source : General Organization for Social Insurance

Reporting the Injury

The injured person or who may act in his behalf shall inform the employer within seven days form the date of the injury, recurrence, complication or the detection of the decease. The employer or who may act on his behalf shall inform the concerned GOSI field office of the occupation injury which the first medical aids have not been sufficient. This shall be within three days of his knowledge or report of the injury. Form No. (10/Occ.) shall be used in this case.

Injury

The injury resulted in an accident which happened to the insured person while conducting his work or as a result of such job, or an accident accrued while commuting from his home to the employer place of work. In addition to the accident which sustained while the worker goes to or from the place he eats in or prays at, or the injury that was sustained by the worker in his transportations while performing his job which the employer has assign the worker to do. The diseases which had been proven that were sustained as a result of conducting the work of the insured person shall be considered as an occupational injury, also, the diseases which are mentioned in the occupational diseases table.

Occupational Disease

A disease that may be cause by occupation and not caused of any other factors outside the insured person's work, provided that this disease is mentioned in the occupational diseases table where such diseases are listed and limited.

Period of Treatment
The duration extending from the date on which the injury occurred and the injured person was hospitalize to the date on which he is recovered, stabilized condition, determining disability or he dies. This period shall include the period of inpatient and visiting outpatient clinics.

Treatment Instructions

The instructions issued by the Medical Authority to be followed by the injured worker where GOSI may have the right to suspend some entitlements if he fails to abide by such instruction.

Date of Determining Disability

The date on which the concerned medical board determines as the end of treating the injured person and considering his condition stable or disable.

Assessing Disability Degree

It is determining the percentage of disability resulting in full incapability to work. It is a percentage assessed by the medical committees in accordance with the disability which the worker had sustained, whether it was physical, mental or psychological disability resulting from the injury. This shall be on the basis of the disability percentage table.

Re-assessing Disability Degree

The insured person will be subject to periodical medical examination during the five following years of providing the benefit where this period will be under re-assessment of disability degree whether in increase, decrease or remain as it is. Assessing the degree of the disability percentage shall be determined by the concerned medical committees according to disability percentage table.

Complication and Recurrence

It is the return of injury symptoms which were in the process of healing or aggravation. This shall be the bases on which the injured person have the right to be subjected once again for examination in order to reassess the disability degree. Complications and recurrences shall be considered an original occupational injury.

Daily Allowance for Injury

It is the cash amount payable to the insured person during the period of interruption of employment as a result of the injury. It shall amounts 100% of the wage, or decreased to 75% if he is under treatment paid by GOSI. This allowance shall continue to the date of recovery or determining disability or death.

Lump Sum Compensation for Injury

Payment which is entitled to the injured insured person for one time in case of not meeting the requirements of monthly benefit, whereas the disability percentage is 1% or more but not exceed 50%.

Total Permanent Occupational Disability

Disability that prevents the insured person totally and permanently from pursuing any work or job which provides with income, whereas such disability amounts 100%. This shall be estimated by the concerned medical committees in GOSI.

Partial Permanent Occupational Disability

Disability afflicted by the insured person resulted from an occupational injury or disease, and may lower his capability to earn his livings. This percentage may equal or exceed 50% to not more than 100% and the benefit or compensation due may be estimated to this percentage or the percentage of the total permanent disability benefit.
Non-occupational Disability The disability resulted from a disease or accident which may not has been included under the description of an occupational injury. The concern medical committees may estimate this disability whereas the injured person can not earn at least 1/3 of his previous wage because of his medical condition whereas such condition may last for a period no less than six months.

The Injured

The insured person covered under the Occupation Hazards Branch (OHB) that was exposed to an occupational accident or disease that were listed among the defined limited diseases with mentioned terms opposite each disease.

Benefit

Due monthly payment payable to the injured person for the permanent total or partial disability that the degree of such disability could reach the limit provided by the law (50% to 100%) or payable to the survivors in case of death because of the injury when implementing OHB.

Assistant of Others

The amount added to the allowance which equals 50% of its value in cases insured person is in need of assistant and help of others in regular basis to perform his daily live. The medical committees shall determine wither the insured person needs such assistant and help, provided that this shall not exceed SR. 3,500.

Pension

It is monthly payments payable to the insured person for reasons of retirement or non-occupational disability. It is also payable to the survivors in case of death when implementing Annuities Branch.

Refund Compensation

The amount payable one time to the insured person in case terms of pension entitlements are not met.

Pension Calculations

The way which the pension is determined, by multiplying one fortieth of the average monthly wage subject to contribution during the last two years of service by the number of contribution years. The pension must be not exceed (100%) of that average.

Qualifying Age for Pension

It is the age of 60 that was determined by the social insurance law for the entitlement of retirement pension so long the period of service required is available.

Discontinuing the Pension

Discontinuing pension made by GOSI for absence of payment conditions. The payment of pension will resume when such lawfully conditions are satisfied.

Suspending Pension Payments

Temporary suspension of payable pension by GOSI due to the pensioner refused to comply with the instruction issued to beneficiary, such as refusing to be re-examined to re-assessment of disability or not fulfilling required procedures for payment. This shall be reactivated when such procedures are met.

