How to Claim SOCSO for Accidents in Malaysia

Workplace accidents can happen anytime, even with strict safety measures in place.

When an employee gets injured at work, they may need medical care, time off, or even long-term support.

As an employer, it’s important to understand how SOCSO (Social Security Organization) helps cover workplace accidents and how you can assist your employees in filing claims.

This article will guide you through SOCSO’s accident coverage, who qualifies, the benefits available, and the steps to file a claim

What is SOCSO Accident Coverage?

SOCSO provides financial and medical assistance to employees who suffer from work-related accidents. These include:

1. Workplace Accidents

Accidents that happen at the workplace while an employee is performing their job duties.

This includes slips, falls, equipment malfunctions, and other injuries that occur during work hours.

2. Commuting Accidents

Injuries that happen while traveling between home and work or while on a work-related journey, such as:

Traveling directly to or from work.
Trips related to job responsibilities, such as meeting a client.
Accidents that happen during an authorized break, such as going out for lunch.

3. Emergency Accidents

Injuries sustained when an employee is trying to help others during an emergency at the workplace.

For example, an employee who gets injured while assisting colleagues during a fire or accident.

4. Occupational Diseases

Work-related illnesses that caused by exposure to hazardous conditions. Examples include:

Hearing loss from continuous exposure to loud noise.
Asthma due to inhalation of dust or chemicals.

Employers should be aware of these SOCSO coverage categories to help employees get the right support when accidents happen.

Eligibility for SOCSO Accident Claims

Not every employee automatically qualifies for SOCSO accident benefits. The following groups are eligible:

Full-time and part-time employees registered under SOCSO with active salary deductions.
Foreign workers under the Employment Injury Scheme.
Self-employed workers in certain government-registered industries (only if they voluntarily contribute to SOCSO).

To be eligible, the accident must be work-related. If an employee is injured outside of work for personal reasons, SOCSO will not cover the claim.

SOCSO Benefits for Accidents

When an employee suffers a workplace accident, SOCSO provides financial aid, medical treatment, and long-term support depending on the severity of the injury.

1. Medical Benefits

SOCSO covers free treatment at:

SOCSO panel clinics or government hospitals until the employee recovers.
Non-panel clinics (employees can claim reimbursement for treatment expenses).
If the injury is severe, employees qualify for second-class ward treatment and specialist care at government hospitals.

2. Temporary Disablement Benefit (for employees who cannot work temporarily)

If an employee is injured and cannot work for at least four days, SOCSO pays 80% of their daily wages until they recover.

Minimum benefit: RM30 per day
Maximum benefit: RM158.67 per day

Employees will not receive payment for the first three days of leave.

3. Permanent Disablement Benefit (for employees with long-term injuries)

For employees who suffer permanent disabilities due to an accident, SOCSO provides 90% of their daily wages.

Minimum benefit: RM30 per day
Maximum benefit: RM178.50 per day

Claims must be submitted within 12 months from the last temporary disablement date.

4. Constant-Attendance Allowance (for employees who need daily care)

Employees with severe injuries that require daily assistance can receive RM500 per month to cover caregiver expenses.

5. Rehabilitation Support

SOCSO provides physical and vocational rehabilitation to help employees recover and return to work. This includes:

Physiotherapy and occupational therapy.
Reconstructive surgery for accident-related injuries.
Prosthetics and assistive devices such as wheelchairs and hearing aids.
Vocational training for employees who need to switch careers due to disability.

6. Dependents’ Benefits (if the employee dies from the accident)

If an accident leads to an employee’s death, SOCSO provides financial support to the worker’s family.

Widow/Widower: 3/5 of the employee’s daily wage for life.
Children: 2/5 of the daily wage (until 21 years old, or longer if studying).
Parents or siblings (if no spouse/children): 3/10 of the daily wage.

7. Funeral Benefit

SOCSO pays RM3,000 to cover funeral expenses if an employee dies due to a workplace accident.

