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Supreme Court rules that claim is premature without a second medical opinion; conflict resolution procedure was not followed

Philippine Shipping Update – Manning Industry

By:  Ruben Del Rosario, President, Del Rosario Pandiphil Inc., 1 October 2019 (Issue 2019/11)

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Supreme Court rules that claim is premature without a second medical opinion; conflict resolution procedure was not followed 
 
The crewmember was engaged to work as a Bar Attendant on board the ship.  While on-board the crewmember complained of pain on his lower back which after medical examination was determined to be “Moderate degenerative disc disease at L5-S1, with a 5 mm right paramedian disc protrusion causing mass effect on the descending S1 nerve root on the right."  He was then repatriated and was referred to the company-designated physician for examination and treatment.  The crewmember underwent a series of physical therapy sessions and eventually, he was cleared to go back to work.  He was then paid his illness allowance and reimbursement for expenses for which he signed a quitclaim.
 
Apparently not convinced with the fit to work declaration, the crewmember filed a complaint for disability benefits.  Thereafter, he sought the opinion of his personal doctor who gave him a certificate that he is unfit to work as a seaman in any capacity which he used to pursue his claim.
 
The Labor Arbiter awarded full disability benefits to the crewmember relying on the latter’s personal doctor’s opinion.  On the other hand, the NLRC dismissed the claim of the crewmember and gave more credence to the findings of the company-designated physician.  The NLRC also observed that the crewmember voluntarily executed a quitclaim in favor of the company right after the issuance of the final medical assessment. In executing the said document, the crewmember impliedly admitted the correctness of the assessment by the company-designated physicians. The Court of Appeals affirmed the NLRC. When the case reached the Supreme Court, the crewmember’s claim was also denied.
 
The claim is premature
 
The Court noted that after the crewmember was declared fit to work by the company-designated physicians, he immediately filed a complaint for disability benefits.  Thereafter, it took him several months to obtain a medical opinion to contradict the findings of the company-designated physician.  With such factual antecedents, the Court held that the crewmember had no cause of action when he filed his complaint. 
 
The Court explained that it is clear that if the company-designated physician made an assessment declaring the seafarer fit to work within the applicable period as prescribed under the POEA Contract and in relevant laws and jurisprudence, the seafarer may pursue his claim for disability benefits only after securing a contrary medical opinion from his physician of choice. In other words, a seafarer seeking compensation for his disability cannot file his claim before seeking a second opinion.
 
There is failure to validly challenge the company-designated physician’s assessment
 
The Court held that the determination of the fitness of a seafarer for sea duty is the province of the company-designated physician, subject to the periods prescribed by law.  However, this does not mean that the company-designated physician's assessment is automatically final, binding or conclusive on the seafarer as he can still dispute the assessment. In assailing the assessment, the seafarer must comply with the procedure provided under the POEA Contract by seasonably exercising his prerogative to seek a second opinion and consult a doctor of his choice. In case the findings of the seafarer's physician of choice differ from that of the company-designated physician, the conflicting findings shall be submitted to a third party doctor, as mutually agreed upon by the parties. The referral of the conflicting findings to an independent third doctor is important and crucial to the claim of the seafarer. If the seafarer fails to signify his intent to submit the disputed assessment to a third physician, then the company can insist on the disability rating issued by the company-designated physician, even against a contrary opinion by the seafarer's doctor. The duty to secure the opinion of a third doctor belongs to the seafarer, who must actively or expressly request for it.  Failure to comply with the requirement of referral to a third-party physician is tantamount to violation of the terms under the POEA Contract, and without a binding third-party opinion, the findings of the company-designated physician shall prevail over the assessment made by the seafarer's doctor.
 
Thus, without the referral to a third doctor, there is no valid challenge to the findings of the company-designated physician. In the absence thereof, the medical pronouncement of the company-designated physician must be upheld.
 
Moreover, the findings of the company-designated physician is more credible as it was arrived at after several months of treatment and medical evaluation as compare to that of the assessment of the crewmember's physician who examined the seafarer only once.
 
Execution of quitclaim implies agreement to company-designated physician’s findings
 
The Court upheld the quitclaim executed by the crewmember as it found the consideration to be reasonable as he was not entitled to disability benefits.  Moreover, it was not proven that the signature of the crewmember was obtained through force or fraud.  As the quitclaim is valid, the crewmember impliedly admitted to the correctness of the assessment of the company-designated physicians and admitted that he could no longer claim for disability benefits.
 
J.D. vs. United Philippine Lines, Inc. an/or Holland America Line Westour, Inc., et al, G.R. No. 223246, June 26, 2019, Second Division, Associate Justice Jose Reyes, Jr., ponente (Attys. Florencio Aquino and Lovereal Ocampo handled for vessel interests)
 
Author’s Note:  Of interest in this case is that the company-designated physician initially issued a medical report stating that the crewmember was considered as “maximally medically improved”.  The crewmember questioned the report which states that he was “maximally medically improved” arguing that this was not a definitive assessment of his fitness. The Court agreed that “maximally medically improved” was indeed not a definite assessment as it could mean either that the patient has fully recovered or that the patient's condition could no longer be improved.  However, since the company-designated physician, in a subsequent report, also stated that the crewmember is fit to work, then the ambiguity is no longer present.

Areas of Specialization: Shipping, Labour, Transport, Corporate, Mergers & Acquisitions, Insurance, Immigration, Litigation, Arbitration, Intellectual Property
 
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TheAsia Business Law Journal has named Managing Partners Arturo Del Rosario, Jr. and Ruben Del Rosario and Senior Partner Joseph Rebano as one of the Philippines Top 100 Lawyers in their recently published list.

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DelRosarioLaw welcomes Ruben Jose G. Del Rosario Jr., as a Junior Associate of the firm. He is a 2011 Bachelor of Science in Management, Major in Legal Management graduate of Ateneo de Manila and a 2017 Bachelor of Laws graduate of San Beda College - Alabang.

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Partners Charles Dela Cruz and Herbert Tria spoke on “Current Crew Claims Handling Issues related to the Data Privacy Act” at the 7th Annual Magsaysay Shipping and Logistics’ Marine Insurance Seminar held on 21 September 2018 at Robert Hall, Times Plaza Building, Manila.

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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.

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  • 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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