This Supreme Court case clarifies the requirements for seafarers’ disability claims, specifically addressing material concealment of pre-existing conditions and the mandatory referral to a third doctor in case of conflicting medical assessments. The Court ruled that while referral to a third doctor is indeed mandatory when the company-designated physician and the seafarer’s physician have differing opinions, the failure to do so does not automatically disqualify a seafarer from receiving disability benefits. Instead, the Court emphasized that a causal connection between the seafarer’s work and the illness must be established, and the seafarer is entitled to disability benefits corresponding to the assessment of the company-designated doctor.

Navigating the Seas of Disclosure: When a Seafarer’s Health History Impacts Disability Claims

The case of Victorino G. Ranoa v. Anglo-Eastern Crew Management Phils., Inc. (G.R. No. 225756, November 28, 2019) revolves around a seafarer, Victorino Ranoa, who sought total and permanent disability benefits after being medically repatriated due to hypertension and coronary artery disease. The primary legal question was whether Ranoa was guilty of material concealment regarding a pre-existing heart condition, and if the mandatory referral to a third doctor was followed correctly. The Court of Appeals (CA) reversed the decision of the National Labor Relations Commission (NLRC), which had previously granted Ranoa’s claim for total and permanent disability benefits, stating that Ranoa failed to prove his condition was work-related and did not follow the procedure for referral to a third doctor.

The Supreme Court, however, partially granted Ranoa’s petition. It delved into the intricacies of the POEA-SEC (Philippine Overseas Employment Administration-Standard Employment Contract) and its provisions regarding disability claims for seafarers. The Court clarified the conditions under which a seafarer can be considered to have concealed a pre-existing condition and reiterated the mandatory nature of referral to a third doctor when medical opinions conflict. Furthermore, the Court emphasized the importance of establishing a causal link between the seafarer’s work and the development or aggravation of the illness.

Regarding the issue of material concealment, the Court underscored that, according to the 2010 POEA-SEC, a pre-existing condition exists if, prior to the processing of the POEA contract, the seafarer had received medical advice or treatment for a continuing illness, or if the seafarer knew about the condition but failed to disclose it during the Pre-Employment Medical Examination (PEME). Importantly, the Court stated that for a misrepresentation to be considered fraudulent, it must involve a deliberate concealment with malicious intent and the aim to profit from the deception. In Ranoa’s case, the Court found no evidence that Ranoa deliberately concealed a pre-existing condition with the intent to deceive or profit from it. Even though the company-designated doctors claimed that Ranoa admitted to a previous diagnosis, this was not sufficiently proven.

Building on this principle, the Court stated that the PEME is crucial. The Court quoted Philsynergy Maritime, Inc., et al. v. Columbano Pagunsan Gallano, Jr., G.R. No. 228504, June 6, 2018, where it held:

At any rate, it is well to note that had respondent been suffering from a pre-existing hypertension at the time of his PEME, the same could have been easily detected by standard/routine tests conducted during the said examination, i.e., blood pressure test, electrocardiogram, chest x-ray, and/or blood chemistry. However, respondent’s PEME showed normal blood pressure with no heart problem, which led the company-designated physician to declare him fit for sea duty. (Emphasis supplied)

This demonstrates that the PEME serves as a vital checkpoint. It determines the seafarer’s fitness for duty and provides crucial information about their health status prior to deployment. Because Ranoa passed his PEME, it was determined that he could not be considered to have had a pre-existing condition prior to boarding.

Moving to the issue of the third doctor referral, the Court affirmed that this is a mandatory procedure under the POEA-SEC when there is a disagreement between the company-designated physician and the seafarer’s chosen physician. The Court emphasized that in Dohle Philman Manning Agency, Inc. v. Doble (G.R. No. 223730, October 4, 2017), it was held that should the seafarer fail to comply with referral to a third doctor, he or she would be in breach of the POEA-SEC, and the assessment of the company-designated physician shall be final and binding. However, the Court also noted that the initiative for referral to a third doctor lies primarily with the seafarer. The seafarer must actively request the referral after fully disclosing the contrary assessment of their own doctor. It is not the employer’s responsibility to initiate this process unless properly notified by the seafarer. Here, Ranoa failed to notify the company of his disagreement or request a third opinion.

