Here are some reasons why SSS maternity benefit claims are denied. These are based on the personal experiences of women SSS members who have commented on our blogs.
1. Birth Certificate of Child is not Authenticated by the local registrar or NSO.
Do not submit the birth certificate issued by the hospital. Get your child's birth certificate from NSO, or get a Certified True Copy of your child's birth certificate from your Local Civil Registrar.
2. Signature in MAT1 is different from Signature in MAT2 because in MAT1, the maiden name is used, and in MAT2, the married name is used, and that SSS has not yet been updated about the change in civil status using SSS E4 form.
If you want to change your surname as you are processing your claim, it is best to first wait that the change in surname is effected before you submit your MAT2 claim. Check your online SSS account from time to time.
3. Applicable Contributions are Paid, but Not yet Remitted by Employer or Not Yet Posted
If you're Employed, before you file your maternity claim, make sure that the 6 monthly contributions that will be considered by SSS in computing your Maternity Benefit are already posted in your SSS account. Check your online SSS account.
4. Your Coverage Status in your Record is Different from your Status in your Claim
Example: You checked VOLUNTARY in your MAT2 form, but your status in your SSS account is EMPLOYED.
5. Questions about the Child's Middle Name and Surname
Example: The child's middle name is different from the mother's surname, and the child's surname is different from the father's surname.
Remedy for this: Submit Affidavit to Explain Discrepancy in Names
6. MAT1 was not submitted to SSS before delivery of the child. Or maternity notification was not filed online before date of delivery.
If you were not able to submit MAT1 or notify SSS online before delivering your child, attach your letter of explanation to your MAT1 form and ultrasound report or pregnancy test report.
Not all explanations are accepted; it depends on your reason and on the SSS officer evaluating your claim.
7. Member is not eligible for maternity benefit.
Member has not paid her contributions for at least 3 of the 12 months BEFORE semester of delivery or semester of contingency.
8. Member delivered her child by CS, but did not submit Operating Room Record
9. Member had Miscarriage, but did not submit Histopathology Report and Medical Certificate
10. Member recently resigned from work, but did not submit these 3 documents:
Certificate of Separation
Certificate of Non-Advancement of Maternity Benefit
If your date of separation from employment is within 6 months of your date of delivery, you need to submit these 3 documents from your former employer:
. Certificate of Separation from Employment (must include date of separation)
. Certificate of Non-Advancement of Maternity Benefit (this means your employer did not advance any amount of maternity benefit to you)
. 2 copies of Specimen Signature Card (SSS Form L-501)
If the gap between your Date of Separation and Date of Delivery is more than 6 months, but less than 1 year, prepare to submit these 3 documents. The rule mentions 6 months, but there are officers still requiring these documents even if the gap is more than 6 months.
There was one member who commented here, saying that the gap in her case is 11 months and 28 days, and her claim papers were accepted. But later on, her claim was Denied due to lack of separation papers. She had to wait for her rejected papers, and had to resubmit her claim.
11. There's an error in the Certificate of Separation or L-501.
Example: The signatures on the L-501 and Certificate of Separation are not the same. Or there is No Date of Separation in the Certificate of Separation.
12. It was Certificate of Employment that was submitted.
Submit Certificate of Separation. These 2 kinds of certificates have almost the same contents, but they have different emphasis. There have been at least 3 members whose claims were Denied because of this reason.
13. The Numbers of Pregnancies or Deliveries or Miscarriages in the Forms or in Previous Maternity Claims are not consistent.
Example: In your MAT1 form, you wrote 2nd pregnancy, but the Birth Certificate shows 3rd in Birth Order. Another Example: 3rd pregnancy in MAT1, but MAT2 shows 2 miscarriages and 2 deliveries or the Birth Certificate shows 4 in Total No. of Children Born Alive.
14. Member has no Date of Coverage.
Usually, a member discovers that she has no Date of Coverage upon submission of MAT1, but there are cases that are not detected early, especially now that MAT1 can be submitted online.
Why are there members without Date of Coverage (DOC)?
These members without DOC are usually the ones who have been paying their contributions as Voluntary without first registering properly and correctly.
You have a Date of Coverage if:
. you were reported to SSS by your employer as Employee
. you registered at an SSS branch as Self-Employed using RS1 form and your Proof of Source of Income and your application was approved
. you registered as Non-Working Spouse and your application was approved
. you registered as OFW and your application was approved
Making your FIRST payment to SSS as Voluntary is not allowed. You become Voluntary only when you stop being an Employee, Non-Working Spouse, Self-Employed or OFW, and you decide to continue making SSS contributions.
15. 5th or Subsequent Pregnancy or Miscarriage
Only the first four deliveries or miscarriages are covered under the SSS maternity benefit program. This policy started on May 24, 1997. Even if you were not able to claim your maternity benefit for your first four deliveries or miscarriages, you can no longer claim for your 5th or subsequent deliveries or miscarriages.
16. Your Employer Has Not Filed Its Sickness and Maternity Benefits Payment Thru the Bank (SMB) form
SSS now requires every employer to file its SMB PB form. SSS will pay your maternity benefit through the SSS-registered bank account of your employer. If you're Employed, ask your employer if it has filed its SMB PB form before filing your maternity benefit claim.
No. of Pregnancies or Deliveries or Miscarriages in Your SSS Maternity Benefit Claim
documents should be consistent
What to Do When Your SSS Maternity Benefit Is Denied
Previous Comments from Users Can Be Seen Here: Reasons Why SSS Maternity Benefit Claims Are Denied
Comments from July 12, 2013 to May 28, 2014