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Regulations for the Implementation of the Social Insurance Law Version 11 م 2021/ ه 1442 DECISION OF THE MINISTER OF LABOUR AND SOCIAL AFFAIRS NO. 128/INSURANCE DATED 25/10/1421 H. THE MINISTER OF LABOUR AND SOCIAL AFFAIRS, Having reviewed the Social Insurance Law issued under the Royal Decree No. M/33 Dated 03/09/1421 H; Having reviewed the old Social Insurance Law Implementing Regulations constituting the rules and procedures for registration, assessment and collection of contribution, survey of establishments, submission of appeals, rules and procedures for application of the Annuities Branch, rules and procedures for application of the Occupational Hazards Branch, rules and procedures for regulating the activities of the inspection agencies and rules and procedures for the medical board membership, issued by the Decision of the Minister of Labour and Social Affairs No. 2/Insurance dated 11/09/1392 H., No. 15/Insurance dated 28/01/1395 H., No. 19/Insurance dated 07/11/1395 H., No 61/Insurance dated 06/04/1402 H., and No. 104/Insurance dated 12/03/1411 H., respectively, and the relevant amending decision; As the new Law demands issuance of new implementing regulations taking into consideration the new and revised provisions thereof; And pursuant to the Decision of the Board of Directors of the General Organization for Social Insurance No. 735 dated 25/10/1421 H. concerning the Regulations adopted in substitution for the said old Regulations; DECIDES THE FOLLOWING : ARTICLE (1) For the purposes of application of the provisions of the Social Insurance Law issued under the Royal Decree No. M/33 dated 03/09/1421 H., the following Regulations attached hereto shall be put into effect: 1. Registration and Contribution Regulations. 2. Annuities Branch Benefits Regulations. 3. Occupational Hazards Branch Benefits Regulations4. Medical Board Regulations. ARTICLE (2) For the purposes of definition of the terms set out in the Regulations mentioned in the preceding Article, they shall have the meaning provided for in Article (2) of the Law and in the said individual Regulations in the addition to the meanings of the following terms: 1. New Law: The Social Insurance Law issued under the Royal Decree No. M/33 dated 03/09/1421 H. 2. Old Law: The Social Insurance Law issued under the Royal Decree No. M/22 dated 06/09/1389 H. Article (3) The provisions of these Implelmenting Regualtions shall be considered as supplementing, explaining and elaborating the provisions of the Law. Artilce (4) 1. The Governor of the General Organization for Social Insurance shall determine the specifications, terms, usages and submission dates of the necessary forms and certificates for the implementation of the Regulations attached hereto. The Governor shall also amend such forms and certificates by addition, omission, intergration, cancellation or creation of new ones. He may also explain or detail any of the provisions of the said Regualtions. 2. For the purposes of improving the work progress, the Governer may obligate all or some employers to commit to electronicaly deal with the Organization. 3. The Governor may delegate some of his powers provided for in the attached Regualtions to such officials of the Organization as he may designate. Article (5) 1. For the purposes of application of the provisions of paragraph (2) of Article (68) of the Law, the Regulations implementing the old Law issued by the Ministerial Decisions referred to in the preamble of this Decision shall become null and void. 2. The previously issued decisions concerning special handling of certain cases of employers and contributors shall remain valid, provided that they do not contradict the provisions of the Law and the Regualtions attached hereto. 3. The decisions already issued in respect of the work organization and procedures shall remain valid so long as they do not contradict the provisions of the said Law and Regulations untill they are amended or replacement decisions are issued. ARTICLE (6) This Decision and the Regualtions attached hereto shall be published in the officail gazette and shall take effect from the date on which the Law is put into effect, and the Governor of the General Organization for Social Insurance shall take the necessary measures to give effect thereto. Ali l. Al-Namlah Minister of Labour and Social Affairs c. As regards to the benefits entitled to the family members under the old Law and are still entitiled to them on the date the new Law is put into effect, the shares of the eligible family members shall be re-determined on the basis of raising their breadwinner’s entitlement to SR 1,500 (one thousand five hundred Saudi Riyals) if it less than such amount. If, thereafter, an individual share is found to be less than SR 300 (three hundred Saudi Riyals), it shall be raised to this much, provided that the total amount of the shares of the family members pusuant to this provisions shall not exceed SR 1,500 (one thousand five hundred Saudi Riyals) or the average wage taken as a basis for the computation of the benefit of the breadwinner, whichever is greater. 2. The non-Saudi contributors or any of their family members, as applicable, who have licensed permit for permanent residece in the Kingdom, and who, prior to putting these Regulations ito effect, were receiving monthly benefit under the old Law and remained payable untill the date of putting the new Law into effect, shall be subject to the provisions of the preceding paragraphs. The appropriate office regularly verify the fulfillment of the permanent residence condition. 