The Supreme Court ruled that a seafarer is entitled to total and permanent disability benefits when the company-designated physician fails to provide a final and definite assessment of their condition within the prescribed period. This decision reinforces the importance of timely and conclusive medical assessments in safeguarding the rights of seafarers to receive just compensation for work-related injuries. It emphasizes the duty of employers to ensure comprehensive medical evaluations and clear communication regarding a seafarer’s fitness for duty.

When a Snap Leads to a Claim: Defining ‘Accident’ and a Seafarer’s Right to CBA Benefits

This case revolves around Danille G. Ampo-on, who worked as an Able Seaman for Reinier Pacific International Shipping, Inc. While on board M/V APL Barcelona, Ampo-on experienced a debilitating back injury. The central legal question is whether Ampo-on is entitled to total and permanent disability benefits under the Collective Bargaining Agreement (CBA) due to this injury, and whether the injury qualifies as an ‘accident’ as defined in the CBA.

Ampo-on’s employment contract stipulated an eight-month term, during which he was declared fit for sea duty after a pre-employment medical examination. However, on October 18, 2014, while performing sanding work, Ampo-on felt a sharp pain in his back, accompanied by a distinct snapping sound. He was later diagnosed with L3-L4 Spondylolisthesis and L3 Pars Fracture upon reaching a port in Taiwan. Following his repatriation, the company-designated physician initiated a series of medical tests and treatments, including a suggestion for back surgery, which Ampo-on declined.

On February 6, 2015, the company-designated physician issued a medical report stating that Ampo-on’s fitness to work within 120 days was unlikely. The report also suggested a disability grading of Grade 8, corresponding to a loss of two-thirds of lifting power in the trunk. Dissatisfied with this assessment, Ampo-on sought a second opinion from an independent physician, Dr. Manuel Fidel M. Magtira, who concluded that Ampo-on was permanently disabled and unfit for work. This divergence in medical opinions became a critical point of contention in the subsequent legal proceedings.

Ampo-on filed a complaint with the National Conciliation and Mediation Board (NCMB), seeking total and permanent disability benefits amounting to US$120,000.00, as stipulated in the CBA. He also claimed moral, exemplary, and compensatory damages, as well as attorney’s fees. The respondents, Reinier Pacific International Shipping, Inc., contested the claim, arguing that Ampo-on’s condition was not work-related and did not qualify as an accidental injury under the POEA-SEC or the CBA. The company further asserted that Ampo-on’s refusal to undergo surgery constituted notorious negligence, thereby negating his entitlement to compensation. The stage was set for a legal battle centered on the interpretation of disability definitions and the responsibilities of both employer and employee.

The NCMB sided with Ampo-on, ordering the respondents to pay US$120,000.00 in disability compensation, along with 10% attorney’s fees. The NCMB reasoned that Ampo-on’s back injury was sustained while performing his duties and was therefore work-related. Additionally, the NCMB highlighted a suppressed portion of the medical report indicating that the certifying doctor had marked ‘Yes’ in response to the question of whether the illness was due to an accident. This piece of evidence significantly bolstered Ampo-on’s claim that his injury was indeed accidental, thus entitling him to compensation under the CBA. This decision was based on the premise that the company-designated physician did not provide evidence that the injury was not work-related.

The Court of Appeals (CA), however, reversed the NCMB’s ruling, limiting Ampo-on’s disability benefits to Grade 8 under the POEA-SEC. The CA prioritized the assessment of the company-designated physician, stating that the assessment was based on thorough examinations and medical tests. The CA questioned the validity and proof of the assessment given by the independent physician, Dr. Magtira. Undeterred, Ampo-on elevated the case to the Supreme Court, challenging the CA’s decision and seeking reinstatement of the NCMB’s ruling.

The Supreme Court’s analysis hinged on several key factors. Firstly, it reiterated that a seafarer’s entitlement to disability benefits is governed by law, contracts, and medical findings, specifically Articles 197 to 199 of the Labor Code, Section 2(a), Rule X of the Amended Rules on Employees’ Compensation, the POEA-SEC, and any applicable CBA. The court emphasized that under the POEA-SEC, employers are liable for disability benefits only if the seafarer suffers a work-related injury or illness during their contract. In this case, the Court found no categorical assessment from the company-designated physician that Ampo-on’s injury was not work-related.

