Tuberculosis among seafarers

Seafarers by nature of their work are exposed to a variety of occupational hazards making exposure to biological agents and the concomitant risk of communicable diseases extremely  high.

Because of their nature of work, seafarers are bound to visit many ports in different parts of the world and are thus exposed to various pandemic and epidemic diseases such as tuberculosis.

In Inter-Orient Maritime  vs. Creer (G.R. No. 181921 September 17, 2014) , the Supreme Court pointed out that pulmonary tuberculosis is airborne and easily transmissible by infected patients. The risk of being infected, or acquiring, the tuberculosis infection is mainly determined by exogenous factors. 

The probability of contact with a case of tuberculosis, the intimacy and duration of that contact, the degree of infectiousness of the case, and the shared environment of the contact are all important determinants of transmission.

On the other hand, the risk of developing the disease after being infected is largely dependent on endogenous factors. The tuberculosis bacteria may lie dormant in the infected person’s immune system for years before it becomes reactivated, or he may ultimately develop the disease within the first year or two after infection, depending on the innate susceptibility to disease of the person and level of immunity.

In ruling for the compensability of tuberculosis, the Supreme Court held in the case of BARKO vs. Alcayno (G.R. No. 188190               April 21, 2014) that  a certification declaring the seafarer  as fit to work contrary to a prior finding of tuberculosis can be considered as a ploy to circumvent the law intended to defeat the seafarer’s  right to be compensated for a disability which the law considers as permanent and total.

The Supreme Court  explained that tuberculosis is a contagious infection caused by the airborne bacterium Mycobacterium tuberculosis. It is usually transmitted by inhaling air contaminated by the bacterium. Active tuberculosis usually begins in the lungs (pulmonary tuberculosis). Tuberculosis that affects other part of the body (extrapulmonary tuberculosis) usually comes from pulmonary tuberculosis that has spread through the blood. Tuberculosis adenitis is a form of tuberculosis which affects the lymph nodes. 

The court noted that under the  POEA contract, "Pulmonary Tuberculosis" shall be considered as an occupational disease in "any occupation involving constant exposure to harmful substances in the working environment in the form of gases, fumes, vapors and dust."

The seafarer’s daily tasks as an able bodied seaman were to paint and chip rust on deck or superstructure of ship and to give directions to crew engaged in cleaning wheelhouse and quarterdeck, which constantly exposed him to different types of hazardous chemicals, such as paints, thinners, and other forms of cleaning agents and harmful substances, that may have invariably contributed to the aggravation of his illness.

The Supreme Court noted the suspicious  gesture of the company in having a medical certification declaring him as "fit to work" despite apparent clear knowledge that he has been subjected to a long period of medical treatment.

For a sick  seafarer to be entitled to medical benefits under the  POEA Contract,  it is not sufficient to simply establish that the seafarer’s illness or injury has rendered him permanently or partially disabled; it must also be shown that there is a causal connection between the seafarer’s illness or injury and the work for which he had been contracted .

TB bacteria most commonly grow in the lungs, and can cause symptoms such as a bad cough that lasts three  weeks or longer, pain in the chest and coughing up blood or sputum (mucus from deep inside the lungs). Other symptoms of TB disease may include weakness or fatigue, weight loss, no appetite, chills, fever, and sweating at night.

Since one of the requirement for an illness to be compensable is that the seafarer suffered said illness during the effectivity of the POEA contract, it is imperative that his condition or symptoms  must be documented while he is on board the vessel.

Otherwise, his claim for disability benefits might be denied due to failure to prove that said illness occurred while his contract is still in force.

(Atty. Gorecho heads the seafarers’ division of the  Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786)

Three Day Reportorial rule for seafarers’ claims

Failure of the Filipino seafarer to comply  with  the mandatory reporting requirement within three days upon arrival  must be for a justifiable reason or due to  inadvertence/ deliberate refusal of the employer to  refer the seafarer to a company-designated physician. Otherwise, such failure shall result in the  forfeiture of his  right  to  claim benefits under the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC)  .

