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EN BANC

TEOD RO B. BUNAYOG, G.R. No. 253480

Petitioner,

Present:

GESMUNDO, Chief Justice,

LEONEN,
CAGUIOA,
HERNANDO,*
LAZARO-JAVIER,
- versus - INTING,
ZALAMEDA,
LOPEZ,M.,
GAERLAN,
ROSARIO *
'
LOPEZ, J.,
DIMAAMPAO,
MARQUEZ,
KHO, JR., and
FOSCO SHIPMANAGEMENT, SINGH,JJ
INC., I REEN MARITIME CO.,
LTD., VELYN M. DEFENSOR, Promulgated:
Respondents. April 25, 2023
X-------- -----------------------------------------,-C:::: ~ - - - X

DECISION

F r the Court's consideration is a Petition for Review on Certiorari 1

under R le 45 of the Rules of Court filed by Teodoro B. Bunayog (petitioner)
seeking t assail the Court of Appeals (CA) Decision2 dated February 21, 2020

On le ve.
Rollo pp. 8-25.
Id . at 27-35; penned by Associate Justice Ramon M. Sato, Jr., with Associate Justices Zenaida T.
Gala ate-Laguil!es and Perpetua Susana T. Ata l-Pafio concurring.
Decision 2 G.R. No. 253480

and the Resolution3 dated September 16, 2020 in CA-G.R. SP No. 154603,
which affirmed the National Labor Relations Commission's (NLRC) Decision4
dated September 29, 2017 which, in tum, dismissed the petitioner's complaint
for total and permanent disability benefits, transportation expenses and
attorney's fees.

The Antecedents

Petitioner was engaged by Foscon Shipmanagement, Inc., (Foscon) on

behalf of its foreign principal, Green Maritime Co., Ltd. (Green), (collectively,
respondents) as a chief cook onboard the vessel MIT Morning Breeze for a
period of nine months. On July 31, 2016, while on board the vessel, petitioner
experienced cough, fever and difficulty in breathing. On August 2, 2016,
petitioner was brought to a clinic in Japan where he was diagnosed with left
lung pneumonia. He was declared by the doctor to be unfit for sea duty. Thus,
he was repatriated to the Philippines on August 4, 2016 and referred
immediately to a company-designated physician. After evaluation, petitioner
was diagnosed to be suffering from pneumonia with recurrent pleural effusion,
left s/p thoracentesis, left. Petitioner's treatment lasted until September 28,
2016. On such date, one of the company-designated physicians, Dr. Percival P.
Pangilinan, declared petitioner fit to work. 5

Petitioner, thereafter, consulted a physician of his choice, Dr. Noel C.

Gaurano (Dr. Gaurano ), who declared him unfit for sea duty due to his pleural
effusion. 6

On November 10, 2016, petitioner sent a letter to respondent Evelyn M.

Defensor (Evelyn), president of Foscon, informing her of the findings of his
doctor and of his willingness to undergo another medical examination to
confirm his permanent disability. No response, however, was made on the part
of respondents. 7

Subsequently, pet1t10ner filed a complaint for total and permanent

disability benefits, among others. Petitioner averred that he is entitled to a total
. and permanent disability benefit in the amount ofUS$60,000.00, since he can
no longer perform his tasks as a chief cook. 8

3
Id. at 37-38.
4
Id. at 54-65; penned by Commissioner Isabel G. Panganiban-Ortiguerra, with Presiding Commissioner
Joseph Gerard E. Mabilog and Commissioner Nieves E. Vivar-De Castro, concurring.
Id. at 27-28.
6
Id. at 28-29.
7
Id. at 29.
Id.
..,
Decision .) G.R. No. 253480

I response, respondents averred that petitioner is not entitled to any

disabili compensation considering that the company-designated physician
had alre dy declared him fit to work; and that as between the findings of the
compan -designated physician and the petitioner's physician of choice, the
former's findings should prevail since petitioner's doctor examined him only
once. 9

The Labor Arbiter Ruling

In a Decision 10 dated June 30, 2017, the Labor Arbiter (LA) dismissed
the com laint for lack of merit. The LA gave credence to the findings of the
compan -designated physician over that of petitioner's physician of choice.
The LA atiocinated that petitioner's doctor based his conclusion that petitioner
was no 1 nger fit to work based on popular observation and findings of patient's
response to treatment, not on a specific study of petitioner's condition and
response to medical treatment. 11 Meanwhile, the company-designated
physicia 's declaration of petitioner's fitness to work was founded on
petitione 's specific responses to the step-by-step medical interventions
administrred on his condition. Accordingly, there was no reason to set aside the
findings bf the company-designated physician. 12 The LA, thus, disposed of the
case int is wise:

WHEREFORE, premises considered, the instant case 1s hereby

Di missed for lack of merit.

so ORDERED. 13

A grieved, petitioner filed a Notice of Appeal and Memorandum of

Appeal 14 with the NLRC.

The NLRC Ruling

September 29, 2017, the NLRC issued a Decision 15 affirming the

findings f the LA. Similar to the conclusion of the LA, the NLRC gave no
probativ value to the assessment made by petitioner's physician of choice. 16
The NL C likewise ruled that despite respondents' failure to seek a third doctor
after pet· ioner signified its intent to undergo another examination to confirm

9
Id.
10 CA r /lo, pp. 116-118; penned by Labor Arbiter Zosima C. Lameyra.
II
Id. at 117.
12
Id. at 118.
IJ
Id.
14
Id. atI 19-1 36.
15
Rollo pp. 54-65 .
16
Id. at 2-63.
Decision 4 G.R. No. 253480

his condition, it does not necessarily redound to the benefit of petitioner, that is,
his physician's assessment should be binding. The NLRC ratiocinated that "the
appointment of a third doctor requires mutual agreement of the employer and
the seafarer, and in case the parties failed to agree on a third doctor, the seafarer
can initiate a complaint before the [LA] or NLRC, and the case will be resolved
based on its merit." 17 Thefallo of the NLRC Decision reads:

WHEREFORE, premises considered, the instant appeal is DENIED.

The assailed Labor Arbiter's Decision dated June 30, 2017 in NLRC NCR
Case No. (M) 12-15998-16 is hereby AFFIRMED.

