Guarded Prognosis

2020 January 08

In one case, the Supreme Court reiterated the following rules relating to seafarer claims of total and permanent disability benefits:

  • The company-designated physician must issue a final medical assessment on the seafarer’s disability grading within a period of 120 days from the time the seafarer reported to him;
  • If the company-designated physician fails to give his assessment within the said period of 120 days without any justifiable reason, then the seafarer’s disability becomes permanent and total;
  • If the company-designated physician fails to give his assessment within the said period of 120 days with a sufficient justification (e.g., seafarer required further medical treatment or seafarer was uncooperative), then the period of diagnosis and treatment shall be extended for another 120 days (or up to 240 days from the time the seafarer reported to him). The employer has the burden to prove that the company-designated physician has sufficient justification to extend the period; and
  • If the company-designated physician still fails to give his assessment within the said extended period, then the seafarer’s disability becomes permanent and total, regardless of any justification.

With regard to the company-designated physician’s medical assessment, the Court set forth the following requirements for determining the seafarer’s condition:

  • The assessment must be issued within the 120/240-day window; and
  • It must be final and definitive.

In the present case, the Supreme Court found that the company-designated physician’s medical report was issued within the 240-day period. However, the Court ruled that the said report was not final and definitive.

According to the Court, a final and definitive disability assessment is necessary in order to truly reflect the extent of the sickness or injuries to the seafarer and his or her capacity to resume work as such. To be conclusive, the medical assessments or reports:

  • must be complete and definite to give the proper disability benefits to seafarers
  • must also be supported with sufficient bases.

The Court found that the company-designated physician’s medical report merely states that

  • the seafarer’s “prognosis for returning to sea duties is guarded” and
  • “if patient is entitled to disability, his suggested disability grading is Grade 10 — loss of grasping power for large objects.”

The Court added that the report was notably bereft of any statement or explanation as to how the company-designated physician arrived with her medical conclusion. The report also did not even contain a definite statement as to the seafarer’s fitness to return to sea duties as it states that his prognosis of returning to his sea duties is still guarded.

Furthermore, the company-designated physician failed to explain in detail the progress of the seafarer’s treatment and the approximate period needed for him to fully recover. Said physician merely adopted the findings or observations of the Orthopedics and Spine Surgery specialist.

Thus, the Court ruled that the company-designated physician’s medical assessment was not final and definitive. The seafarer’s disability is deemed permanent and total by operation of law. The seafarer was awarded $110,000.00 under the CBA.

Further reading:

  • Wilhelmsen-Smithbell Manning, Inc. v. Aleman, G.R. No. 239740 (Notice), January 8, 2020.