Two Branches of GOSI:
- Annuity Branch – Pension Insurance Retirement plan for Saudi
- Occupational Hazard Branch (OHB) – Insurance benefits for workers who meet accidents and injured while performing their respective duties. It is also compulsory to all Saudi nationals and Expatriates to be covered with GOSI regardless of profession, sex, nationality and age.
What is the status of pensions and benefits previously paid before the implementation of the new law (Social Insurance Law)
The insured person or entitled family members receiving, as of the date of implementing this law, due benefits or pensions shall be treated in accordance with the social insurance law as follows:
- If any pension or benefit received by the insured person is less than SR. 1,500, such amount shall be raised to this limit.
- If such amount of pension or benefit divided after the death or the insured person between survivors was less than SR. 1,500, such amount shall be raised to this limit and shares will be recalculated in accordance to the new amount.
- If any share of a family member is less than SR. 300, such amount shall be raised to this limit, provided that the total shares of survivors do not exceed the limit of SR. 1,500, per month or the average wage that pension or benefit calculations were base on, whichever is the higher.
Implementing the previous paragraphs shall be on the first day of the following months of putting the new law into force.
Are there any specified dates for submitting claims for payments of social insurance entitlements?
Claims for transportation, lodging allowances and deceased’s family grant shall not be accepted after the expiry of one year, and claims for remaining benefits shall not be accepted after the expiry of five years from the date on which the entitlement to benefits arises, unless there is an excuse accepted to GOSI.
Is the employer committed to pay compensation to the injured insured person who suffered from an occupational injury, or to pay the survivors for such injury?
Basically, GOSI is obligated to pay the lawful benefits to the insured person or family members and the employer is not committed to pay unless the injury occurred intentionally by the employer, due to an obvious mistake, not complying to rules and regulations regarding healthy and safe working environment.
In case this is proven correct, the insured person or entitled survivors may return to the employer for any claims or rights given by Islamic Sari’ah or other applicable rules implied in Saudi Arabia. GOSI will pay in any case all the amounts of benefits and pensions due by law.
What are the amounts payable to survivors of the insured person?
GOSI pays to survivors of the insured person a grant of three months to a maximum of SR. 10,000 in any of the following cases:
- In case of death of the insured person while performing his job and has the qualifying period of service for pension.
- In case of death of the insured person because of an occupational injury, or in case of death of a person who was entitled a benefit for reasons of total or partial permanent disability.
- In case of death of retired pensioner or a pensioner for non-occupational disability.
Are there certain provisions regarding benefit payment under OHB for non-Saudi?
For non-Saudi injured person, it has been decided by law to replace the right of benefit payment with a lump sum compensation payment. There will be no right to apply for another payment after that. This shall be done according to the following rules:
- 1. In case the injury resulted in 100% total disability to the insured person, such person shall be entitled to a lump sum compensation amounting 84 months of the benefit amount to a maximum of SR. 330,000. For example, the wage of that insured person is SR. 4,000 and received a disability percentage of 100%, the compensation shall amount: 4,000 x 84 = SR. 336,000. Whereas this amount has exceeded the maximum limit provided by law, this amount shall be reduced to SR. 330,000.
- If disability degree is (50% – 99%), partial disability, the lump sum compensation shall amount 66 months of the benefit amount to a maximum of SR. 165,000. For example, the insured person’s wage is SR. 2,000, and has a disability degree of 55%, the compensation shall amount: 2,000 x 55 x 60 = SR. 66,000.
- In case of the insured person died while performing his job because of an occupational injury, his survivors shall receive lump sum compensation equals 84 months and will be divided equally.
Note that lump sum compensation payment ends all right for the insured person or survivors due from GOSI, taking into consideration that such payment shall not exceed, in this case, the sum of SR. 330,000.
It has been mentioned many times the words “benefit” and “pension”, what is the deference between them?
The pension is the amount which is paid monthly under Annuities Branch, while the benefit is paid monthly under OHB. Pension and benefit can be added together.
What happens in the event of discontinuing one of the survivors share?
In case of suspending a share of one family member for any reason – such as death, reaching the maximum limit for entitlement for boys, marriage of girls – this share shall be divided to the remaining survivors, provided that the total shares do not exceed the average wage which calculation basis of the benefit were built upon or the amount of SR. 1,500 for each share.
When does the injured insured person’s family members are entitled to payment of their benefits in case the injured person died, and what are their shares?
In case of the death of the injured person who was entitled to a partial or total disability benefit, or in the event of the insured person death while working as a result of an occupational injury, the survivors are entitled to the following:
- Full benefit, in case the survivors are three persons or more and shall be divided equally.
- 75% of the benefit, in case the survivors are two persons and shall be divided equally.
- 50% of the benefit, in case there was only one survivor.
