ASG Law

Tag: Third-Doctor Procedure

  • Seafarer Disability Claims: Understanding Employer Obligations and Final Assessments

    Seafarers’ Rights: Employers Must Provide Clear Disability Assessments

    G.R. No. 245857, June 26, 2023

    Imagine a seafarer, far from home, injured while performing their duties. They return to the Philippines, hoping for medical care and compensation, only to be met with silence and bureaucratic hurdles. This scenario highlights the importance of clear and timely disability assessments in seafarer employment contracts, as emphasized in the Supreme Court’s decision in Angelito S. Magno v. Career Philippines Shipmanagement, Inc. This case underscores that employers must not only provide medical attention but also ensure that seafarers are fully informed of their medical assessments and disability ratings within the prescribed period, or risk facing claims for permanent and total disability benefits.

    The Legal Framework: Protecting Seafarers’ Rights

    Seafarers’ rights to disability benefits are primarily governed by the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC), which is incorporated into every seafarer’s employment agreement. This contract outlines the obligations of employers when a seafarer suffers a work-related injury or illness. Key provisions include the employer’s responsibility to provide medical attention until the seafarer is declared fit or the degree of disability has been established. The POEA-SEC also specifies the process for resolving disputes regarding disability assessments, including the crucial “third-doctor” conflict resolution procedure.

    The Labor Code and the Amended Rules on Employee Compensation (AREC) also play a vital role in defining disability and determining compensation. Article 198(c)(1) of the Labor Code states that disability shall be deemed total and permanent when the “[t]emporary total disability [lasts] continuously for more than one hundred twenty days.” Similarly, the AREC provides that a disability is total and permanent if, due to injury or sickness, the employee cannot perform any gainful occupation for over 120 days.

    SECTION 20. COMPENSATION AND BENEFITS

    A. COMPENSATION AND BENEFITS FOR INJURY OR ILLNESS

    The liabilities of the employer when the seafarer suffers work-related injury or illness during the term of his contract are as follows:

    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.

    The disability shall be based solely on the disability gradings provided under Section 32 of this Contract, and shall not be measured or determined by the number of days a seafarer is under treatment or the number of days in which sickness allowance is paid.

    For example, if a seafarer injures their back while lifting heavy equipment on board, they are entitled to medical care and sickness allowance. If, after treatment, the company-designated physician assesses a partial disability, the seafarer can seek a second opinion. If the two doctors disagree, the POEA-SEC mandates referral to a third, independent doctor whose decision is final and binding.

    The Case of Angelito Magno: A Seafarer’s Struggle for Justice

    Angelito Magno, working as an Able Seaman, experienced back and knee pain while on duty. Upon repatriation, the company-designated physician diagnosed him with lumbar strain and right knee arthritis. Despite undergoing treatment and surgery, Magno continued to suffer from pain. The company-designated physician eventually issued a medical report addressed to the company’s Finance Manager, assessing a partial disability. Magno, feeling the assessment was insufficient, consulted his own doctor, who declared him permanently unfit for work.

    Here’s a breakdown of the case’s journey:

    • Magno requested a copy of his medical records and referral to a third doctor but was denied.
    • He filed a complaint with the National Labor Relations Commission (NLRC) for total and permanent disability benefits.
    • The Labor Arbiter (LA) ruled in Magno’s favor, awarding him USD 60,000.00.
    • The NLRC affirmed the LA’s decision, emphasizing that the company failed to heed Magno’s request for a third doctor.
    • The Court of Appeals (CA) reversed the NLRC, granting only partial disability benefits.

    The Supreme Court ultimately reversed the CA’s decision, reinstating the NLRC’s ruling that granted Magno total and permanent disability benefits. The Court emphasized that the employer failed to properly inform Magno of the company-designated physician’s final assessment. It reiterated the importance of due process and compliance with the POEA-SEC guidelines. The Court highlighted that the company-designated physician must issue a medical certificate, which should be personally received by the seafarer, or, if not practicable, sent to [the seafarer] by any other means sanctioned by present rules.

    “There being no final and definite assessment of Magno’s fitness to work or permanent disability within the prescribed periods by the company-designated physician that was provided to Magno, his disability has, by operation of law, become total and permanent.”

    The Supreme Court also added, that in order to be conclusive, the final and definite disability assessment should not only inform seafarers of their fitness or non-fitness to resume their duties, as well as the perceived level or rating of their disability, or whether such illness is work-related. Said final and definite assessment must also no longer require any further action on the part of the company-designated physician and is issued after he or she has exhausted all possible treatment options within the periods allowed by law.

