In a dispute over disability benefits, the Supreme Court held that a seafarer’s failure to cooperate with medical treatment prescribed by a company-designated physician can affect their claim for permanent and total disability. The court emphasized that while the law protects seafarers, they must also fulfill their obligations, including diligently following prescribed medical treatments. This decision clarifies the responsibilities of seafarers in pursuing disability claims and the importance of adhering to medical advice to ensure a fair assessment of their condition.

Sailing Through Uncertainty: When a Seafarer’s Actions Affect Disability Claims

The case of Marlow Navigation Philippines Inc. v. Braulio A. Osias (G.R. No. 215471) revolves around Braulio Osias, a chief cook who sought permanent and total disability benefits after an accident on board a vessel. The central legal question is whether Osias’s failure to fully comply with the prescribed medical treatment impacts his entitlement to these benefits. The Labor Arbiter (LA) and the National Labor Relations Commission (NLRC) initially denied Osias’s claim, emphasizing the findings of the company-designated physician and Osias’s own role in delaying his treatment. However, the Court of Appeals (CA) reversed these decisions, leading to the Supreme Court review.

At the heart of the matter is the interpretation and application of the 120-day and 240-day rules concerning disability claims for seafarers. The Labor Code provides that temporary total disability lasting continuously for more than 120 days shall be deemed total and permanent. However, the Implementing Rules and Regulations (IRR) allow for an extension beyond 120 days, up to 240 days, if the injury or sickness requires further medical attendance. The 2000 Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC) also stipulates a 120-day period for sickness allowance. These provisions aim to balance the rights of seafarers with the operational needs of employers, setting a framework for assessing disability claims within specific timeframes.

The Supreme Court has addressed the interplay of these rules in several landmark cases. Initially, Crystal Shipping, Inc. v. Natividad established that permanent disability is the inability of a worker to perform their job for more than 120 days. However, Vergara v. Hammonia Maritime Services, Inc. refined this doctrine, allowing for an extension of the treatment period up to 240 days if further medical attention is required. The court in Elburg Shipmanagement Phils., Inc. v. Quiogue, Jr. further clarified that the company-designated physician must provide a final medical assessment within 120 days, extendable to 240 days only with sufficient justification. This justification could include the seafarer requiring further medical treatment or being uncooperative.

In Osias’s case, the Supreme Court found that a sufficient justification existed to extend the period of medical treatment to 240 days. The court noted that Osias did not fully comply with the prescribed physical therapy sessions. Dr. Arago, the company-designated physician, had required Osias to undergo ten sessions of physical therapy starting April 5, 2010. However, Osias failed to appear for the continuation of his physical therapy after only four sessions, without any prior notice, and returned only after more than a month, following a trip to La Union. This non-compliance demonstrated a lack of cooperation with the prescribed treatment, thus justifying the extension of the medical assessment period. The court emphasized that Osias disregarded the limited amount of time available to the company-designated physician to finalize his medical assessment by ignoring the scheduled therapy sessions.

The Supreme Court also addressed the validity of the medical assessment provided by the company-designated physician. Section 20(B)(3) of the POEA-SEC provides a mechanism to challenge this assessment: If a doctor appointed by the seafarer disagrees with the assessment, a third doctor may be agreed jointly between the employer and the seafarer, whose decision shall be final and binding. In this case, Osias sought the opinion of Dr. Li-Ann Lara Orencia, who opined that Osias’s osteoarthritis prevented him from returning to his work as a chief cook. However, Osias never signified his intention to resolve the disagreement by referring the matter to a third doctor, as required by the POEA-SEC. The court held that absent proper compliance with this procedure, the final medical report and certification of the company-designated physician declaring Osias fit to return to work must be upheld.

The Court provided a summation of periods when the company-designated physician must assess the seafarer, to wit:

1. The company-designated physician must issue a final medical assessment on the seafarer’s disability grading within a period of 120 days from the time the seafarer reported to him;
2. If the company-designated physician fails to give his assessment within the period of 120 days, without any justifiable reason, then the seafarer’s disability becomes permanent and total;
3. If the company-designated physician fails to give his assessment within the period of 120 days with a sufficient justification (e.g., seafarer required further medical treatment or seafarer was uncooperative), then the period of diagnosis and treatment shall be extended to 240 days. The employer has the burden to prove that the company-designated physician has sufficient justification to extend the period; and
4. If the company-designated physician still fails to give his assessment within the extended period of 240 days, then the seafarer’s disability becomes permanent and total, regardless of any justification.

The Supreme Court’s decision underscores the importance of adhering to the prescribed procedures and timelines in pursuing disability claims. It also highlights the seafarer’s duty to cooperate with medical treatment, as outlined in the POEA-SEC. In this case, because the medical report of the company-designated physician was suitably issued within the extended 240-day period, and Osias failed to comply with the third doctor process, the assessment of the company-designated physician, stating Osias was fit to work, was upheld, thus, Osias was not entitled to permanent and total disability benefits.

FAQs

What was the key issue in this case?	The key issue was whether a seafarer’s failure to cooperate with medical treatment prescribed by a company-designated physician affects their entitlement to permanent and total disability benefits.
What is the 120-day rule in seafarer disability claims?	The 120-day rule, derived from the Labor Code and POEA-SEC, initially stipulates that a seafarer is entitled to sickness allowance until declared fit to work or assessed with a permanent disability, but not exceeding 120 days. This period is for the company-designated physician to make a final assessment.
Under what conditions can the 120-day period be extended?	The 120-day period can be extended to 240 days if the seafarer requires further medical treatment or is uncooperative with the prescribed treatment, as determined by the company-designated physician. The employer has the burden to prove justification for the extension.
What is the role of the company-designated physician?	The company-designated physician is responsible for assessing the seafarer’s medical condition and determining their fitness to work or the degree of permanent disability within the prescribed periods. Their assessment is crucial in the disability claims process.
What happens if a seafarer disagrees with the company-designated physician’s assessment?	If a seafarer disagrees with the company-designated physician’s assessment, they can appoint their own doctor. If the two doctors’ assessments conflict, the POEA-SEC provides for referral to a third, jointly agreed upon doctor, whose decision is final and binding.
What is the significance of the third doctor’s opinion?	The third doctor’s opinion is final and binding on both the seafarer and the employer, resolving any conflicts between the assessments of the company-designated physician and the seafarer’s appointed doctor.
What was the Court’s ruling regarding Osias’s claim for disability benefits?	The Court ruled against Osias, stating that because Osias was uncooperative and went to La Union capriciously, the period for medical treatment and assessment was properly extended to 240 days. As such, the medical report of the company-designated physician was valid because it was issued within the extended period and not validly challenged.
What is the key takeaway from this case for seafarers?	Seafarers must actively participate in and comply with the prescribed medical treatment to ensure a fair and accurate assessment of their condition. Failure to do so may negatively impact their disability claims.

This case emphasizes the need for seafarers to actively engage in their medical treatment and follow the established procedures for resolving disputes over medical assessments. The Supreme Court’s decision serves as a reminder that while seafarers are entitled to protection under the law, they also bear the responsibility of fulfilling their obligations in pursuing 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 PHILIPPINES INC. vs. BRAULIO A. OSIAS, G.R. No. 215471, November 23, 2015