Seafarer Disability Claims: The 120/240-Day Rule and the Third Doctor Requirement

In Esplago v. Naess Shipping Philippines, Inc. (G.R. No. 238652, June 21, 2021), the Supreme Court tackled recurring questions in seafarer disability claims: When does a temporary disability become permanent and total? And what happens when the seafarer disagrees with the company doctor's assessment but refuses to submit to a third-doctor referral?

The ruling is a practical guide for seafarers and employers on the strict procedural requirements under the 2010 POEA Standard Employment Contract (POEA-SEC) and the Labor Code.

The Case: A Motorman's Eye Injury

Juan Esplago worked as a motorman on a vessel. In October 2011, while in the engine boiler room, excessive smoke hurt his eyes. He was later diagnosed with mature cataracts in both eyes and was repatriated for treatment. The company-designated physician monitored his recovery, and Esplago underwent cataract surgery on his left eye in January 2012.

On May 7, 2012—roughly 200 days after repatriation—the company-designated physician declared Esplago "fit to resume sea duties." Esplago disagreed. He consulted his own doctor, who assessed him as permanently and totally disabled. He then filed a claim for disability benefits without first seeking a third-doctor opinion, as required by the POEA-SEC.

The labor tribunals ruled in his favor, but the Court of Appeals reversed, dismissing his complaint. The Supreme Court affirmed the appellate court's ruling.

The 120/240-Day Rule Explained

Under the Labor Code, temporary total disability lasting continuously for more than 120 days is deemed total and permanent, unless the Rules provide otherwise. The implementing rules allow an extension to 240 days if the injury or sickness still requires medical attendance beyond 120 days.

The Court, citing Elburg Shipmanagement Phils., Inc. v. Quiogue, Jr., laid down the rules:

1. The company-designated physician must issue a final medical assessment within 120 days from the seafarer's report.
2. If no assessment is issued within 120 days without justifiable reason, the disability becomes permanent and total.
3. If the physician fails to assess within 120 days but has sufficient justification (e.g., further treatment needed or the seafarer was uncooperative), the period extends to 240 days. The employer bears the burden of proving justification.
4. If no assessment is issued within 240 days, the disability becomes permanent and total, regardless of justification.

Why the Assessment Here Was Valid

Esplago argued that because the company doctor issued his assessment beyond 120 days, he should be deemed totally and permanently disabled by operation of law. The Court disagreed.

The records showed that Esplago underwent continuous treatment: surgery, follow-up check-ups, medication, and fitting of prescription lenses. The company-designated physician's report documented this progress in detail. This continuous treatment sufficiently justified extending the assessment period to 240 days. Since the fit-to-work declaration came on the 200th day, it fell within the extended period and was valid.

The Third-Doctor Requirement Is Mandatory

The POEA-SEC provides that if the seafarer's doctor disagrees with the company-designated physician's assessment, a third doctor may be jointly agreed upon, and that doctor's decision is final and binding.

Esplago bypassed this procedure. He relied solely on his private physician's assessment. The Court held this was fatal to his claim. The procedure cannot be disregarded; failure to comply constitutes a breach of the rules and results in dismissal of the claim.

The Court also noted that Esplago's private doctor examined him for only one day and based her "unfit to work" conclusion on the fact that his right eye had not been operated on. The attending specialist, who had monitored Esplago over months, was in the best position to assess his condition.

Practical Takeaways

• The 120-day period is not absolute. It can extend to 240 days if the seafarer needs continued medical treatment, but the employer must prove the justification.
• A final assessment issued within 240 days is valid. Even if it comes after the 120th day, a well-documented assessment within the extended period will be upheld.
• Do not skip the third-doctor referral. If you disagree with the company doctor's assessment, you must jointly agree with your employer on a third doctor. Skipping this step can defeat an otherwise valid claim.
• Documentation matters. Detailed medical records showing continuous treatment and progress are crucial in justifying an extended assessment period.
• A one-day examination by a private doctor may not outweigh months of monitoring by the company-designated physician.

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