an invalid.

 

 

27.               Certificate in support of claim: A claim for invalidity benefit shall be supported by a certificate of a medical practitioner in accordance with the First Schedule to these Regulations or by such other evidence as the Director may require for the purposes of establishing the incapacity of the insured person for work.

 

 

28.               Conditions to be satisfied: Invalidity pension shall b awarded if-

 

(a)    the insured person has not attained the age of sixty years; and

 

 

(b)    not less than one hundred and fifty weekly contributions have been paid by the insured person.

 

 

29.               Duration: Subject to the provisions of these Regulations, invalidity pension shall be paid for so long as invalidity continues, but shall cease at age sixty when it shall be converted to an age pension of the same amount.

 

 

30.               Rate of benefit: (1) The annual rate of invalidity pension shall be thirty per centum of the average annual insurable earnings of the insured person to which shall be added one half per centum of his average annual insurable earnings for each twenty-five weekly contribution paid by or credited to him in excess of the first five hundred such contributions:

 

 

Provided that in no case shall invalidity pension exceed sixty per centum of the insured persons average annual insurable earnings, nor be less than a weekly rate of forty dollars.

 

 

(2)                For the purpose of this regulation the average annual insurable earnings shall be the sum of the insurable earnings or credits of the insured person in the best three contribution years out of the fifteen contribution years immediately preceding the contribution year in which invalidity occurs, or such lesser number being the total number of contribution years since the Appointed Day or since the initial date of insurance of the insured person divided by three.

 

 

(3)                The weekly rate of invalidity benefit shall be the annual rate thereof divided by fifty-two and rounded to the nearest multiple of ten cents.

 

 

31.               Invalidity grant: (1) Subject to the provisions of these Regulations an insured person who does not satisfy the provisions of regulation 28 but who

 

(a)    is an invalid,

 

 

(b)    has not attained the age of sixty, and

 

(c)    has paid not less than fifty weekly contributions, shall be entitled to an invalidity grant.

 

 

(2)                The amount of invalidity grant shall be a lump sum equal to six times the average insurable weekly earnings of the insured person for each complete fifty contributions paid by or credited to him.

 

 

(3)                Average insurable weekly earnings for the purpose of this regulation means the sum of the last fifty weekly insurable earnings or credits of the insured per­son prior to the onset of incapacity, divided by fifty.

 

 

32.               Disqualification: An insured person entitled to payment of invalidity pension shall be disqualified from receiving such benefit for such period as the Director may decide, if-

 

 

(a)    the claimant has become incapable of work through his own misconduct: or

 

 

(b)    the claimant fails, without good cause, to comply with a notice in writing by the Director requiring him to attend for and submit himself to medical or other examination; or

 

 

(c)    the claimant fails, without good cause, to observe any of the following rules of behaviour namely-

 

 

(i)   to refrain from behaviour calculated to retard his recovery, or to answer any reasonable enquiries by an officer of the Board directed to ascertaining whether he is doing so,

 

 

(ii)  not to be absent from his place of residence without leaving word where he may be found, or

 

(iii)               to do no work for which remuneration is or would ordinarily be payable.

 

D. AGE BENEFIT

 

33.               Age pension entitlement: Age benefit shall be awarded as a pension to an insured person who has attained the age of sixty years and who

 

(b)    has paid not less than one hundred and fifty weekly contributions; and

 

(c)    has paid or been credited with not less than five hundred weekly contributions.

 

34.               Duration of age pension: Subject to the provisions of these Regulations age pension shall be payable from the date of the beneficiary's sixtieth birthday until his death.

 

35.               Rate of age pension: (1) The annual rate of age pension shall be sixteen per centum of the average annual insurable earnings of the insured person to which shall be added one per centum of his average annual insurable earnings for each complete twenty-five weekly contributions paid by or credited to him in excess of the first one hundred and fifty weekly contributions and up to the first five hundred weeks, plus one half per centum of his average insurable earnings for each complete twenty-five weekly contributions paid or credited to him in excess of the first five hundred weeks.

 

(2)                In no case shall age pension exceed sixty per centum of the average insurable earnings of the insured person nor less than a weekly rate of forty dollars. (Click here for 2002 Amendments)

 

(3)                For the purpose of this regulation -"average annual insurable earnings" means the sum of the insurable earnings or credits of the insured person during the best three contribution years of the last fifteen contribution years before he attains sixty years or such lesser amount being the number of contributions -

 

(a)    since the Appointed Day: or -

(b)    since the initial date of insurance of the insured person,

divided by three.

 

(4)                The weekly rate of age pension shall be the annual rate divided by fifty-two and rounded to the nearest multiple of ten cents.

 

36.               Age_Grant entitlement: (1) Subject to the provisions of these Regulations age grant shall be payable to an insured person who does not satisfy the requirements set out in regulation 33 but who

 

(a)    has attained the age of sixty years; and

(b)    has paid not less than fifty weekly contributions.

 

(2)               The amount of age grant shall be a lump sum equal to six times the average insurable weekly earnings of the insured person for each complete fifty weekly contributions paid by or credited to him.

 

(3)                For the purpose of this regulation "average insurable weekly earnings" means the sum of the last fifty weekly insurable earnings or credits prior to age sixty divided by fifty.

 

37.               Reduced Age pension: (1) A person of the age of thirty-seven years and over on the Appointed Day shall be eligible for an age pension, when he has

 

(a)    attained the age of sixty years; and

(b)    paid one hundred and fifty weekly contributions; and (Click here for 20002 amendment)

(c)    paid or credited an additional twenty-five weekly contributions for every year during which he was under the age of 50 years on the appointed day as described in the Second Schedule.

 

(2)                The annual rate of age pension payable in accordance with paragraph (1) shall be computed in accordance with regulation 35.

 

 

 

E.         FUNERAL GRANT