The Supreme Court ruled that a seafarer’s failure to seek a third doctor’s opinion, as required by the POEA Standard Employment Contract, undermines their disability claim. This decision reinforces the importance of adhering to the prescribed procedures for resolving disputes in maritime employment, emphasizing that without a binding third opinion, the assessment of the company-designated physician prevails. The ruling clarifies the process for disability claims and highlights the seafarer’s responsibility to follow contractual obligations.
Navigating Conflicting Medical Opinions: Whose Assessment Prevails?
This case, Maersk-Filipinas Crewing, Inc. v. Jaleco, revolves around Rommel Rene O. Jaleco’s claim for disability benefits after experiencing lower back pain while working as an Able Bodied Seaman. The central legal issue is determining whose medical assessment should prevail when there are conflicting opinions between the company-designated physician and the seafarer’s independent physician regarding the extent of the seafarer’s disability. Specifically, the Supreme Court examined the procedural requirements under the POEA Standard Employment Contract for resolving such disputes.
The factual backdrop begins with Jaleco’s employment by Maersk-Filipinas Crewing, Inc. on behalf of A.P. Moller A/S. During his service on the vessel “M/T Else Maersk,” Jaleco experienced intermittent pain in his left buttock radiating to his lower back and left groin. Medical examinations in Singapore and Dubai yielded different diagnoses, including a suspected prolapsed intervertebral disc and acute lumbago with left-sided sciatica. He was eventually repatriated and referred to the company-designated physician, Dr. Natalio Alegre II, for further evaluation and treatment. Dr. Alegre’s initial findings indicated paralumbar spasm and limitations of movement, leading to prescribed medication and physical therapy.
As Jaleco’s condition persisted, further examinations and tests were conducted, including an MRI scan and EMG-NCV testing. A spine surgeon recommended provocative discography to assess the need for disc replacement. The provocative discography revealed a midposterior Grade 1 annular tear, but the pain experienced was deemed not commensurate with the findings. This discrepancy led Dr. Alegre to recommend a Minnesota Multiphasic Personality Inventory – 2 Test (MMPI-2) to rule out malingering. The MMPI-2 results suggested that Jaleco was exaggerating his symptoms, motivated by external incentives such as financial compensation and avoiding work. Subsequently, Dr. Alegre assessed Jaleco with a Grade 11 disability rating based on the POEA Contract.
Dissatisfied with the company-designated physician’s assessment, Jaleco sought an independent medical opinion from Dr. Ramon Santos-Ocampo, who diagnosed him with sacro-iliitis and bilateral facet joint arthropathy. Later, he consulted another independent physician, Dr. Alan Leonardo R. Raymundo, who declared him unfit for duty and assigned a Grade 6 disability rating. These conflicting medical opinions formed the crux of the legal dispute. Jaleco filed a complaint for illegal dismissal, non-payment of wages, disability claims, medical expenses, damages, and attorney’s fees before the National Labor Relations Commission (NLRC). He argued that his injury incapacitated him from returning to work and that he was entitled to a Grade 6 disability rating, along with other forms of compensation.
The Labor Arbiter initially granted disability benefits and attorney’s fees in favor of Jaleco, citing the company-designated physician’s failure to declare Jaleco fit for work. However, the NLRC reversed this decision, upholding the Grade 11 disability rating assigned by the company-designated physician. The NLRC emphasized Jaleco’s failure to refute the physician’s opinion that he was malingering and exaggerating his pain. The Court of Appeals (CA) then reversed the NLRC’s decision, granting Jaleco permanent total disability benefits based on Dr. Raymundo’s assessment and declaring him unfit for duty. The CA also awarded attorney’s fees, leading to the present petition before the Supreme Court.
The Supreme Court, in reversing the CA’s decision, emphasized the importance of adhering to the procedural requirements outlined in the POEA Standard Employment Contract for resolving disputes regarding disability assessments. Section 20(B)(3) of the POEA Standard Employment Contract explicitly states that 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, and that the third doctor’s decision shall be final and binding on both parties. The Court cited Philippine Hammonia Ship Agency, Inc. v. Dumadag, which underscored that the POEA-SEC and the CBA are the law between the parties and that pursuing a claim without observing the laid-out procedure constitutes a breach of contractual obligation.
