• Advise Jenique about her entitlement at retirement

• She inquires about paying contributions on her gratuity to increase her pension. Explain how much contribution she would have to pay.

• Mr. Utica approaches you to find out how much contributions he has to pay on the production bonus and the severance pay. Please advise him.

• A new employer is hoping to establish a business at Diamond Industrial Estate and asks you what constitutes earnings for purposes of contributions. Kindly advise him.

4. Wages for purposes of contributions according to SR&O #21 of 1986 include:

• Overtime payment
• Payments for night or shift work
• Wages / salary received by or on behalf of the employed person (between $60.00 per month - $3,350 per month)
• Any allowances granted to the employee in lieu of salary
• Commission
• Holiday pay
• Service charge

Case 4

“Good Morning Officer, My name is Jane Francis. I was married to John Francis. He died in 1997 at the age of 42 leaving me with two children aged 4 years and 6 years. I came to the office and asked whether I would receive benefit; seeing that my husband was employed at one of this country’s leading Industrial Departments for over 15 years. The lady told me yes and she gave me two (2) sets of forms. I started to receive benefits in the sum of $57.50 per week. Sometime in 2000 I started to receive $25.00 per week. I made a check with the NIS Office and I was told that my benefit had to be discontinued.”

Questions

• You are the benefit officer and the lady approaches you; explain to her the type of benefits, which she received and the possible reasons for the discontinuity.

• What does the legislation state regarding benefits paid to the widow/widower at the time of death of wife/husband?

• What does the regulation stipulate for common law unions?

(a) If the man did not have a spouse, what would have happened to the Survivors’ Pension?

(b) If he had neither spouse nor children what would have happened to the money

available for Survivors’ Pension?

Answers

(1) Mrs. Jane Francis was qualified for the Survivors’ Benefit under the National Insurance (Benefits) Regulations SR&O #13 of 1994 Section. 42. The qualifying conditions for a Survivors’ Benefit are that the deceased person:

(a) should have been receiving Age or Invalidity Pension

(b) could have satisfied the prescribed conditions for an Invalidity Pension or Grant

(c) was sixty years of age or over and would have been entitled to an Age Pension or Grant if he/she had submitted such a claim.

She had started to receive benefits in the sum of $57.50 per week. This means that her husband John Francis would have been entitled to a minimum Age Pension of $50.00 per week. By virtue of his death she, the widow would receive 75 % of that, which is equivalent to $32.50 and the children would have received minimum Survivors Benefit of $12.50 each, hence the total of $57.50 payable to Mrs. Francis.

According to Mrs. Francis, she started to receive $25.00 per week in 2000 and she was told that her benefit had to be discontinued and she wanted to know the reason for that decision.

SR&O #13 of 1994 Section 5 explains that a Survivors’ Pension payable to a widow shall cease on her re-marriage or if she cohabits with a man i.e. lives together with him in the same house. This might well have been the case with Jane Francis. The same situation applies in the case of a widower.

(2) The legislation states (SR&O #13 of 1994 section 44) that a widow/widower at the time of death of wife/husband is entitled to:

• If she/he is 50 years or over a Survivors’ Pension for life, or a Survivors’ Grant is payable.
• If she is under the age of 50 and she is an invalid, she will be paid a Survivors’ Pension during her invalidity. She will continue to receive a pension for life if her invalidity ceases and she is over fifty years.
• If she is under the age of 50 she will be paid a benefit for one year unless she is pregnant at the time of her husband’s death or if she has children whose ages at the time of her husband’s death will make her eligible for pension for life.

 

(3) The stipulation for common-law union is the same as that for husband and wife but they must be living together for at least 3 years. (SR&O #13 of 1994 section 44)

(4) (a) If the man did not have a spouse, the full amount of Survivors’ Pension or Grant may be paid to the children of the deceased (SR&O #13 of 1994 section 50 (3)).

(b)If John Francis did not have a wife or children then his benefit would have been paid to a surviving parent who was 60 years or over and who received at least 50 percent of his/her support (income) from him. If he had no surviving parent then the money will stay in the “pool” of funds at the National Insurance. The National Insurance is a social solidarity programme. Funds are ‘pooled’ together to share the risks of the members of the Scheme.

