Perhaps the busiest portal within Social Security is the benefits window. This is the point through which all claims enter the system. They have processed literally millions of claims, the last 3,400 within the first quarter of 2008.
It is an efficient department. The clerk who receives the claim casts a very practiced eye over the claim form, checks his computer and releases the customer in less than a minute once the information is in order. But he has help; the forms are colour coded – yellow for sickness, pink for maternity, blue for invalidity, green for medical expenses, white for employment injury and for Age pension. The only place I can recall seeing such colour coding is at airport control towers. The analogy is not lost on me, both times we are trying our hardest to land on our feet.
The system has changed over the years. The most important one being that the worker is no longer obligated to send the form through the employer (except for government workers). This has speeded up the receipt of the claims and cut down on our response time to the extent that we can say that most claims are processed within 2 days when the law requires us to do so within 10 working days. The employer’s input is required only in the case of injury on the job and for persons with more than one employer.
During our public consultations, some persons had a problem with Social Security not paying for sickness on a Sunday. That is incorrect. Social Security breaks down all wages into weeks, and a week for us is 6 days. Therefore, if a person who qualifies works for $250.00 per Monday to Friday, his daily wage becomes $41.67 (the wage is divided by 6 to include the Saturday because a Social Security week is Monday to Saturday). If that person is off work, sick from Friday to Thursday of the next week, his benefit becomes $162.50 (65% of $41.67 multiplied by 6). He gets paid by his boss for the Friday that he returns to work. If the Sunday was included, he would have received the same money. That is, $250.00 divided by 7 multiplied by 7 and 65% of that). Nothing is lost!
Claims can be “extinguished”. In other words, they have expiry dates. Claims must be submitted within six months or else they cease to be valid. And late claims are only honoured with three months back payment (usually pensions). So to delay is dangerous.
A key player in the management of claims is your medical doctor (and ours). In fact, a comment we heard at a consultation sums up the role of the doctor. “if de doctor watch you in your face and sign say you dead, you dead!”. Your doctor triggers the claim because he or she is the only person by law who can say you’re sick, diseased, dis-eased or deceased. He or she is the only one who can say you are pregnant, even if we watch the baby being born.
I must confess though that sometimes we wonder about things to the extent that we ask our doctors to verify what we see. We saw records of 225 maladies for the first 3 months of this year. The major ones were viral illnesses, influenza, hypertension, back pains and respiratory infections. I call upon our health authorities to begin to tell us what to do about these things as we go about our day to day lives
I cannot stress the role of the doctor enough. Some members of the public accuse us of discriminating against certain doctors. We do not. By law we only honour claims that are certified by a doctor who is authorized to practice by the medical board of the Federation. Claims from a practitioner who is uncertified by the medical board will not be honoured, even if the practitioner is in possession of a business licence. I will also appeal to the doctors to explain to their patients. Do not send them to us if they should not come to us. Do not make us the “fall” guys.
Claims are as important to us as they are to you. They tell us what you become sick from (not who you become sick of), what bothers you on the job (apart from nosey coworkers); about your reproductive behaviour and your life span. We are then able to inform and guide relevant sectors of the economy using the general data. We do not disclose your personal information. In fact, there is a thick SR&O governing the management of benefits that has had two amendments to date. And we have paid $30 million for claims in 2007. It is our major expenditure item and is indeed our raison d’etre.
One of the most misunderstood claims is perhaps that for Non-Contributory Assistance Pension, NCAP. It is the EC$210.00 per month that is paid to persons who are considered in need. It is maligned because of the amount paid, and it is maligned because it is needs assessed and everybody has needs. The truth is that it is intended to relieve abject poverty. An applicant is not to be denied on the basis of their agility, their assets, their children or the whereabouts of their children. The burden of proof lies with the applicant to demonstrate their need. You convince us, we pay. Four of the 12 persons who applied last quarter convinced us of their need and are now in receipt of the NCAP.
When I spoke to the manager of the Benefits Department, he said to me that ‘we cannot afford to get it wrong’. He is right. Too many people depend on us for too many things. And we have been doing it for too long not to do it properly.
On your part, get to know your rights!