What to do in contradictory findings by employer, seafarer physicians on claims for disability benefits

What to do in contradictory findings by employer, seafarer physicians on claims for disability benefits
Rey G. Panaligan May 4, 2023 https://mb.com.ph/2023/5/3/what-to-do-in-contradictory-findings-by-emplo...

The Supreme Court (SC) has laid down the guidelines to resolve a seafarer’s claim for disability benefits in case of conflicting findings from the employer-designated physician and the seafarer’s physician of choice, and when the examination by a third physician is sought by the seafarer but is denied or not acted upon by the employer.

In decision written by Justice Samuel H. Gaerlan, the SC said that a seafarer who received contrary medical findings from his or her physician of choice must “within a reasonable period,’ request the employer a medical examination by a third physician of their mutual choice.

It said the request must contain the medical report of the seafarer’s physician of choice to be considered a valid request, and if a valid request is denied, a seafarer can file a complaint before the National Labor Relations Commission (NLRC).

Once the complaint is with the NLRC, the labor arbiter would direct both parties – employer and the seafarer – to secure a third physician. The failure of the parties to get a third physician would make the findings of the employer-designated physician final and binding “unless the same is found to be biased, i.e., lacking in scientific basis or unsupported by the medical records of the seafarer.”

If found biased, the issue would have to be resolved by the NLRC and thereafter by the court.

However, if both the employer and the seafarer were able to secure a third physician, the medical findings of the third physician “is considered final and binding.”

The seafarer’s request for the services of a third physician must be acted upon by the employer within 10 days from receipt. If the request is granted, the third physician must be secured in 15 days and the findings must be submitted in 30 days.

The SC decision, which contained the guidelines, dismissed the petition filed by seafarer Teodoro B. Bunayog who challenged the rulings of the labor arbiter and the NLRC in favor of his employer, Foscon Shipmanagement, Inc.

The NLRC’s decision, which denied Bunayog’s claim for total and permanent disability benefits, was affirmed by the Court of Appeals (CA). Bayog elevated his case to the SC.

In 2016, while onboard as chief cook of M/T Morning, Bunayog was diagnosed with pneumonia. After treatment and evaluation, the company-designated physician declared Bunayog fit to work.

Bunayog, however, presented a conflicting evaluation from his physician of choice, who declared him unfit for sea duty. Bunayog also requested another medical examination to confirm his permanent disability, but his employer failed to respond to his request.

He then filed a complaint before the NLRC. The labor arbiter dismissed his complaint. The dismissal was affirmed by NLRC and the CA.

In a summary, the SC’s public information office (PIO) said “the Court found that Bunayog sufficiently complied with the requirement to notify the employer of the seafarer’s request for a third doctor… because it included the medical report from his chosen physician.”

“The Court also found that Bunayog’s employer, Foscon, refused to act on Bunayog’s request. Hence, applying the guidelines, the findings of Bunayog’s physician should be conclusive between Bunayog and Foscon, unless such findings are clearly biased, i.e., lacking in scientific basis or unsupported by the medical records of the seafarer,” the PIO said.

But the PIO said: “Evaluating the medical report issued by Bunayog’s physician, the Court held it was vague and inconclusive. While the doctor’s medical certificate enumerated the tests Bunayog underwent, the results of such tests were not discussed nor correlated to the finding of unfitness to work as a seafarer. Thus, the findings of Bunayog’s physician were without any scientific and medical basis.”

“The Court also evaluated the findings of the company-designated physician and found them more credible given that the extensive medical treatment that enabled the doctor to make a final diagnosis of Bunayog’s health condition was sufficiently demonstrated,” it also said.

“Reviewing the conflicting medical findings based on their inherent merits and the totality of evidence, the Court found that the exception under the guidelines applies since there is no evidence that would justify compensation in favor of Bunayog on top of the monetary aid and assistance already extended to him by his employer,” the PIO said.

It said that “the Court stressed that while labor rules must be applied fairly, reasonably, and liberally in favor of the seafarers, they cannot be taken to sanction award of disability benefits anchored on flimsy evidence.”

It added that a copy of the decision will be posted online – sc.judiciary.gov.ph – once officially released to the public.