In a dispute over disability benefits for a seafarer, the Supreme Court affirmed the importance of adhering to the conflict-resolution procedure outlined in the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC). The Court ruled that when there’s a disagreement between the company-designated physician and the seafarer’s chosen doctor regarding the seafarer’s fitness to work or degree of disability, the mandatory procedure of consulting a third, jointly agreed-upon doctor must be followed. Failure to comply with this procedure renders the company-designated doctor’s assessment final and binding, impacting the seafarer’s claim for disability benefits.

The Saga of the Unbalanced Box: When a Seafarer’s Back Pain Met Contractual Obligations

Generato M. Hernandez, a Head Wine Waiter with Magsaysay Maritime Corporation, experienced a back injury while working on board the “MV Saga Sapphire.” After being repatriated and examined by company-designated physicians who assessed him with a Grade 11 disability, Hernandez sought a second opinion that deemed him unfit to work. The core legal question revolved around whether Hernandez was entitled to permanent total disability benefits despite the company doctor’s assessment and his failure to follow the POEA-SEC’s procedure for resolving conflicting medical opinions.

The case underscores the critical role of the POEA-SEC, which is deemed integrated into every Filipino seafarer’s employment contract. This contract dictates the rights and obligations of both the seafarer and the employer, particularly in cases of work-related injuries or illnesses. Section 20(A)(3) of the 2010 POEA-SEC explicitly addresses situations where there are conflicting medical assessments:

“[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 doctors decision shall be final and binding on both parties.”

This provision provides a mechanism for resolving disputes related to a seafarer’s fitness to work or the extent of their disability. It aims to provide a fair and impartial resolution by involving a neutral third party whose decision is binding on both sides. The Supreme Court emphasized that this procedure is not merely optional but a mandatory requirement. Failure to follow it can have significant consequences for the seafarer’s claim for disability benefits.

Building on this principle, the Court clarified that the duty to initiate the process of consulting a third doctor rests primarily with the seafarer. As the one challenging the company doctor’s assessment, the seafarer must actively signify their intention to submit the disputed assessment to a third physician. This requirement is not a mere formality; it’s a crucial step in ensuring that the conflict is resolved through an objective and impartial evaluation. The Supreme Court has consistently held that failure to comply with this procedure can be detrimental to the seafarer’s claim.

In INC Navigation Co. Philippines, Inc., et al. v. Rosales, the Supreme Court elaborated on the proper course of action when a seafarer disagrees with the company doctor’s assessment:

“To definitively clarify how a conflict situation should be handled, upon notification that the seafarer disagrees with the company doctor’s assessment based on the duly and fully disclosed contrary assessment from the seafarer’s own doctor, the seafarer shall then signify his intention to resolve the conflict by the referral of the conflicting assessments to a third doctor whose ruling, under the POEA-SEC, shall be final and binding on the parties. Upon notification, the company carries the burden of initiating the process for the referral to a third doctor commonly agreed between the parties.”

The Court stressed that the seafarer must explicitly express their intention to seek a third opinion. Only then does the burden shift to the company to initiate the process of finding a mutually acceptable third doctor. This places a responsibility on the seafarer to take the first step in resolving the conflict through the prescribed procedure. Without this clear indication from the seafarer, the company cannot be expected to act, and the company doctor’s assessment will prevail.

This approach contrasts with situations where the company-designated physician fails to provide a valid, final, and definite assessment within the 120-day or 240-day period. In such cases, the seafarer may have grounds to pursue their claim for disability benefits without necessarily resorting to the third-doctor procedure. However, when a timely and definitive assessment is provided by the company doctor, the seafarer must adhere to the prescribed procedure if they disagree with the assessment.

The Supreme Court in Phil. Hammonia Ship Agency, Inc., et al. v. Dumadag emphasized that:

“while a seafarer has 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.”

This highlights the importance of following the established rules and procedures, even when seeking multiple medical opinions. The Court recognized that seafarers have the right to consult their own doctors. However, the ultimate resolution of conflicting opinions must be done through the mechanism provided in the POEA-SEC.

