Paringit vs. Global Gateway Crewing Services, Inc., et al.

A seafarer's claim for permanent total disability benefits may be upheld where the employer's failure or refusal to act on the company-designated physician's recommended treatment causes the physician to reach an impasse and prevents a timely disability assessment within the 120-day period; the employer cannot rely on that delay to defeat the claim, and the labor tribunals' finding of work-related or work-aggravated disability, supported by substantial evidence, must be respected.

Paringit was engaged by Mid-South Ship and Crew Management, Inc., for and on behalf of Seaworld Marine Services, S.A., under a six-month employment contract, and was deployed as Chief Mate of the Panaman vessel Tsavliris Hellas. Global Gateway Crewing Services, Inc. and Captain Simeon Flores were among the respondents in the labor proceedings. The parties' relationship was governed by the POEA Standard Employment Contract, which defines work-related illness by reference to Section 32-A occupational diseases and prescribes procedures for post-employment medical examination and disability assessment. Paringit's pre-employment medical examination disclosed high blood pressure, but he was declared fit for duty.

On June 1, 2010, Oscar M. Paringit entered into a six-month employment contract with Mid-South Ship and Crew Management, Inc., representing Seaworld Marine Services, S.A., and was employed as Chief Mate of the Panaman vessel Tsavliris Hellas. His contract provided a basic monthly salary of US$1,700.00 for 48 hours a week, overtime pay of US$1,500.00, and vacation leave with pay of US$200.00. Before deployment, he underwent a pre-employment medical examination, disclosed that he had high blood pressure, and was nevertheless declared fit for duty.

A few months later, Paringit began to feel constantly fatigued and stressed, and he noticed blood in his feces beginning October 1, 2011. On January 13, 2012, when the vessel docked at the port of Las Palmas, Spain, he was rushed to the intensive care unit of Clinica Perpetuo Socorro, where he underwent blood transfusion. On January 14, 2012, he was discharged from the intensive care unit with a diagnosis of decompensated cardiac insufficiency, severe anemia, and renal dysfunction. He was transferred to a regular room for further treatment and monitoring, discharged from the hospital on February 2, 2012, medically repatriated, and arrived in Manila on February 9, 2012.

On February 13, 2012, Paringit was admitted to YGEIA Medical Center for evaluation and management, again underwent blood transfusion, and was placed on medication. On February 20, 2012, he was discharged with a working diagnosis of congestive heart failure, hypertensive cardiovascular disease, valvular heart disease, and anemia secondary to upper GI bleeding secondary to bleeding peptic ulcer disease. Dr. Maria Lourdes A. Quetulio, the company-designated physician, prescribed his medication and advised him to return on February 29, 2012. After that check-up, Dr. Quetulio advised him to continue his medication and referred him to a valvular heart specialist for further management, with a follow-up on March 5, 2012. On March 2, 2012, Paringit consulted a valvular heart specialist at the Philippine Heart Center, who advised a repeat 2D echocardiogram and coronary angiography. On March 5, 2012, Dr. Quetulio noted that he was a candidate for open heart surgery and advised him to continue his medication while waiting for his employer's go signal. A repeat 2D echocardiogram showed a severe valvular problem, and the cardiologist recommended open heart surgery for valve replacement or repair, with possible coronary bypass graft. On March 19, 2012, after more laboratory tests, procedures, and consultation with a cardiologist, Dr. Quetulio informed Global Gateway that Paringit had to undergo open-heart surgery, which costs around ₱1,000,000.00 to ₱1,200,000.00. On March 22, 2012, Paringit underwent coronary angiography; it revealed no blocked coronary vessels, but the attending cardiologist still opined that he had to undergo open heart surgery for valve replacement or repair. Dr. Quetulio again advised him to continue his medication while awaiting his employer's approval. By April 30, 2012, he was still waiting for his employer's decision, and on May 18, 2012, Dr. Quetulio noted that he hesitated to undergo the recommended open-heart surgery and wanted herbal treatment instead.

