In a significant ruling, the Supreme Court has clarified that a seafarer who fails to attend scheduled medical check-ups during the treatment period may forfeit their right to claim full disability benefits. This decision emphasizes the seafarer’s responsibility to comply with mandatory reporting requirements as part of their employment contract. It provides clarity on the obligations of both seafarers and employers in the context of disability claims under the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC).

Broken Appointments, Broken Benefits: When a Seafarer’s Missed Check-Up Impacts Disability Claims

The case of Philippine Transmarine Carriers, Inc. vs. Allan N. Tena-e revolves around a seafarer, Allan N. Tena-e, who sustained a shoulder injury while working on board a vessel. After being medically repatriated to the Philippines, he underwent treatment with company-designated physicians. However, he failed to attend a scheduled re-evaluation appointment, leading the company to argue that he had abandoned his treatment and forfeited his right to claim full disability benefits. The Supreme Court was tasked to determine whether Allan’s failure to attend the appointment justified the denial of his claim for permanent total disability benefits.

The entitlement of a seafarer to disability benefits is governed by the POEA-SEC, which outlines the responsibilities of both the employer and the employee. Section 20(A) of the 2010 POEA-SEC details the compensation and benefits for injury or illness. Crucially, it states:

For this purpose, the seafarer shall submit himself to a post-employment medical examination by a company-designated physician within three working days upon his return except when he is physically incapacitated to do so, in which case, a written notice to the agency within the same period is deemed as compliance. In the course of the treatment, the seafarer shall also report regularly to the company-designated physician specifically on the dates as prescribed by the company-designated physician and agreed to by the seafarer. Failure of the seafarer to comply with the mandatory reporting requirement shall result in his forfeiture of the right to claim the above benefits.

This provision places a clear obligation on the seafarer to actively participate in their medical treatment by attending scheduled appointments. Failure to do so can have significant consequences on their ability to claim benefits.

The Supreme Court, in its analysis, highlighted the importance of the company-designated physician’s assessment in determining the extent of a seafarer’s disability. Citing Elburg Shipmanagement Phils., Inc. v. Quiogue, the Court reiterated the rules governing claims for total and permanent disability benefits:

In summary, if there is a claim for total and permanent disability benefits by a seafarer, the following rules shall govern:

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
4. burden to prove that the company-designated physician has sufficient justification to extend the period; and
5. 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.

In this case, the Court found that the company-designated physician had not issued a final and definitive assessment of Allan’s disability within the 240-day period. However, the Court also noted that this failure was directly attributable to Allan’s failure to attend his scheduled re-evaluation appointment. The Court emphasized that it was Allan’s duty to report for his regular check-ups, and his failure to do so prevented the company-designated physician from completing the assessment.

The Court distinguished this case from situations where the company-designated physician fails to issue an assessment without justification. In those cases, the seafarer’s disability is deemed permanent and total by operation of law. However, when the seafarer’s own actions prevent the physician from making an assessment, the seafarer cannot claim the benefit of this rule.

Furthermore, the Court gave greater weight to the medical reports of the company-designated physicians over those of Allan’s personal physicians. The Court reasoned that the company-designated physicians had a more comprehensive understanding of Allan’s condition, having closely monitored and treated him over a longer period. The reports from Allan’s personal physicians, on the other hand, were based on a single examination and lacked the depth of analysis provided by the company doctors.

The Court ultimately ruled that Allan was not entitled to permanent total disability benefits. However, he was entitled to disability benefits equivalent to Grade 12 under the POEA-SEC, as reflected in the last report by the company-designated physician. The Court also deleted the award of attorney’s fees, finding that the company had not acted in bad faith.

This ruling reinforces the principle that seafarers have a responsibility to actively participate in their medical treatment and comply with the requirements of the POEA-SEC. Failure to do so can have a detrimental impact on their ability to claim disability benefits. This case also underscores the importance of the company-designated physician’s assessment in determining the extent of a seafarer’s disability, and the need for seafarers to cooperate with the company’s medical team.

The Supreme Court, in the case of Lerona v. Sea Power Shipping Enterprises, Inc., further elaborated on the duty of a seafarer in completing medical treatment:

A seafarer is duty-bound to complete his medical treatment until declared fit to work or assessed with a permanent disability rating by the company-designated physician.

This statement emphasizes the continuous obligation of the seafarer to adhere to the prescribed medical regimen until a final determination of their fitness or disability is made by the designated medical professional. This continuous engagement is crucial for accurate assessment and appropriate compensation.

In conclusion, this case highlights the delicate balance between the rights and responsibilities of seafarers and their employers. While the law aims to protect seafarers who suffer work-related injuries, it also requires them to actively participate in their treatment and comply with the requirements of the POEA-SEC. A seafarer’s failure to fulfill these obligations can have significant consequences on their ability to claim disability benefits. The ruling underscores the necessity for clear communication and cooperation between seafarers, employers, and company-designated physicians to ensure fair and just outcomes in disability claims.

FAQs

What was the key issue in this case?	The key issue was whether the seafarer, Allan N. Tena-e, was entitled to permanent total disability benefits despite failing to attend a scheduled medical re-evaluation appointment with the company-designated physician. The court needed to determine if this absence constituted abandonment of treatment.
What is the POEA-SEC?	The POEA-SEC stands for the Philippine Overseas Employment Administration-Standard Employment Contract. It is a standard employment contract that governs the overseas employment of Filipino seafarers, outlining the terms and conditions of their employment, including compensation and benefits for work-related injuries or illnesses.
What is the role of the company-designated physician?	The company-designated physician is responsible for assessing the seafarer’s medical condition, providing treatment, and issuing a final assessment of their disability. Their assessment is crucial in determining the seafarer’s eligibility for disability benefits and the extent of those benefits.
What is the 120/240-day rule?	The 120/240-day rule refers to the period within which the company-designated physician must issue a final assessment of the seafarer’s disability. Initially, the physician has 120 days, but this can be extended to 240 days if further treatment is required and justified.
What happens if the company-designated physician fails to issue an assessment within the 120/240-day period?	If the company-designated physician fails to issue a final assessment within the 120/240-day period without justifiable reason, the seafarer’s disability is generally deemed permanent and total. However, this rule does not apply if the seafarer’s own actions prevent the physician from making an assessment.
What is medical abandonment in the context of seafarer disability claims?	Medical abandonment occurs when a seafarer fails to comply with their medical treatment plan or fails to attend scheduled appointments with the company-designated physician. This can result in the forfeiture of their right to claim disability benefits.
Can a seafarer consult their own physician?	Yes, a seafarer has the right to seek a second opinion from their own physician. However, the assessment of the company-designated physician generally carries more weight, especially if they have closely monitored and treated the seafarer over a longer period.
What are the implications of this ruling for seafarers?	This ruling emphasizes the importance of seafarers actively participating in their medical treatment and complying with the requirements of the POEA-SEC. They must attend scheduled appointments and follow the advice of the company-designated physician to avoid forfeiting their right to claim disability benefits.

This decision serves as a reminder for seafarers to prioritize their health and diligently follow the prescribed medical treatment plans to ensure their rights are protected. It is a testament that the scales of justice are balanced between the rights of the employee and the duties that goes with it. Only by ensuring the continuous performance of the latter can one be rewarded with the former.

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: Philippine Transmarine Carriers, Inc. vs. Allan N. Tena-e, G.R. No. 234365, July 06, 2022