The Supreme Court ruled that a seafarer, despite disclosing a pre-existing condition (Diabetes Mellitus) during his pre-employment medical examination (PEME), was not automatically entitled to disability benefits. The court emphasized that the seafarer failed to prove a causal link between his illness and his work as Chief Engineer. Additionally, his failure to disclose his hypertension and to follow the procedure for resolving conflicting medical opinions further weakened his claim. This decision underscores the importance of proving the work-relatedness of an illness for seafarers seeking disability benefits, even when a pre-existing condition is known to the employer. The ruling underscores the need to meet specific evidentiary requirements and adhere to established procedures.

Navigating the Murky Waters: When a Seafarer’s Health History Impacts Disability Claims

This case revolves around Martin K. Ayungo, a Chief Engineer who sought disability benefits from his employers, Beamko Shipmanagement Corporation and Eagle Maritime RAK FZE, after experiencing health issues while working on a vessel. The central legal question is whether Ayungo’s pre-existing Diabetes Mellitus and subsequent Hypertension entitle him to disability benefits, considering the requirements of the Philippine Overseas Employment Agency Standard Employment Contract (POEA-SEC).

The facts of the case reveal that Ayungo disclosed his Diabetes Mellitus during his PEME but failed to mention his Hypertension, for which he was already taking medication. He was declared “FIT FOR SEA DUTY” despite this disclosure. Subsequently, he experienced hearing loss and dizziness while on duty, leading to his repatriation and further medical diagnoses, including Hypertension, Multiple Lacunar Infarcts, and Coronary Artery Disease (CAD). This set the stage for a legal battle over whether these conditions were work-related and therefore compensable under the POEA-SEC.

The Labor Arbiter (LA) initially ruled in favor of Ayungo, awarding him disability benefits, moral and exemplary damages, and attorney’s fees. The LA reasoned that the employers were aware of Ayungo’s Diabetes Mellitus and still declared him fit for duty. The LA did not find the company-designated physician’s opinion that his illnesses were not work-related credible. However, the National Labor Relations Commission (NLRC) affirmed the LA’s decision, further solidifying Ayungo’s initial victory. Despite this, the Court of Appeals (CA) reversed the NLRC’s ruling, finding that Ayungo failed to establish a causal connection between his illnesses and his work, leading to the Supreme Court appeal.

The Supreme Court’s analysis hinged on the principle that for a disability to be compensable, a seafarer must demonstrate a reasonable link between their illness and their work. This means showing that the work either caused or aggravated the condition. The court emphasized that simply having a pre-existing condition, even if known to the employer, does not automatically entitle a seafarer to disability benefits. In essence, the burden of proof lies with the seafarer to substantiate their claim with credible evidence.

The Court referenced the case of Quizora v. Denholm Crew Management (Philippines), Inc., which clarified that the disputable presumption of work-relatedness under the POEA-SEC does not relieve the seafarer of the responsibility to prove their claim. The Court stated:

At any rate, granting that the provisions of the 2000 POEA-SEC apply, the disputable presumption provision in Section 20 (B) does not allow him to just sit down and wait for respondent company to present evidence to overcome the disputable presumption of work-relatedness of the illness. Contrary to his position, he still has to substantiate his claim in order to be entitled to disability compensation. He has to prove that the illness he suffered was work-related and that it must have existed during the term of his employment contract. He cannot simply argue that the burden of proof belongs to respondent company.

In Ayungo’s case, the Court found that he failed to provide sufficient evidence to establish a causal link between his Diabetes Mellitus and his duties as Chief Engineer. Furthermore, the Court highlighted Ayungo’s failure to disclose his pre-existing Hypertension during his PEME, which constituted fraudulent misrepresentation under Section 20(E) of the 2000 POEA-SEC. According to the court, this non-disclosure alone could disqualify him from receiving disability benefits.

Section 20(E) of the 2000 POEA-SEC states:

A seafarer who knowingly conceals and does not disclose past medical condition, disability and history in the pre-employment medical examination constitutes fraudulent misrepresentation and shall disqualify him from any compensation and benefits.

