Seafarers' Rights: Overcoming Pre-Existing Conditions for Disability Claims

The Supreme Court has clarified that a seafarer with a pre-existing medical condition is not automatically barred from receiving disability benefits. In Sestoso v. United Philippine Lines, Inc. (G.R. No. 237063, July 24, 2019), the Court ruled that what matters is whether the illness is work-related or was aggravated by the seafarer's duties—not whether it existed before employment. The ruling also reinforced the importance of the 120/240-day assessment window for company-designated physicians.

The Facts of the Case

Franciviel Derama Sestoso was hired as a Team Headwaiter on board M/V Carnival Inspiration. In October 2014, while cleaning a dining table, he felt a sharp pain in his right knee. An MRI revealed a complex tear of the medial meniscus and degenerative joint changes, along with evidence of a prior knee surgery from February 2014.

Despite the pain, Sestoso continued working with pain relievers until his contract ended and he was repatriated in February 2015. Upon returning to the Philippines, the company-designated physician treated him and referred him to an orthopedic surgeon, who recommended surgery and suggested a Grade 10 disability rating. However, no final and definite disability assessment was issued within the prescribed period.

The company argued that Sestoso's illness was pre-existing and therefore not compensable. The Labor Arbiter awarded Grade 10 benefits, the NLRC upgraded this to total and permanent disability benefits, but the Court of Appeals reversed, ruling the illness was pre-existing and not work-related. The Supreme Court reversed the Court of Appeals.

The Issue

The central question was whether the Court of Appeals erred in denying total and permanent disability benefits to a seafarer whose illness was pre-existing.

The Ruling: Pre-Existing Illness Does Not Bar Compensation

The Supreme Court held that compensability does not depend on whether the illness was pre-existing at the time of employment. Instead, the key question is whether the illness is work-related or was aggravated by the seafarer's working conditions.

The Court cited More Maritime Agencies, Inc. v. NLRC, which stated that employers take employees as they find them and assume the risk of having a weakened condition aggravated by work. If the work is the proximate cause of disability, the employee's previous physical condition is unimportant.

The Burden of Proof: Work-Relatedness vs. Compensability

The Court drew an important distinction between two concepts:

Work-relatedness enjoys a legal presumption in favor of the seafarer under the POEA Standard Employment Contract. For illnesses not listed as occupational diseases, they are disputably presumed work-related. The employer bears the burden of disproving this presumption with substantial evidence.

Compensability requires the seafarer to prove that work conditions caused or increased the risk of contracting the disease. This applies to both listed and non-listed illnesses.

In this case, the company failed to refute the presumption of work-relatedness. Osteoarthritis is a listed occupational disease under Section 32-A of the POEA-SEC, and a headwaiter's tasks—carrying heavy loads, cleaning, serving food, and exposure to temperature changes—clearly involve the risks described.

The 120/240-Day Window

The Court also emphasized the significance of the 120/240-day assessment period. Under Article 192(c)(1) of the Labor Code and the Amended Rules on Employees' Compensation, a disability becomes total and permanent if the company-designated physician fails to issue a final assessment within the prescribed period.

Here, Sestoso was repatriated on February 13, 2015. The company-designated physician treated him until June 26, 2015—more than 120 days—but never issued a final and definite disability rating. The letter and medical report issued in late June and July 2015 merely noted the orthopedic surgeon's comments without any definitive assessment. This failure meant the disability became total and permanent by operation of law.

Practical Takeaways

• Pre-existing conditions are not an automatic bar. A seafarer can still claim disability benefits if the illness is work-related or aggravated by work duties.
• Know the presumption. Non-listed illnesses are disputably presumed work-related; the employer must present substantial evidence to overturn this.
• Compensability still requires proof. Seafarers must show that work conditions caused or increased the risk of contracting the illness.
• Watch the 120/240-day window. If the company-designated physician fails to issue a final, definite disability assessment within 240 days from repatriation, the disability becomes total and permanent by operation of law.
• Document everything. Medical reports, treatment records, and evidence of work duties are crucial to establishing work-relatedness and compensability.

This article is general information and not legal advice. For your specific situation, consult a lawyer or ask ASG Legal AI.