On June 4, 2012, Paringit consulted Dr. May S. Donato-Tan, a cardiologist at the Philippine Heart Center. After evaluating him and reviewing his laboratory examinations, Dr. Donato-Tan concluded that his heart condition required regular medication, further laboratory procedures, and periodic check-ups with a cardiologist to prevent aggravation, and she declared him permanently disabled and unfit for duty as a seaman. On June 11, 2012, Paringit filed a Complaint for medical expenses and other money claims against Global Gateway Crewing Services, Inc., Mid-South Ship & Crew Management, Inc., Seaworld Marine Services, S.A., and Captain Simeon Flores, president of Global Gateway. On June 13, 2012, he executed a quitclaim acknowledging receipt of US$6,636.70 from St. Tsavliris Hellas as sickness allowance from February 8, 2012 to June 8, 2012. On June 18, 2012, Dr. Quetulio informed Global Gateway that Paringit seemed hesitant to undergo the recommended operation and instead opted for herbal treatment, and she also stated that his heart condition was pre-existing and not work-related. After the parties failed to settle the issue, they were directed to submit their respective position papers.

Labor Arbiter Savari found that Paringit's various illnesses were work-related or work-aggravated, brought about by the type of food served and the stressful nature of his job aboard the ship. She found that since Dr. Donato-Tan declared him unfit to work as a seafarer, his disability was total and permanent. The National Labor Relations Commission upheld the finding that his current medical condition was a work-acquired illness, noting that he had been subjected to tests prior to embarkation and was declared fit for sea duty.

• Work-Relatedness and Aggravation: Petitioner asserted that his ailment was work-related and aggravated by the nature of his job aboard the vessel.
• Statutory Presumption of Compensability: Petitioner insisted that the Court of Appeals erred in relying on the company-designated physician's assessment to refute the statutory presumption of compensability of a listed disease, pointing out that the disputable presumption is in favor of the seafarer and that the employer bears the burden of overcoming it.
• Entitlement to Maximum Disability Benefit: Petitioner argued that, with his employer's failure to discredit his claim of a work-related or work-aggravated ailment, he was entitled to the maximum disability benefit because he was already unfit to work on board the vessel.
• Company-Designated Physician's Diagnosis and Unexplained Conclusion: In his Reply, petitioner emphasized that the company-designated physician diagnosed him with a coronary disease and recommended open-heart surgery, and that the issue of compensability arose only when she concluded that his ailment was not work-related; he underscored that she never explained why his ailment was not work-related or what caused it.
• Reversal of Uniform Labor Tribunal Findings: Petitioner assailed the Court of Appeals' reversal of the labor tribunals' uniform factual findings that he was entitled to disability benefits due to his permanent and total disability.

• Failure to Prove Work-Related Illness: Respondents maintained that the Court of Appeals did not err in reversing the labor tribunals' rulings because petitioner failed to prove that he suffered a work-related illness.
• Credence to Company-Designated Physician: Respondents claimed that the findings of the company-designated physician were rightfully given credence over those of petitioner's private physician, since she had the opportunity to closely monitor petitioner through a prolonged period.
• Failure to Refer to a Third Doctor: Respondents highlighted petitioner's failure to refer the matter to a third doctor, as required under the law.

• Court of Appeals' Reversal of the Labor Tribunals: Whether the Court of Appeals erred in reversing the findings and rulings of the labor tribunals, which granted petitioner's disability claims.

• Court of Appeals' Reversal of the Labor Tribunals: Yes. The Court of Appeals erred in reversing the labor tribunals, whose findings were amply supported by substantial evidence. The employer's failure or refusal to act on the recommended open-heart surgery prevented the company-designated physician from issuing a timely disability assessment within the 120-day period, and that delay could not be used to defeat the claim.

