Section 57.²³ In the calculation of daily wages for payment of income replacement to an insured person under section 33, it shall be computed from the first three month of wages employed which the employer uses as a basis in calculating contributions to be paid to the Office within the retroactive nine months and divided by ninety. If the insured person has an evidence proving that wages employed of another three month during the period of such retroactive nine moths shall produce the better output than the first one, it should be calculated by using wages employed of such another three months and divided by ninety. In the case where an insured person paid contributions less than nine months, it shall be computed by using the last three month of wages employed which the employer used as a basis in calculating contributions to be paid to the Office and divided by ninety.

For the calculation of daily wages for payment of income replacement to an insured person under section 39, it shall be computed from the average wages used as basis for calculation of contribution under section 39 paragraph two.
Section 58. In case the benefits under this Act are medical services, an insured person or his or her spouse shall receive such services from the hospitals or other places rendering medical services as prescribed under section 59.
Details and conditions of medical services to an insured person or his or her spouse shall be in accordance with the regulation prescribed by the Secretary – General, with the approval of the Committee.

Section 59. The Secretary – General shall publish in the Government Gazette the area of coverage and the names of hospitals or other places rendering medical services at which an insured person or his or her spouse shall be entitled to receive medical services.

An insured person or his or her spouse, who is entitled to receive medical services and is employed or has domicile in a locality, shall receive medical services at the hospital or places prescribed under paragraph one in such locality, except no hospital or other places under paragraph one thereof are existed in such locality or if the insured person or his or her spouse has justifiable reason that he or she is unable to receive medical services at the hospital or places prescribed thereof. Upon such reason, the medical services may be rendered at the hospital or places as prescribed under paragraph one in another locality.

In the case where an insured person or his or her spouse receives medical services at hospital or places other than those prescribed under paragraph two, the insured person shall be entitled to reimburse for the cost of medical services being paid at the amount fixed by the Office, taking into account the conditions of injury or sickness, maternity, economic situation in each locality and nature of medical services having received . In this respect, it shall not exceed the rate prescribed by the Medical Committee, with the approval of the Committee.

Section 60. In the case where an insured person or his or her spouse who has received medical services at the prescribed hospital or place ignores or does not comply with the recommendations or instructions of the doctor without justifiable reason, the Secretary - General or a person entrusted by the Secretary – General, with the approval of the Medical Committee, may determine to reduce benefits which such insured person or his or her spouse is entitled.

Section 61.²⁴ An insured person or a person under section 38 paragraph two, section 73 or section 73 bis shall not be entitled to benefits when there is any cause showing that the above mentioned person intentionally causes the injury or sickness or invalidity or death to be happened or permits other person in doing such incidents thereof.

Section 61 bis.²⁵ In the case where an insured person is entitled to income replacement under section 64 and section 71 and, simultanously, entitled to allowance for work – leave as a result of child delivery under section 67, the said person shall be entitled to receive only one category of benefit, either income replacement or allowance for work-leave as a result of child delivery, by stating his or her intention according to the form prescribed by the Secretary – General.

Chapter 2
Injury or Sickness Benefits

Section 62.²⁶ An insured person shall be entitled to non - occupational injury or sickness benefits when he or she has paid contribution for a period of not less than three months during period of fifteen months before the date of receiving medical services.

Section 63. Benefits for non-occupational injury or sickness shall consist of:
(1) medical examination expense;
(2) medical treatment expense;
(3) lodging, meals and treatment expenses in hospital;
(4) medicine and medical supplied expenses;
(5) cost of ambulance or transportation for patient;
(6) other necessary expenses

The above mentioned expenses shall be in accordance with the rules and rates prescribed by the Medical Committee, with the approval of the Committee.

The insured person who is taking work-leave to receive medical treatment under the instruction of doctor, shall, also, be entitled to income replacement according to the prescribed criteria under section 64.

Section 64. In the case where an insured person suffers from non-occupational injury or sickness, the insured person shall be entitled to income replacement at the rate of fifty per cent of wages employed under section 57 for a period the insured person has take work-leave to receive medical treatment under the instruction of doctor which shall not exceed ninety days on each occasion and not more than one hundred and eighty days in a calendar year. Except for sickness from chronic disease as prescribed in the Ministerial Regulations, the said insured person shall be entitled to income replacement for more than one hundred and eighty days but not exceeding three hundred and sixty – five days.

The calculation period for receiving income replacement shall be computed from the first day of work – leave under the instruction of doctor until the last day specified by the doctor or until the last day of work - leave in case insured person has returned to work before the fixed date under the instruction of doctor but not exceeding the periods of time under paragraph one.

If an insured person is entitled to receive wages from the employer during sick leave for medical treatment according to the law on labour protection or entitled according to work regulation, hire of services contract or conditions of employment, as the case may be, the insured person shall not be entitled to receive benefits under paragraph one until the entitlement to receive wages is subsequently exhausted, and shall only be entitled to receive the said income for the remaining period. However, if the wages received from employer in any case is less than the income replacement payable by the Fund, the insured person shall be entitled from the Fund, the income replacement for the difference.

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23 As amended by section 20 of the Social Security Act (No.2), B.E. 2537 (1994)

24 As amended by section 21 of the Social Security Act (No.2), B.E. 2537 (1994)

25 As added by section 22, ibid.

26 As amended by section 23 of the Social Security Act (No.2), B.E. 2537 (1994)