SO ORDERED. 18

Undaunted, petitioner filed a petition for review with the CA assailing

the NLRC Decision.

The CA Ruling

The CA, in the assailed Decision19 dated February 21, 2020, dismissed
the petition and affirmed the findings of the LA and the NLRC. The CA
disregarded the assessment made by petitioner's physician considering that the
physician did not require petitioner to undergo medical tests; nor was the
assessment based on petitioner's response after a specific treatment was
administered to him. 20 The CA, thus, concluded:

WHEREFORE, the Amended Petition for Certiorari is DENIED for

lack of merit. The 29 September 2017 Decision and 29 November 2017
Resolution of the National Labor Relations Commission in NLRC LAC No.
08-000519-17 (NLRC NCR Case No. (M)12-15998-16) are hereby
AFFIRMED.

SO ORDERED. 21

Petitioner, thereafter, moved for reconsideration. It was, however, denied

in a Resolution22 dated September 16, 2020.

Hence, the instant petition wherein petitioner raises the following issues:

17 Id. at 64.
18
Id. at 65.
19
Id. at27-35.
20 Id. at 34.
21 Id. at 34-35.
22
Id. at 37-38.
Decisio 5 G.R. No. 253480

Issue

I.
[CA] GRAVELY ERRED IN NOT AWARDING
[ ITIONER] TOTAL AND PERMANENT DISABILITY
FITS;

II.
T [CA] GRAVELY ERRED IN NOT AWARDING
.A. TORNEY'S FEES AND MORAL DAMAGES .23

The Court's Ruling

e petition is bereft of merit.

A the outset, entitlement to disability benefits by a seafarer is a matter

goveme , not only by medical findings but also, by law and by contract. The
material statutory provisions areArticles 197-199 (formerly Articles 191 to 193)
under C apter VI (Disability Benefits), Book IV of the Labor Code, in relation
to Rule of the Rules and Regulations Implementing Book IV of the Labor
Code. B contract, Memorandum Circular No. 10, Series of 2010, Philippine
Oversea Employment Administration - Standard Employment Contract
(POEA- EC) also known as the Amended Standard Terms and Conditions
Governi g the Overseas Employment of Filipino Seafarers on Board Ocean-
Going S ips (the governing POEA-SEC at the time petitioner was employed
by resp dents in 2016), and the parties' Collective Bargaining Agreement,
bind the eafarer and his employer to each other. 24

S ction 20(A), paragraph 3 of the 2010 POEA-SEC reads in part:

For this purpose, the seafarer shall submit himself to a post-

ployment medical examination by a company-designated physician within
e working days upon his return except when he is physically incapacitated
o so, in which case, a written notice to the agency within the same period
eemed as compliance. In the course of the treatment, the seafarer shall
al report regularly to the company-designated physician specifically on the
da es as prescribed by the company-designated physician and agreed to by
th seafarer. Failure of the seafarer to comply with the mandatory reporting
re uirement shall result in his forfeiture of the right to claim the above
be efits.

23
24
OSG hipmanagernent Manila, Inc. v. De Jesus, G.R. No. 207344, November 18, 2020.
Decision 6 G.R. No. 253480

If a doctor appointed by the seafarer disagrees with the

assessment, a third doctor may be agreed jointly between the employer
and the seafarer. The third doctor's decision shall be final and binding on
both parties. (Emphasis supplied)

This provision requires that, after medical repatriation, the company-

designated physician must assess the seafarer's fitness to work or the degree of
his disability. If the seafarer disagrees with the findings of the company-
designated physician, the seafarer may choose his own doctor to dispute such
findings. If the findings of the company-designated physician and the seafarer's
doctor of choice are conflicting, the matter is then referred to a third doctor,
whose findings shall be binding on both parties. 25

This provision clearly gives the parties the opportunity to settle, without
the aid of the labor tribunals and/or the courts, the conflicting medical findings
of the company-designated physician and the seafarer's physician of choice
through the findings of a third doctor, mutually agreed upon by the parties.

The rationale for this rule is laid out in the case of Transocean Ship
Management (Phils.), Inc. v. Vedad, 26 thus:

x x x it is understandable that a company-designated physician would be

more positive and in favor of the company than, say, the physician of the
seafarer's choice. It is on this account that a seafarer is given the option by
the POEA-SEC to seek a second opinion from his preferred physician. And
the law has anticipated the possibility of divergence in the medical findings
and assessments by incorporating a mechanism for its resolution wherein a
third doctor selected by both parties decides the dispute with finality, as
provided by Sec. 20(B)(3) of the POEA-SEC quoted above. 27

Referral to a third doctor is mandatory, and

failure of the seafarer to comply therewith is
tantamount to a breach ofthe POEA-SEC

In a plethora of cases, it was held that referral to a third doctor is

mandatory in disability claims such that should the seafarer fail to comply
therewith, he or she would be in breach of the POEA-SEC, and, as a
consequence, the assessment of the company-designated physician shall be
final and binding. 28

25
Pacific Ocean Manning, Inc. i, Solacito, 871 Phil. 236, 250-251 (2020).
26
707 Phil. 194 (2013).
27
Id. at 207.
28
Ranoai, Anglo-Eastern Crew Mgnt. Phils., Inc., 867 Phil. 108, 123-124 (2019) citing, Dahle Philman
Manning Agency, Inc. v. Doble, 8 ! 9 Phil. 500, 5 l 4 (2017).
Decision 7 G.R. No. 253480

In the case of INC Navigation Co. Philippines, Inc. v. Rosales, 29 it was

made cl ar that:

This referral to a third doctor has been held by this Court to be a

m ndatory procedure as a consequence of the provision that it is the
co pany-designated doctor whose assessment should prevail. In other
w rds, the company can insist on its disability rating even against a
co trary opinion by another doctor, unless the seafarer expresses his
di agreement by asking for the referral to a third doctor who shall make
hi or her determination and whose decision is final and binding on the
pa ies. We have followed this rule in a string of cases among them,
P ilippine Hammonia, Ayungo v. Beamko Shipmanagement Corp., Santiago
v. acbasin Shipmanagement, Inc., Andrada v. Agemar Manning Agency,
an Masangkay v. Trans-Global Maritime Agency, Inc. Thus, at this point,
th matter ofreferral pursuant to the provision of the POEA-SEC is a settled
rul · ng. 30 (Emphasis supplied; citations omitted)

It s, therefore, settled that in cases where the seafarer fails to signify his
or her i tent to refer the conflicting medical findings to a third doctor, the
compan -designated physician's findings shall be final and binding. However,
there is exception to this rule.

