Conflicting fitness assessments: a referral request still needs medical support

Facts and context

After treatment for pneumonia, Bunayog received a fit-to-work assessment from the company-designated physician and a conflicting opinion from his own doctor. His employer did not act on his request for another medical assessment.

Issue

What follows a valid request for a third doctor, and did the employer’s inaction establish entitlement to disability benefits?

Ruling

The Court issued referral guidelines but denied the claim. Bunayog’s request was valid; however, his doctor’s conclusion did not explain how the test findings supported inability to work. The company physician’s assessment had stronger documented support.

The referral process and the scientific merits of an opinion are distinct. Employer nonresponse did not make an unsupported medical conclusion sufficient in this case.

Practice implications

Parao Law practice guidance

For physicians

• State the records reviewed, examination findings, relevant test results, and the reasoning connecting them to functional limitations. Listing investigations without interpreting them may leave the conclusion unsupported.
• Relate the assessment to the actual duties under consideration. Explain what the patient can or cannot do and the clinical basis for that opinion.
• Identify the assessment date, uncertainty, and any need for reassessment. Avoid a bare unfit-for-work conclusion unsupported by the report.

For lawyers

• Preserve the written referral request, the accompanying medical report or its stated contents, and proof of receipt. Examine the employer’s response and subsequent efforts to agree on a doctor.
• Under the announced guidelines, a valid request triggers a 10-day written response period, followed by periods for selecting the doctor and assessment. Consult the full guidelines for each branch of the procedure and applicable later law before calendaring a current claim.
• Evaluate the medical reasoning even when the other party failed to cooperate.

Limits of the ruling

This briefing concerns the seafarer framework applied in the case, not all occupational-health disputes. Its practical report-writing guidance does not convert physicians into decision-makers on legal entitlement to benefits.