Guzmán Muñoz v. Industrial Commission
Guzmán Muñoz v. Industrial Commission
Opinion of the Court
delivered the opinion of the Court.
Since its original enactment § 5 of the Workmen’s Accident Compensation Act, No. 45 of April 18,1935,11 L.P.R.A. § 6, provides in part that “The refusal or objection of a workman or employee, without just cause, to submit to the medical examination or professional treatment provided by the Manager shall deprive him of his right to receive compensation under this Act or to institute or bring proceedings hereunder to recover such compensation; Provided, That should the workman or employee fail to present himself to the physician for professional treatment within a period of not more than five (5) working days after the accident occurs, and fails to explain his delay satisfactorily to the Manager, the said Manager may deprive him of his right to receive any compensation, but under no circumstances can the workman or employee be denied such medical attendance as, in the judgment of the Manager, may be deemed necessary in endeavoring to bring about his complete recovery.”
Section 13 of the existing Act, 11 L.P.R.A. § 14, which makes it the duty of the employer to notify the occurrence of any accident sustained by a workman or employee by filing a written report within a period of five days,
In Torres v. Industrial Commission, 55 P.R.R. 425, 430 (1939), we said that the purpose of the requirement that the workman report for medical examination within a period of five days is to inform the insurer of the occurrence of the accident, and thus give it an opportunity to investigate in order to determine whether it is actually compensable under the law. And in Montaner v. Industrial Commission, 56 P.R.R. 272, 280 (1940), we added that the failure to comply with this requirement is not an absolute bar to recovery, and that it is a matter within the discretion of the Manager to be exercised in accordance with the circumstances of each particular case.
It seems clear that, in addition to giving the Manager an opportunity to investigate the accident, the main purpose of the provision must be to make sure that the workman receives proper medical treatment for the injury or damage sustained. This prevents that the hospitalization period be prolonged and that the consequences of the accident be greater, thereby reducing the medical expenses as well as the compensation to which the injured would be entitled. It is therefore the purpose of this five-day peiriod to protect the Fund from unworthy or fraudulent claims.
Accepting the fact that the purposes sought are those pointed out, and bearing in mind that the law should
We now turn to consider the facts of the instant case. Late in March 1960, petitioner Antonio Guzmán Muñoz, who was in charge of a warehouse of Sucesores de Abarca, was required to remove some scrap iron which was piled up in the warehouse yard. For this operation they used a crane which the petitioner was operating that day in the absence of the regular operator. While he was assembling some iron the crane strut broke loose and in order to prevent it from falling and breaking Guzmán suddenly pulled the lever. As a result of the effort made he felt an intensive pain in the chest which he attributed to gases. However, he continued to feel the pain for about two weeks and requested a vacation from his immediate superior, who told him it was not necessary because it was Easter. He also suggested that it was probably gas pains and advised him to take lemon and soda. The pains became worse and in the morning of April 14 he was hospitalized in Pavia Hospital.
He was confined in the hospital under medical treatment until May 7. He was maintained incommunicado and only his wife was permitted in the room. No visitors were allowed. Upon his discharge he was advised to stay in bed for two more weeks, and during that period he was advised to get up for one hour in the morning and another hour in the afternoon.
On the following June 6 he wrote a letter to the Manager of the State Insurance Fund claiming compensation for the accident which he had sustained late in March. The notice was therefore given more than two months after the occurrence of the accident. It appears that he had suffered a coronary thrombosis which caused an infarct of the myocar-dium. When he was questioned on the reason for his delay
The Industrial Commission determined that the accident was covered by the Act, but disallowed the compensation claimed on the ground that the petitioner had not been diligent nor accounted satisfactorily for his delay in presenting himself for medical treatment. We agreed to review this decision.
It appears from the record that the Manager’s untimely knowledge did not prevent him from conducting the pertinent investigation for the purpose of ascertaining the circumstances surrounding the accident. As a matter of fact, the evidence offered by that officer at the hearing before the Industrial Commission consisted of copies of the sworn statements made by the claimant and by three witnesses in the course of the investigation conducted on July 21 and 23, 1960. Despite the time elapsed no prejudice was caused to him by the delay,
The decision rendered by the Industrial Commission on January 27, 1961, will be set aside and the case remanded with instructions to compensate petitioner.
By Act No. 405 of May 11, 1951 (Sess. Laws, p. 1058) a provided clause was added to this section to the effect that “... when' the workman has satisfactorily explained his delay, the Manager shall he under obligation to pay him the total compensation or compensation for the disability, including per diems to such time as he may have been under medical treatment.”
See § 9 of Act No. 19 of April 13, 1916 (Sess. Laws, p. 51, at 54); 5 5 of Act No. 10 of February 25, 1918 (Sp. Sess. Laws, p. 54, at 60); and 5 5 of Act No. 85 of May 14, 1928 (Sess. Laws, p. 630, at 646).
To the same effect, see § 22 of Act No. 85 of 1928 supra,; § 7 of Act No. 10 of 1918 supra; and § 11 of Act No. 19 of 1916 supra, which gfranted a period of 10 days therefor.
We have adopted an identical position where an insurance company has interposed as defense the lack of notice. Lafontaine v. Municipality, 79 P.R.R. 548 (1956); Landol v. Colón, 78 P.R.R. 572 (1955); Faulkner v. Nieves, 76 P.R.R. 407 (1954); cf. Cuebas v. Porto Rican and American Insurance Company, 85 P.R.R. 601. A fortiori, we can not uphold with greater strictness this provision which relieves from liability where a social-benefit act is involved. In the ease of a public liability policy required by statute — compulsory insurance — the lack of notice is no defense because the legislative purpose is the protection of the public. Annotation, 31 A.L.R.2d 645 (1953).
On October 7, 1960 the workman was informed of the Manager’s refusal to award compensation because the delay “deprived this agency of the opportunity to ascertain whether or not your condition had any relation with the alleged accident.” We fail to understand this officer’s attitude because since the past July he had the statements of the witnesses from which it appears, as was finally determined by the Industrial Commission, that the accident was a labor accident.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.