Title
Maersk-Filipinas Crewing, Inc. vs. Jaleco
Case
G.R. No. 201945
Decision Date
Sep 21, 2015
Seafarer Jaleco claimed permanent disability due to back pain; company-designated physician assessed Grade 11 disability within 240 days, overriding independent doctor’s Grade 6 rating. SC ruled no entitlement to benefits, citing failure to follow conflict resolution procedure and lack of evidence for damages.
disability benefits
malingering
symptoms

Case Summary (G.R. No. 201945)

Factual Background: Injury, Medical Treatment, and Conflicting Assessments

Respondent complained in February 2007 of intermittent pain on the left buttock radiating to the lower back and left groin. An x-ray in Singapore on April 13, 2007 produced normal findings, yet he was diagnosed with “suspected prolapsed intervertebral disc” and was still declared fit to sail. On April 29, 2007, a Dubai examination diagnosed “acute lumbago with left-sided sciatica r/o disc prolapsed,” with advice to obtain an MRI, undergo neurosurgical review, avoid lifting heavy objects for one week, and he was declared unfit for duty. He was repatriated on May 1, 2007 and was immediately referred to the company-designated physician, Dr. Natalio Alegre II (Dr. Alegre), who examined him on May 2 and 3, 2007. Dr. Alegre found “paralumbar spasm and limitation of movement due to pain,” with normal straight leg raise and intact sensation, and prescribed medication and physical therapy.

On May 17, 2007, Dr. Alegre continued to document severe left buttock pain radiating to respondent’s lower back and lateral left thigh, with partial relief from medication, and recommended MRI and epidural steroid injection, with continued physical therapy. On June 4, 2007, Dr. Alegre reported persistence of low back pain radiating to the left lower extremity, associated with numbness and ongoing paralumbar spasm, prompting further medication, physical therapy, and epidural steroid injection. Respondent was confined at St. Luke’s Medical Center during June 13 to 19, 2007 and again during July 24 to 27, 2007. On June 16, 2007, he underwent epidural steroid injection and EMG-NCV testing.

Respondent again sought medical care after returning on June 20, 2007, and on June 29, 2007, he was evaluated by a spine surgeon who recommended provocative discography to determine whether he would need disc replacement. In Dr. Alegre’s July 9, 2007 Progress Report, the spine surgeon’s assessment was noted as: EMG-NCV returned normal and “beginning L5S1 disc herniation.” Dr. Alegre then recommended provocative discography because the pain intensity was “not commensurate” with the alleged symptoms, and he noted an incidental probable small cyst in the left kidney.

Respondent underwent provocative discography on July 26, 2007, which showed a midposterior Grade 1 annular tear with contrast leakage more to the left, but the conclusion stated that “elicited areas are not concordant with usual pain based on patient’s experience.” On July 27, 2007, Dr. Alegre issued another progress report diagnosing “beginning disk dessication, L5S1,” along with the small kidney cyst. Interventional radiology opined that respondent’s complained-of pain was not commensurate with the discography findings. Dr. Alegre stated that “personality reasons should be evaluated to rule out malingering” and sought approval to conduct the MMPI-2, with an approximate cost of PhP 10,000.00. On August 15, 2007, respondent took the MMPI-2. In the August 30, 2007 progress report, Dr. Alegre explained that the test showed validity indicators consistent with exaggeration and malingering. Dr. Alegre concluded that respondent intentionally produced exaggerated physical symptoms motivated by external incentives, including financial compensation and avoiding work.

On September 4, 2007, Dr. Alegre reported continued subjective complaints of persistence of back pains, with slightly spastic paraspinal muscles and normal straight leg raising. He again referred to the MMPI as indicating malingering and exaggeration. Dr. Alegre assessed a mild L5S1 disc desiccation and, if disability were to be assessed then, assigned a disability grade of 11 under the POEA Contract—“Slight Rigidity or 1/3 loss of motion or lifting power of the trunk.”

Subsequently, respondent obtained examinations from independent physicians. On February 8, 2008, Dr. Ramon Santos-Ocampo examined him and noted no tenderness on pressing the left buttock, but slightly tenderness and radiating pain when the L5-S1 facet joints were pressed. He assessed sacro-iliitis and facet arthropathy and planned injections for diagnostic and therapeutic purposes. On April 28, 2008, orthopedic surgeon Dr. Alan Leonardo R. Raymundo issued a medical report based on respondent’s history and prior diagnostic tests. Dr. Raymundo stated that respondent’s MRI plates showed no significant disc protrusion and his EMG-NCV results were normal, but respondent continued to suffer low back pain with walking and prolonged sitting. He reported that facet joint and sacroiliac joint injections relieved pain temporarily, but it recurred after three weeks. He concluded that, considering the nature of seafaring work, it would be impossible for respondent to return to previous duties and he declared respondent unfit for duty.

