FINAL MEDICAL ASSESSMENT IS REQUIRED BEFORE REFERRAL TO THIRD DOCTOR

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Final medical assessment on the seafarer’s disability grading is required to be issued to determine the extent of compensation. Thus, the SC held in the following case:c

Wilhelmsen Smith Bell Manning, Inc., et al. vs. Villaflor
G.R. No. 225425, January 29, 2020

Final and definitive assessment; Third doctor; Disability rating of foreign doctor merely addressed to company-designated physician

Facts:

Petitioner Wilhelmsen Smith Bell Manning, Inc., on behalf of its principal Wilhelmsen Ship Management Ltd. (collectively, WSBM, et al.) hired respondent Franklin J. Villaflor (Villaflor) as Third Engineer on board their vessel MIV NOCC Puebla on a seven-month contract.

Villaflor underwent the required pre-employment medical examinations and was thereby pronounced fit to work on August 22, 2012. Villaflor boarded the vessel.

On board, while conducting maintenance works on the vessel and lifting heavy engine and generator spare parts with his crewmates, Villaflor felt severe back pain which caused him to fall on his knees. He was given pain relievers by his superiors for immediate relief but was advised by the Master to be repatriated for further examination.

Villaflor was, thus, medically repatriated on March 28, 2013. Upon arrival in Manila, WSBM, et al. referred Villaflor to Marine Medical Service for examination. He was diagnosed to have S/P Laminotomy, L4 Bilateral Interspinous Process Decompression Coflex and has been advised to regularly consult with the specialists for the monitoring of his condition. He also underwent out-patient rehabilitation sessions at the Metropolitan Medical Center.”

On July 9, 2013, Dr. William Chuasuan, Jr. (Dr. Chuasuan), an Orthopedic and Adult Joint Replacement Surgeon, issued a letter addressed to the company-designated physician, Dr. Robert D. Lim (Dr. Lim), stating that Villaflor’s prognosis is guarded and that the latter had already reached his maximum medical improvement. Consequently, Dr. Chuasuan gave Villaflor a disability grading of 8 or 2/3 loss of lifting power of the trunk. Despite this, the company-designated physician still advised Villaflor to continue with his medications and rehabilitation. Villaflor was also directed to see Dr. Lim sometime in May 2014.

Villaflor independently consulted a physician of his choice, Dr. Manuel C. Jacinto, Jr. (Dr. Jacinto). Dr. Jacinto issued a Medical Certificate, stating that Villaflor’s disability is total and the cause of injury is work-related/work-aggravated, thus, declaring Villaflor unfit to go back to work as a seafarer. This promptedVillaflor to file a complaint for total and permanent disability benefits against WSBM, et al..

For its part, WSBM, et al. alleged that Villaflor’s condition was merely brought about by the recurrence of his lumbar problem from his previous employment, for which he had already claimed total and permanent disability benefits from his previous employer.

LA Ruling:

The labor arbiter (LA) dismissed the complaint for disability benefits.

The LA found that Villaflor’s injury is not work-related as it was merely a recurrence of the condition he suffered from his previous employment and as such, the complained injury did not occur during his term of employment with WSBM, et al..

NLRC Ruling:

On appeal, the National Labor Relations Commission (NLRC) affirmed the dismissal of the complaint.

The NLRC found that Villaflor failed to exhibit good faith when he entered into the contract of employment with WSBM, et al. as he already knew that he was not fit to work then, considering that he previously pursued a case for and was actually granted total and permanent disability benefits against his former employer. Hence, Villaflor’s appeal was likewise dismissed.

Villaflor’s motion for reconsideration of said NLRC Resolution was likewise denied.

CA Ruling:

The Court of Appeals (CA) reached a different conclusion.

The CA ruled that WSBM, et al. cannot harp on the fact that Villaflor had previously claimed disability benefits from his former employer. According to the CA, the fact that Villaflor was able to find gainful employment even after such claim against his former employer does not preclude him from instituting another disability claim against his WSBM, et al. as long as his complained injury is work-related or work-aggravated and that such injury has prevented him from doing the same work.

The CA found that when WSBM, et al. engaged Villaflor’s services, they were aware of the latter’s history of back injury as this was disclosed by Villaflor in his PEME. Despite such history, Villaflor passed all the required tests in the PEME and was declared fit to work. The CA also found that while Villaflor had a pre-existing back problem, his condition was aggravated by the nature of his work on board the vessel as Third Engineer like lifting heavy materials during maintenance operations, among others.

It was further found that while Dr. Chuasuan gave Villaflor a Grade 8 disability rating, his findings also stated that the prognosis on Villaflor’s case is guarded, meaning “the outcome of the patient’s illness is in doubt.” Villaflor was thereafter still required to continue his medications and rehabilitation for over a year since his repatriation. Hence, the CA concluded that Villaflor is considered totally and permanently disabled.

WSBM, et al. then filed a motion for reconsideration which was denied by the CA.

