ASG Law

Tag: Hypertensive Cardiovascular Disease

  • The Unsigned Assessment: Seafarer Entitled to Disability Benefits Despite ‘Fitness’ Certification

    In Avior Marine, Inc. v. Turreda, the Supreme Court affirmed that a seafarer, Arnaldo R. Turreda, was entitled to total and permanent disability benefits due to an incomplete and questionable medical assessment by the company-designated physician. The court emphasized the importance of a final, definitive, and scientifically supported disability assessment to protect seafarers’ rights, especially when their health conditions are uncertain. This ruling underscores the legal responsibility of employers to ensure thorough and unbiased medical evaluations, and to actively participate in resolving disputes regarding a seafarer’s fitness for duty.

    Navigating Murky Waters: Can a Hasty ‘Fit to Work’ Certification Sink a Seafarer’s Disability Claim?

    Arnaldo R. Turreda, a Chief Cook employed by Avior Marine, Inc., experienced severe headaches while aboard the vessel Water Phoenix. After being repatriated due to his condition, he underwent medical examinations by the company-designated physician. While initially diagnosed with several health issues, including hypertension and heart-related conditions, he was abruptly declared fit to work just three weeks later. Concerned about his persistent symptoms, Turreda sought a second opinion from his own doctor, who deemed him unfit for sea duty. This divergence in medical opinions led to a legal battle over Turreda’s entitlement to disability benefits, with the core question being whether the company-designated physician’s assessment was sufficient to deny his claim.

    The Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC) governs the rights and obligations of seafarers and their employers. According to the POEA-SEC, a work-related illness is defined as “any sickness resulting to disability or death as a result of an occupational disease listed under Section 32-A of this Contract with the conditions set therein satisfied.” This definition highlights the importance of determining whether a seafarer’s illness is linked to their work environment and conditions.

    Notably, the Supreme Court has previously recognized hypertensive cardiovascular disease as an occupational disease under certain circumstances, as elucidated in Bautista v. Elburg Shipmanagement Philippines, Inc., et al. The Court stipulated that for a seafarer to claim compensation for hypertensive cardiovascular disease, they must demonstrate that the disease was contracted under specific conditions, such as an acute exacerbation due to unusual strain from their work or the onset of symptoms during work performance. In this case, Avior Marine argued that Turreda’s illness was merely a simple migraine, not a work-related condition. However, the Court found compelling evidence suggesting otherwise.

    The court noted that the prompt repatriation and subsequent medical tests conducted by the company-designated physician indicated a more serious underlying condition than a simple migraine. The fact that Turreda was prescribed medications for high blood pressure and underwent cardiac evaluations suggested that he was indeed suffering from hypertensive cardiovascular disease. Furthermore, the Court emphasized that Turreda had been declared fit for sea duty prior to his employment, implying that his cardiovascular issues arose during his time aboard the Water Phoenix. This aligns with the POEA-SEC provision recognizing a causal relationship between the disease and the seafarer’s job when symptoms manifest during employment.

    “A party in whose favor the legal presumption exists may rely on and invoke such legal presumption to establish a fact in issue. The effect of a presumption upon the burden of proof is to create the need of presenting evidence to overcome the prima facie case created thereby which, if no contrary proof is offered, will prevail.”, Bautista v. Elburg Shipmanagement Philippines, Inc. et al. In disability claims, the POEA-SEC outlines a specific procedure for resolving disputes regarding medical assessments. If the seafarer’s doctor disagrees with the company-designated physician’s assessment, the parties may jointly agree to consult a third doctor, whose decision shall be final and binding. This process ensures an impartial resolution based on expert medical opinion.

    The case of INC Navigation Co. Philippines, Inc., et al. v. Rosales, clarifies that the burden of initiating the third doctor provision lies with the company once the seafarer challenges the company doctor’s assessment. The Court emphasized that the company must actively respond by setting into motion the process of choosing a third doctor. In Ilustricino v. NYK-FIL Ship Management, Inc., et al., the Court further underscored the importance of the employer’s response to the seafarer’s request for a third-doctor referral. The court highlighted that the burden to refer the case to a third doctor shifts to the respondents upon being notified of the petitioner’s intent to dispute the company doctors’ findings.

    In Turreda’s case, he notified Avior Marine of the conflicting medical assessments and requested a third-doctor referral, but the company failed to initiate the process. While Avior Marine argued that the request was made after the case had already been filed, the Court clarified that the POEA-SEC does not specify a timeframe for seeking a third opinion, allowing it even during labor tribunal proceedings. Since no third doctor was appointed, the Court proceeded to evaluate the medical reports, emphasizing the importance of a final, complete, and definitive disability assessment. To be conclusive, the medical assessment or report of the company-designated physician should be complete and definite to provide the appropriate disability benefits to seafarers.

