Letter to a Lawyer:

Dear Attorney,

I hope this letter finds you well. I am writing to seek your legal advice regarding an issue with my previous employer. Specifically, I did not receive the SSS sickness benefit that I am entitled to as mandated under Philippine labor laws. Despite my efforts to follow up with my former company, the issue remains unresolved.

I would like to know whether I can file a complaint with the National Labor Relations Commission (NLRC) to recover this unpaid benefit. I also wish to understand the process involved, any associated costs, and what my legal options are in pursuing this matter.

Your guidance on this concern will be greatly appreciated.

Sincerely,
A Concerned Employee

Understanding the Legal Recourse for Unpaid SSS Sickness Benefits

The situation you have described falls under an essential facet of Philippine labor law, specifically the entitlement of employees to Social Security System (SSS) benefits, including the sickness benefit. Employers are obligated to ensure that employees receive their rightful benefits as mandated by law. Failure to provide these benefits is a serious violation that may warrant filing a case with the NLRC or other appropriate government agencies.

This article comprehensively addresses your concerns, starting with the SSS sickness benefit framework, the employer's obligations, remedies available for employees, and the role of the NLRC in resolving disputes related to unpaid benefits.

What is the SSS Sickness Benefit?

The SSS sickness benefit is a daily cash allowance paid by the SSS to a qualified employee who is unable to work due to sickness or injury. To qualify, the employee must meet the following conditions:

SSS Membership and Contributions: The employee must be an SSS member with at least three monthly contributions within the 12-month period preceding the semester of sickness.
Sickness/Injury Certification: A qualified physician must certify the sickness or injury.
Notification: The employee must notify their employer about the sickness or injury within five calendar days or directly notify the SSS if separated from employment.
Confinement Period: The employee must have been confined for at least four days due to sickness or injury.

Employers act as intermediaries in filing and advancing the sickness benefit to employees, reimbursing the amount from the SSS upon approval.

Employer Obligations Under SSS Laws

Under the Social Security Act of 2018 (RA 11199), employers are legally required to:

Advance Payment: Pay the sickness benefit in advance to the employee within 30 days of filing a valid claim.
Timely Submission: File the sickness benefit claim with the SSS within a specific period.
Compliance: Ensure proper remittance of monthly SSS contributions, as failure to comply can affect the employee’s eligibility for benefits.

Employers who neglect these responsibilities may be held liable for violations of labor and social welfare laws.

Can You File a Complaint with the NLRC?

Yes, an employee can file a complaint with the NLRC under certain circumstances. The NLRC has jurisdiction over claims involving employer-employee relationships, particularly if there is an issue of non-payment of legally mandated benefits. Below are detailed steps and considerations:

Scope of NLRC Jurisdiction:
- Cases of non-payment or underpayment of wages, benefits, or other monetary claims fall under the NLRC's jurisdiction.
- SSS-related claims that involve the employer’s refusal or failure to advance benefits to the employee may qualify.
Pre-Complaint Requirements:
- Documentation: Gather all relevant documents, such as medical certificates, employment contracts, pay slips, SSS records, and written communications with the employer regarding the unpaid benefit.
- Demand Letter: Consider sending a demand letter to the employer first, stating your claim and requesting immediate compliance. This can serve as evidence of good faith and an attempt to resolve the issue amicably.
Filing a Complaint:
- File a formal complaint with the nearest NLRC office. Include a detailed narration of facts, supporting documents, and the specific relief sought (i.e., payment of the unpaid sickness benefit).
- The NLRC will require you and your former employer to attend a mandatory conciliation/mediation conference to resolve the issue before formal adjudication.
Other Avenues:
- If the primary issue pertains solely to SSS and does not directly involve the employer-employee relationship, the case may instead fall under the jurisdiction of the SSS or the Social Security Commission (SSC).

SSS and Social Security Commission Complaints

If your employer failed to advance the benefit but the SSS approved the claim, you may directly address the issue with the SSS. The Social Security Commission, which oversees the SSS, can also hear complaints involving violations of RA 11199. To file a complaint:

Submit a written complaint to the SSS, detailing the employer’s non-compliance.
Provide all supporting documentation.
The SSS may investigate and impose penalties on the employer, including fines or imprisonment for serious violations.

Legal Remedies Available

Restitution of Unpaid Benefits:
- Employees are entitled to the unpaid sickness benefit plus any applicable penalties, such as legal interest for delayed payments.
Administrative Penalties for Employers:
- Non-compliant employers may face administrative fines, revocation of business permits, or criminal liability for willful violations of RA 11199.
Civil Claims:
- In extreme cases, employees may pursue civil claims for damages resulting from the employer’s negligence or bad faith.

Timeframes and Costs

Employees should act promptly as labor-related claims are subject to prescriptive periods. Claims involving monetary benefits must generally be filed within three years from the time the cause of action accrued.

Filing fees for NLRC complaints are minimal, and employees may represent themselves in the proceedings. However, legal assistance is advisable for complex cases.

Key Takeaways

Legal Rights: Employees are entitled to sickness benefits under the Social Security Act of 2018, and employers are obligated to comply.
Recourse: The NLRC, SSS, and SSC provide avenues for addressing non-payment issues.
Documentation: Prepare comprehensive evidence before filing a complaint.
Deadlines: Act within the prescribed periods to avoid dismissal due to technicalities.

Addressing unpaid SSS sickness benefits is a matter of enforcing workers’ rights and ensuring compliance with labor and social welfare laws. If unresolved through initial steps, pursuing a case via the NLRC or SSC is a legitimate course of action.