Case 5

Nequette, Shephette and Shantelle work with Islanders Photo Studio. During 2000 Nequette became pregnant and applied for thirteen (13) weeks Maternity Benefit. She received the allotted 65% benefit from NIS. Islanders Photo Studio paid the 35% as salary to Nequette.

Shephette received a back injury. She started to collect Sickness Benefit but she had to rush off to Barbados.

Shantelle who has three (3) dependent children was receiving Employment Injury Benefit. She still had another twenty-six (26) weeks to collect but she went to Layne’s Hardware and stole two (2) locks. She was sentenced to three (3) months in prison.

Questions

(1) Nequette approaches you to find out about paying contributions, advise her.

(2) Explain to Islanders Photo Studio what will happen to Nequette during the thirteen (13) weeks when she receives NIS benefit payments.

(3) What should happen to Shephette’s benefit?

(4)What would become of Shantelle’s benefit?

Answers

(1) The questions raised by this problem concern the legislation relating to paying contributions and also to Benefits legislation.

Let us consider first, Nequette’s case. She has qualified for the Maternity Allowance according to SR&O #13 of 1994. These qualifying conditions are:

• A woman must be between the ages of 16 and 60 years and;

• she must have been employed for at least thirty (30) contribution weeks and has paid or has been credited with at least twenty (20) weekly contributions immediately before the date of making the claim for Maternity Allowance.

SR&O #13 of 1994 Section 22 states that “weekly rate of benefit shall be 65 percent of the sum of the insurable earnings or credits of the insured person in the 30 weeks stipulated in the qualifying conditions”.

The problem states that Nequette has received the 65% from the NIS. Additionally, she has received 35% salary from her employer, Islanders Photo Studio. It would appear that Nequette is concerned about paying contributions on the 35% that she has received as wages from her employer Islanders Photo Studio. Since the 65%, which she has received as benefits, payment from the National Insurance Scheme is not wages no contributions should be made on that. Although the 35% may be classified as wages it is not NIS deductible because SR&O #13 of 1994 Section 57 (1) makes it quite clear that “for every contribution week for the whole of which an insured person receives sickness benefit or maternity benefit a credited contribution shall be credited to that person without actual payment thereof”.

Paragraph 3 of the same section states that “credited contributions shall be valid for maternity benefit and shall be at the level of the weekly wages corresponding to, or most closely corresponding to, those on the basis of which the maternity benefit is paid. Provided that where maternity benefit is payable at different rates, during a contribution week, the credited contribution shall be at the highest level of weekly wages on which the benefit is paid”.

(2) During the thirteen (13) weeks that Nequette receives Maternity Benefit from the NIS, Islanders Photo Studio is not under any obligation to make contributions on Nequette’s behalf. However, they should pay her 35% salary since the NIS would only pay her 65% of her average weekly insurable earnings.

(3) Shephette received a back injury. She would have submitted a claim for Sickness Benefit. She had already started to collect Sickness Benefit from the NIS, which means that she would have satisfied the qualifying conditions of:

(1) being between ages of 16 and 60 years

(ii) having paid or has been credited with at least twenty–six (26) weekly contributions, eight (8) of which would have been paid in the thirteen (13) weeks before her illness.

(iii) having been employed immediately before the illness.

Apparently, Shephette’s condition has deteriorated and she has to rush off to Barbados. Under normal circumstances and according to SR&O #13 of 1994 section 60 a person should be disqualified from receiving benefit for any period during which he/she is absent from St.Vincent & the Grenadines. However, Shephette had already started to receive the benefit and had to leave the state temporarily to receive treatment. In this case Shephette’s benefits will continue. This benefit may be deposited directly into her bank account or she may leave instructions to the NIS to pay to her agent.

(4) Shantelle’s situation is unfortunate. She was sentenced to three (3) months in prison. Shantelle cannot receive the Employment Injury benefit for the period that she is imprisoned (SR&O #13 of 1994 Sec. 63). However, her three dependent children cannot be punished for Shantelle’s crime. SR&O #13 of 1994 Sec. 63 paragraph 2 allows the National Insurance Board to make some form of payments to the dependants. However, they would only receive one half of the Employment Injury benefit that was payable to their mother, Shantelle.