Provided that the share of any survivor shall not be less than SR. 300 and the total shares do not exceed the average wage which the basis of calculation of the benefit was built upon, or SR. 1,500 per month, whichever is higher. If the total exceeds this amount, each share of survivors shall be deducted equally to any of the said two limits.
What happens if the injured person that was entitled an allowance or benefit before he had suffered a new injury?
Determining the status of the insured person who was entitled to a benefit for a partial disability that had suffered a new injury as follows:
- In case the person who was entitled to a benefit for a partial disability had suffered a new injury resulting in a degree of disability, the injured person shall be entitled to a new benefit calculated an the basis of the total injuries sustained by this person, i.e. total percentage of the disabilities, provided that the total does not exceed 100% of disability. The benefit shall be calculated on the basis of the average wage of the first injury or the previous average wages of the month prior the second injury, whichever is higher.
- In case the injured person received lump sum compensation and had suffered from another injury resulting in a disability degree, whereas the total percentage became 50% or more, the injured person shall be entitled to a benefit according to what has been mentioned previously, with deducting the previous compensation amount on a 36 regular basis. Collecting such deductions shall stop in case of discontinuing benefit payment or death of the injured person.
- Degree of disability resulting from different injuries shall be added together even without such addition the injured person may not be entitled to pension, whenever this may increase the amount of lump sum compensation.
What does the injured Saudi and non-Saudi insured person entitled to if the degree of disability was less than 50%?
If the disability degree for an injury is less than 50%, the insured person is entitled to a lump sum compensation equals 60 times the monthly benefit for partial disability, whereas the age of this insured person did not exceed 40 years at the date when the injury occurred.
Example: (age 39 – disability degree 32%), for this case, if the average wage is SR. 1,000, the lump sum compensation shall be:
32 x 1000 x 60 = SR. 19,200
If the age was more than 40 years, the compensation shall be decreased to the number of monthly benefit equivalent to the number of years which are above 40. If we assume in the previous example that the age of the insured person is 47 years, the compensation shall be decreased 7 times the monthly benefit:
32 x 1000 x 53 = SR. 16,900
Provided that the compensation shall not be less than 36 times the monthly benefit and does not exceed the amount SR. 165,000. For the interest of the insured person, the fraction of any year shall be considered as a whole year if such fraction year has completed six months or more. Fewer fractions shall be discarded.
What can disabled injured person receive when the assistant of other is needed to perform daily affairs?
If the concerned medical committee decided that there is a need for the injured person to be assisted by other to do his daily affairs, such injured person shall has the right to have the assistance of others benefit by 50% of that allowance to a maximum of SR. 3,500 per month.
What is the meaning of the average wage where the benefit is calculated on its basis, and what is considered if the injured person did not has the required period of service with the employer which the injury occurred while working there?
Average wage which the benefit is calculated upon means the total wages applied to contribution paid in the last three previous months at the time when the injury had occurred. If the injured person did not work at all or had worked for part time for the employer which the injury occurred while working there, the average wage will be calculated by taking one third of the total wages that could have been contributed if the injured person would have worked on the same conditions for the last employer for a period of three months taken into consideration when calculating the benefit.
When does the right for daily allowance payments end?
1. The injured person’s right for payment of daily allowances end in the following cases:
- In the event of the injured person has gain the ability to work and completely recovered from the injury. This shall be determined by a decision from the treatment body or the concerned medical committee.
- When the concerned medical committee decided to end the medical treatment for the injury person after discharge from the hospital and his condition became stable with a result of permanent disability sustained by that person, whether it is partial or total disability.
- In case of the insured person death.
2. The right to be entitled to daily allowance does not end in case the work relationship had been terminated or suspended for any reasons.
When does payment of daily allowance for an injured person may be suspended?
It is permitted by law to suspend the allowance when the injured insured person refuses to comply with the medical instructions which is required for such cases or has refused to be presented to a medical examination. This shall be made by a decision of the director of the concerned field office and must be on the bases of a medical report from the treatment party or GOSI physician.
Is it allowed to combine daily allowance with wage along with benefit?
The law does not allow the injured person to combine the daily allowance with the wage. In case it has been found that the injured person had worked for a wage, whatever it amounts during such period the injured person was paid the allowance, GOSI shall has the right to redeem what the injured person has gain unlawfully.
However, it is allowed to combine daily allowance with due benefit from a previous injury sustained by the injured insured person.
What is the cash value that is received by the injured person during the period of temporary inability to work?
- In case the injured person is temporary disable from work caused by an occupational injury reported during applicable time frames, the injured person is entitled to a daily allowance for each day including weekends and official holidays in such period of disability to work. GOSI shall pay this sum which amounts 100% of the wage applied to contribution and may be reduced to 75% for all the period of hospitalizing the injured person as an inpatient in any medical center or hospital.
- Determining temporary disability is made by a medical report issued from a specialized medical body, provided that the person who shall be assigned for an allowance will be presented for a medical examination by a committee or physician whenever the concerned medical committee in GOSI asks for.