In Dionio v. Trans-Global Maritime Agency, Inc. 31 (Dionio), We

stressed hat when the company-designated physician's medical conclusion is
found to ave been issued with a clear bias in favor of the employer, i.e., lacking
in scient fie basis, or unsupported by the medical records of the seafarer, the
inherent nerits of the respective medical findings shall be considered by the
tribunals or court, to wit:

Thus, while failure to refer the conflicting findings between the

co 1pany-designated physician and the seafarer's physician of choice gives
th former's medical opinion more weight and probative value over the latter,
stil , it does not mean that the courts are bound by such doctor's findings, as
th court may set aside the same if it is shown that the findings of the
pany-designated doctor have no scientific basis or are not suppo1ied by
ical records of the seafarer.

Indeed, the rule that the company-designated doctor's findings shall

ail in case of non-refenal of the case to a third doctor is not a hard-and-
rule as labor tribunals and the courts are not bound by the medical
fin ings of the company-doctor. Instead, the inherent merits of the
res ective medical findings shall be considered. 32

29
744 P ii. 774 (20 14).
30
Id. at 87.
31
843 P ii. 409 (2018).
32
Id. at 20-421.
Decision 8 G.R. No. 253480

In this case, upon his repatriation on August 4, 2016, petitioner was

immediately referred to a company-designated physician. After evaluation, he
was diagnosed to be suffering from "pneumonia with recurrent pleural effusion,
left s/p thoracentesis, left." Petitioner, from his repatriation on August 6, 2016
to September 28, 2016, underwent a series of medical treatments. On
September 28, 2016, he was declared by the company-designated physician fit
to work. 33

Petitioner, thereafter, consulted his physician of choice, Dr. Gaurano,

who declared him unfit for sea duty. 34

On November 10, 2016, petitioner, through counsel, sent a letter to

Evelyn, president ofFoscon, informing her that he consulted an independent
doctor, who found that he was already unfit to resume his work as a seaman.
Petitioner likewise signified his willingness to undergo another test or
examination to confirm his present disability. 35

From the established facts, it is clear that petitioner complied with the
procedural requirements set forth above. After consulting his own physician,
who, contrary to the findings of the company-designated physician, declared
him unfit for sea duty, he signified his intention to undergo another test or
examination to confirm his present condition. Simply, he informed respondents
of his willingness to seek a third doctor. Interestingly, respondents failed to
respond to the letter. Thus, petitioner was obliged to file a complaint for
disability benefits.

Moreover, it is also settled that once the seafarer notifies his or her
employer that he or she intends to refer the conflict to a third doctor, the
burden shifts to the employer to complete the process of referral to a third
doctor so that, once and for all, the medical assessment of the seafarer will be
put to rest. 36

However, what if the employer refuses to complete the third doctor

referral process or ignores the request or demand of the seafarer, such as in the
instant case?

Before answering this, We first need to determine what should be the

contents or attack111ents of the written request or demand of the seafarer for a
third doctor referral before the employer is obligated to put the process in

33
Rollo, p. 28.
34
CA rollo, pp. 56-58.
35
Id. at 59.
36
Benhur Shipping C01p. v. Riego, G.R. No. 229179, March 29, 2022.

J
Decisio 9 G.R. No. 253480

motion.

The sea rer must signify his intent to refer the

conjlictz g medical findings to a third doctor
through writing and attach a copy of the
medical report or abstract ofhis physician, or
at the v ry least indicate its contents therein,
to be co sidered valid

l Benhur Shipping Corp. v. Riego37 (Benhur), We ruled that the written

request r demand to refer the conflicting medical findings to a third doctor
does no need to be accompanied by the medical report or opinion of the
seafarer s physician of choice. A mere "statement regarding the seafarer's
fitness t work OR the disability rating," is sufficient. 38 The reason for such
ement is that:

x x it was neither stated nor required therein that when the seafarer sends
a equest for a referral to a third doctor to the employer, the seafarer must
m ndatorily attach the medical report of his own medical doctor to such
re uest. Notably, it is not the employer who will assess the medical report
of the seafarer's chosen physician; rather, it will be the labor tribunals where
th complaint for disability benefits is filed that would assess the medical
re ort. 39

, however, need to further clarify the Benhur 1uling on this particular

issue.

B nhur dismissed the fact that it was the third doctor, mutually agreed
upon by the parties, who would first make an assessment not only on the
medical findings of the company-designated physician but also that of the
seafarer's physician of choice. Without the medical report or medical abstract
on the s afarer' s condition, how could the third doctor make an exhaustive
assessm nt of the seafarer's condition and arrive at a final and binding medical
conclusi n?

rthermore, without attaching to the written request or demand, or

even icating therein the contents of the medical report or the medical
abstract f the seafarer's condition, how could the employer know whether
the sea£ rer was indeed examined by his doctor of choice and that his claim
of a con ary finding by his purported doctor has basis? Needless to state, it is
not far- . tched that the seafarer may just indicate in his written request or

37
Id.
38
Id.
Id.
Decision 10 G.R. No. 253480

demand that his doctor of choice found him unfit for sea duty, which is
contrary to the findings of the company-designated physician, just to put the
third doctor referral process in motion even though the seafarer was actually
not subjected to a medical examination by a doctor of his choice.

Thus, to avoid being abused by the seafarer, there should be a safeguard.

Attaching the medical report or medical abstract, or at the very least,
indicating in the written request or demand the contents thereof would serve
as a deterrent from such abuse. This will further discourage seafarers from
simply submitting doubtful, incomplete, and unsupported contrary
assessments from his/her doctor of choice. The seafarer would also be
compelled to undergo a comprehensive medical examination and treatment in
order for his/her doctor to arrive at an exhaustive medical report or abstract.