Case 6

“Sir, I have a complaint that I want to lodge at your office. Since December 1982 I was employed at Marine’s and Generalty Insurance Co. I received salary of $750.00 per month. In September 1996 I fell ill and I submitted a claim to the National Insurance Office. The claim covered a period of ten (10) days. To my surprise I only received an amount of about $122.00. I want to know the reason for my receiving such a small amount.”

Question

You are the benefit clerk. Kindly explain to the gentleman the specific legislation that deals with his case and the reason for all that transpired in his particular situation.

Answer

The National Insurance (Benefits) Regulations SR&O # 13 of 1994 Section 9 entitles a person who is incapable of work as a result of illness to claim a Sickness Benefit.

Section 12 of the same regulations stipulates the eligibility conditions as being:

• the person must be between ages of 16 and 60 years inclusive, who
• has paid or has been credited with at least twenty-six (26)contributions into the National Insurance Scheme, at least eight (8)of which must have been paid in the thirteen (13) weeks before the illness.
• has been employed immediately before the illness.

The gentleman in question has qualified. He claims that he was given a ten (10) days sick leave from the doctor but that is based on his salary of $750.00 per month. The $122.00 that he received could never compensate. SR&O # 13 of 1994 Sec. 13 indicates that an insured person who qualifies for Sickness Benefit will not be entitled to receive any benefit for the first three (3) days. These days are called ‘waiting days’. These are there to act as a buffer to ensure that a claim is not submitted for any frivolous reason and in any event most persons are granted two (2) days sick leave with full pay from the employer. Also, the same section 13 of SR&O #13 of 1994 does not allow payment for Sundays. Definitely the gentleman’s ten (10) days would have included the three (3) waiting days and it may well be that two (2) Sundays would have been included in the ten (10) days or he may have returned to work before the expiry of the ten (10) days or he may have submitted the claim late hence the reason for receiving $122.00.

Case 7

Jeptuni Lambert is 68 years old. He comes to the National Insurance Office on May 10, 2001 with an ID card stating that he worked at Children’s Wear and he wants to be enlisted on the NAAP Programme.

Questions

• What documents do you need to verify Jeptuni’s age?

• What conditions must Jeptuni satisfy to receive a NAAP benefit?

• If Jeptuni satisfies the requirements, to what other benefits would Jeptuni and his family be entitled?

Answers

(1) This case is based on the Non-Contributory Assistance Age Pension (NAAP) 1997, which is an amendment/addition to SR&O #13 of 1994 National Insurance (Benefits) Regulations.

In order to verify Jeptuni’s age, one would need a birth certificate, passport or deed poll. In circumstances where it is nigh impossible to obtain any of these documents, e.g. if there are no relatives alive and the person is a national, then school records would be acceptable. This is a last resort.

(2) The conditions which are stipulated in section 37 A (1) state “notwithstanding the provisions of this part a pension of $20.00 per week to be known as the Non-Contributory Assistance Age Pension may be granted to persons who are residents of Saint Vincent and the Grenadines who satisfy the following conditions”.

• were 57 years or older on January 5, 1987;
  • are not engaged in remunerative (paid) employment;
  • do not have income equivalent to the Non-Contributory Assistance Age Pension benefit (e.g.) Social Welfare benefit or a regular income from any other source;
  • are not receiving any pension income from the National Insurance Scheme;
  • were actively employed for a significant number of continuous years prior to 5 th January 1987
  • Satisfy the following residency requirement:

    (i) is at the date of claim a resident of St.Vincent & the Grenadines;

    (ii) has been living in St.Vincent & the Grenadines for at least 5 of the last 8 year

    (iii) has been living in St.Vincent & the Grenadines for at least 25 years since his twentieth birthday.

(3) As long as Jeptuni satisfies the foregoing requirements, Jeptuni would be entitled to the $20.00 per week NAAP benefit. On his death his relatives would be entitled to a Funeral Grant of $1,500.00. On the death of his spouse/common law wife the relatives will be entitled to a Funeral Grant of $750.00. If he has dependent children, Funeral Grant will be payable on their death as follows:

Under 3 years= $200.00

3 years =$225.00

4 years= $300.00

5 years= $375.00

6 years =$450.00

7 years =$525.00

8 years =$600.00

9 years= $675.00

10 years and over =$750.00

Case 8

Laura Gonzalez aged 33 years worked with Jopina Ltd. from January 1993. She worked until July 1994. They paid full contributions on her behalf. She went to the United States for three (3) months August, September and October 1994. When she returned to St. Vincent in November 1994, she fell ill and sent a claim to NIS.