3. The provisions of the preceding paragraphs shall be applied on and from the beginning of the month immediately following the date on which the new Law is put into effect. 4. The daily allowance payable to the Saudi or non-Saudi contributor, who sustained employment injury under the old Law, shall be raised to the amount provided for in the new Law for the disability periods following the date of putting it into effect. The recipient of the monthly benefit for permanent total disability under the old Law who subjects himslef to regular mendical examinations under the new Law, and as a result of re-examination, his disability degree is reduced or raised, shall continue to be treated according to the provisions of the old Law as to the determination of the kind and amount of the benefit payable in the form of monthly benefit or lump sum compensation, as appropriate, subject to the new degree of disability Medical Board Regulation MEDICAL BOARD REGULATIONS Chapter One: The Formation Of Medical Committees And Places To Be Held On Article (1) 1- The primary medical committees referred to in paragraph (1) of Article (53) of the Law consists of two doctors, at least, that is, including one doctor representing GOSI whenever possible, by the Committee in each office of GOSI offices in the regoins and provinces. GOSI governor may merge the juridiction of two or more in one committee of work by the size and needs. 2- The appellate medical committee referred to in paragraph (2) of Article (53) of the law in the main center of at least three doctors not from GOSI. 3- Without prejudice to the provisions of the two preceding paragraphs governor chooses the members of the Primary Medical Boards and the appeals of GOSI doctors or doctors of the Ministry of Health or others with medical effciency, whether by assignment or contract, to be among these doctors in each committee a doctor who specializes in occupational medicine as much as possible. Article (2) 1- Appeal Medical Committee meets at GOSI office, and may, if necessary, to take place in another place with the consent of the Governor. 2- Primary medical committee meets at the headquarters of the competent office, and may, if necessary, to take place in another place with the consent of the competent manager. 3- Primary medical committee meets once a month at least as long as any of the cases offered her. 4- Competent Director determines the dates of the Medical Committee in coordination with the Physicians Committee members. Article (3) 1- If one of the members of the Medical Committee of Apeal fails to appear for any reason, and resulted in his absence that the number of members of the Committee became less tham three doctors governor laments another doctor to be replaced at his absence who should not be member of the Committee, which issued the challenged decision. 2- In the event of default by one of the members of the medical committee for elementary attendance for any reason, and resulted from his absence that the number of members of the Committee became smaller than two doctors, competent manager replace him during period of his absence. SECTION II : MEDICAL BOARD WORK RULES AND PROCEDURES ARTICLE (4) The following procedures shall be followed upon receving a request for establishment of an occupational or a non-occupational disability state of a contributor: 1. The contributor’s case shall be presented to the Office physican who may medicaly examine the contributor or refer him to the approprite medical body for undergoing the necessary medical examinations before being presented to the Board. The contributor shall submit his medical reports to the said Office physician. 2. Where all the medical reports and examinationed deemed to be necessary by the Office physician are completed, the Secretary to the Medical Board shall refer the conributor to the Board on the date fied by the Office Director for the session and shall notify the contributor of the fixed time of the session. 3. As an exception of the provisions of the preceding two paragraphs, there shall be no consideration of the employment injury cases fr which five or more years have elapsed without submission of an application and receipt of an injury notification, unless Governor’s approval of the tolerance of the delay is issued. Article (5) Board members or the one the Board authorizes to do so and submit thereto a report, if the Board or Office physican is of the opinion that the physical condition of the contributor or beneficairy does not enable him to appear before the Board. 2. For the purposes of determining the jurisdiction of the Primary Medical Board, if the contributor or beneficiary is present in a place falling within the jurisdiction of another Medical Board, his case may be examined by the Medical Board operating in the place where he is present. 3. As an exception of the provisions of paragraph (1), the Medical Board may consider the medical reports and laboratory tests as suffcient for the purposes of establishment or continuity of the disability state in the following cases: a. If the case is appealed against to the Appeal Medical Board, the contributor has lest the Kingdom and the Board is stisfied with the adeqacy of the report submitted in respect of this case. b. In case the medical reports required by the Medical Boards for the establishment of the state of disability are submitted after the contributor’s departure from the Kingdom as supllementary to previous medical examination by the Medical Board. c. If the contributor, who is afflicted with a non-occupational disablity, is only entitled to a lump sum compensation. d. In case of submission of the medical reports required by the Medical Boards for periodical re-examination of the contributor or beneficiary. e. Where the case of any family member is considered for the establishment of his earning incapacity. f. Such other cases as the Governor may permit the Board to be satisfied with the medical reports without the requirement of the contributor to appear before the Board. 