Finally, it is settled that the company-designated physicians must

furnish their assessment to the seafarer concerned; that is to say that the
seafarer must be fully and properly informed of his/her medical condition,
including inter alia, the results of his/her medical examinations, the treatments
extended to him/her, the diagnosis, and prognosis, if needed. 40 Just as the
seafarer must be fully informed of the company-designated physician's
findings, the employer, in this case, the respondents, has the similar right to
be sufficiently informed by the seafarer of the contrary findings of his/her
doctor. Hence, the need to attach to the written request or demand the medical
report or abstract of the seafarer's doctor.

We, therefore, hold and so rule that only by attaching to the written
request or demand the medical report or the medical abstract of his physician
or indicating therein the contents thereof, may a seafarer be deemed to have
duly and fully disclosed to the employer the contrary assessment of his/her
own doctor.

Corollarily, when a seafarer signifies his/her intent to refer the case to

a third doctor through a written request or demand, without attaching the
required medical report or medical abstract from his/her physician, or at the
very least, indicating therein the contents of the medical report, the employer
has the option to refuse, or even ignore the written request or demand, without
violating the pertinent provision of the POEA-SEC.

In such a case, the tribunals and the courts must follow the general rule
that the company-designated doctor's assessment should prevail. However, as
held in Dionio, when the company-designated physician's findings lack
scientific and medical basis, the tribunals and courts may still consider the

40 Reyes v. Magsaysay Mitsui Osk Marine, Inc.. G.R. No, 209756, June 14, 2021.

JJ
Decision 11 G.R. No. 253480

inherent merits of the respective medical findings of the company-designated

physicia and the seafarer's doctor of choice.

0 the other hand, when a seafarer's written request or demand is

accomp nied by the medical report or medical abstract of his physician of
choice, t e employer has no other option but to initiate the third doctor referral
process. Simply put, the employer is required to make and send a written reply
to the w itten request or demand acceding thereto and putting into motion the
procedu e for the referral to a third doctor.

In addition, We deem it necessary to give the employer a certain period,

i. e., 10 d ys upon receipt of the seafarer's written request or demand, to serve
a written reply to the seafarer in response to the written request or demand for
the imm diate resolution of the conflicting assessment of their respective
doctors. lthough the Labor Code and the POEA-SEC do not expressly grant
the Cour the power to impose such period, there is a need to prescribe a period
to reply o the written request or demand as it is not only reasonable and
practical ut also in line with the conflict-resolution mechanism under Section
20(A)(3) of the POEA-SEC, which allows the parties to settle disability
claims v luntarily at the parties' level more speedily and without delay.

Fu berm.ore, if the employer agrees to refer the seafarer's condition to a

third doc or, the parties should be given a specific period to complete the third
doctor re erral procedure. We are thus, inclined to adopt the directive of the
NLRC E Banc to its LAs as enunciated in NLRC En Banc Resolution No.
008-14, 41 to wit:

x x x The Commission, in line with its mission to resolve labor disputes

inv lving Seafarers in the fairest, quickest, least expensive and most effective
wa possible, directs all Labor Arbiters, during mandatory conference, to give
the arties a period of fifteen (15) days within which to secure the services of
a th rd doctor and an additional period of thirty (30) days for the third doctor
to s bmit his/her reassessment. 42

Ac ordingly, after an affirmative response from the employer, the parties

are given a period of 15 days within which to secure the services of a third
doctor an an additional period of 30 days for the third doctor to submit his/her

In is case, records show that after undergoing a medical examination

by his physician of choice (Dr. Gaurano ), petitioner, through

41 Nove er 12, 2014.

42
Id.
Decision 12 G.R. No. 253480

counsel, sent a written request 43 to respondents signifying his intention to

undergo another test or examination to confirm his present condition. He also
attached to the letter the medical report44 of Dr. Gaurano, where he was found
to be unfit for sea duty. By doing so, petitioner duly and fully disclosed to
respondents the contrary assessment of his own doctor and tendered his
willingness to refer the contradicting medical findings to a third doctor. It is
clear, therefore, that petitioner made a valid written request. Notwithstanding,
respondents failed to even respond to petitioner's request for a third doctor
referral.

We now ask again the question, what happens when the seafarer tenders
a valid request to refer the conflicting findings of the company-designated
physician and his physician of choice to a third doctor, and the employer
refuses to accede to such request?

In such a case, the seafarer acquires the right to validly insist on an

assessment different from that made by the company-designated physician and
file a complaint against the employer. This was Our pronouncement in the case
of Maersk-Filipinas Crewing, Inc. v. Alferos,45 viz.:

The need for the evaluation of the respondent's condition by the third
physician arose after his physician declared him unfit for seafaring duties. He
could not initiate his claim for disability solely on that basis. He should
have instead set in motion the process of submitting himself to the
assessment by the third physician by first serving the notice of his intent
to do so on the petitioners. There was no other way to validate his claim
but this. Without the notice of intent to refer his case to the third
physician, the petitioners could not themselves initiate the referral.
Moreover, such third physician, because he would resolve the conflict
between the assessments, must be jointly chosen by the parties thereafter.
Unless the respondent served the notice of his intent, he could not then
validly insist on an assessment different from that made by the company-
designated physician. This outcome, which accorded with the procedure
expressly set in the POEA-SEC, was unavoidable for him, for, as well
explained in Hernandez v. Magsaysay Maritime Corporation:

Under Section20 (A) (3) of the 2010 POEA-SEC, "[if]

a doctor appointed by the seafarer disagrees with the
assessment, a third doctor may be agreed jointly between the
Employer and the seafarer. The third doctor's decision shall ·
be final and binding on both parties." The provision refers to
the declaration of fitness to work or the degree of disability. It
presupposes that the company-designated physician came up
with a valid, final and definite assessment as to the seafarer's
fitness or unfitness to work before the expiration of the 120-

43
CA rollo, p. 59.
44 Id. at 56-58.
45 850 Phil. i075 (2019).
Decision 13 G.R. No. 253480

day or 240-day period. The company can insist on its

disability rating even against a contrary opinion by
another doctor, unless the seafarer signifies his intent to
submit the disputed assessment to a third physician. The
duty to secure the opinion of a third doctor belongs to the
employee asking for disability benefits. He must actively or
expressly request for it. 46 (Emphasis supplied, underlining
and citations omitted)

on the filing of the complaint, however, the parties are given another
opportu ity to refer the seafarer's condition to a third doctor, whose findings
shall be mal and binding between the parties.