In the recent case of Veronico Tagud vs. BSM Crew Service Center  ( Gr. No. 219370, December 6, 2017), the Supreme Court reiterated that payment of disability benefits to seafarers  who failed to comply with the mandatory three-working days reporting and examination requirement will be denied.  Settled is the rule that the entitlement of seafarers  to disability benefits is a matter governed, not only by medical findings, but by law and by contract.

In the said  case, the seafarer disembarked in Singapore and was repatriated to Manila on 8 November 2008. He ·alleged that he reported to his manning agency but was not given any assistance or referred to a company-designated physician. However, the court noted that the seafarer  did not present any evidence to prove that he tried to submit himself to a company-designated physician within three working days upon his return. The seafarer did not also present any letter that he was physically incapacitated to see the company­ designated physician in order to be exempted from the rule. It took him about four months from repatriation or on 9 and 10 March 2009 to seek medical attention for pain in his upper right extremities, not from respondents' company-designated physician, but at a private clinic in Caloocan City. No other documents were submitted to prove that he asserted his rights against the company, or that he immediately took action to seek medical assistance from the company, within three days from his repatriation.

 The Supreme Court held that the three-day mandatory reporting requirement, whether to undergo a post-employment medical examination or report the seafarer's physical incapacity, must be strictly observed since within three days from repatriation, it would be fairly manageable for the company-designated physician to identify whether the illness or injury was contracted during the term of the seafarer's employment or that his working conditions increased the risk of contracting the ailment.( Heirs of the Late Delfin Dela Cruz v. PTC , 758 Phil. 382, 394-395) 

It is the company-designated physician who is initially entrusted with the task of assessing  the  seafarer's  disability,  whether  total or  partial,  due   to either injury or illness, during the term of the latter's employment. Nevertheless, such  assessment is not viewed final, binding or conclusive on the claimant, the labor tribunal  or  the courts. The seafarer has the prerogative to request  a  second  opinion  and  to  consult  a  physician   of  his  choice regarding his ailment or injury, in which case the medical report issued by the latter shall be evaluated by the labor tribunal and the court, based on its inherent merit.(Andres  L. Dizon  vs. NAESS Shipping Ltd. (G.R. No. 201834, June 1, 2016). 

Ascertaining  the  real cause of the illness or injury beyond the three-day period may prove difficult. To ignore the rule might set a precedent with negative repercussions, like opening floodgates to a limitless number of seafarers claiming disability benefits, or causing unfairness to the employer who would have difficulty determining the cause of a claimant's illness because of the passage of time. ( Interorient v. Creer, 735 SCRA 267.).

However, such requirement is not absolute and admits of some  exception, i.e., when the seafarer is physically incapacitated from complying with the requirement. Indeed, for a man who was terminally ill and in need of urgent medical attention one could not reasonably expect that he would immediately resort to and avail of the required medical examination, assuming that he was still capable of submitting himself to such examination at that time. (Wallem, Inc. v. Inductivo (376 Phil. 738)

The other exception to the three-day rule is when failure to  do so was not due to the seafarer's fault  but due to the inadvertence or deliberate refusal of the employer to  refer the seafarer to a company-designated physician. (Interorient Maritime Enterprises, Inc. v. Leonora S. Remo, 622 SCRA 237).

Supreme Court Associate Justice Marvic Leonen , in a separate opinion in the Interorient vs. Creer case, said   that there is basis to revisit the scope of such a doctrine.  He noted that current doctrine assumes that seafarers will make claims only on the basis of breaches of contractual obligations. While this may be the theory pursued in practice, substantive law still allows recovery of damages for injuries suffered by the seafarer as a result of a tortious violation on the part of the employer. This may be on the basis of the provisions of the Civil Code as well as special laws. These special laws may relate, among others, to environmental regulations and requirements to ensure the reduction of risks to occupational hazards both for the seafarer and the public in general. In such cases, the process for recovery should not be constrained by contract. Second, even as a basis for contractual breach, the exceptions provided in the POEA regulations and current jurisprudence do not contemplate situations that may result in an unreasonable denial of the constitutional protection to labor.