Social Insurance Law
PART 1: THE CONSOLIDATED ACT ON SOCIAL INSURANCE
CHAPTER V INSURANCE BRANCH AGAINST EMPLOYMENT INJURIES
The social insurance against employment injuries shall be financed by the following :-
1- the monthly contributions which the employer shall be required to pay to the General Organisation at the rate of 3% of the monthly wages of his workers. The employer alone shall be responsible for the payment of this contribution;
2- profits from the investment of the contributions referred to in the foregoing paragraph. .
The percentage rate of the contribution stipulated in sub-paragraph 1 of the previous Article may be reduced by one-third when permitted by Order of the Minister for Labour and Social Affairs on the agreement of the Board of Directors, in respect of an employer who bears the cost of the daily allowance in the case of injury and the transportation expenses.
Further, the contributions may be reduced by the same percentage as prescribed in the previous paragraph if the employer undertakes to provide the medical care prescribed in the following Article 50, if he owns a private hospital for the treatment of his workers. The reduction shall be by Order of the Minister for Labour and Social Affairs on the agreement of the Board of Directors.
The rate of contribution stipulated in Section 1 of the previous Article may be increased by up to twice thereof in respect of those employers who refuse to comply with the instructions issued by the appropriate authorities on the subject of worker's safety and health. The actions for implementation of the preceding paragraph shall be determined by Order of the Minister for Labour and Social Affairs.
PART 2 Medical Care
a-The General Organisation shall undertake to provide medical are to the insured in the event of employment injury, and medical care shall include :-
1- the services of general practitioners, specialists and medical aids and related services dental services diagnostic examinations of any kind or nature; admission of the injured to hospital or his treatment and medication in a convalescence centre or in any other appropriate establish-ment within the appropriate social insurance grade, the details of which shall be determined by Order of the Minister for Health in agreement with the Minister for Labour and Social Affairs. The injured may remain at a higher grade by paying the difference provision of medicines and the required medicinal materials; provision of artificial limbs and the like, including eye glasses, or any medical or surgical fittings to correct the injury as required by the condition of the injured person as a result thereof, and the maintenance and renewal of such items as the case may be;
2- the transportation expenses of the injured person from the place of work or from his dwelling to the medical centre, hospital or physician's clinic, etc., whereat he can receive the treatment called for by his condition, as well as the expenses of his return therefrom by normal means of transport. The methods of calculation of transportation expenses shall be determined by Order of the Minister for Labour and Social Affairs based on the agreement of the Board of Directors.
b-The General Organisation also undertakes to provide medical care without time limitation and for as long as the condition of the injured person requires until cured or his condition stabilizes by proof of permanent disability or death, whichever is earlier.
c-The employer shall be required to provide first aid to the injured and shall, for this purpose, make all the necessary arrangements for the discharge of this obligation, taking into consideration the number of workers he employs and the occupational hazards inherent in the performance of the operations carried out in his enterprise and in accordance with the conditions and circumstances as determined by the Labour Law.
The employer shall also be required to transport the injured to the designated treatment centre on the occurrence of an injury.
Without prejudice to the second paragraph of Article 48, medical care shall primarily be provided by Public Health Centres of the appropriate social insurance grade and, if not available, the General Organisation shall provide such care at its own expense without any change to the injured at such private clinics or hospitals as may be designated.
In case of emergency, the injured may have recourse to any doctor or to any private clinic; the General Organisation shall bear the ensuing expenses, provided that it shall be notified within three days from the date on which this right is exercised, save if exceptional circumstances shall prevent such notification; in which case this period shall be extended accordingly.
The General Organisation may conclude certain agreements with the Ministry of Health and with doctors and private clinics and hospitals for the provision of medical care in accordance with fees to be fixed per case classified into grades or by lump sum, as per the rules which shall be issued by Order of the Minister for Labour and Social Affairs with the agreement of the Minister for Health and the Board of Directors.
The employer shall pay the wage for the day of the injury irrespective of the time of its occurrence, and the General Organisation shall bear thereafter the daily allowance and pay it at the times established for the payment of wages for the duration of the incapacity of the injured to perform work or until he recovers or his condition stabilizes by proof of permanent disability or occurrence of death, whichever is earlier.
