BW Shipping Philippines, Inc. vs. Ong

A seafarer's entitlement to permanent total disability benefits requires proof that the illness is work-related and existed during the term of the employment contract; where the seafarer fails to substantiate work-causation or work-aggravation and fails to comply with the third-doctor referral mechanism under Section 20(A)(3) of the POEA-SEC, the company-designated physician's fit-to-work declaration prevails.

Respondent Mario H. Ong was a seafarer repeatedly hired and promoted by petitioner BW Shipping Philippines, Inc. over a span of nine years. The entitlement of overseas seafarers to disability benefits is governed not only by medical findings but also by law and contract — the employment contract and the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC), which are deemed incorporated therein. Section 20(B), paragraph 6 of the 2000 POEA-SEC sets two conditions for compensability: the illness must be work-related and must have existed during the term of the seafarer's employment contract. Section 32-A of the POEA-SEC enumerates recognized occupational diseases and their corresponding disability gradings, while Section 20(A)(3) establishes a mandatory conflict-resolution mechanism whereby a seafarer who disagrees with the company-designated physician's assessment must refer the matter to a third doctor jointly agreed upon by the parties, whose decision is final.

Respondent Mario H. Ong was first hired by petitioner BW Shipping Philippines, Inc. in January 1999 and was rehired and promoted several times over a span of nine years. On March 19, 2008, respondent was employed to work as Chief Steward and Chief Cook on board the vessel BW Hemina for a period of nine months with a basic monthly salary of USD1,127.00. Prior to embarkation, he underwent the required physical and physiological evaluation by company-designated physicians and was declared "fit for sea duty (without restriction)." He boarded the vessel on March 29, 2008. His duties required him to manage and monitor food supplies, supervise crew meals, carry supplies, supervise subordinates, and prepare reports and requests for the vessel's provision sent to port authorities and the principal company.

On June 8, 2008, respondent complained of dizziness, nausea, recurring headache, body itchiness, frequent urination, and shortness of breath. On June 17, 2008, he was seen by a doctor in Tampa, Florida, and diagnosed with "uncontrolled diabetes and uncontrolled hypertension." Respondent was repatriated on June 20, 2008 and referred to the company-designated physicians. He underwent a series of tests and was advised to take medications. On October 2, 2008, or 104 days from his repatriation, the company-designated physicians declared him "fit to resume sea duties."

Respondent felt his condition had not improved and sought the opinion of Dr. Antonio C. Pascual, a cardiologist, more than three months after the fit-to-work declaration. In a Medical Certificate dated January 12, 2009, Dr. Pascual found respondent to be suffering from "Essential Hypertension, Stage 2 and Diabetes Mellitus, Type 2," with no prior history of the same diseases. Respondent sought petitioner's assistance to defray the costs of his medications, but the latter refused, prompting him to file a complaint for permanent disability benefits, medical reimbursement, damages, and attorney's fees before the Labor Arbiter. The Labor Arbiter granted the complaint, awarding USD90,000.00 in permanent total disability benefits and 10% attorney's fees, reasoning that respondent had been unable to return to his customary work for more than 241 days from repatriation. The NLRC affirmed, correcting the LA's legal basis but sustaining the award. The CA denied the petition for certiorari, finding that respondent had proven his illnesses were work-related and that his continued inability to work and ongoing medication supported his entitlement to benefits.

• Grave Abuse of Discretion by NLRC: Petitioners alleged that the NLRC committed grave abuse of discretion in granting respondent's claim for disability benefits, sickness allowance, and attorney's fees.
• Error of the CA: Petitioners attributed error to the CA in affirming the labor tribunals' finding that respondent is entitled to permanent total disability benefits.

• 120-Day Rule: Respondent argued that since he was unable to work as a seafarer for more than 120 days from the time of his repatriation, his disability should be considered permanent and total.
• Continued Medication Belies Fit-to-Work Finding: Respondent contended that the company-designated physician's prescription that he continue taking anti-hypertensive medications belied the finding that he was already fit to work.

• Compensability of Illnesses: Whether respondent is entitled to permanent total disability benefits for diabetes mellitus and hypertension.
• Weight of Medical Assessments: Whether the company-designated physician's fit-to-work declaration should prevail over the assessment of respondent's doctor of choice.
• 120-Day Rule: Whether the seafarer's inability to work for more than 120 days from repatriation automatically renders his disability permanent and total.
• Third-Doctor Referral Procedure: Whether respondent's failure to comply with the conflict-resolution mechanism under Section 20(A)(3) of the POEA-SEC affects the validity of the company-designated physician's assessment.

