PRESUMPTION OF COMPENSABILITY VS. PRESUMPTION OF WORK-RELATEDNESS

Presumption of compensability, as differentiated from presumption of work-relatedness, is not accorded in favor of the seafarer. As such, he bears the burden of proving that these conditions are met .

Presumption of work-relatedness was borne out from the fact that the list under Section 32-A of 2000 POEA SEC cannot account for all known and unknown illnesses/diseases that may be associated with, caused or aggravated by such working conditions. The presumption is made in the law to signify that the non-inclusion in the list of occupational diseases does not translate to an absolute exclusion from disability benefits.

Now available: Re-numbered and updated Labor Code 2018

Atienza vs. Orophil Shipping International Co., Inc., et al.

G.R. No. 191049, August 7, 2017

Facts:

Petitioner Tomas Atienza (Atienza) was employed as an Able Seaman by respondent Orophil Shipping International Co., Inc. (Orophil) on behalf of its principal, respondent Hakuho Kisen Co., Ltd. (Hakuho), and was assigned at the MN Cape Apricot.

In the course of his employment contract, Atienza complained of severe headaches, nausea, and double vision which the foreign port doctors diagnosed to be right cavernous sinus inflammation or Tolosa Hunt Syndrome (THS). As a result, Atienza was repatriated on February 4, 2005 and referred to a company-designated physician, Doctor Nicomedes G. Cruz (Dr. Cruz), who confirmed the findings and advised him to continue the medication prescribed by the foreign doctors.

On June 28, 2005, Dr. Cruz issued a certification declaring Atienza fit to resume work. Dissatisfied, Atienza consulted an independent physician, Dr. Paul Matthew D. Pasco (Dr. Pasco), who, on the other hand, assessed his illness as a Grade IV disability and declared him unfit for sea duty.

Consequently, Atienza filed a complaint against Orophil, Engineer Tomas N. Orola, and Hakuho (Orophil Shipping, et al.) before the NLRC for payment of disability benefits, reimbursement of medical expenses, damages, and attorney’s fees.

For their part, Orophil Shipping, et al. opposed the claim for disability benefits, asserting that Atienza was declared fit to work by the company-designated physician and that his illness is not work-related, adding too that he maliciously concealed the fact that he had previously suffered from THS that effectively barred him from claiming disability benefits under the 2000 Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC). They likewise contended that Atienza had been paid his sickness allowance, while the claims for damages and benefits are without basis.

LA Ruling:

The Labor Arbiter (LA) ordered Orophil Shipping, et al. to pay Atienza the amount equivalent to US$34,330.00 for his Grade IV disability and ten percent (10%) attorney’s fees, while the rest of the claims were denied for lack of basis.

The LA found Atienza’s illness to be work-related and that he cannot be faulted for not declaring his previous treatment for the same illness given that it had occurred way back in 1996 and has not recurred despite several contracts.

The LA did not give merit to the company-designated physician’s finding of fitness to work, noting that Atienza was subsequently declared unfit for sea duty in a medical certificate dated March 14, 2006.

Dissatisfied, both parties appealed the case to the NLRC.

NLRC Ruling:

The NLRC set aside the LA’s Decision and dismissed the complaint for Atienza’s failure to establish that his illness is work-related. In so ruling, it did not give credence to the certificate issued by Dr. Pasco as the finding of Atienza’s unfitness to resume work was not supported by any explanation.

Atienza’s motion for reconsideration having been denied by the NLRC. Atienza elevated his case to the CA via a petition for certiorari.

CA Ruling:

The CA affirmed the NLRC, finding no grave abuse of discretion on the latter’s part in dismissing Atienza’s complaint for disability benefits, allowances, and damages. It held that Atienza failed to prove that his illness was caused or aggravated by his employment conditions.

Further, the CA pointed out that Atienza was also declared fit to work by the company-designated physician and that while his independent physician found otherwise, the said assessment was made after the lapse of a considerable period of time.

Aggrieved, Atienza filed a motion for reconsideration, which was, however, denied by the CA. Hence, the petition with SC.

Issue/s:

Whether or not the presumption of work-relatedness is equated to presumption of compensability

Whether or not compensability is dependent on the pre-existing nature of the disease

Whether or not failure of the company-designated physician to issue a final assessment within the 120-day period gave rise to a conclusive presumption that Atienza’s disability is total and permanent.

SC Ruling:

The SC found the petition meritorious.

The SC held that under the 2000 POEA-SEC, “any sickness resulting to disability or death as a result of an occupational disease listed under Section 32-A of this Contract with the conditions set therein satisfied” is deemed to be a “work-related illness.” On the other hand, Section 20 (B) (4) of the 2000 POEA-SEC declares that “[t]hose illnesses not listed in Section 32 of this Contract are disputably presumed as work related.”

The legal presumption of work-relatedness was borne out from the fact that the said list cannot account for all known and unknown illnesses/diseases that may be associated with, caused or aggravated by such working conditions, and that the presumption is made in the law to signify that the non-inclusion in the list of occupational diseases does not translate to an absolute exclusion from disability benefits.

