How to Claim SOCSO for Critical Illness in Malaysia

A critical illness can happen to anyone, including your employees.

When they are sick, they can’t work, which means they stop earning money. At the same time, they have to spend a lot on medical treatment.

As an employer, it’s important to register your employees under SOCSO.

If they are covered and diagnosed with a critical illness, they can apply for SOCSO’s Critical Illness Claim, which provides financial support to help with medical costs and daily expenses.

Read this article to know the explanation of how employees can apply for the claim, what documents are needed, and what illnesses are covered.

What is a SOCSO Critical Illness Claim?

SOCSO provides financial help to employees who are diagnosed with serious medical conditions that stop them from working.

These illnesses often need expensive treatment and long-term care.

Without support, employees may struggle to pay for hospital bills, medicine, or even basic daily needs.

Under the Invalidity Scheme, SOCSO offers financial aid to employees who can no longer work because of:

Cancer
Heart disease and heart attacks
Stroke
Kidney failure
Chronic liver disease

When a worker falls seriously ill, they may lose their income. This can make it difficult for them to pay rent, buy food, or cover hospital expenses.

Without financial support, both the worker and their family may struggle to cope.

For employers, this situation brings important concerns:

What financial protection does your employee have?
How can they continue to support their family?
Is there any assistance available to help them through this crisis?

The SOCSO critical illness claim provides monthly financial aid to help affected employees.

This assistance helps cover medical costs, rehabilitation, and daily expenses, allowing employees to focus on recovery without worrying about their financial situation.

Eligibility for SOCSO Critical Illness Claims

Not all employees can immediately apply for SOCSO’s critical illness benefits. There are specific conditions that must be met before filing a claim.

To qualify for a SOCSO critical illness claim, the employee must:

Be registered under SOCSO and have contributed through salary deductions.
Be diagnosed with a critical illness by a certified doctor.
Have an illness that seriously affects their ability to work.
Be below 60 years old at the time of diagnosis (for claims under the Invalidity Scheme).

SOCSO covers both local and foreign workers, but their eligibility depends on their contribution history and the scheme they are under.

1. Full-time Employees

Any full-time worker registered under SOCSO who has been making regular contributions may qualify.

This includes employees in various industries, from office workers to factory staff.

2. Foreign Workers

Foreign employees are covered under SOCSO, but their eligibility depends on the type of SOCSO scheme they are registered under.

They may receive medical assistance and financial support, depending on their contribution record.

3. Self-Employed Workers

Some self-employed individuals, especially those in government-registered industries, may also be eligible if they have voluntarily contributed to SOCSO’s self-employment scheme.

SOCSO Benefits for Critical Illness

When an employee is diagnosed with a serious illness, it can cause not only health challenges but also financial struggles.

Medical treatments can be expensive, and if the worker is unable to continue working, they may lose their income.

This is where SOCSO supports by providing:

Monthly financial aid
Medical assistance, covering for hospital treatments, medications, and therapy.
Rehabilitation support such as physical therapy or recovery programs.

The duration of benefits depends on:

The severity of the illness and its impact on the employee’s ability to work.
The contribution history of the employee (how long they have been paying into SOCSO).
Medical assessments that determine whether the employee can return to work.

Some employees may receive benefits for months or even years, depending on their condition.

If the illness leads to permanent disability, the employee may qualify for long-term financial support under the Invalidity Pension Scheme.

Who Can Apply for a SOCSO Critical Illness Claim?

To qualify for financial assistance under SOCSO, your employee must meet these conditions:

They must have contributed to SOCSO before their diagnosis.
A certified doctor must confirm their illness as critical.
There may be a waiting period depending on when they started contributing to SOCSO.

How to Help Your Employee Submit a SOCSO Claim for Critical Illness in Malaysia

Employees should file their SOCSO claims as soon as possible after receiving their diagnosis.

There is a limited timeframe for submitting claims, so delaying the process may affect eligibility.

