ASG Law

Tag: Third Doctor Provision

  • Understanding Disability Benefits for Seafarers: Key Insights from Recent Supreme Court Ruling

    The Importance of Clear Medical Assessments and Compliance with Contractual Provisions in Seafarer Disability Claims

    Nicasio M. Dagasdas v. Trans Global Maritime Agency, Inc., G.R. No. 248445 and G.R. No. 248488, May 12, 2021

    Imagine a seafarer, far from home, battling a debilitating illness that threatens his career and livelihood. This is the reality for many seafarers who face the challenge of obtaining disability benefits when their health fails. The case of Nicasio M. Dagasdas against Trans Global Maritime Agency, Inc. sheds light on the critical issues surrounding disability claims for seafarers, particularly the importance of medical assessments and adherence to contractual obligations. In this case, Dagasdas, a seafarer, was diagnosed with pulmonary tuberculosis and sought compensation under the terms of his employment contract. The central question was whether he was entitled to disability benefits and under which contractual provisions.

    Legal Context: Navigating Seafarer Disability Claims

    Seafarer disability claims are governed by a complex interplay of laws, regulations, and contractual agreements. The Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC) sets the minimum standards for seafarer employment, including provisions for disability benefits. Additionally, collective bargaining agreements (CBAs) may offer more favorable terms, as was the case with the AMOSUP/ITF TCCC NON-IBF CBA applicable to Dagasdas.

    Key to these claims is the medical assessment process. The POEA-SEC and CBAs typically outline procedures for determining disability, often involving assessments by company-designated physicians and, in cases of disagreement, the possibility of consulting a third doctor. The Supreme Court has emphasized that the findings of the company-designated physician generally prevail, but this can be challenged if the assessment is biased or unsupported by medical records.

    The relevant provision from the POEA-SEC 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.” Similarly, the CBA specifies: “If a doctor appointed by the seafarer and his Union disagrees with the assessment, a third doctor may be agreed jointly between the Employer and the Seafarer and his Union, and the third doctor’s decision shall be final and binding on both parties.”

    Case Breakdown: The Journey of Nicasio M. Dagasdas

    Nicasio M. Dagasdas was employed by Trans Global Maritime Agency, Inc. as a pumpman on the vessel Ridgebury Pride. In January 2016, he experienced severe health issues, including shortness of breath and chest pain, which led to his repatriation to the Philippines. Upon his return, he was diagnosed with pulmonary tuberculosis and underwent treatment.

    Despite completing his treatment, the company-designated physician declared Dagasdas fit to work in August 2016. However, Dagasdas sought a second opinion from his doctor of choice, who found that his condition had not fully healed and declared him permanently disabled due to chronic obstructive pulmonary disease secondary to tuberculosis.

    When Dagasdas attempted to claim disability benefits, Trans Global refused to settle, leading to arbitration proceedings. The Office of the Voluntary Arbitrator (OVA) initially awarded Dagasdas benefits under the CBA, but the Court of Appeals (CA) modified this to align with the POEA-SEC. The Supreme Court ultimately sided with Dagasdas, emphasizing the lack of supporting medical records for the company’s fit-to-work certification and the failure to refer the case to a third doctor.

    Key quotes from the Supreme Court’s reasoning include:

    “The submission to a third doctor is not the sole duty of the seafarer; it must be jointly agreed upon by the employer and the seafarer.”

    “If the findings of the company-designated physician are biased in favor of the employer, then labor tribunals and courts may give greater weight to the findings of the seafarer’s personal physician.”

    The procedural steps involved in this case were:

    • Dagasdas filed a claim through the Single-Entry Approach (SEnA) and a Notice to Arbitrate.
    • The OVA awarded disability benefits based on the CBA, but the CA modified this to the POEA-SEC standard.
    • The Supreme Court reviewed the case, focusing on the medical assessments and the third doctor provision.

    Practical Implications: Lessons for Seafarers and Employers

    This ruling underscores the importance of thorough and unbiased medical assessments in seafarer disability claims. Employers must ensure that their designated physicians provide assessments supported by comprehensive medical records. Seafarers, on the other hand, should be aware of their rights to seek a second opinion and the importance of the third doctor provision in resolving disputes.