Questions

• Laura came to NIS to check on her claim. Advise Laura about the status of her claim.

• Assume that Laura had returned to St. Vincent in early September, would that have made a difference?

• Under what circumstances might a claim be disallowed or discontinued?

Answers

(1) Laura submitted a claim for Sickness Benefit. The qualifying conditions are identified as:

• the person must be between the ages of 16 and 60 years
• has paid, or has been credited with at least twenty-six (26) weekly contributions, at least eight (8) contributions in the thirteen (13) weeks before the illness and
• has been employed immediately before the illness.

The problem states that Laura went to the United States for three (3) months, August, September and October 1994. This means that she would not have been employed immediately before the illness. Therefore, she would not have the required eight (8) contributions in the thirteen (13) weeks before the illness. Laura’s claim will have to be disallowed.

(2) Even if Laura had returned to St. Vincent in early September she still would not have qualified because she would not have had the required eight (8) out of thirteen (13) weeks contributions before the illness.

(3) Under Section 16 of SR&O #13 of 1994, a claim might be disqualified for any of the following reasons:

(a) the claimant has become incapable of work through his/her own misconduct

(b) the claimant refuses to attend a medical examination on the request of the Director

(c) (i) the claimant engages in any behaviour that will retard his recovery, or fails to answer any reasonable enquiry by an officer of the Board regarding his conduct in relation to his illness

(ii) the claimant’s whereabouts is unknown

(iii) engages in paid labour

The claim might also be disallowed if:

the claim is submitted late

the claimant is not insured under the NIS

the claimant is not gainfully employed

the claimant has attained maximum payment

the claim is submitted for three (3) days and less

the claimant is over 60 years and submits a claim for Sickness or Maternity Benefit

the claimant has since returned to work

the claimant is a pensionable officer with government – cannot receive Sickness Benefit

the medical certificate is invalid

the claimant was on vacation leave and not sick leave.

 

Case 9

Drina and Sandrina aged 12 years and 15 years respectively are the two (2) surviving children of Letesha Priam who worked for ten years with Cheno Ltd. Their father Lanceford who is 46 years old is a known mental case. Drina and Sandrina were the named beneficiaries to their mother’s NPF benefit. Sandrina and Drina live with their Aunt Thordina in Bequia but she has suffered a stroke, which left her speechless and paralysed on her right side. Drina and Sandrina went to live with Thordina’s neighbour.

Questions

• For what benefit do Drina, Sandrina and Lanceford qualify?

• To whom should benefits be made payable? Why?

• Given Thordina’s condition, what should happen to the benefits?

• What would happen to the NPF benefit?

Answers

(1)Since Letesha Priam worked for 10 years with Cheno Ltd., she would have been entitled to an Age Pension. Therefore, her children Drina and Sandrina and her husband Lanceford would be entitled to Survivors’ Benefit.

(2) Section 55 (1) SR&O # 13 of 1994 makes provision for persons unable to act. The age of majority in St. Vincent & the Grenadines is 18 years old. Drina and Sandrina are aged 12 years and 15 years respectively. Since they are children then they will be categorized as being unable to act. Lanceford is a known mental case so he too is unfit to act. In any event one cannot legally enter into a contractual agreement with a person of unsound mind.

In Drina and Sandrina’s case the benefit should be made payable to their Aunt Thordina who is their guardian.

In Lanceford’s case the Board may upon written application being made to it, appoint somebody to act on Lanceford’s behalf.

(3) Thordina is paralysed. This means that she is no longer able to be guardian for Sandrina and Drina. They have been sent to live with a neighbour. The Board should be notified (in writing) that the neighbour now has charge of the children and she will be entitled to receive the benefits since she is now the bonafide guardian of the children.

