Cristobal vs. Employees Compensation Commission

A sickness not listed as an occupational disease is compensable under the theory of increased risk when substantial evidence shows a reasonable work-connection between the working conditions and the risk of contracting the disease; proof of direct causal relation is not required, especially where the etiology of the disease is medically unknown and the claimant was free from disease at the time of employment.

Petitioner Luz G. Cristobal is the widow of Fortunato Cristobal, who was employed as a supervising information officer in the printing department of the National Science Development Board (NSDB). The claim for employees' compensation arose under Presidential Decree No. 626, as amended, which governs the employees' compensation program and which, unlike the earlier Workmen's Compensation Act, abandoned the presumption of compensability and the theory of aggravation, substituting instead the requirement that non-listed diseases be shown to have an increased risk of contraction due to working conditions. The State policy of giving maximum aid and protection to labor, embodied in Article 4 of the Labor Code, requires that all doubts in the implementation and interpretation of the Code be resolved in favor of labor.

Fortunato Cristobal entered government service in 1964, free from any kind of disease. He was assigned to the printing department of the NSDB as a supervising information officer, where he was exposed to various chemicals and intense heat. His ailment supervened in the course of his employment with the agency. According to the affidavit of Angel Peres, a co-employee, Cristobal continued working even while already suffering from a rectal illness, complaining that the illness became more painful whenever he performed his job. Peres also observed that Cristobal often ate food without washing his hands, that the place where he was assigned was polluted with chemicals, and that the odor of the chemicals made him feel dizzy. Cristobal always handled chemicals in the Bureau of Printing while performing his duties.

A medical certificate issued by Dr. Rufo A. Guzman stated that the illness may be aggravated by the unhygienic conditions in the Bureau of Printing, including the handling of chemicals for printing, eating without proper washing of hands, tension due to pressure of work, and neglected personal necessity attributable to inadequate facilities. Even respondent ECC's own medical officer, Dr. Mercia C. Abrenica, certified that the cause of rectal carcinoma, as of any other malignancy, is still unknown. Cristobal died of rectal cancer on May 27, 1977, leaving seven dependent children at the time of his death. He received an annual salary of P11,904.00.

Petitioner Luz G. Cristobal filed a claim for employees' compensation benefits, which was denied by the respondents on the ground that rectal cancer is not a listed occupational disease and that no proof of increased risk was established. The Court, in its April 30, 1980 decision, found the claim compensable and ordered the GSIS to pay death benefits, medical expenses, funeral expenses, and attorney's fees. Both respondents filed motions for reconsideration challenging the compensability of the illness, the amounts awarded, and the grant of attorney's fees.

• Compensability of the Illness: Respondents argued that rectal cancer is not a listed occupational disease and that petitioner failed to show proof of a direct causal relation between the disease and the working conditions, asserting that the Court only found a case of aggravation, which is different from proof of increased risk of contracting the ailment.
• Amount of Benefits: Respondents contended that the benefits awarded are not in accordance with the new law, specifically Articles 193(a) and 191(a) of the Labor Code, as amended by PD 891.
• Attorney's Fees: Respondents argued that the grant of attorney's fees equivalent to 10% of the death benefits is improper under Article 203 of the Labor Code, which prohibits the charging or deduction of attorney's fees from any benefit granted under the title.
• Medical Reimbursement: Respondents maintained that since the cause of death is not a compensable illness, the order for reimbursement of medical, surgical, and hospital expenses has no basis.
• Incompatibility with In Forma Pauperis Appeal: Respondents asserted that the petitioner's appeal in forma pauperis is incompatible with the award of attorney's fees.

• Compensability Under Increased Risk Theory: Whether rectal cancer, a disease whose etiology is medically unknown and which is not listed as an occupational disease, is compensable under the theory of increased risk under Section 1(b), Rule III of PD 626.
• Death Benefits Computation: Whether the award of P12,000.00 as death benefits is in accordance with Articles 193(a) and 191(a) of the Labor Code, as amended.
• Attorney's Fees: Whether the award of attorney's fees equivalent to 10% of the death benefits is proper notwithstanding Article 203 of the Labor Code and the petitioner's appeal in forma pauperis.
• Medical and Funeral Benefits: Whether the reimbursement of medical, surgical, and hospital expenses is proper, and whether the funeral benefits award should be modified.

• Compensability Under Increased Risk Theory: Yes. Rectal cancer is compensable under the theory of increased risk, substantial evidence having established a reasonable work-connection between the decedent's working conditions and the risk of contracting the disease; proof of direct causal relation is not required.
• Death Benefits Computation: Yes. The P12,000.00 award is well within the limitations prescribed by Articles 193(a) and 191(a) of the Labor Code, as the computation yields a total of P23,293.20 over five years, which the law caps at P12,000.00.
• Attorney's Fees: Yes. Article 203 prohibits charging attorney's fees against the claimant's award, but the defaulting employer or government agency remains liable for attorney's fees when it compelled the claimant to litigate by unjustly refusing to recognize the validity of the claim.
• Medical and Funeral Benefits: Yes as to medical reimbursement, which is mandated by Article 166 of the Labor Code; and the funeral benefits award was increased from P700.00 to P1,000.00 pursuant to PD 1146 and PD 1641.