4. In all cases referred to in sub-paragraphs (a), (b), (c), (d) and (e) of paragraph (3), the Governor may require to have the contributor or beneficiary subjected to medical examination under the supervision of the Organization, if he deems such action to be necessary in any of the cases. 5. The Governor shall determine the conditions that shall be satisfied by the medical reports and the tests that shall be made outside the Kingdom in order to be considered as reliable. ARTILCE (6) 1. The appropriate Medical Board may request the presence of a competent Organization officer to be selected by the concerned Director to explain the provisions of the Law and implementing regulations relevant to the case being presented to the Board. 2. The Medical Board may call for the advice of a specialized medical consultant, and the Secretary to the Board shall record the advice of such consultant or attach his relevant report, if any. If the Board is not of the opinion to adopt the consultant's advice, it should mention in detail the reasons therefore, and the secretary shall record such reasons. 3. The Board may, as necessary, consult the representative of the Minister of Labour on the available job opportunities that may be suitable to the condition of the contributor. The said representative shall be invited by a decision from the concerned Director. The representative of the Ministry of Labour shall be designated by virtue of such regulating rules as may be issued by coordination between the Organization and the Ministry. 4. The Medical Board may request making any laboratory tests or any other tests if the contributor's condition necessitates such tests in the opinion of the Board. 5. a The Organization shall bear the costs of the medical reports and examinations made within the Kingdom so long as they are made upon the request of the Medical Board or on their behalf. b. The Organization shall not bear the costs of the medical reports and examinations made outside the Kingdom except in such cases as may be approved by the Governor. ARTICLE (7) 1. Without prejudice to the provisions of paragraph (2) of Article (39) of the Law, the contributor's non-occupational disability shall be established if the conditions for establishment of disability in its insurance meaning provided for in paragraph (6) of the said Article are met. The Medical Board - upon the presentation of the contributor after the leaving the work subject to the law-shall determine the starting date of disability to take effect on and from the date of satisfaction of all statutory and medical conditions. 2. The Primary Medical Board shall not determine the state of permanent disability of the injured person as long as he is hospitalized for treatment. It shall determine the state of permanent disability, if any, after the required treatment is completed and the condition is stabilized and he is discharged from the treating center. 3. As an exception of the provisions of paragraph (2), if the treatment center or the office physician discovers that the physical condition of the non-Saudi injured person does not permit him to resume his employment and that he must leave the hospital to his home country directly, the Medical Board may examine him while he is in the treating center. If the Board is satisfied that his condition is stabilized, it may issue its decision before he is discharged from the treating medical center, in which case, the Office shall coordinate with the employer and arrange for his travel to his home country, so that his cash benefit will be paid to him in due course prior to his departure. His receipt of such benefit shall be considered a final settlement of all his entitlements due from the Organization. The Governor shall set out the required arrangements and controls to ensure that the Organization does not pay any medical expenses or additional allowances beyond the time it has fixed for the travel of the injured person. ARTICLE (8) The Medical Board may issue its decision on the establishment of the state of non-occupational disability even after the contributor attains sixty years of age in the following two cases: 1. If the case had been presented to the Board before the contributoe attained age sixty and the procedures had taken some time until he reached such age. 2. If the case had been presented to the Board for the first time on the date the contributor attained age sixty or thereafter and the Board had been certain that the disability state was established before the contributor reached such age. ARTILCE (9) 1. If the symptoms of the occupational disease appeared after the termination of the employment covered under the Law, the case shall be presented to the Medical Board to determine the relation of the disease with the occupation he was exercising before he left employment, without prejudice to the provisions of the Schedule of the Occupational Diseases. 