In the definition of injury shall be included any relapse of his condition or compounding thereof and also every condition of an occupational disease, as specified in Schedule 3 attached, which may manifest itself within a period of one year from the date of termination of service of the insured and whether these symptoms became apparent whilst he is unemployed or was engaged in industry or his occupation or any other activity unrelated to this disease.
The daily allowance shall equal 100% of the contributory daily wage of the injured insured, and shall be paid for the duration of the incapacity resulting out of the employment injury or, in the case of relapse of the injury or the complication thereof. * The new text was passed by Decree Law No. 1/1985 published in the Official Gazette No. 1625 of 10 January 1985. The daily allowance shall be calculated on the basis of the monthly wage used for payment of the contribution divided by thirty (30) and the General Organisation shall be responsible for its payment to the injured
There shall be no entitlement to the daily allowance for the injury or to compensation for permanent disability in the following cases:
1- if the insured intentionally inflicts upon himself an injury or mistreats his injury;
2- if he refuses to abide by the medical instructions necessary for his treatment or to submit to medical examinations or if he refuses to abstain from activities which his health does not permit.
except that as a result of the injury death occurs or the residual permanent disability exceeds 25% of the permanent total disability.
The above mentioned conditions may not be taken into consideration unless proven by investigation which shall be conducted in accordance with Article 63..
In the case of permanent partial disability resulting from an employment injury which is less than 30% of permanent total disability, the injured shall be entitled to receive lump sum injury compensation equal to thirty-six times the monthly pension for permanent partial disability which he could have claimed under Article 56 hereinafter in accordance with the percentage of the resultant disability.
The employer is not entitled to terminate the employment of the worker as a result of the partial disability stated in the preceding paragraph..
In the case of permanent partial disability resulting from an employment injury which is equivalent to or in excess of 30% but less than total permanent disability the injured shall be entitled to receive a monthly pension equal to the percentage of the disability and proportionate to the pension payable for the total permanent disability. The insured shall receive his pension together with his wages received from employment without limitations so long as the percentage disability does not reach total permanent disability.
In the case of permanent total disability or death resulting from an employment injury, the insured shall be entitled to a monthly pension equivalent to 80% of his wage, subject to the contribution. * The ratio was raised to 80% by Prime Ministerial Edict No. 11/1989 published in the Official Gazette No. 1851 of 18/5/1989.
The pension for permanent total disability or death for those who work without pay or for those who earn the statutory minimum wage shall be 30 Dinars per month.
The percentage of permanent partial disability shall be determined in accordance with the following rules :-
1-if the disability is prescribed in Schedule 2 attached to this Law, then the percentage shown as a degree of total disability shall be taken into account; if the disability is not mentioned in the aforementioned Schedule, then the percentage shall be estimated on the degree of loss of earning due to the incapacity of the injured, and this percentage shall be stated in the Medical Certificate;.
2- if the residual disability has a special effect on the capacity of the injured to earn in his original occupation then it is necessary to explain the alternative type of work which the injured may perform and any effect this may have in increasing the degree of disability in these circumstances over the percentages stated in the Schedule 2 attached to this Law. The Schedule 2 referred to in paragraph 1 above and also the Schedule 3 referred to in the second paragraph of Article 52 may be altered by Order of the Council of Ministers on the recommendation of the Minister for Health in agreement with the Minister for Labour and Social Affairs.
If the injured has sustained a previous injury or if there is a relapse of his injury or if his injury has deteriorated, the following rules shall be observed in respect of his present injury :-
1-if the percentage of the disability resulting from his present injury and previous injuries is less than 30%, the injured shall be compensated for the latest injury on the basis of the percentage of the residual disability by itself and of the wage subject to the contributions at the time of the latest injury; .
2-if the percentage of the disability resulting from his present injury and the previous injuries is equivalent to 30% or more, then the injured will be treated as follows :-
a-if the injured has been compensated for his previous injury by lump sum compensation, the pension shall be calculated on the basis of the percentage residual disability of all his injuries and the wage subject to the contribution at the time of the last injury;
b-if the insured was entitled to a disability pension, his pension shall be calculated on the basis of the percentage residual disability of all his injuries and the wage subject to the contribution at the time of the last injury, provided that this pension shall not be less than the pension for the previous injury.
