Concealment of pre-existing illnesses and disability benefits

Concealment of pre-existing illnesses and disability benefits
ATTY. DENNIS R. GORECHO - | November 12,2019 https://cebudailynews.inquirer.net/269674/concealment-of-pre-existing-il...

A seafarer must fully disclose past medical condition, disability and history in the pre-employment medical examination (PEME), otherwise his claim for disability benefits will be denied.

The POEA contract bars the compensability of disability arising from a pre-existing illness when attended by a seafarer’s fraudulent misrepresentation.

The POEA contract states that “a seafarer who knowingly conceals and does not disclose past medical condition, disability and history in the pre-employment medical examination constitutes fraudulent misrepresentation and shall disqualify him from any compensation and benefits.”

This rule in compensation cases was recently reiterated by the Supreme Court in the case of Danilo Lerona vs. Sea Power Shipping Enterprises (G.R. No. 210955 August 24, 2019).

In denying the claims, the Supreme Court noted that the seafarer did not indicate in the appropriate box in his Pre-Employment Medical Examination (PEME) form that he has hypertension, although he had been taking Norvasc as maintenance medicine for two years.

The seafarer only disclosed his pre-existing medical condition after he was repatriated to the Philippines.

The Supreme Court brushed aside the seafarer’s argument that he did not reveal his hypertension during his PEME out of an honest belief that it had been “resolved.”

The Court noted the fact that the seafarer continues to take maintenance medicine indicates that his condition is not yet resolved. Additionally, within the two years that he had been taking maintenance medication for his hypertension, he had boarded the company’s ships four times.

Since PEME is mandatory before a seafarer is able to board a ship, the Court stressed that it goes to show that the seafarer concealed his hypertension no less than four times as well, which negates any suggestion of good faith that petitioner makes in defense of his misdeed.

However, the Supreme Court ruled in an earlier case that honest mistakes on a pre-existing illness during the PEME will not deprive seafarers of their right over disability or death benefits.

In Manansala, v. Marlow Navigation Phils., Inc. (G.R. No. 208314, August 23, 2017),the Supreme Court noted that the contract’s terminology is carefully calibrated: it does not merely speak of incorrectness, falsity, of incompleteness or inexactness, or failure to disclose the truth. Rather, to negate compensability, it requires fraudulent misrepresentation, that he deliberately concealed it for a malicious purpose.

To amount to fraudulent misrepresentation, falsity must be coupled with intent to deceive and to profit from that deception.

Between the seafarer and an examining physician, the Supreme Court said that the latter is in a better position to assess fitness for the rigors of sea duty. Apart from one’s literal body, the seafarer’s only other contribution to a medical examination is a set of responses to questions.

His personal health assessment is based on his amateur opinion, or otherwise unrefined understanding of nuanced medical conditions. In contrast, the PEME procedures are conducted and supervised by professionals with scientific and technical capabilities.

Ultimately, the Supreme Court said that it is more appropriate that the examining physician, a trained professional, and not the seafarer, who is a layperson, be faulted for discounting the presence of diseases even after subjecting the seafarer to a series of procedures, verifiable empirical data, which are then evaluated by a physician.

Consequently, reasonable leeway may be extended for inability to make complete and fastidiously accurate accounts when this inability arises from venial human limitation and frailty. This is a normal tendency for laypersons-such as seafarers-rendering accounts of their own medical conditions.

The greater possibility is that a seafarer’s self-assessment of personal medical conditions will fail to capture nuances that can make the difference between fitness and unfitness for work

As laypersons, they do not have the requisite medical knowledge to properly characterize their illnesses.

Even if they are aware of their own medical conditions, they may, in their non professional opinion but still in good faith, be convinced that their conditions are not so severe and that they can manage to perform work aboard a vessel.

Seafarers cannot be held to account under an inordinate standard. The POEA contract takes exception to fraudulent misrepresentation, not to honest mistakes.