The Supreme Court has ruled that in disability claims of seafarers, the assessment of the company-designated physician prevails when it is thorough and well-supported, particularly if the seafarer fails to follow the prescribed procedure for resolving conflicting medical opinions. This decision underscores the importance of adhering to contractual and legal frameworks in assessing disability claims, protecting the rights and obligations of both seafarers and their employers, and highlights the significance of medical evaluations in determining disability benefits.

When a Hand Injury at Sea Leads to a Dispute Over Disability Benefits

This case revolves around Joselito B. Pellazar, an oiler who sustained a hand injury while working on the vessel M/T Delphina. After being medically repatriated, he sought permanent total disability benefits from his employer, OSG Shipmanagement Manila, Inc., and related entities. The central legal question is whether Pellazar is entitled to permanent total disability benefits based on his own physician’s assessment, or whether the company-designated physician’s assessment, which gave him a lower disability rating, should prevail.

The facts of the case indicate that Pellazar injured his right hand after being struck by an iron pipe while on duty. Upon returning to Manila, he was promptly referred to company-designated physicians, who diagnosed him with a fracture and provided treatment, including surgery and therapy sessions. After months of treatment, the company-designated physicians gave Pellazar a Grade 10 disability rating, corresponding to a “loss of grasping power for large objects between fingers and palm of one hand.” Dissatisfied with this rating, Pellazar consulted his own physician, who declared him permanently unfit for sea duty. This divergence in medical opinions sparked the legal battle over the appropriate disability benefits.

The Labor Arbiter initially ruled in favor of Pellazar, awarding him permanent total disability benefits, but the National Labor Relations Commission (NLRC) modified this decision, limiting his benefits to the Grade 10 disability rating assessed by the company physicians. The NLRC emphasized that the company physicians had provided extensive medical attention and were in a better position to evaluate Pellazar’s condition accurately. However, the Court of Appeals (CA) reversed the NLRC’s decision, reinstating the Labor Arbiter’s award of permanent total disability benefits, arguing that the length of the disability, exceeding 120 days, qualified it as total and permanent. The Supreme Court then reviewed the CA’s decision, focusing on whether the NLRC had committed grave abuse of discretion in its ruling.

In its analysis, the Supreme Court emphasized that disability benefits for seafarers are governed by both law and contract. Key provisions include Articles 191 to 193 of the Labor Code, Rule X of the Implementing Rules, the POEA Standard Employment Contract (POEA-SEC), and any applicable Collective Bargaining Agreement (CBA). The Court referenced its ruling in Vergara v. Hammonia Maritime Services, which clarified the interplay of these provisions, noting that a seafarer is on temporary total disability during treatment, up to a maximum of 120 days, extendable to 240 days if further medical attention is required. The mere lapse of the 120-day period does not automatically warrant the payment of permanent total disability benefits.

The Court then addressed the critical issue of whose medical assessment should prevail. The POEA-SEC and the CBA stipulate that the company-designated physician determines a seafarer’s disability or fitness to work. Section 20(B)3 of the POEA-SEC outlines the procedure for post-employment medical examination and the resolution of conflicting medical opinions, stating:

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.

Similarly, the CBA specifies that if the seafarer’s doctor disagrees with the company physician’s assessment, a third doctor should be jointly agreed upon for a final and binding decision. The Supreme Court found that Pellazar failed to comply with this procedure. After consulting his own physician and receiving a conflicting assessment, Pellazar did not seek a third opinion as required by the POEA-SEC and the CBA. The Court cited Philippine Hammonia v. Dumadag, where it held that failure to follow the prescribed procedure constitutes a breach of contractual obligation and can invalidate a disability claim.

The Court also addressed the weight to be given to the company-designated physician’s findings. While recognizing that these findings are not absolutely binding, the Court noted that they generally prevail due to the extensive evaluation and treatment provided by the company physicians. In Pellazar’s case, the company physicians, including specialists, had thoroughly evaluated and treated him over several months, leading to the Grade 10 disability rating. In contrast, Pellazar’s chosen physician examined him only once. This difference in the depth and duration of medical attention supported the NLRC’s decision to give more credence to the company physicians’ assessment.

Building on this principle, the Supreme Court underscored that the NLRC’s disagreement with the Labor Arbiter did not constitute grave abuse of discretion, as the NLRC’s decision was based on substantial evidence and the contractual provisions governing disability claims. The Court concluded that Pellazar was not entitled to full disability benefits under the CBA because the company physicians had not certified him as permanently unfit for further sea service, the Court reiterated that:

Furthermore, any seafarer assessed at less than 50% disability under the contract but certified as permanently unfit for further sea service in any capacity by the company doctor, shall be entitled to 100% compensation.

Since Pellazar was only given a Grade 10 disability rating, he was only entitled to the corresponding benefits under the POEA-SEC, which amounts to US$10,075.01.

Finally, the Court dismissed the award of attorney’s fees, as the petitioners had valid grounds under the POEA-SEC and the CBA to deny Pellazar’s claim for permanent total disability benefits.

FAQs

What was the key issue in this case?	The key issue was whether a seafarer was entitled to permanent total disability benefits based on his own physician’s assessment or the company-designated physician’s assessment. The Supreme Court favored the company-designated physician’s assessment due to the thoroughness of their evaluation and the seafarer’s failure to follow the contractual procedure for resolving conflicting medical opinions.
What is the role of the company-designated physician in disability claims?	The company-designated physician plays a crucial role in assessing a seafarer’s disability or fitness to work, as stipulated in the POEA-SEC and CBA. Their assessment is given significant weight, especially when based on extensive evaluation and treatment.
What happens if there is a conflict between the company physician and the seafarer’s physician?	If there is a conflict, the POEA-SEC and CBA provide a mechanism for resolving it: a third doctor, jointly agreed upon by the employer and seafarer, should make a final and binding decision. Failure to follow this procedure can impact the seafarer’s claim.
What is the significance of the 120-day period for disability assessment?	The 120-day period is the initial timeframe for temporary total disability, during which the seafarer receives sickness allowance. However, the mere lapse of this period does not automatically entitle the seafarer to permanent total disability benefits; the actual assessment of disability is more critical.
What are the implications of this ruling for seafarers?	This ruling emphasizes the importance of following the prescribed procedures in the POEA-SEC and CBA when disputing a company physician’s assessment. Seafarers should ensure they comply with the requirements for seeking a third medical opinion to strengthen their claims.
Can a seafarer seek a second opinion from a physician of their choice?	Yes, seafarers have the right to seek a second medical opinion. However, for the opinion to carry significant weight in a disability claim, the process outlined in the POEA-SEC and CBA for resolving conflicting opinions must be followed.
What is a Grade 10 disability rating?	A Grade 10 disability rating, as defined under the POEA-SEC, corresponds to a specific level of impairment, such as “loss of grasping power for large objects between fingers and palm of one hand.” It entitles the seafarer to a specific amount of compensation, as outlined in the schedule of benefits.
Under what conditions is a seafarer entitled to full disability benefits?	A seafarer is generally entitled to full disability benefits if assessed with a disability of 50% or more under the POEA Employment Contract or if the company doctor certifies that they are permanently unfit for further sea service, even with a lower disability rating.

This case reinforces the need for seafarers and employers to adhere to the established legal and contractual frameworks in resolving disability claims. By following the proper procedures and respecting the role of the company-designated physician, both parties can ensure a fair and equitable resolution of disputes.

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: OSG SHIPMANAGEMENT MANILA, INC. vs. JOSELITO B. PELLAZAR, G.R. No. 198367, August 06, 2014