PART V

Benefits

Benefits

41. Benefits under this Act shall comprise-

(a) sickness benefit;

(b) invalidity benefit;

(i) maternity grant; and

(ii) maternity allowance;

(d) hospitalisation and medical treatment;

(e) survivors benefit including:

(i) widow’s allowance;

(ii) widower’s allowance

(iii) widow’s pension;

(iv) widower’s pension;

(v) survivor’s grant;

(f) retirement benefit including:

(i) retirement grant;

(ii) retirement pension;

(g) funeral grant;

(h) employment injury benefit, including disablement benefit and medical expenses.

Entitlement to benefit

42.- (1) Entitlement to any of the benefits described in section 41 shall be dependent upon the fulfilment of the prescribed condition, including payment of the prescribed contributions; nevertheless, the Director may grant to an insured person any benefit where it appears to the Director to be expedient to do so, notwithstanding that the prescribed conditions have not been fulfilled.

(2) In respect of persons insured under section 26 (2) of this Act, the

prescribed conditions relating to retirement and invalidity benefits shall be deemed to have commenced as from their date of membership under the National Provident Act, 1970.

(3) Except where Regulations provide otherwise, an insured person shall not be entitled to more than one benefit at any one time.

Contribution credits during receipt of short-term benefit

43. Regulations may provide for crediting contributions to an insured person during the period such a person is in receipt of a short-term benefit, to enable him or her to satisfy the prescribed conditions for entitlement to any benefit at a later or subsequent date.

SICKNESS BENEFIT

Conditions for sickness benefit

44.- (1) Subject to this section, an insured person who satisfies the prescribed conditions shall be entitled to sickness benefit in respect of any day of temporary incapacity for work, which forms part of a period of interruption of employment caused otherwise than by employment injury.

(2) A person claiming for sickness benefit shall make the claim in the prescribed manner and shall satisfy the Director that -

(a) he or she is under pensionable age on the day in question;

(b) he or she is engaged in insurable employment immediately prior to the day on which incapacity commenced;

(d) he or she has been employed in insurable employment during the prescribed contribution period immediately preceding the month in which the day of the continuous period of incapacity for work occurred.

(e) he or she has been certified by a registered medical practitioner as being temporarily incapable of work.

(3) For the purpose of subsection (2) (e) temporary incapacity for work includes any period during which a person is required to abstain from work because he or she is under medical observation.

(4) An insured person shall not be entitled to receive sickness benefit for the first three days of any period of interruption of employment.

(5) The Director may for the purposes of this section require the claimant to attend for and submit himself or herself to examination by one or more registered medical practitioners nominated by the Director from a panel of registered medical practitioners approved by the Board.

(6) Sickness benefit shall be paid for each day as long as the incapacity for work continues, subject to such maximum period as may be prescribed; provided that any two or more periods of incapacity for work not separated by more than two months or such other period as may be prescribed, shall be treated as one continuous period of incapacity for work starting on the first day of such periods.

(7) For the purpose of subsection (6) Sunday or such other days in each month (or week) as may be determined by the Director in any particular case or class of cases shall not be treated as a day of incapacity for work and shall be disregarded in computing any period of consecutive days.

(8) The rate of sickness benefit shall be such percentage of the insured person’s relevant earnings as shall be prescribed.

(9) An insured person who is in receipt of sickness benefit shall be

disqualified from receiving such benefit for such period as the Director may decide if -

(a) the claimant has become incapable of work through his or her own misconduct;

(b) the claimant fails, without good cause, to comply with a notice in writing by the Director requiring him or her to attend for and submit himself or herself to medical examination;

(i) refrain from any conduct which is likely to retard his or her recovery;

(ii) remain at his or her place of residence;

(iii) refrain from doing any work for which remuneration is ordinarily payable.

INVALIDITY BENEFIT

Conditions for invalidity benefit

45.- (1) Subject to this section, where, in respect of any period of incapacity for work, not caused by employment injury, an insured person is entitled to sickness benefit, he or she shall cease to be entitled to such sickness benefit for any subsequent period of incapacity for work, if he or she is appropriately certified by a registered medical practitioner to be an invalid; but is entitled to an invalidity pension or grant as the case may be, for so long as the invalidity continues.

(2) For the purpose of this section, an insured person, who has been

certified as an invalid, shall be granted an invalidity pension if he or she:

(a) has contributions to his or her credit for the prescribed period prior to becoming an invalid;

(b) has not attained pensionable age; and

(3) If an insured person does not satisfy the conditions under subsection (2), but has been appropriately certified as an invalid, he or she shall receive an invalidity grant.