• Compensability Under Increased Risk Theory: Section 1(b), Rule III of PD 626 provides that for a sickness not listed as an occupational disease to be compensable, proof must be shown that the risk of contracting the disease is increased by the working conditions. The degree of proof required is substantial evidence, defined as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion," or clear and convincing evidence. The strict rules of evidence are not applicable in claims for compensation. Respondents insisted on evidence establishing a direct causal relation between rectal cancer and the decedent's employment, but such a strict requirement is untenable because even medical experts cannot ascertain the cause of the disease, as acknowledged by the ECC's own medical officer. What the law requires is a reasonable work-connection, not a direct causal relation. The decedent was free from disease when he entered government service in 1964, was exposed to unhygienic conditions, various chemicals, and intense heat — factors generally considered predisposing to cancer — and the ailment supervened during employment. This interpretation gives meaning to the liberal and compassionate spirit of Article 4 of the Labor Code, which mandates that all doubts in the implementation and interpretation of the Code be resolved in favor of labor. While the presumption of compensability and the theory of aggravation under the Workmen's Compensation Act may have been abandoned under the new Labor Code, the liberality of the law in general still subsists.

• Death Benefits Computation: The computation under Articles 193(a) and 191(a) of the Labor Code, as amended by PD 891, proceeds as follows: the decedent's average monthly salary was P992.00. The basic benefit is computed at 45% of the first P300 (P135.00), 25% of the next P300 (P75.00), and 9% of each succeeding P100 or fraction thereof (P9.00 × 3 plus P8.28 for the P92 fraction), yielding a basic benefit of P235.28. The monthly income benefit is 115% of the basic benefit, or P270.57. An additional 10% of the basic benefit (P23.53) is granted for each dependent child, not exceeding five; the deceased left seven dependent children, so five are counted, yielding P117.65. The total monthly income benefit is P388.22, amounting to P4,658.64 annually and P23,293.20 over five years. The proviso in Article 193(a) caps total payments at P12,000.00, which is the amount awarded.

• Attorney's Fees: Article 203 of the Labor Code prohibits any agent or attorney from demanding or charging fees for the preparation or filing of a claim, and prohibits the retention or deduction of any amount from any benefit granted. However, the intent of the provision is to free the award from any liability or charge so that the claimant, who is exempt from liability for attorney's fees, receives the full benefit. The defaulting employer or government agency remains liable for attorney's fees because it compelled the claimant to employ counsel by unjustly refusing to recognize the validity of the claim. The participation of petitioner's counsel was not limited to the preparation or filing of the claim but extended to appealing the case before the Supreme Court, necessitating the submission of pleadings to establish the cause of action and rebut the respondents' arguments. Fairness dictates that counsel receive compensation; otherwise, claimants — most of whom are not learned in the law — would find it difficult to obtain competent legal service. The petitioner's appeal in forma pauperis under Section 22, Rule 3 of the Rules of Court merely exempts her from payment of legal fees and filing of appeal bond, printed record, and printed brief, but does not exempt her from the payment of attorney's fees.

• Medical and Funeral Benefits: Article 166 of the Labor Code provides that the State shall promote and develop a tax-exempt employees' compensation program whereby employees and their dependents may promptly secure adequate income benefit and medical or related benefits in the event of work-connected disability or death. This provision supports the reimbursement of medical, surgical, and hospital expenses duly supported by proper receipts. As to funeral benefits, the award of P700.00 was increased to P1,000.00 pursuant to PD 1146, Section 19 in relation to Section 45, and PD 1641, Section 6(d), which took effect on May 31, 1977. This increase is consistent with prior rulings in Mitra vs. ECC, Vda. de Torbela vs. ECC, and Tuquero vs. ECC.

• Theory of Increased Risk — Under Section 1(b), Rule III of PD 626, a sickness not listed as an occupational disease is compensable if proof is shown that the risk of contracting the disease is increased by the working conditions. The law requires only a reasonable work-connection, not a direct causal relation. The degree of proof required is substantial evidence — "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion" — or clear and convincing evidence. The strict rules of evidence are not applicable in claims for compensation. Where the etiology of a disease is medically unknown, the claimant need not prove direct causation; it suffices that working conditions are shown to be predisposing factors and that the claimant was free from disease at the time of employment.

