Prematurely filed complaint for total, permanent disability benefits

Entitlement to disability benefits of seafarers is governed by law, contract and the applicable medical findings. The material legal provisions are Articles 191 to 193 of the Labor Code, in relation to Section 2, Rule X of the Amended Rules on Employees' Compensation. The relevant contracts are the POEA-SEC and the CBA, if any.

Under Article 192(c)(1) of the Labor Code, permanent total disability includes temporary total disability lasting continuously for more than one hundred twenty (120) days, except as otherwise provided in the Rules. The rule adverted to is Section 2, Rule X of the Amended Rules on Employees' Compensation Implementing Title II, Book IV of the Labor Code, which states:
SECTION 2. Period of Entitlement. (a) The income benefit shall be paid beginning on the first day of such disability. If caused by an injury or sickness it shall not be paid longer than 120 consecutive days except where such injury or sickness still requires medical attendance beyond 120 days but not to exceed 240 days from onset of disability in which case benefit for temporary total disability shall be paid. However, the System may declare the total and permanent status at any time after 120 days of continuous temporary total disability as may be warranted by the degree of actual loss or impairment of physical or mental functions as determined by the System. (Underscoring supplied)
This must be read in conjunction with Section 20-B(3) of the POEA-SEC, which provides: xxx
  1. Upon sign-off from the vessel for medical treatment, the seafarer is entitled to sickness allowance equivalent to his basic wage until he is declared fit to work or the degree of permanent disability has been assessed by the company-designated physician but in no case shall this.period exceed one hundred twenty (120) days. (Underscoring supplied)
Combining the foregoing provisions, the Supreme Court has held that in order for a claim for total and permanent disability benefits to prosper, any of the following circumstances must obtain:
  1. The company-designated physician failed to issue a declaration as to his fitness to engage in sea duty or disability even after the lapse of the 120-day period and there is no indication that further medical treatment would address his temporary total disability, hence, justify an extension of the period to 240 days; 
  2. 240 days had lapsed without any certification being issued by the company[-] designated physician;
  3. The company-designated physician declared that he is fit for sea duty within the 120-day or 240-day period, as the case may be, but his physician of choice and the doctor chosen under Section 20-B(3) of the POEA-SEC are of a contrary opinion;
  4. The company-designated physician acknowledged that he is partially permanently disabled but other doctors whom he consulted, on his own and jointly with his employer, believed that his disability is not only permanent but total as well;
  5. The company-designated physician recognized that he is totally and permanently disabled but there is a dispute on the disability grading;
  6. The company-designated physician determined that his medical condition is not compensable or work-related under the POEA-SEC but his doctor-of-choice and the third doctor selected under Section 20-B(3) of the POEA-SEC found otherwise and declared him unfit to work;
  7. The company-designated physician declared him totally and permanently disabled but the employer refuses to pay him the corresponding benefits; and
  8. The company-designated physician declared him partially and permanently disabled within the 120-day or 240-day period but he remains incapacitated to perform his usual sea duties after the lapse of the said periods.

In the 2018 case of Esposo v. Epsilon (G.R. No. 218167), it is not disputed that Esposo was repatriated on June 20, 2013. He filed the present complaint 104 days therefrom or on October 2, 2013. Esposo's Complaint for total and permanent disability benefits was prematurely filed.In other words, Esposo filed his complaint for total and permanent disability benefits before the lapse of the initial 120-day period from repatriation which the law affords a company-designated physician to determine the nature and extent of a seafarer's disability. This period may even be extended to a maximum period of 240 days on justifiable grounds. In this case, the company had no occasion at all to refer Esposo to its designated physician for assessment because, as will be discussed further, Esposo never submitted himself to the company physician for medical examination.

The medical certificate dated June 22, 2013 from Dr. Santos did not provide Esposo with a cause of action against respondents. While a seafarer has the right to seek the opinion of other doctors under Section 20-B(3) of the POEA-SEC, this is on the assumption that there is already a certification by the company-designated physician as to his fitness or disability which he disagrees with. It is the company-designated physician who is entrusted with the task of assessing a seafarer's disability and there is a procedure to contest his findings.