(4) The invalidity grant shall be a lump sum payment, equal to the total amount standing to his or her credit in the Fund.

(5) Invalidity pension shall be at such rate as shall be prescribed of his or her final average salary for so long as the invalidity continues.

(6) If the invalidity ceases, the contribution taken into account for the purpose of an invalidity grant shall not be applied towards the satisfaction of the contributions for any subsequent claim to benefit of any description except funeral grant.

(7) All claims to invalidity benefit shall be accompanied by an appropriate medical certificate from a registered medical practitioner or medical board stating the nature of the incapacity, and that the incapacity for work is likely to be permanent; provided that the Director may, for such purpose, require the claimant to attend for and submit himself or herself to examination by one or more medical practitioners nominated by the Director from a panel of registered medical practitioners approved by the Board.

(8) An insured person entitled to receive invalidity pension or grant shall be disqualified from receiving such benefit for such period as the Director may decide, if the claimant fails without good cause:

(a) to comply with a notice in writing by the Director requiring him or her to submit himself or herself to medical examination; or

(b) to refrain from behaviour calculated to worsen his or her condition or to answer any reasonable enquiries by an officer of the Corporation, directed to ascertain whether he or she is doing so.

(9) For the purposes of this section “sickness benefit” includes maternity allowance.

Calculation of day of incapacity for work

46. For the purpose of any provision of this Act relating to sickness or invalidity benefit a day shall not be treated in relation to any person as a day of incapacity for work -

(a) unless on that day he or she is deemed, in accordance with the Regulations, to be incapable of work by reason of some specific disease or bodily or mental disablement; or

(b) where in the normal course of his or her employment (which has not been terminated) he or she would not work on that day.

Regulations for sickness and invalidity benefits

47. The Minister may make Regulations to provide for -

(a) the days which are or are not to be counted for the purpose of sickness benefits, or invalidity benefits, as days of incapacity for work;

(b) the respective circumstances in which, for the purposes of section 46 -

(i) employment which has not been terminated may be treated as if it had been terminated; or

(ii) a day which falls in a period when a person’s employment is suspended but does not fall to be so treated and which apart from the Regulations would not fall to be treated as a day of incapacity for work, may be treated as such a day;

(d) the proper and effective administration of sickness and invalidity benefits and related matters.

MATERNITY BENEFITS

Maternity grant and allowance

48.- (1) A woman is entitled to a maternity grant or allowance in the prescribed sum if she has been confined and either she or her husband satisfies the prescribed contribution conditions.

(2) In subsection (1), the reference to a woman’s husband includes a widow’s late husband in the case of a posthumous child.

(3) Regulations may provide for a woman confined of twins or of a greater number of children to receive a maternity grant for each child.

Entitlement to maternity allowance

49.- (1) A woman is entitled to a maternity allowance in the prescribed sum if she is pregnant and has reached a stage in her pregnancy which is not more than six weeks before the week in which it is expected that she will be confined (in this section referred to as the ‘expected week of confinement’).

(2) Subject to this section, the period for which a maternity allowance is payable shall be the period of thirteen weeks, beginning with the sixth week before the expected week of confinement, and this shall be the maternity allowance period for the purposes of this section and the relevant contribution conditions.

(3) A day for which a woman is entitled to a maternity allowance shall be deemed, for the purposes of this Part of the Act to be for her, a day of incapacity for work.

(4) Maternity allowance shall not be payable in respect of a woman who dies before the beginning of the maternity allowance period, and if she dies after the beginning, but before the end of that period, the allowance shall not be payable for any week subsequent to her death.

(5) A claim for maternity benefit shall be accompanied -

(a) in the case of a claim made prior to the date of confinement, by a certificate issued by a registered medical practitioner as to the expected week of confinement; or

(b) in the case of a claim, made subsequent to the date of confinement, by a certificate of a registered medical practitioner or a registered midwife, obtained not later than one month after the actual date of confinement.

(6) Notwithstanding subsection (5) the Director may accept such other evidence in support of such claims as in his or her opinion the special circumstances of the particular case so justifies.

