The Supreme Court ruled that a seafarer’s claim for disability benefits was denied because he failed to follow the proper procedures outlined in the POEA Standard Employment Contract (POEA SEC). Specifically, the seafarer did not fully cooperate with the company-designated physician and prematurely filed a complaint without seeking a third opinion to resolve conflicting medical assessments. This decision clarifies the importance of adhering to established protocols when claiming disability benefits for illnesses that may have pre-existed employment.
When a Seafarer’s Duty to Disclose Meets the Reality of a Denied Claim
This case revolves around Danilo L. Pacio’s claim for permanent total disability benefits against Dohle-Philman Manning Agency, Inc., Dohle (IOM) Limited, and Manolo T. Gacutan. Pacio, hired as an Able Seaman, disclosed a pre-existing condition of hypertension during his pre-employment medical examination (PEME). Despite this, he was declared fit for sea duty but signed an undertaking acknowledging his condition and agreeing that any disability resulting from it would be non-compensable. The central legal question is whether Pacio is entitled to disability benefits when his condition, allegedly aggravated by his work, led to his repatriation and a subsequent diagnosis of a transient ischemic attack.
The factual backdrop reveals that Pacio began experiencing high blood pressure and dizziness five months into his employment, leading to his repatriation from Romania. Upon his return, he underwent medical evaluation by the company-designated physician, who determined that his condition was not work-related. Despite this assessment, the respondents shouldered the costs of his medical evaluation. Dissatisfied, Pacio consulted his own physician, who diagnosed him with Hypertension Stage II. Subsequently, he filed a claim for permanent total disability benefits, damages, and attorney’s fees, arguing that his work aggravated his pre-existing condition.
The Labor Arbiter (LA) initially ruled in favor of Pacio, awarding him US$60,000.00 in disability benefits, plus attorney’s fees. The National Labor Relations Commission (NLRC) affirmed the LA’s decision. However, the Court of Appeals (CA) reversed these rulings, finding that Pacio had not complied with the prescribed procedure for disability compensation and that the labor tribunals had gravely abused their discretion. The CA emphasized Pacio’s pre-existing hypertension and his failure to follow the POEA SEC’s guidelines for seeking a third medical opinion.
The Supreme Court upheld the CA’s decision, emphasizing the importance of adhering to the procedural requirements for disability claims under the POEA SEC. The Court referenced Article 198, formerly Article 192 of the Labor Code, outlining conditions for total and permanent disability, along with Section 2, Rule X of the Amended Rules on Employees’ Compensation. These provisions, the Court noted, must be read in harmony to properly evaluate a disability claim. It highlighted the seafarer’s obligation to report to the company-designated physician within three days of arrival for diagnosis and treatment, as stated in Section 20(B)(3) of the POEA SEC.
The court emphasized the process a seafarer must undergo to claim disability benefits.
3. Upon sign-off from the vessel for medical treatment, the seafarer is entitled to sickness allowance equivalent to his basic wage until he is declared fit to work or the degree of permanent disability has been assessed by the company-designated physician but in no case shall this period exceed one hundred twenty (120) days.
Further, the decision in TSM Shipping Phils., Inc., et al. v. Patiño underscores the importance of this process:
As these provisions operate, the seafarer, upon sign-off from his vessel, must report to the company-designated physician within three (3) days from arrival for diagnosis and treatment. For the duration of the treatment but in no case to exceed 120 days, the seaman is on temporary total disability as he is totally unable to work. He receives his basic wage during this period until he is declared fit to work or his temporary disability is acknowledged by the company to be permanent, either partially or totally, as his condition is defined under the POEA Standard Employment Contract and by applicable Philippine laws.
In Pacio’s case, the Court found that he failed to comply with these statutory requirements, despite the respondents’ efforts to adhere to them. The Court noted that the company-designated physician provided an assessment within the allotted time, contradicting Pacio’s claim that a full report was not given. Moreover, Pacio refused further tests and waited almost a year before filing the complaint, indicating a lack of good faith in his handling of the claim.