• Liberality in Compensation Claims — Article 4 of the Labor Code mandates that all doubts in the implementation and interpretation of the Code, including its implementing rules and regulations, shall be resolved in favor of labor. While the presumption of compensability and the theory of aggravation under the Workmen's Compensation Act may have been abandoned under the new Labor Code, the liberality of the law in general still subsists. Government agencies charged with implementing social justice guarantees should adopt a liberal attitude in deciding claims for compensation, especially when there is some basis in the facts for inferring a work-connection.

• Attorney's Fees in Compensation Claims — Article 203 of the Labor Code prohibits the charging or deduction of attorney's fees from the claimant's award, but this prohibition does not preclude the Court from awarding attorney's fees against the defaulting employer or government agency that compelled the claimant to litigate by unjustly refusing to recognize the validity of the claim. The prohibition is designed to protect the claimant's award, not to shield the defaulting party from liability for counsel fees. Appeal in forma pauperis exempts the pauper litigant from payment of legal fees and filing requirements but does not exempt the payment of attorney's fees.

• "Apparently, what the law merely requires is a reasonable work-connection and not a direct causal relation. This kind of interpretation gives meaning and substance to the liberal and compassionate spirit of the law as embodied in Article 4 of the new Labor Code which states that 'all doubts in the implementation and interpretation of the provisions of this Code, including its implementing rules and regulations shall be resolved in favor of labor.'" — This passage articulates the ratio decidendi on compensability: the standard is reasonable work-connection, not direct causation, grounded in the pro-labor presumption of Article 4.

• "The intent of the law is to free the awrad from any liability or charge so that the claimaint who is exempt from liabitity for attorney's fees. The defaulting employer or governement agency remains libale for attorney's fees; because it compelled the claimant to employ the services of counsel by unjustly refusing to recognize the validity of the claim of peitioner." — This passage defines the scope and rationale of Article 203's prohibition on attorney's fees, distinguishing the claimant's protection from the defaulting party's liability.

• "Therefore, whether or not the disease rectal cancer was caused or the risk of contracting the same was increased by the decedent's working conditions remains uncertain. This uncertainty, of course, cannot eliminate the probability that the ailment was work connected as it had been established that the deceased was exposed to unhygienic working conditions, various chemicals and intense heat which are generally considered as predisposing factors of cancer." — This passage explains how medical uncertainty regarding etiology does not defeat compensability when working conditions constitute predisposing factors.

• Ang Tibay vs. The Court of Industrial Relations and National Labor Union, Inc., 69 Phil. 635 — Cited for the definition of substantial evidence as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion," establishing the evidentiary standard in compensation claims.
• Mitra vs. Employees' Compensation Commission, 96 SCRA 284 (1980) — Cited in support of the increase in funeral benefits to P1,000.00, as a consistent application of PD 1146 and PD 1641.
• Vda. de Torbela vs. ECC, 96 SCRA 260 (1980) — Cited for the same proposition regarding funeral benefits increase.
• Tuquero vs. ECC, 96 SCRA 291 (1980) — Cited for the same proposition regarding funeral benefits increase.

• Section 1(b), Rule III, PD 626 (Employees' Compensation Law) — Provides that for a sickness not listed as an occupational disease to be compensable, proof must be shown that the risk of contracting the disease is increased by the working conditions. Applied as the controlling legal basis for compensability of rectal cancer.
• Article 4, Labor Code — Mandates that all doubts in the implementation and interpretation of the Code shall be resolved in favor of labor. Applied to justify a liberal interpretation of compensability requirements.
• Articles 193(a) and 191(a), Labor Code, as amended by PD 891 — Govern the computation of death benefits and monthly income benefits for permanent total disability. Applied to validate the P12,000.00 death benefits award, which falls within the statutory cap.
• Article 203, Labor Code — Prohibits the charging or deduction of attorney's fees from benefits granted under the employees' compensation program. Interpreted as protecting the claimant's award, not barring the Court from imposing attorney's fees on the defaulting government agency.
• Article 166, Labor Code — Declares the State policy of developing an employees' compensation program providing income and medical benefits for work-connected disability or death. Applied to support the reimbursement of medical, surgical, and hospital expenses.
• Section 22, Rule 3, Rules of Court — Governs appeals in forma pauperis, exempting pauper litigants from payment of legal fees and filing requirements. Applied to clarify that the exemption does not extend to attorney's fees.
• PD 1146, Section 19 in relation to Section 45, and PD 1641, Section 6(d) — Took effect on May 31, 1977. Applied to increase funeral benefits from P700.00 to P1,000.00.

Teehankee (Chairman), Fernandez, Guerrero, and De Castro, JJ., concurred. De Castro, J. was designated to sit with the First Division.

• Melencio-Herrera, J. — Justice Melencio-Herrera reiterated her dissent in the main opinion and voted to grant the motions for reconsideration. The text does not provide the substantive basis of her dissent beyond this statement.