As a working adult in Malaysia, you would have definitely heard about SOCSO, the Malaysian government agency responsible for providing social security protection to employees in Malaysia.
This social security protection covers various cases and circumstances, for example: work related injuries, critical illnesses, and occupational diseases. It is important for you to understand your SOCSO benefits if you are an employee in Malaysia, especially on how you can claim SOCSO for critical illnesses like heart attacks, cancer, or in the event of an unfortunate death.
In this guide, we will walk you through everything you need to know about making a SOCSO claim for critical illnesses, from eligibility criteria to the claim procedure, and more.
What is SOCSO?
The Social Security Organisation (SOCSO), also known as PERKESO (Pertubuhan Keselamatan Sosial), established in 1971, provides social security protection by offering financial assistance to employees in Malaysia and their dependents in the event of illness, disability, accidents, unemployment, or death.
The organization operates under the Ministry of Human Resources and manages two main schemes: the Employment Injury Scheme and the Invalidity Scheme. The Employment Injury Scheme covers workplace accidents, while the Invalidity Scheme covers employees who are facing invalidity due to death or non-work related causes. Both schemes offer different types of benefits to eligible employees, including survivors' benefits, medical benefits, and temporary and permanent disablement benefits.
SOCSO claim for critical illness
Critical illnesses are severe medical conditions that require substantial medical treatment and often lead to long-term disability or death, like cancer or stroke. A patient that is diagnosed with critical illnesses will often find their daily and working life severely impacted, leading to pay cuts or even unemployment in some cases.
In such a situation, SOCSO will be of aid as it covers a range of critical illnesses, providing financial support to employees who are diagnosed with such conditions.
Some common critical illnesses that SOCSO covers include cancer, stroke, heart attacks, and kidney failure. But remember to check with a medical practitioner and SOCSO as regulations can and will change with time.
1. SOCSO claim for cancer
Cancer is one of the most common critical illnesses that is covered under SOCSO for employees in Malaysia. If you are diagnosed with cancer, you may be eligible to claim SOCSO benefits under the Invalidity Scheme, since cancer patients will find their working life significantly impacted.
The Invalidity Scheme provides monthly payments to employees who are unable to work due to a critical illness such as cancer. The amount that you can claim depends on the severity of your illness, and on your average monthly salary.
2. SOCSO claim for heart attack
A heart attack is a common critical illness that can result in sudden death and occurs when blood flow to a part of the heart is blocked, causing damage to the heart muscle. If you experience a heart attack that significantly impairs your ability to work, you can apply for SOCSO benefits as heart attacks falls under its Invalidity Scheme.
These benefits include financial support and access to necessary medical care. The claim amount and eligibility are influenced by your employment status, your SOCSO contributions, and the extent of your medical condition.
3. SOCSO claim for stroke
A stroke is another common critical illness that is covered by SOCSO and happens when the blood supply to part of your brain is interrupted or reduced, thus preventing your brain tissues from getting oxygen and nutrients.
SOCSO recognises stroke as a critical illness, and employees who suffer a stroke and are unable to return to work can apply for SOCSO benefits. These benefits depend on your eligibility and contribution, and may include a monthly pension, support for rehabilitation, and medical care.
4. SOCSO claim for kidney failure
Kidney failure, or end-stage renal disease (ESRD), occurs when your kidneys lose their ability to filter waste from the blood effectively. Patients with kidney failures will need to attend regular dialysis treatment, which is costly. This will also greatly affect a patient’s working life.
SOCSO provides coverage for kidney failure under its Invalidity Scheme, offering financial assistance to employees who are unable to work due to this condition. The benefits may cover dialysis treatment, hospitalization, and other necessary medical expenses needed for a kidney failure condition.
5. SOCSO claim for chronic liver disease
Chronic liver disease can severely impair liver function, leading to long-term disability. This includes conditions like cirrhosis and hepatitis. Employees that are diagnosed with chronic liver disease may be eligible for SOCSO benefits under the Invalidity Scheme.
This can include benefits like medical care, financial support, and in severe cases, a monthly pension if the illness prevents them from working.
Eligibility for SOCSO claims
Before you proceed with a SOCSO claim for critical illness, it is important for you to understand the eligibility criteria. The eligibility for SOCSO claims varies depending on the scheme under which you are claiming.
Here, we will cover some common criterias that you will most probably need. It is crucial to note to always check the criteria with Perkeso, as changes may take place with time.
General eligibility criteria
Employment status: to claim SOCSO, you must be a registered employee under SOCSO and contribute. Employers are required to contribute to SOCSO on behalf of their employees.
Contribution period: before you can claim SOCSO benefits, there is a minimum contribution period that must be met depending on the scheme.
Medical certification: a certified medical practitioner must confirm that you have a critical illness with a medical report. This is crucial in determining your eligibility.
Age limit: for the Invalidity Scheme, the age limit is typically 60 years. However, there are certain exceptions based on specific circumstances.
Specific Eligibility for Critical Illness Claims
Critical illnesses can have a significant impact on an individual's ability to work and maintain their financial stability. SOCSO provides essential support to employees diagnosed with such illnesses, to ensure that they receive the necessary assistance during challenging times. Below are the some requirements for claiming SOCSO for various critical illnesses:
Cancer: To claim SOCSO for cancer, a patient must be diagnosed by a registered medical practitioner. The employee must also be unable to work due to the effects of cancer, which could include the physical toll of the disease itself or the side effects of treatment such as chemotherapy or radiation.
A significant part of the claim process involves submitting a medical report that details the diagnosis, the extent to which the illness has affected the employee's ability to perform their job and the treatment plan. Depending on the case, SOCSO may require additional medical assessments to confirm the severity of the condition and the impact of the illness on the employee's earning capacity.