• Compensability of Illnesses: No. Diabetes mellitus is not an occupational disease under Section 32-A of the POEA-SEC, and respondent failed to prove the work-relatedness and gravity of both diabetes and hypertension as required by Section 20(B), paragraph 6.
• Weight of Medical Assessments: The company-designated physician's assessment prevails. It was supported by laboratory tests yielding normal results, while respondent's doctor of choice merely stated a conclusion without adequate factual or medical support, and the respondent delayed consultation by more than three months.
• 120-Day Rule: No. The extent of a seafarer's disability is judged by the disability grading given by the doctor on the basis of incapacity to work and earn wages, not by the number of days the seafarer could not work.
• Third-Doctor Referral Procedure: Respondent's failure to comply is fatal. Under Section 20(A)(3) of the POEA-SEC, the seafarer must signify his intention to resolve the disagreement by referral to a third doctor jointly agreed upon by the parties; his failure to do so means the company-designated physician's diagnosis must be upheld.

• Compensability of Illnesses: The entitlement of an overseas seafarer to disability benefits is governed by law and contract — the POEA-SEC and the employment contract. Section 20(B), paragraph 6 of the 2000 POEA-SEC requires two conditions: the illness must be work-related and must have existed during the term of the employment contract. Diabetes mellitus is not an occupational disease under Section 32-A; it is a metabolic and familial disease pre-disposed by heredity, obesity, or old age, and does not indicate work-relatedness. Essential hypertension is a recognized occupational disease, but the POEA-SEC requires an element of gravity — hypertension must be of such nature as indicative of impairment of the function of body organs such as the kidneys, heart, eyes, and brain, resulting in permanent disability. Respondent's allegations failed to demonstrate how his work responsibilities led to the acquisition of diabetes and hypertension, or to substantiate that his hypertension was of such nature as to render him permanently and totally disabled. The duty to prove work-causation or work-aggravation is real and not merely apparent, and evidence must be real and substantial.

• Weight of Medical Assessments: After repatriation, respondent was immediately attended to by company-designated physicians, undergoing months of checkups, tests, and treatment, all documented and undisputed. The company-designated physician issued a fit-to-work certification on October 2, 2008, 104 days after repatriation. Respondent did not immediately contest this finding; it took him more than three months to consult his own physician. Dr. Pascual's medical certificate seemingly stated a conclusion without adequate factual or medical support, and the records were unclear as to the extent of examination conducted. The company-designated physicians' diagnoses were supported by laboratory tests yielding normal results, and thus their assessment was given greater weight and credit. Under Section 32-A, a seafarer can still be employed although afflicted with hypertension and diabetes as long as the conditions are controlled by prescribed maintenance medications and lifestyle changes — which was the case here, as the company-designated physicians initially validated the illnesses but, after treatment, found respondent fit to work.

• 120-Day Rule: The extent of a seafarer's disability is judged not by the number of days he could not work, but by the disability grading given by the doctor on the basis of the resulting incapacity to work and earn wages. The Court gives great significance to timely medical evaluation in determining entitlement to disability benefits. The mere fact that respondent was unable to work for more than 120 days does not automatically render his disability permanent and total.

• Third-Doctor Referral Procedure: Section 20(A)(3) of the POEA-SEC sets forth the mechanism to challenge the validity of the assessment of the company-designated physician. It is the duty of the seafarer, after disclosing to the company the conflicting assessment of his doctor, to signify his intention to resolve the disagreement by referral to a third doctor jointly agreed upon by the parties, whose decision on the matter shall be final. Respondent did not signify his intention to resolve the conflict but instead filed the complaint directly before the Labor Arbiter. On account of this failure to comply with the proper conflict-resolution procedure, the diagnosis of the company-designated physician must be upheld.

• Entitlement of Seafarers to Disability Benefits — The entitlement of an overseas seafarer to disability benefits is a matter governed not only by medical findings but also by law and contract — the employment contract and the POEA-SEC, which are deemed incorporated therein. Two conditions must be proven under Section 20(B), paragraph 6 of the 2000 POEA-SEC: (1) the injury or illness must be work-related, and (2) it must have existed during the term of the seafarer's employment contract. The Court applied this by finding that respondent failed to prove the work-relatedness of his diabetes mellitus (not an occupational disease) and the gravity of his hypertension.

• Third-Doctor Referral Mechanism — Under Section 20(A)(3) of the POEA-SEC, when a seafarer disagrees with the company-designated physician's assessment, the seafarer must: (a) disclose to the company the conflicting assessment of his doctor of choice; and (b) signify his intention to resolve the disagreement by referral to a third doctor jointly agreed upon by the parties, whose decision on the matter shall be final. Failure to comply with this procedure means the company-designated physician's diagnosis prevails. The Court applied this by upholding the fit-to-work declaration because respondent filed his complaint directly with the Labor Arbiter instead of initiating the third-doctor referral process.