On October 8, 2009, respondent underwent a second lumbar spine MRI, which revealed findings including a focal left of central disc protrusion at L5-S1 mildly abutting the ipsilateral traversing nerve root, and degenerative osteitis and vertebral hemangioma, generally unchanged from the previous study, along with a left renal cyst. On October 12, 2009, Dr. Raymundo issued a new report noting a disk protrusion at L5-S1 and stated that he had given respondent a Grade 8 rating earlier. He also stated that if re-evaluated, respondent’s functional capacity could be more severe. Dr. Raymundo opined that, despite absence of fracture, he would still give a Grade 6 rating in terms of pain and affectation of the spinal cord.

NLRC Proceedings: Labor Arbiter and NLRC Rulings

Respondent filed a complaint before the NLRC for illegal dismissal, nonpayment of salaries/wages and other benefits, disability claims, medical expenses, damages, and attorney’s fees, docketed as NLRC-NCR Case No. (M) 12-17087-08. In his Position Paper, respondent alleged that during February 2007 he suffered a spine injury during ship-to-ship mooring involving lifting and pulling heavy wires and ropes. He claimed petitioners delayed medical attention and he continued working despite severe pain, causing aggravation of his condition. He asserted that after repatriation and treatment he remained incapacitated and, after consulting an independent physician, he was declared unfit for sea duty and assigned a Grade 6 disability rating. He demanded disability benefits, reimbursement of medical expenses, compensation under the Consolidated Workers’ Compensation Act of Denmark, and damages and attorney’s fees.

Petitioners and Maersk General Manager Jerome P. delos Angeles denied liability. They maintained that respondent was not entitled to Grade 6 but only to Grade 11 as determined by Dr. Alegre. They alleged malingering based on the tests conducted by Dr. Alegre, and argued that under the POEA Standard Employment Contract, where there is disagreement, the parties must secure a third doctor. They insisted that no third opinion was obtained. Petitioners also contended that expenses incurred after the company-designated physician’s September 4, 2007 findings were not reimbursable. They denied damages and attorney’s fees due to absence of bad faith, malice, or negligence, and argued that respondent failed to prove the alleged injuries and delay in medical attention.

On March 23, 2010, the Labor Arbiter granted disability benefits and attorney’s fees. The Labor Arbiter held that respondent’s illness was compensable and reasoned that the company-designated physicians failed to declare fitness for work, which the Labor Arbiter viewed as an inference of a scheme to evade full payment by declaring partial disability. It further held that respondent continued to suffer his ailment despite treatment and remained unable to work and earn income for his family. Although the Labor Arbiter found lack of particulars for medical expenses and claims for nonpayment of wages, leave, and other benefits, it awarded disability benefits corresponding to the schedule under the CBA between AMOSUP and respondent’s manning agency, with attorney’s fees at ten percent (10%) of the total award.

Petitioners appealed to the NLRC, docketed as NLRC LAC No. OFW(M) 07-000539-10. On November 30, 2010, the NLRC reversed the Labor Arbiter. It held that, had the parties followed the POEA Standard Employment Contract, particularly the appointment of a third physician in case of disagreement, controversy would have been avoided. It then evaluated the divergent medical opinions. It found that the private physician’s Grade 6 rating relied on pain severity and recurrence, but it noted that the company-designated physician had considered that pain was not commensurate with the provocative discography and had conducted the MMPI-2, which found malingering and exaggeration. The NLRC held that because the company-designated physician found malingering based on scientific tests, respondent failed to refute that assessment. It thus upheld the Grade 11 disability grading equivalent to US$7,465.00 and 14.93% disability under the POEA Standard Employment Contract. The NLRC deleted attorney’s fees for lack of legal basis and found the complaint unfounded.

Respondent’s motion for reconsideration was denied by the NLRC on February 28, 2011.

Court of Appeals Proceedings: Permanent Total Disability and Monetary Awards

Respondent elevated the case to the CA through a petition for certiorari, docketed as CA-G.R. SP No. 118688. He asserted entitlement to permanent total disability benefits because he had been incapacitated from repatriation until the filing of his petition for more than three years. He also argued entitlement to reimbursement of medical expenses, moral and exemplary damages, and attorney’s fees due to petitioners’ alleged bad faith and inexcusable negligence.

On March 13, 2012, the CA reversed and set aside the NLRC. The CA reasoned that Dr. Alegre’s Grade 11 assessment was grounded on the spine surgeon’s evaluation, interventional radiology’s view that pain was not commensur

...continue reading

Analyze Cases Smarter, Faster
Jur helps you analyze cases smarter to comprehend faster, building context before diving into full texts. AI-powered analysis, always verify critical details.

About Privacy Terms