The Importance of Following Procedure in Seafarer Disability Claims

Philippine Transmarine Carriers, Inc., Carlos C. Salinas, and/or General Maritime Management LLC v. Almario C. San Juan, G.R. No. 207511, October 05, 2020

Imagine a seasoned seafarer, dedicated to his work on the high seas, suddenly facing a medical condition that threatens his livelihood. Almario C. San Juan, a Chief Cook who had served aboard various vessels for nearly two decades, found himself in this predicament when he was diagnosed with hypertension. His case against his employer, Philippine Transmarine Carriers, Inc., and others, underscores the complexities of seafarer disability claims and the critical role of procedural compliance in such disputes. The central legal question was whether San Juan was entitled to permanent total disability benefits and additional sickness allowance, and how conflicting medical assessments should be resolved.

The Supreme Court’s decision in this case highlights the importance of adhering to the mandatory referral to a third doctor when there is a disagreement between the company-designated physician and the seafarer’s chosen doctor. This ruling not only affects San Juan but sets a precedent for future seafarer disability claims, emphasizing the need for clear and fair procedures in assessing disability.

Legal Context: Understanding Disability Claims and the POEA-SEC

Seafarers’ rights to disability benefits are governed by the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC), which is incorporated into their employment contracts. The POEA-SEC outlines the procedure for assessing a seafarer’s disability, which is crucial for determining compensation.

Under the POEA-SEC, when a seafarer suffers from a work-related illness or injury, the company-designated physician assesses their fitness or unfitness for work. If the seafarer disagrees with this assessment, they can seek a second opinion from their chosen doctor. However, if there is a conflict between these assessments, the POEA-SEC mandates a referral to a third doctor, whose decision is final and binding on both parties.

The relevant provision from the POEA-SEC states: “If a doctor appointed by the seafarer disagrees with the assessment [of the company-designated physician], a third doctor may be agreed jointly between the Employer and the seafarer. The third doctor’s decision shall be final and binding on both parties.”

This procedure ensures fairness and objectivity in disability assessments, preventing unilateral decisions that could disadvantage either party. For example, if a seafarer is injured while working on a ship and the company’s doctor declares them fit to return to work, but the seafarer’s doctor finds them unfit, a third doctor’s assessment would be crucial in resolving this dispute.

Case Breakdown: The Journey of Almario C. San Juan

Almario C. San Juan, a veteran Chief Cook, was hired by Philippine Transmarine Carriers, Inc. (PTCI) to work aboard the MV Genmar George T. Before embarking, San Juan underwent a routine Pre-Employment Medical Examination (PEME) and was certified fit to work despite his known hypertension.

During his tenure, San Juan’s condition worsened, leading to his medical repatriation in February 2010. Upon returning to the Philippines, he was examined by PTCI’s company-designated physicians, who, after conducting various tests, declared him fit to resume sea duties on April 20 and 30, 2010.

However, San Juan sought a second opinion from his chosen doctor, Dr. Antonio C. Pascual, who certified him as medically unfit to work as a seaman. This conflicting assessment led to a dispute over San Juan’s entitlement to permanent total disability benefits and additional sickness allowance.

The Labor Arbiter initially awarded San Juan permanent total disability benefits, sickness allowance, and attorney’s fees. However, the National Labor Relations Commission (NLRC) reversed this decision, dismissing San Juan’s claims. The Court of Appeals (CA) then reinstated the Labor Arbiter’s decision, albeit with modifications.

The Supreme Court’s analysis focused on the procedural aspect of the case. The Court noted that the company-designated physicians had declared San Juan fit to work within the 120-day period prescribed by the POEA-SEC. Despite this, San Juan failed to request a referral to a third doctor to resolve the conflicting assessments.

The Supreme Court emphasized the mandatory nature of the third doctor referral, stating: “The referral to a third doctor has been consistently held by this Court as a mandatory procedure.” The Court further clarified that in the absence of a third doctor’s assessment, the company-designated physician’s findings should prevail.

Additionally, the Court rejected the CA’s reliance on San Juan’s non-rehiring by PTCI as evidence of his disability, stating: “Neither can we lend credence to the CA’s findings that the non-hiring of San Juan served as convincing proof that his illness or disability is permanent.”

Ultimately, the Supreme Court ruled that San Juan was not entitled to permanent total disability benefits due to his failure to follow the mandatory procedure. However, he was awarded additional sickness allowance for the period he was not compensated.

Practical Implications: Navigating Future Disability Claims

This ruling has significant implications for seafarers and employers alike. Seafarers must be aware of the importance of following the POEA-SEC procedure, particularly the mandatory referral to a third doctor when there is a disagreement in medical assessments. Failure to do so could jeopardize their claims for disability benefits.

Employers, on the other hand, should ensure that they adhere to the POEA-SEC guidelines and facilitate the referral to a third doctor when necessary. This not only ensures compliance with legal standards but also promotes fairness in resolving disability claims.

Key Lessons:

• Seafarers should promptly seek a second medical opinion if they disagree with the company-designated physician’s assessment.
• Both parties must actively participate in the referral to a third doctor to resolve conflicting assessments.
• Non-compliance with the mandatory third doctor referral can result in the company-designated physician’s assessment prevailing.

Frequently Asked Questions

What should a seafarer do if they disagree with the company-designated physician’s assessment?

A seafarer should seek a second opinion from their chosen doctor and request a referral to a third doctor if there is a disagreement.

Is the referral to a third doctor mandatory?

Yes, the Supreme Court has ruled that the referral to a third doctor is mandatory when there are conflicting medical assessments.

Can a seafarer claim permanent total disability benefits if the company-designated physician declares them fit to work?

No, unless the seafarer follows the mandatory procedure of seeking a second opinion and referring the case to a third doctor, the company-designated physician’s assessment will prevail.

How long does a seafarer have to be under medical treatment to claim sickness allowance?

A seafarer is entitled to sickness allowance for up to 120 days from the time they sign off from the vessel for medical treatment until they are declared fit to work or their disability is assessed.

What happens if the seafarer does not request a referral to a third doctor?

If the seafarer does not request a referral, the company-designated physician’s assessment will be upheld, potentially affecting their claim for disability benefits.

ASG Law specializes in maritime law and seafarer rights. Contact us or email hello@asglawpartners.com to schedule a consultation.