• When claim of disability benefits is premature

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    Persida Acosta

    Dear PAO,
    My son worked as a seafarer in a foreign vessel and was found to have been injured. It has been 112 days and the company-designated doctor still has not determined the disability classification of my son. Yesterday, he filed an action against the company for failing to give him the disability benefits due him. Will my son win his case?
    Sincerely yours,
    Eula

    Dear Eula,
    In the case of Status Maritime Corporation, et al. v. Rodrigo C. Doctolero (G.R. No. 198968, 18 January 2017), pennedby the Honorable Associate Justice Lucas P. Bersamin, there is an extensive discussion about the claims on disability benefits and when filing of a complaint relative to it is actually premature. It is stated in the said case:

    “Permanent and total disability is defined in Article 198(c )

    (1) of the Labor Code, to wit:

    xx xx
    (c) The following disabilities shall be deemed total and permanent:

    (1) Temporary total disability lasting continuously for more than one hundred twenty days, except as otherwise provided for in the Rules.

    xx xx
    “The relevant rule is Section 2, Rule X, of the Rules and Regulations implementing Book IV of the labor Code, which states:

    Period entitlement. – (a) The income benefit shall be paid beginning the first day of such disability. If caused by an injury or sickness it shall not be paid longer than 20 consecutive days except where such injury or sickness still requires medical attendance beyond 120 days but not to exceed 240 days from onset of disability in which case benefit for temporary total disability shall be paid. However, the System may declare the total and permanent status at anytime after 120 days of continuous temporary total disability as may be warranted by the degree of actual loss or impairment of physical or mental functions as determined by the System.

    “These provisions have to be read together with the POEA-SEC, whose Section 20(3) states:

    Upon sign-off from the vessel for medical treatment, the seafarer is entitled to sickness allowance equivalent to his basic wage until he is declared fit to work or the degree of permanent disability has been assessed by the company-designated physician but in no case shall this period exceed one hundred twenty (120) days.

    “Applying the aforementioned provisions, we find the filing of the respondent’s claim to be premature. In order for a seafarer’s claim for total and permanent disability benefits to prosper, any of the following conditions should be present:

    (a) The company-designated physician failed to issue a declaration as to his fitness to engage in sea duty or disability even after the lapse of the 120-day period and there is no indication that further medical treatment would address his temporary total disability, hence, justify an extension of the period to 240 days;

    (b) 240 days had lapsed without any certification issued by the company designated physician;

    (c) The company-designated physician declared that he is fit for sea duty within the 120-day or 240-day period, as the case may be, but his physician of choice and the doctor chosen under Section 20-8(3) of the POEA-SEC are of a contrary opinion;

    (d) The company-designated physician acknowledged that he is partially permanently disabled but other doctors who he consulted, on his own and jointly with his employer, believed that his disability is not only permanent but total as well;

    (e) The company-designated physician recognized that he is totally and permanently disabled but there is a dispute on the disability grading;

    (f) The company-designated physician determined that his medical condition is not compensable or work-related under the POEA-SEC but his doctor-of-choice and the third doctor selected under Section 20-B(3) of the POEA-SEC found otherwise and declared him unfit to work;

    (g) The company-designated physician declared him totally and permanently disabled but the employer refuses to pay him the corresponding benefits; and

    (h) The company-designated physician declared him partially and permanently disabled within the 120-day or 240-day period but he remains incapacitated to perform his usual sea duties after the lapse of said periods.

    “Although the degree and extent of the seafarer’s disability constitute a factual question that this Court should not re-assess on review, the conflict between the factual findings of the Labor Arbiter and NLRC, on one hand, and those of the CA, on the other hand, compel the Court to dwell on the factual matters and to re-examine the evidence adduced by the parties. Upon its re-evaluation of the records, therefore, the Court concludes that the CA’s findings in favor of entitling Doctolero to permanent and total disability benefits were erroneous. While the fact that Doctolero suffered the disability during the term of his contract was undisputed, it was evident that he had filed his complaint for disability benefits before the company-designated physician could determine the nature and extent of his disability, or before even the lapse of the initial 120-day period. With Doctolero still undergoing further tests, the company-designated physician had no occasion to determine the nature and extent of his disability upon which to base Doctolero’s “fit to work” certification or disability grading. Consequently, the petitioners correctly argued that Doctolero had no cause of action for disability pay and sickness allowance at the time of the filing of his complaint.” [Emphasis and underscoring supplied]

    In sum, the 120-day period set forth by law should be abided. Your son cannot just file a complaint to claim for his disability benefits pending the determination of the company-designated physician. Moreover, under the law, the company-designated physician, provided that there was a justifiable reason, can still make a determination of the nature of your son’s disability within 240 days. Hence, considering that your son filed a complaint for the claim of his disability benefits short of the period given by the contract and the law to the company-designated physician to determine its proper classification, your son may not succeed in the case he just filed.

    Again, we find it necessary to mention that this opinion is solely based on the facts you have narrated and our appreciation of the same. The opinion may vary when the facts are changed or elaborated.

    We hope that we were able to enlighten you on the matter.

    Editor’s note: Dear PAO is a daily column of the Public Attorney’s Office. Questions for Chief Acosta may be sent to dearpao@manilatimes.net.

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