The Court scrutinized the medical assessment provided by the company-designated physician. The Court found that the assessment lacked the finality and definiteness required by law. The report used language indicating uncertainty, such as ‘prognosis is guarded’ and ‘if patient is entitled to a disability, his suggested disability grading is Grade 8.’ The court stressed that a conclusive assessment is essential to accurately reflect the extent of the seafarer’s injuries and their ability to resume work. Citing Sharpe Sea Personnel, Inc. v. Mabunay, Jr., the Court highlighted that an interim disability grading does not fully assess a seafarer’s condition and cannot sufficiently support an award of disability benefits.

Moreover, the Court emphasized that Ampo-on’s injury persisted despite the company-designated physician’s declaration of partial disability Grade 8. This persistence, the Court noted, warrants considering the disability as total and permanent under Article 198 (c) (1) of the Labor Code. The Supreme Court in Sunit v. OSM Maritime Services, Inc., underscored that the critical factor in determining total or partial disability is whether the employee can still perform their work despite the injury. A permanent partial disability implies that a seafarer can resume sea duties before the 120/240-day medical treatment period ends, while total disability compensates for the inability to work, regardless of the injury’s physical impact.

The Court also addressed the issue of Ampo-on’s refusal to undergo surgery. It rejected the respondents’ claim that this refusal constituted notorious negligence, which would bar him from claiming compensation. The Court clarified that notorious negligence involves a deliberate act by the employee to disregard their own personal safety. There was no indication that Ampo-on was informed that surgery was the sole remedy for his back injury, nor was he warned about the consequences of choosing physical therapy instead.

Regarding the amount of compensation, the Court referenced Article 25 (1) of the CBA, which mandates compensation for injuries arising from accidents during employment. An accident is defined as an unforeseen and unintended injurious occurrence. The Court agreed with the NCMB that Ampo-on’s sudden back injury while performing sanding work qualified as an accident because he could not have foreseen the unexpected snap in his back from exerting normal force. Adding weight to this conclusion was the respondents’ suppression of a medical report page indicating that the certifying doctor had identified the injury as accident-related.

FAQs

What was the central issue in this case?	The central issue was whether the seafarer, Ampo-on, was entitled to total and permanent disability benefits under the CBA due to a back injury sustained while working, and whether that injury qualified as an ‘accident’ under the CBA.
What is the significance of a ‘final and definite assessment’ by the company-designated physician?	A ‘final and definite assessment’ is crucial because it determines the extent of the seafarer’s disability and their ability to return to work. Without it, the seafarer’s condition may be considered total and permanent by operation of law, entitling them to maximum benefits.
What happens if the company-designated physician fails to provide a final assessment within the prescribed period?	If the company-designated physician fails to provide a final assessment within the 120/240-day period, the seafarer’s disability is considered total and permanent. This entitles the seafarer to corresponding disability benefits, as the law steps in to protect their rights.
What constitutes ‘notorious negligence’ in the context of a seafarer’s injury?	‘Notorious negligence’ is more than simple negligence; it signifies a deliberate act by the employee to disregard their own personal safety. It is a high standard that must be proven to bar a seafarer from claiming compensation for an injury.
How does the CBA define an ‘accident’ in relation to disability claims?	Under the CBA, an ‘accident’ is defined as an unintended and unforeseen injurious occurrence. It is something that does not occur in the usual course of events, is not reasonably anticipated, and is not attributable to mistake, negligence, neglect, or misconduct.
Why was the suppressed medical report significant in this case?	The suppressed medical report, which indicated that the certifying doctor had marked the injury as accident-related, served as an admission against the respondents. This admission supported the seafarer’s claim that his injury was indeed accidental and compensable under the CBA.
What is the role of the POEA-SEC in determining disability benefits?	The POEA-SEC sets the minimum standards for the employment of Filipino seafarers. It outlines the conditions under which employers are liable for disability benefits, particularly for work-related injuries or illnesses suffered during the contract term.
What are the implications of this ruling for shipping companies and seafarers?	For shipping companies, this ruling emphasizes the need for thorough and timely medical assessments of injured seafarers. For seafarers, it reinforces their right to just compensation for work-related injuries and ensures that their claims are properly evaluated.

In conclusion, the Supreme Court’s decision underscores the importance of providing seafarers with comprehensive medical evaluations and ensuring that their rights to disability benefits are protected. By requiring a final and definite assessment from company-designated physicians within a specific timeframe, the Court has strengthened the legal framework that safeguards the well-being of seafarers injured in the course of their employment.

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: Danille G. Ampo-on vs. Reinier Pacific International Shipping, Inc., G.R. No. 240614, June 10, 2019