    The court found the company-designated physician’s assessment to be lacking in several respects. First, the physician issued a certificate of fitness to work just three weeks after advising Turreda to continue medication for high blood pressure and related conditions. Second, the assessment lacked supporting documentation, such as laboratory results and specialist reports. Third, the medical reports were unsigned, further casting doubt on their validity. Clear bias on the part of the company-designated physician may be shown if there is no scientific relation between the diagnosis and the symptoms felt by the seafarer, or if the final assessment of the company-designated physician is not supported by the medical records of the seafarer.

    Because of the incomplete, questionable, and unsubstantiated nature of the company-designated physician’s assessment, the Supreme Court affirmed the lower courts’ decisions, holding that Turreda was entitled to total and permanent disability benefits. This case reinforces the importance of a thorough and unbiased medical evaluation in determining a seafarer’s fitness for duty and entitlement to disability benefits. The court emphasized that employers must ensure that medical assessments are complete, definitive, and supported by sufficient medical evidence.

    FAQs

    What was the key issue in this case? The key issue was whether the company-designated physician’s assessment was sufficient to deny the seafarer’s claim for total and permanent disability benefits, considering the incomplete and questionable nature of the assessment.
    What is a work-related illness under the POEA-SEC? A work-related illness is any sickness resulting in disability or death as a result of an occupational disease listed under Section 32-A of the POEA-SEC, provided the conditions set therein are satisfied. This definition requires a clear link between the illness and the seafarer’s work.
    Under what conditions is hypertensive cardiovascular disease considered an occupational disease for seafarers? Hypertensive cardiovascular disease is considered an occupational disease if it was known to be present during employment and an acute exacerbation was clearly precipitated by the unusual strain of the seafarer’s work, the strain of work brought about an acute attack followed within 24 hours by clinical signs, or if a person was asymptomatic before work and showed signs during work.
    What happens when the company-designated physician and the seafarer’s doctor disagree on the medical assessment? The POEA-SEC provides that a third doctor may be agreed jointly between the Employer and the seafarer, and the third doctor’s decision shall be final and binding on both parties. The burden of initiating the third doctor provision lies with the company once the seafarer challenges the company doctor’s assessment.
    What are the requirements for a valid disability assessment by the company-designated physician? A valid disability assessment must be final, complete, and definitive, reflecting the true extent of the seafarer’s illness or injuries and their capacity to resume sea duties. It must also be supported by sufficient medical evidence and free from bias.
    What happens if the company fails to initiate the process of choosing a third doctor? If the company fails to initiate the process of choosing a third doctor after being notified of the disagreement, the assessment of the company-designated physician is not binding. The court will then evaluate the medical reports and evidence presented by both parties.
    Why was the company-designated physician’s assessment in this case considered insufficient? The assessment was considered insufficient because it was issued hastily, lacked supporting documentation, and was unsigned, raising concerns about its validity and completeness. The physician also certified Turreda as fit to work despite ongoing health issues and medication.
    What is the significance of a seafarer being declared fit for duty during the pre-employment medical examination? If a seafarer is declared fit for duty during the pre-employment medical examination, it creates a presumption that any subsequent illness developed during employment is work-related. The burden then shifts to the employer to prove otherwise.

    This case demonstrates the Supreme Court’s commitment to protecting the rights of seafarers and ensuring fair and thorough medical evaluations in disability claims. The ruling emphasizes the importance of employers fulfilling their obligations under the POEA-SEC and acting in good faith when assessing a seafarer’s fitness for duty.

    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: AVIOR MARINE, INC. VS. ARNALDO R. TURREDA, G.R. No. 250806, September 29, 2021

  • Navigating the Seas of Truth: The Impact of Concealment on Seafarer Disability Claims

    Honesty is the Best Policy: Concealment Can Sink Your Disability Claims

    Leonides P. Rillera v. United Philippine Lines, Inc. and/or Belships Management (Singapore) Pte., Ltd., G.R. No. 235336, June 23, 2020

    Imagine setting sail on the high seas, leaving behind the safety of land for the promise of adventure and opportunity. For seafarers like Leonides P. Rillera, this dream turned into a nightmare when health issues arose, and his claim for disability benefits was denied. At the heart of this case was a crucial question: Can a seafarer’s failure to disclose pre-existing medical conditions during pre-employment medical examinations (PEMEs) disqualify them from receiving disability benefits? The Supreme Court’s ruling in Rillera’s case sheds light on the importance of honesty and transparency in the maritime industry.

    Leonides P. Rillera, a 3rd Mate on the vessel Caribbean Frontier, was hired by United Philippine Lines, Inc. and Belships Management (Singapore) Pte., Ltd. in January 2012. During his deployment, Rillera developed several serious health issues, including hypertensive cardiovascular disease, diabetes, and osteoarthritis. Upon repatriation, he sought total and permanent disability benefits, claiming that his conditions were work-related. However, the respondents argued that Rillera had concealed his pre-existing conditions of hypertension and diabetes during his PEME, which should disqualify him from receiving any benefits.