The Court also addressed the issue of conflicting medical findings. Under Section 20(A)(3) of the 2010 POEA SEC, if a seafarer’s doctor disagrees with the company-designated physician’s assessment, a third doctor, jointly agreed upon, should provide a final and binding opinion. Pacio failed to utilize this remedy, filing the complaint without informing the respondents of his physician’s contrary findings. This omission was deemed prejudicial to his claim, as highlighted in Veritas Maritime Corporation v. Gepanaga, Jr., where the Court emphasized the seafarer’s duty to seek a third opinion.
Gepanaga failed to observe the prescribed procedure of having the conflicting assessments on his disability referred to a third doctor for a binding opinion.
Finally, the Court reiterated that Pacio had the burden to prove that his condition was aggravated by his work, not merely rely on a presumption of work-relatedness. Citing Espere v. NFD International Manning Agents, Inc., et al., the Court stated that the seafarer must show a reasonable connection between the nature of the work and the illness contracted or aggravated. Since Pacio failed to provide substantial evidence demonstrating that his work conditions caused or increased the risk of contracting his illness, his claim for disability benefits was denied.
FAQs
What was the key issue in this case? | The key issue was whether a seafarer was entitled to disability benefits when a pre-existing condition was allegedly aggravated by his work, and whether he followed the correct procedures for claiming those benefits. |
What is the POEA SEC? | The POEA SEC is the Philippine Overseas Employment Administration Standard Employment Contract, which outlines the terms and conditions of employment for Filipino seafarers. It includes provisions for disability benefits and the procedures for claiming them. |
What is the role of the company-designated physician? | The company-designated physician is responsible for assessing a seafarer’s medical condition after repatriation and determining whether the illness or injury is work-related. Their assessment is crucial in determining eligibility for disability benefits. |
What happens if the seafarer disagrees with the company-designated physician? | If the seafarer disagrees with the company-designated physician’s assessment, they can seek a second opinion. If the disagreement persists, a third, independent physician, jointly agreed upon by both parties, should be consulted, and their opinion will be final and binding. |
What is the seafarer’s responsibility in claiming disability benefits? | The seafarer has the responsibility to comply with the procedures outlined in the POEA SEC, including reporting to the company-designated physician within three days of arrival, cooperating with medical examinations, and seeking a third opinion if necessary. |
What evidence is needed to prove work-related aggravation of a pre-existing condition? | The seafarer must present substantial evidence demonstrating a reasonable connection between their work on board the vessel and the aggravation of their pre-existing condition. This may include medical records, witness testimonies, and documentation of work conditions. |
What is the significance of the pre-employment medical examination (PEME)? | The PEME is a medical examination conducted before a seafarer begins employment to assess their fitness for sea duty. Disclosing any pre-existing conditions during the PEME is crucial, as it can affect future claims for disability benefits. |
What is the effect of signing an undertaking related to a pre-existing condition? | Signing an undertaking acknowledging a pre-existing condition and agreeing that any resulting disability is non-compensable can significantly impact a seafarer’s ability to claim disability benefits. However, it doesn’t automatically bar a claim if the condition is proven to be work-related or aggravated by work. |
What happens if a seafarer refuses to cooperate with the company physician? | Refusal to cooperate with the company physician can negatively impact a seafarer’s ability to claim disability benefits, as it could be interpreted as a sign of bad faith, undermining the validity of the claim. |
This case serves as a crucial reminder of the importance of strictly adhering to the procedural requirements set forth in the POEA SEC when claiming disability benefits. Seafarers must actively participate in the medical evaluation process, fully cooperate with company-designated physicians, and utilize the available remedies, such as seeking a third medical opinion, to strengthen their claims. Failure to do so may result in the denial of benefits, regardless of the legitimacy of their underlying medical condition.
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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: DANILO L. PACIO, PETITIONER, V. DOHLE-PHILMAN MANNING AGENCY, INC., DOHLE (IOM) LIMITED, AND/OR MANOLO T. GACUTAN, RESPONDENTS., G.R. No. 225847, July 03, 2019