Resolving Medical Disputes in Seafarer Disability Claims: The Importance of a Third-Doctor Referral

G.R. No. 255889, July 26, 2023

Imagine a seafarer, far from home, injured on the job. Upon returning to the Philippines, conflicting medical opinions arise regarding the extent of their disability. Who decides their fate and their entitlement to compensation? This is the crucial issue addressed in Leonardo L. Justo v. Technomar Crew Management Corp., a recent Supreme Court decision clarifying the process for resolving medical disputes in seafarer disability claims. This case underscores the critical role of the third-doctor referral mechanism in ensuring fair and just compensation for injured seafarers.

Legal Context: Protecting Seafarers’ Rights in the Philippines

Philippine law prioritizes the protection of seafarers, recognizing the inherent risks and challenges of their profession. This protection is enshrined in the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC), which governs the employment of Filipino seafarers. The POEA-SEC outlines the rights and responsibilities of both the seafarer and the employer, including provisions for disability compensation.

Section 20(A)(3) of the 2010 POEA-SEC is central to understanding seafarer disability claims. It mandates a post-employment medical examination (PEME) by a company-designated physician within three days of the seafarer’s arrival. This PEME aims to assess the seafarer’s fitness to work or the degree of disability. The POEA-SEC also 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.”

This “third-doctor referral” mechanism is vital for resolving conflicting medical opinions. It ensures an impartial assessment of the seafarer’s condition. Without the third doctor, the company doctor’s report often prevails, potentially disadvantaging the seafarer. Moreover, the Collective Bargaining Agreement (CBA) can provide additional benefits beyond the POEA-SEC minimum, particularly if the disability results from a work-related accident.

Case Breakdown: Leonardo Justo’s Fight for Disability Benefits

Leonardo Justo, a cook on the M/V New Yorker, experienced a hearing impairment after a cargo hold fell near his workplace. He was repatriated to the Philippines and examined by a company-designated physician, Dr. Cruz, who eventually declared him fit to work. Dissatisfied, Leonardo consulted Dr. Reyno, who deemed him totally and permanently disabled.

Here’s how the case unfolded:

• The Accident: While working as a cook, Leonardo experienced a sudden loud noise leading to hearing problems.
• Conflicting Medical Opinions: The company doctor cleared him to work, but his personal doctor found him permanently disabled.
• Third-Doctor Referral Request: Leonardo requested a third doctor, as per POEA-SEC guidelines.
• Voluntary Arbitration: The case reached the Panel of Voluntary Arbitrators (PVA), which ruled in Leonardo’s favor, granting total and permanent disability benefits.
• Court of Appeals Reversal: The Court of Appeals (CA) reversed the PVA’s decision, emphasizing Leonardo’s alleged failure to cooperate with the third-doctor referral.
• Supreme Court Intervention: The Supreme Court (SC) ultimately sided with Leonardo, highlighting the importance of the company’s ENT specialist findings, and the premature issuance of fit-to-work certification by the company doctor.

The Supreme Court emphasized the ENT specialist’s report noting “severe hearing loss on the left ear” and suggested the use of a hearing aid. As the court stated, “Left hearing acuity is severe and may improve with hearing aid.”

The Court also stated that “the recommendation to use a hearing aid is palliative in nature because the device will not cure Leonardo’s hearing loss. The clinical assessment from the ENT specialist only bolsters the fact that his hearing loss is already at the critical stage, akin to total deafness.”

Another key aspect was that the company doctor cleared Leonardo, despite the ENT specialist recommended speech and pure tone audiometry, effectively short-circuiting the process. The Supreme Court found this unacceptable. “To be sure, the unceremonious issuance of a Fit-to-Work Certification by Dr. Cruz, without first addressing or without any definite declaration as to Leonardo’s left ear hearing loss, is not the final medical assessment envisioned by law.“

Practical Implications: Protecting Seafarers and Employers

This ruling clarifies the obligations of both seafarers and employers in disability claims. Seafarers must actively pursue their right to a third-doctor referral when disagreeing with the company doctor’s assessment. Employers, on the other hand, must facilitate this process and ensure a thorough and unbiased evaluation of the seafarer’s condition.

Key Lessons:

• Seafarers: Document all incidents, seek independent medical evaluations promptly, and formally request a third-doctor referral if needed.
• Employers: Actively participate in the third-doctor referral process, ensuring transparency and fairness in medical assessments.
• Importance of ENT Specialist Findings: The assessment of the company’s own ENT specialist was critical in the Supreme Court’s decision.

Example: Imagine a seafarer develops back pain after an accident on board. The company doctor attributes it to a pre-existing condition, but the seafarer’s personal doctor links it to the accident. Based on the Justo ruling, the seafarer should formally request a third-doctor referral to resolve this conflict impartially.

Frequently Asked Questions (FAQs)

Q: What is a company-designated physician?

A: A doctor chosen by the employer to conduct post-employment medical examinations on repatriated seafarers.

Q: What if I can’t afford my own doctor?

A: Legal aid organizations and seafarer advocacy groups may offer assistance in obtaining independent medical evaluations.

Q: What happens if the employer refuses to refer to a third doctor?

A: The seafarer can file a complaint with the National Labor Relations Commission (NLRC) and the assessment of the seafarer’s physician of choice will be conclusive between the parties, unless the same is clearly biased.

Q: Is a CBA always better than the POEA-SEC?

A: Not necessarily. A CBA can offer more benefits, but the POEA-SEC provides a baseline of protection. If the disability is not the result of an accident, then the POEA-SEC benefits apply.

Q: How long do I have to file a disability claim?

A: The prescriptive period is generally three years from the time the cause of action accrues.

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