For Invalidity Pension, claims should ideally be filed before the employee reaches 60 years old. Any delay can result in missed financial benefits.

Below are the steps on how to file a SOCSO claim for critical illness:

Step 1: Obtain Medical Certification

The first step is for the employee to visit a doctor or specialist who can confirm the diagnosis and assess whether the illness prevents them from working.

The doctor will provide a medical report, which is a required document for the claim.

Step 2: Inform the Employer

Once diagnosed, your employee should notify you as soon as possible. This allows you to start the claim process quickly.

Step 3: Complete the Required Forms

To apply for SOCSO benefits, employees must fill out Form 34, which is the official application for Invalidity Pension or financial aid under SOCSO.

Details of Interest Notices and Claims - Form 34 for Malaysians

Foreign Worker Accident And Occupational Diseases Notification Form for Foreigner

Step 4: Submit the Claim to SOCSO

The claim can be submitted through three main channels:

Online via the SOCSO portal
At the neaerst SOCSO office
Through an appointed agent (some companies use third-party agents to handle SOCSO claims.)

Step 5: Wait for Approval

SOCSO will review the application and may request additional medical examinations to confirm the severity of the illness.

The approval process may take several weeks, depending on the complexity of the case.

If the claim is approved, SOCSO will deposit financial aid directly into the employee’s bank account.

If the claim is rejected, employees have the option to appeal the decision by providing additional medical evidence.

Role of Employers in SOCSO Claims for Critical Illness

Employers have a responsibility to assist employees in filing SOCSO claims, especially when they are dealing with a serious illness.

Here’s how employers can help:

1. Check if SOCSO contributions are up to date

Employees can only receive SOCSO benefits if their employer has made the required payments.

Before filing a claim, employers should verify that all contributions have been paid correctly.

2. Help employees gather the necessary documents

Employers need to provide employment records, salary details, and other paperwork required for the claim.

Helping employees collect these documents early can prevent delays in processing.

3. Submit the claim if the employee is unable to do so

If an employee is too sick to handle the application, the employer should take the initiative to submit the claim on their behalf.

This can be done online via the SOCSO portal or at a SOCSO office.

4. Assist with the employee’s return to work

If the employee recovers and is fit to work again, employers should provide support in helping them return to their job.

This may involve adjusting their workload or allowing flexible working arrangements.

What Documents Are Needed for a SOCSO Critical Illness Claim?

To file a SOCSO critical illness claim, employees must submit several important documents.

Documents that are need are below:

Detailed medical report from a registered doctor confirming the critical illness.
Form 32
Employee’s identification (MyKad (for Malaysians) or passport (for foreign workers))
Employer’s report as a proof about the the employee’s work history and contributions to SOCSO.
Employment details (Recent salary slips or proof of contributions to SOCSO)
Bank account details

If the information is incomplete or unclear, SOCSO may reject the claim or request further medical reviews, which could delay financial assistance.

What Happens After Submitting a SOCSO Critical Illness Claim?

Once the claim is submitted, SOCSO will review the application and determine whether the employee qualifies for financial support.

The process may take some time, and there are three possible outcomes:

Approved: The employee will start receiving financial aid and medical support. Payments will be deposited into the employee’s bank account based on the eligibility.
Additional Review Needed: SOCSO may ask for further medical examinations or additional documents.
Rejected: If the claim is denied, the employee can appeal the decision.

If a claim is rejected, employers should assist the employee in filing an appeal. This usually requires submitting additional evidence or a second medical report.

Employees and employers can check the claim status by:

Logging into the SOCSO online portal to monitor updates.
Visiting the nearest SOCSO office for direct inquiries.
Contacting SOCSO customer service for assistance.

SOCSO Benefits for Critical Illness Diagnosis in Foreign Workers

Foreign workers in Malaysia are also covered under SOCSO, but their benefits may differ.

They are usually covered under the Employment Injury Scheme, which provides financial support for work-related illnesses and injuries.

