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[ GSIS Resolution No. 107, July 30, 2015 ]

APPROVAL OF THE AMENDED RULES OF PROCEDURE OF THE GSIS COMMITTEE ON CLAIMS

Adopted: 30 July 2015
Date Filed: 20 August 2015
WHEREAS, on 27 November 2014, the Board issued Resolution No. 184 approving the Rules of Procedure of the Committee on Claims (CoC);

WHEREAS, the CoC s Rules of Procedure was revisited in order to include in its jurisdiction the evaluation and resolution of other issues, except non-life insurance related transactions, which affect the settlement of a member's social insurance claim;

WHEREAS, this also necessitated the inclusion and amendment of other provisions of the CoC Rules of Procedure;

RESOLVED, to APPROVE and CONFIRM the amended Rules of Procedure of the Committee on Claims, as proposed by the CoC Chairperson in his Memorandum dated 21 July 2015.

RESOLVED FURTHER, that Board Resolution No. 184 dated 27 November 2014 is hereby SUPERSEDED and that Rule V, Section 26 of the Revised Implementing Rules and Regulations of R.A. No. 8291 is hereby AMENDED.

RESOLVED FINALLY, that the amended Rules of Procedure of the CoC shall take effect fifteen (15) days after publication in a newspaper of general circulation.

A copy of the amended Rules of Procedure of the CoC is made an integral part of this Resolution.

Certified Correct:

(SGD) ATTY. MARIA THERESA ABESAMIS-RAAGAS Corporate Secretary

Confirmed:

(SGD) RENATO T. DE GUZMAN Chairman


(SGD) ROBERT G. VERGARA Vice-Chairman	(SGD) KARINA CONSTANTINO-DAVID Trustee


(SGD) GREGORIO T. YU Trustee	(SGD) ROMAN FELIPE S. REYES Trustee


(SGD) MARIO J. AGUJA Trustee	(SGD) ELISEA G. GOZUN Trustee


(SGD) ROMEO M. ALIP Trustee	(SGD) GERALDINE MARIE BERBERABE-MARTINEZ Trustee

Attachment:

RULES OF PROCEDURE OF THE COMMITTEE ON CLAIMS

Pursuant to the Revised Implementing Rules and Regulations of Republic Act No. 8291 creating a Committee on Claims in the Operations Sector, the following rules are hereby adopted and shall be known as the Rules of Procedure of the Committee on Claims , as amended.

RULE I
MEMBERS OF THE COMMITTEE ON CLAIMS

SEC. 1. The members of the Committee on Claims (COC) are the following:

Chairperson: Senior Vice President (SVP), Operations Group

Vice Chairperson: SVP, Operations Group

Members:

SVP, Operations Group
SVP, Other Functional Group, except the Chief Legal Counsel
Department Manager, Technical Services Department
Department Manager, Controller Group

Head of Secretariat:

Any Lawyer or Law graduate from a unit/office/department other than the Legal Services Group

RULE II
DESIGNATION OF COC MEMBERS

SEC. 2. The composition of the COC shall be designated and revised by the President and General Manager (PGM).

RULE III
DUTIES AND POWERS OF THE CHAIRPERSON

SEC. 3. The duties and responsibilities of the Chairperson are as follows:

(a)

to preside over the meetings of the COC on the days and at the hours designated by it; to call the COC to order and, if there is a quorum, to order the reading of the Minutes of the preceding meeting, and, after the COC shall have acted upon it, to dispose of the matters appearing in the Agenda in accordance with the Rules;

(b)

to decide all points of order;

(c)

to see to it that all Decisions or Resolutions of the COC are complied with;

(d)

to have general control over the meeting; and

(e)

to vote in case of a tie.

SEC. 4. The Vice-Chairperson shall assume the duties and responsibilities of the Chairperson in the absence of the latter.

RULE IV
DUTIES AND RESPONSIBILITIES OF THE MEMBERS

SEC. 5. The duties and responsibilities of the Members are as follows:

(a)

to study and review matters included in the agenda;

(b)

to attend regular and special meetings called by the Chairperson through the Secretariat;

(c)

to deliberate on issues and cases raised before the COC, and ask questions, if necessary;

(d)

to cast their votes on matters for resolution in accordance with Rule X on Voting; and

(e)

to sign the Resolutions or Decisions issued by the COC, and to approve Minutes of the Meeting.

RULE V
DUTIES AND RESPONSIBILITIES OF THE SECRETARIAT HEAD

SEC. 6. The duties and responsibilities of the Secretariat Head are as follows:

(a)

to attend the meetings of the COC;

(b)

to prepare the Agenda and the Minutes of Meetings;

(c)

to keep records of the Minutes and discussions of the COC;

(d)

to prepare and distribute the calendars and notices of meetings;

(e)

to serve as custodian of all the records of the COC;

(f)

to furnish copies of the Decisions or Resolutions to parties concerned;

(g)

to certify all measures, orders, decisions and resolutions approved by the COC and to stamp them with its official seal which shall also be under its custody;

(h)

to recommend to the COC the members of the Secretariat; and

(i)

to perform other duties inherent to the office.

