In a maritime dispute, the Supreme Court has reaffirmed the importance of adhering to the third doctor rule outlined in the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC). The Court held that when a seafarer disputes the disability assessment of a company-designated physician, they must actively seek a third, independent medical opinion as stipulated in the POEA-SEC. Failure to do so results in the upholding of the company physician’s assessment, impacting the seafarer’s claim for disability benefits.

Navigating Seafarer Disability Claims: When a Second Opinion Isn’t Enough

The case of Magsaysay Maritime Corporation vs. Buico revolves around Allan Buico, a seafarer who sustained an injury while working aboard a cruise ship. After undergoing treatment, the company-designated physician assessed Buico with a Grade 10 disability. Dissatisfied, Buico consulted his own doctor who deemed him unfit for sea duty, leading him to file a claim for total and permanent disability benefits. The central legal question is whether Buico is entitled to total and permanent disability benefits despite the company-designated physician’s assessment and his failure to seek a third medical opinion as required by the POEA-SEC.

The Supreme Court’s analysis hinged on the specific provisions of the 2010 POEA-SEC, which governs the employment terms and conditions of Filipino seafarers. Section 20(A) of the POEA-SEC details the process for claiming disability benefits, emphasizing the role of the company-designated physician in determining the seafarer’s fitness or degree of disability. The provision states:

SECTION 20. COMPENSATION AND BENEFITS

A. COMPENSATION AND BENEFITS FOR INJURY OR ILLNESS

The liabilities of the employer when the seafarer suffers work-related injury or illness during the term of his contract are as follows:

2. x x x However, if after repatriation, the seafarer still requires medical attention arising from said injury or illness, be shall he so provided at cost to the employer until such time he is declared fit or the degree of his disability has been established by the company-designated physician.

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.

Building on this provision, the Court emphasized the seafarer’s obligation to follow the prescribed procedure when contesting the company-designated physician’s assessment. The third doctor rule mandates that if the seafarer’s personal physician disagrees with the company doctor’s findings, a third, independent physician must be jointly agreed upon by both parties to provide a final and binding opinion. This mechanism ensures impartiality and serves as a check against potentially biased assessments from either side. The Court cited the case of Jebsens Maritime, Inc. v. Mirasol, which succinctly summarized the rules governing seafarers’ claims:

1. The company-designated physician must issue a final medical assessment on the seafarer’s disability grading within a period of 120 days from the time the seafarer reported to him;

2. If the company-designated physician fails to give his assessment within the period of 120 days, without any justifiable reason, then the seafarer’s disability becomes permanent and total;

3. If the company-designated physician fails to give his assessment within the period of 120 days with a sufficient justification (e.g. seafarer required further medical treatment or seafarer was uncooperative), then the period of diagnosis and treatment shall be extended to 240 days. The employer has the burden to prove that the company-designated physician has sufficient justification to extend the period; and

4. If the company-designated physician still fails to give his assessment within the extended period of 240 days, then the seafarer’s disability becomes permanent and total; regardless of any justification.

The Court found that the company-designated physician in Buico’s case had indeed issued a final and precise disability grading within the extended 240-day period, justifying the delay due to Buico’s ongoing medical treatment. The medical report explicitly stated that Buico was deemed maximally medically improved for the orthopedic condition referred, with a corresponding Grade 10 disability assessment. Given this timely and specific assessment, the burden shifted to Buico to challenge the findings through the third doctor mechanism. It is important to note that this assessment was given to Buico at least twice already as an interim disability grading, strengthening the assessment given by the company-designated physician.

This approach contrasts with the findings of the NLRC and the Court of Appeals, which had ruled in favor of Buico, deeming the company physician’s assessment inaccurate. The Supreme Court, however, reversed these decisions, emphasizing that without a valid challenge through the third doctor procedure, the company-designated physician’s findings must prevail.

In its reasoning, the Court clarified that securing a third doctor’s opinion is not merely optional but a mandatory step when a seafarer disagrees with the company’s assessment. This requirement ensures that any challenge to the company physician’s findings is based on a neutral and authoritative medical opinion. Without this referral, the seafarer’s personal doctor’s opinion cannot override the company-designated physician’s assessment.

The Supreme Court, therefore, reinstated the Labor Arbiter’s decision, awarding Buico Grade 10 disability benefits based on the company-designated physician’s assessment. The Court underscored the importance of adhering to contractual obligations and established procedures in resolving maritime labor disputes. The decision serves as a reminder that while seafarers are entitled to protection and compensation for work-related injuries, they must also comply with the established framework for claiming benefits.

FAQs

What was the key issue in this case?	The key issue was whether a seafarer is entitled to total and permanent disability benefits when they dispute the company-designated physician’s assessment but fail to seek a third medical opinion as required by the POEA-SEC.
What is the third doctor rule?	The third doctor rule stipulates that if a seafarer’s personal physician disagrees with the company-designated physician’s assessment, a third, independent doctor must be jointly agreed upon by both parties to provide a final and binding opinion.
Is seeking a third doctor’s opinion mandatory?	Yes, the Supreme Court clarified that seeking a third doctor’s opinion is a mandatory step when a seafarer disagrees with the company’s assessment.
What happens if the seafarer doesn’t follow the third doctor rule?	If the seafarer fails to comply with the third doctor rule, the company-designated physician’s assessment prevails over the opinion of the seafarer’s personal doctor.
What is the significance of the company-designated physician’s assessment?	The company-designated physician’s assessment is crucial in determining the seafarer’s fitness for work or the degree of disability, as it is the initial basis for disability claims under the POEA-SEC.
How long does the company-designated physician have to issue an assessment?	The company-designated physician has 120 days from the seafarer’s repatriation to issue a final medical assessment, which can be extended to 240 days if further medical treatment is required.
What law governs seafarer disability claims?	Seafarer disability claims are governed by the law, the parties’ contracts, and medical findings, specifically Section 20(A) of the 2010 POEA-SEC.
What was the Supreme Court’s ruling in this case?	The Supreme Court ruled that Buico was not entitled to total and permanent disability benefits because the company-designated physician had issued a final and precise disability grading, and Buico failed to seek a third medical opinion.

The Supreme Court’s decision underscores the importance of procedural compliance in seafarer disability claims. By reaffirming the third doctor rule, the Court provides clarity and reinforces the established framework for resolving disputes in the maritime industry. This promotes fairness and ensures that claims are based on objective and impartial medical assessments.

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: Magsaysay Maritime Corporation, Princess Cruise Lines Ltd., And/Or Gary M. Castillo, Petitioners, vs. Allan F. Buico, Respondent, G.R. No. 230901, December 05, 2019