8. Education Benefit

SOCSO provides education loans to children of employees who die or receive permanent disability benefits.

How to File a SOCSO Accident Claim for Employers

When an accident happens, filing a SOCSO claim quickly is important to avoid delays in benefits. Employers should assist employees with the process:

Step 1: Report the Accident

Submit Form 21 (Accident Report) to SOCSO within 48 hours. If an employer does not report the accident, the employee can file the report themselves.

Step 2: Seek Medical Treatment

The injured employee should visit a SOCSO panel clinic or government hospital for treatment. If treated at a private clinic, they may need to apply for reimbursement.

Step 3: Complete the Necessary Forms

Fill in these forms and attach these when submitting the claim:

Form 34 (Benefit Claim Form). This needs financial assistance.
Medical report from the doctor.

Step 4: Submit the Claim

Employees or employers can submit SOCSO claims online via the SOCSO portal, at a SOCSO office, or through an appointed agent.

Step 5: SOCSO Reviews the Claim

SOCSO will assess the claim. If needed, they may ask for additional documents or medical checkups.

Step 6: Payment of Benefits

If approved, SOCSO transfers financial benefits directly to the employee’s bank account.

Employees can track their claim status on the SOCSO portal or visit a SOCSO office for updates.

Role of Employers in SOCSO Accident Claims

Employers are responsible for helping employees navigate the claim process. In details, employers can help in these areas:

Report accidents quickly within 48 hours to avoid delays in claiming the approval.
Keep SOCSO contributions updated.
Assist employees with claim submissions by gathering necessary documents.
Accommodate employee recovery when the employee returns to work after an accident by adjusting work tasks or offering flexible hours.

Required Documents for SOCSO Accident Claims

To process an accident claim, employees must submit:

Form 21 (Accident Report Form)
Form 10 (Claim Form)
Form 16A (Employer’s Report)
Form 34 (Notice and Benefit Claim Form)
Medical report stating the severity of the injury and how it affects the employee’s ability to work.
Hospital or clinic treatment receipts (for reimbursement if treatment is done at a non-SOCSO panel clinic)
Employee’s identification documents (MyKad (for Malaysians) or passport (for foreign workers))
Employer’s SOCSO contribution statement

Ensure all information and documents that are shared with the SOCSO are accurate. This is crucial for claiming approval.

If medical reports are incomplete or unclear, SOCSO may delay or reject the claim. So, employers should:

Encourage employees to get their medical reports from SOCSO-approved doctors.
Ensure the accident report is detailed and includes time, location, and how the accident happened.

What Happens After Submitting an Accident Claim to SOCSO?

Once the claim is submitted, SOCSO will review the case. Employees and employers should be aware of the possible outcomes:

After sending your claim, SOCSO will check your case. Here’s what might happen:

Approved

If everything is correct, SOCSO will accept the claim. The employee will get financial help based on their condition.

Medical costs will be covered under the Employment Injury Scheme.

Needs More Review

SOCSO may ask for extra documents or medical checks if:

The medical report is unclear about the injury.
Form 21 is missing accident details.
The employer’s SOCSO payment records need checking.

Rejected

If SOCSO rejects the claim, the employee can appeal. Reasons for rejection may include:

The accident is not related to work.
There is not enough medical proof.
The employee was not registered under SOCSO at the time of the accident.

To appeal, the employee should submit Form 9 (Appeal Application) with extra documents. SOCSO’s Medical Board may review the case if needed.

Employees can check their claim status online, visit a SOCSO office, or call the SOCSO hotline at 1-300-22-8000.

SOCSO Benefits for Foreign Workers in Accidents

Foreign workers are covered under SOCSO, but only for work-related accidents.

Their eligibility depends on their contribution history. Employers should check with SOCSO to confirm coverage for foreign employees.

Employers should consult SOCSO for guidance on foreign worker claims to avoid complications during the claim process.

