Title
Lerona vs. Sea Power Shipping Enterprises, Inc.
Case
G.R. No. 210955
Decision Date
Aug 14, 2019
Seafarer denied disability benefits due to fraudulent misrepresentation of pre-existing hypertension and medical abandonment, failing to complete treatment or follow-up.
seafarer
fraudulent misrepresentation
medical abandonment

Case Summary (G.R. No. 210955)

Factual Background: Illness, Repatriation, and Conflicting Medical Assessments

On August 1, 2009, petitioner experienced severe chest pains and dizziness. He sought medical attention and was brought to a hospital in China, where the examining doctor did not prescribe medication nor recommend hospitalization or repatriation. Despite this, petitioner was repatriated on August 13, 2009. The following day, he was confined at De Los Santos Medical Center and examined by respondents’ accredited physicians, including Dr. Jose Emmanuel F. Gonzales (Dr. Gonzales).

In the initial medical report, Dr. Gonzales recorded petitioner’s chief complaint as body weakness and noted that petitioner had a history of hypertension for two years, for which he was taking Norvasc. Dr. Gonzales, in consultation with a cardiologist, indicated possible Coronary Arterial Disease and recommended pertinent laboratory and diagnostic examinations. Petitioner’s laboratory tests showed elevated triglycerides, but his electrocardiogram (ECG) showed no significant findings. The cardiologist required a Stress-Thallium Test, which revealed a mild reversible defect in the apical to basal inferior wall of petitioner’s heart’s blood vessels, with blood pressure recorded at 130/80. Petitioner was provided maintenance drugs, and further evaluation through a coronary angiogram was advised.

The angiogram was negative for vessel abnormalities. Dr. Gonzales later stated in a medical report dated October 15, 2009 that petitioner was cleared of Coronary Arterial Disease. Because petitioner continued complaining of dizziness, he was referred to an ear, nose and throat specialist. After Pure Tone Audiometry with Tympanometry, results showed mild sensori-neural hearing loss on both ears. No surgical procedure was required, and petitioner was prescribed Vitamin B complex. Dr. Gonzales placed petitioner under observation for another week, with a follow-up check scheduled on October 23, 2009; petitioner did not appear, and Dr. Gonzales declared him to have absconded.

Unknown to respondents, petitioner sought independent medical evaluation on December 17, 2009, when Dr. Efren R. Vicaldo (Dr. Vicaldo) of the Philippine Heart Center diagnosed petitioner with Hypertensive Cardiovascular Disease, Angina Pectoris, and an impediment grade VII (41.80%). Dr. Vicaldo opined that petitioner was permanently unfit to resume work as a seaman in any capacity, that the illness was work-aggravated or related, and that petitioner was not expected to land gainful employment.

LA Proceedings: Award of Total and Permanent Disability Benefits

On January 14, 2010, petitioner filed a complaint for recovery of disability benefits, reimbursement of medical expenses, and attorney’s fees against respondents. During the mandatory conference, respondents asserted that petitioner failed to report back to their company-designated physician for a final assessment. Petitioner later returned to Dr. Gonzales on April 21, 2010, at which time he was declared “Fit to Resume Sea Duties.”

In its position, petitioner claimed entitlement to total and permanent disability benefits on the ground that he was unable to work for more than 120 days due to his illness. Respondents countered that petitioner was declared fit for sea duty by their company-designated physician and thus was not entitled to benefits. They further alleged that petitioner concealed his hypertension during the PEME, which, under Section 20(E) of the 2000 POEA-SEC, disqualified him from disability compensation. Respondents also argued that Dr. Gonzales’ findings should prevail over Dr. Vicaldo’s, considering that Dr. Vicaldo examined petitioner only once.

On August 2, 2010, the LA rendered a decision ordering respondents, jointly and severally, to pay petitioner permanent and total disability benefits of US$60,000.00 and attorney’s fees equivalent to ten percent of the total award. The LA reasoned that Dr. Gonzales did not issue any disability rating or grading within the mandatory period, and instead declared petitioner “fit to resume sea duties” only on April 21, 2010, after Dr. Vicaldo’s December 17, 2009 pronouncement of unfitness. The LA further held that petitioner’s pre-existing hypertension did not disqualify him from disability claims. It also invoked estoppel, stating that in petitioner’s previous contracts with respondents, company physicians consistently declared him fit to work after PEME. Finally, it found respondents’ defense of petitioner’s absconding unavailing, because respondents could have issued the results to petitioner and instructed him to report for duty.

