Period for Final Medical Assessment and Referral to a Third Doctor for Disability Claims

Read. - https://sc.judiciary.gov.ph/29033/


"SC Reminds Manning Industry on Period for Final Medical Assessment and Referral to a Third Doctor for Disability Claims

August 1, 2022


The Supreme Court reminded the manning industry to strictly observe the required period in giving final medical assessment in connection with disability claims, and the mandatory procedure on the referral to a third doctor in cases of conflict between the medical opinions of the company-designated physician and the seafarer’s chosen physician.

These reminders were articulated by the Court in a Decision penned by Chief Justice Alexander G. Gesmundo that denied the appeal by certiorari of a shipping firm and affirmed with modification the rulings of the Court of Appeals (CA) that ordered the former employers of a seafarer to pay him total and permanent disability benefits.

Benhur Shipping Corporation (BSC)/Sun Marine Shipping S.A. (SMS) and Edgar B. Bruselas sought to reverse and set aside the rulings of the CA which, in turn, annulled and set aside the July 16, 2015 Decision of the National Labor Relations Commission (NLRC) and granted total disability benefits to respondent Alex P. Riego. The NLRC upheld the February 27, 2015 Decision of the Labor Arbiter (LA) which partially granted respondent’s claim for disability benefits and ordered the petitioners to pay respondent Riego the total amount of US$7,465.00 pursuant to Grade 11 Disability Assessment – 1/3 loss of lifting power as determined by the company designated physician plus 10% attorney’s fees.

On October 8, 2013, BSC engaged Riego’s work as Chief Cook on board the vessel MV Hikari I, an ocean-going vessel of its foreign principal, SMS.

On the first week of December 2013, Riego suffered from abdominal and lower back pain while on board the vessel. After he was examined by a doctor in Thailand and given medications, he was recommended for repatriation for further medical evaluation. Riego returned to the Philippines on December 15, 2013 and was endorsed by BSC to Marine Medical Services wherein he was attended to by the company-designated physician, for further medical care and treatment.

On December 16, 2013, the company-designated physician issued the first Medical Report stating that Riego was referred to a gastro-enterologist and orthopedic surgeon. The specialist recommended that Riego undergo laboratory exam, gastroscopy, ultrasound of the whole abdomen and magnetic resonance imaging, or MRI, of the lumbosacral spine. He was requested to come back the following day for reevaluation.

Subsequently, the company-designated physician issued four more Medical Reports until the same issued the final Medical Report on May 26, 2014, stating that on follow-up check-up, Riego still complained of lower back pain radiating to the left lower extremity with no significant improvement with physical therapy, and there was still sensory deficit on his left leg. The company-designated physician further stated that if respondent is entitled to disability benefits, his final disability grading under the POEA schedule of disabilities remains at Grade 11 – 1/3 loss of lifting power. The same issued on May 30, 2014 a certification that Riego “has under medical/surgical evaluation treatment from Dec. 16, 2013 to present due to Hiatal Hernia; L4-L5, L5-S1 Disc Bulge.”

Riego consulted a physician of his choice for a second medical opinion. On June 5, 2014, his physician of choice issued a Medical Report stating that he was permanently disabled and permanently unfit to work in any capacity. Subsequently, on two occasions, he sent a letter-request to the petitioners for referral to a third doctor, but the latter ignored his request. This prompted him to file a case with the LA especially after the shipping firm stopped shouldering his medical treatment.

The LA partially granted Riego’s complaint for disability benefits and gave credence to the medical assessment provided by the company-designated physician. The NLRC affirmed the LA’s ruling and held that Riego’s claim for permanent and total disability benefits was without basis at all. On appeal, the CA reversed and set aside the NLRC ruling.

The CA held that if the treatment of 120 days is extended to 240 days, but still no medical assessment is given, the finding of permanent and total disability becomes conclusive. It held that respondent Riego should be granted total and permanent disability benefits since no assessment was issued for a disability grade before the lapse of the 120-day period, prompting the shipping firm to elevate the case to the SC.

