Case Digest (G.R. No. 237063)
Facts:
Petitioner Franciviel Derama Sestoso was hired by respondents United Philippine Lines, Inc. (UPLI) for a foreign principal (Carnival Cruise Lines) as Team Headwaiter on board M/V Carnival Inspiration. He reported knee pain after kneeling to clean a dining table in October 2014, underwent shore-side treatment in Los Angeles, and was repatriated on February 13, 2015.
He claimed total and permanent disability benefits, asserting that respondents’ company-designated physicians failed to issue a definite and final disability rating within the 120/240-day period. The Labor Arbiter awarded Grade 10 benefits, the NLRC later awarded total and permanent disability benefits, and the Court of Appeals reversed, holding the illness to be pre-existing and non-compensable.
Issues:
- Whether the Court of Appeals erred in denying petitioner’s claim for total and permanent disability benefits.
- Whether petitioner’s knee ailment was work-related and compensable despite being allegedly pre-existing.
- Whether petitioner’s disability became total and permanent by operation of law due to the company-designated physician’s failure to issue a final assessment within the 120/240-day period.
Ruling:
The Supreme Court granted the petition, reversing and setting aside the Court of Appeals’ rulings. It held that petitioner’s illness was work-related and compensable, and that the failure to issue a definite and final disability rating within the statutory period resulted in total and permanent disability.
The Court ordered respondents to jointly and severally pay petitioner US$60,000.00 (or its peso equivalent) as total and permanent disability benefits, plus ten percent (10%) attorney’s fees, with six percent (6%) interest per annum from the date of finality until full payment.
Ratio:
The Court ruled that compensability does not turn solely on whether a disease was pre-existing, but on whether it is work-related or was aggravated by work. Under the 2010 POEA-SEC, a non-listed illness is presumed work-related, and the employer bears the burden to disprove that presumption by substantial evidence; however, compensability itself is not presumed, and the seafarer must still establish the conditions for compensability by substantial evidence.
Applying these rules, the Court found that osteoarthritis is listed and presumed work-related when the seafarer’s work involves risks such as joint strain from heavy loads or strenuous use. It held that petitioner’s headwaiter tasks—carrying heavy food provisions, cleaning and serving, and exposure to extreme temperature changes—could have caused or at least aggravated the ailment.
On the 120/240-day rule, the Court found no showing that the company-designated physician issued a definite and final disability rating within the prescribed periods. Petitioner required further medical attention beyond 120 days from repatriation, and the July 28, 2015 letter and June 25, 2015 medical report were not definitive final assessments. Since petitioner remained incapacitated beyond the 240-day period, his disability became total and permanent by operation of law.
Doctrine:
- Compensability of an illness in seafaring service does not depend on whether the disease was pre-existing, but on whether it is work-related or aggravated by the seafarer’s work.
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