The Importance of Timely and Definite Medical Assessments for Seafarers’ Disability Benefits

Wilfredo Lim Salas v. Transmed Manila Corporation, Transmed Shipping Ltd., and Egbert M. Ellema, G.R. No. 247221, June 15, 2020

Imagine being a seafarer, far from home, when a sudden illness strikes, leaving you unable to work. Your future hangs in the balance, dependent on the outcome of a medical assessment that will determine your eligibility for disability benefits. This is the reality faced by Wilfredo Lim Salas, whose case before the Philippine Supreme Court highlights the critical role of timely and definitive medical assessments in securing disability benefits for seafarers.

In the case of Wilfredo Lim Salas, a seafarer hired as a Second Officer, the central issue was whether his illnesses—diabetes mellitus and gouty arthritis—were work-related and thus entitled him to disability benefits under the 2010 Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC). The Supreme Court’s ruling emphasized the legal presumption that illnesses not listed in the POEA-SEC are considered work-related unless proven otherwise by the employer.

Legal Context

The legal framework governing seafarers’ disability benefits is primarily outlined in the POEA-SEC, which sets forth the rights and obligations of seafarers and their employers. Under Section 20(A) of the 2010 POEA-SEC, employers are liable for disability benefits when a seafarer suffers a work-related injury or illness during the term of their contract. A work-related illness is defined as any sickness resulting from an occupational disease listed under Section 32-A of the POEA-SEC, or those illnesses not listed are disputably presumed as work-related.

This legal presumption shifts the burden of proof to the employer to demonstrate that the illness is not work-related. The term disputable presumption means that while the law presumes a fact to be true, it can be challenged and disproven with substantial evidence. For seafarers, this means they can rely on this presumption to establish their eligibility for disability benefits.

The POEA-SEC also mandates that the company-designated physician must issue a final and definite assessment of the seafarer’s fitness or degree of disability within 120 days from repatriation, extendable up to 240 days if further medical treatment is needed. Failure to issue such an assessment within these periods results in the seafarer being entitled to total and permanent disability benefits by operation of law.

Case Breakdown

Wilfredo Lim Salas was hired by Transmed Manila Corporation for its principal, Transmed Shipping Ltd., to work as a Second Officer on board the M/V Coalmax. After being declared fit for duty during a pre-employment medical examination, Salas began his tour of duty in April 2014. However, in February 2015, he reported symptoms of weakness, fatigue, loss of appetite, and difficulty sleeping, which led to his diagnosis of diabetes mellitus and gouty arthritis in Rio de Janeiro, Brazil.

Upon repatriation to Manila on March 21, 2015, Salas was referred to a company-designated physician for further evaluation. The physician’s initial assessment declared his illnesses as not work-related, citing diabetes as typically familial/hereditary and gouty arthritis as a metabolic disorder due to purine metabolism or diet. However, the most recent medical report from May 4, 2015, only indicated that Salas was ‘cleared orthopedic wise’ without stating whether he was fit to resume work or had been assessed with a disability grading.

Salas, feeling his treatment was discontinued prematurely, consulted an independent physician who diagnosed him with degenerative osteoarthritis with gouty arthritis and controlled non-insulin-dependent diabetes mellitus (NIDDM). This physician opined that Salas’ knee pain could be due to repeated stresses and strains from his work, rendering him unfit to work as a seafarer.

The case proceeded through various levels of the Philippine judicial system:

• The Labor Arbiter initially ruled in favor of Salas, granting him total and permanent disability benefits based on the lack of a definitive assessment from the company-designated physician.
• The National Labor Relations Commission (NLRC) reversed this decision, arguing that Salas failed to prove the work-relatedness of his illnesses.
• The Court of Appeals upheld the NLRC’s decision, finding no grave abuse of discretion.

The Supreme Court, however, reversed these rulings, stating that the company-designated physician’s assessment was not final and definite as required by law. The Court emphasized:

“Failure of the company-designated physician to arrive at a definite assessment of the seafarer’s fitness to work or permanent disability within the prescribed periods – as in this case – renders the seafarer’s disability as total and permanent by operation of law.”

Furthermore, the Supreme Court noted that the legal presumption of work-relatedness was not rebutted by the employer:

“Hence, contrary to the findings of the NLRC and the CA, the presumption remains in Salas’ favor that his illnesses were work-related or aggravated by his work condition.”

Practical Implications

This ruling has significant implications for seafarers and their employers. It underscores the importance of timely and definitive medical assessments by company-designated physicians. Employers must ensure that such assessments are issued within the prescribed periods to avoid automatic entitlements to total and permanent disability benefits.

For seafarers, this case reaffirms their right to rely on the legal presumption of work-relatedness for illnesses not listed in the POEA-SEC. It also highlights the importance of seeking independent medical opinions when company assessments are inconclusive or disputed.

Key Lessons:

• Seafarers should be aware of their rights under the POEA-SEC, particularly the legal presumption of work-relatedness for certain illnesses.
• Employers must ensure that company-designated physicians provide timely and definitive assessments to avoid legal liabilities.
• Seafarers should consider consulting independent physicians if they believe their medical condition is not adequately addressed by the company.

Frequently Asked Questions

What is considered a work-related illness for seafarers?

A work-related illness for seafarers is any sickness resulting from an occupational disease listed under Section 32-A of the POEA-SEC. Illnesses not listed are disputably presumed as work-related.

How long does the company-designated physician have to assess a seafarer’s disability?

The company-designated physician must issue a final and definite assessment within 120 days from the seafarer’s repatriation, extendable up to 240 days if further medical treatment is needed.

What happens if the company-designated physician fails to issue a final assessment within the prescribed period?

If the physician fails to issue a final assessment within 120/240 days, the seafarer is entitled to total and permanent disability benefits by operation of law.

Can a seafarer seek a second opinion from an independent physician?

Yes, seafarers can consult independent physicians, especially if they believe the company’s assessment is inadequate or disputed.

What should seafarers do if they disagree with the company’s assessment?

Seafarers can seek a third doctor’s opinion, agreed upon by both the employer and the seafarer, whose decision will be final and binding.

How can ASG Law help with seafarer disability claims?

ASG Law specializes in maritime law and can provide expert guidance on seafarer disability claims. Contact us or email hello@asglawpartners.com to schedule a consultation.