In a disability claim filed by a seafarer, the Supreme Court has clarified the mandatory nature of seeking a third doctor’s opinion when there is a conflict between the assessments of the company-designated physician and the seafarer’s personal physician. While the seafarer’s failure to comply with this requirement generally binds them to the company doctor’s assessment, the Court also reiterated that a seafarer’s illness may still be deemed compensable if certain conditions are met, particularly if symptoms of the illness manifested during employment even if the referral to a third doctor was not pursued. This decision provides critical guidance on navigating the complex procedures and substantive requirements for seafarers seeking disability benefits.

Navigating Troubled Waters: When a Seafarer’s Health Claim Sails Against the Third Doctor Rule

Victorino G. Ranoa, a seafarer, filed a claim for total and permanent disability benefits against Anglo-Eastern Crew Management after developing hypertension and coronary artery disease while working as a Master on their vessel. The company-designated doctors assessed Ranoa with a Grade 12 disability, while his personal physician declared him unfit for sea duties. This divergence in medical opinions triggered a dispute, highlighting a critical juncture in maritime disability claims: the mandatory referral to a third, independent doctor. The core legal question revolves around whether Ranoa’s failure to secure this third opinion negates his claim, and whether his condition qualifies as a compensable work-related illness under the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC).

The Supreme Court, in analyzing the case, underscored the governing principles of seafarer employment. Their contracts are paramount, provided they align with the law and public policy. The POEA-SEC is integrated into every seafarer’s contract, outlining the rights and obligations of both the seafarer and the employer. A key contention in the case was whether Ranoa had engaged in material concealment regarding any pre-existing medical conditions. The 2010 POEA-SEC defines a pre-existing condition as one where, prior to contract processing, the seafarer had received medical advice or treatment for a continuing illness, or had knowledge of a condition that was not disclosed during the Pre-Employment Medical Examination (PEME) and could not be diagnosed during the PEME.

The Court emphasized that material concealment involves more than just a failure to disclose; it requires a deliberate act of hiding information with malicious intent. In this case, the company-designated doctors claimed that Ranoa admitted to a prior diagnosis of hypertension and coronary artery disease. However, the Court noted that the respondents failed to provide concrete evidence substantiating this prior diagnosis. Furthermore, Ranoa passed his PEME, which would have likely revealed any pre-existing heart conditions through standard tests like blood pressure checks and electrocardiograms, as highlighted in the case of Philsynergy Maritime, Inc., et al. v. Columbano Pagunsan Gallano, Jr.:

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.

Therefore, the Court concluded that Ranoa could not be found guilty of material concealment, as there was no proof of a prior diagnosis or any deliberate intent to deceive the employer.

Turning to the matter of the third doctor’s opinion, the Court affirmed its mandatory nature in resolving conflicting medical assessments. The POEA-SEC outlines a clear procedure: upon repatriation, the seafarer undergoes examination by the company-designated physician. If the seafarer disagrees with the assessment, they can seek a second opinion. A third doctor, jointly agreed upon by both parties, should then provide a final and binding assessment. The Court referenced Dohle Philman Manning Agency, Inc. v. Doble, reiterating that failure to comply with this referral process constitutes a breach of the POEA-SEC. Despite this, the Court clarified that the seafarer must initiate the process, informing the employer of the contrary assessment and requesting referral to a third doctor.

However, the Court did not entirely dismiss Ranoa’s claim, emphasizing that even without the third doctor’s opinion, his illness could still be compensable under certain conditions. The 2010 POEA-SEC outlines the requirements for an occupational disease to be compensable, including that the seafarer’s work must involve the described risks, the disease was contracted as a result of exposure to those risks, and there was no notorious negligence on the part of the seafarer. For cardiovascular diseases, specific conditions apply. The Court highlighted paragraph (c), which states that if a person asymptomatic before starting work shows symptoms of cardiac injury during their employment, a causal relationship can be claimed. Here, Ranoa was declared fit for work after his PEME and began experiencing symptoms while working aboard the vessel. These symptoms persisted even after repatriation. The Court stated that based on these factors, a causal relationship between his work and his illness could be reasonably claimed.