RULE VI
THE SECRETARIAT, ITS DUTIES AND RESPONSIBILITIES

SEC. 7. The Secretariat shall be responsible for the following:

(a)

to receive written communications for the COC and assign reference control numbers to each;

(b)

to formally notify the Vice President (VP) of the Operating Unit Concerned (OUG) and SVP for Financial Management Group (FMG) when the submitted matter shall be deliberated by the COC;

(c)

to provide all members of the COC with electronic files of the Completed Staff Work (CSW) prepared for matters included in the agenda three (3) days prior to the scheduled meeting of the COC;

(d)

to send a certified true copy of the COC Decision or Resolution to the VP of the OUC and SVP-FMG.

(e)

to maintain a database of all received communications, and COC Decision or Resolution;

(f)

to regularly report to the COC all pending matters;

(g)

to provide all Operating Units access to COC Decision or Resolution; and

(h)

to perform other duties inherent to the office.

RULE VII
MATTERS FOR SUBMISSION TO THE COC

SEC. 8. The COC shall evaluate and resolve issues or complaints arising from any dispute in the settlement of claims, such as, but not limited to the following:

(a)

interpretation of an existing policy or procedure;

(b)

no existing program or system to process a claim;

(c)

no existing policy as basis to process a claim;

(d)

appeal from an aggrieved party to a settled claim;

(e)

findings from either the Internal Audit Services Office (IASO) or the Commission on Audit (COA) that are disputable;

(f)

implementation of and Order from any Court, quasi-judicial body or duly authorized entity due to its being in conflict or inconsistent with existing GSIS laws, policies, rules and regulations;

(g)

non-life insurance related transactions which affect the settlement of social insurance claim of a member^[1] ; and

(h)

any other matter related to any or all of the foregoing which is necessary for their determination.

SEC. 9. The COC shall elevate matters pertaining to policy formulation or revision and submit a status report on decided claims and issues to the Board of Trustees (BOT) through the PGM.

SEC. 10. The COC shall accept matters for consideration if:

(a)

directly appealed by the claimant or his/her attorney in fact; or

(b)

referred by the VP of the OUC; or

(c)

referred by the BOT or the Office of the PGM; or

(d)

referred by judicial and quasi-judicial bodies.

RULE VIII
MEETINGS

SEC. 11. The COC shall hold its regular meeting once a month, preferably on the last Tuesday of each month. The notice, including the agenda, place and time of the meeting shall be given three (3) days before the regular meeting.

Special meetings may be called by the Chairperson, but notice including the agenda, place and time of the meeting, shall be given one day in advance to every member of the COC.

SEC. 12. In case a member cannot attend the meeting, he or she may send his or her representative who should have a position title not lower than the Department Manager (DM) or Branch Manager (BM). The presence of a representative shall not be considered in determining the existence of a quorum. The representative cannot vote on any motion.

RULE IX
QUORUM

SEC. 13. A majority of the members, including the Chairperson, shall constitute a quorum (i.e., four out of six).

SEC. 14. Should the question of lack of quorum be raised, the Chairperson, without debate, shall immediately proceed to a verification thereof by causing the reading of the roll of the members and announcing forthwith the result.

RULE X
VOTING

SEC. 15. The voting shall be nominal. In a nominal voting, the Secretariat Head shall call alphabetically the names of the members present and each member shall answer yes or no upon being called.

Immediately thereafter, the Secretariat Head shall inform the Chairperson about the result of the voting, and the latter forthwith shall in turn announce it to the COC.

SEC. 16. The yes and no with the names of the members voting shall be recorded in the Minutes.

SEC. 17. The Chairperson shall not vote except when his or her vote is decisive or when his or her vote is necessary to break a tie between the yes and the no votes.

SEC. 18. The vote of a member who is absent from the session at the moment he or she is called to vote shall not be counted.

SEC. 19. No member shall be permitted to vote on any measure after the Chairperson has announced the result of the voting.

SEC. 20. Voting shall not be interrupted except on a question of quorum.

SEC. 21. A motion subject of voting shall be considered approved or disapproved if it garners a majority vote of the members of the COC present.

RULE XI
ORDER OF BUSINESS

SEC. 22. The Secretariat Head shall prepare for each meeting the Agenda in which shall be listed the following:

(a)

Roll Call;

(b)

Reading and Approval of the Minutes of the previous meeting;

(c)

Pending Matters;

(d)

Regular Matters; and

(e)

Other Matters

RULE XII
MINUTES OF THE MEETING

SEC. 23. The COC shall keep the Minutes of its meetings which shall contain a brief and accurate account of what has taken place in every meeting.