• Court of Appeals' Reversal of the Labor Tribunals: Under Montoya vs. Transmed Manila Corporation, review of the Court of Appeals' decision is for legal correctness, asking whether the Court of Appeals correctly determined the presence or absence of grave abuse of discretion in the NLRC decision. Grave abuse of discretion requires capricious or whimsical judgment so flagrant as to amount to a virtual refusal to perform a duty; mere abuse is not enough. Under Jebsen Maritime, Inc. vs. Ravena, the requisites for a seafarer's disability claim are: (1) illness; (2) illness during the term of the employment contract; (3) compliance with Section 20-B procedures; (4) illness is an enumerated occupational disease or otherwise work-related; and (5) compliance with the four conditions under Section 32-A for an occupational disease or disputably-presumed work-related disease to be compensable. It was undisputed that Paringit was initially diagnosed with heart disease, anemia, and renal dysfunction, that he fell ill aboard the vessel, that he was medically repatriated, and that he submitted to a post-employment medical examination by the company-designated physician. Dr. Quetulio directed his admission for blood transfusion and further tests, later informed Global Gateway that he needed open-heart surgery costing around ₱1,000,000.00 to ₱1,200,000.00, and awaited permission for several months. Her June 18, 2012 diagnosis was consistent with Dr. Donato-Tan's finding of a heart ailment. Under the POEA Standard Employment Contract, a work-related illness is one resulting from an occupational disease listed under Section 32-A with the conditions satisfied. Section 32-A requires that the work involve the described risks, that the disease be contracted as a result of exposure to those risks, that it be contracted within the period of exposure and under other necessary factors, and that there be no notorious negligence. Paringit's heart ailments fall under cardiovascular events in Section 32-A(11), which includes heart failure. For a known hypertensive, Section 32-A(11)(d) requires proof of compliance with prescribed maintenance medications and doctor-recommended lifestyle changes, and the employer must provide a workplace conducive to such compliance. The Court of Appeals held that Paringit failed to prove a causal connection and that his valvular heart disease was mostly due to poor lifestyle choices and health habits, but this was mistaken. Paringit took medication to normalize his high blood pressure, yet the working conditions and mandatory diet aboard the vessel made it difficult and nearly impossible to maintain a healthy lifestyle; seafarers were served mostly high-fat, high-cholesterol, and low-fiber food, and his work as Chief Mate carried considerable stress and required him to stay up for long stretches, up to the early hours of the morning. The Labor Arbiter took judicial notice that ocean-going vessels remain at sea for considerable periods, that seafarers cannot freely choose their diet, and that provisions are usually frozen, preserved, smoked, salted, and canned; fresh fruits and vegetables cannot last long. The stress of the job, the need to keep the vessel, crew, and cargoes safe, storms, typhoons, high waves, and sudden climate and temperature changes were factors sufficient to make a person ill. The Labor Arbiter also found that Paringit, despite being hypertensive, was declared fit to work in his pre-employment medical examination, leading to the conclusion that he developed or his illnesses were triggered or aggravated on board and that his working conditions precipitated his unknown illnesses. The NLRC upheld the finding that his condition was a work-acquired illness. Under Magsaysay Maritime Services vs. Laurel, compensability does not require the nature of employment to be the sole reason for the illness; a reasonable linkage between the disease and the work suffices. The Court of Appeals also faulted Paringit for filing his Complaint while Dr. Quetulio was still evaluating his condition and declared that she had 240 days to do so since he needed additional treatment and evaluation, but this was mistaken. Under Vergara vs. Hammonia Maritime Services, Inc., upon sign-off the seafarer must report to the company-designated physician within three days from arrival; during treatment but not exceeding 120 days, the seaman is on temporary total disability; if the 120-day period is exceeded and no declaration is made because further medical attention is required, the temporary total disability period may be extended up to a maximum of 240 days, subject to the employer's right to declare permanent partial or total disability within that period; and temporary total disability becomes permanent when so declared by the company physician within the periods allowed, or upon expiration of the maximum 240-day period without a declaration of fitness to work or permanent disability. Here, Dr. Quetulio recommended open-heart surgery, but Global Gateway failed or refused to act despite repeated follow-ups. The company's silence stretched beyond the mandated 120 days within which Dr. Quetulio could give her assessment, so it could not be said that she needed additional time to assess Paringit. Paringit had to undergo open-heart surgery before Dr. Quetulio could properly assess his condition and issue a disability assessment, and Dr. Quetulio reached an impasse with her management of the case. Global Gateway's silence meant she could neither issue the required disability assessment within the 120-day period nor extend the period to 240 days to further evaluate and treat him. Her failure to timely issue a disability assessment was due to Global Gateway, not because Paringit impliedly refused treatment due to his supposed inclination toward an alternative treatment. Thus, the labor tribunals did not err in giving credence to the private physician's findings that Paringit had mitral valve prolapse with severe mitral regurgitation and severe tricuspid regurgitation, that his persistent symptoms hindered him from sufficiently performing his work as a seaman, and that he was permanently disabled and unfit for duty in whatever capacity as a seaman. The POEA Standard Employment Contract spells out the conditions for compensability, and the compensability of Paringit's condition was clear; instead of fulfilling its responsibilities, Global Gateway delayed his treatment and raised technical procedural barriers that were unwarranted.