The SC ruled that the petition lacked merit.

The SC reiterated that for a company-designated physician to avail of the extended 240-day period, he or she must perform some complete or definite medical assessment to show that the illness still requires medical attendance beyond the 120 days, but not to exceed 240 days. In such case, the temporary total disability period is extended to a maximum of 240 days. Without sufficient justification for the extension of the treatment period, a seafarer’s disability shall be conclusively presumed to be permanent and total. Even if the 120-day period was extended to 240 days, 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.

Petitioners claimed that there was no lapse of the 120-day period, adding that since the final medical report was issued after 156 days from repatriation, then it is within the extended 240-day period.

But the Court was not convinced. Citing the Progress Note on the 106th day of the 120-day period, the specialist noted that Riego was still suffering from lower back pain radiating to leg aggravated by prolonged sitting, standing, and walking.

Noting that after issuance of the said final medical report by the company-designated physician, the same physician issued a Certification indicating that Riego has undergone medical/surgical evaluation treatment to Hiatal Hernia; L4-L5, L5-S1 Disc Bulge from December 16, 2013 until May 30, 2014. “This evidently demonstrates that the assessment of the medical condition of respondent was still continuing and not conclusive even after the company-designated physician issued his May 26, 2014 Final Medical Report,” said the Court.

The SC further added that even if the 120-day period was extended to 240 days, there was still no proper final medical assessment issued. Citing its ruling in the case of Elburg Shipmanagement Phils., Inc. v. Quiogue, the SC said that 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.

Based on the Medical reports, “The Court finds that respondent is suffering from permanent disability, which renders him unfit to work in any capacity as a seafarer.”

The SC said that the issue of whether Riego’s illness is compensable as total and permanent disability is a question of fact, which the SC would not disturb since, the SC “not being a trier of facts, is not duty-bound to reexamine and calibrate the evidence on record.”

However, the SC said that it was imperative to resolve the case at bar on the merits presented novel issues, such as, the form and content of the request for referral to a third doctor to resolve conflicting medical opinions involving a claim for disability benefits.

The SC noted the failure of petitioners to comply with the respondent’s request of referral to a third doctor, which has been held to be a mandatory procedure as a consequence of the provision under the POEA-SEC that the company-designated doctor’s assessment should prevail.

The SC stressed that it is the duty of the seafarer to notify his employer that he or she intends to refer the conflict to a third doctor. Once notified, the burden shifts to the employer to complete the process of referral to a third doctor so that, finally, the medical assessment of the seafarer will be put to rest.

“Accordingly, petitioners’ obliviousness to the mandatory procedure of referral to a third doctor must be taken against them,” said the SC as it cited Riego’s two letter-request for referral to a third doctor.

Furthermore, it held that when the employer fails to act on the seafarer’s valid request for referral to a third doctor, the tribunals and courts are empowered to conduct its own assessment to resolve the conflicting medical opinions.

The Court stressed that it is only through the strict observance of this compulsory procedure that assessment of the disability of the seafarer can be resolved with finality. “Consequently, the procedure laid down by the [Philippine Overseas Employment Administration-Standard Employment Contract] POEA-SEC requires mandatory fulfilment by both the employer and the seafarer. If either of the parties disregards the good faith compliance of the other, the legal consequences shall be borne by the erring party,” the Court held.

In ruling for respondent Riego, the SC ordered the petitioners to pay him total and permanent disability benefits in the amount of US$60,000.00 at the prevailing rate of exchange at the time of payment, as well as attorney’s fees equivalent to 10% of the total monetary award. Finally, all monetary awards shall earn legal interest at the rate of six percent per annum from finality of this Decision until full payment.

Justice Alfredo Benjamin S. Caguioa wrote a separate concurring and dissenting opinion.

FULL TEXT: https://sc.judiciary.gov.ph/28769/

Xxx."