NLRC n Banc Resolution No. 008-14

requires all LAs, during mandatorv
conferen e, to give the parties a chance to
secure th services ofa third doctor

T e NLRC En Banc issued Resolution No. 008-14 wherein it directs all

LAs, du ing mandatory conference, to give the parties a period of 15 days
within w ich to secure the services of a third doctor and an additional period of
30 days r the third doctor to submit his/her reassessment.47

In his case, upon the filing of the complaint, and during the mandatory
conferen e, the records do not show whether the LA required the parties to
institute he third doctor referral procedure. Even if there was such a directive
from the LA, it would seem that the parties still failed to refer petitioner's
conditio to a third doctor which led to a full-blown hearing before the LA.

Wi , however, deem it necessary to further lay down rules in case where

there is a f irective from the LA to refer the seafarer's condition to a third doctor,
but one o the parties refuses to give heed to such directive. Thus, if the seafarer
1
refuses t comply with the directive of the LA, such refusal should be taken
against h m/her.

the other hand, if it is the employer who, despite the LA's directive,
refuses t refer the seafarer's condition to a third doctor, such refusal, as well
as thee player's failure to respond to the seafarer's valid written request or
demand r a third doctor referral should be taken against the employer.

46
Id. at 085- 1086.
47
NLR En Banc Resolution No. 008-14, November 12, 2014.
Decision i4 G.R. No. 253480

The employer's failure to respond to the

seafarer's valid request to refer the conflicting
medical findings to a third doctor is a
violation of the POEA-SEC

The Court, in Reyes v. Jebsens Maritime, lnc. 48 (Reyes), ruled that in

case the employer refuses or ignores the written request or demand of the
seafarer for a third doctor referral, the findings of the company-designated
physician cannot be automatically deemed conclusive and binding. Instead,
the court or tribunals must weigh the inherent merits of the medical findings
presented by both sides. 49

Then came Benhur. Benhur followed the ruling in Reyes. Similar to the
Reyes case, the employer in Benhur refused to initiate referral to third doctor
despite an adequate and valid request from the seafarer. The Court then
concluded that:

Indeed, when the employer fails to act on the seafarer's valid request
for referral to a third doctor, the tribunals and courts are empowered to
conduct its own assessment to resolve the conflicting medical opinions
of the company-designated physician and the seafarer's chosen
physician based on the totality of evidence. The employer simply cannot
invoke the conclusiveness of the company-designated physician's medical
opinion vis-a-vis the seafarer's chosen physician's medical opinion when it
is because the employer's own inaction and neglect that the medical
assessment was not referred to a third doctor. 50 (Emphasis supplied)

In the more recent case of Ledesma v. CF Sharp Crew Management,

51
Inc. (Ledesma), the Court applied the ruling in Reyes and Benhur. In that
case, the employer again failed to respond despite receipt of the seafarer's
demand letter to refer the conflicting medical claims to a third doctor. The
Court was, thus, constrained to resolve the conflicting findings as to the
seafarer's fitness to resume sea duty, as stated in the final assessment of the
company-designated physician and the medical certificate of the seafarer's
physician of choice. 52

It is evident from the decisions of Reyes, Benhur, a.rid Ledesma, that the
employer's non-compliance with the conflict-resolution procedure, as
mandated by the POEA-SEC, merely gives the tribunals and the courts the
power to weigh the conflicting medical assessments of the employer's
physician and that of the seafarer. In other words, the rulings in Reyes, Benhur,

48
G.R. No. 230502, February 15, 2022.
49 Id.
50
Supra note 36.
51
G.R. No. 241067, October 5, 2022.
52
Id.

J
Decision 15 G.R. No. 253480

and Lede ma do not impose sanctions on employers who fail and/or refuse to
acquiesc to a valid request for referral to a third doctor by a seafarer. Instead,
the empl yers, who deviate from such mandatory rule are "rewarded."

To ecall, in such a case, instead of imposing sanctions on the employer,

the tribun 1 and the courts will just conduct their own assessment to resolve the
conflictin medical claims of the parties based on the findings of the parties'
respectiv doctors. Since, more often than not, the employers are in a better
position o defend the medical assessment of their physicians before the
tribunals nd the courts, the tribunals and courts often favor the findings of the
employer s doctors. Simply, despite non-compliance with the mandatory rule,
the comp ny-designated physician's findings are upheld and the employers are
rewarded The prevailing jurisprudence clearly encourages employers to
simply ig ore or deny the seafarer's request which will then leave the hapless
seafarer ith no other option but to institute a complaint against the employer.

Th s should not be countenanced. This obvious and unfair situation

needs to be rectified. There is, likewise, a need to balance the rights and
obligatio s of the seafarer and the employer under the POEA-SEC. This was
the esse ce of the Dissenting Opinion of the Honorable Justice Alfredo
S. Caguioa (Justice Caguioa) in Benhur.

is Dissenting Opinion, Justice Caguioa explains:

xx when the non-compliance with the conflict resolution mechanism is due

to tl e fault of the seafarer, the medical assessment of the company-designated
ph ician is deemed conclusive and binding. However, when the failure to
con ply is due to the fault of the employer, the medical findings of the
sea arer's doctor shall be conclusive and binding against the employer. The
cou s are obliged to uphold the conclusive and binding findings unless tl1e
s e are tainted with bias or not supp01ted by medical records or lack
sci 1tific basis, in which case, the courts are not precluded to review the
con· icting findings and decide the case based on the totality of the
evi ence.53

ply put, Justice Caguioa opines in Benhur that because the

failed to initiate the referral of the physicians' conflicting findings
octor, the employer violated the POEA-SEC; as a consequence, the
findings f the seafarer's physician should be upheld and be binding between
the parti s unless the same are tainted with bias, not supported by medical
records, r lack scientific basis. In such a case, the courts are not precluded to
review th conflicting findings and decide the case based on the totality of the
evidence.