(7) An insured person entitled to payment of maternity benefit shall be disqualified from receiving such benefit for such period as the Director may decide if during the maternity allowance period -

(a) she does any work in employment as an employed or self-employed earner;

(b) she fails, without good cause, to observe any prescribed conditions;

(c) she fails, without good cause, to take due care of her health, or to answer any reasonable inquiries by an officer of the Corporation, directed to ascertain whether she is doing so; or

(d) she fails, without good cause, to comply with a notice in writing by the Director before her confinement, requiring her to attend for or to submit herself to medical examination by a registered medical practitioner.

Regulations for maternity allowance

50. The Minister may make Regulations to provide -

(a) that a woman who has become entitled to a maternity allowance shall cease to be so entitled if her pregnancy is terminated otherwise than by confinement;

(b) for extending the maternity allowance period;

(c) for modifying paragraph (b) of this section and section 49 (2) in relation to cases where a woman has been confined and either:

(i) she has not made a claim for a maternity allowance in expectation of that confinement (other than a claim which has been disallowed); or

(ii) she has made a claim for a maternity allowance in expectation of that confinement (other than a claim which has been disallowed), but the date of that confinement was more than two weeks before the expected week of confinement;

(d) for all other matters appertaining or incidental to maternity benefits.

Calculation of daily rate of maternity allowance

51.- (1) Where, for the purpose of this Part or of Regulations under this Act, it is necessary to calculate the daily rate of maternity allowance:

(a) Sunday or such other day in each week as may be prescribed shall be disregarded; and

(b) the amount payable by way of that allowance for any other day shall be taken as one-sixth of the weekly rate of the allowance.

(2) In this Part -

(a) “confinement” means labour resulting in the issue of a living child, or labour after twenty eight weeks of pregnancy resulting in the issue of a child whether alive or dead, and “confined” shall be construed accordingly; and

(b) references to the date of the confinement shall be taken as referring, where labour began on one day results in the issue of a child on another day, to the date of the issue of the child or last child, if more than one.

Unmarried woman and maintenance under Affiliation Ordinance Chapter 8.

52. Nothing in this Act shall debar a woman from claiming maternity benefits only by reason that she is not married to the father of her child; and the fact that the mother of a child born out of wedlock is entitled to receive maternity benefit shall not be taken into consideration by any court in Saint Lucia in making any order for maintenance under the Affiliation Ordinance Ch. 8 or any other enactment.

HOSPITALISATION AND MEDICAL TREATMENT

Hospitalisation grant

53.- (1) Subject to this Act an insured person who satisfies the prescribed conditions shall be entitled to a hospitalisation grant in the prescribed sum for the payment of medical treatment obtained by him or her as a patient at an approved hospital.

(2) Except where Regulations otherwise provide, a hospitalisation grant shall not be payable for medical treatment obtained outside Saint Lucia.

Scheme of medical insurance

54.- (1) The Minister may by Regulations establish a scheme of medical insurance providing for such medical treatment as he or she may prescribe from time to time.

(2) Regulations under this section may contain such modification of the provisions of this Act as may be necessary for putting into effect any scheme established under subsection (1).

SURVIVOR’S BENEFIT

Survivor’s benefit

55.- (1) A widow or widower shall be entitled to a survivor’s benefit if-

(a) the survivor is under pensionable age at the time when his or her late spouse dies;

(b) the survivor’s late spouse’s death was not due to employment injury; and

(c) the late spouse satisfied the prescribed contribution conditions for a survivor’s benefit; or was at the time of his or her death in receipt of a pension under this Act.

(2) A survivor’s benefit shall be payable to a widow or widower for

such period as is prescribed following his or her spouse’s death; provided that this benefit shall not be payable for any period during which he or she cohabits with another person as his or her spouse.

Survivor’s pension and grant

56.- (1) A person who has been widowed is entitled to a survivor’s pension at the prescribed rate if -

(a) the late spouse satisfied the prescribed contribution conditions for a survivor’s pension; or was at the time of his or her death, in receipt of a pension under this Act;

(b) he or she was married to his or her late spouse for at least three years prior to his of her death;

(d) he or she was under the age of fifty five and had the care of his or her children (with his or her late spouse) under the age of sixteen or eighteen if the children are in receipt of a full-time education.

(2) Where a widow or widower dies leaving any children specified in paragraph (d) of subsection (1) the survivor’s pension shall be payable to such children or to a guardian on their behalf as determined by the Director, until they attain the age specified in the said paragraph.

(3) A survivor’s pension shall continue for life or until such time as the widow or widower remarries or co-habits with another person as his or her spouse.

