This Supreme Court case clarifies the process for determining disability benefits for Filipino seafarers. It emphasizes the importance of adhering to the procedures outlined in the POEA-SEC, particularly regarding medical assessments by company-designated physicians. The Court ruled that if a seafarer disagrees with the company doctor’s assessment, they must follow the established procedure for seeking a second opinion and, if necessary, a third, jointly-agreed upon doctor. Failure to follow this procedure renders the company-designated physician’s assessment final and binding, impacting the seafarer’s entitlement to disability benefits.

When a Seafarer’s Broken Spine Leads to a Dispute Over Disability Benefits

William David P. Ocangas, a pumpman on board the vessel M/T Phoenix Admiral, suffered a broken spine while on duty. After being medically repatriated, he underwent treatment by company-designated physicians who assessed him with a Grade 11 disability. Ocangas later sought a second opinion, claiming total and permanent disability. The legal question at the heart of this case is whether the assessment of the company-designated physician is binding, and what recourse a seafarer has if they disagree with that assessment.

The initial point of contention revolves around the application of the 120-day versus the 240-day rule. Prior jurisprudence, particularly Crystal Shipping, Inc. v. Natividad, had established a 120-day rule, stating that a seafarer’s inability to perform their customary work for more than 120 days constitutes permanent and total disability. However, the Supreme Court, in cases like Splash Philippines Inc., et al. v. Ruizo, has since modified this stance. Now, for complaints filed after October 6, 2008, the 240-day rule applies, as clarified in Vergara v. Hammonia Maritime Services Inc. Since Ocangas filed his complaint on January 24, 2013, the 240-day rule governs his case.

The POEA-SEC outlines specific procedures for medical assessments. Section 20(A) states that a seafarer must submit to a post-employment medical examination by a company-designated physician within three working days upon repatriation. Sickness allowance is provided until the seafarer is declared fit to work, or the degree of disability is assessed, but this period cannot exceed 120 days. Importantly, the POEA-SEC emphasizes that:

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.

Building on this, the Court in Alpha Shipmanagement Corporation v. Calo clarified that, apart from illnesses classified as Grade 1, an illness can be considered permanent and total:

[W]hen so declared by the company-designated physician, or, in case of absence of such a declaration either of fitness or permanent total disability, upon the lapse of the 120 or 240-day treatment period, while the employee’s disability continues and he is unable to engage in gainful employment during such period, and the company-designated physician fails to arrive at a definite assessment of the employee’s fitness or disability. This is true “regardless of whether the employee loses the use of any part of his body.”

Therefore, a seafarer is initially under temporary total disability upon repatriation, which becomes permanent under specific conditions. These conditions include a declaration by the company-designated physician, the lapse of the 120 or 240-day period without a declaration, or the necessity for further medical attention extending beyond the 240-day period without a fitness or disability declaration. If the company-designated physician declares the seaman fit to work within the said periods, such declaration should be respected unless other doctors disagree. It’s a structured process designed to protect the seafarer while respecting the employer’s rights.

In Ocangas’ case, the company-designated physicians diagnosed his condition within the 240-day period, specifically after 141 days, with a Grade 11 disability. The critical point here is that Ocangas did not challenge this diagnosis through the proper channels outlined in the POEA-SEC. He did not seek a second opinion from a physician of his choice and initiate the process for a third, jointly-agreed upon doctor. Instead, he filed a complaint for permanent total disability benefits, initially without supporting medical evidence contradicting the company doctor’s assessment. It was only two months after filing the complaint that he obtained a permanent and total disability (Grade 1) rating from his own chosen physician.

The POEA-SEC clearly stipulates that if a seafarer disagrees with the company-designated physician’s findings, they must seek a second opinion. If disagreements persist, the parties should jointly refer the matter to a third doctor, whose decision becomes binding. Failure to follow this procedure is fatal to the seafarer’s claim, as it renders the company-designated physician’s rating conclusive. While the POEA-SEC provisions should be construed liberally in favor of Filipino seafarers, this principle must be balanced with adherence to prescribed procedures and contractual agreements, respecting the rights of both the seafarer and the employer.

