PERMANENT AND TOTAL DISABILITY ARISES WHERE THE COMPANY-DESIGNATED PHYSICIAN FAILED TO ISSUE MEDICAL FINDINGS WITHIN THE 120-DAY PERIOD AND LACK OF JUSTIFICATION TO EXTEND TO 240 DAYS

Permanent and total disability benefits may be awarded to seafarers whose medical treatment lasted for more than 120 days, but not exceeding 240 days, because the company-designated physician did not give a justification for extending the period of diagnosis and treatment. If the treatment of 120 days is extended to 240 days, but still no medical assessment is given, the finding of permanent and total disability becomes conclusive.

Thus, the SC held in the following case:

Abosta Shipmanagement Corp. vs. Segui
G.R. No. 214906, January 16, 2019

Facts:

Respondent Dante C. Segui (Seguialleged that he was hired by petitioners Abosta Shipmanagement Corporation/Cido Shipping Company Ltd./ Alex Estabillo (Abosta, et al.) as an able seaman on board the vessel MN Grand Quest. His employment was covered by an ITF IBF JSU Collective Bargaining Agreement (CBA).

During Segui’s employment, he would be on duty more than 12 hours a day resulting in extreme fatigue and exhaustion. While on duty, he felt cramps followed by a severe back pain. Later, he was admitted to a medical facility and he underwent an x-ray of his back and injection on his left knee. He was diagnosed with a lumbar disc problem and was recommended repatriation.

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On December 2, 2010, he arrived in Manila and was referred to the Manila Doctors Hospital where a CT Scan showed he was suffering from “Circumferential Disc Bulge at L4-L5 with Posteromedial Herniation of the Nucleus Pulposus as well as associated Spinal Canal and Neuroforaminal Narrowings as described; Lumbar Spondylosis”. On December 14, 2010, he underwent Laminotomy and Discectomy at Level L4-L5 and was confined for 3 weeks. He continued with his therapy but his condition did not improve. Despite the treatment, his pain and discomfort persisted, thus, he sought another treatment and opinion from an independent doctor in the person of Dr. Nicanor Escutin. After a thorough examinations and test, his doctor concluded that the nature and extent of his injury rendered him permanently and totally unable to work as a seafarer.

Thus, Segui asked Abosta, et al. to pay his total and permanent disability. The latter however, refused. Hence, the complaint filed with the Labor Arbiter.

For its part, Abosta, et al. did not dispute the circumstances of Segui’s engagement and subsequent deployment to his assigned vessel, as well as his repatriation on medical grounds, but deny liability for the claims. Abosta, et al. argued that following his repatriation on December 2, 2010 he was immediately referred to the company-designated physician. Segui was diagnosed with Lumbar Disc Herniation and was referred to an orthopedic surgeon and physiatrist. He underwent foraminotomy and discectomy of [L4-L5] and tolerated the procedure well. He was placed on therapy for healing and possible fitness to work.

However, unknown to Abosta, et al., Segui stopped attending his medical appointments and instituted his complaint. During the mandatory conferences, Abosta, et al. prevailed upon Segui to continue his treatment for the final disability assessment. Segui returned to the company-designated physician on May 17, 2011 to continue treatment and obtain his final assessment. Finding that Segui had reached maximum medical cure, the company-designated-physician assessed him with Grade 8 disability-moderate rigidity or 2/3 loss of motion of lifting power of the trunk.

Hence, Abosta, et al. argued that Segui is only entitled to the compensation corresponding to the assessment made by the company-designated physician. There is no basis to claim permanent total disability compensation. He failed to prove his entitlement to full disability compensation. Finally, they argued that the findings of the company-designated physician are binding on Segui.

LA Ruling:

The LA rendered a Decision in favor of Segui.

The LA held that Segui is entitled to maximum disability benefit after finding that he suffered from a work-related illness/injury while on board the vessel, and applying the terms and conditions of the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC), which is incorporated in his employment contract. Section 20.B of POEA-SEC provides that the employer shall be liable for disability compensation for work-related illness/injury sustained during the term of the contract.