Given the legal presumption in favor of the seafarer, he may rely on and invoke such legal presumption to establish a fact in issue. The SC, citing the case of Racelis vs. United Philippine Lines, Inc. and David vs. OSG Shipmanagement Manila, Inc., explained that the legal presumption of work-relatedness of a non-listed illness should be overturned only when the employer’s refutation is found to be supported by substantial evidence.

The presumption provided under Section 20 (B) (4) is only limited to the “work-relatedness” of an illness. It does not cover and extend to compensabilitv. In this sense, there exists a fine line between the work-relatedness of an illness and the matter of compensability. Compensability pertains to the entitlement to receive compensation and benefits upon a showing that his work conditions caused or at least increased the risk of contracting the disease.

For an occupational disease and the resulting disabilitv or death to be compensable, all of the following conditions must be satisfied: 1. The seafarer’s work must involve the risks described herein; 2. The disease was contracted as a result of the seafarer’s exposure to the described risks; 3. The disease was contracted within a period of exposure and under such other factors necessary to contract it; 4. There was no notorious negligence on the part of the seafarer.

As differentiated from the matter of work-relatedness, no legal presumption of compensability is accorded in favor of the seafarer. As such, he bears the burden of proving that these conditions are met.

The SC declared that in Tagle vs. Anglo-Eastern Crew Management, Phils., lnc., the Court ruled that while work-relatedness is indeed presumed, “the legal presumption in Section 20 (B) (4) of the [2000] POEA-SEC should be read together with the requirements specified by Section 32-A of the same contract.”

Further, in the case of Licayan vs. Seacrest Maritime Management, lnc., it was explicated that the disputable presumption does not signify an automatic grant of compensation and/or benefits claim, and that while the law disputably presumes an illness not found in Section 32-A to be also work-related, the seafarer/claimant nonetheless is burdened to present substantial evidence that his work conditions caused or at least increased the risk of contracting the disease and only a reasonable proof of work-connection, not direct causal relation is required to establish its compensability. The proof of work conditions referred thereto effectively equates with the conditions for compensability imposed under Section 32-A of the 2000 PO EA-SEC.

The conditions under Section 32-A of the 2000 POEA-SEC also apply to non-listed illnesses. Notably, the SC held that the seafarer will, in all instances, have to prove compliance with the conditions for compensability, whether or not the work-relatedness of his illness is disputed by the employer

The seafarer will, in all instances, have to prove compliance with the conditions for compensability, whether or not the work-relatedness of his illness is disputed by the employer.

When the presumption of work-relatedness is contested by the employer, the factors which the seafarer needs to prove to rebut the employer’s contestation would necessarily overlap with some of the conditions which the seafarer needs to prove to establish the compensability of his illness and the resulting disability. In this regard, the seafarer, therefore, addresses the refutation of the employer against the work-relatedness of his illness and, at the same time, discharges his burden of proving compliance with certain conditions of compensability.

When an employer does not attempt to discharge the burden of disputing the presumption of work-relatedness, the seafarer must still discharge   his own burden of proving compliance with the conditions of compensability, which does not only include the three (3) conditions above-mentioned, but also, the distinct fourth condition, i.e., that there was no notorious negligence on the part of the seafarer. Thereafter, the burden of evidence shifts to the employer to now disprove the veracity of the information presented by the seafarer.

Subsequently, if the work-relatedness of the seafarer’s illness is not successfully disputed by the employer, and the seafarer is then able to establish compliance with the conditions of compensability, the matter now shifts to a determination of the nature (i.e., permanent and total or temporary and total) and in tum, the amount of disability benefits to be paid to the seafarer.

The seafarer is declared to be on temporary total disability during the 120-day period within . which he is unable to work. However, a temporary total disability lasting continuously for more than 120 days, except as otherwise provided in the Rules, is considered as a total and permanent disability. This exception pertains to a situation when the sickness “still requires medical attendance beyond the 120 days hut not to exceed 240 days,” in which case, the temporary total disability period is extended up to a maximum of 240 days.

Records show that Atienza, as an Able Seaman, was called to keep watch at sea during navigation, and to observe and record weather and sea conditions, among others. It was also not disputed that in the performance of his duties, Atienza was constantly exposed to cold, heat, and other elements of nature. It was likewise in the exercise of his functions that he experienced major symptoms of THS, namely, severe headache, nausea, and double vision.

The activities performed by Atienza necessarily entail the use of eye muscles that can cause an eye strain as in fact, he experienced headache, nausea, and double vision that worsened when he looked at his right side.

Further, compensability does not depend on whether the injury or disease was pre-existing at the time of the employment but rather if the disease or injury is work-related or aggravated his condition. It is indeed safe to presume that, at the very least, the arduous nature of the seafarer’s employment had contributed to the aggravation of his injury, if indeed it was pre-existing at the time of his employment.

Considering that Atienza’s complaint was filed on March 29, 2006, during which time the 120-day rule pronounced in Crystal Shipping was the prevailing doctrine, the failure of the company-designated physician to issue a final assessment within the 120-day period gave rise to a conclusive presumption that Atienza’s disability is total and permanent.

Thus, the SC concluded that the fact that the assessment was made beyond the 120-day period prescribed in the Labor Code this entitles him to the maximum disability benefit of USD60,000.00.