(4) Where the Board is satisfied that any sum or part of the NPF fund is needed for the benefit of the children under age 18 years the Board may pay that sum to an adult who satisfies the Board that he will apply the sum so paid to the benefit of the persons under 18 years. In this case Thordina (later the neighbour) has satisfied this requirement. Of course, the application should be done in writing.

Case 10

Joancilla worked as a factory hand at Shilah Garment Factory. Joancilla was given the responsibility to iron some finished garments. During the process the iron slipped from the ironing board and chopped off Joancilla’s little toe and her fourth toe. The doctor recommended that Joancilla should travel to Barbados. She did not have any money to travel to Barbados so she approached the NIS for help. She received a benefit from the NIS. Joancilla returned to work after six weeks. This time an abscess came up on her right hand and she was hospitalized for four weeks. During the time she was in the hospital her husband Johnathan who was employed with Gibcon’s Construction fell from the scaffolding on Dembas’ public school and died on the spot.

Questions

• What benefit was Joancilla entitled to following the first accident?
• What should the NIS have done when Joancilla approached them?
• Advise Joancilla about her benefits rights regarding the abscess.
• Can Joancilla claim any benefit following Johnathan’s death? If so, what are they?
• Johnathan had an 18-year-old son whose legs and hands were amputated? Is he eligible for any benefit? Explain.
• State under what other circumstances can benefits be duplicated?

Answers

• According to SR&O # 6 of 1997 National Insurance (Employment Injury Benefit) Joancilla is entitled to Employment Injury Benefit since she was injured during the course of her employment. She is also entitled to disablement in the form of a Disablement Grant since she has permanently lost two (2) toes (5% injury). She is also entitled to medical expenses that were reasonably incurred.
• The case states that Joancilla approached the NIS after the doctor advised her to travel to Barbados. She informed the NIS that she did not have any money. The National Insurance has an obligation to refund reasonable medical expenses that are incurred as a result of treatment obtained outside the state. This is normally done when the person returns. However, Section 15 of SR&O #6 of 1997 makes allowance for direct payment for medical expenses by the Board. This means that the Board can assign the medical expenses that are due to the insured directly to the medical practitioner or institution from which the treatment was obtained. This section of the legislation could have been invoked in Joancilla’s situation.
• Joancilla was entitled to receive Sickness Benefit since the abscess was not a work-related disease.
• Yes, Joancilla can claim Death Benefit due to Employment Injury even if she is receiving Sickness Benefit. Under normal circumstances a person cannot claim more than one benefit at a time from the National Insurance Scheme. In situations where this arises the person is paid the benefit first awarded unless the other benefit is payable at a higher rate and in this case the higher of the two benefits is paid.

However, section 24 (2) #6 of 1997 allows for full duplication of Death Benefit with Sickness Benefit so that Joancilla is duly eligible to receive Death Benefit as a result of the death of her husband Johnathan. She can also claim Funeral Grant.

• The case infers that Johnathan’s son is an invalid. Although he is 18 years old he is entitled to a Death Benefit as long as the invalidity continues.
• Section 24 (2) states that:-

Injury Benefit could be duplicated with Age Benefit or Death Benefit

Disablement Benefit with Sickness Benefit, Maternity Benefit, Survivors Benefit, Death Benefit or Age Benefit

The other circumstances under which benefits can be duplicated are:

Death Benefit with Sickness Benefit, Maternity Benefit, Injury Benefit, Invalidity Benefit, Age Benefit or Disablement Benefit.

Any other benefit may be duplicated in full with Funeral Grant

 

Case 11

Salma is employed at Richelle’s Boutique. She makes a claim for Maternity Benefit. She is paid for a full thirteen (13) weeks. Subsequently, the NIS is informed that Salma returned to work after six (6) weeks. The NIS calls in Salma but she does not have any money to repay. Subsequently Salma sends in a sickness claim for one hundred (100) days and the claim is honoured. At the end of the year Salma is filing her income tax return. She is itemizing her deductions. She has paid NIS contributions in the sum of three hundred and sixty dollars ($360.00).

The Manager of Richelle’s Boutique informs the NIS that Salma’s Sickness Benefit should be made payable to them because Salma is indebted to the Boutique in the sum of $200.00.

Questions

(1)How should NIS deal with Salma regarding the payment of the surplus Maternity

Benefit?