    Key Lessons:

    • Ensure that medical assessments are supported by detailed records to avoid disputes.
    • Both parties should actively engage in the process of appointing a third doctor if assessments differ.
    • Seafarers should document all medical consultations and treatments to support their claims.

    Frequently Asked Questions

    What is the role of the company-designated physician in seafarer disability claims?

    The company-designated physician’s role is to assess the seafarer’s medical condition and determine the degree of disability. Their findings generally prevail unless challenged by the seafarer’s own doctor.

    What happens if there is a disagreement between the company doctor and the seafarer’s doctor?

    If there is a disagreement, the seafarer and employer can jointly agree to consult a third doctor, whose decision will be final and binding.

    Can a seafarer claim disability benefits if declared fit to work by the company?

    Yes, if the seafarer’s own doctor disagrees and the case is not referred to a third doctor, the seafarer can still claim benefits based on their doctor’s assessment.

    What are the key provisions in the POEA-SEC regarding disability benefits?

    The POEA-SEC provides for disability benefits based on the degree of disability assessed by the company-designated physician, with provisions for a third doctor in case of disagreement.

    How can a seafarer ensure they receive fair compensation for disability?

    Seafarers should keep detailed medical records, seek a second opinion if necessary, and ensure that the third doctor provision is utilized if assessments differ.

    What are the implications of this ruling for future seafarer disability claims?

    This ruling emphasizes the need for clear and supported medical assessments and adherence to contractual provisions, which may lead to more rigorous documentation and processes in future claims.

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

  • Seafarer Disability Claims: The Importance of Company-Designated Physician’s Assessment and Timely Procedures

    In the case of Romil T. Olaybal v. OSG Shipmanagement Manila, Inc. and OSG Shipmanagement [UK] Ltd., the Supreme Court clarified the process for determining disability benefits for seafarers. The Court emphasized the critical role of the company-designated physician in assessing a seafarer’s disability, particularly the need for a final assessment within the prescribed 240-day period. This ruling underscores the importance of adhering to the established procedures under the POEA-SEC and relevant collective bargaining agreements when claiming disability benefits, ensuring that seafarers’ rights are protected while maintaining a structured framework for disability assessment.

    Navigating Murky Waters: When Can a Seafarer Claim Total Disability Before the 240-Day Assessment Period?

    Romil T. Olaybal, an oiler working for OSG Shipmanagement, experienced vision problems after a workplace incident. After his repatriation, the company-designated physician provided an interim assessment of Grade 7 disability due to vision loss in one eye. Olaybal, however, filed a claim for permanent total disability benefits before the 240-day period for assessment had lapsed. The central legal question was whether Olaybal was entitled to total and permanent disability benefits despite the ongoing assessment and before the expiration of the specified period.

    The Supreme Court addressed the issue by clarifying the interplay between the Labor Code, the POEA-SEC, and the Amended Rules on Employee Compensation (AREC). The Court referenced Article 192(c)(1) of the Labor Code, noting that while a disability lasting more than 120 days is generally considered total and permanent, this is subject to exceptions outlined in the implementing rules. Specifically, the Court cited Section 2(b), Rule VII of the Implementing Rules of Title II, Book IV of the Labor Code. It emphasizes the importance of considering Rule X in determining disability benefits.

    ART. 192. Permanent and total disability, x x x x

    (c) The following disabilities shall be deemed total and permanent:

    (1) Temporary total disability lasting continuously for more than one hundred twenty days, except as otherwise provided for in the Rules

    Building on this, the Court referenced the landmark case of Vergara v. Hammonia Maritime Services, Inc., which harmonized the POEA-SEC with the Labor Code and AREC. This case established that the 120-day period (extendable to 240 days) is provided for the employer to assess the seafarer’s fitness for work. During this time, the seafarer is under temporary total disability, which only becomes permanent upon declaration by the company-designated physician or after the lapse of the specified period without such a declaration.

    The Court further cited C.F. Sharp Crew Management, Inc. v. Taok to delineate the specific scenarios under which a seafarer can initiate an action for total and permanent disability benefits. These scenarios include failure of the company-designated physician to issue a timely assessment, conflicting medical opinions, disputes over disability grading, or refusal by the employer to pay benefits despite a declaration of total and permanent disability. This framework ensures that seafarers are not unduly delayed in receiving compensation when their conditions warrant it.

