LACK of a final medical assessment from the company-designated physician (CDP) negates the need to comply with the third doctor referral provision on seafarer’s disability claims.
This was the ruling of the Supreme Court in Pacific Ocean Manning, Inc. v. Nicolas Bobiles (GR 259982 October 28, 2024) in connection with a seafarer who was medically repatriated due to back injury.
A month after the seafarer embarked on the vessel, on January 27, 2017, while the seafarer was lifting the equipment (welded pumps) to be fixed in the work area, he felt something that snapped his back nerves. The impact caused pain, which radiated from his shoulder down to his waist.
The seafarer was later medically repatriated on February 28, 2017, he was diagnosed to have suffered severe injury on his lumbar spine.
In the medical report dated June 14, 2017, the CDP advised the seafarer to continue his physical therapy and medications and to return for re-evaluation on June 30, 2017.
The CDP issued on September 4, 2017 the final disability assessment of Grade 11 (slight rigidity or 1/3 loss of lifting power of the trunk).
The seafarer filed a case for total permanent disability claiming that he lost the possibility of being employed as a seafarer as he cannot tolerate the pain because of the injury.
The respondents moved for the dismissal of the case arguing, among others, that there was complete refusal on the part of seafarer to have the matter referred to a third doctor.
The Supreme Court ruled in favor of the seafarer.
The Court stressed that referral to a third doctor is mandatory when: (1) there is a valid and timely assessment by the company-designated physician, and (2) the seafarer-appointed doctor refuted such assessment.
A seafarer’s compliance with the POEA Standard Employment Contract (SEC) conflict resolution procedure presupposes that the CDP came up with an assessment as to their fitness to work before the expiration of the 120- or 240-day periods.
In Elburg Shipmgt Phils., Inc. v. Quiogue, Jr. (GR 211882, July 29, 2015), the Supreme Court laid down the rules for seafarer total and permanent disability benefits claims:
1. The CDP must issue a final medical assessment on the seafarer’s disability grading within a period of 120 days from the time the seafarer reported to him;
2. If the CDP fails to give assessment within the period of 120 days, without any justifiable reason, then the seafarer’s disability becomes permanent and total;
3. lf the CDP fails to give assessment within the period of 120 days with a sufficient justification (e.g. seafarer required further medical treatment or seafarer was uncooperative), then the period of diagnosis and treatment shall be extended to 240 days. The employer has the burden to prove that the CDP has sufficient justification to extend the period; and
4. If the CDP still fails to give assessment within the extended period of 240 days, then the seafarer’s disability becomes permanent and total, regardless of any justification.
In the instant case, the CDP only issued the disability assessment on September 4, 2017 or 188 days after the seafarer was repatriated, and did not explain why he did not issue it within the original 120-day period.
There was likewise no allegation that the seafarer was uncooperative during his treatment, which would otherwise justify an extension of the period to 240 days.
Despite the therapies the seafarer underwent from April 22, 2017 to May 18, 2017, he showed no favorable prognosis, hence, the therapy needed extension.
The fact that the CDP, after
observing the seafarer to be suffering from low back pain and stiffness and referring him to the physiatrist, advised him to continue his physical therapy and medications and to return for re-evaluation, shows that the seafarer required further medical treatment, thus justifying the extension.
While the CDP issued a “final” disability assessment of Grade 11 on September 4, 2017 i.e., within the extended period, a medical certificate of even date reveals that such assessment was not yet final.
A CDP’s medical assessment is not final when there is a contemporaneous finding by said physician that the employee requires further treatment or reevaluation.
Failure of the CDP to issue a final and valid assessment transforms the temporary total disability to permanent total disability, regardless of the disability grade.
Hence, it was unnecessary for the seafarer to even refer the findings of the CDP to his own doctor.
The conflict-resolution mechanism only takes effect if the CDP issues a valid and definite medical assessment.
The lack of a conclusive, valid final and definite medical assessment from the CDP negates the need to comply with the POEA-SEC third doctor referral provision, and the law steps in to consider the seafarer’s disability as total and permanent.
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Atty. Dennis R. Gorecho heads the seafarers’ division of the Sapalo Velez Bundang Bulilan law offices. For comments, e-mail info@sapalovelez.com, or call 09088665786./PN