SEC. 24. The reading of the Minutes may be dispensed with by unanimous consent, in which case the Minutes shall be deemed to have been approved.

SEC. 25. If a member finds any error in the Minutes, the reading of which was dispensed with, he or she shall verbally call the attention of the COC to this fact and move for its correction during the meeting.

SEC. 26. The Minutes of the meetings shall be furnished to each of the members through their individual corporate email addresses three (3) days prior to the next meeting.

RULE XIII
UNFINISHED BUSINESS

SEC. 27. Unfinished business at the end of the meeting shall be taken up at the next session in the same status.

RULE XIV
MANNER OF PRESENTING ISSUES, BEHAVIOR AND LANGUAGE

SEC. 28. Matters for deliberation shall be presented by the VP of the OUC or the SVP-FMG on housing matters, or their authorized representative, with the corresponding CSW and/or slide Power Point Presentation (PPT).

SEC. 29. Whenever a member wishes to speak, he or she shall raise his or her hand and request the Chairperson to allow him or her to speak, which consent shall be necessary before he or she may proceed. If various members wish to have the floor, the Chairperson shall recognize the one who first made the request.

SEC. 30. No member shall interrupt another without the latter s consent, which may not be obtained except through the Chairperson.

SEC. 31. Acts and language which may offend any party present during the meeting shall be avoided.

SEC. 32. Any party, under any circumstance, shall not use offensive or improper language against any person or institution subject of the claim.

SEC. 33. When any party, by word or deed, violates any of these rules, the Chairperson, at his or her own volition or at the instance of another member, may call him or her to order.

SEC. 34. The COC may expel any party for disorderly behavior upon concurrence of the majority of the members present during the meeting of the COC.

RULE XV
APPEAL TO THE COC

SEC. 35. Appeals from the decision of the VP of the OUC shall be in writing and filed by the claimant or his/her attorney-in-fact to the COC within thirty (30) days from receipt thereof. The appeal shall be filed through personal delivery or registered mail addressed to the COC.

Appeals filed with the COC shall be referred to the VP of the OUC for the preparation of the CSW.

SEC. 36. Appeals concerning housing transactions shall be referred to the VP of the OUC for preparation of CSW; the CSW shall then be forwarded to the SVP-FMG for proper evaluation and resolution of the issues.

SEC. 37. The SVP-FMG shall provide technical assistance concerning the evaluation and resolution of issues and complaints,^[2] in accordance with Section 36 of this Rule.

RULE XVI
PROCEDURE FOR SUBMISSION OF MATTERS TO THE COC

SEC. 38. The VP of the OUC, and/or the SVP-FMG, in accordance with Rule XV of these Rules, shall transmit the CSW to the COC Secretariat not more than ten (10) days from receipt of the notice or letter of appeal.

The CSW shall contain the following:

RULE XVII
TIME FRAME FOR SUBMITTED MATTERS

SEC. 39. Only matters submitted to the COC not later than three (3) days before the scheduled meeting shall be included in the agenda.

SEC. 40. The Secretariat shall calendar the issue or case for COC deliberation not later than 30 days from receipt of the notice or letter of appeal and complete supporting documents by the Secretariat.

SEC. 41. The COC shall render its decision on issues or cases within sixty

(60) days from the last deliberation.

RULE XVIII
COC DECISIONS

SEC. 42. Every decision shall clearly and distinctly state the basis thereof, and shall be signed by the COC members who participated in the deliberations; it shall be served either personally or by mail/courier to the claimant s or his/her counsel s address of record.

SEC. 43. Whenever practicable, service by mail shall be by private courier. If no private courier is available in the claimant s locality, service may be done by registered mail.

RULE XIX
APPEAL TO THE BOT

SEC. 44. The COC shall in no case take a motion for reconsideration of a Decision or Order denying a claim.

Appeal from the COC s decision shall be filed with the Board of Trustees within sixty (60) days from receipt thereof.

RULE XX
EXECUTIVE SESSION

SEC. 45. Executive sessions shall be held whenever a member so requests it and his or her motion has been duly seconded.

SEC. 46. The executive sessions of the COC shall always be held behind closed doors. In such sessions, only the Secretariat and/or such other persons as may be authorized by the COC may be admitted to the meeting hall.

SEC. 47. The member who presented the motion shall then explain the reasons which he or she had for submitting the same.

SEC. 48. The Minutes of the executive sessions shall be recorded in a separate book.

RULE XXI
CONFIDENTIALITY

SEC. 49. The Chairperson as well as the members and the Secretariat shall absolutely refrain from divulging any of the confidential matters taken up by the COC, and all discussions which might have taken place in connection with the said matters shall be likewise considered as strictly confidential.

