Rules on Referral to a Third Doctor under Philippine Labor Law

In the context of disability and death benefits under labor law and social legislation in the Philippines, the referral to a third doctor arises when there is a disagreement between the findings of the company-designated physician and the employee’s chosen physician regarding the employee’s fitness to work or disability grading. The procedure is governed by jurisprudence, notably in cases involving seafarers under POEA contracts, and by the Labor Code and its implementing rules. Below is a detailed discussion of the rules and jurisprudential principles on this subject:

1. Legal Basis

The rules on referral to a third doctor are primarily rooted in:

The Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC) for seafarers, particularly Section 20, which outlines the duties of the company-designated physician, the process of contesting medical findings, and the procedure for referral.
Labor Code of the Philippines, as supplemented by relevant social legislation (e.g., Employees’ Compensation Act).

2. Company-Designated Physician’s Role

The company-designated physician has the primary responsibility to assess the medical condition of an employee who suffers from work-related injury or illness. This physician must:

Issue a medical assessment or final disability grading within the prescribed period (usually 120 to 240 days, depending on the circumstances and compliance with legal and procedural requirements).
Certify whether the employee is fit to work or assign a degree of permanent disability.

Failure to issue a timely and complete medical assessment may result in the presumption of permanent total disability in favor of the employee.

3. Dispute with the Employee’s Chosen Physician

If the employee disputes the findings of the company-designated physician, they may consult their own physician of choice. The employee’s physician may issue a differing opinion on:

Fitness to work, or
The degree of disability.

4. Referral to a Third Doctor

If a conflict arises between the assessments of the company-designated physician and the employee’s chosen physician, the third-doctor referral rule applies:

A. Who Can Initiate Referral?

Either the employer or the employee can initiate the referral to a third doctor, provided there is a conflict between the findings of the two prior physicians.

B. Binding Nature of the Third Doctor’s Findings

The findings of the third doctor, mutually agreed upon by both parties, are final and binding on both the employer and the employee.

C. When Should Referral Be Made?

Referral must be made immediately or within a reasonable time after the issuance of the conflicting medical opinions.
Delays in referral or failure to invoke the third-doctor rule may prejudice the case of the party responsible for the delay.

D. Procedure for Referral

There is no fixed procedural requirement for the referral, but it is generally expected that the parties agree on the third doctor and cooperate in the referral process.
The cost of the referral is typically borne by the employer.

E. Employer’s Obligation to Act Promptly

Employers must act promptly in addressing the dispute and in facilitating the referral process. Failure to do so may result in a presumption in favor of the employee’s claims.

5. Jurisprudence on Third-Doctor Referral

Philippine courts have consistently emphasized the importance of compliance with the third-doctor referral rule in cases involving disability claims. Key rulings include:

A. Vergara v. Hammonia Maritime Services, Inc. (2008)

Established the 120/240-day rule and clarified that the referral to a third doctor is the mandatory recourse in case of conflicting medical findings.
The third doctor’s decision is final and binding.

B. Wallem Maritime Services, Inc. v. Tanawan (2016)

Highlighted that failure to invoke the third-doctor referral process results in the binding effect of the employee’s chosen physician’s findings if they are supported by substantial evidence.

C. Elburg Shipmanagement Phils., Inc. v. Quiogue, Jr. (2017)

Clarified the procedural aspects of invoking the third-doctor rule, emphasizing the need for prompt and reasonable action by both parties.

D. C.F. Sharp Crew Management, Inc. v. Taok (2020)

Reiterated that a valid referral to a third doctor must be mutually agreed upon and conducted in good faith.

6. Practical Implications

For Employees:

Ensure that disagreements with the company-designated physician’s findings are substantiated by a credible medical opinion from a qualified physician.
Promptly request referral to a third doctor if disagreement arises.

For Employers:

Strictly observe the timelines and procedural requirements for medical assessments and third-doctor referrals.
Facilitate the referral process and act in good faith to avoid adverse rulings.

For the Third Doctor:

The third doctor must be a mutually agreed-upon, independent medical expert who will issue an impartial assessment based on the employee’s condition.

7. Key Takeaways

The third-doctor referral rule is mandatory in resolving disputes over medical findings.
Failure to comply with this process can significantly impact the outcome of disability or death benefit claims.
Both parties must act promptly, reasonably, and in good faith to ensure compliance with the rule.

This framework ensures fairness in the resolution of disability claims, balancing the rights of employees and employers.