(2) Salma approaches you regarding using the NIS contributions on her income tax returns. Advise her.

(3) How should NIS treat Salma’s indebtedness to Richelle’s Boutique?

Answers

(1) Section 32 (1) of the Principal Act # 33 of 1986 makes it categorically clear that any person who non-discloses or misrepresents any material fact to the NIS whether fraudulently or otherwise for the purpose of receiving any benefit to which he/she was not entitled shall be asked to repay the sum that was received.

Salma claims that she does not have the money to repay. However, she subsequently submits a claim for Sickness Benefit, the Act in Section 32 (2) allows the NIS to recover the money from the Sickness Benefit to cover the money that Salma had previously received fraudulently as Maternity Benefit. If the amount of Sickness Benefit cannot cover the previous amount then the NIS will have to press a criminal charge against Salma to recover the money.

(2) The Principal Act # 33 of 1986 Section 5 allows employers and employees to include contributions made to the NIS as allowance deductions for income tax purposes. Salma can therefore use the contributions on her income tax returns.

(3) Salma’s indebtedness to Richelle’s Boutique is outside the scope of the NIS. The Principal Act # 33 of 1986 Section 33 makes it plain that benefits from the NIS cannot pass to any trustee or other person acting on behalf of creditors. Richelle’s Boutique will have to press charges against Salma for recovery of the $200.00

 

Case 12

Dorothy Lynn is an age pensioner at the NIS. She receives pension at the rate of $75.00 per week. Dorothy marries Benn who is also an age pensioner but he is receiving pension at the rate of $150.00 per week.

(1) If Benn dies what type of benefits will Dorothy receive? Why?

(2) If Dorothy had children for Benn under the age of sixteen (16) what would have happened?

Answers

(1) Dorothy Lynn and Benn are age pensioners with the National Insurance Scheme. If Benn dies Dorothy will only be entitled to a Funeral Grant, which is a benefit that is payable on the death of an insured person or invalidity or age pensioner or the spouse or dependent child of any of the persons mentioned above (SR&O #13 of 94, section 38)

Dorothy cannot receive any Survivors’ Pension since she would have married Benn after he started to receive the Age Pension (Section 42 (4) SR&O #13 of 1994).

If they were married before he started to receive a pension then Dorothy would have been awarded a Survivors’ Pension. In this case she would have received 75% of Benn’s Age Pension or $112.50. She would have stopped receiving the $75.00 Age Pension since the Survivors’ Benefit would have been higher, Section 46 SR&O #13 of 1994.

(2) Even if Dorothy had children for Benn under sixteen (16) years they would not have been entitled to Survivors’ Benefit because the marriage was contracted after Benn became an age pensioner (SR&O #13 of 1994 Section 42 (4)).

 

Case 13

Sinbad is a 40-year-old Security Guard who worked for seven (7) years at Jeloni Salon and Restaurant. Sinbad was involved in a vehicular accident and died subsequently. He had two (2) children with Rhona aged 3 years and 15 years. They are living with their mother Rhona. His wife Sharmin was 37 years old at the time of his death.

Questions

• Advise Sharmin about her entitlement to Survivors’ Benefit. If Sharmin were an invalid, what would have happened?

• Advise Rhona about her children’s entitlement to Survivors’ Benefit?

• If Sharmin had adopted Rhona’s children, would it have made a difference to her Survivors’ entitlement?

Answers

(1) SR&O #13 of 1994 makes it clear that Survivors’ Benefit is payable to the widow of an insured person who would have satisfied the eligibility conditions for receiving the same. Sinbad worked seven (7) years at Jeloni Salon and Restaurant so he would have satisfied the conditions. Sinbad was 40 years old when he died and his wife Sharmin was 37 years old. The case states that Sharmin had no children therefore, she would be only entitled to Survivors’ Pension for a period of one year. If Sharmin were incapable of self-support (invalid) she would receive a Survivors’ Pension for the duration of her invalidity. If the invalidity does not cease before she attains the age of 50 years then the Survivors’ Pension would be payable for life.