Accident Benefits for Self-Employed Individuals

Some self-employed workers, such as e-hailing drivers or small business owners, can claim SOCSO accident benefits if they voluntarily contribute to the Self-Employment Social Security Scheme (SKSPS).

However, to be eligible for accident claims, self-employed workers must register and contribute regularly.

Reporting and Prevention of Workplace Accidents

While SOCSO provides financial protection, the best way to handle accidents is to prevent them. Employers should:

Follow workplace safety regulations.
Conduct regular safety training for employees.
Provide proper protective equipment.
Encourage employees to report unsafe conditions.

Penalties for Failing to Make SOCSO Contributions

If the employers fail to make SOCSO contributions regularly so, it can lead to serious consequences. The consequences are below:

Fines for non-compliance fined up to RM10,000 or face imprisonment of up to two years, or both, under Section 94 of the Employees’ Social Security Act 1969.
Backdated payments with a 6% annual interest on overdue amounts
Employer blacklisting and investigation by SOCSO

FAQ

How long does it take to process a SOCSO accident claim?

SOCSO typically takes a few weeks to process an accident claim, depending on the complexity of the case and the completeness of the documents. The process includes:

Initial Review: SOCSO checks if all required documents are submitted.
Medical Assessment: If needed, SOCSO may request additional medical evaluations.
Approval & Payment: Once approved, payments will be deposited into the employee’s bank account.

The process may take longer if documents are missing or further medical checks are required. Employees and employers can track the claim status through the SOCSO online portal or by visiting a SOCSO office.

What should I do if the accident occurred outside the workplace but is still work-related?

SOCSO covers accidents that happen outside the workplace if they are related to work. This includes:

Commuting accidents while traveling between home and work or while going out for work-related tasks.
Work assignments outside the office accidents, such as in meetings, deliveries, or site visits.
Accidents during meal breaks in working hours

When one of these things happens, employees should report the accident immediately to their employer and seek medical treatment from a SOCSO panel clinic or hospital. Then, employers must file a claim with SOCSO.

Can I claim compensation for both medical expenses and lost wages?

Yes, SOCSO provides different types of financial support for workplace accidents:

Medical benefits that cover hospital treatments, surgeries, medications, and rehabilitation therapy.
Temporary disablement benefit of 80% of the employee's average daily wage with a minimum of RM30 and a maximum of RM158.67 per day with the condition the employee is unable to work for at least 4 days.
Permanent disablement benefits at the rate of up to 90% of their average daily wage, with a minimum of RM30 and a maximum of RM178.50 per day.

If the injury is severe, SOCSO also provides rehabilitation support to help employees recover and return to work.

What to do if the employer fails to report the accident to SOCSO?

Employers must report workplace accidents to SOCSO within 48 hours. If they fail to do so, the employee can take these steps:

Report the accident directly to SOCSO by visiting the nearest SOCSO office or using the online portal.
Submit Form 34 (Notice and Benefit Claim Form) along with medical reports and other required documents.
Provide witness statements or any proof of the accident, such as hospital records or CCTV footage.

If an employer refuses to report the accident, they may face fines or legal action. Employees can also contact SOCSO for further help.

What happens if I cannot return to work due to the severity of the injury?

If an employee is permanently disabled and unable to work, SOCSO provides long-term financial and rehabilitation support, including:

Permanent Disablement Benefits up to 90% of the employee’s daily wage for life, depending on the severity of the disability.
Constant-Attendance Allowance: RM500 per month.
Vocational & Physical Rehabilitation, such as therapy, prosthetics, and retraining programs to help employees regain skills or transition to a new job.

If the injury makes it impossible for the employee to work again, they may continue receiving monthly payments based on their disability assessment.

No employer wants to see their workers injured, but when accidents happen, knowing how to guide employees through the SOCSO claim process is crucial.

As an employer, ensure timely reporting, provide necessary documentation, and keep SOCSO contributions up to date. This can help employees receive medical treatment and financial aid faster.

Workplace accidents can be unpredictable, but the right preparation can make all the difference in supporting employees during recovery.

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