“The filing of the complaint constituted a breach of Dumadag’s contractual obligation to have the conflicting assessments of his disability referred to a third doctor for a binding opinion.”
In this case, Jaleco preempted the mandated procedure by filing a complaint for permanent disability compensation based on his chosen physicians’ opinions without referring the conflicting opinions to a third doctor for final determination. Because Jaleco was the one pursuing a claim, the Court emphasized that it was his responsibility to initiate securing the opinion of a third physician before seeking intervention from labor tribunals. The Court found no reason to doubt Dr. Alegre’s medical opinion, noting the extensive tests conducted and the objective findings that Jaleco’s reported pain was not commensurate with the test results.
“If a doctor appointed by the seafarer disagrees with the assessment, 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.”
– Section 20(B)(3) of the POEA Standard Employment Contract
The Court also reiterated that the mere lapse of the 120-day period does not automatically warrant the payment of permanent total disability benefits, as the period may be extended up to 240 days. Since Dr. Alegre arrived at an assessment of a Grade 11 disability rating before the expiration of the maximum 240-day period, there was no basis for claiming permanent total disability. As a result, the Supreme Court reversed the CA’s decision and reinstated the NLRC’s ruling, entitling Jaleco only to disability benefits corresponding to a Grade 11 disability as determined by the company-designated physician.
This decision underscores the importance of procedural compliance in maritime disability claims. The process of securing a third doctor’s opinion serves as a crucial mechanism for resolving disputes and ensuring fairness in disability assessments. Failure to adhere to this process can result in the dismissal of a seafarer’s claim, as the company-designated physician’s assessment will prevail in the absence of a binding third opinion. Therefore, seafarers must be diligent in following the prescribed procedures and exhausting all available remedies before resorting to litigation.
FAQs
| What was the key issue in this case? | The key issue was whether the seafarer’s failure to seek a third doctor’s opinion, as required by the POEA Standard Employment Contract, undermined his disability claim. The Supreme Court emphasized the importance of adhering to the prescribed procedures for resolving disputes in maritime employment. |
| What is the role of the company-designated physician? | The company-designated physician is responsible for conducting post-employment medical examinations and assessing the seafarer’s fitness for work or degree of disability. Their assessment is considered authoritative unless challenged by the seafarer through the proper channels, including seeking a third doctor’s opinion. |
| What happens if the seafarer disagrees with the company-designated physician’s assessment? | If the seafarer disagrees with the company-designated physician’s assessment, the POEA Standard Employment Contract provides a mechanism for resolving the dispute. The seafarer can seek a second opinion, and if the opinions remain conflicting, a third doctor may be jointly agreed upon to provide a final and binding opinion. |
| What is the significance of the third doctor’s opinion? | The third doctor’s opinion is considered final and binding on both parties, providing a definitive resolution to the conflicting medical assessments. Without a binding third opinion, the assessment of the company-designated physician prevails. |
| What is the 120/240-day rule in disability claims? | The 120/240-day rule refers to the period within which the company-designated physician must make a final assessment of the seafarer’s disability. The initial period is 120 days, which may be extended up to 240 days if further medical attention is required. |
| What does it mean to be declared permanently and totally disabled? | Permanent total disability means the seafarer is unable to perform their customary work for more than 120 days, as declared by the company-designated physician, or after the lapse of the 120/240-day treatment period. This entitles the seafarer to receive total disability benefits. |
| What happens if the seafarer fails to follow the prescribed procedures for resolving disputes? | If the seafarer fails to follow the prescribed procedures, such as seeking a third doctor’s opinion, their disability claim may be dismissed. The company-designated physician’s assessment will prevail in the absence of a binding third opinion. |
| What is the POEA Standard Employment Contract? | The POEA Standard Employment Contract is a standardized employment agreement prescribed by the Philippine Overseas Employment Administration (POEA) for Filipino seafarers. It outlines the terms and conditions of employment, including provisions for disability benefits, medical care, and dispute resolution. |
This case serves as a reminder of the importance of adhering to the procedural requirements in maritime disability claims. By following the prescribed steps for resolving disputes, seafarers can ensure that their claims are properly evaluated and that their rights are protected.
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: MAERSK-FILIPINAS CREWING, INC. VS. ROMMEL RENE O. JALECO, G.R. No. 201945, September 21, 2015