IX. Disability Benefit Claims, Refusal and Dismissal

Occupational Disease: Cancer of the Philippine Business Sector

Like in any other claims, an investigation is imperative as stated in government and company policies. Oftentimes, the investigation reaches litigation through court hearing. This is the most difficult part – proving the claim and the liability of the employee and employer, respectively. Inauspiciously, it is safe to state that claimants who reach this stage are somehow luckier to have known such right exists. Hence, many Filipinos do not know the concept of company liabilities.

An employee who plans to file for compensation benefits due to the declaration of disability to the SSS or GSIS needs to prove the veracity of medical condition to qualify as occupational disease and be declared compensable. Contests from concerned companies are anticipated, but concomitant complaints can be redirected to the Employee’s Compensation Commission (ECC), which is the governing body in regulating employee benefits as part of the Liability Rule under the Handbook on Employee’s Compensation and State Insurance Fund, should the complaints be dismissed. Court proceedings come next if another dismissal happens at the level of the governing body.

Diseases, whether recognized as environmental/occupational or not, do not receive approval without much scrutiny to protect the rights of employers against extortion and abuse of employees seeking compensation. Certain qualifications and due process have been identified towards the resolve of cases to keep both parties equally treated. But why does the law allow refusal of claims and dismissal of subsequent cases?

Many listed occupational diseases have relatively high number of cases even outside the environmental and occupational setting. Carpal tunnel syndrome (CTS) is an example of an occupational disease that is very popular among office workers who spend hours in front of the computer. However, it cannot be associated with work right away as there are many ways of acquiring it even inside the home. Students are also susceptible to the disease.

For a disease to be quantified as work-related, it should be proven to have first existed on or after employment period. Pre-existing condition can be dismissed right away, especially if the condition has far association with the company industry or the nature of the job has low chance of producing such health problem.

It should not also be categorized as secondary ailment resulting from a pre-existing primary ailment. Secondary ailments, or practically quantified as complications, should be proven to have been exacerbated by the occupational disease per se to have merit. Unfortunately, a complication said to have started from a pre-existing primary ailment has weaker, but not essentially impossible, substance on the claim.

A good example of a workman’s compensation filed as claim to GSIS and subsequently, as an appeal to ECC and case to the Court of Appeals (CA), is the case GSIS vs. Valenciano. Valenciano was a Clerk II and eventually, a Senior Terminal Operations Officer at the Philippine Ports Authority (PPA). He filed a claim for compensation benefits with the GSIS after being diagnosed with coronary artery disease in 1984. Two years later, Diabetes Mellitus was discovered rendering him to be insulin resistant leading to increased arterial pressure. This condition gave him the risk of developing hypertension in 1988. A decade has passed and he was diagnosed with Pulmonary Tuberculosis II.

By 2002, he was suffering from diabetes mellitus, pneumonia, hypertension, pulmonary tuberculosis and cerebro-vascular disease (CVD).

The claim was denied by GSIS while the appeal was also dismissed by ECC on the ground that Valenciano’s primary ailment was not occupational disease; “neither was there any showing that his duties have increased the risk of contracting said ailments.” The ECC concluded that his “hypertension, pneumonia and pulmonary tuberculosis were mere complications of his primary ailment of diabetes mellitus, which is not an occupational disease; hence, not compensable.” CVD, albeit possibly an occupational disease, was likewise dismissed after the claimant “failed to show compliance with all the conditions for its compensability.”

However, the Court of Appeals (CA) reversed the decision, ruling that while hypertension, pneumonia and pulmonary tuberculosis were caused by diabetes mellitus, the development of the diseases didn’t occur without environmental and occupational factors, as deemed associated with Valenciano’s employment history.

Valenciano began smoking frequently at the age of 20 which has a strong association with the contracted diseases. His primary ailment is undisputedly conterminous to the presented complications. But whatever it is that the cause of the diseases are inclined to, occupational factors undoubtedly affected the end result of his health which became CA’s basis for the subsequent standing. Nonetheless, grey areas and point for disputes are available for the case.

For similar cases, modern scientific findings are leaning towards conclusions that certain types of sicknesses may evolve into something else due to external factors other than what originally caused the primary ailments. The inclusion of these scientifically plausible factors on the epidemiology and mutation of recognized occupational disease may improve the overall regulation of benefits for employees and add credibility to the existing list of considerable and recognized occupational diseases.

The traditional way of looking at health conditions and their causes are still prevalently applied in the Philippines, which make consideration for possible work-disease link narrower; hence, it is more inefficient.