• Work-Related Illness and Reasonable Linkage — For an illness to be compensable, it is not necessary that the nature of the employment be the sole and only reason for the seafarer's illness; a reasonable linkage between the disease and the work suffices to lead a rational mind to conclude that the work may have contributed to the establishment or, at the very least, the aggravation of a pre-existing condition. The Court applied this principle to Paringit's heart disease, finding that his diet and the stressful conditions aboard the vessel contributed to or aggravated his condition.
• Section 32-A Occupational Disease Compensability — Under the POEA Standard Employment Contract, an occupational disease and the resulting disability or death are compensable only if all of the following conditions are satisfied: (1) the seafarer's work must involve the risks described; (2) the disease was contracted as a result of the seafarer's exposure to the described risks; (3) the disease was contracted within a period of exposure and under such other factors necessary to contract it; and (4) there was no notorious negligence on the part of the seafarer. The Court found Paringit's heart ailments to be cardiovascular events under Section 32-A(11) and concluded that compensability was clear.
• Cardiovascular Events and Known Hypertensive Seafarers — Section 32-A(11) classifies cardiovascular events, including heart failure, as occupational when contracted under working conditions involving the described risks. For a known hypertensive, Section 32-A(11)(d) requires proof of compliance with prescribed maintenance medications and doctor-recommended lifestyle changes, while the employer must provide a workplace conducive to such compliance. The Court held that Paringit took medication but the vessel's working conditions and mandatory diet made compliance difficult, and the employer failed to provide a conducive workplace.
• 120/240-Day Rule for Seafarer Disability — Upon sign-off, the seafarer must report to the company-designated physician within three days from arrival. During treatment but not exceeding 120 days, the seaman is on temporary total disability; if the 120-day period is exceeded and no declaration is made because further medical attention is required, the temporary total disability period may be extended up to a maximum of 240 days, subject to the employer's right to declare permanent partial or total disability within that period. Temporary total disability becomes permanent when so declared by the company physician within the periods allowed, or upon expiration of the maximum 240-day period without a declaration of fitness to work or permanent disability. The Court held that Global Gateway's failure to act on the recommended open-heart surgery prevented Dr. Quetulio from issuing a timely assessment and caused the impasse, so the delay was attributable to the employer.
• Grave Abuse of Discretion in Labor Cases — A court or tribunal acts with grave abuse of discretion when it capriciously acts or whimsically exercises judgment, and the abuse must be so flagrant as to amount to a virtual refusal to perform a duty as provided by law; mere abuse of discretion is not enough. The Court found the NLRC's findings amply supported by substantial evidence, so the Court of Appeals erred in reversing them.

• "Settled is the rule that for illness to be compensable, it is not necessary that be nature of the employment be the sole and only reason for the illness suffered by the seafarer. It is sufficient that there is a reasonable linkage between the disease suffered by the employee and his work to lead a rational mind to conclude that his work may have contributed to the establishment or, at the very least, aggravation of any pre-existing condition he might have had." — States the reasonable-linkage standard for compensability, which the Court used to uphold Paringit's claim despite the pre-existing nature of his hypertension.
• "A temporary total disability only becomes permanent when so declared by the company physician within the periods he is allowed to do so, or upon the expiration of the maximum 240-day medical treatment period without a declaration of either fitness to work or the existence of a permanent disability." — States the point at which temporary total disability ripens into permanent disability, central to the 120/240-day rule applied to the employer's failure to act on the recommended surgery.
• "Dr. Quetulio's failure to timely issue a disability assessment was due to respondent Global Gateway, not because petitioner impliedly refused treatment due to his supposed inclination toward an alternative treatment, as the Court of Appeals held." — Directly rejects the Court of Appeals' basis for faulting Paringit and attributes the delay to the employer.
• "The POEA Standard Employment Contract spells out the conditions for compensability. Here, the compensability of petitioner's condition is clear; however, instead of fulfilling its responsibilities, respondent Global Gateway delayed his treatment and raised technical procedural barriers that were clearly unwarranted." — Summarizes the conclusion that compensability was established and that the employer's procedural objections were unwarranted.

