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Ortega vs SSS G.R. No. 176150 June 25, 2008 Justice CAR !O "ORA#$S %acts& Petitioner, a member of respondent Social Security System (SSS), filed claims for 'artia( 'er)anent *isa+i(it, +ene-its on account of his condition o- Genera(i.e* Art/ritis an* artia( An0,(osis, which claims the SSS granted for a total monthly pension of 21 )ont/s. After the expiration of his disability pension, petitioner filed a claim for tota( 'er)anent *isa+i(it, +ene-its. His application was denied, however, on the ground that he was already granted disability benefits for the same illness and physical examination showed no progression of illness. As observed by the SSS alabon !ranch senior physician, merely had a " slight limitation of grasping movement for both hands .". However, his attending physician diagnosed him with 2rigger -inger 3t/ 4#5 an* t/u)+ 4#5 while another private medical practitioner diagnosed him to be also suffering from 6ronc/ia( Ast/)a, 7,'ertension an* Gastro8$so'/agea( Re-(u9 :isease . Petitioner contended that the medical opinion of the SSS physician who interviewed him for less than three minutes cannot prevail over the findings of his physicians who have been treating him over a long period of time.#pon referral the SSS edical Program $epartment, confirmed that, upon examination of petitioner, t/ere ;as no 'rogression o- /is i((ness, prompting petitioner to submit a letter%opposition charging the SSS medical officers of issuing fraudulent medical findings. #nperturbed, the SSS edical Program $epartment stood its ground and denied with finality petitioner&s claim, by letter. !y resolution, the SS' denied petitioner&s claim for entitlement to total permanent disability for lac( of merit. !SS<$) *hether or not petitioner is entitled to total permanent disability benefits. 7$#:& +,. -he conclusion that petitioner is not entitled to total permanent disability benefits under the Social Security .aw was reached after petitioner was examined not /ust by one but four SSS physicians. -he initial physical examination and interview revealed that petitioner had slight limitation of grasping movement for both hands. -his finding was not enough to grant an extension of benefit since petitioner had already received benefits e0uivalent to 123 of the body. #nder the SSS .aw ) 4xxx (g) -he percentage degree of disability which is e0uivalent to the ratio that the designated number of months of compensability bears to seventy%five (56), rounded to the next higher integer, shall not be additive for distinct, separate and unrelated permanent partial disabilities, but shall be additive for deteriorating and related permanent partial disabilities to a maximum of one hundred percent (7223), in which case, the member shall be deemed as 'er)anent(, tota((, *isa+(e*.8 -he proviso of such provisions on the percentage degree of disability applies when there is a related deterioration of the illness previously considered as partial permanent disability. 9n this case, there is dearth of evidence on the proposition that petitioner&s array of illnesses is related to :enerali;ed Arthritis and Partial An(ylosis of the specific body parts. Petitioner&s reliance on /urisprudence on wor(%connected disability claims insofar as it relates to a demonstration of disability to perform his trade and profession is misplaced. 'laims under the .abor 'ode for compensation and under the Social Security .aw for benefits are not the same as to their nature and purpose. ,n the one hand, the pertinent provisions of the .abor 'ode govern compensability of wor(%related disabilities or when there is (oss o- inco)e *ue to ;or08 connecte* or ;or08aggravate* in=ur, or i((ness .66 ,n the other hand, the benefits under the Social Security .aw are intended to 'rovi*e insurance or 'rotection against t/e /*s or ris0s o- *isa+i(it,, sic0ness, o(* age or *eat/, inter alia, irrespective of whether they arose from or in the course of the employment. 6< And unli(e under the Social Security .aw, a disability is total and permanent under the .abor 'ode if as a result of the in/ury or sic(ness the employee is una+(e to 'er-or) an, gain-u( occu'ation -or a continuous 'erio* e9cee*ing 120 *a,s regardless of whether he loses the use of any of his body parts.