The percentage of the permanent disability shall be determined according to the nature of the residual disability of the injured, his general condition, his age and occupation, his physical and mental aptitudes, and occupational capabilities and qualifications. This shall be determined by reference to Schedule 2 attached. Compensation and pensions for permanent disability shall be granted on a temporary basis, and the General Organisation shall subject the injured person to periodical medical examinations in the course of the first four years from the date of ascertainment of the disability, unless the Medical Board has determined the unlikely event of any change taking place during this period. Period of permanent disability and the degree thereof or the occurrence of any change thereto or the recovery of the injured or his return to work shall be by a certificate issued by the Designated Medical Board.
In the case of a change of the degree of disability on medical re-examination in accordance with the preceding Article, the following rules shall be observed :-
1- if the insured is a recipient of a pension, the disability pension shall be altered or shall cease with effect from the first of the month following the ascertainment of the latest degree of disability, or in accordance with what transpires from the medical re-examination and of the effects it may have on the degree of disability of either an increase or decrease therein dependent upon the case; and if the degree of disability has decreased below 30%, the payment of the pension shall finally cease and the injured shall be granted a lump sum compensation in accordance with the provision of the preceding Article 55;
2-if the insured has previously been compensated for a degree of disability fixed initially by a lump sum compensation the following rules shall be observed :-
- where assessed degree of disability upon re-examination exceeds the degree of disability estimated previously and it is less than 30%, the injured shall be entitled to compensation on the basis of the latest degree and of the wage taken for the contribution or of the determination of the disability for the first time less the compensation already paid to him. Any reduction of the degree of disability from the previously estimated degree shall have no effect whatsoever;
-where the assessed degree of disability upon the re-examination amounts to 30% or more, the injured shall be entitled to a disability pension computed in accordance with the provisions of Article 56 on the basis of the wage at the time of determination of the disability for the first time. The pension shall be paid to him with effect from the first of the month following the date of determination of the latest degree of disability less the difference between the previous compensation paid to him and the value of the pension on the assumption that it was due to him on the basis of the degree of disability determined for the first time, and that repayment shall be within 25% of the monthly pension until the repayment of compensation paid to him previously.
In the case of an injury to the insured necessitating his discontinuance of work for treatment, the employer shall be required to notify the accident within 24 hours to :-
1-the Police Station within whose area of jurisdiction the injury occurred;.
2-the General Organisation.
The insured shall make this notification if his state of health so permits. The notification in all cases shall be in accordance with the proforma prescribed for this purpose and an Order of the Minister for Labour and Social Affairs, on the submission of the Board of Directors, shall specify the particulars to be contained therein. The Police Station or the authority investigating such notification referred to in the preceding paragraph shall prepare a proces-verbal of the investigation in respect of every notification which shall be in duplicate. The investigation shall at least include the name of the insured (upto four names), his permanent insurance identification number, occupation, address, nationality, his wage on the date of the injury on the basis of which his monthly social insurance contributions were made, together with a brief description of the accident, the causes thereof, the appropriate actions taken for first aid or treatment, the circumstances of the accident, the statements of witnesses, whether the accident was the result of deliberate misconduct or an immoral act and so intended by the injured, and the investigation shall also record the statements of the employer or his representative and the statements of the injured if his condition so permits. Such authorities shall provide the General Organisation with a certified copy of the proces-verbal and it may request completion thereof if it is so deemed necessary
The insured who is injured shall be required to inform the employer or his representative immediately even if the injury does not prevent him from continuing at work. Where the injury occurs outside the work place, the insured shall be required to notify the police station within whose area of jurisdiction is located the place whereat the injury occurred, as soon as his condition permits. Where the injury precludes the injured from so notifying, it may be so notified by anyone on his behalf.
The employer shall place a notice in a prominent position in the work place in Arabic and in a foreign language stating the designated medical facility for the treatment of his workers and the procedure which they must follow in case of an injury either within the work place or outwith it.