Basic Wage

It is the total income received by the mandated insured person as cash return for performing the original duties whether they were strict to a period of time, outcomes or both. The basic wage shall not include provided allowance according to the kind of job, level of hazard or place of job, paid for additional working hours or for other reasons. Also, not including annual bonuses, grants or other in kind benefits. The basic wage shall include commissions, percentage of sales and profits whether the basic wage was limited to such additions or was added to a steady wage.
Allowances provided to the insured person by the employer

This shall be cash housing allowance and in kind housing allowance. The cash housing allowance is an estimated agreed amount between the employer and the insured person. On the other hand, the in kind housing allowance which is subject to contribution deductions will be estimated with what is equivalent to the basic wage for two months.

Occupational Hazards Branch Contribution

Amounts paid by the employer for all Saudi and non-Saudi workers on a 2% basis of monthly wage applied to contribution. These payments shall be submitted to GOSI every month.

Insured Person

Every person covered under the social insurance scheme whether a man or a woman.

Establishment

Place where the employer conducts business or determine as a place of work. This place carries the name of the employers, the trade name of the activity and the workers perform their jobs whereas such workers are covered by the social insurance law.

Entitled Person

The remaining family member alive after the death of the insured person, pensioner or the person whose was entitled to benefit. The family member that is considered by law to be entitled to the pension includes:

• The Son: son of the insured person as long as his age does not exceed 21 years. If he is studying, the age of entitlement shall continue to the age of 26 years, there is no limit of age regarding the disabled son.
• The Daughter: the daughter of the insured person until she is married.
• The Brother: the full brother or the brother by father or by mother of the insured person which was supported by the insured person to the date of the insured person death under the same conditions of the Son.
• The Sister: the full sister or the sister by father or by mother of the insured person which was supported by the insured person to the date of the insured person death under the same conditions of the Daughter.
• The Father: the father of the insured person which was supported by the insured person to the date of the insured person death, subject to that he is considered unable to work or his age is above 60 years and is not in employment.
• Sons and Daughters of the Deceased Brother: the sons and daughters of the insured person’s son where their father has died while the insured person was alive, subject to support conditions are available to the date when the insured person died and under the same conditions of the Son and Daughter.
• The Mother: the mother of the insured person, provided that she was supported by the insured person.
• The Widow: the wife or wives of the insured person upon the death of the insured person the revocable divorced woman when the death of the insured person was before the end of such applicable period. The widow is entitled even if she is in employment under the social insurance law and she has the right to have both of entitled pension as a beneficiary from her husband’s pension and her work income or pension without any limitation.
• The Widower: the man who his insured wife died if he is unable to work until his disability recovers.
• The Grandfather and Grandmother: shall be under the same conditions for the Father and Mother.

Support

The family member shall be considered supported by the insured person or the pensioner if such member is supported by the insured person in any basic living expenses.

Marriage Grant

The grant paid to the widow, daughter, son or sister entitled to a pension or allowance in case of marriage for one time only. It shall amount 18 times of her/his share. Payment of this grant will discontinue on the following month of the entitled person marriage.

Death Grant

Grant paid by GOSI equals three months of the entitled pension/benefit for a maximum of (SR. 10,000.00) and shall be due in the event of the insured person death for reasons of an occupational injury, the death of a working insured person where such insured person has a period of service entitling the survivors for pension or in the event of the pensioner death where the pension was due for reasons of retirement or non-occupational disability.

Contribution share

Contributions which are lawfully paid by each of the employer and the insured person according to the percentage rate determined by the law whereas the employer pays the total contributions due to him and the insured persons working for him. The insured persons shares will be deducted from their wages in the periods determined by law. The contribution share in Annuities Branch is 18%, whereas 9% is paid by the employer and 9% is paid by the insured person, also the contribution share in OHB is 2% paid only by the employer.

Insurance Card

Card provided to the insured person caring the registration number for social insurance identification purposes that prove the insured person registration in the scheme.

Registration

It is the procedures done by GOSI for the implementation of the social insurance law regarding registering employers and their insured workers.

Employer

Is any natural or legal person employing one or more paid workers, regardless of wage.

Objection

Statement of the employer, insured person, pensioner or the person entitled to benefit or compensation, or any family member stating his/her un-convention of a decision made by any authority in GOSI and claiming for reconsideration. Such action shall be submitted within the determined period by law for this objection.

Contribution Number

It is the fixed registration number for the insured person in GOSI.

Insurance Entitlements

Benefits and advantages provided by the social insurance law due from GOSI to insured persons or their family members provided that entitlement conditions are to be satisfied.

Primary Medical Board

Committee assigned by GOSI to discuss medical matters in accordance with the social insurance law. Such board shall determine the disability degree, the disease caused by an occupation or the status of non-occupational disability of the insured person. This board shall consist of at least two physicians of whom one of them represents GOSI, if possible.

Appeal Medical Board

Committee formed of specialized physicians selected from high medical authority to renew Primary Medical Board decisions for appeal cases in the event of objection by the insured person of GOSI to decisions made by the later boards. The Appeal Medical Board shall consist of three physicians minimum.

Inspector

Officer elected by GOSI authorized among its staff to inspect the implementation of the social insurance law and procedures, such staff members are vested with legal powers in the limitation of conducting their duties.