    “Viewed in these lights, the Court, therefore finds that the CA seriously erred in reversing the NLRC’s ruling. There being no final and definite assessment of Magno’s fitness to work or permanent disability within the prescribed periods by the company-designated physician that was provided to Magno, his disability has, by operation of law, become total and permanent. As such, Magno is entitled to the corresponding disability benefits under the POEA-SEC.”

    Practical Implications: Protecting Seafarers and Ensuring Compliance

    This ruling reinforces the importance of employers’ compliance with the procedural requirements of the POEA-SEC. It clarifies that employers cannot simply rely on the company-designated physician’s assessment without ensuring that the seafarer is fully informed and has the opportunity to challenge the findings. The decision underscores the seafarer’s right to due process and the employer’s obligation to facilitate the third-doctor conflict resolution procedure when necessary.

    Key Lessons:

    • Employers must provide seafarers with a copy of the company-designated physician’s final assessment.
    • Seafarers have the right to seek a second opinion and request referral to a third doctor.
    • Failure to comply with these procedural requirements may result in a finding of total and permanent disability.

    Hypothetical Example:

    Suppose a seafarer suffers a heart attack while on duty. The company-designated physician assesses a partial disability but fails to provide the seafarer with a copy of the assessment. The seafarer seeks a second opinion, which contradicts the first. If the employer refuses to refer the matter to a third doctor, the seafarer may be deemed totally and permanently disabled, regardless of the initial assessment.

    Frequently Asked Questions

    Q: What is the POEA-SEC?

    A: The Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC) is a standard set of provisions that is deemed incorporated in every seafarer’s contract of employment, outlining the rights and obligations of both the seafarer and the employer.

    Q: What is a company-designated physician?

    A: A company-designated physician is a doctor chosen by the employer to assess the medical condition of the seafarer.

    Q: What happens if the seafarer disagrees with the company-designated physician’s assessment?

    A: The seafarer can seek a second opinion from their chosen physician. If the two doctors disagree, the POEA-SEC mandates referral to a third, independent doctor whose decision is final and binding.

    Q: What is the third-doctor conflict resolution procedure?

    A: It is the process outlined in the POEA-SEC for resolving disputes regarding disability assessments, where a third, independent doctor is jointly selected by the employer and seafarer to provide a final and binding assessment.

    Q: What is the significance of the 120/240-day rule?

    A: 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. 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. 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. 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.

    Q: What is considered a total and permanent disability?

    A: Under Article 198(c)(1) of the Labor Code, disability shall be deemed total and permanent when the “[t]emporary total disability [lasts] continuously for more than one hundred twenty days.” Similarly, the AREC provides that a disability is total and permanent if, due to injury or sickness, the employee cannot perform any gainful occupation for over 120 days.

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

  • Seafarer Disability Claims: The Primacy of Company-Designated Physician’s Assessment

    In a claim for disability benefits by a seafarer, the assessment of the company-designated physician holds significant weight. This means that if a seafarer seeks a second opinion from their own doctor and the assessments conflict, a specific procedure must be followed: both parties must jointly agree on a third, independent physician whose decision will be final. If the seafarer fails to notify the employer of their intention to seek a third opinion and follow this procedure, the company-designated physician’s assessment prevails, potentially impacting the seafarer’s ability to claim disability benefits. This ensures a fair and structured process for resolving medical disputes in maritime employment.

    Navigating the Seas of Seafarer Health: Whose Medical Opinion Prevails?

    Edgar S. Alferos, employed as an Able Seaman by Maersk-Filipinas Crewing Inc. and A.P. Moller A/S, experienced lower back and abdominal pain during his employment. Upon repatriation and examination by company-designated physicians, he was initially diagnosed with prostatitis but later cleared to resume duties. Disagreeing with this assessment, Alferos consulted another physician who found him unfit due to kidney stones and vertigo, leading him to file a claim for disability benefits. The core legal issue revolves around which medical assessment should prevail when there is a conflict between the company-designated physician and the seafarer’s chosen physician, especially concerning the procedural requirements outlined in the POEA-SEC.

    The Supreme Court, in this case, emphasized the importance of adhering to the procedure outlined in the POEA-SEC for resolving conflicting medical assessments. When a seafarer sustains a work-related illness or injury, the POEA-SEC mandates that the company-designated physician determines the seafarer’s fitness or unfitness for work. However, recognizing the possibility of differing opinions, the POEA-SEC provides a mechanism to address disagreements. According to the Court in TSM Shipping Phils., Inc. v. Patiño:

    …the non-observance of the requirement to have the conflicting assessments determined by a third physician would mean that the assessment of the company-designated physician prevails.

    This underscores the primacy given to the company-designated physician’s assessment unless the prescribed procedure is followed. The POEA-SEC clearly stipulates the process for resolving disputes in medical assessments:

    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.