The treatment of the insured in case of injury shall be either in the hospital of the employer who has been allowed the reduction specified in the second paragraph of Article 48 or in the appropriate social insurance grade at one of the public hospitals based on the agreements which are entered into by the Minister for Labour and Social Affairs and the Minister for Health as proposed by the Board of Directors. The General Organisation may conclude contracts with private hospitals or specialist doctors for the provision of medical care to the injured in accordance with the agreements entered into by the Minister for Labour and Social Affairs with the concurrence of the Board of Directors
The agreements and contracts entered into with the appropriate medical authorities mentioned in the preceding Article shall include the obligations of such authorities for the following :-
1-the treatment shall be in accordance with the medical standards which conform to the provisions of the law;
2-for the provision of necessary documents recording the condition of the injured, the whereabouts of the treatment and its duration, the date of return to work and the assessment of degree of disability in accordance with the timetable and in the format of the specimens which shall be determined by the Minister for Labour and Social Affairs with the occurrence of the Board of Directors;
3-to maintain the documents of treatment in respect of the injured and to present the same to the General Organisation upon request. The appropriate medical authorities shall preserve these documents for a period of five years.
The daily allowance referred to in the aforementioned Article 53 shall be paid if the injury prevents the insured from performing his work and which is supported by a medical certificate from the appropriate medical authorities.
The payment of the daily allowance referred to in the preceding paragraph shall be paid periodically in accordance with an Order made by the Minister for Labour and Social Affairs with the concurrence of the Board of Directors, and this Order shall also determine the details of the medical certificate referred to.
The insured shall be entitled to the daily allowance for the duration of his absence from work by reason of the fitment or maintenance or change of compensatory organ or artificial limb, and this shall be on the basis of his contributory wage upon the date of such absence. If the insured was a pensioner, the pension shall cease for the duration of his entitlement to the daily allowance unless the allowance was less than the pension where the pension shall be continued, provided that the period of interruption referred to in the preceding paragraph is certified by a doctor of the public hospital or of the hospital wherein he received treatment.
The General Organisation shall bear the return transportation expenses of the injured from the place of work or residence to :-
1-the place where he is receiving treatment the place where the diagnostic tests are being carried out the place where the laboratory or medical tests are being carried out for the fitment of compensatory organs or for training him in their use
2-the place for the assessment of the degree of disability.
The transportation expenses shall be paid for normal means of transportation or of the mode which the doctor considers appropriate for the state of health of the injured, and such expenses shall be paid periodically in accordance with what shall be determined by Order of the Minister for Labour and Social Affairs with the agreement of the Board of Directors.
The injured person, the appropriate medical authority and the General Organisation each is entitled to request a medical re-examination to review the injury medically once in every six months during the first year from the date of certification of the disability and thereafter once every year during the following three years. The medical board concerned shall re-evaluate on each occasion the percentage of disability; and after the lapse of four years from the date of the certification of the disability such evaluation shall be final. The medical re-examination shall be undertaken by the competent Medical Board concerned.
The injured insured may request the General Organisation to reconsider the decision of the appropriate medical authority within one week from the date of the completion of treatment, or of the date of return to work or of not being afflicted with an occupational disease; and within one month from the date of the notification to him of a nil disability or, of the assessment of its degree. The request shall be accompanied by a medical certificate supporting his view point.
The General Organisation shall convey the request referred to in the preceding Article to the Appellate Medical Board, and this body shall notify the injured of its decision by registered letter with recorded delivery within one week at the latest from the date of receiving the decision. Such decision shall be final and binding on both parties and the Organisation shall discharge whatever obligation it may then have.
The General Organisation may cease payment of a disability pension with effect from the first of the month following the date specified for the medical re-examination by the designated Medical Board should the pensioner not present himself for the re-examination required by the General Organisation at the time advised to him or if he refuses to submit to the treatment, or to the visits or to medical examinations, of if he abstains from attending regularly rehabilitation which is decided upon by the designated Medical Board or if he does not abstain from practising any activity not permitted by the decision of such Board. The cessation of the pension shall continue until the elimination of its causes or until the pensioner presents himself for re-examination. If the examination results in reducing the degree of disability in relation to the previous assessment, the new degree shall be used for settlement effective from the date established for the medical re-examination. The General Organisation may disregard the non-attendance of the injured for re-examination if hepresents acceptable reasons. The payment due for the period of cessation shall accord with the result of the medical re-examination