CHAPTER
V Article 47 The social insurance against employment injuries shall be financed by the following :-
Article 48 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. Article 49 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
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Article 51 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. PART
3 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. Article 53* 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. Article 54 There
shall be no entitlement to the daily allowance for the injury or
to compensation for permanent disability in the following cases:-
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. PART
4 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. Article 56 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. Article 57* 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. Article 58 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. Article 59 The percentage of permanent partial disability shall be determined in accordance with the following rules :-
Article 60 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 :-
Article 61 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. Article 62 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 :-
PART
5 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 :-
The
insured shall make this notification if his state of health so permits. 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. Article 64 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 precludes the injured from so notifying, it may be so notified by anyone on his behalf. Article 65 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. Article 66 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. Article 67 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 :-
Article 68 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. Article 69 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. Article 70 The General Organisation shall bear the return transportation expenses of the injured from the place of work or residence to :-
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. Article 71 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. Article 72 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. Article 73 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. Article 74 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.
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