53 See D ssenting Opinion of Associate Justice A lfredo Benjamin S. Caguioa in Benhur Shipping Corp.
v. Rie o, supra note 37.
Decision 16 G.R. No. 253480

Justice Caguioa's Dissenting Opinion in Benhur is clearly more in line

with justice, equity, and the general standard of fairness. It is more consistent
with the Court's constitutional mandate to afford full protection to labor.
Needless to state, it gives true meaning and wisdom to the provision of the
POEA-SEC.

Moreover, Justice Caguioa's position in his Dissenting Opinion would

discourage and even forbid employers from ignoring and refusing to acquiesce
to the seafarer's valid request to refer the conflicting medical findings to a third
doctor. In other words, in order not to incentivize the employer for its failure to
respond or assent to the seafarer's valid request for a third doctor referral, the
findings of the seafarer's physician of choice should be considered final and
binding. An exception to this rule is when the seafarer's physician's findings
"are tainted with bias or not supported by medical records or lack scientific
basis, in which case, the courts are not precluded to review the conflicting
findings and decide the case based on the totality of the evidence." 54

In the present case, to recall, after consulting his own physician,

petitioner was declared unfit for sea duty. He signified his intention to undergo
another test or examination to confirm his present condition, and attached to his
letter to respondents the medical report of Dr. Gaurano. There is, therefore, a
valid request on his part to refer the conflicting medical assessments to a third
doctor. Interestingly, respondents failed to respond to the letter for reasons
unknown. Respondents, therefore, violated the POEA-SEC, specifically
Section 20(A), paragraph 3 thereof.

Following the immediately preceding discussion, the medical findings

of Dr. Gaurano, petitioner's physician of choice, should be affirmed and be
made final and binding between petitioner and respondents. However, after a
careful review of the medical report of Dr. Gaurano, We find it bereft of
scientific and medical basis.

Dr. Gaurano 's medical report on petitioner's

condition lacks scientific and medical basis

We cite in verbatim the medical report of Dr. Gaurano, viz.:

NOEL C. GAURANO, MD
Internal Medicine • Adult Pulmonology

I. General Information

This is a case of Mr. Teodoro B. Bunayog, 41 y/o male, single, from,

54 Id.
Decision 17 G.R. No. 253480

Mati, Davao Oriental, works as a chief cook for MT Morning Breeze.

He has no hype11ension, 110 diabetes, non- asthmatic, non -smoker, and
was repatriated to the Philippines due to difficulty in breathing.

II. History of present illness

His condition apparently started about 3 weeks prior to his repatriation

as on and off cough accompanied by undocumented fever, chest pain
aggravated by deep breathing. He tried observing his symptoms initially
but when he started to experience difficulty of breathing and worsening
of the other symptoms, he sought consult at a nearby hospital in Japan
and was subsequently admitted.

While in a hospital in Japan, it was found out that he has pneumonia but
he was eventually repatriated for further work-up and treatment. He was
confined at Cardinal Santos where it was found out that he has pleural
effusion over his left hemithorax. This was aspirated percutaneously
which provided relief of his symptoms. He was later discharged,
improved.

III Pertinent Ancillary Procedures

Chest Ultrasound (Aug. 8, 2016)

Pleural Effusion, Left (1,679 cc
Normal sonogram of the Right Chest.

Chest xray (Aug. 6, 2016)

Pleural effusion, left, no evidence of pneumothorax, pai1ial clearing of

the streaky infiltrates in the right paracardiac area, Heart size cannot be
properly assessed, aorta is tortuous and calcified. The rest of the study
is unchanged.

IV Justification of Disability

A pleural effusion is an abnormal collection of fluid in the pleural

space resulting from excess fluid production or decreased absorption
or both.

The normal pleural space contains approximately 1 rnL of fluid,

representing the balance between (1) hydrostatic and oncotic forces in
the visceral and parietal pleural vessels and (2) extensive lymphatic
drainage. Pleural effusions result from disruption of this balance.

Pleural effusion is an indicator of an underlying disease process that

may be pulmonary or 11(mpulmonary in origin and may be acute or
chronic.

The clinical manifestations of pleural effusion are variable and often are
related to the underlying disease process. The most commonly
associated symptoms are progressive dyspnea, cough, and pleuritic
chest pain, fever and even weight loss.
Decision 18 G.R. No. 253480

Imaging techniques to document the presence of pleural effusion

include: Chest radiography, ultrasound and Chest CT scans. Once a
pleural effusion is identified on imaging, a fluid sample is usually taken
to determine the pleural effusion's character and seriousness. In a
procedure called thoracentesis, a doctor inserts a needle and a catheter
between the ribs, into the pleural space. A small amount of fluid is
withdrawn for testing; a large amount can be removed simultaneously
to relieve symptoms. The collected fluid is sent to the laboratory for
analysis.

There are many causes of pleural effusions. The following is a list of

some of the major causes:

Congestive heart failure Pulmonary Embolism

Kidney failure Hypoalbuminemia
Infection Cirrhosis
Malignancy Trauma

One of the more common causes of pleural effusion due to an infection

is Tuberculosis. Pulmonary Tuberculosis statistics according to World
Health Organization (WHO) the estimated prevalence of pleural
effusion is 320 cases per 100,000 people in third world countries.
According to the Department of Health (DOH) the Philippines currently
have 250,000 cases of Tuberculosis, as of the year 2010. Pleural effusion
accounts to approximately 38% of patients with tuberculosis.

Mr. Bunayog, developed pleural effusion while on board the ship. This
was eventually drained out when he went for treatment at Cardinal
Santos Medical Center. He is presently still undergoing medical
treatment.

Although most cases like that of Mr. Bunayog respond to treatment,

radiographic findings such as residual fibrosis, pleural thickening/
reaction, loculated pleural effusions do not usually resolve even in time.
The extent and degree of involvement of the lungs determines physical
activity and disability.

Mr. Teodoro Bunayog therefore is UNFIT for sea duty.

Sgd.
NOEL C. GAUR4.NO
Lie. No. 70148 55

The medical certificate of Dr. Gaurano shows that his declaration of

petitioner's unfitness for sea duty lacks scientific and medical basis. Dr.
Gaurano merely defined what pleural effusion is and how it is detected, and
explained the causes for such disease and the treatment therefor. He then
concluded that petitioner was unfit for sea duty, without any further explanation.

