FAILURE TO ISSUE A FINAL AND DEFINITE MEDICAL ASSESSMENT WITHIN THE 120-DAY PERIOD MAKES SEAFARER ENTITLED TO PERMANENT AND TOTAL DISABILITY BENEFITS

Issuance of final and definite medical assessment within the 120-day period from repatriation of the seafarer is necessary to comply with the legal requirements concerning claim for permanent and total disability.

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. 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.

Hence, the Supreme Court (SC) held in the following case:

Jebsens Maritime, Inc. and/or Star Clippers, Ltd. vs. Mirasol
G.R. No. 213874, June 19, 2019

Permanent and total disability; Final, conclusive, and definite medical assessment; A final, conclusive, and definite medical assessment must clearly state whether the seafarer is fit to work or the exact disability rating, or whether such illness is work-related, and without any further condition or treatment; The final, conclusive, and definite medical assessment should no longer require any further action on the part of the company-designated physician and it is issued by the company-designated physician after he or she has exhausted all possible treatment options within the periods allowed by law; Failure to issue a final and definite assessment within the 120-day period makes Mirasol entitled to permanent and total disability benefits.

Facts:

Respondent Edgardo M. Mirasol claims that he is entitled to total permanent disability benefits of US$60,000.00 under the POEA Standard Employment Contract.

Mallari alleged that he incurred illness which is work-related as it was sustained in the course of his duties. It was not pre-existing since he underwent the mandatory pre-employment medical examination before he was employed by Petitioner Jebsens Maritime, Inc. (Jebsens, et al.), and was found to be fit and given a clean bill of health. He argued that the law does not require that a seafarer be totally paralyzed in order to claim total permanent disability benefits.

In filing his complaint, Mallari contended that he is entitled to moral and exemplary damages, and attorney’s fees, moral damages, and exemplary damages. Further, Jebsens, et al.’s refusal to pay sickness allowance is a manifest sign of bad faith which makes them liable for damages.

Jebsens, et al. filed their Position Paper and averred, inter alia, that Mallari is not entitled to disability compensation under the POEA Standard Employment Contract because his testicular cancer is not work-related. According to them Section 32 of the POEA Standard Employment Contract states that epidydimitis and testicular cancer are not considered as occupational diseases. Section 32-A of the POEA Standard Employment Contract provides that for an occupational disease and the resulting disability or death to be compensable, four conditions must be satisfied. None of these conditions have been met.

Jebsens, et al. further countered that Mallari’s work did not involve the risks inherent in acquiring epidydimitis and testicular cancer; none of his duties as a First Cook was a contributing factor in the development of epidydimitis which is an illness pertaining to the male reproductive organ in relation to sexual intercourse. Testicular cancer is a disease in which cells become malignant in one or both testicles. He has the burden of proving the reasonable connection between his ailments and his working conditions. He was onboard the Royal Clipper for ten days before he started complaining of pain in his right testicle. Thus, it is medically impossible for him to have developed his epidydimitis and testicular cancer in such a short period of time.

Jebsens, et al. argued that Mallari’s epidydimitis, which became testicular cancer, is not work-related, and not compensable and he is not entitled to sickness allowance and reimbursement of medical expenses, damages and attorney’s fees.

LA Ruling:

The LA found that Jebsens, et al. were liable to pay Mirasol permanent and total disability benefits and sickness allowance for 120 days, as well as attorney’s fees.

The LA found that Mirasol acquired epidydimitis and testicular cancer while he was on-board the vessel because he was declared fit to work during his pre-employment medical examination. The LA also found that Mirasol was subjected to enormous stress and constantly exposed to dusts, If chemical irritants, and/or natural elements such as harsh sea weather.

NLRC Ruling:

On appeal, the NLRC partially granted the appeal, modifying the LA Decision by ordering Jebsens, et al. who are solidarily held liable, to pay Mallari disability compensation in the amount of US$7,465 corresponding to the Grade II Schedule of Disability under Section 32 of the POEA Standard Contract.

The NLRC ruled that Mirasol’s testicular cancer is not work-related because Mirasol complained of pain in his right testicle on his 10th day onboard the   vessel and that cancer cannot happen in just 10 days. Nonetheless, the NLRC ruled that given the fact that it was undisputed that Mirasol lost one testicle, which is considered an illness under Urinary and Generative Organs with a disability grade of 11, Mirasol is entitled to US$7,465.00. Having failed to show proof of payment of sickness allowance to Mirasol, the NLRC affirmed the LA’ s award of sickness allowance to Mirasol.

CA Ruling:

Aggrieved, Mirasol filed a petition for certiorari with the CA, which nullified the NLRC Resolutions and reinstated the LA Decision.

The CA ruled that Mallari is entitled to permanent and total disability benefits because the company-designated physicians failed to arrive at a timely and definite assessment of Mirasol’s fitness to work or permanent disability. The CA found that Mirasol was repatriated on August 4, 2012 and in a Medical Report dated August 29, 2012, the company-designated physicians diagnosed Mirasol with epidydimitis and solid mass in his right testicle and recommended for radical orchiectomy.

The CA found that Mirasol was admitted at the Manila Doctors Hospital on October 18, 2012, radical orchiectomy was performed on October 19, 2012, and he was discharged from the hospital on October 23, 2012. Thereafter, the company-designated physicians did not arrive at an assessment of Mirasol’s fitness to work or permanent disability. The CA therefore ruled that Mirasol is entitled to permanent and total disability benefits for the company-designated physicians’ failure to declare a definite assessment of Mirasol’s fitness to work or permanent disability during the 120 or 240-day periods.

Further, the CA affirmed the award of sickness allowance and attorney’s fees. Hence Jebsens, et al. moved for reconsideration but the CA denied this. Hence, this Petition.

Issue/s:

Whether or not an illness cannot be considered work-related when the seafarer only experienced symptoms ten (10) days after joining the vessel

SC Ruling:

The SC denied the petition.

Citing El burg Shipmanagement Phils., Inc. vs. Quiogue, Jr. (El burg), the SC held that it is in said decision the the Court summarized the rules when a seafarer claims total and permanent disability benefits, thus:

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.

A final, conclusive, and definite medical assessment must clearly state whether the seafarer is fit to work or the exact disability rating, or whether such illness is work-related, and without any further condition or treatment. It should no longer require any further action on the part of the company-designated physician and it is issued by the company-designated physician after he or she has exhausted all possible treatment options within the periods allowed by law.

Here, Jebsens, et al. admit that Mallari was repatriated on August 4, 2012. Further, they also admit that the last medical assessment issued by the company-designated physicians was on August 29, 2012 where the status of treatment was declared as in progress.

The foregoing shows that the 5th Medical Report does not reflect a definite and final assessment of Mirasol’s fitness to work or disability rating, or whether his illness was work-related. The report was merely an interim report as it specifically stated a date for the next appointment. Further, it indicates that Mirasol’s treatment was “in progress.”

Following Elburg, the company-designated physicians’ failure to issue a final and definite assessment within the 120-day period makes Mirasol entitled to permanent and total disability benefits. It was no longer necessary for Mirasol to present evidence that his illness is work-related and compensable because the law operates to declare Mirasol entitled to total and permanent disability benefits after the company-designated physicians’ failure to issue a final and definite assessment within the 120-day period.