The Supreme Court also emphasized the reliance on the company-designated physician’s assessment due to their direct involvement in Ocangas’ treatment. They had been monitoring his case since repatriation, allowing them to gain detailed knowledge of his medical condition. The Court referenced its ruling in Vergara v. Hammonia Maritime Services, Inc., stating that:

Thus, while petitioner had the right to seek a second and even a third opinion, the final determination of whose decision must prevail must be done in accordance with an agreed procedure. Unfortunately, the petitioner did not avail of this procedure; hence, we have no option but to declare that the company-designated doctor’s certification is the final determination that must prevail. We do so mindful that the company had exerted real effort to provide the petitioner with medical assistance…

The case underscores the importance of following the specific procedures outlined in the POEA-SEC for resolving disputes over disability assessments. Seafarers must actively engage in the process of seeking second opinions and, if necessary, involving a third doctor to challenge the company-designated physician’s findings. This case affirms that, while Filipino seafarers are entitled to protection and benefits, they must also adhere to the contractual obligations and established procedures to ensure a fair and just resolution of their claims. This also highlights the fact that medical doctors accredited by companies are independent medical practitioners who are required to pass requirements by employers to protect them from fraud.

FAQs

What was the key issue in this case?	The key issue was whether the company-designated physician’s assessment of the seafarer’s disability is binding, especially when the seafarer obtains a different assessment from their own doctor. The court emphasized the importance of following the POEA-SEC procedure for challenging the company doctor’s findings.
What is the POEA-SEC?	The POEA-SEC refers to the Philippine Overseas Employment Administration Standard Employment Contract. It sets the terms and conditions for the employment of Filipino seafarers, including provisions for compensation and benefits in case of injury or illness.
What is the 240-day rule?	The 240-day rule refers to the maximum period for which a seafarer can receive sickness allowance while undergoing treatment for a work-related injury or illness. If the company-designated physician fails to issue a final assessment within this period, the seafarer’s disability may be considered permanent and total.
What should a seafarer do if they disagree with the company doctor’s assessment?	If a seafarer disagrees with the company-designated physician’s assessment, they should seek a second opinion from a doctor of their choice. If the two doctors disagree, the POEA-SEC provides for a third, jointly-agreed upon doctor whose decision shall be final and binding.
What happens if the seafarer doesn’t follow the POEA-SEC procedure?	If the seafarer fails to follow the procedure outlined in the POEA-SEC for challenging the company-designated physician’s assessment, the company doctor’s assessment becomes final and binding. This can significantly impact the seafarer’s entitlement to disability benefits.
What is a Grade 11 disability?	A Grade 11 disability is a specific disability rating under the POEA-SEC schedule of benefits. It corresponds to a permanent partial disability, with a corresponding level of compensation that is lower than a total disability.
Why is the company-designated physician’s assessment given weight?	The company-designated physician’s assessment is given weight because they are often the first to examine and treat the seafarer after repatriation. They have a longitudinal view of the seafarer’s condition and are familiar with the medical history.
What does this case mean for future seafarer disability claims?	This case reinforces the importance of strictly adhering to the procedures outlined in the POEA-SEC for seafarer disability claims. It clarifies the binding nature of the company-designated physician’s assessment when the seafarer fails to properly challenge it.

In conclusion, this case serves as a critical reminder to Filipino seafarers of the importance of understanding and following the prescribed procedures for disability claims. The ruling emphasizes the binding nature of the company-designated physician’s assessment when proper protocols for challenging it are not observed. This highlights the need for seafarers to be proactive in protecting their rights by seeking timely medical advice and adhering to the established legal framework.

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: ORIENTAL SHIPMANAGEMENT CO., INC. V. OCANGAS, G.R. No. 226766, September 27, 2017