Supreme Court (SC)

For claims for disability benefits, the employee and the employer must “strictly observe the mandatory procedure” for referral to a third-party doctor of contradictory medical opinions between the doctor appointed by the company and the doctor chosen by the employee.

The Supreme Court (SC) said that “it is only this compulsory procedure that the assessment of the seafarer’s disability can be finally resolved”.

“If either party disregards the good faith compliance of the other, the legal consequences will be borne by the offending party,” the SC pointed out in the decision written by Chief Justice Alexander G. Gesmundo. .

The decision made public on July 21 rejected the motion filed by Benhur Shipping Corporation (BSC)/Sun Marine Shipping SA (SMS) as it confirmed with modification the decisions rendered by the Court of Appeal (CA) in 2016 and 2017 in favor of sailor Alex Pefiaredonda Riego.

A summary of the decision issued by the SC’s Public Information Office (PIO) stated that on October 8, 2013, BSC employed Riego a chef aboard the vessel MV Hikari I, an ocean-going vessel of its principal alien, SMS.

The first week of December 2013, Riego suffered from abdominal and lower back pain on board the ship. After being examined by a doctor in Thailand and given medication, he was recommended to be repatriated for further medical evaluation.

Riego returned to the Philippines on December 15, 2013, and was approved by BSC for Marine Medical Services where he was cared for by the company’s designated physician, for further medical care and treatment.

On December 16, 2013, the company’s Designated Physician issued the first medical report indicating that Riego had been referred to a gastroenterologist and an orthopedic surgeon.

The specialist recommended that Riego undergo a lab exam, gastroscopy, ultrasound of the entire abdomen, and magnetic resonance imaging, or MRI, of the lumbosacral spine, and was asked to return for reassessment.

Subsequently, the company’s DMP released four more medical reports with the final report dated May 26, 2014, stating that at follow-up, Riego was still complaining of lower back pain radiating to the lower extremity. left without significant improvement with physiotherapy, and there was still a sensory deficit on his left leg.

The company’s designated physician said that while Riego is eligible for disability benefits, his final disability classification under the POEA (Philippine Overseas Employment Administration) Disability Scale remains at Grade 11 – 1/3 loss of lifting capacity.

On May 30, 2014, a certification was issued stating that Riego “underwent medical/surgical evaluation treatment from December 16, 2013 to present due to Hiatal Hernia; L4-L5 Disc Bulge, L5-S1 . »

Riego consulted a doctor of his choice for a second medical opinion. On June 5, 2014, the doctor of his choice issued a medical report stating that he was permanently disabled and permanently unfit to work in any capacity.

Subsequently, Riego twice sent a request letter to BSC and an SMS for a referral to a third doctor. His requests were ignored. He then filed a case with the National Labor Relations Commission (NLRC) for disability benefits,

The labor arbitrator partially granted Riego’s disability benefit claims at $7,465 with 10% attorney fees.

On July 16, 2015, the NLRC upheld the labor arbitrator’s decision. He ruled that Riego’s claim for permanent and total disability benefits was without merit.

On appeal, the CA overturned the NLRC as it ordered BSC and SMS to pay $60,000 as Riego’s permanent disability benefits with 10% attorney fees.

The CA ruled that “if the 120-day treatment is extended to 240 days, but no medical assessment is still given, the finding of permanent and total disability becomes conclusive”.

He pointed out that Riego “should be granted total and permanent disability benefits since no assessment was issued for a degree of disability before the expiration of the 120-day period.”

The matter came to the SC at the request of BSC and SMC.

In denying the company’s motion, the SC said.

“Indeed, when the employer does not follow up on the seafarer’s valid request for referral to a third-party doctor, the courts and tribunals are empowered to proceed at their own discretion to resolve the contradictory medical opinions of the doctor appointed by the employer. company and the doctor chosen by the sailor on the basis of all the evidence.

“The employer simply cannot rely on the conclusiveness of the medical opinion of the doctor appointed by the company vis-à-vis the medical opinion of the doctor chosen by the seafarer when it is because of his inaction and his negligence that the medical assessment was not entrusted to a third doctor.

“In this case, the final medical report of May 26, 2014 from the doctor appointed by the company, as well as the medical reports of June 5, 2014 and July 2, 2014 from the doctor chosen by the sailor, have always concluded that the Respondent (Riego) had actually suffered a disability. These reports simply differ on the extent of the disability suffered by the Respondent.

“Indeed, with the respondent’s disability, he can no longer resume his occupation as a sailor. He will not be able to perform his duties as a sailor. Moreover, the records do not show that the respondent was actually able to resume his work as a sailor.

“The Court emphasizes again that in matters of compensation for invalidity, it is not the damage which is compensated, but rather the incapacity for work resulting in a reduction in earning capacity.

“Given the defendant’s condition, it is highly unlikely that he would perform his usual duties as a seaman on a vessel which effectively prevents him from earning wages in the same or similar type of work for which he been formed.

“In truth, the occupation which enabled him to earn a living is now a thing of the past because of the disability he suffered while employed by the petitioners. The respondent’s disability resulted in his loss of capacity of earnings and, consequently, entitles him to permanent and total invalidity benefits.

“THEREFORE, the petition is DENIED. The September 30, 2016 decision and January 6, 2017 resolution of the Court of Appeals in CA-GR SP No. 142911 are CONFIRMED with AMENDMENT. Plaintiffs are hereby ORDERED TO PAY Respondent Alex Pefiaredonda Riego total and permanent disability benefits in the amount of USD 60,000 at the exchange rate in effect at the time of payment, together with attorneys’ fees equivalent to ten percent (10%) of the total amount awarded.

“Finally, all monetary awards shall bear statutory interest at the rate of six percent (6%) per annum from the finality of this decision until paid in full. THEREFORE ORDERED.

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