The Court pointed out that Ranoa also failed to provide the company with a copy of his chosen physician’s findings, thereby hindering the referral process. Without full disclosure and a formal request from the seafarer, the employer’s duty to activate the third-doctor provision does not arise. The Court then emphasized that the initiative for referral to a third doctor should come from the employee, and that he must actively or expressly request for it.

Despite the procedural lapse regarding the third doctor referral, the Court did not entirely dismiss Ranoa’s claim. It acknowledged that under Section 32-A of the POEA-SEC, cardiovascular diseases can be compensable if certain conditions are met. Citing paragraph (c) of the conditions, the Court observed that Ranoa was asymptomatic prior to boarding and only showed signs and symptoms of hypertension and heart ailment while performing his work aboard the vessel. Considering that the symptoms persisted even after his repatriation, the Court deemed it reasonable to claim a causal relationship between Ranoa’s illness and his work as a vessel master.

The Court also considered Ranoa’s work environment as a vessel master, which involved strenuous activities that could have contributed to his heart ailment. Since Ranoa did not comply with the mandatory procedure for referral to a third doctor, the Court upheld the Grade 12 disability rating assigned by the company-designated physicians. This ultimately meant that he was not entitled to permanent and total disability benefits, but to the benefits corresponding to the Grade 12 disability rating.

The Supreme Court emphasized the importance of following the mandated procedures under the POEA-SEC for resolving conflicting medical assessments. The Court highlighted that failure to comply with these procedures can result in the affirmance of the company-designated physician’s assessment. This serves to stress that the timely and accurate assessment of the seafarer’s condition is vital. It emphasized the importance of procedural compliance, while not completely denying benefits in light of the established link between Ranoa’s work and illness. The Court stressed that while referral to a third doctor is mandatory, it is not an insurmountable barrier if the illness is clearly work-related.

FAQs

What was the key issue in this case?	The key issue was whether the seafarer was guilty of material concealment of a pre-existing heart condition and whether he properly followed the mandatory procedure for referral to a third doctor when his physician’s assessment conflicted with that of the company-designated physician.
What is material concealment in the context of seafarer’s disability claims?	Material concealment refers to the deliberate withholding of information about a pre-existing medical condition with the intent to deceive and profit from the deception. The POEA-SEC specifies conditions that define a pre-existing condition, such as prior medical advice or treatment, or knowledge of the illness that was not disclosed during the PEME.
Is referral to a third doctor mandatory?	Yes, referral to a third doctor is mandatory under the POEA-SEC when there is a disagreement between the company-designated physician and the seafarer’s chosen physician regarding the assessment of the seafarer’s medical condition. The decision of the third doctor is considered final and binding on both parties.
Who is responsible for initiating the referral to a third doctor?	The seafarer is primarily responsible for initiating the referral to a third doctor. The seafarer must actively request the referral after fully disclosing the contrary assessment of their own doctor to the employer.
What happens if the seafarer fails to comply with the third-doctor referral procedure?	If the seafarer fails to comply with the third-doctor referral procedure, the assessment of the company-designated physician becomes final and binding. This means that the seafarer’s claim may be evaluated based on the company-designated physician’s assessment.
Under what conditions can a cardiovascular disease be considered compensable for a seafarer?	A cardiovascular disease can be compensable if it meets the conditions specified in Section 32-A of the POEA-SEC. This includes scenarios where the disease was known during employment and exacerbated by unusual strain, or where symptoms appeared during work and persisted thereafter, indicating a causal relationship.
What evidence did the Court consider in determining whether a causal relationship existed between Ranoa’s work and his illness?	The Court considered that Ranoa was asymptomatic before starting his work as a vessel master and only exhibited symptoms while on board the vessel. The persistence of these symptoms after repatriation and the strenuous nature of his work were also important factors.
What was the final ruling of the Supreme Court in this case?	The Supreme Court partially granted the petition. It affirmed that Ranoa was not guilty of material concealment but ruled that he was only entitled to Grade 12 disability benefits as assessed by the company-designated physicians, due to his failure to comply with the third-doctor referral procedure.

In conclusion, this case underscores the critical importance of procedural compliance and accurate disclosure in seafarers’ disability claims. While the Court reaffirms the mandatory nature of the third-doctor referral, it also acknowledges the need to establish a clear causal relationship between the seafarer’s work and their illness. This serves to safeguard the rights of seafarers while ensuring that claims are evaluated fairly and in accordance with 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: Victorino G. Ranoa v. Anglo-Eastern Crew Management Phils., Inc., G.R. No. 225756, November 28, 2019