As Master of the vessel, Ranoa was exposed to strenuous work, which could have contributed to or aggravated his heart condition, making it a compensable work-related illness. Nonetheless, the Court ultimately ruled that Ranoa was only entitled to a Grade 12 disability benefit, as determined by the company-designated doctors, due to his failure to comply with the mandatory third-doctor referral procedure. In Generato M. Hernandez v. Magsaysay Maritime Corporation, et al., a similar case, the Court upheld the company-designated doctor’s assessment due to the seafarer’s non-compliance with the referral process. The Court also pointed out that Dr. Pascual, Ranoa’s personal physician, only examined him once, while the company-designated physicians had monitored and treated him extensively, lending more weight to their assessment.

Finally, the Court noted that Ranoa had been re-employed as a seafarer after his medical repatriation, which further undermined his claim of total and permanent disability. The Supreme Court partially granted the petition, affirming the Court of Appeals’ decision with the modification that Anglo-Eastern Crew Management was ordered to pay Ranoa the amount equivalent to a Grade 12 disability rating, attorney’s fees, and interest. The Court also reiterated the need for strict compliance with the POEA-SEC guidelines on disability claims. The decision underscores the importance of following the prescribed procedures and timelines to ensure the validity of claims for disability benefits.

FAQs

What was the key issue in this case?	The key issue was whether the seafarer, Victorino G. Ranoa, was entitled to total and permanent disability benefits despite failing to secure a third doctor’s opinion, and whether his illness was compensable.
What is the role of the company-designated physician?	The company-designated physician is responsible for examining and treating the seafarer upon repatriation and determining the seafarer’s fitness to work or degree of disability. Their assessment is initially controlling, subject to the seafarer’s right to seek a second opinion.
What is the significance of the third doctor’s opinion?	The third doctor’s opinion is considered final and binding when there is a disagreement between the company-designated physician and the seafarer’s chosen physician regarding the seafarer’s condition. It resolves the medical conflict and determines the extent of the disability.
Who is responsible for initiating the referral to a third doctor?	The seafarer has the primary responsibility to inform the employer of the conflicting assessment and to request a referral to a third doctor to resolve the disagreement. This active step is crucial for the seafarer’s claim.
What happens if the seafarer fails to comply with the third-doctor referral process?	If the seafarer fails to comply with the mandatory third-doctor referral process, the assessment of the company-designated physician generally prevails. This non-compliance can significantly weaken the seafarer’s claim for higher disability benefits.
What constitutes material concealment in disability claims?	Material concealment involves a seafarer deliberately hiding a pre-existing medical condition with the intent to deceive the employer. It requires proof that the seafarer knew about the condition and intentionally failed to disclose it during the PEME.
Under what conditions is a cardiovascular disease considered compensable for seafarers?	A cardiovascular disease is considered compensable if it was known to be present during employment and exacerbated by unusual strain at work, or if symptoms appeared during work performance even if the seafarer was asymptomatic before. Meeting these conditions is essential for a successful claim.
What is the effect of a seafarer being re-employed after a disability claim?	A seafarer’s re-employment after a disability claim can undermine the claim of total and permanent disability, as it indicates the seafarer is still capable of performing their usual work. This factor is considered when determining the extent of disability benefits.
What are the key factors in assessing a doctor’s medical report?	Key factors include the doctor’s familiarity with the seafarer’s medical history, the regularity of examinations and treatments, and the extent of diagnostic tests performed. Reports from doctors with comprehensive knowledge of the seafarer’s condition are generally given more weight.

This case clarifies the procedural and substantive requirements for seafarers’ disability claims. While compliance with the third doctor referral process is crucial, it is not the sole determinant of compensability. The presence of work-related factors contributing to the illness and the lack of material concealment can still support a claim for disability benefits, albeit potentially at a lower grade. As such, navigating these cases require a deep understanding of both the POEA-SEC guidelines and the specific circumstances of each seafarer’s employment.

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