What are the benefits entitled to the insured person who was injured?
There are two kinds of benefits:
- Benefits in kind: include medical care for deferment cases that may be needed in an injury.
- Cash compensation: includes the following entitlement:
- Daily allowances for temporary disability to work when the injured person has become disabled temporarily as a result of the injury.
- Monthly benefits and lump sum compensation for total or partial permanent disability resulting from an injury.
- Monthly benefits for the family members of the deceased insured person.
- Grant to the family of the deceased insured person or the family of the insured person who was entitled to a benefit in case of his death.
What is the definition of the occupational injury in the law?
In Article 27 of the law, the occupational injury is defined as:
- Any accident suffered by the insured person during performance or by reason of work shall be considered an employment injury.
- They shall also be considered an employment injury any accident suffered by the insured person on his way from his dwelling to his workplace and back, or on his way from his workplace to the place where he usually takes his meal or gives his prayer and back.
- The same shall also apply to accidents suffered by the insured person during movements he makes for the purpose of doing an assignment required by the employer.
- The diseases established to be caused by work shall be considered as employment injury.
What is the contribution portion in OHB by law?
It is mentioned in Article 18 of the law that OHB percentage of contribution is 2% of the applicable wage paid by the employer only.
To who does Annuities Branch is compulsory applied?
Annuities Branch is compulsory applied to Saudi workers whom are working under Labor and Workers Law and working in state and Simi-state bodies on wage provisionally.
To who does OHB is applied by law?
OHB is compulsory applied to all Saudi and non-Saudi workers.
Who are the family members that are entitled by law for payment?
Article (2/8) of the law specified the family members and qualifying conditions for entitlement in the following cases:
- “Widow of the deceased insured person” is the wife of the deceased insured person at the time of his death.
- “Widower of the deceased female insured person” is the one whose insured wife died and is suffering an earning incapacity for as long as he is incapacitated . He is deemed to be legally incapacitated if, upon the death of his wife, he was over sixty years of age and unemployed.
- “Sons” are the sons of the deceased insured person who are under twenty one years of age until they complete such age, which age limit is extendible to twenty six if they are pursuing their studies in an educational or vocational institution, and no age limit is set as long as they are suffering an earning incapacity by reason of chronic disease or infirmity
- “Daughters” are the daughters of the deceased insured person until they marry.
- “Grandsons and grand-daughters” are those whose father (the son of the insured person) died during the lifetime of the insured person, subject to the same conditions prescribed in respect of the sons and daughters, provided that they have been supported by the insured person until the date of his death.
- “Father” is the father of the deceased insured person who was supported by the insured person until he died, provided that he is suffering a loss of earning capacity, and he shall be deemed to be legally incapacitated to earn if he was over sixty and not working at the time of the death of his son.
- “Mother” is the mother of the deceased insured person who was supported by the insured person until the date of his death.
- “Grandfather” and “Grandmother” is the grandfather and grandmother of the deceased insured person who were supported by the insured person until the date of his death, subject to the same conditions applicable to the father and mother.
- “Brothers and sisters” are the brothers and sisters of the insured person subject to the same conditions provided for in respect of the sons and daughters so long as they were supported by the insured person until the time of his death.
What is the meaning of the word “insured person” mentioned in the Law?
The insured person is any person covered under the social insurance law, whether a man or a woman. He/she may be registered voluntarily or compulsory.
- The compulsory insured person is any worker has had contractual relationship with one employer or more for carrying out a work primarily within the Kingdom of Saudi Arabia in consideration of a wage, regardless of the nature, form or duration of such relationship or of the amount or kind of the paid wage, performing such job must be mainly inside the Kingdom. Only the Saudi worker may perform such duties outside the Kingdom for an employer that has a main office inside the Kingdom. The latter worker is subject to Annuities Branch Coverage only.
- Voluntary insured person are Saudis permitted by law to have the right to benefit from Annuities Branch, such as free lancers, self employed persons, person corporation with others in a commercial, industrial or agricultural activities, or in services fields or craftsmen. Also, Saudi workers who work abroad without any work relation with an employer who has a main office inside the Kingdom or persons who their contributions in Annuities Branch had stopped and wishes to continue registration.
For Filipinos who are still working with their employers/sponsors, please be advised that your employers have the obligation to provide for your medical insurance upon your arrival in the kingdom. If employers are not willing to provide medical insurance, they are obliged to pay in cash hospitalization expenses/bills of their employees or workers.
• For overstaying or absconding filipino workers, please be advised that between life and death or in extremely emergency cases, the saudi governorate for health affairs has issued a directive to all government hospitals to accept patients who are in need of immediate medical attention and treatment.
Articles or Provisions found in Saudi Labor Law in relation to accident and death benefits:
Articles, 132 to 141 click link re: Saudi Labor Law