Wrule Dr. Gaurano enumerated the tests that petitioner underwent while
55
CA rollo, pp. 56-58.
Decision 19 G.R. No. 253480

he was mder treatment by the company-designated physician, he neither

discusse the results of these tests nor correlated such results to his finding that
I

petitione was already unfit to work as a seafarer. Furthermore, while Dr.

Gaurano mentioned that petitioner was still under treatment, he failed to
expound on such observation. Was petitioner still under medication? Was he
having a hard time to breathe? Clearly, Dr. Gaurano's medical report is vague
and inc nclusive. Indubitably, Dr. Gaurano's conclusion is without any
scientifi and medical basis. As such, following Justice Caguioa's dissent in
Benhur, We are not precluded to review the conflicting findings of
respond nts' designated physician and petitioner's doctor based on their
inherent erit and the totality of the evidence.

Based o the inherent merits ofthe conflicting

medical zndings of the company-designated
physicia . and petitioner 's doctor and the
totality if evidence, the .findings of the
compan designated physician are more
credible

To stress, the records lack competent showing of the extent of the

medical reatment that the independent doctor gave to the petitioner. Dr.
Gaurano in his undated medical certificate, 56 did not require him to undergo
any med·cal examination prior to issuing the medical certificate declaring him
unfit to work. Otherwise stated, his conclusion was based on popular
observati n and findings of petitioner's responses to treatment, not on a specific
study of etitioner's condition and responses to medical treatment.

In contrast, the company-designated physician's extensive medical

treatmen that en11bled him to make a final diagnosis of petitioner's health
conditio was amply demonstrated. This is summarized by the CA, viz.:

xxxx

Thus, on 6 August 2016, petitioner was referred to a pulmonologist,

itted to the hospital for close monitoring and further work-ups, underwent
lab ratory exams, chest x-ray, ultrasound, administered with intravenous
flu ds and medication, and started nebulization.

On 9 August 2016, petitioner underwent thoracentesis and the fluid

ob ined from his lung cavity was sent to the laboratory for cell block and
cyt logy.

On 11 August 2016, ri repeat che~t ultrasound was done on petitioner.

Th company-designated phy<siciar1 noted that on said date, petitioner had no
di 1culty in breathing.

56 Id.
Decision 20 G.R. No. 253480

On 14 August 2016, petitioner had a repeat ultrasound done.

On 16 August 2016, he had a repeat thoracentesis and a tuberculosis
gene xpert was done. The company-designated physician opined that no
mycobacterium tuberculosis was detected. The cytology report of pleural fluid
showed chronic inflammatory pattern but it was negative for atypical cells.

On 18 August 2018, he underwent repeat chest ultrasound. Thereafter,

the company-designated physician opined that petitioner had no more cough
and difficulty of breathing. Thus, he was discharged from the hospital on 19
August 2016.

On 1 September 2016, the company-designated physician opined that

after petitioner repeated his chest ultrasound and xray, there was an interval
decrease in the left-sided pleural effusion. He was advised to undergo repeat
chest ultrasound after 1 month.

On 22 September 2016, petitioner had a repeat chest ultrasound which

showed decrease in the amount of pleural effusion on the left, measuring
159cc from the previous 367cc. However, he was not seen by a pulmonologist
on that day because he arrived past the clinic hours. He was advised to come
back on 26 September 2016.

On 28 September 2016, after petitioner was seen by a pulmonologist

and underwent a repeat ultrasound, the company-designated physician opined
that petitioner was cleared from a pulmonary standpoint. As such, he was
declared fit to work on that day. The final diagnosis was - "Pneumonia with
Recurrent Pleural Effusion, Left - Resolved SIP Thoracentesis, Left.

x x x x 57 ( Citations omitted)

Corollarily, between the findings of the company-designated physician

and that of the petitioner's doctor, We lend more credence to the findings of the
company-designated physician considering that it was done in the regular
performance of his duties as company physician and it was he who consistently
examined and treated petitioner's health condition. We cannot simply brush
aside the findings and certification issued as a consequence thereof in the
absence of solid proof that it was made with grave abuse of authority on the
part of the company-designated physician.

From all the foregoing, respondents' failure to respond to petitioner's

valid written request or demand signifying his intention to refer the conflicting
medical findings to a third doctor, should be taken against them. We could have
confirmed as final and binding Dr. Gaurano's medical findings if not for its lack
of medical and scientific basis. This leaves Us nothing but to review the
conflicting findings of respondents' designated physician and petitioner's
doctor, and decide the case based on their inherent merits and the totality of
evidence. This, as above discussed, proved to be favorable to respondents.

57 Rollo, pp. 33-34.

Decision 21 G.R. No. 253480

Guideline in case the sea.farer requests for a

third doct r refe rral

As hings are, We deem it necessaiy to lay down rules that would serve
as guideli es for future cases.

Fir t, a seafarer who receives a contrary medical finding from his or her
doctor m st send to the employer, within a reasonable period of time, a written
request 01 demand to refer the conflicting medical findings of the company-
designate physician and the seafarer's doctor of choice to a third doctor, to be
mutually greed upon by the parties, and whose findings shall be final and
binding b tween the parties.

Sec nd, the written request must be accompanied by, or at the very least,
must indi ate the contents of the medical report or medical abstract from his or
her docto1 to be considered a valid request. Otherwise, the written request shall
be cons id red invalid and as if none had been requested.

Thi -d, in case where there was no request for a third doctor referral from
the seafar r or there was such a request but is deemed invalid, the employer
may opt t ignore the request or demand or refuse to assent, either verbal or
written, t such request or demand without violating the pertinent provision of
the POE -SEC. Accordingly, if a complaint is subsequently filed by the
seafarer a ainst the employer before the labor tribunal, and the pat1ies, after a
directive rom the LA pursuant to NLRC En Banc Resolution No. 008-14,58 fail
to secure e services of a third doctor, the labor tribunals shall hold the findings
of the co pany-designated physician final and binding, unless the same is
found to e biased, i. e., lacking in scientific basis or unsupported by the medical
records o the seafarer. In such a case, the inherent merits of the respective
medical ndings shall be considered by the tribunals or court. 59

If, owever, the parties were able to secure the services of a third doctor
during m ndatory conference, the latter's assessment of the seafarer' s medical
condition should be considered final and binding.