(2) Rhona’s children would be entitled to Survivors’ Benefit although they were born out of wedlock. The 3-year-old child will receive Survivors’ Benefit until she attains age 16 or age 18 years if she is in full-time education. The 15-year-old child will receive Survivors’ benefit until she attains age 16 years. If she is still at school the NIS will write the school to ascertain whether he/she will be continuing in full-time education.

(3) If Sharmin had adopted Rhona’s children they would have been regarded as her own children and she would have been entitled to a Survivors’ Pension for life since the 3-year-old child would have taken her age up to 50 years. If she chose to be remarried or if she had cohabited before the 3-year-old child attained age 16 years then the pension would have ceased.

Case 14

Alladin was a self-employed fisherman. One day he and his 30-year-old wife Jodi who was employed with Tameco Restaurant were travelling to Petit Martinique. The Boat capsized and both of them drowned and no one found the boat or the bodies. Three children, Joma (12), Janie (4) and Sunell (7) survived them. They went to live with their maternal grandmother.

Questions

• Who would receive the Funeral Grant for Jodi and Alladin?

• If Jodi and Alladin had died of natural causes, what type of benefit would the children be entitled to?

• If Alladin had died of natural causes and he was survived by his pregnant wife Jodi and the three children would it make any difference to the benefits payable?

Answers

(1) Jodi and Alladin died at sea and their remains were not found so no one is entitled to receive a Funeral Grant. Funeral Grant is only payable when expenses for burial have been incurred.

(2) If Jodi and Alladin had died of natural causes then the children would have been entitled to Survivors’ Pension. Their maternal grandmother would receive an Orphan’s Pension on their behalf. Orphan’s Pension is calculated at 50% of the Age Pension earned up to the date of death. She would receive the Survivors’ Pension until each child reaches age 16 years or 18 years if they continued in full-time education.

(3) If Alladin had died of natural causes then Jodi would have received 75% of the Age Pension earned up to the date of death as Survivors’ Pension. Since Jodi would have been pregnant at the time of Alladin’s death then when the baby was born Jodi would be entitled to Survivors’ Benefit until the child attained the age of 16 years or 18 years if he/she is in full-time education. The children would receive 25% of the Age Pension earned up to the date of death as Survivors’ Pension. Depending on the salary they might receive the minimum Survivors’ Pension of $12.50 per week. If she had one child he/she would receive the full 25% of the Age Pension earned up to death as Survivors’ Pension until age 16 years or 18 years.

Return to top

CHAPTER 2

EMPLOYMENT INJURY

Overview

• Employment Injury Benefit
• Disablement Grant/Pension
• Constant Attendance Allowance
• Death Benefit
• Medical Expenses
• Funeral Grant

Checklist

Salient points

• Linked claims
• Waiting days
• Reasonableness in relation to medical bills
• Conditions relating to Constant Attendance
• Employer & Employee negligence

Case 15

• Under which legislation is this person governed?

• Explain the specific sections that are relevant to his situation?

• Advise him about his entitlement.

• reporting the accident to the employer or someone in authority as soon as possible.
• visiting the doctor immediately and asking him/her to certify the injury on the Medical Report form
• completing and signing the claim and submitting it to the National Insurance Office within fifteen (15) days from the date of the accident.

• Under what legislation is Theolinda covered?

• What benefits are available to Theolinda?

• What must Theolinda do to claim these benefits?

• Theolinda is covered under SR&O #7 of 1997, the National Insurance (Employment Injury Benefits) Regulations.

• Theolinda is entitled to receive the Employment Injury Benefit and the Medical Expenses. She must submit all bills and receipts for treatment undertaken in St. Vincent and Barbados. Since Theolinda would have informed the National Insurance Scheme about the treatment in Barbados then she would be reimbursed for all expenses that have been reasonably incurred.

• In order for Theolinda to claim the Employment Injury Benefit and the Medical Expenses Benefit, she would have had to report the injury to her supervisor as soon as the incident occurred and have them submit an injury report to the NIS within ten (10) working days. She must go to the Doctor to have him/her authenticate the accident and then submit a duly signed form within fifteen (15) days of the accident. For the medical expenses she must submit all bills and receipts for expenses that were reasonably incurred.

(1) The First Schedule of the Principal Act #33 of 1986 sets out the composition of the Board. The Board shall consist of nine (9) members appointed by Cabinet as follows.

