In a claim for disability benefits by a seafarer, the assessment of the company-designated physician holds significant weight. This means that if a seafarer seeks a second opinion from their own doctor and the assessments conflict, a specific procedure must be followed: both parties must jointly agree on a third, independent physician whose decision will be final. If the seafarer fails to notify the employer of their intention to seek a third opinion and follow this procedure, the company-designated physician’s assessment prevails, potentially impacting the seafarer’s ability to claim disability benefits. This ensures a fair and structured process for resolving medical disputes in maritime employment.

Navigating the Seas of Seafarer Health: Whose Medical Opinion Prevails?

Edgar S. Alferos, employed as an Able Seaman by Maersk-Filipinas Crewing Inc. and A.P. Moller A/S, experienced lower back and abdominal pain during his employment. Upon repatriation and examination by company-designated physicians, he was initially diagnosed with prostatitis but later cleared to resume duties. Disagreeing with this assessment, Alferos consulted another physician who found him unfit due to kidney stones and vertigo, leading him to file a claim for disability benefits. The core legal issue revolves around which medical assessment should prevail when there is a conflict between the company-designated physician and the seafarer’s chosen physician, especially concerning the procedural requirements outlined in the POEA-SEC.

The Supreme Court, in this case, emphasized the importance of adhering to the procedure outlined in the POEA-SEC for resolving conflicting medical assessments. When a seafarer sustains a work-related illness or injury, the POEA-SEC mandates that the company-designated physician determines the seafarer’s fitness or unfitness for work. However, recognizing the possibility of differing opinions, the POEA-SEC provides a mechanism to address disagreements. According to the Court in TSM Shipping Phils., Inc. v. Patiño:

…the non-observance of the requirement to have the conflicting assessments determined by a third physician would mean that the assessment of the company-designated physician prevails.

This underscores the primacy given to the company-designated physician’s assessment unless the prescribed procedure is followed. The POEA-SEC clearly stipulates the process for resolving disputes in medical assessments:

If a doctor appointed by the seafarer disagrees with the assessment (of the company-designated physician), a third doctor may be agreed jointly between the Employer and the seafarer. The third doctor’s decision shall be final and binding on both parties.

The Court found that Alferos failed to comply with this critical requirement. Despite obtaining an assessment from his chosen physician that contradicted the company-designated physician’s fit-to-work declaration, Alferos did not notify his employers of his intent to seek a third opinion. This failure to provide notice is a crucial point. Without such notification, the employers were not given the opportunity to participate in the selection of a third, independent physician, as mandated by the POEA-SEC. The purpose of the third-doctor provision is to provide an impartial resolution to conflicting medical opinions, ensuring fairness and objectivity in the assessment process.

The Supreme Court referenced Hernandez v. Magsaysay Maritime Corporation to emphasize the seafarer’s responsibility in initiating the third-doctor process:

Under Section 20 (A) (3) of the 2010 POEA-SEC, “[if] a doctor appointed by the seafarer disagrees with the assessment, a third doctor may be agreed jointly between the Employer and the seafarer. The third doctor’s decision shall be final and binding on both parties.” The provision refers to the declaration of fitness to work or the degree of disability. It presupposes that the company-designated physician came up with a valid, final and definite assessment as to the seafarer’s fitness or unfitness to work before the expiration of the 120-day or 240-day period. The company can insist on its disability rating even against a contrary opinion by another doctor, unless the seafarer signifies his intent to submit the disputed assessment to a third physician. The duty to secure the opinion of a third doctor belongs to the employee asking for disability benefits. He must actively or expressly request for it.

Because Alferos did not actively request the opinion of a third doctor, the Court deemed his claim for disability benefits premature. The Court further clarified that the PEME (Physical Employment Medical Examination) conducted by Supercare, which found Alferos unfit, was primarily for re-employment purposes and could not substitute the formal notification required under the POEA-SEC. In essence, the PEME’s findings were considered too tentative to override the company-designated physician’s assessment, especially in the absence of proper notification and the opportunity for the employers to participate in the third-doctor process.

The Court highlighted that for a writ of certiorari to be issued, the abuse of discretion must be grave, indicating an arbitrary or despotic exercise of power, evasion of duty, or action in a capricious manner tantamount to lack of jurisdiction. The NLRC’s decision to affirm the Labor Arbiter’s award of disability benefits, despite Alferos’ failure to comply with the third-doctor procedure, was deemed a grave abuse of discretion. By disregarding the express language of the POEA-SEC, the NLRC acted in a whimsical and capricious manner, justifying the reversal of its decision.

This ruling reinforces the significance of adhering to the prescribed procedures in seafarer disability claims. The POEA-SEC provides a clear framework for resolving medical disputes, and failure to comply with its provisions can have significant consequences for seafarers seeking disability benefits. The case serves as a reminder that while seafarers have the right to seek independent medical opinions, they must also fulfill their contractual obligations by actively participating in the third-doctor process when disagreements arise.

FAQs

What was the key issue in this case?	The key issue was determining which medical assessment should prevail in a seafarer’s disability claim when there’s a conflict between the company-designated physician and the seafarer’s chosen physician, specifically regarding compliance with POEA-SEC procedures.
What is the role of the company-designated physician?	The company-designated physician is primarily responsible for assessing a seafarer’s fitness or unfitness for work when the seafarer sustains a work-related illness or injury while on board the vessel, and their assessment initially prevails.
What happens if the seafarer disagrees with the company-designated physician’s assessment?	If the seafarer’s chosen physician disagrees with the company-designated physician’s assessment, the POEA-SEC provides a process where both parties must jointly agree on a third, independent physician whose decision will be final and binding.
What is the seafarer’s responsibility in the third-doctor process?	The seafarer has the duty to actively notify the employer of their intent to seek a third medical opinion, initiating the process for selecting a mutually agreed-upon physician to resolve the conflicting assessments.
What happens if the seafarer fails to notify the employer of their intent to seek a third opinion?	If the seafarer fails to notify the employer and follow the POEA-SEC procedure, the company-designated physician’s assessment prevails, potentially impacting the seafarer’s ability to claim disability benefits.
Can a PEME (Physical Employment Medical Examination) substitute for the third-doctor process?	No, a PEME conducted for re-employment purposes cannot substitute for the formal notification and third-doctor process required under the POEA-SEC when there are conflicting medical assessments.
What is the significance of the POEA-SEC in seafarer disability claims?	The POEA-SEC provides a clear framework for resolving medical disputes and outlines the procedures that must be followed to ensure fairness and objectivity in the assessment process for seafarer disability claims.
What was the Court’s ruling in this case?	The Court ruled in favor of the employers, stating that the seafarer’s claim for disability benefits was premature because he failed to notify his employers of his intent to seek a third medical opinion and comply with the POEA-SEC procedure.

In conclusion, this case underscores the critical importance of strictly adhering to the procedures outlined in the POEA-SEC for seafarer disability claims. The primacy given to the company-designated physician’s assessment highlights the need for seafarers to proactively engage in the third-doctor process when seeking to challenge such assessments.

For inquiries regarding the application of this ruling to specific circumstances, please contact ASG Law through contact or via email at frontdesk@asglawpartners.com.

Disclaimer: This analysis is provided for informational purposes only and does not constitute legal advice. For specific legal guidance tailored to your situation, please consult with a qualified attorney.
Source: MAERSK-FILIPINAS CREWING INC. v. ALFEROS, G.R. No. 216795, April 01, 2019