Heart Attack: Similarly to cancer and other critical illnesses, an employee must prove that he/she has suffered a significant loss of earning capacity due to the heart attack. This would mean that the heart attack has severely limited the person’s ability to work, or has left them completely unable to work.
To claim SOCSO for heart attack, the employee must provide a medical report by a certified medical practitioner. The report must be detailed and outline the nature of the heart attack, the treatment received, and the prognosis. SOCSO will then assess whether the employee's condition qualifies for benefits under the Invalidity Scheme.
Stroke: A stroke can lead to different undesirable aftermaths, like memory loss, paralysis, speech difficulties, and more. Depending on the severity of it, a patient may be eligible for SOCSO benefits, including medical treatment and financial support, especially if the stroke has made them unable to work, or has impacted their job performance. This illness must also be confirmed by a medical practitioner as a critical condition that has impaired the employee’s cognitive abilities.
Kidney failure: For kidney failure, also known as end-stage renal disease (ESRD), to claim SOCSO benefits, the condition of the patient must be severe enough that they require ongoing treatment such as dialysis or a kidney transplant. Just like the other illnesses, a certified report must be given to show that the patient’s ability to work was impacted, SOCSO may provide support for medical expenses, as well as a monthly pension if the illness leads to permanent disability.
Chronic liver disease: A medical report is required for any critical illness, like a chronic liver disease. Similarly, the patient’s condition must be severe enough to impact their working ability and their financial state. In order to approve a claim, SOCSO may require additional medical evaluations. Benefits from a successful claim may include financial assistance, coverage for medical treatment, and, in cases of permanent disability, a monthly pension.
SOCSO Claim Procedure
Knowing the SOCSO claim procedure for critical illnesses is vital to ensure that your claim is both processed efficiently and approved. Here's a step-by-step guide on how to claim SOCSO for critical illness:
Step 1: Obtain Medical Certification
The first step in the SOCSO claim procedure is to get properly diagnosed. This includes getting a medical certification from a registered medical practitioner. The doctor will assess your condition and provide a medical report that confirms your critical illness, and how it affects your work.
Step 2: Notify Your Employer
Once you have the medical certification by your doctor, your next step is to inform your employer about your condition. Your employer will then be required to submit a claim to SOCSO on your behalf, and/or provide an employer's report on the matter.
Step 3: Submit the Claim
You or your employer must submit the SOCSO claim form along with the medical report and other necessary documents to the nearest SOCSO office. The documents required may include:
Medical report
Employer report
Employment details
Identity card (MyKad) copy
Bank account details
SOCSO claim form
Step 4: SOCSO Assessment
After receiving your claim, SOCSO will then assess your eligibility. This step may involve further medical examinations or interviews.
Step 5: Claim Approval and Payment
If your claim is approved, SOCSO will credit the benefits directly to your bank account. The payment amount depends on a number of conditions, like your average monthly wage, the severity of your illness, and other factors.
Conclusion
If you or someone you know has been diagnosed with a critical illness, be sure to make a claim to SOCSO, which offers social security protection for the effects of the condition. The benefits can include monthly payments, help with treatment, and more.
The eligibility for SOCSO depends on the severity of each case, and a number of other factors. Before making a claim, be sure to check with the organization on the procedure and required documents.
FAQs
1. What is claimable under SOCSO?
SOCSO covers a wide range of claims, including occupational diseases, critical illnesses, work-related injuries, accidents, and also death. Benefits of a SOCSO claim can include medical care, temporary and permanent disability benefits, invalidity pension, survivors' pension, funeral benefits, and more.
2. Can I claim SOCSO after 60 years old?
Depending on the scheme, the general age limit is 60 years. However, if you were diagnosed with a critical illness before reaching 60, you may still be eligible to claim SOCSO benefits.
3. How to claim SOCSO medical?
To claim SOCSO medical benefits, you must first obtain a medical report from a registered practitioner. Submit this report along with the SOCSO claim form to your employer, who will then submit it to SOCSO. After this, SOCSO will assess your claim and provide the needed benefits.
4. Can we claim SOCSO after resignation?
Yes, you can claim SOCSO benefits even after resignation, provided that the illness or injury occurred while you were still employed and contributing to SOCSO.
5. How do I get a refund from SOCSO?
Refunds from SOCSO are generally unavailable as contributions are meant to provide coverage and benefits for an illness or accident. However, if you notice an overpayment or incorrect deduction, you can contact SOCSO directly to address the issue.
6. How do I claim SOCSO for loss of employment?
SOCSO provides an Employment Insurance System (EIS) that offers financial assistance to those who have lost their jobs. To claim this:
Register with EIS
Submit a Claim
Provide Required Documents
Attend an Interview
Receive Payments
7. How much can I claim from SOCSO for death?
SOCSO provides a Survivors' Pension to the dependents of a deceased employee in the event of death due to critical illness, or a work-related incident. The amount that is credited is typically calculated as a percentage of the deceased’s average monthly salary.
8. Does SOCSO cover disability?
Yes, SOCSO covers disability. Depending on the nature of the disability, if an employee is permanently disabled due to a critical illness or a work-related injury, they may be eligible for Permanent Disablement Benefits or Invalidity Pension.
9. Can I claim SOCSO for an accident at home?
SOCSO in general, covers accidents that occur in the workplace or while commuting to and from work. However, accidents that occur at home are not usually covered unless you are working from home, and the accident that took place is directly related to your job. In such a situation, it is advisable to check with SOCSO for their guidelines.
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