• Disability Grading vs. Duration of Incapacity — The extent of a seafarer's disability is judged not by the number of days he could not work, but by the disability grading given by the doctor on the basis of the resulting incapacity to work and earn wages. The Court rejected the argument that inability to work for more than 120 days automatically renders a seafarer's disability permanent and total.

• Weight of Company-Designated Physician's Assessment — The diagnosis of the company-designated physician should be given greater weight and credit when it is supported by laboratory tests and documentary proof, and when the seafarer's doctor of choice merely states conclusions without adequate factual or medical support. The Court applied this by favoring the company-designated physicians' fit-to-work declaration, which was backed by laboratory tests yielding normal results, over Dr. Pascual's medical certificate, which lacked clear evidentiary foundation.

• "The entitlement of an overseas seafarer to disability benefits is a matter governed not only by medical findings but also by law and contract – the employment contract and the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC) – which are deemed incorporated therein." — This passage articulates the foundational principle that seafarer disability claims are governed by the interplay of medical findings, law, and contract, establishing the analytical framework for the Court's ruling.

• "Diabetes mellitus is a metabolic and a familial disease to which one is pre-disposed by reason of heredity, obesity or old age. It does not indicate work-relatedness and, by its nature, is more the result of poor lifestyle choices and health habits for which disability benefits are improper." — This quotation, adopted from C.F. Sharp Crew Management, Inc. vs. Santos, defines the canonical formulation for why diabetes mellitus is not compensable as a work-related illness, frequently cited in subsequent seafarer disability jurisprudence.

• "The extent of a seafarer's disability is judged not by the number of days that he could not work, but by the disability grading given by the doctor on the basis of the resulting incapacity to work and earn wages." — This passage establishes the rule that the 120-day period is not the determinative factor for permanent total disability; rather, the disability grading by the physician controls.

• "it is the duty of the respondent, after disclosing to the company the conflicting assessment of his doctor, to signify his intention to resolve the disagreement by referral to a third doctor jointly agreed upon by the parties, whose decision on the matter shall be final." — This passage states the mandatory conflict-resolution procedure under Section 20(A)(3) of the POEA-SEC, the non-compliance with which was decisive in the Court's ruling.

• Rillera vs. United Philippine Lines, Inc., G.R. No. 235336, June 23, 2020 — Cited for the proposition that diabetes mellitus is ordinarily acquired through inheritance and is remotely caused by environmental and occupational conditions, supporting the finding that respondent's diabetes was not work-related.

• C.F. Sharp Crew Management, Inc. vs. Santos, 838 Phil. 82 (2018) — Followed for the principles that diabetes mellitus is not an occupational disease and does not indicate work-relatedness, and that essential hypertension, while a recognized occupational disease, requires proof of gravity indicative of impairment of body organs resulting in permanent disability.

• Ayungo vs. Beamko Shipmanagement Corp., 728 Phil. 244 (2014) — Followed for the definition of grave abuse of discretion in labor disputes (findings and conclusions not supported by substantial evidence) and for the two conditions of compensability under Section 20(B), paragraph 6 of the POEA-SEC, as well as the third-doctor referral procedure under Section 20(A)(3).

• Jebsens Maritime, Inc. vs. Undag, 678 Phil. 938 (2011) — Followed for the principle that the duty to prove work-causation or work-aggravation is real and not merely apparent, and that evidence must be real and substantial.

• Montoya vs. Transmed Manila Corp., 613 Phil. 696 (2009) — Followed for the scope of review in labor appeals before the Supreme Court, limited to determining whether the CA correctly determined the presence or absence of grave abuse of discretion in the NLRC decision.

• Section 20(B), paragraph 6, 2000 POEA-SEC — Sets the two conditions for compensability of a seafarer's illness: (1) the illness must be work-related, and (2) it must have existed during the term of the seafarer's employment contract. The Court found that respondent failed to satisfy the first condition for diabetes mellitus and failed to prove the required gravity for hypertension.

• Section 32-A, 2000 POEA-SEC — Enumerates recognized occupational diseases and their corresponding disability gradings. Diabetes mellitus is not listed as an occupational disease. Essential hypertension is listed but requires that it be of such nature as indicative of impairment of the function of body organs (kidneys, heart, eyes, brain) resulting in permanent disability. The provision also states that a seafarer can still be employed if hypertension and/or diabetes are controlled by prescribed maintenance medications and lifestyle changes.

• Section 20(A)(3), 2000 POEA-SEC — Establishes the mandatory conflict-resolution mechanism: when a seafarer disagrees with the company-designated physician's assessment, he must disclose the conflicting assessment to the company and signify his intention to refer the disagreement to a third doctor jointly agreed upon by the parties, whose decision is final. The Court held that respondent's failure to comply with this procedure meant the company-designated physician's fit-to-work declaration must be upheld.

Hernando, Inting, and Dimaampao, JJ., concurred. Perlas-Bernabe, J. (Senior Associate Justice), was on official leave.