Article 198 [192] of the Labor Code: Permanent total disability

The article has four paragraphs:

• (a) The benefit. An employee covered by this Title who gets sick or injured and becomes permanently and totally disabled is paid by the System, each month until death, an amount equal to the monthly income benefit, plus ten percent of it for each dependent child, up to five, beginning with the youngest and without substitution. This wording comes from Section 6 of Presidential Decree No. 1368.
• (b) How long it is guaranteed. The monthly income benefit is guaranteed for five years. It is suspended if the employee is gainfully employed, recovers, or fails to present himself for examination at least once a year upon notice by the System, except as otherwise provided in other laws, decrees, orders or Letters of Instructions. This wording comes from Section 5 of Presidential Decree No. 1641.
• (c) What counts as total and permanent. The list quoted below.
• (d) Months of paid coverage. Defined by a formula approved by the Commission.

The list in paragraph (c):

The exception in item (1) is also part of the article as the Supreme Court quoted it in Vergara v. Hammonia Maritime Services (2008) and in Elburg Shipmanagement v. Quiogue (2015), where it reads "except as otherwise provided in the Rules."

Item (1) is the most cited part. A temporary total disability that lasts continuously for more than 120 days is deemed total and permanent, "except as otherwise provided for in the Rules." In Vergara, the Court quoted the employees' compensation rules (Rule X, Section 2): the income benefit for temporary total disability is not paid longer than 120 consecutive days, except where the injury or sickness still requires medical attendance beyond 120 days but not beyond 240 days from onset. The rules also let the System declare total and permanent status at any time after 120 days of continuous temporary total disability, as warranted by the actual loss or impairment.

So 120 days is not automatic in every case. The rules allow a longer period of treatment, up to 240 days, when medical attendance is still needed.

Seafarers on overseas work usually claim disability benefits under their employment contract, not only under the employees' compensation program. In Vergara, the Court said: "Entitlement to disability benefits by seamen on overseas work is a matter governed, not only by medical findings but, by law and by contract." It read Articles 191 to 193 of the Labor Code (now 197 to 199), their implementing rules, and the POEA standard contract together.

The Court held in Vergara that a temporary total disability "only becomes permanent when so declared by the company physician within the periods he is allowed to do so, or upon the expiration of the maximum 240-day medical treatment period without a declaration of either fitness to work or the existence of a permanent disability." In that case, the seafarer was declared fit to work within the period, and his claim was denied.

In Elburg (2015), the Court summed up four rules for seafarer claims for total and permanent disability:

1. The company-designated physician must issue a final medical assessment of the disability grading within 120 days from the time the seafarer reported to him.
2. If the physician fails to do so within 120 days without a justifiable reason, the disability becomes permanent and total.
3. If there is a sufficient justification, such as further treatment or the seafarer's lack of cooperation, the period extends to 240 days. The employer must prove the justification.
4. If the physician still gives no assessment within 240 days, the disability becomes permanent and total, regardless of any justification.

In Elburg the seafarer kept his award of permanent and total disability benefits. Later rulings may have refined these rules; they are not covered here.