In a dispute over disability benefits, the Supreme Court has affirmed the significance of a company-designated physician’s assessment in determining a seafarer’s fitness to work. This ruling emphasizes the binding nature of the company doctor’s assessment, provided it is made within the prescribed period and based on a thorough medical evaluation. The Court also clarified that a seafarer’s right to seek a second opinion does not automatically invalidate the company doctor’s findings unless a jointly agreed-upon third doctor provides a differing assessment. The ruling balances the rights of seafarers to medical care with the contractual obligations and procedures established in employment contracts and collective bargaining agreements, offering clarity for employers and employees in the maritime industry. The Court reinforced the principle that disability claims must adhere to both medical evidence and contractual stipulations.

Navigating the Seas of Sickness: Whose Medical Opinion Prevails?

This case revolves around Jesus E. Vergara, a seaman who experienced vision problems while working aboard the vessel British Valour. Hired by Hammonia Maritime Services, Inc. and assigned to Atlantic Marine Ltd., Vergara’s employment was governed by the Philippine Overseas Employment Administration Standard Employment Contract (POEA Standard Employment Contract) and a collective bargaining agreement (CBA). The central legal question emerged when, after medical treatment for his condition, Vergara was declared fit to work by the company-designated physician, Dr. Robert Lim. Disagreeing with this assessment, Vergara sought opinions from other doctors who suggested he was unfit for his previous duties. This divergence in medical opinions led to a legal battle over Vergara’s entitlement to disability benefits, raising critical questions about whose medical assessment should take precedence in such cases.

The Supreme Court grounded its analysis in the established legal framework governing seafarer disability claims. These include Articles 191 to 193 of the Labor Code, Rule X of the Implementing Rules, and the POEA Standard Employment Contract. Central to the Court’s decision was the interpretation of the POEA Standard Employment Contract’s provision regarding medical assessments. Specifically, Section 20(3) states that a seafarer is entitled to sickness allowance until declared fit to work or until a permanent disability is assessed by the company-designated physician, within a 120-day period. Moreover, this period could be extended to 240 days if further treatment was required.

The Court emphasized that upon repatriation, the seafarer must report to the company-designated physician within three days. For the duration of treatment, not exceeding 120 days, the seafarer is on temporary total disability and receives his basic wage. Only when the company physician declares permanent disability, either partial or total, does the seafarer become eligible for disability benefits under the POEA Standard Employment Contract and Philippine laws.

“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.”

In Vergara’s case, Dr. Lim, the company-designated physician, declared him fit to work within the extended 240-day period, based on the opinion of the handling eye specialist. Despite Vergara’s own doctors providing conflicting opinions, the Court upheld the primacy of the company doctor’s assessment. It noted that the POEA Standard Employment Contract and CBA clearly stipulate that the company-designated physician determines a seafarer’s fitness or unfitness for work. If a seafarer’s personal physician disagrees, a third doctor, jointly agreed upon by both parties, should provide a final and binding opinion.

Building on this principle, the Court found that Vergara did not follow the agreed procedure for resolving conflicting medical opinions. He sought second and third opinions without involving the company in selecting a third, impartial doctor. The Court also highlighted that Vergara had initially executed a “certificate of fitness for work,” indicating his concurrence with Dr. Lim’s assessment. Given these circumstances, the Court deferred to the company-designated physician’s certification as the prevailing determination. This approach contrasts with scenarios where the company fails to provide adequate medical assistance or the company doctor’s assessment is questionable.

The Court also addressed Vergara’s reliance on the Crystal Shipping, Inc. v. Natividad case. The petitioner invoked this ruling apparently for its statement that the respondent was unable to perform his customary work for more than 120 days, which constitutes permanent total disability. However, the Court clarified that Crystal Shipping involved a situation where the seafarer was unable to work for three years. In such prolonged situations where no determination has been made, a ruling of permanent and total disability is called for, which contrasts Vergara’s case because a fitness-to-work declaration was released well within the prescribed period. Additionally, the petitioner’s reliance on the disability assessment of 20.15% conducted by Dr. Efren R. Vicaldo, a physician who was also not designated by the company was also challenged, as this assessment was short of what is defined under the POEA Standard Employment Contract.

FAQs

What was the key issue in this case?	The central issue was determining whose medical opinion prevails in assessing a seafarer’s fitness for work when there are conflicting assessments between the company-designated physician and the seafarer’s personal physicians.
What is the role of the company-designated physician?	The company-designated physician is primarily responsible for assessing a seafarer’s fitness for work and determining the degree of disability, as outlined in the POEA Standard Employment Contract and CBA.
What happens if a seafarer disagrees with the company-designated physician’s assessment?	If a seafarer disagrees, the POEA Standard Employment Contract provides a mechanism for selecting a third, impartial doctor jointly agreed upon by both the employer and the seafarer, whose decision will be final and binding.
What is the significance of the 120-day period mentioned in the decision?	The 120-day period refers to the timeframe during which a seafarer is entitled to sickness allowance while undergoing medical treatment, and within which the company-designated physician must assess the seafarer’s fitness to work or degree of permanent disability.
Under what conditions can a temporary total disability become permanent?	A temporary total disability becomes permanent when the company-designated physician declares it so, or if the seafarer remains unable to work after the maximum 240-day medical treatment period without a declaration of fitness.
What if the seafarer requires additional time after 120 days, does it mean total disability?	No. The initial temporary disability of 120 days can be extended for a maximum of 240 days. This only gives more time for temporary disability, which is not automatically considered total and permanent disability.
Does the Court consider the opinions from private doctors to be enough to determine disability?	While the seafarer can seek opinions from private doctors, the Supreme Court gives preference to company-designated physicians due to the primary responsibility as designated by the POEA and CBA, and must resort to following the appropriate procedure in case there is disagreement with the physician.
Are there situations where the seafarer could be deemed to be totally and permanently disabled?	Yes, these situations could include if a seafarer is completely unable to work after 240 days, or that there are injuries classified under Grade I total and permanent disability, and in cases where the POEA/CBA requirements for benefits are adequately fulfilled.

This ruling reinforces the importance of adhering to the procedures outlined in the POEA Standard Employment Contract and CBA for resolving disability claims. It underscores the binding nature of the company-designated physician’s assessment when made within the prescribed timeframe and based on thorough medical evaluation. Both employers and seafarers must understand their rights and obligations under these contracts to ensure fair and equitable resolution of disability 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: Jesus E. Vergara vs. Hammonia Maritime Services, Inc. and Atlantic Marine Ltd., G.R. No. 172933, October 06, 2008