SEC. 50. Any member or party who violates the provisions contained in the preceding section shall, by a vote of all the members of the COC, be subject to disciplinary action.

RULE XXII
DOCUMENTS FILED WITH THE COC

SEC. 51. All documents filed with the COC for consideration shall be kept and preserved by the COC Secretariat.

SEC. 52. When the documents sought to be copied or withdrawn are, in the opinion of the Chairperson, not confidential in nature, the authorized personnel of the Secretariat may issue certified copies thereof.

RULE XXIII
AMENDMENTS TO OR REVISION OF THE RULES

SEC. 53. Any and all amendments and revisions to these Rules shall be recommended by COC for approval by the BOT through the PGM.

RULE XXIV
EFFECTIVITY

SEC. 54. These Rules shall take effect fifteen (15) days after filing a copy with the Office of the National Administrative Register (ONAR), and they shall govern the processing of all pending and future claims.

RULE XXV
TRANSITORY PROVISION

SEC. 55. Pending the reconstitution of the COC and its Secretariat in accordance with Rule I above, and in order to avoid delays in the resolution of complaints arising from any dispute in the settlement of claims, the existing members of COC and its Secretariat, as designated by the PGM shall continue to perform their respective functions and assume the duties and responsibilities outlined in Rules III, IV, V and VI above.

^[1] Non-life insurance related transactions not affecting the settlement of social insurance claim of a member is under the jurisdiction of the GSIS Underwriting and Claims Committee.

^[2] Per Board directive dated 15 April 2015.

(a)	to preside over the meetings of the COC on the days and at the hours designated by it; to call the COC to order and, if there is a quorum, to order the reading of the Minutes of the preceding meeting, and, after the COC shall have acted upon it, to dispose of the matters appearing in the Agenda in accordance with the Rules;
(b)	to decide all points of order;
(c)	to see to it that all Decisions or Resolutions of the COC are complied with;
(d)	to have general control over the meeting; and
(e)	to vote in case of a tie.

(a)	to study and review matters included in the agenda;
(b)	to attend regular and special meetings called by the Chairperson through the Secretariat;
(c)	to deliberate on issues and cases raised before the COC, and ask questions, if necessary;
(d)	to cast their votes on matters for resolution in accordance with Rule X on Voting; and
(e)	to sign the Resolutions or Decisions issued by the COC, and to approve Minutes of the Meeting.

(a)	to attend the meetings of the COC;
(b)	to prepare the Agenda and the Minutes of Meetings;
(c)	to keep records of the Minutes and discussions of the COC;
(d)	to prepare and distribute the calendars and notices of meetings;
(e)	to serve as custodian of all the records of the COC;
(f)	to furnish copies of the Decisions or Resolutions to parties concerned;
(g)	to certify all measures, orders, decisions and resolutions approved by the COC and to stamp them with its official seal which shall also be under its custody;
(h)	to recommend to the COC the members of the Secretariat; and
(i)	to perform other duties inherent to the office.

(a)	to receive written communications for the COC and assign reference control numbers to each;
(b)	to formally notify the Vice President (VP) of the Operating Unit Concerned (OUG) and SVP for Financial Management Group (FMG) when the submitted matter shall be deliberated by the COC;
(c)	to provide all members of the COC with electronic files of the Completed Staff Work (CSW) prepared for matters included in the agenda three (3) days prior to the scheduled meeting of the COC;
(d)	to send a certified true copy of the COC Decision or Resolution to the VP of the OUC and SVP-FMG.
(e)	to maintain a database of all received communications, and COC Decision or Resolution;
(f)	to regularly report to the COC all pending matters;
(g)	to provide all Operating Units access to COC Decision or Resolution; and
(h)	to perform other duties inherent to the office.

(a)	interpretation of an existing policy or procedure;
(b)	no existing program or system to process a claim;
(c)	no existing policy as basis to process a claim;
(d)	appeal from an aggrieved party to a settled claim;
(e)	findings from either the Internal Audit Services Office (IASO) or the Commission on Audit (COA) that are disputable;
(f)	implementation of and Order from any Court, quasi-judicial body or duly authorized entity due to its being in conflict or inconsistent with existing GSIS laws, policies, rules and regulations;
(g)	non-life insurance related transactions which affect the settlement of social insurance claim of a member^[1] ; and
(h)	any other matter related to any or all of the foregoing which is necessary for their determination.

(a)	directly appealed by the claimant or his/her attorney in fact; or
(b)	referred by the VP of the OUC; or
(c)	referred by the BOT or the Office of the PGM; or
(d)	referred by judicial and quasi-judicial bodies.

(a)	Roll Call;
(b)	Reading and Approval of the Minutes of the previous meeting;
(c)	Pending Matters;
(d)	Regular Matters; and
(e)	Other Matters