MEDICAL FINDINGS STATING THAT NO OTHER TREATMENT INTERVENTION IS REQUIRED AND PROVIDING A SPECIFIC DISABILITY GRADING ARE FINAL, ACCURATE, AND PRECISE

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Medical findings that provide that no other treatment intervention was indicated aside from continued self-guided home exercises and as needed intake of pain medication and the Disability Grading stating that it is a Grade 10 disability are final, accurate, and precise. Failure of the seafarer to comply with the third doctor rule means that the company-designated physician’s findings must be upheld.

Thus, the SC held as follows:

Magsaysay Maritime Corporation vs. Buico
G.R. No. 230901, December 5, 2019

Permanent disability; Sufficient justification for failure to give timely medical assessment; Third doctor rule; Failure by the seafarer to comply with the requirement of referral to a third doctor is tantamount to violation of the terms under the POEA-SEC; Without a binding third-party opinion, the final, accurate and precise findings of the company-designated physician prevail over the conclusion of the seafarer’s personal doctor

Facts:

On November 5, 2013, petitioner Magsaysay Maritime Corporation (Magsaysay), a local manning agency, in behalf of its principal, petitioner Princess Cruise Lines Ltd., collectively referred to as Magsaysay, et al., entered into a contract of employment with respondent Allan F. Buico (Buico) as Second Pantryman aboard the vessel Star Princess (Hotel).

While on board, Buico met an accident which caused him an injury on his right leg and ankle. After treatment abroad, he was repatriated to the Philippines on July 9, 2014 for further treatment. After examination, the company-designated physician initially diagnosed Buico to have “S/P ORIF (July 4, 2014-Canada) for Fracture, lateral and posterior malleolus with talar shift, right,” and recommended an orthopedic follow-up checkup and continued wound care. The company-designated physician again examined him on August 14, 2014 and, in a medical report, he recommended 12 sessions of physicaltherapy. All in all, he underwent therapy for a total of 36 sessions until November 28, 2014.

On October 11, 2014 and November 14, 2014, the company-designated physician issued an Interim Disability Grading, assessing Buico’s disability at Grade 10 pursuant to the POEA-SEC. Subsequently, on December 1, 2014, the company-designated physician gave a Final Medical Report and a Disability Grading of Grade 10 disability in accordance with the POEA-SEC.

Unhappy with this assessment, Buico consulted his own physician who diagnosed him unfit to perform sea duty in whatever capacity with a permanent disability status. On March 13, 2015, Buico filed a Complaint with the Labor Arbiter (LA) against Magsaysay, et al for permanent and total disability benefits.

On the part of Magsaysay, et al, they argued that Buico was not entitled to permanent and total disability benefits because the company-designated physician had already assessed his disability at Grade 10 pursuant to the POEA-SEC; Buico fialed to follow the third doctor rule; the company-designated physician had knowledge of Buico’s actual medical condition, hence, he was more qualified to assess his disability and his assessment should be upheld.

LA Ruling:

The LA found that Buico suffered from Grade 10 disability.

The LA ruled further that Buico’s physician’s assessment was not done thoroughly as that of the company-designated physician who had continuously attended to him for a period of more than four (4) months.

Aggrieved, Buico appealed with the National Labor Relations Commission (NLRC).

NLRC Ruling:

The NLRC reversed the LA.

The NLRC ruled that the referral to a third doctor was not mandatory and that the findings of the company-designated physician and the seafarer’s doctor were inconclusive because they still had to be weighed and considered by the labor tribunals.

Further, the NLRC ruled that the company-designated physician’s assessment was not accurate and precise, pointing out that the company-designated physician even admitted in the Final Medical Report that Buico was not restored to his previous condition, hence, his disability should therefore be considered as total and permanent.

The NLRC denied Magsaysay, et al.’s motion for reconsideration. Subsequently, Magsaysay, et al filed Rule 65 with the Court of Appeals.

