Timely Medical Assessments are Crucial for Seafarers Seeking Full Disability Benefits

Pastrana v. Bahia Shipping Services, et al., G.R. No. 227419, June 10, 2020

Imagine working tirelessly aboard a ship, only to suffer an injury that jeopardizes your livelihood. For seafarers like Henry Espiritu Pastrana, the promise of disability benefits can be a lifeline. However, as Pastrana’s case illustrates, the timing and process of medical assessments can significantly impact the outcome of these claims. This case delves into the critical 120-day rule and its implications for seafarers seeking compensation for work-related injuries.

Henry Espiritu Pastrana, an Environmental Team Leader on the Carnival Fascination, suffered a back injury while lifting a heavy bin. Despite initial treatment, his condition worsened, leading to his repatriation to the Philippines. The central issue in his case was whether he was entitled to total and permanent disability benefits or merely partial disability benefits, hinging on the timing and validity of the medical assessments provided by the company-designated physician.

Legal Context: Understanding the 120-Day Rule and Disability Assessments

The rights of seafarers to disability benefits are governed by the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC), the Labor Code, and its implementing rules and regulations. A key provision is the 120-day rule, which states that a seafarer unable to perform their job for 120 days is deemed permanently disabled unless a final and definitive medical assessment is issued within this period.

POEA-SEC Section 20(A)(3) outlines the employer’s obligation to provide medical treatment and sickness allowance until the seafarer is declared fit to work or the degree of disability is assessed, not exceeding 120 days. This rule is crucial as it sets a timeline for the company-designated physician to evaluate the seafarer’s condition.

Key legal terms to understand include:

• Temporary Total Disability: When a seafarer is unable to work due to an injury but is expected to recover.
• Permanent Total Disability: When a seafarer’s injury prevents them from resuming their usual work or any gainful employment.
• 120-Day Rule: The period within which the company-designated physician must issue a final disability assessment.

For example, if a seafarer suffers a severe injury and is unable to work for over 120 days without a final assessment, they could be entitled to permanent total disability benefits, which offer more substantial compensation than partial disability benefits.

Case Breakdown: Pastrana’s Journey Through the Legal System

Henry Pastrana’s ordeal began in November 2012 when he injured his back while lifting a bin on board the Carnival Fascination. Despite initial treatment and medications, his condition deteriorated, leading to his repatriation to the Philippines on December 10, 2012.

Upon returning home, Pastrana consulted the company-designated physician, Dr. Robert Lim, who diagnosed him with a herniated disc. Despite undergoing physical therapy for nearly four months, Pastrana’s condition showed minimal improvement. On April 2, 2013, Dr. Lim declared Pastrana fit to work, but this assessment was contradicted by the ship’s Medical Director, who found Pastrana still unfit due to a stiff trunk and painful gait.

On April 11, 2013, Dr. Lim issued a final assessment, suggesting a Grade 11 disability rating, which corresponds to partial disability. Pastrana, seeking a second opinion, consulted Dr. Manuel Fidel M. Magtira, who declared him permanently unfit for sea duties. This discrepancy led Pastrana to file a complaint for total and permanent disability benefits.

The Labor Arbiter (LA) initially ruled in Pastrana’s favor, awarding him USD60,000.00 for permanent total disability and attorney’s fees. The National Labor Relations Commission (NLRC) affirmed this decision, emphasizing that Pastrana’s inability to return to sea duties rendered him permanently disabled.

However, the Court of Appeals (CA) reversed this ruling, finding that Pastrana did not follow the POEA-SEC’s procedure for resolving conflicting medical assessments by referring the matter to a third doctor. The CA upheld the company-designated physician’s assessment, limiting Pastrana’s compensation to partial disability benefits.

The Supreme Court, in its final ruling, reinstated the LA’s decision. The Court found that Dr. Lim failed to issue a timely final assessment within the 120-day period from Pastrana’s repatriation, rendering his opinion irrelevant. As a result, Pastrana was deemed permanently and totally disabled, entitling him to full disability benefits.

Key quotes from the Supreme Court’s reasoning include:

“The company-designated physician is required to issue a final and definite assessment of the seafarer’s disability rating within the aforesaid 120/240-day period; otherwise, the opinions of the company-designated and the independent physicians are rendered irrelevant because the seafarer is already conclusively presumed to be suffering from a permanent and total disability, and thus, is entitled to the benefits corresponding thereto.”

“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.”

Practical Implications: Navigating Disability Claims as a Seafarer

This ruling underscores the importance of timely medical assessments for seafarers seeking disability benefits. Employers and their designated physicians must adhere strictly to the 120-day rule, as failure to do so can result in the seafarer being deemed permanently and totally disabled, regardless of the actual disability grade.

For seafarers, it’s crucial to document all interactions with medical professionals and to seek a second opinion if the initial assessment seems inadequate. If there’s a discrepancy between assessments, the seafarer should promptly request referral to a third doctor, as outlined in the POEA-SEC.

Key Lessons:

• Seafarers should be aware of their rights under the POEA-SEC and the 120-day rule.
• Employers must ensure that their designated physicians issue timely and definitive medical assessments.
• Seeking a second medical opinion and, if necessary, a third doctor’s assessment can be critical in securing fair compensation.

Frequently Asked Questions

What is the 120-day rule for seafarers?

The 120-day rule states that if a seafarer is unable to work for more than 120 days due to a work-related injury or illness, they are considered permanently and totally disabled unless a final medical assessment is issued within that period.

Can a seafarer seek a second medical opinion?

Yes, under the POEA-SEC, seafarers have the right to seek a second opinion from a physician of their choice if they disagree with the company-designated physician’s assessment.

What happens if there’s a discrepancy between medical assessments?

If there’s a conflict between the company-designated physician’s assessment and the seafarer’s chosen physician, the matter should be referred to a third doctor whose assessment will be binding on both parties.

How can a seafarer ensure they receive fair compensation?

Seafarers should document all medical consultations, seek a second opinion if necessary, and follow the POEA-SEC’s procedure for resolving conflicting assessments by requesting a third doctor’s evaluation.

What are the implications of this ruling for employers?

Employers must ensure their designated physicians adhere to the 120-day rule and issue timely and definitive assessments to avoid automatic classification of seafarers as permanently and totally disabled.

ASG Law specializes in labor and employment law, particularly in cases involving seafarers’ rights. Contact us or email hello@asglawpartners.com to schedule a consultation and ensure your rights are protected.