A('/a S/i' "anage)ent Cor'oration vs. Ca(o Gr. No. 1>2013, Januar, 11, 2013 Justice *e( Casti((o
%AC2S& ?espondent @leosis A. 'alo wor(ed for petitioners B Alpha Ship anagement 'orporation, Cunel . 'han and their foreign principal, 'huo%Daiun 'ompany .imited ('D'.) B since 1>>8 under seven employment contracts. ,n %e+ruar, 17, 2003, respondent was once more hired by petitioners as C/ie- Coo0 on board 'D'.&s vessel, A 9ris. *hile on the ship, the foreign doctors diagnosed that he was declared 4 un-it -or ;or08 and advised to be sent home and undergo further detailed examination and treatment. ?espondent was thus repatriated on Octo+er 12, 2003 and was referred by petitioners to :r. Cru., t/e co)'an,8*esignate* '/,sician. ,n a series of examinations, he was diagnosed with <retero(it/iasis. ,n Culy E>, E226, respondent B who felt that his condition has not improved B consulted another specialist in internal medicine, :r. ?ica(*o. ?espondent underwent surgery for his nephrolithiasis on August 17, E226. ?espondent filed a claim for *isa+i(it, +ene-its ;it/ 'etitioners, but the claim was *enie*. eanwhile, ,n Culy 1, E22<, respondent returned to $r. 'ru; and underwent urinalysis, ultrasound and x%ray. $r. 'ru; issued his Final edical ?eport, stating that his urinalysis is now normal and is now -it to ;or0. $eciding on the complaint filed by respondent on ,ctober 7>, E226, the #a+or Ar+iter ruled that respondent is entitled to 'er)anent tota( *isa+i(it, +ene-its, because as a result of his inability to wor( despite undergoing treatment and medication by the company%designated physician -or )ore t/an 120 *a,s, or from ,ctober 76, E22G through Culy 7>, E22<H the company%designated physician&s Culy 7>, E22< 4fit to wor(8 declaration was irrelevant and belated as it was made (ong a-ter t/e e9'iration o- t/e continuous 1208 *a, 'erio* during which respondent was unable to wor(. 2/e N#RC ruled otherwise and held that for purposes of claiming disability benefits under the Philippine ,verseas @mployment Administration (P,@A) Standard @mployment 'ontract, it is t/e co)'an,8*esignate* '/,sician, $r. 'ru; B and not respondent&s physician $r. Aicaldo B who should ma(e the corresponding proclamation or finding that respondent suffered permanent total or partial disability. -hus, $r. 'ru;&s Culy 7>, E22< edical ?eport declaring respondent as fit to wor( prevails over $r. Aicaldo&s Culy E>, E226 edical 'ertificate declaring respondent unfit to resume wor( as seaman in any capacity. -he Court o- A''ea(s affirmed the ruling of the .abor Arbiter and held that respondent&s permanent disability was total. !SS<$& *hether respondent is entitled to disability benefits under the P,@A Standard @mployment 'ontract for Seafarers despite the fact that he was declared fit to wor( 7$#:& @$S. Article 7IE(c)(7) of the .abor 'ode provides that) 4 temporary total disability lasting continuously for more than one hundred twenty days, except as otherwise provided for in the Rules .8 -he 7E2%day period may be extended up to EG2 days, under ?ule J, Section E of the Amended ?ules on @mployees 'ompensation and pursuant to the pronouncement in Vergara v. Hammonia Maritime Services, Inc.G7 stating that a temporary total disability becomes permanent when so declared by the company%designated physician within the period allowed, or upon expiration of the maximum EG2%day medical treatment period in case of absence of a declaration of fitness or permanent disability. !ased on the ruling in estrel Shipping !o., Inc. v. Munar" #t/e co)'an,8*esignate* '/,sician is e9'ecte* to arrive at a *e-inite assess)ent o- t/e sea-arerAs -itness to ;or0 or 'er)anent *isa+i(it, ;it/in t/e 'erio* o- 120 or 230 *a,s. 2/at s/ou(* /e -ai( to *o so an* t/e sea-arerAs )e*ica( con*ition re)ains unreso(ve*, t/e sea-arer s/a(( +e *ee)e* tota((, or 'er)anent(, *isa+(e* B a seaferer&s disability becomes permanent and total ;/en so *ec(are* +, t/e co)'an,8*esignate* '/,sician, or, in case of absence of such a declaration either of fitness or permanent total disability, u'on t/e (a'se o- t/e 120 or 2308*a, treat)ent 'erio* , while the employee&s disability continues and he is unable to engage in gainful employment during such period, and the company%designated physician fails to arrive at a definite assessment of the employee&s fitness or disability. -his is true 4regardless of whether the employee loses the use of any part of his body.8 ?espondent was repatriated on ,ctober 7E, E22G and underwent treatment by the company% designated physician, $r. 'ru;, until ,ctober 7G, E226, or for a continuous period of over one year B or for more than the statutory 7E2%day G5 or even EG2%dayG> period. $uring said treatment period, $r. 'ru; did not arrive at a definite assessment of respondent&s fitness or disabilityH thus, respondent&s medical condition remained unresolved. 9t was only on Culy 7>, E22< that respondent was declared fit to wor( by $r. 'ru;. Such declaration, however, became irrelevant, for by then, respondent had been under medical treatment and unable to engage in gainful employment for more than EG2 days. Pursuant to the doctrine in estrel, the conclusive presumption that the respondent is totally and permanently disabled thus arose. -he 'A is therefore correct in declaring that respondent suffered permanent total disability.