NLRC Proceedings: Initial Reversal and Subsequent Reinstatement

On appeal, the NLRC initially reversed the LA on February 8, 2011, and dismissed petitioner’s claim. The NLRC found that the medical examinations performed by respondents’ accredited doctors, including Dr. Gonzales and Dr. Ana Ma. Luisa D. Javier (an internist-cardiologist), were more extensive than Dr. Vicaldo’s single evaluation. It held that petitioner failed to prove he had a cardiovascular disease acquired during the term of employment. The NLRC also addressed compensability of hypertension under Section 32(A)(20) of the 2000 POEA-SEC, which conditions compensation on impairment of body organs and submission of specified documents. It noted that petitioner’s ECG had no significant findings and that the coronary angiogram was negative for vessel abnormalities. Additionally, the NLRC held that petitioner failed to comply with the third doctor referral rule under the 2000 POEA-SEC, warranting denial of compensation.

Upon petitioner’s motion for reconsideration, the NLRC reversed itself and reinstated the LA ruling through a June 24, 2011 Resolution. It held that the 2000 POEA-SEC did not require the parties to assign a third doctor at all times, and that petitioner was not barred from filing a complaint even if the third doctor’s opinion was not secured. The NLRC also stated that the record did not show petitioner’s health condition had returned to the status quo ante to enable him to return as a fitter, and that the absence of surgical intervention did not conclusively prove fitness for work. It further concluded that as of petitioner’s filing on January 14, 2010, about five months after repatriation, he remained unable to return to his work as fitter, and his inability to perform customary work for more than 120 days constituted total and permanent disability. Respondents’ motion for reconsideration was denied on October 24, 2011.

CA Proceedings: Dismissal for Fraudulent Misrepresentation and Lack of Grounds for Total and Permanent Disability

Respondents then filed a petition for certiorari with the CA, docketed as CA-G.R. SP No. 122984. On October 2, 2013, the CA set aside the NLRC resolution, finding grave abuse of discretion, and reinstated the decision to dismiss petitioner’s complaint.

The CA ruled that petitioner committed misrepresentation during the PEME. It found it undisputed that petitioner’s hypertension was a pre-existing condition, yet he did not indicate it in the PEME form. The CA thus held that petitioner was disqualified from disability benefits under Section 20(E) of the 2000 POEA-SEC. It further held that even assuming no concealment, inability to resume work after lapse of more than 120 days did not automatically entitle a seafarer to total and permanent disability benefits. It noted that Dr. Gonzales declared petitioner fit to work on April 10, 2010 (about 200 days after repatriation). The CA attributed the delay to petitioner’s failure to report for medical evaluation after the scheduled appointments, which prevented earlier issuance of the fit to work certification. It also reaffirmed the rule that the company-designated physician is entrusted with determining fitness or disability, and that Dr. Vicaldo’s opinion arose from a same-day consultation without the same diagnostic depth. Lastly, the CA observed that petitioner still did not comply with the third doctor referral rule.

Petitioner’s motion for reconsideration was denied through a January 22, 2014 Resolution, prompting the present Rule 45 petition.

Issues Before the Court and Scope of Review

The principal issue was whether petitioner was entitled to total and permanent disability benefits under the 2000 POEA-SEC. The Court recognized that under Rule 45, review is confined to legal errors committed by the CA. It nonetheless proceeded to examine factual issues due to exceptional circumstances presented by the inconsistent findings among the LA, NLRC, and CA, requiring a determination of which outcome best conformed to evidentiary facts.

Legal Basis and Reasoning: Fraudulent Misrepresentation under Section 20(E)

The Court held that petitioner’s claim must fail because he committed fraudulent misrepresentation. It emphasized that the 2000 POEA-SEC, particularly Section 20(E), disqualifies a seafarer from any disability compensation and benefits when the seafarer knowingly conceals and does not disclose past medical conditions, disabilities, and history during the PEME.

The Court found that petitioner did not mark hypertension on his PEME form, despite being on Norvasc for two years. The concealment was not cured because petitioner only disclosed his hypertension after repatriation. Petitioner argued he did not reveal his condition because he allegedly believed it had been resolved. The Court rejected this defense. It noted that petitioner continued maintenance medication, which contradicted a claim of resolution. It also found that petitioner had boarded respondents’ ships four times during the two-year period while taking maintenance medication. Since PEME is mandatory before deployment, the Court held that petitioner concealed his hypertension at least four times, negating any good faith.

The Court reiterated that it had repeatedly disqualified seafarers from disability claims for similar fraudulent misrepresentation base

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