However, if a foreign worker is diagnosed with a critical illness that is not related to work, their eligibility for benefits may depend on their SOCSO contribution history.

In such cases, employers should check with SOCSO to understand whether the worker qualifies for support and what steps need to be taken to file a claim.

SOCSO Critical Illness Claims for Self-Employed Individuals

Self-employed workers in Malaysia can get SOCSO protection, but only if they register and contribute under the Self-Employment Social Security Scheme (SKSPS).

Unlike employees who have their SOCSO payments deducted from their salary, self-employed individuals must make their own contributions every month.

If a self-employed person is diagnosed with a serious illness and can no longer work, they may qualify for financial aid under SOCSO’s Invalidity Scheme. This can include:

Monthly payments if they are unable to work.
Medical cost coverage for treatments related to their illness.
Support for rehabilitation if they need therapy or recovery programs.

However, the amount and type of support depend on how long they have been contributing and the seriousness of their illness.

To receive benefits, they must have an active SOCSO account and a valid contribution history.

SOCSO Coverage for Mental Health Conditions

Mental health issues can make it difficult or impossible to work, just like physical illnesses.

SOCSO recognizes some severe mental health disorders as serious conditions that may qualify for financial support. These include:

Major depression
Bipolar disorder
Severe anxiety disorders
Schizophrenia
Post-traumatic stress disorder (PTSD)

To make a SOCSO claim for mental health, the employee must:

Get a medical report from a psychiatrist confirming the illness.
Show that the condition prevents them from working or affects their daily life.
Provide treatment records or proof of hospitalization, if applicable.

Penalties for Failing to Make SOCSO Contributions

If an employer does not register employees under SOCSO or fails to make the required payments, workers may be denied critical illness benefits.

This could leave the employer legally responsible for the worker’s medical costs.

Employers who fail to comply with SOCSO requirements may face:

Fines
Legal action
Backdated payments to cover missing contributions

To avoid these penalties, employers should always keep SOCSO contributions up to date.

FAQ

1. What should I do if my employee is diagnosed with a critical illness?

Encourage them to inform you immediately so you can assist with their SOCSO claim.

2. What documents are required for the claim?

Your employee needs a medical report from a doctor, Form 34, and other supporting documents as required by SOCSO.

3. Who is responsible for submitting the claim?

Employers should help employees complete the forms, but the employee or employer can submit the documents to SOCSO.

4. How long does SOCSO take to process the claim?

Processing time varies, but it can take several weeks. Employers can follow up with SOCSO for updates.

5. Can an employee claim SOCSO benefits while still working?

Yes, as long as they meet the eligibility criteria and their condition affects their ability to work.

6. What if my employee is no longer fit to work?

They may qualify for further SOCSO benefits, such as a disability pension. Guide them to check with SOCSO for additional assistance.

7. Where should the claim be submitted?

Claims should be submitted to the nearest SOCSO office. Check their website for the latest submission guidelines.

8. How long does it take to process a SOCSO critical illness claim?

SOCSO usually takes a few weeks to process a critical illness claim, but the exact timeline depends on the complexity of the case and required medical reviews. Roughly, the process includes:

Review: SOCSO checks the documents to confirm everything is complete.
Medical assessment: Some cases may need additional medical evaluation.
Approval & payment: If approved, payments are sent to the employee’s bank account.

9. How do I check the status of my SOCSO claim?

You can check online via the SOCSO portal, visit a SOCSO office (provide the employee’s IC number and claim reference), or contact SOCSO customer service.

10. What should I do if my claim is denied?

You can appeal by submitting additional medical documents or requesting a review at a SOCSO office.

If you have employees diagnosed with a critical illness, now is the time to act.

Help them navigate the SOCSO claims process, check their eligibility, and submit their documents as soon as possible.

The faster a claim is processed, the sooner financial aid reaches the employee and reduce their financial stress.

Employers who are proactive in assisting their workers strengthen trust and build a more resilient workforce.

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