    The Legal Framework: Honesty in Pre-Employment Medical Examinations

    In the maritime industry, the Philippine Overseas Employment Administration (POEA) Standard Employment Contract (SEC) governs the relationship between seafarers and their employers. Section 20(E) of the POEA-SEC, as amended by POEA Memorandum Circular No. 10, series of 2010, states:

    A seafarer who knowingly conceals a pre-existing illness or condition in the Pre-Employment Medical Examination (PEME) shall be liable for misrepresentation and shall be disqualified for any compensation and benefits. This is likewise a just cause for termination of employment and imposition of appropriate administrative sanctions.

    This provision underscores the importance of full disclosure during PEMEs. The term “pre-existing illness” refers to any condition diagnosed or known to the seafarer before the contract’s processing, which they fail to disclose during the PEME and cannot be diagnosed during the examination.

    The concept of “fraudulent misrepresentation” in this context goes beyond mere nondisclosure; it requires intent to deceive and profit from that deception. For example, if a seafarer knows they have a condition like hypertension and deliberately lies about it during their PEME to secure employment, this could be considered fraudulent misrepresentation.

    The Journey of Leonides P. Rillera: From Diagnosis to Denial

    Leonides P. Rillera’s journey began with his employment in January 2012, where he underwent a PEME and was declared fit for sea duty. However, by September 2012, he began experiencing chest pain and difficulty breathing, leading to a diagnosis of congestive heart failure and other conditions. Upon repatriation, Rillera was treated by company-designated doctors who eventually declared him fit to work by March 2013. However, Rillera sought second opinions from other doctors who deemed him permanently unfit for sea duties.

    The case took a procedural turn when Rillera filed a complaint for total and permanent disability benefits with the National Conciliation and Mediation Board (NCMB). The NCMB initially granted Rillera’s claim, but the Court of Appeals (CA) reversed this decision, citing Rillera’s concealment of his pre-existing conditions of hypertension and diabetes during his PEME.

    The Supreme Court upheld the CA’s decision, emphasizing Rillera’s fraudulent misrepresentation. The Court noted:

    As the Court of Appeals correctly found, records show that petitioner had already been diagnosed with hypertension during his previous 2009 PEME with another employer. He had been maintained on metoprolol to treat his hypertension. He also got diagnosed with diabetes in 2010 and was treated at Seaman’s Hospital and prescribed with metformin as maintenance medicine.

    The Court further explained that Rillera’s failure to disclose these conditions, despite knowing about them, constituted material concealment. This was compounded by the fact that Rillera did not initiate a referral to a third doctor to resolve the conflicting medical assessments, as required by the POEA-SEC.

    The Ripple Effect: Implications for Seafarers and Employers

    The Rillera case has significant implications for both seafarers and their employers. For seafarers, it serves as a stark reminder of the importance of honesty during PEMEs. Concealing pre-existing conditions can lead to the denial of disability benefits, even if those conditions worsen during employment.

    For employers, the ruling reinforces the need to conduct thorough PEMEs and to maintain clear records of a seafarer’s medical history. It also highlights the importance of the third-doctor referral process in resolving disputes over medical assessments.

    Key Lessons:

    • Seafarers must disclose all known pre-existing conditions during PEMEs to avoid disqualification from disability benefits.
    • Employers should ensure that PEMEs are comprehensive and that any disputes over medical assessments are resolved through the third-doctor referral process.
    • Both parties should be aware of the legal requirements under the POEA-SEC to protect their rights and interests.

    Frequently Asked Questions

    What is considered a pre-existing condition in the context of seafarer employment?

    A pre-existing condition is any illness or medical condition diagnosed or known to the seafarer before the processing of the POEA contract, which they fail to disclose during the PEME and cannot be diagnosed during the examination.

    Can a seafarer be denied disability benefits for concealing a pre-existing condition?

    Yes, according to Section 20(E) of the POEA-SEC, a seafarer who knowingly conceals a pre-existing condition during the PEME can be disqualified from receiving any compensation and benefits.

    What should a seafarer do if there is a dispute over medical assessments?

    If there is a conflict between the findings of the company-designated physician and the seafarer’s chosen doctor, the seafarer should initiate a referral to a third doctor to resolve the dispute, as mandated by the POEA-SEC.

    Does the POEA-SEC cover all types of illnesses?

    The POEA-SEC lists specific occupational diseases that are compensable, but it also allows for the compensation of illnesses not listed if they are contracted during employment and meet certain criteria.

    How can employers protect themselves from fraudulent misrepresentation by seafarers?

    Employers should ensure that PEMEs are thorough and that they maintain clear records of a seafarer’s medical history. They should also follow the third-doctor referral process to resolve any disputes over medical assessments.

    What are the potential consequences for a seafarer found guilty of fraudulent misrepresentation?

    A seafarer found guilty of fraudulent misrepresentation can be disqualified from receiving any compensation and benefits, and it can also be a just cause for termination of employment.

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