Third Doctor's Opinion Prevails in Seafarer Disability Claims: Clarifying Conflict Resolution Under POEA-SEC

The Supreme Court's 2018 decision in Yialos Manning Services, Inc. v. Borja (G.R. No. 227216) clarifies a recurring issue in seafarer disability claims: what happens when the company-designated physician and the seafarer's own doctor disagree on the disability rating. The ruling reinforces that the conflict-resolution procedure under the POEA Standard Employment Contract (POEA-SEC) is mandatory, and a seafarer who refuses to submit to a third doctor's assessment cannot claim total permanent disability benefits based merely on the passage of time.

The Facts of the Case

Ramil Borja was employed as an oiler on board M/V Thetis. In November 2010, he felt pain in his buttocks radiating down his leg after lifting a metal plate. He was medically repatriated and referred to the company-designated physician at Metropolitan Medical Center, who diagnosed "lumbar strain" and advised physical therapy.

On April 15, 2011, the company-designated physician issued a disability rating of Grade 11 — "slight rigidity of 1/3 loss of motion or lifting power of the trunk." Borja, however, continued therapy and later consulted his own physician, who declared him "physically unfit to return to work" or suffering from "total permanent disability."

During conciliation proceedings before the Labor Arbiter, the parties initially agreed to refer the case to a third doctor, but Borja allegedly backed out. The Labor Arbiter and the NLRC nonetheless awarded Borja total permanent disability benefits of US$60,000, reasoning that his disability became total and permanent because the company physician's assessment was issued beyond the 120-day period.

The Issue

The central question was whether Borja was entitled to total permanent disability benefits despite the company-designated physician's Grade 11 rating, given that the seafarer's own doctor certified a total permanent disability.

The Court's Ruling

The Supreme Court reversed the lower tribunals and granted the petition, holding that Borja was entitled only to the Grade 11 disability compensation of US$7,465.00.

The Third-Doctor Procedure is Mandatory

The Court emphasized that Section 20(B)(3) of the POEA-SEC provides a clear solution when medical findings conflict: if the seafarer's doctor disagrees with the company-designated physician's assessment, a third doctor may be jointly agreed upon, and the third doctor's decision is final and binding on both parties.

Citing Marlow Navigation Philippines, Inc. v. Osias, the Court held that referral to a third doctor is mandatory when: (1) there is a valid and timely assessment by the company-designated physician, and (2) the seafarer's appointed doctor refuted that assessment.

The Burden is on the Seafarer

The Court clarified that the duty to initiate the conflict-resolution process falls on the seafarer, who is contesting the company-designated physician's findings. Citing Bahia Shipping Services, Inc. v. Constantino, the Court explained that the seafarer bears the burden of positive action to prove that his own doctor's findings are correct and to notify the company of the contrary finding.

In this case, Borja refused to submit to a third doctor during conciliation. Without a third doctor's opinion, there was no valid challenge to the company-designated physician's Grade 11 assessment, which therefore prevailed.

The 120/240-Day Rule Does Not Automatically Grant Total Disability

The Court rejected Borja's argument that he was totally and permanently disabled by operation of law because the company-designated physician did not declare him fit within 120 days. Citing Vergara v. Hammonia Maritime Services, Inc., the Court clarified that the seafarer's condition is temporary total disability during treatment, which may extend up to 240 days. Within these periods, the company-designated physician must assess whether the seafarer is fit to work or has a permanent partial or total disability.

Only if the 240-day period lapses without any assessment from the company-designated physician does a conclusive presumption of total and permanent disability arise. Here, the company physician issued the Grade 11 rating on April 15, 2011 — within the extended 240-day period — so that assessment controlled.

Disability is Based on the Schedule, Not Duration

The Court emphasized that under Section 20(B)(6) of the POEA-SEC, disability compensation is based on the schedule of benefits in Section 32, not on the duration of treatment. Only Grade 1 constitutes total permanent disability; Grades 2 to 14 are partial permanent disability.

Practical Takeaways

• The company-designated physician's assessment prevails unless a third doctor is jointly agreed upon and issues a contrary opinion.
• The seafarer must actively initiate the third-doctor referral process when disputing the company physician's findings; refusing to do so weakens the claim.
• The 120/240-day rule is not an automatic grant of total permanent disability; it only creates a conclusive presumption if no assessment is made within 240 days.
• Disability grading follows the POEA-SEC schedule, not the length of treatment. A Grade 11 rating entitles the seafarer to partial permanent disability benefits only.
• Settlement at the conciliation stage through a third-doctor referral can avoid costly and prolonged litigation for both parties.

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