• Two members representing Government;
• Two members representing employers
• Two members representing employed persons
• Two members who have experience in matters relating to business administration, finance, accountancy or banking
• The Executive Director or in his absence the Deputy Executive Director

(2)The Principal Act #33 of 1986 Sec. 13 states that the Investment Committee shall consist of five (5) members as follows:

• The Chairman of the National Insurance Board who is also the Chairman of the Investment Committee
• The Executive Director of the National Insurance Scheme
• Three Board members who shall be nominated by the Minister with responsibility for National Insurance. Cabinet must approve these names.

(1) The National Insurance Scheme was established by Act # 33 of 1986. The Act is sub-divided into seven (7) sections as follows: -

• React to this conversation citing the relevant legislation to support your answer.

Case 24

O’Keefe and O’Reilly Co. is a partnership that was established on 4 th March 1989. They employ fourteen (14) persons in their business. They have been paying their contributions regularly. In 1998 Mr. O’Keefe approached you and said that he wanted to contribute on behalf of O’Reilly and himself. O’Keefe’s wife is also employed for about eighteen (18) hours a week on a contractual basis as a stenographer. O’Reilly’s son is employed as a pilot on his aircraft “Swandingo”, which transports goods weekly to the Grenadines.

Questions

(1) Advise Mr. O’Keefe about making contributions for himself and O’Reilly

(2) Should O’Keefe make contributions on behalf of his wife?

(3) Should O’Reilly’s son be registered as an employee?

Answers

(1) This case is based on SR&O #7 of 1997 – National Insurance (Classification) Regulations.

According to the First Schedule, the fourteen (14) regular employees are treated as employees. The issue at hand though covers Mr. O’Keefe and Mr. O’Reilly. As is indicated in the problem, O’Keefe and O’Reilly are partners and O’Keefe wants to find out about their contribution status. The Second Schedule of SR&O #7 of 1997 specifies employment in respect of which subject to the provisions of regulation 3(2) persons are treated as self-employed persons (O’Keefe and O’Reilly are not employees, they are the owners of the business)

As owners of the business they are covered by paragraph 3 of the Second Schedule which

sets out the conditions for such persons. These are: -

(i) where the person is employed as an agent paid by commission or fees:

(ii) where the person so employed shares in the profits or on any combination of profits and fees.

(iii) where the person employed is dependent for his/her livelihood from the business, other than as an agent.

(iv) where the person is employed by more than one employer as an agent and he is not treated as a regularly employed person.

Based on the above stipulations such a person is self-employed. For all intents and purposes O’Keefe and O’Reilly can make contributions as self-employed persons.

(2) Since O’Keefe’s wife is employed on a contractual basis for eighteen (18) hours a week, she can be classified as a regularly employed person provided that she receives salary over the minimum $60.00 a month and satisfies the other conditions for an employed person (between ages 16 – 60 etc.). She can also be classified as a self-employed person according to schedule 2 of #7 of 1997 section 6, which states that “employment of a married person, whether or not under a contract of service by or as a partner of, or in similar association with his or her spouse as the case may be where that employment is in trade or business and the spouse is ordinarily engaged therein for not less than sixteen (16) hours in a contribution week.” Since she is a stenographer for the business one may conclude that she is indirectly engaged in the business. If however, Mrs. O’Keefe falls outside the scope of that definition she is still covered under section 4 of the second schedule, which covers “employment under a contract of service by the insured person’s spouse.”

(3) O’Reilly’s son is employed as a pilot on “Swandingo.” According to the First Schedule, a pilot is classified under employment of a casual nature in section 6 (b), therefore, O’Reilly’s son should be registered as an employee.

• Which Company should pay Joni’s contribution?

• What records should Katash Ltd send to NIS for June and July? Why?

• Should Jason be treated as a regularly employed person? Why?

• What should happen to Jemima Enterprises’ contribution following the death of the owner, Mr. Jemima?

(1) Mr. Darby approaches you as an officer at the NIS regarding his operations. Advise Mr. Darby about his obligations

(2) What documents should Mr. Darby send to NIS on a monthly basis and at the end of the year?

(3) For which workers should Mr. Darby make deductions?