2. For the purposes of considering a disease an occupational disease, the Medical Board shall take into account that the occupation which caused such disease to the contributor was one of the causative occupations shown opposite to the respective diseases in the Schedule of the Occupational Diseases. SECTION III : MEDICAL BOARD’S DECISIONS AND APPEALS AGAINST SUCH DECISIONS ARTILCE (10) 1. The Medical Board shall adopt its decisions by majority voting if its members are three or over and by unanimous voting if its members are two only. 2. The Governor shall call another physician to join the Medical Board membership to review the case if the Board fails to issue the relevant decision by virtue of the provisions of paragraph (1) above. 3. The decision of the Board shall, in all cases, be reason-based. However, if no reasons are instituted in the decision, the case shall be presented again to the same Board to issue its final reason-based decision on such case. ARTICLE (11) 1. The contributor may appeal against the decision issued in respect of his case by the Primary Medical Board, provided that he shall submit his appeal to the Appeal Medical Board within twenty one working days at the most from the date he is notified of the Board's decision. The Governor may forego the contributor's delay in submitting the appeal, if such delay is due to justifiable reasons. 2. The Organization may appeal against the decisions issued by the Primary Medical Boards, in which case it shall submit its appeal to the Appeal Medical Board within twenty one working days at the most from the date of issue of the Board's decision. The Organization shall show the reasons for its appeal. 3. The Organization or the contributor may withdraw the appeal submitted to the Appeal Medical Board at any time before the Board issues its decision. 4. If the contributor appeals against the decision of the Primary Medical Board, he shall bear the transportation and residence expenses for himself and his companion (if any) throughout the entire period of his appeal before the Appeal Medical Board. In case the appeal is accepted, the Organization shall bear the said expenses in accordance with the approved rules. ARTICLE (12) 1. The Medical Board shall fix the times for the periodical medical examination of the recipient of pension or benefit regardless of the state of disability. However, the Board may extend the times of the periodical medical examination in cases where the Board believes that the case is, most likely, stabilized and neither recovery nor improvement is expected, provided that, in occupational disability cases, the injured person shall be re-examined at the beginning of the fifth year from the starting date of issuance by the Primary Medical Board of the first decision on the assessment of the state of disability. In cases of non-occupational disability, the final examination shall be made early before the contributor reaches age sixty. 2. The Medical Board may subject the recipient of pension or benefit to a medical examination after he reaches age sixty, in non-occupational disability cases, and after the lapse of five years from the allocation of benefit in occupational disability cases, in order to verify whether the beneficiary is still in need of assistance of others in performing his everyday life activities. The allowance determined for this purpose shall become final by completion by the contributor of sixty five years of age for non-occupational disability and by the lapse of ten years from the date of allocation of benefit for occupational disability. As an exception to the provisions of the preceding two paragraphs, the appropriate Medical Board may, if the contributor's injury is hopeless or unexpected to be healed, issue a decision that it is not necessary for the contributor to conduct medical periodical examination during the appointments referred to SECTION IV : REMUNERATIONS OF MEDICAL BOARD MEMBERS AND LODGING AND TRANSPORTATION EXPENSES ARTICLE (13) The physicians who are members of the Medical Boards other than the GOSI physicians, or those who are called by the Board for consultation, shall, in consideration of their work with such Boards, be paid fees to be determined by the Governor in accordance with such standards as may be deemed appropriate by the Governor. ARTICLE (14) The Governor shall, by decision to be issued by him, determine the circumstances in which the contributor or any of the family members who is called to appear before the Medical Board, is entitled to reimbursement of the lodging and transportation expenses and prescribe the sum of such expenses. SECTION V : GENERAL PROVISIONS ARTICLE (15) For the purposes of application of the provisions of these Regulations, the concerned Director shall be taken to mean the Director General of Insurance Rights with respect to the Appeal Medical Board and the appropriate Office Director with respect to the Primary Medical Board ARTICLE (16) The Governor shall secure the work environment and requirements to the Medical Board to perform its function. He shall also select a Secretary to the Board who shall be adequately aware of the provisions of the Law and Regulations thereof and of the work procedures. The Governor shall also prescribe the authorities and duties of the Secretary. ARTICLE (17) Each Medical Board shall keep the records required for entering the cases presented thereto showing, in particular, the date of referral, the date of review, and the relevant Board's decision, and the date of referral absuch decision to the concerned Director ARTICLE (18) The Governor may compel any of the addressees to the provisions of this regulation by dealing with the organization electronically.