In this case, Hernandez failed to initiate the third-doctor referral process after the company-designated physician assessed him with a Grade 11 disability. He prematurely filed his complaint with the labor arbiter, bypassing the mandatory procedure outlined in the POEA-SEC. As a result, the Supreme Court upheld the company-designated doctor’s assessment, emphasizing that failure to follow the prescribed procedure is fatal to the seafarer’s claim for permanent total disability.

The Court also considered the circumstances surrounding the medical assessments. The company-designated physician had examined and treated Hernandez for several months, gaining a detailed understanding of his condition. In contrast, Hernandez’s chosen doctor conducted only a single examination and relied primarily on the MRI results. The Court gave greater weight to the company-designated physician’s assessment, citing their continuous monitoring and treatment of the seafarer.

Furthermore, the Court reiterated the importance of adhering to the schedule of disability compensation under Section 32 of the POEA-SEC. This schedule provides a specific grading for various types of disabilities and injuries. The Court emphasized that any item classified under Grade 1 is considered a total and permanent disability. Other gradings, such as Grade 11 in Hernandez’s case, may only constitute a partial disability. This underscores the need to consider the specific grading assigned by the company-designated physician in determining the appropriate level of compensation.

In light of its ruling, the Supreme Court ordered Hernandez to return the excess amount he had received from the respondents. He had previously received a sum equivalent to US$66,000.00 as a conditional satisfaction of judgment award. This payment was made without prejudice to the respondents’ pending petition for certiorari. Since the Court ultimately ruled in favor of the respondents, Hernandez was obligated to return the amount exceeding what the Court had determined to be the appropriate compensation.

The Supreme Court’s decision in this case serves as a reminder of the importance of adhering to the procedures outlined in the POEA-SEC for resolving disability claims. Seafarers who disagree with the company-designated physician’s assessment must actively initiate the third-doctor referral process to ensure their claim is properly evaluated. Failure to do so may result in the company doctor’s assessment becoming final and binding, significantly impacting their entitlement to disability benefits.

FAQs

What is the main point of this case?	The case emphasizes the importance of following the third-doctor referral process in the POEA-SEC when there’s a disagreement on a seafarer’s disability assessment. Failure to do so makes the company doctor’s assessment final.
What is the POEA-SEC?	The Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC) is a standard contract for Filipino seafarers. It outlines the terms and conditions of their employment, including provisions for disability compensation.
What happens if the seafarer and company doctor disagree?	If there is disagreement, the seafarer must signify intent to consult a third, jointly-agreed doctor. The third doctor’s decision is final and binding.
Who is responsible for initiating the third doctor consultation?	The seafarer has the initial responsibility to signify their intent to consult a third doctor. Then, the company must start the process of finding a doctor both parties agree on.
What is a Grade 11 disability?	A Grade 11 disability is a specific rating under the POEA-SEC’s schedule of disabilities. Unlike Grade 1 disabilities, it is not considered a permanent total disability.
What was the outcome for the seafarer in this case?	The Supreme Court ruled against the seafarer’s claim for permanent total disability benefits. The Court upheld the Grade 11 disability rating assigned by the company-designated physician.
What should seafarers do if they have a work-related injury?	Seafarers should immediately report the injury, seek medical attention from the company-designated physician, and follow the procedures outlined in the POEA-SEC for resolving any disputes about their medical condition.
What is the effect of a ‘Conditional Satisfaction of Judgment’?	It means the payment is subject to the outcome of any appeals. If the judgment is reversed, the recipient may be required to return the money.

In conclusion, this case clarifies the critical importance of procedural compliance in seafarer disability claims. Seafarers must adhere to the steps outlined in the POEA-SEC, especially the third-doctor referral process, to protect their rights.

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: GENERATO M. HERNANDEZ VS. MAGSAYSAY MARITIME CORPORATION, G.R. No. 226103, January 24, 2018