NLRC Ruling:

On appeal to the National Labor Relations Commission (NLRC), the commission affirmed the Decision of the LA.

The NLRC pronounced that since the International Transport Workers’ Federation (ITF) Standard Agreement provides for higher disability compensation than the POEA-SEC, the former should prevail over the latter. The NLRC also ruled that while it is the company-designated physician who must declare that the seaman suffered permanent disability during employment, it does not deprive the seafarer of his right to seek a second opinion, which can then be used by the labor tribunals in awarding disability claims.

Abosta, et al. moved for reconsideration, which the NLRC denied in a Resolution. Undaunted, Abosta, et al. elevated the case to the Court of Appeals (CA) through a petition for certiorari under Rule 65 of the Rules of Court, as amended.

CA Ruling:

The CA rendered a Decision dismissing the petition and affirming the NLRC’ s Decision.

The CA resolved that the NLRC did not commit grave abuse of discretion in affirming the LA’s award of permanent total disability benefits and maximum disability benefits to respondent Segui. The CA expounded that the disability is considered total if there is disablement of an employee to earn wages in the same kind of work of similar nature that he was trained for, or accustomed to perform, or any kind of work, which a person of his mentality and attainments could do. It does not mean absolute helplessness.

The disability is considered permanent if there is inability of a worker to perform his job for more than 120 days, regardless of whether he loses the use of any part of his body. What determines entitlement to permanent disability benefits is the inability to work for more than 120 days.

The CA’s findings reveal that from the date of Segui’s repatriation on December 2, 2010 up to his consultation with his physician of choice on June 4, 2011, more than 120 days have passed and the company-designated physician failed to give him a disability grading or declare him fit to work.

The company-designated physician only gave him a disability grading when he had already reached a maximum medical cure and even then, Segui’ s condition had not improved. Although he was given a disability grading, the company-designated physician did not declare him fit for sea duty in any capacity.

Thus, the CA determined that the NLRC was correct in affirming the LA’s Decision in declaring his disability as total and permanent, and awarding maximum disability benefits to Segui.

Abosta, et al. moved for reconsideration, which the CA denied in a Resolution.

Issue/s:

Whether or not the failure of the company-designated physician to issue medical assessment within the 120-day period and absence of justification to extend the period to 240 days rendered the disability permanent and total although he issued a disability rating of only Grade 8 on the 219^th day from repatriation

SC Ruling:

The SC denied the petition.

The SC held that in the case of Elburg Shipmanagement Phils., Inc. v. Quiogue, the Court expounded and summarized the rule in awarding permanent and total disability benefits.

If there is a claim for total and permanent disability benefits by a seafarer, the following rules shall govern:

1. The company-designated physician 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 company-designated physician fails to give his assessment within the period of 120 days, without any justifiable reason, then the seafarer’s disability becomes permanent and total;
3. If the company-designated physician fails to give his 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 company-designated physician has sufficient justification to extend the period; and
4. If the company-designated physician still fails to give his assessment within the extended period of 240 days, then the seafarer’s disability becomes permanent and total, regardless of any justification.

In the present case, the records reveal that from Segui’s repatriation and immediate referral to the company-designated physician on December 2, 2010 until the 120-day period on March 31, 2011, the latter did not issue a medical assessment on Segui’s disability grading. It was only on the 219th day or on July 8, 2011, when Segui reached the maximum medical cure, that the company-designated physician issued a disability rating of “Grade 8 disability -moderate rigidity or 213 loss of motion or lifting power of the trunk.”

Notably, the company-designated physician did not determine Segui’s fitness to work. Clearly, there was non-compliance with Items 1 and 2 of the rules on claim for total and permanent disability benefits cited in the Elburg case. The company-designated physician failed to issue a medical assessment within the 120-day period from the time Segui reported to him, and there was no justifiable reason for such failure. Likewise, there was no sufficient justification to extend the 120-day period to 240 days.

Thus, following the above rules, Segui ‘s disability becomes permanent and total, and entitles him to permanent and total disability benefits under his contract and the collective bargaining agreement.