Fo trth, in case of a valid written request from the seafarer for a third
doctor re erral, the employer must, within 10 days from receipt of the written
request o demand, send a written reply stating that the procedure shall be
initiated y the employer. After a positive response from the employer, the

58 The Le bor Arbiter shall give the pm1ics a period of fifteen ( 15) days within which to sec.:ure the services
of a ti ird doctor and an additional period of thirty (30) days for the third doctor to submit his/her
reasse sment.
5') Dionir v. Trans-Global Maritime .4,g-ency Inc., supra note 3 I al 42 1.
Decision 22 G.R. No. 253480

paiiies are given a period of 15 days within which to secure the services of a
third doctor and an additional period of 3 0 days for the third doctor to submit
his/her assessment. The assessment of the third doctor shall be final and binding.

In case, however, where the parties fail to mutually agree as to the third
doctor who will make a reassessment, a complaint for disability benefits may
be filed by the seafarer against the employer. The labor tribunals shall then
consider and peruse the inherent merits of the respective medical findings of
the parties' doctors before making a conclusion as to the condition of the
seafarer.

Fifth, if, however, the employer ignores the written request or demand of
the seafarer, or sends a written reply to the seafarer refusing to initiate the
refen-al to a third doctor procedure, or sends a written reply giving its assent to
the request beyond 10 days from receipt of the written request or demand of the
seafarer, the employer is considered in violation of the POEA-SEC. The
seafarer may now institute a complaint against his or her employer.

Sixth, upon the filing of the complaint and during the mandatory
conference, the LA shall give the parties a period of 15 days within which to
secure the services of a third doctor and an additional period of 30 days for the
third doctor to submit his/her reassessment.

Seventh, if the services of a third doctor were not secured on account of

the employer's refusal to give heed to the LA's request or due to the failure of
the parties to mutually agree as to the third doctor who will make a reassessment,
the labor tribunals should make conclusive between the parties the findings of
the seafarer's physician of choice, unless the same is clearly biased i.e., lacking
in scientific basis or unsupported by the medical records of the seafarer. In such
a case, the inherent merits of the respective medical findings and the totality
of evidence shall be considered by the labor tribunals or courts. This is in
conjunction with Our earlier ruling that the employer's failure to respond to
the seafarer's valid request or demand for a third doctor refen-al should be
taken against the employer.

If, however, the failure to refer the seafarer's condition to a third doctor
after directive from the LA was due to the fault of the seafai·er, that is, the
seafarer refuses to comply H1erewith, then the labor tribunals and the courts
should make conclusive between the parties the findings of the company-
designated physician, subject to the exception in Dionio.

Eight, if, despite the employer's failure to respond to the seafarer's valid
request or demand to refer his or her condition to a third doctor, the paiiies,
Decision 23 G.R. No. 253480

during ma datory conference, were able to secure the services of a third doctor
'
and the lat er was able to make a reassessment on the seafarer's condition the
'
third doct r's findings should be final and binding between the parties. In such
employer's refusal to respond to the seafarer's valid request for a
r referral should be considered immaterial.

final note, consistent with the purpose underlying the fonnulation

of the P EA-SEC, its provisions must be applied fairly, reasonably, and
liberally i favor of the seafarers, for it is only then that its beneficent provisions
can be c ried into effect. Said exhortation, however, cannot be taken to
sanction ward of disability benefits anchored on flimsy evidence. 60 As
exhaustiv ly explained, there is nothing on record that would justify a
compensa ion on top of the monetary aid and assistance already extended to
petitioner y respondents.

Fm herrnore, while it is settled that social legislations, such as the Labor

Code, sho Id be liberally construed in favor of those who are in most need-
the labore s, 61 the labor tribunals and the courts are still called upon to decide
the matt r objectively, taking into account the respective rights and
obi igation of the parties, the totality of evidence the parties were able to
proffer d ring the proceedings, as well as the prevailing jurisprudence
pertinent o the case. This was Our pronouncement in the case of Raza v.
Daikoku lectronics Phils., Inc. ,62 viz.:

While the Court remains invariably committed towards social

jusf ce and the protection of the working class from exploitation and unfair
trea ment, it, nevertheless, recognizes that management also has its own
righ s which, as such, are entitled to respect and enforcement in the interest
of s·mple fair play. The aim is always to strike a balance between an avowed
pre ilection for labor, on the one hand, and the maintenance of the legal
righ s of capital, on the other. Indeed, the Court should be ever mindful of
the egal norm that justice is in every case for the deserving, to be dispensed
wit! in the light of established facts, the applicable law, and existing
j uri prudence. 63

All told, We find no reason to overturn the decisions of the LA, NLRC
and CA i favor of respondents.

W EREFORE, in view of the foregoing premises, the instant petition

is DISM SSED. The Court of Appeals Decision dated February 21, 2020 and
the Reso ution dated September 16, 2020 in CA-G.R. SP No. 154603, are
AFFIR ED in toto.

Coast I Safeway Marine Services, Inc. v. Esguerra, 671 Phil. 56, 70(2011 ).
Sa/ab v. Social Security Commission, G.R. No.2230 18, August 27, 2020.
6'.! 765 Pl ii. 61 (20 15).
Id. at 7.
Decision 24 G.R. No. 253480

SO ORDERED.

WE CONCUR:

(On leave)
RAMON PAULL. HERNANDO
Associate Justice

HEN~ B. INTING
Associa :e Justice

(On leave)
RICARDO R. ROSARIO
Associate Justice

JHOSE~~PEZ
Associate Justice
Decision 25 G.R. No. 253480

Associate Justice
~~
Associate Justice

/ M~LO NA D. SINGH
~ / Associate Justice
/~

CERTIFICATION

Pu ·suant to Section 13, Article VIII of the Constitution, 1 certify that

the concl sions in the above Decision had been reached in consultation before
the case as assigned to the writer of the opinion of the Court.

. GESMUNDO