    In Olaybal’s case, the Court found that he had prematurely filed his claim. Since the company-designated physician had not yet issued a final assessment and was still evaluating his condition within the 240-day period, Olaybal had not exhausted the proper procedures. The Court highlighted that it is the company-designated physician who is primarily responsible for assessing the seafarer’s disability during the employment term.

    The Supreme Court also clarified the importance of the third doctor provision under Section 20-B(3) of the POEA-SEC. This provision allows a seafarer to seek a second opinion, but only after the company-designated physician has issued a final certification. If there are conflicting medical opinions, the seafarer and the company must jointly select a third doctor whose opinion will be final and binding. This mechanism is crucial for resolving disputes and ensuring fair assessment of disability claims.

    Considering the facts, the Court determined that Olaybal was not entitled to total and permanent disability benefits. Instead, he was only qualified for partial permanent disability benefits equivalent to a Grade 7 disability assessment. The Court also rejected Olaybal’s claim for full disability compensation based on Article 20.1.4 of the AMOSUP CBA, since he did not have a certification from the company-designated doctor stating that he was permanently unfit for further sea service.

    Regarding moral and exemplary damages, the Court concurred with the Court of Appeals that there was no evidence of bad faith or malice on the part of the respondents. The Court noted that the respondents had covered Olaybal’s medical expenses, indicating a good-faith effort to address his medical needs.

    However, the Court reinstated the award of attorney’s fees, citing Article 2208(8) of the Civil Code, which justifies such awards in actions for indemnity under workmen’s compensation and employer’s liability laws. The Court deemed an award of US$1,000.00 as reasonable attorney’s fees, aligning with previous rulings on similar cases.

    FAQs

    What was the key issue in this case? The key issue was whether the seafarer, Olaybal, was entitled to total and permanent disability benefits despite filing his claim before the lapse of the 240-day period for the company-designated physician to assess his condition.
    What is the role of the company-designated physician in disability claims? The company-designated physician is primarily responsible for assessing the seafarer’s disability, whether total or partial, during the term of employment. This assessment must be made within the 120-day period, which can be extended to 240 days if further medical treatment is required.
    Under what conditions can a seafarer file for disability benefits before the 240-day period expires? A seafarer can file for disability benefits before the 240-day period expires if the company-designated physician fails to issue a timely assessment, there are conflicting medical opinions, or the employer refuses to pay benefits despite a declaration of total and permanent disability.
    What is the significance of the third doctor provision in the POEA-SEC? The third doctor provision allows for a neutral medical assessment in case of conflicting opinions between the company-designated physician and the seafarer’s personal doctor. The opinion of the third doctor, jointly selected by both parties, is final and binding.
    What are the implications of this ruling for seafarers? This ruling emphasizes the importance of following the prescribed procedures for claiming disability benefits, including allowing the company-designated physician the full assessment period and seeking a third doctor’s opinion if necessary. Seafarers must comply with these procedures to ensure their claims are valid.
    What is the difference between total and permanent disability versus partial disability? Total and permanent disability means the seafarer is unable to perform any gainful occupation for a continuous period, while partial disability refers to a loss or impairment of physical or mental functions that does not completely prevent the seafarer from working.
    What was the basis for the denial of moral and exemplary damages in this case? The Court denied moral and exemplary damages because there was no concrete evidence of bad faith or malice on the part of the employer. The employer’s actions, such as covering the seafarer’s medical expenses, indicated a good-faith effort.
    Why was the award of attorney’s fees reinstated? The award of attorney’s fees was reinstated based on Article 2208(8) of the Civil Code, which allows for such awards in actions for indemnity under workmen’s compensation and employer’s liability laws.

    In conclusion, the Supreme Court’s decision in Olaybal v. OSG Shipmanagement highlights the necessity for seafarers to adhere strictly to the procedural requirements outlined in the POEA-SEC and relevant CBAs when pursuing disability claims. The case reinforces the pivotal role of the company-designated physician in assessing disabilities and underscores the importance of exhausting all available remedies before seeking judicial intervention. This structured approach ensures fairness and clarity in resolving disputes related to seafarer disability benefits.

    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: Romil T. Olaybal, vs. OSG Shipmanagement Manila, Inc. and OSG Shipmanagement [UK] Ltd., G.R. No. 211872, June 22, 2015