Moreover, in their Comment, respondents attached a POEA-certified OFW Information showing that Esposo was processed for employment on February 10, 2014 or within the maximum extended period of 240 days from his repatriation. Based on this evidence, Esposo was "engaged" as a Chief Engineer Officer by local manning agent Conautic Maritime Inc. in behalf of its principal HK Marine PTE, LTD. for six (6) months.

The authenticity and the data contained in this evidence remains to be undisputed by Esposo whose Reply is deafeningly silent on the matter. As such, the Court is left with no recourse but to seriously doubt the truthfulness of the allegations in his Petition that he is "totally unfit for work as x x x he has no more capacity to perform the usual physical, strenuous and stressful activities which is the usual function of the seafarers on board the vessel x x x [and with his] deteriorated physical and medical condition of petitioner, petitioner may not be qualified anymore to resume his seafaring duties as very certainly he may not pass or comply with the rigid and rigorous PEME that is being required under POEA regulation as a condition of redeployment abroad." These appear to be falsehoods and cast serious questions on Esposo's general credibility.

Indeed, prior to his subsequent engagement as reflected in the OFW Information, Esposo underwent a PEME and was therein found fit for sea duty; otherwise, he would not have been hired. In other words, Esposo could have been found by Epsilon's designated physician as fit again for sea duty within the required period of time under the POEA-SEC had Esposo submitted himself for medical examination and such finding would have negated his claim for total and permanent disability benefits.

In Oriental Shipmanagment Co., Inc. v. Nazal, the High Court dismissed the claim of a seafarer who was able to secure a seafaring job after his repatriation and ruled:
If Nazal was able to secure an employment as a seaman with another vessel after his disembarkation in November 2001, how can there be a case against the petitioners, considering especially the lapse of time when the case was instituted? How could Nazal be accepted for another ocean-going job if he had not been in good health? How could he be engaged as a seaman after his employment with the petitioners if he was then already disabled?

Surely, before he was deployed by Crossocean, he went through a pre-employment medical examination and was found fit to work and healthy; otherwise, he would not have been hired. Under the circumstances, his ailments resulting in his claimed disability could only have been contracted or aggravated during his engagement by his last employer or, at the very least, during the period after his contract of employment with the petitioners expired.

ADDITIONAL READINGS:

[1] Gomez v. Crossworld Marine Services, Inc., G.R. No. 220002, August 2, 2017, 834 SCRA 279, 294.
[2] Status Maritime Corporation v. Doctolero, 803 Phil. 453, 461-462 (2017), citing C.F. Sharp Crew Management, Inc. v. Taok, 691 Phil. 521, 538-539 (2012).
[3] B. COMPENSATION AND BENEFITS FOR INJURY OR ILLNESS

x x x x x
  1. Upon sign-off from the vessel for medical treatment, the seafarer is entitled to sickness allowance equivalent to his basic wage until he is declared fit to work or the degree of permanent disability has been assessed by the company-designated physician but in no case shall this period exceed one hundred twenty (120) days.
    For this purpose, the seafarer shall submit himself to post-employment medical examination by a company-designated physician within three working days upon his return except when he is physically incapacitated to do so, in which case, a written notice to the agency within the same period is deemed as compliance. Failure of the seafarer to comply with the mandatory reporting requirement shall result in his forfeiture of the right to claim the above benefits.
    If a doctor appointed by the seafarer disagrees with the assessment, a third doctor may be agreed jointly between the Employer and the seafarer. The third doctor's decision shall be final and binding on both parties. (Emphasis and underscoring supplied)
[4] New Filipino Maritime Agencies, Inc. v. Despabeladeras, 747Phil. 626, 642 (2014).
[5] Coastal Safeway Marine Services, Inc. v. Esguerra, 671 Phil. 56, 65-66 (2011).
[6] 710 Phil. 45 (2013).