(4) Where an insured person has not fulfilled the prescribed conditions for a survivor’s pension the Director may pay to his or her survivor, a survivor’s grant in the prescribed sum.

Regulations relating to survivor’s benefits

57.The Minister may make Regulations to provide for all other matters concerning survivor’s benefits.

AGE PENSIONS AND GRANTS

Matters affecting entitlement to age pension

58.- (1) For the purposes of this Act a person’s working life is the period between the year in which he or she attained the age of sixteen and the year in which he or she attained the pensionable age or died before that age.

(2) A person shall not be entitled for the same period to more than one age pension; but where under reciprocal arrangement as provided under Part IX of this Act, a person would otherwise be entitled to more than one such pension, he or she shall be entitled (whichever he or she may apply for) to whichever one is from time to time most favourable to him or her.

(3) Subject to this Act, an insured person of pensionable age is entitled to receive during his or her lifetime an age pension if he or she has satisfied the prescribed contribution conditions.

(4) The Minister may, by order published in the Gazette, fix the pensionable age to be an age other than sixty (60) years.

Entitlement to age grant

59. Subject to this Act, an insured person who has -

(a) not satisfied the contribution conditions; and

(b) attained the pensionable age,

is entitled to an age grant in the prescribed sum.

Regulations concerning age pensions and grants

60. The Minister may make Regulations to make further provisions relating and appertaining to age pensions and age grants.

FUNERAL BENEFIT

Funeral grant

61.- (1) Subject to this Act there shall be paid on the death of any insured person for the purpose of defraying funeral expenses, a funeral grant in the prescribed sum.

(2) Payment may be made to the personal representative of the deceased or to any person appearing to the Director to have a valid claim to such payment for the purpose stated in subsection (1).

(3) The Minister may make Regulations to provide for all other matters relating to funeral benefits.

EMPLOYMENT INJURY

Employment injuries

62.- (1) Subject to this Act, where an insured person has become incapable of working as a result of employment injury, he or she shall be entitled to payment of an employment injury benefit for such period as may be prescribed.

(2) Where the death of an insured has resulted from an employment injury, there shall be paid to his or her survivor such lump sum or periodical sums for such period as shall be prescribed.

Presumptions regarding employment injury

63.- (1) Employment injury shall be deemed to arise out of and in the course of the employment of an employee if -

(a) the accident which caused the injury was done for the purposes of or in connection with the employer’s trade or business;

(b) the accident occurred while an employee was with the express or implied permission of his or her employer traveling as a passenger by any vehicle operated by or on behalf of his or her employer to or from his place of work, notwithstanding that he or she is under no obligation to his or her employer to travel by that vehicle;

(c) the accident occurred in or about any premises at which he or she is for the time being employed for the purposes of his or her employer’s trade or business if it happened while he or she was taking steps, in an actual or supposed emergency at those premises to rescue, succour or to protect persons who are or are thought to be or possibly to be injured or imperilled, or to avert or minimize serious damage to property.

(2) A disease or injury may be prescribed for the purposes of this Part in relation to any insured persons if the Minister is satisfied that:

(a) it ought to be treated, having regard to its cause and incidence and any other relevant considerations, as a risk of their occupation and not as a risk common to all persons; and

(b) it is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty.

(3) In this section a reference to a vehicle includes reference to a ship, vessel or aircraft.

Conditions where employment injury benefit not payable

64. Subject to this Act, employment injury benefit shall not be payable in respect of -

(a) an accident which occurred outside Saint Lucia;

(b) a prescribed disease contracted whilst an uninsured person was engaged in a prescribed occupation outside Saint Lucia;

(c) any injury sustained wholly through the negligence of the claimant; provided that such a claimant shall not be precluded from applying for any other benefit under this Act in respect of medical treatment required by him or her.

Regulations for employment Injury

65. The Minister may make Regulations to provide for -

(a) classifying employment injuries relative to degrees or forms of disablement or loss of faculty or other injury and the scale of benefit applicable to them respectively;

(b) the conduct of inquires regarding employment injury;

(c) the places or occupations or circumstances or times in or during which injury suffered by an insured person shall be deemed an employment injury;

(d) determining the time at which a person is to be treated for the purposes of this Act as having developed any disease or injury prescribed for the purposes of this Part and the circumstances in which any such disease or injury is, or where the person in question has previously suffered such disease or injury, to be treated as a continuing situation or as having been contracted afresh;

(e) all other matters relating to employment injury benefit.