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Supreme Court states requirements for concealment of a pre-existing medical condition to be validly raised as a defense against a claim for disability benefits

Philippine Shipping Update – Manning Industry

By:  Ruben Del Rosario, President, Del Rosario Pandiphil Inc., 17 August 2018 (Issue 2018/11)
 
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 Supreme Court states requirements for concealment of a pre-existing medical condition to be validly raised as a defense against a claim for disability benefits
 
 Seafarer was engaged as Master by the company.  After passing the required pre-employment medical examination (PEME for short), he boarded the vessel and commenced his employment.
 
While in the performance of his duties, seafarer felt sudden numbness on the left side of his body and noticed that his speech was slurred. He was immediately provided first aid and his condition allegedly improved after taking an Isordil tablet which he personally brought to the vessel.  On the next day, his symptoms recurred which did not improve despite taking another dose of Isordil. Thus, seafarer was brought to a local hospital where he was confined and underwent physical therapy.  He was diagnosed with ischemic cerebrovascular accident.  He was then recommended for further treatment upon return.
 
Upon repatriation, the seafarer was referred by the company to their designated doctors where he was diagnosed with “Cerebrovascular Infarct Middle Cerebral Artery, Right and Hypertension”.  The company-designated doctor issued an opinion that the illness is not work-related considering that the risk factors for cerebrovascular infarct (brain stroke or cerebrovascular accident) were hypertension, Diabetes Mellitus, smoking, lifestyle, dyslipidemia, family history, age, and sex, while the cause for hypertension was multifactorial in origin which included genetic predisposition, poor lifestyle, high salt intake, smoking, Diabetes Mellitus, age, and increased sympathetic activity.
 
Meanwhile, the company-designated Cardiologist explained that the medicine (Isordil) brought by the seafarer on board the vessel is a medication used to treat patients with angina (chest pain), and that while the latter denied taking any maintenance medications, the company-designated Cardiologist opined that possession of the same suggests that he may be experiencing some symptoms for which he was given that medications previously.
 
The seafarer then filed a complaint for disability benefits based on the provisions of a collective bargaining agreement (CBA for short) alleging that despite the lapse of 120 days, he is still unfit to work as his condition did not improve.  The company disputed the claim arguing that the seafarer is disqualified to receive benefits as he committed fraudulent concealment when he did not disclose in his PEME that he had a previously diagnosed medical condition for which he was prescribed Isordil.
 
In the interim, the seafarer sought medical consult with another doctor who assessed him to be permanently unfit for work.
 
The Labor Arbiter awarded full disability benefits of US$60,000 to the seafarer under the POEA Contract and held that there was no concealment considering that seafarer’s possession of Isordil did not mean that he was hypertensive and under medical maintenance.  This was echoed by the NLRC but the award was increased to reflect the CBA rates of US$151,470 in disability compensation.  The NLRC held that the CBA contemplates all kinds of accident or unforeseen events that cause physical harm or injury to the body, and that the illness suffered by the seafarer was an unforeseen event that physically injured the brain.  On petition, the Court of Appeals affirmed the ruling of the NLRC.
 
The Supreme Court affirmed the conclusion of the lower tribunals but modified the award based on the POEA Contract.
 
Requirements for concealment as a defense; no direct relation between Isordil and hypertension was shown
 
The Court has noted that a seafarer who knowingly conceals a pre-existing illness or condition during the PEME shall be disqualified from compensation under the POEA Contract.
 
Under the POEA Contract, an illness shall be considered as pre-existing if prior to the processing of the POEA contract, any of the following conditions is present: (a) the advice of a medical doctor on treatment was given for such continuing illness or condition; or (b) the seafarer had been diagnosed and has knowledge of such illness or condition but failed to disclose the same during the PEME, and such cannot be diagnosed during the PEME.
 
According to the Court the above requirements were not met here.
 
The Court explained that Isordil tablets are taken for the prevention of angina pectoris or chest pain due to coronary artery diseases. It is, however, not a medication directly used for hypertension, which illness the company claimed seafarer to be suffering from prior to his engagement, as well as the reason for his repatriation. To properly determine whether a person suffers from hypertension, it is imperative that he or she undergoes medical check-ups, and consequently, procures a diagnosis from a medical doctor. In this case, no such diagnosis was presented by the company.
 
