03 IBARRA P. ORTEGA vs.

SOCIAL SECURITY COMMISSION, and SOCIAL SECURITY AUTHOR:

SYSTEM BIGALBAL
G.R. No. 176150. June 25, 2008 MFR- motion for
TOPIC: SSS Act- Beneficiaries reconsideration
PONENTE: CARPIO-MORALES, J.
CASE LAW/ DOCTRINE: Claims under the Labor Code for compensation and under the Social Security
Law for benefits are not the same as to their nature and purpose. On the one hand, the pertinent
provisions of the Labor Code govern compensability of work-related disabilities or when there is loss
of income due to work-connected or work-aggravated injury or illness. On the other hand, the
benefits under the Social Security Law are intended to provide insurance or protection against the
hazards or risks of disability, sickness, old age or death, inter alia, irrespective of whether they arose
from or in the course of the employment. And unlike under the Social Security Law, a disability is total
and permanent under the Labor Code if as a result of the injury or sickness the employee is unable
to perform any gainful occupation for a continuous period exceeding 120 days regardless of
whether he loses the use of any of his body parts.
EMERGENCY RECIT: Ortega asked for partial permanent disability benefit and was given pension for
23 months. He then filed for permanent disability benefits but was denied. SSS doctors find that there
is no progression of illness. Ortega filed a petition and argued that his physicians’ findings shall prevail
over the less than 3-minute interview of the SSS doctors. SC held that the condition of Ortega does
not fall under any of the enumeration set forth under the SSS Law. Ortega’s reliance on jurisprudence
on work-connected disability claims insofar as it relates to a demonstration of disability to perform his
trade and profession is misplaced. Doctrine above. Moreover, it was only on the first time on appeal
that Ortega disclosed the operation he had- coronary angiogram and coronary angioplasty.
However, the case was dismissed without prejudice to him filing a new application mainly on
coronary artery disease and diabetes mellitus type 2 which is a different subject matter from this
case.
FACTS:
 Petitioner Ibarra Ortega is a member of SSS and occupations include him being a consultant,
security consultant, security officer and investigator. He filed a claim for partial permanent
disability benefits on account of his condition of Generalized Arthritis and Partial Ankylosis,
which SSS claims that they granted for a total monthly pension of 23 months.
 After the expiration of his pension benefits, petitioner filed a claim for total permanent
disability benefits-denied on the ground that he was already granted disability benefits for the
same illness and physical examination showed no progression of illness.
 SSS doctors noted that the petitioner merely has a slight limitation of grasping movement for
both hands.
 Petitioner filed an unverified petition before the SSC alleging that SSS denied his petition
despite the fact that his physician diagnosed him to be suffering from Trigger finger 4th (L) and
thumb (L) while another private medical practitioner, Dr. Flo dela Cruz, diagnosed him to be
also suffering from Bronchial Asthma, Hypertension and Gastro-Esophageal Reflux Disease.
 He alleged that the medical interview of the SSS doctors for less than 3 minutes cannot prevail
over the findings of the doctors who have been treating him for a long time.
 The matter was referred to the SSS office of the Medical Program director for review. SSS
department denied his reconsideration. Another set of SSS doctors confirmed that there was
no progression of his illness. SSC docketed his petition but still denied his claim for lack of merit.
MFR-denied.
 He appealed via rule 43 with the CA. – affirmed in toto the SSC resolution.
ISSUE(S): W/N Ortega is entitled to total permanent disability benefits from the SSS?
HELD: No. Petition is dismissed.
RATIO:
 4 SSS doctors had already examined Ortega with the conclusion that he is not entitled to
permanent disability benefit. As to the allegation that he was only observed for a short
period of time, the doctor explained that Ortega’s movements were already being
monitored and evaluated from a distance as part of the examination of his extremities in
order to minimize malingering and overacting.
 It was not true that SSC ignored the certification of Ortega’s physicians as SSC did another
medical observation before it took the petition.
 Dr. Sison (SSS doctor) subsequently noted that his Electrocardiograph, Chest X-ray, Kidney
and Urinary Bladder Ultrasound indicated his condition as normal, which conclusion was
arrived at by going through the same medical documents presented by petitioner following
a series of tests conducted on him by hospitals of his choice.
