In a dispute over disability benefits, the Supreme Court ruled that a seafarer must follow the procedure outlined in the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC) for resolving conflicting medical opinions. This means that if a seafarer’s personal doctor disagrees with the company-designated physician’s assessment, the seafarer must initiate the process for a third doctor to provide a final, binding opinion before filing a claim for disability benefits. Failure to do so can result in the denial of the claim.

Navigating Murky Waters: When Must a Seafarer Seek a Third Medical Opinion?

This case, Career Phils. Shipmanagement, Inc., CMA Ships UK Limited, and Sampaguita D. Marave v. John Frederick T. Tiquio, revolves around John Frederick T. Tiquio, a seafarer who sought disability benefits after being diagnosed with hyperthyroidism secondary to Graves’ Disease during his employment. The central legal question is whether Tiquio prematurely filed his claim by failing to secure a third doctor’s opinion to reconcile conflicting medical assessments, as required by the POEA-SEC.

The facts of the case reveal that Tiquio was hired as an ordinary seaman. During his employment, he suffered from high fever, nausea, and vomiting. Consequently, he was diagnosed with hyperthyroidism and repatriated. The company-designated physician (CDP) diagnosed him with hyperthyroidism secondary to Graves’ Disease and, later, declared him unfit for work, stating his illness was “NOT Work Oriented.” Tiquio then consulted his own doctor, who declared him unfit and stated that his condition was work-related. Subsequently, Tiquio filed a complaint for disability benefits without first seeking a third opinion to reconcile the differing medical assessments.

The Supreme Court emphasized that a seafarer’s entitlement to disability benefits is governed by law, contract, and medical findings. The applicable law includes Articles 197 to 199 of the Labor Code and Section 2(a), Rule X of the Amended Rules on Employees Compensation. Contractually, the POEA-SEC is the primary document outlining the terms and conditions of employment, including provisions for disability compensation.

Section 20(A) of the 2010 POEA-SEC details the procedure for compensation and benefits when a seafarer suffers a work-related injury or illness. A critical aspect of this section is the requirement for a third doctor’s opinion in case of conflicting medical assessments. The provision states:

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 doctor’s decision shall be final and binding on both parties.

The Court referred to established jurisprudence, particularly the case of C.F. Sharp Crew Management, Inc. v. Taok, which outlines conditions under which a seafarer may pursue an action for total and permanent disability benefits. One such condition arises when “the company-designated physician determined that his medical condition is not compensable or work-related under the POEA- SEC but his doctor-of-choice and the third doctor selected under Section 20-B (3) of the POEA-SEC found otherwise and declared him unfit to work.” In this case, the Supreme Court found that Tiquio failed to comply with the mandated procedure, which prejudiced his claim.

The court noted that Tiquio filed his complaint without the assessment of a third doctor, thus failing to adhere to the conflict-resolution procedure outlined in the POEA-SEC. The Supreme Court cited Gargallo v. Dohle Seafront Crewing (Manila), Inc., which reiterated that non-compliance with the conflict-resolution procedure under the POEA-SEC undermines the seafarer’s claim and affirms the company-designated physician’s assessment.

The [POEA-SEC] and the CBA clearly provide that when a seafarer sustains a work-related illness or injury while on board the vessel, his fitness or unfitness for work shall be determined by the company-designated physician. If the physician appointed by the seafarer disagrees with the company-designated physician’s assessment, the opinion of a third doctor may be agreed jointly between the employer and the seafarer to be the decision final and binding on them.

Furthermore, the Court observed that when Tiquio filed his complaint, he had not yet presented a contrary opinion from his chosen doctor. The medical certificate from Dr. San Luis was presented later, and there was no indication that Tiquio had informed the petitioners of his consultation or the doctor’s contradictory assessment before filing the disability claim. Thus, this failure further demonstrated Tiquio’s non-compliance with the POEA-SEC’s mandated procedure.

Moreover, the Court noted that petitioners expressed willingness to refer the matter to a third doctor during the mandatory conferences before the Labor Arbiter (LA). However, because Tiquio had not yet presented a second doctor’s opinion, there was no valid contest to the CDP’s opinion that could have been referred to the third doctor. Therefore, the Supreme Court emphasized that the seafarer’s failure to observe the conflict-resolution procedure rendered the complaint premature and justified the denial of disability benefits.

