The Importance of Proper Procedure in Claiming Disability Benefits

Heirs of Amadeo Alex G. Pajares v. North Sea Marine Services Corporation, G.R. No. 244437, September 14, 2020

Imagine working tirelessly on a cruise ship, only to be struck down by a debilitating illness. For seafarers like Amadeo Alex G. Pajares, the promise of disability benefits can be a lifeline during such challenging times. Yet, navigating the legal waters to secure these benefits can be as daunting as the seas they sail. In the case of the Heirs of Amadeo Alex G. Pajares against North Sea Marine Services Corporation, the Supreme Court of the Philippines shed light on the critical importance of following proper procedure when claiming disability benefits.

Amadeo, a dedicated Suite Attendant on the Silver Whisper cruise ship, was exposed to harsh cleaning chemicals daily. When he suffered severe nosebleeds and was eventually diagnosed with Multiple Myeloma, a type of blood cancer, he sought the disability benefits he believed he was entitled to under his employment contract. However, his journey through the legal system revealed the complexities and procedural nuances that can determine the outcome of such claims.

Legal Context: Disability Benefits and Seafarer’s Rights

In the Philippines, the rights of seafarers are protected under various legal frameworks, including the Philippine Overseas Employment Administration (POEA) Standard Employment Contract and the Labor Code. These laws ensure that seafarers receive compensation for work-related injuries or illnesses that result in disability.

Disability Benefits refer to the financial compensation awarded to employees who suffer from permanent or temporary incapacity due to work-related incidents. For seafarers, the POEA contract specifies the conditions under which they can claim these benefits, including the requirement to submit medical evidence and follow a specific procedure for assessment.

The company-designated physician plays a crucial role in this process, as their medical assessment is often considered authoritative. However, seafarers have the right to seek a second opinion from an independent physician and, if necessary, a third doctor’s assessment if the first two opinions differ.

Consider the case of a seafarer who develops a respiratory condition due to prolonged exposure to harmful substances on board. If the company-designated physician deems the illness non-work-related, the seafarer must gather substantial evidence to challenge this assessment, including medical reports from independent doctors and documentation of their work conditions.

Case Breakdown: The Journey of Amadeo Alex G. Pajares

Amadeo’s story began with a shipboard employment contract with North Sea Marine Services Corporation, where he was tasked with maintaining the cabins on the Silver Whisper. His duties involved handling strong cleaning chemicals, which he alleged led to his severe nosebleeds and subsequent diagnosis of Multiple Myeloma.

Upon repatriation to the Philippines, Amadeo reported to North Sea and was referred to the company-designated clinic. Despite his inquiries about returning to work, he was informed that his treatment had been discontinued. When he attempted to obtain copies of his medical reports, he was denied, though he managed to take a snapshot of his final medical assessment, which indicated a Grade 1 Disability.

Seeking a second opinion, Amadeo consulted an independent physician who confirmed his diagnosis and declared him unfit for sea service. He then requested a third medical opinion from North Sea, but his request went unanswered. This led to a series of mediation and conciliation proceedings, culminating in a decision by the Panel of Voluntary Arbitrators (Panel of VAs) to dismiss his claim for disability benefits, citing a lack of substantial evidence to prove that his illness was work-related.

North Sea appealed the Panel of VAs’ decision to the Court of Appeals (CA), which affirmed the dismissal but reduced the financial assistance awarded to Amadeo’s heirs from US$20,000 to US$8,500. The CA reasoned that while Amadeo was not entitled to disability benefits, he deserved financial assistance due to his long service and the humanitarian considerations of his situation.

The Supreme Court upheld the CA’s decision, emphasizing that a non-appellant cannot seek affirmative relief. As Amadeo’s heirs did not appeal the Panel of VAs’ decision, they could not request a modification of the judgment to include disability benefits.

Key quotes from the Supreme Court’s reasoning include:

“It is well settled and unquestionable that a party who does not appeal or file a petition for review is not entitled to any affirmative relief.”

“Even if Amadeo is not entitled to any disability benefits, the Court, has in several instances, awarded financial assistance to separated employees due to humanitarian considerations through the principle of social and compassionate justice for the working class.”

Practical Implications: Navigating Disability Claims

The ruling in the Heirs of Amadeo Alex G. Pajares case underscores the importance of adhering to procedural requirements when seeking disability benefits. Seafarers and their legal representatives must be diligent in gathering and presenting evidence, following the proper channels for medical assessments, and appealing decisions within the required timeframes.

For businesses employing seafarers, this case highlights the need to ensure transparency and fairness in handling disability claims. Companies should provide clear communication about medical assessments and be open to third-party evaluations when necessary.

Key Lessons:

• Seafarers must follow the procedural steps outlined in their employment contracts to claim disability benefits.
• Medical evidence from both company-designated and independent physicians is crucial in proving the work-related nature of an illness.
• Appealing decisions promptly is essential to securing the desired outcome in disability claims.

Frequently Asked Questions

What are disability benefits for seafarers?

Disability benefits are financial compensations provided to seafarers who suffer from work-related injuries or illnesses that result in permanent or temporary incapacity.

How can a seafarer prove that an illness is work-related?

A seafarer must provide medical evidence, including assessments from both the company-designated physician and an independent physician, to demonstrate the link between their work and their illness.

What happens if the company-designated physician and the independent physician disagree?

In case of disagreement, the seafarer can request a third medical opinion to resolve the dispute.

Can a seafarer appeal a decision on disability benefits?

Yes, a seafarer can appeal a decision through the appropriate legal channels, such as the Panel of Voluntary Arbitrators or the Court of Appeals, within the specified timeframes.

What are the implications of not appealing a decision on disability benefits?

Failure to appeal a decision means that a seafarer cannot seek affirmative relief or modification of the judgment in their favor.

How can financial assistance be awarded in lieu of disability benefits?

Financial assistance may be awarded based on humanitarian considerations and the principle of social and compassionate justice, even if disability benefits are not granted.

ASG Law specializes in labor and employment law. Contact us or email hello@asglawpartners.com to schedule a consultation and ensure your rights as a seafarer are protected.