 From the foregoing recital of petitioner’s medical history, the SSC concluded that petitioner
is not entitled to total permanent disability benefits under the Social Security Law, the
pertinent provisions of which read:
(d) The following disabilities shall be deemed permanent total:
1. Complete loss of sight of both eyes;
2. Loss of two limbs at or above the ankle or wrists;
3. Permanent complete paralysis of two limbs;
4. Brain injury resulting to incurable imbecility or insanity; and
5. Such cases as determined and approved by the SSS.
(f) If the disability is permanent partial and such disability occurs after thirty-six (36) monthly
contributions have been paid prior to the semester of disability, the benefit shall be the monthly
pension for permanent total disability payable not longer than the period designated in the
following schedule:
One thumb 10 mos.
One index finger 8 mos.
One middle finger 6 mos.
One ring finger 5 mos.
One little finger 3 mos.
One big toe 6 mos.
One hand 39 mos.
(g) The percentage degree of disability which is equivalent to the ratio that the designated
number of months of compensability bears to 75, 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 (100%), in which case, the
member shall be deemed as permanently totally disabled.
 The evidence presented as to Ortega’s condition does not fall under the enumeration. Also,
such provisions on the percentage degree of disability applies when there is a related
deterioration of the illness previously considered as partial permanent disability. Here, there is
dearth of evidence on the proposition that petitioner’s array of illnesses is related to
Generalized Arthritis and Partial Ankylosis of the specific body parts.
 Ortega relied on jurisprudence on work-connected disability claims insofar as it relates to a
demonstration of disability to perform his trade and profession but this is misplaced.
 Claims under the Labor Code for compensation and under the Social Security Law for
benefits are not the same as to their nature and purpose. On the one hand, the pertinent
provisions of the Labor Code govern compensability of work-related disabilities or when
there is loss of income due to work-connected or work-aggravated injury or illness. On the
other hand, the benefits under the Social Security Law are intended to provide insurance or
protection against the hazards or risks of disability, sickness, old age or death, inter alia,
irrespective of whether they arose from or in the course of the employment. And unlike
under the Social Security Law, a disability is total and permanent under the Labor Code if as
a result of the injury or sickness the employee is unable to perform any gainful occupation
 for a continuous period exceeding 120 days regardless of whether he loses the use of any of
his body parts.
 He claimed that he should be given the benefits given his “angioplasty operation of the heart,
coronary artery disease, ischemic heart disease, severe hypertension and a host of other
serious illnesses filed with the SSS
 When this case was submitted for decision, petitioner claimed that he had undergone a
coronary angiogram and coronary angioplasty. However, CA was correct when it ruled that
it could not consider such events since a factual question cannot be raised for the first time
on appeal. A change of theory on appeal is not allowed. He did not raise his heart issue in
his application or in his petition before the SSC.
 Fair play dictates that the SSS be afforded the opportunity to properly meet the issue with
respect to the new ailments besetting petitioner, in line with the actual practice that only
qualified government physicians, by virtue of their oath as civil service officials, are
competent to examine persons and issue medical certificates which will be used by the
government for a specific official purpose. This holds greater significance where there exist
differences or doubts as to the medical condition of the person.
 In this case, the SSS medical examiners are tasked by law to analyze the extent of personal
incapacity resulting from disease or injury. Oftentimes, a physician who is adequately versed
in the knowledge of anatomy and physiology will find himself deficient when called upon to
express an opinion on the permanent changes resulting from a disability. Unlike the general
practitioner who merely concerns himself with the examination of his patient for purposes of
diagnosis and treatment, the medical examiner has to consider varied factors and ascertain
the claimant’s related history and subjective complaints. The members of this Court cannot
strip their judicial robe and don the physician’s gown, so to speak, in a pretense to correlate
variances in medical findings.
 However, the case was dismissed without prejudice to him filing a new application mainly
on coronary artery disease and diabetes mellitus type 2 which is a different subject mater
from this case.
DISSENTING/CONCURRING OPINION(S):