“THE REDUCTION OF DENIAL RATE IN THE AVAILMENT OF CLAIMS FOR MEDICAL REIMBURSEMENT/HOSPITALIZATION EXPENSES AMONG UNIFORMED PERSONNEL IN BFP-NCR THROUGH INFORMATION DRIVE.” September 2022
Type
Thesis
Authors
Category
FOAC Research
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Publication Year
2022
Publisher
NFTI Library, Philippines
Pages
2
Subject
Research
Abstract
ABSTRACT
A considerable number of uniformed personnel assigned with Bureau of Fire Protection-National Capital Region (BFP-NCR) sustained injuries and contracted various diseases while in active duty in the years 2020 to 2021. Because of these, they incurred expenses for their medication and hospitalization expenses. In order to lighten their predicaments brought by their sickness or injuries, they filed a claim for medical reimbursement/hospitalization expenses with an understanding and expectation that they can be paid pursuant to existing rules and policies pertaining to said claims. Moreover, this endeavor is one way of enhancing welfare and granting reasonable benefits to the personnel in the BFP. As such, they submitted their claims to the Regional Office of BFP-NCR through the Regional Claims and Adjudication Committee (RCAC). The RCAC is created in every BFP region whose function is to deliberate, review, assess, and evaluate claims for medical reimbursement/hospitalization expenses whether the same is in compliance with applicable laws and policies. Upon careful deliberation and evaluation of all the requirements submitted to support their claims, the RCAC shall issue a committee resolution granting or denying a claim. Surprisingly, with the total number of seven (7) claims for 2020-2021, none of these was granted. In other words, all claims were denied to the detriment of the claimants. The injury or sickness contracted is not mainly in connection with the performance of his duty or by reason of his office or position.
The researchers were able to determine the main reasons why the claims for medical reimbursement were denied is that such injury or sickness was not sustained while in the performance of duty or by reason of office and non-compliance with documentary requirements provided for under existing policy on reimbursement. Moreover, the researchers were able to discover that as early as 2018 the BFP issued a memorandum suspending the processing of claims for reimbursement of medical/hospitalization expenses except for fire operations-related injuries because of the Audit Observation Memorandum (AOM) of the Bureau of Fire Protection-Commission on Audit (BFP-COA). It was also discovered that prior to the issuance of a Memorandum relative to suspension of processing of claims for medical reimbursement/hospitalization expenses except for fire operations-related injuries, the BFP sought legal opinion from the Department of Justice (DOJ) in order shed light on the matter. In response, the DOJ was hesitant to render a legal opinion since the matter was within the jurisdiction and expertise of the BFP-COA, hence, pending resolution of the AOM, the BFP opted to suspend the said processing of claims for medical reimbursement except for fire operations related injuries.
Interestingly, despite these memoranda, claimants have another avenue where to file a claim, and that is to lodge a claim at the Employees’ Compensation Commission (ECC). In ECC Circular No. 13-807-A or Advisory issued by ECC Executive Director on August 7, 2013, it announced to the public that the uniformed personnel is covered under the Employees’ Compensation Program (ECP) despite their exclusion from the coverage of Republic Act No. 8291 or the GSIS Act of 1997. It emphasized in the said advisory that in the event of work-connected sickness, injury, or death, the person or his beneficiary may avail of their employees’compensation (EC) benefits at any GSIS office.
The researchers came up with these recommendations such but not limited to effective information dissemination on the updated policies and guidelines pertaining to claims for medical reimbursement and hospitalization expenses, the coverage of ECC as regards uniformed personnel, periodic seminar for the RCAC members, the inclusion of medical reimbursement claims as a subject to the orientation course of the newly hired BFP personnel and amendment of RA 6963 or legislation of law that gears toward additional benefits and welfare enhancement of BFP.
Somehow, this research is considered an intervention to this high denial rate of claims for medical reimbursement/hospitalization expenses. Its recommendations will surely enhance the welfare of the personnel and will drive the same to work well with passion and enthusiasm for the betterment of the whole organization.
A considerable number of uniformed personnel assigned with Bureau of Fire Protection-National Capital Region (BFP-NCR) sustained injuries and contracted various diseases while in active duty in the years 2020 to 2021. Because of these, they incurred expenses for their medication and hospitalization expenses. In order to lighten their predicaments brought by their sickness or injuries, they filed a claim for medical reimbursement/hospitalization expenses with an understanding and expectation that they can be paid pursuant to existing rules and policies pertaining to said claims. Moreover, this endeavor is one way of enhancing welfare and granting reasonable benefits to the personnel in the BFP. As such, they submitted their claims to the Regional Office of BFP-NCR through the Regional Claims and Adjudication Committee (RCAC). The RCAC is created in every BFP region whose function is to deliberate, review, assess, and evaluate claims for medical reimbursement/hospitalization expenses whether the same is in compliance with applicable laws and policies. Upon careful deliberation and evaluation of all the requirements submitted to support their claims, the RCAC shall issue a committee resolution granting or denying a claim. Surprisingly, with the total number of seven (7) claims for 2020-2021, none of these was granted. In other words, all claims were denied to the detriment of the claimants. The injury or sickness contracted is not mainly in connection with the performance of his duty or by reason of his office or position.
The researchers were able to determine the main reasons why the claims for medical reimbursement were denied is that such injury or sickness was not sustained while in the performance of duty or by reason of office and non-compliance with documentary requirements provided for under existing policy on reimbursement. Moreover, the researchers were able to discover that as early as 2018 the BFP issued a memorandum suspending the processing of claims for reimbursement of medical/hospitalization expenses except for fire operations-related injuries because of the Audit Observation Memorandum (AOM) of the Bureau of Fire Protection-Commission on Audit (BFP-COA). It was also discovered that prior to the issuance of a Memorandum relative to suspension of processing of claims for medical reimbursement/hospitalization expenses except for fire operations-related injuries, the BFP sought legal opinion from the Department of Justice (DOJ) in order shed light on the matter. In response, the DOJ was hesitant to render a legal opinion since the matter was within the jurisdiction and expertise of the BFP-COA, hence, pending resolution of the AOM, the BFP opted to suspend the said processing of claims for medical reimbursement except for fire operations related injuries.
Interestingly, despite these memoranda, claimants have another avenue where to file a claim, and that is to lodge a claim at the Employees’ Compensation Commission (ECC). In ECC Circular No. 13-807-A or Advisory issued by ECC Executive Director on August 7, 2013, it announced to the public that the uniformed personnel is covered under the Employees’ Compensation Program (ECP) despite their exclusion from the coverage of Republic Act No. 8291 or the GSIS Act of 1997. It emphasized in the said advisory that in the event of work-connected sickness, injury, or death, the person or his beneficiary may avail of their employees’compensation (EC) benefits at any GSIS office.
The researchers came up with these recommendations such but not limited to effective information dissemination on the updated policies and guidelines pertaining to claims for medical reimbursement and hospitalization expenses, the coverage of ECC as regards uniformed personnel, periodic seminar for the RCAC members, the inclusion of medical reimbursement claims as a subject to the orientation course of the newly hired BFP personnel and amendment of RA 6963 or legislation of law that gears toward additional benefits and welfare enhancement of BFP.
Somehow, this research is considered an intervention to this high denial rate of claims for medical reimbursement/hospitalization expenses. Its recommendations will surely enhance the welfare of the personnel and will drive the same to work well with passion and enthusiasm for the betterment of the whole organization.
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