In a dispute over a seafarer’s disability benefits, the Supreme Court has reaffirmed the critical role of a third, jointly-agreed upon doctor’s opinion in resolving conflicting medical assessments between a company-designated physician and a seafarer-appointed physician. The Court emphasized that if a seafarer contests the company doctor’s assessment, they must initiate the process for a third doctor’s evaluation; failure to do so results in the company’s assessment prevailing. This ruling offers clarity on the procedural requirements for disability claims under the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC), ensuring that the final medical determination is unbiased and binding.

Conflicting Diagnoses on the High Seas: Who Decides a Seafarer’s Fate?

Ramil G. Borja, an oiler employed by Yialos Manning Services, Inc. (YMSI) experienced back pain while working on a vessel. Upon repatriation, he was examined by a company-designated physician who assessed his disability as “Grade 11 – slight rigidity of 1/3 loss of motion or lifting power of the trunk.” Disagreeing with this assessment, Borja consulted his own doctor, who declared him “physically unfit to return to work” or suffering from “total permanent disability.” The core legal question arose: which medical assessment should prevail, and what is the proper procedure for resolving such conflicts under the POEA-SEC?

The Supreme Court, in resolving this issue, turned to the POEA-SEC, the governing contract between the parties. The POEA-SEC explicitly outlines a mechanism for resolving conflicting medical opinions:

Section 20(B)(3) of the POEA-SEC: If a doctor appointed by the seafarer disagrees with the assessment, a third doctor may be agreed jointly between the Employer and seafarer. The third doctor’s decision shall be final and binding on both parties.

Building on this contractual provision, the Court emphasized that the referral to a third doctor is not merely optional but a mandatory step when a seafarer challenges the company-designated physician’s assessment. The responsibility to initiate this process lies with the seafarer, as highlighted in Bahia Shipping Services, Inc. v. Constantino:

As the party seeking to impugn the certification that the law itself recognizes as prevailing, Constantino bears the burden of positive action to prove that his doctor’s findings are correct, as well as the burden to notify the company that a contrary finding had been made by his own physician. Upon such notification, the company must itself respond by setting into motion the process of choosing a third doctor who, as the POEA-SEC provides, can rule with finality on the disputed medical situation.

The Court noted that Borja and YMSI initially agreed to seek a third opinion during the mandatory conference before the Labor Arbiter. However, Borja later refused to proceed with this agreement, arguing that he was already considered totally and permanently disabled due to the lapse of the 120-day and 240-day periods for medical assessment. The Supreme Court rejected this argument, clarifying that the lapse of these periods does not automatically equate to a total and permanent disability. Instead, the company-designated physician must provide a certification regarding the seafarer’s fitness to work or the nature of their disability within these periods.

This clarification is crucial, as it distinguishes between temporary total disability and permanent disability, as discussed in Vergara v. Hammonia Maritime Services, Inc.:

[A] temporary total disability only becomes permanent when so declared by the company physician within the periods he is allowed to do so, or upon the expiration of the maximum 240-day medical treatment period without a declaration of either fitness to work or the existence of a permanent disability.

In Borja’s case, the company-designated physician issued a disability rating within the 240-day period. Since Borja did not pursue the agreed-upon third opinion to challenge this assessment, the Court held that the company-designated physician’s assessment must prevail. The Court also emphasized the importance of adhering to the conflict-resolution procedure outlined in the POEA-SEC to prevent parties from strategically delaying treatment to claim higher disability benefits. The Court stressed that the determination of disability should be based on medical findings and the schedule of benefits provided in the POEA-SEC, rather than solely on the duration of treatment.

Because of the lack of the third opinion, the Supreme Court found the Labor Arbiter and NLRC’s rulings seriously flawed for disregarding the conflict-resolution procedure laid down in the POEA-SEC. Consequently, the Court granted the petition, setting aside the Court of Appeals’ decision and declaring Borja entitled only to the disability benefits corresponding to a Grade 11 disability, as assessed by the company-designated physician.

FAQs

What was the key issue in this case?	The key issue was whether Ramil Borja was entitled to total permanent disability benefits as a seafarer, given the conflicting medical assessments between the company-designated physician and his own doctor. The Supreme Court clarified the procedure for resolving such conflicts under the POEA-SEC.
What is the role of the company-designated physician?	The company-designated physician is responsible for assessing a seafarer’s fitness for work or the extent of their disability within a specified timeframe (120 or 240 days). Their assessment is the initial basis for determining disability benefits.
What happens if the seafarer disagrees with the company-designated physician’s assessment?	If the seafarer disagrees, they can consult their own physician. However, the POEA-SEC requires a third, jointly-agreed upon doctor to provide a final and binding assessment in case of conflicting opinions.
Who is responsible for initiating the process of consulting a third doctor?	The seafarer, as the party contesting the company-designated physician’s assessment, bears the responsibility to initiate the process of consulting a third doctor. This includes notifying the company and agreeing on a third doctor.
What happens if the seafarer refuses to consult a third doctor?	If the seafarer refuses to consult a third doctor, the company-designated physician’s assessment prevails. The seafarer’s claim for disability benefits will then be based on that assessment.
Does the lapse of 120 or 240 days automatically mean the seafarer is entitled to total permanent disability benefits?	No, the lapse of these periods does not automatically equate to total permanent disability. A medical assessment from the company-designated physician is still required to determine the nature and extent of the disability.
What is the basis for determining the amount of disability benefits?	The amount of disability benefits is determined based on the disability grading provided by the company-designated physician (or the third doctor, if consulted) and the schedule of benefits outlined in Section 32 of the POEA-SEC.
What was the final ruling in this case?	The Supreme Court ruled that Ramil Borja was only entitled to disability benefits corresponding to a Grade 11 disability, as assessed by the company-designated physician. This was because he failed to pursue the agreed-upon third opinion to challenge the assessment.

This case underscores the importance of adhering to the procedural requirements outlined in the POEA-SEC for resolving disputes over seafarer disability claims. The decision reinforces the binding nature of the company-designated physician’s assessment when the seafarer fails to initiate the process for a third, impartial medical opinion. This clarity ensures a more structured and predictable approach to disability claims, protecting the rights of both seafarers and employers.

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: Yialos Manning Services, Inc. v. Borja, G.R. No. 227216, July 4, 2018