    The Court found that Alferos failed to comply with this critical requirement. Despite obtaining an assessment from his chosen physician that contradicted the company-designated physician’s fit-to-work declaration, Alferos did not notify his employers of his intent to seek a third opinion. This failure to provide notice is a crucial point. Without such notification, the employers were not given the opportunity to participate in the selection of a third, independent physician, as mandated by the POEA-SEC. The purpose of the third-doctor provision is to provide an impartial resolution to conflicting medical opinions, ensuring fairness and objectivity in the assessment process.

    The Supreme Court referenced Hernandez v. Magsaysay Maritime Corporation to emphasize the seafarer’s responsibility in initiating the third-doctor process:

    Under Section 20 (A) (3) of the 2010 POEA-SEC, “[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.” The provision refers to the declaration of fitness to work or the degree of disability. It presupposes that the company-designated physician came up with a valid, final and definite assessment as to the seafarer’s fitness or unfitness to work before the expiration of the 120-day or 240-day period. The company can insist on its disability rating even against a contrary opinion by another doctor, unless the seafarer signifies his intent to submit the disputed assessment to a third physician. The duty to secure the opinion of a third doctor belongs to the employee asking for disability benefits. He must actively or expressly request for it.

    Because Alferos did not actively request the opinion of a third doctor, the Court deemed his claim for disability benefits premature. The Court further clarified that the PEME (Physical Employment Medical Examination) conducted by Supercare, which found Alferos unfit, was primarily for re-employment purposes and could not substitute the formal notification required under the POEA-SEC. In essence, the PEME’s findings were considered too tentative to override the company-designated physician’s assessment, especially in the absence of proper notification and the opportunity for the employers to participate in the third-doctor process.

    The Court highlighted that for a writ of certiorari to be issued, the abuse of discretion must be grave, indicating an arbitrary or despotic exercise of power, evasion of duty, or action in a capricious manner tantamount to lack of jurisdiction. The NLRC’s decision to affirm the Labor Arbiter’s award of disability benefits, despite Alferos’ failure to comply with the third-doctor procedure, was deemed a grave abuse of discretion. By disregarding the express language of the POEA-SEC, the NLRC acted in a whimsical and capricious manner, justifying the reversal of its decision.

    This ruling reinforces the significance of adhering to the prescribed procedures in seafarer disability claims. The POEA-SEC provides a clear framework for resolving medical disputes, and failure to comply with its provisions can have significant consequences for seafarers seeking disability benefits. The case serves as a reminder that while seafarers have the right to seek independent medical opinions, they must also fulfill their contractual obligations by actively participating in the third-doctor process when disagreements arise.

    FAQs

    What was the key issue in this case? The key issue was determining which medical assessment should prevail in a seafarer’s disability claim when there’s a conflict between the company-designated physician and the seafarer’s chosen physician, specifically regarding compliance with POEA-SEC procedures.
    What is the role of the company-designated physician? The company-designated physician is primarily responsible for assessing a seafarer’s fitness or unfitness for work when the seafarer sustains a work-related illness or injury while on board the vessel, and their assessment initially prevails.
    What happens if the seafarer disagrees with the company-designated physician’s assessment? If the seafarer’s chosen physician disagrees with the company-designated physician’s assessment, the POEA-SEC provides a process where both parties must jointly agree on a third, independent physician whose decision will be final and binding.
    What is the seafarer’s responsibility in the third-doctor process? The seafarer has the duty to actively notify the employer of their intent to seek a third medical opinion, initiating the process for selecting a mutually agreed-upon physician to resolve the conflicting assessments.
    What happens if the seafarer fails to notify the employer of their intent to seek a third opinion? If the seafarer fails to notify the employer and follow the POEA-SEC procedure, the company-designated physician’s assessment prevails, potentially impacting the seafarer’s ability to claim disability benefits.
    Can a PEME (Physical Employment Medical Examination) substitute for the third-doctor process? No, a PEME conducted for re-employment purposes cannot substitute for the formal notification and third-doctor process required under the POEA-SEC when there are conflicting medical assessments.
    What is the significance of the POEA-SEC in seafarer disability claims? The POEA-SEC provides a clear framework for resolving medical disputes and outlines the procedures that must be followed to ensure fairness and objectivity in the assessment process for seafarer disability claims.
    What was the Court’s ruling in this case? The Court ruled in favor of the employers, stating that the seafarer’s claim for disability benefits was premature because he failed to notify his employers of his intent to seek a third medical opinion and comply with the POEA-SEC procedure.

    In conclusion, this case underscores the critical importance of strictly adhering to the procedures outlined in the POEA-SEC for seafarer disability claims. The primacy given to the company-designated physician’s assessment highlights the need for seafarers to proactively engage in the third-doctor process when seeking to challenge such assessments.

    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. v. ALFEROS, G.R. No. 216795, April 01, 2019