In cases involving disability claims by seafarers, illnesses not explicitly listed as occupational diseases can be presumed to be work-related if the seafarer provides substantial evidence linking their work conditions to the illness. This ruling clarifies that while a disputable presumption exists, the seafarer must still demonstrate a reasonable connection between the nature of their work and the illness contracted, or its aggravation, to be entitled to disability benefits. Without proving this link, the claim may be denied.

From Casino to Clinic: When Does a Seafarer’s Illness Qualify for Disability Benefits?

The case of Maricel S. Nonay v. Bahia Shipping Services, Inc. revolves around Nonay’s claim for permanent disability benefits following her medical repatriation due to abnormal uterine bleeding secondary to adenomyosis with adenomyoma. Nonay, a casino attendant on board M/S Braemer, argued that her illness was work-related and sought compensation under her Collective Bargaining Agreement (CBA) and the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC). The central legal question is whether Nonay sufficiently proved that her illness was caused or aggravated by her work as a seafarer, thereby entitling her to disability benefits.

The Supreme Court denied Nonay’s petition, affirming the Court of Appeals’ decision. The Court emphasized that while illnesses not listed as occupational diseases are disputably presumed to be work-related under Section 20(B)(4) of the POEA-SEC, the claimant still bears the burden of providing substantial evidence to establish a reasonable connection between their work and the illness. In this instance, Nonay failed to demonstrate how her duties as a casino attendant caused or aggravated her condition. She argued that her illness resulted from “constantly walking upward and downward on board the vessel carrying loads,” but she did not explain the duties of her job or show how these activities are causally linked to her adenomyoma.

The Court referenced Quizora v. Denholm Crew Management (Phils.), Inc., where it was held that a seafarer cannot solely rely on the disputable presumption in Section 20 (B) (4) of the 2000 POEA-SEC. They must actively substantiate their claim to receive disability compensation by proving the work-relatedness of the illness and its existence during the employment contract. In line with this, the Court determined that Nonay did not show a relationship between her work and her illness.

Furthermore, the Court addressed Nonay’s argument that she was entitled to total and permanent disability benefits because the company-designated physician did not declare her fit to work after 120 days. Citing Article 192(c)(1) of the Labor Code and Rule VII, Section 2(b), and Rule X, Section 2(a) of the Amended Rules on Employees’ Compensation, the Court clarified that the 120-day period could be extended up to 240 days if further medical treatment was required. The Court found that Nonay’s treatment exceeded 120 days, justifying the company-designated physician’s delay in issuing a final assessment.

The Court also underscored the importance of following the procedure outlined in Section 20(B)(3) of the POEA-SEC for resolving conflicting medical assessments. This section stipulates that if the seafarer’s personal physician disagrees with the company-designated physician’s assessment, a third doctor may be jointly agreed upon by both parties. The third doctor’s decision becomes final and binding. Nonay failed to follow this procedure, which resulted in the company-designated physician’s assessment holding more weight.

The Court acknowledged that a company-designated physician could be biased towards the employer. However, in this case, the company-designated physician, an obstetrician-gynecologist, was deemed more qualified to assess Nonay’s condition compared to her personal physician, an orthopedic surgeon. Moreover, the company-designated physician closely monitored Nonay’s condition throughout her treatment, while her personal physician merely evaluated her medical records. This close monitoring reinforced the credibility of the company-designated physician’s assessment.

Ultimately, the Supreme Court ruled that the Court of Appeals did not err in dismissing Nonay’s complaint due to lack of cause of action. Nonay did not provide sufficient evidence to prove that her illness was work-related or aggravated by her employment. She also failed to comply with the mandatory procedure for resolving conflicting medical opinions, making the company-designated physician’s assessment prevail. This case serves as a reminder to seafarers to actively establish the connection between their work and their illnesses to successfully claim disability benefits.

FAQs

What was the key issue in this case?	The key issue was whether the seafarer, Maricel S. Nonay, sufficiently proved that her illness (adenomyosis with adenomyoma) was work-related or aggravated by her employment as a casino attendant, entitling her to disability benefits. The court examined the burden of proof and the process for resolving differing medical opinions.
What is the “disputable presumption” in the POEA-SEC?	Section 20(B)(4) of the POEA-SEC states that illnesses not listed as occupational diseases are disputably presumed to be work-related. However, this presumption doesn’t relieve the seafarer of the responsibility to provide evidence connecting their work to the illness.
What kind of evidence is needed to prove work-relatedness?	The seafarer must provide substantial evidence showing a reasonable connection between the nature of their work and the illness. This may include describing job duties, explaining how work conditions contributed to the illness, and presenting medical opinions that support the connection.
What is the role of the company-designated physician?	The company-designated physician is responsible for assessing the seafarer’s fitness for work and determining the extent of disability. Their assessment carries significant weight, especially if the seafarer fails to follow the procedure for resolving conflicting medical opinions.
What is the third-doctor referral provision?	Section 20(B)(3) of the POEA-SEC provides that if the seafarer’s personal physician disagrees with the company-designated physician’s assessment, a third doctor may be jointly agreed upon by both parties. The third doctor’s decision is final and binding.
What happens if the seafarer doesn’t follow the third-doctor referral process?	If the seafarer does not follow the third-doctor referral process, the assessment of the company-designated physician generally prevails. The court expects that this procedure is followed to resolve differing opinions.
Can the 120-day period for medical assessment be extended?	Yes, the 120-day period for the company-designated physician to assess the seafarer can be extended up to 240 days if the seafarer requires further medical treatment. The extension is permissible if ongoing treatment is necessary.
Does satisfaction of judgment render a case moot?	Not necessarily. A petition for certiorari can still be filed even after the National Labor Relations Commission’s (NLRC) decision has become final and executory. This is possible as long as the petition is filed within the 60-day reglementary period under Rule 65.

In conclusion, the Nonay v. Bahia Shipping Services, Inc. case underscores the importance of substantiating claims for disability benefits with credible evidence linking the seafarer’s illness to their work. While the law provides a disputable presumption of work-relatedness, it remains incumbent upon the seafarer to demonstrate a clear connection to the conditions of their employment. Compliance with procedural requirements, such as the third-doctor referral, is also crucial in ensuring a fair and just resolution of disability claims.

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: MARICEL S. NONAY VS. BAHIA SHIPPING SERVICES, INC., G.R. No. 206758, February 17, 2016