Even if the Court were to disregard the issue of misrepresentation, Ayungo’s claim for Hypertension would still fail because he did not meet the requirements of Section 32-A(20) of the 2000 POEA-SEC, which specifies the conditions under which essential Hypertension is considered compensable. This section requires evidence that Hypertension caused impairment of body organs and supporting documents like chest x-ray reports, ECG reports, blood chemistry reports, funduscopy reports, and C-T scans. These requirements were not met in Ayungo’s case.

Furthermore, the Court emphasized Ayungo’s non-compliance with the third-doctor conflict resolution procedure outlined in Section 20(B)(3) of the 2000 POEA-SEC. This section mandates that when the seafarer’s doctor disagrees with the company-designated physician, a third doctor should be jointly agreed upon to provide a final and binding opinion. This procedure was not followed, as stated in Philippine Hammonia Ship Agency, Inc. v. Dumadag:

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. x x x Thus, the complaint should have been dismissed, for without a binding third opinion, the fit-to-work certification of the company-designated physician stands x x x.

In summary, the Supreme Court found that the CA correctly reversed the NLRC’s decision because Ayungo failed to provide substantial evidence linking his Diabetes Mellitus to his work, misrepresented his pre-existing Hypertension, and did not follow the proper procedure for resolving conflicting medical opinions. Therefore, the petition for disability benefits was denied. The Court underscored that while it adheres to the principle of liberality in favor of seafarers, claims must be based on solid evidence and not mere surmises, to avoid injustice to employers.

FAQs

What was the key issue in this case?	The key issue was whether a seafarer was entitled to disability benefits for Diabetes Mellitus and Hypertension, considering that he disclosed the former during his pre-employment medical examination but failed to disclose the latter.
What is the significance of the pre-employment medical examination (PEME)?	The PEME is crucial because it establishes the seafarer’s health condition before employment. Any concealment of pre-existing conditions can disqualify the seafarer from claiming disability benefits later on.
What does it mean for a disease to be considered “work-related”?	For a disease to be work-related, there must be a reasonable link between the seafarer’s work and the illness, meaning the work either caused or aggravated the condition. The seafarer has the burden of proving this connection.
What is the third-doctor rule in seafarer disability claims?	The third-doctor rule requires that when the company-designated physician and the seafarer’s doctor disagree, a third, jointly agreed-upon doctor must provide a final and binding opinion. Failure to follow this procedure can invalidate the seafarer’s claim.
What is the effect of misrepresentation of health conditions during the PEME?	Under Section 20(E) of the POEA-SEC, a seafarer who knowingly conceals a past medical condition during the PEME commits fraudulent misrepresentation, disqualifying them from receiving compensation and benefits.
What specific documents are needed to substantiate a claim for hypertension?	To substantiate a claim for hypertension, Section 32-A(20) of the 2000 POEA-SEC requires documents such as chest x-ray report, ECG report, blood chemistry report, funduscopy report, and C-T scan to prove impairment of body organs.
What is the POEA-SEC?	The POEA-SEC stands for Philippine Overseas Employment Administration Standard Employment Contract. It is a standard employment contract that contains the minimum terms and conditions of employment for Filipino seafarers.
What was the CA’s ruling in this case?	The Court of Appeals (CA) reversed the NLRC’s decision, ruling that Ayungo failed to prove the causal connection between his illnesses and his work. It also noted the lack of evidence showing impairment of body organs due to hypertension and failure to follow the third-doctor procedure.
What was the Supreme Court’s basis for denying the petition?	The Supreme Court upheld the CA’s decision, emphasizing that Ayungo failed to establish a causal link between his illnesses and his work, misrepresented his health condition, and did not comply with the conflict-resolution procedure under the POEA-SEC.

This case highlights the critical importance of transparency during the PEME and the need for seafarers to provide sufficient evidence to support their claims for disability benefits. It underscores the significance of adhering to the procedures outlined in the POEA-SEC to ensure a fair and just 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: Martin K. Ayungo v. Beamko Shipmanagement Corporation, G.R. No. 203161, February 26, 2014