Issue/s:

Whether or not the medical findings on disability of a foreign doctor addressed to the company-designated physician amounts to final and definitive assessment

Whether or not referral to third doctor is mandatory if there is no final and definitive medical assessment

Whether or not the resurgence of seafarer’s former disability condition bars disability claim against the new employer

SC Ruling:

The Supreme Court (SC) affirmed the rulings of the CA.

The SC held that the CA correctly ruled that WSBM, et al. could not harp on the fact of Villaflor’s previous disability benefits complaint against his former employer to support their argument that Villaflor’s condition is not work related as it is pre-existing. It is noteworthy that despite such back injury history, Villaflor was able to pass all the required tests in the PEME. It should also be pointed out that WSBM, et al. were aware of such history as Villaflor disclosed the same in his PEME. Nevertheless, WSBM, et al. engaged his services.

Hence, while it may be true that Villaflor’s back injury is a recurrence of his previous condition, still, such recurrence can be attributed to the nature of his work on board WSBM, et al.’ vessel. As found by the CA, the normal duties of a Third Engineer include daily maintenance and operation of the engine room, which entail activities such as lifting of heavy materials and spare parts. It was also established that Villaflor felt pain in his back while lifting some heavy spare engine parts during maintenance operations with his co-workers. That Villaflor’s condition is work aggravated and as such, compensable, cannot be denied.

As to the extent of compensability, the entitlement of an overseas seafarer to disability benefits is governed by the law, the employment contract, and the medical findings in accordance with the rules. By law, the seafarer’s disability benefits claim is governed by Articles 191 to 193, Chapter VI of the Labor Code, in relation to Rule X, Section 2 of the Implementing Rules and Regulations (IRR) of the Labor Code.

A disability is total and permanent if as a result of the injury or sickness the employee is unable to perform any gainful occupation for a continuous period exceeding 120 days, except as otherwise provided for in Rule X of these Rules. The exception to the 120-day rule repeatedly cited above is Rule X of the Implementing Rules and Regulations (IRR) of Book IV of the Labor Code, specifically Section 2 thereof.

By the medical findings, the assessment of the company-designated doctor generally prevails, unless the seafarer disputes such assessment by exercising his right to a second opinion by consulting a physician of his choice, in which case, the medical report issued by the latter shall also be evaluated by the labor tribunal and the court, based on its inherent merit. In case of disagreement in the findings of the company-designated doctor and the seafarer’s personal doctor, the parties may agree to jointly refer the matter to a third doctor whose decision shall be final and binding on them.

In the landmark case of Elburg Shipmanagement Phils., Inc. vs. Quiogue, Jr., the Court had the occasion to summarize the rules above cited regarding the company-designated physician’s duty to issue a final medical assessment on the seafarer’s disability grading to determine the extent of compensation.

In this case, Villaflor was repatriated on March 28, 2013. He was immediately referred to the company-designated physician upon arrival. While he was subjected to a series of medications and rehabilitation, no definite disability assessment was, however, given to Villaflor at all. The Grade 8 disability rating given by Dr. Chuasuan cannot be considered as the complete, definite, and final medical assessment contemplated by the rules.

Consider: the Grade 8 disability assessment given by Dr. Chuasuan was merely addressed to Dr. Lim, who despite such assessment from the specialist, still advised Villaflor to continue with his medications and rehabilitation. Records also show that up to May 2014, Villaflor was still ordered to see Dr. Lim for re-evaluation. Villaflor’s treatment lasted for over a year, evidencing that Villaflor’s condition remained unresolved. Also worthy is the fact that Dr. Chuasuan’s prognosis on Villaflor’s condition was guarded, meaning, “the outcome of the patient’s illness is in doubt.”

Clearly, there is nothing definite and final in the assessment given by the company-designated doctor/s to Villaflor’s condition. Due to this failure, Villaflor’s disability, under legal contemplation, is deemed total and permanent.

To emphasize, a final and definite disability assessment within the 120-day or 240-day period under the rules is necessary in order to truly reflect the true extent of the sickness or injuries of the seafarer and his capacity to resume to work as such. Otherwise, the corresponding disability benefits awarded might not be commensurate with the prolonged effects of the injuries suffered.

Invoking Section 20(A)(6) of the 2010 POEA-SEC will not help WSBM, et al.’ case. Indeed, the recent amendments on the POEA-SEC, specifically Section 20(A)(6) thereof, states that “[t]he disability shall be based solely on the disability gradings provided under Section 32 of this contract, and shall not be measured or determined by the number of days a seafarer is under treatment or the number of days in which sickness allowance is paid.”

Nevertheless, the Court has consistently ruled that before the disability gradings under Section 32 should be considered, the disability ratings should be properly established and contained in a valid and timely medical report of a company-designated physician or the third doctor agreed upon by the parties. In other words, the periods prescribed by the rules should still be complied with. Thus, the foremost consideration of the courts should be to determine whether the medical assessment or report of the company-designated physician was complete and appropriately issued; otherwise, the medical report shall be set aside and the disability grading contained therein cannot be seriously appreciated.

As above-discussed, no final and complete assessment was given in this case.