Moreover, there was no clear showing that seafarer was taking Isordil as maintenance medication for his hypertension or that it was the appropriate medication for his condition that gave rise to his brain stroke. At the most, the company submitted the opinion of a specialist, claiming that seafarer may have previously experienced some symptoms of hypertension for the bare reason that he had with him Isordil.  This opinion deserves scant consideration as the same is clearly tentative and speculative in nature. In the final analysis, the company failed to demonstrate that seafarer's act of carrying Isordil in itself conclusively established the fact he had actual knowledge of his medical condition, and consequently, concealed the same in his PEME. At any rate, if the seafarer had been suffering from a pre-existing hypertension at the time of his PEME, the same could have been easily detected by standard/routine tests conducted during the said examination, i.e., blood pressure test, electrocardiogram, chest xray, and/or blood chemistry. However, seafarer's PEME showed normal blood pressure with no heart problem, which led the PEME doctor to declare him fit for sea duty.
 
The medical condition is compensable
 
The Court noted that hypertension is listed as an occupational disease in the POEA Contract.
 
In the POEA Contract, end organ damage resulting from uncontrolled hypertension is an occupational disease if there is impairment of function of the organs such as kidneys, heart, eyes and brain.  If the seafarer is not known to have hypertension, his last PEME should show a normal blood pressure, chest x-ray and ECG/treadmill test.
 
In this case, records show that seafarer’s brain stroke was brought about by his hypertension which occurred only while in the performance of his duties as a Master.  There was no indication that seafarer was known to be previously suffering from hypertension, and considering further that his last PEME showed normal blood pressure, chest x-ray and ECG results, his illnesses and the resulting disability were correctly declared to be compensable.
 
The CBA is not applicable
 
The Court clarified that seafarer's disability benefits should be awarded pursuant to the provisions of the POEA Contract, and not the CBA as held by the NLRC and the Court of Appeals. To be entitled to compensation in accordance with the CBA, a seafarer must suffer an injury as a result of an accident, which is defined in case law as "an unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could not be reasonably anticipated; an unforeseen and injurious occurrence not attributable to mistake, negligence, neglect or misconduct. Accident is that which happens by chance or fortuitously, without intention and design, and which is unexpected, unusual and unforeseen".  Here, the seafarer was suffering from an occupational disease; hence, it cannot be said that seafarer figured in an accident.
 
Philsynergy Maritime, Inc. and/or Trimurti Shipmanagement Ltd. vs. C. G., G.R. No. 228504, June 6, 2018, Second Division, Associate Justice Estela Perlas-Bernabe, ponente
 
Author’s Note:  It was not mentioned in the case if there was an argument on the part of the company that notwithstanding the relation between the medication taken by the seafarer and his ailment which caused the disability, concealment was still present in the case.  This is because the seafarer did not declare that he was provided medications for a certain illness during the time he took his PEME.  In any event, the Supreme Court should have taken note of this fact and still considered that concealment existed even if what was concealed was not the reason for repatriation.  Had the company knew of this material medical information prior to the employment of the seafarer, then this would have provided them further basis to evaluate whether they will still hire the seafarer.
 
 Firm News
 

DelRosarioLaw Senior Partner Charles Jay Dela Cruz was elected as member of the Board of Trustees of the Philippine Bar Association (PBA) for the term 2018-2019. Founded in 1891, PBA is the oldest and most prestigious voluntary national organization of lawyers in the Philippines.

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Downloads

  • IRR Seafarer's Protection Act
  • Seafarers Protection Act
  • ORDINANCE No. 28 Series of 2015 Zambales, Philippines
  • NLRC MEMO on 3rd Doctor
  • NLRC Rules of Procedure 2011
  • Standard Terms and Conditions of Del Rosario Law
  • POEA SEC - 2010 Amendments
  • POEA Memorandum Circular No. 10 Series of 2010
  • Governing Board Resolution No. 09 Series of 2010

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