CA Ruling:

The CA denied the petition and affirmed the NLRC rulings finding Buico entitled to permanent and total disability benefits.

The CA held that the Disability Grading given by the company-designated physician was not accurate and precise as to Buico’s actual medical condition. Because the company-designated physician failed to arrive at a definite assessment of Buico’s fitness or disability within the statutory periods, the CA ruled that Buico should be deemed totally and permanently disabled and entitled to the corresponding disability benefit.

Magsaysay, et a. filed a Motion for Reconsideration, but this was denied by the CA. Aggrieved, they filed the instant petition before the Supreme Court (SC).

Issue/s:

Whether or not extension beyond the 120-day period, and within the 240-day period, to come up with the final and definitive medical assessment is justified when the seafarer still required further medical treatment

Whether or not the findings of the company-designated physician were final, accurate, and precise, if there was a specific disability grading and it stated that there was no other treatment intervention indicated

Whether or not referral to a third doctor is mandatory to validly challenge the company-designated physician’s findings which is contradicted by seafarer’s personal doctor’s findings

SC Ruling:

The SC found the petition meritorious.

The SC held that it is settled that the seafarer’s entitlement to disability benefits is governed by law, the parties’ contracts, and by medical findings. Since Buico was employed in 2013, the procedure to be observed in claiming disability benefits is outlined in Section 20(A) of the 2010 POEA-SEC.

When a seafarer suffers a work-related injury, the employer is obligated to refer the seafarer to a company-designated physician who has to arrive at a definite assessment of the seafarer’s fitness or degree of disability within a period of 120 days from repatriation. However, if there is no definitive declaration because the seafarer required further medical attention, then the period may be extended up to a maximum of 240 days, subject to the right of the employer to declare within this period that a permanent, partial or total disability already exists.

In the case at bar, while the company-designated physician had issued both the Final Medical Report and Disability Grading on December 1, 2014—beyond the initial 120-day period from repatriation which ended on November 6, 2014—there was sufficient justification for such failure to give a timely medical assessment and to extend the period of diagnosis and treatment because Buico had required further medical treatment. Buico had religiously undergone therapy until November 28, 2014. The Final Medical Report and Disability Grading was thus timely issued by the company-designated physician within the extended 240-day period which ended on March 6, 2015.

The SC held further that the Final Medical Report finding that no other treatment intervention was indicated aside from continued self-guided home exercises and as needed intake of pain medication and the Disability Grading stating that it is a Grade 10 disability are final, accurate, and precise. There was specific disability grading and it stated that there was no other treatment intervention indicated for Buico.

The disability grading given by the company-designated physician was a result of several months of diagnosis and treatment. In fact, this Grade 10 disability rating was already given to Buico at least twice as an interim disability grading, thereby further lending credence to the assessment given by the company-designated physician.

In the fact of such final disability grading given by the company-designated physician within the prescribed period, the seafarer who intends to contest such assessment has the duty to observe the third doctor provision under the POEA-SEC. In case of non-observance by the seafarer of the third doctor referral provision in the contract, the employer can insist on the company-designated physician’s assessment even against the contrary opinion by another doctor, unless the seafarer express his disagreement by asking for a referral to a third doctor who shall make a determination and whose decision shall be final and binding on the parties. Securing a third doctor’s opinion is the duty of the seafarer, who must actively or expressly request for it.

Without referral to a third doctor, there is no valid challenge to the company-designated physician’s findings. Ultimately, therefore, the company-designated physician’s findings in such situation must be upheld over the findings of the personal doctor of the seafarer. Buico filed a complaint against his employers without first requesting the company for the referral of the matter to a third doctor.

This failure by Buico to comply with the requirement of referral to a third doctor is tantamount to violation of the terms under the POEA-SEC. consequently, without a binding third-party opinion, the final, accurate and precise findings of the company-designated physician prevail over the conclusion of the seafarer’s personal doctor.