The Court addressed the exception to the third doctor rule, which applies when the CDP fails to issue a final and definitive assessment within the prescribed period. However, this exception did not apply in Tiquio’s case. The CDP had already diagnosed Tiquio with Graves’ Disease, declared it as “NOT Work Oriented,” and assessed him as unfit for sea duty, requiring lifetime treatment with hormone replacement.

The Supreme Court found that Tiquio failed to prove the four conditions for compensability under Section 32-A of the 2010 POEA-SEC. These conditions are:

1. The seafarer’s work must involve the risks described herein;
2. The disease was contracted as a result of the seafarer’s exposure to the described risks;
3. The disease was contracted within a period of exposure and under such other factors necessary to contract it; and
4. There was no notorious negligence on the part of the seafarer.

The Court referenced Romana v. Magsaysay Maritime Corporation, emphasizing that while work-relatedness is presumed, there is no legal presumption of compensability. Therefore, Tiquio bore the burden of proving that these conditions were met. Tiquio’s illness, hyperthyroidism secondary to Graves’ Disease, is an autoimmune disorder. Although stress is a known risk factor, the records lacked evidence demonstrating the nature and extent of the stress to which Tiquio was exposed that could have triggered or aggravated his condition.

Furthermore, regarding Tiquio’s alleged exposure to paint solvents and other chemicals, the Court found no evidence that his duties involved such exposure or that it contributed to the development of his illness. Exposure to chemicals and paint solvents is not a known risk factor for developing Graves’ Disease. The Court determined that Tiquio did not establish a causal connection between his functions as an ordinary seaman and the risks of contracting hyperthyroidism.

The Court distinguished this case from Magsaysay Maritime Services v. Laurel, where the disability benefits claim was granted because the petitioners failed to explain the not work-related assessment, and the seafarer showed how his duties caused or aggravated his hyperthyroidism. Here, the petitioners successfully debunked the presumption of work-relatedness, and Tiquio failed to prove compliance with the conditions for compensability.

FAQs

What was the key issue in this case?	The key issue was whether the seafarer, John Frederick T. Tiquio, prematurely filed his claim for disability benefits by failing to secure a third doctor’s opinion to reconcile conflicting medical assessments, as required by the POEA-SEC.
What is the POEA-SEC?	The Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC) is a standard set of provisions incorporated into every seafarer’s contract, governing the terms and conditions of their employment, including compensation and benefits for work-related injuries or illnesses.
What does the POEA-SEC say about conflicting medical opinions?	The POEA-SEC stipulates that if a seafarer’s personal doctor disagrees with the company-designated physician’s assessment, a third doctor, jointly agreed upon by the employer and seafarer, must provide a final and binding opinion.
What is the role of the company-designated physician (CDP)?	The company-designated physician (CDP) is responsible for assessing a seafarer’s fitness or unfitness for work when they sustain a work-related illness or injury while on board the vessel.
What happens if the seafarer doesn’t follow the third doctor procedure?	Failure to comply with the third doctor procedure can result in the denial of the seafarer’s claim for disability benefits, as the assessment of the company-designated physician prevails.
What did the company-designated physician find in this case?	The company-designated physician diagnosed Tiquio with Graves’ Disease, declared it as “NOT Work Oriented,” and assessed him as unfit for sea duty, requiring lifetime treatment with hormone replacement.
What are the conditions for an occupational disease to be compensable under the POEA-SEC?	For an occupational disease to be compensable, the seafarer’s work must involve the risks, the disease must be contracted due to exposure to those risks, the disease must be contracted within a specific period, and there must be no notorious negligence on the seafarer’s part.
What is the legal presumption regarding work-relatedness of an illness?	There is a legal presumption that an illness is work-related; however, there is no automatic presumption of compensability, and the seafarer must provide substantial evidence to support their claim.
Why was the seafarer’s claim ultimately denied in this case?	The seafarer’s claim was denied because he failed to follow the third doctor procedure outlined in the POEA-SEC and did not provide sufficient evidence to prove that his illness was work-related and met the conditions for compensability.

In conclusion, the Supreme Court’s decision reinforces the importance of adhering to the procedures outlined in the POEA-SEC for resolving disputes over disability benefits. Seafarers must ensure compliance with the conflict-resolution mechanism, particularly the third doctor referral, to strengthen their claims and avoid premature filing of complaints.

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: CAREER PHILS. SHIPMANAGEMENT, INC. v. TIQUIO, G.R. No. 241857, June 17, 2019