• Montoya vs. Transmed Manila Corporation, 613 Phil. 696 (2009) — Laid down the parameters of judicial review for a labor case under Rule 45, requiring the Court to examine the Court of Appeals decision from the prism of whether it correctly determined the presence or absence of grave abuse of discretion in the NLRC decision.
• Magsaysay Maritime Corporation vs. National Labor Relations Commission, 630 Phil. 352 (2010) — Cited for the standard that legal correctness is determined from the prism of whether the Court of Appeals correctly determined the presence or absence of grave abuse of discretion in the NLRC decision.
• Magsaysay Maritime Services, et al. vs. Laurel, 707 Phil. 210 (2013) — Emphasized that for illness to be compensable, it is not necessary that the nature of the employment be the sole and only reason for the illness; a reasonable linkage between the disease and the work suffices.
• Vergara vs. Hammonia Maritime Services, Inc., et al., 588 Phil. 895 (2008) — Explained the relevant rules and periods for reckoning a seafarer's permanent disability, including the 120-day and 240-day periods and the point at which temporary total disability becomes permanent.
• Kestrel Shipping Co., Inc., et al. vs. Munar, 702 Phil. 717 (2013) — Summarized the rules for entitlement to disability benefits discussed in Vergara, including the 120/240-day periods and the conversion of temporary total disability into permanent disability.
• Jebsen Maritime, Inc., et al. vs. Ravena, 743 Phil. 371 (2014) — Cited for the requisites that must be present to grant a seafarer's claim for disability benefits.
• The Hongkong Shanghai Banking Corporation Employees Union vs. National Labor Relations Commission, 421 Phil. 864 (2001) — Cited for the definition of grave abuse of discretion as capricious or whimsical judgment so flagrant as to amount to a virtual refusal to perform a duty as provided by law.

• Section 20-B, POEA Standard Employment Contract — Prescribes the procedures for a seafarer's post-employment medical examination and disability assessment. The Court discussed the 120-day and 240-day periods under this provision in harmony with the Labor Code and the AREC, and found that the company-designated physician could not timely issue an assessment because the employer failed to act on the recommended surgery.
• Section 32-A, POEA Standard Employment Contract — Lists the conditions for compensability of an occupational disease: the seafarer's work must involve the risks described; the disease was contracted as a result of exposure to those risks; the disease was contracted within a period of exposure and under such other factors necessary to contract it; and there was no notorious negligence on the part of the seafarer. The Court applied these conditions to Paringit's heart ailment.
• Section 32-A(11), POEA Standard Employment Contract — Classifies cardiovascular events, including heart attack, chest pain (angina), heart failure, or sudden death, as occupational when contracted under working conditions involving the risks described. The Court found Paringit's heart ailments to fall under this category.
• Section 32-A(11)(d), POEA Standard Employment Contract — Requires a known hypertensive seafarer to show compliance with prescribed maintenance medications and doctor-recommended lifestyle changes, and requires the employer to provide a workplace conducive to such compliance. The Court found that Paringit took medication but the vessel's working conditions and diet made compliance difficult, and the employer failed to provide a conducive workplace.
• Philippine Overseas Employment Administration Memorandum Circular No. 010-10 (2010), definition of terms, no. 16 — Defines a work-related illness as any sickness resulting from an occupational disease listed under Section 32-A of the contract with the conditions set therein satisfied. The Court used this definition in assessing the compensability of Paringit's condition.

Peralta (Chairperson), Jardeleza, A. Reyes, Jr., and Hernando, JJ., concur. The text also notes that Jardeleza was designated additional Member per Special Order No. 2624-1 dated January 28, 2019.