In Marlow Navigation Phils., Inc. v. Cabatay, the Supreme Court held that a seafarer’s claim for disability benefits is primarily governed by the assessment of the company-designated physician, especially when the seafarer does not contest this assessment or refuses to undergo examination by a mutually appointed doctor as stipulated in their Collective Bargaining Agreement (CBA). This decision underscores the importance of adhering to contractual provisions and the POEA-SEC guidelines in determining disability claims of seafarers.

Navigating Disability Claims: When Contractual Obligations Meet Medical Realities

Wilfredo Cabatay, an able seaman, sustained injuries while working on the M/V BBC OHIO. Upon repatriation, he was examined and treated by the company-designated physician, Dr. Dolores Tay, who assessed him with a 36% disability rating. Despite this assessment, Cabatay filed for permanent total disability benefits, arguing that his injuries rendered him unfit for future sea service. The Labor Arbiter initially granted his claim, but the National Labor Relations Commission (NLRC) reversed this decision, reinstating Dr. Tay’s assessment. The Court of Appeals (CA) then reversed the NLRC, prompting the Supreme Court to review the case.

The central legal question revolved around whether Cabatay was entitled to permanent total disability benefits despite the company doctor’s assessment of a 36% disability. This required an examination of the interplay between the POEA-SEC, the TCC-FA (the applicable CBA), and the medical findings. The Supreme Court emphasized that entitlement to disability benefits is governed not only by medical findings but also by law and contract, citing Vergara v. Hammonia Maritime Services, Inc., 588 Phil. 895, 908 (2008). The Court reiterated that the POEA-SEC and the TCC-FA serve as the law between the parties, as highlighted in Philippine Hammonia Ship Agency, Inc., v. Eulogio Dumadag, G.R. No. 194362, June 26, 2013, 700 SCRA 65.

According to Section 20(B)(3) of the POEA-SEC, the company-designated physician has the primary responsibility to determine a seafarer’s fitness to work or the degree of disability. This provision mandates that the seafarer must submit to a post-employment medical examination by the company-designated physician. In Cabatay’s case, he underwent extensive medical treatment and evaluation by Dr. Tay, the company-designated physician, for six months. Dr. Tay provided a combined 36% disability assessment, which Cabatay initially did not dispute.

The TCC-FA also outlines the process for determining disability. Section 19.2 states:

The disability suffered by the Seafarer shall be determined by a doctor appointed mutually by the Owners/Managers and the ITF, and the Owners/Managers shall provide disability compensation to the Seafarer in accordance with the percentage specified in the table below xxx.

Annex 3 of the TCC-FA provides the Compensation Scale, which Dr. Tay used to assess Cabatay’s disability. While the TCC-FA stipulates a mutually appointed doctor for disability assessment, the Court noted that Cabatay did not pursue this option and, in fact, refused the petitioners’ proposal to refer his condition to a mutually appointed doctor. This refusal was crucial in the Court’s decision.

The Court addressed the CA’s reliance on the 120-day rule, which presumes permanent total disability if a seafarer remains disabled for more than 120 days. The Supreme Court clarified that this rule is not a rigid formula and must be applied considering the specific circumstances and contractual obligations, citing Splash Philippines, Inc. v. Ruizo, G.R. No. 193628, March 19, 2014, 719 SCRA 496. The Court emphasized that the company-designated physician had already provided a disability assessment, rendering the 120-day rule less relevant. The Court, quoting Vergara v. Hammonia, explained the implications of the 120-day and 240-day periods:

For the duration of the treatment but in no case to exceed 120 days, the seaman is on temporary total disability as he is totally unable to work. He receives his basic wage during, this period until he is declared fit to work or his temporary disability is acknowledged by the company to be permanent, either partially or totally, as his condition is defined under the POEA Standard Contract and by applicable Philippine laws. If the 120 days initial period is exceeded and no such declaration is made because the seafarer requires further medical attention, then the temporary total disability period may be extended up to a maximum of 240 days, subject to the right of the employer to declare within this period that a permanent partial or total disability already exists. The seaman may of course also be declared fit to work at any time such declaration is justified by medical condition.

Ultimately, the Supreme Court held that Cabatay was only entitled to the disability benefits as assessed by Dr. Tay. His failure to contest the assessment and his refusal to undergo examination by a mutually appointed doctor were critical factors in the Court’s decision. The Court stressed that seafarers cannot claim full disability benefits solely based on their own assessment, disregarding the POEA-SEC and CBA provisions. This decision reinforces the importance of adhering to contractual procedures and respecting the role of the company-designated physician in disability claims.

FAQs

What was the key issue in this case?	The key issue was whether a seafarer was entitled to permanent total disability benefits despite the company-designated physician’s assessment of a lower disability rating and the seafarer’s refusal to undergo examination by a mutually appointed doctor.
What is the role of the company-designated physician?	Under the POEA-SEC, the company-designated physician has the primary responsibility to assess a seafarer’s fitness to work or the degree of disability following repatriation for medical reasons.
What is the significance of the Collective Bargaining Agreement (CBA)?	The CBA, such as the TCC-FA in this case, outlines the procedures for determining disability and the compensation scale to be used. It serves as a binding contract between the employer and the seafarer.
What is the 120-day rule, and how does it apply?	The 120-day rule initially provides for temporary total disability, which may be extended up to 240 days if further medical attention is needed. It cannot be applied as a rigid formula and must be considered with the specific circumstances and the existence of medical findings.
What happens if the seafarer disagrees with the company doctor’s assessment?	The TCC-FA stipulates that in case of disagreement, a mutually appointed doctor should determine the seafarer’s disability. Refusal to undergo examination by a mutually appointed doctor can weaken the seafarer’s claim.
What are the implications of this ruling for seafarers?	Seafarers must adhere to the procedures outlined in the POEA-SEC and their CBAs when claiming disability benefits. They should actively participate in medical examinations and, if necessary, seek a mutually appointed doctor for assessment.
What is the impact of refusing to see a mutually appointed doctor?	Refusing to be examined by a mutually appointed doctor, as stipulated in the CBA, can be detrimental to a seafarer’s claim, especially if the company-designated physician has already made an assessment.
What is the meaning of a disability rating?	A disability rating is a percentage assigned by a physician to indicate the extent of impairment caused by an injury or illness. It is used to determine the amount of compensation a seafarer is entitled to.

This case serves as a reminder of the importance of contractual compliance and the role of medical assessments in determining disability claims for seafarers. By adhering to established procedures and respecting medical evaluations, both employers and seafarers can ensure a fair and equitable resolution of disability claims.

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: MARLOW NAVIGATION PHILS., INC. VS. WILFREDO L. CABATAY, G.R. No. 212878, February 01, 2016