Cases in Insurance
Cases in Insurance
Cases in Insurance
mean that the insurer can be held solidarily liable with the insured and/or the other parties found at
fault. The liability of the insurer is based on contract; that of the insured is based on tort.
Facts:
Vicente Mendoza, Jr. as heir of his mother (Feliza Vineza de Mendoza) who was killed in a vehicular
accident, filed an action for damages against the erring taxicab driver (Rodrigo Dumlao), the owner
(Armando Abellon) of the taxicab (Lady Love Taxi with Plate No. 438-HA Pilipinas Taxi 1980) and the
alleged insurer of the vehicle which featured in the vehicular accident. The erring taxicab was allegedly
covered by a third-party liability insurance policy issued by petitioner Travellers Insurance & Surety
Corporation. Petitioner was included in the complaint as the compulsory insurer of the said taxicab
under Certificate of Cover No. 1447785-3. The trial court rendered judgment in favor of private
respondent and ordered
Rodrigo Dumlao, Armando Abellon and petitioner to pay private respondent death indemnity, moral
damages, exemplary damages, attorneys fees and other litigation expenses, jointly and severally. The
decision was affirmed by the CA and the subsequent MR was denied.
Hence this petition.
II. At the time of the vehicular incident which resulted in the death of private respondents mother, during
which time the Insurance Code had not yet been amended by Batas Pambansa (B.P.) Blg. 874, Section
384 provided as follows:
Any person having any claim upon the policy issued pursuant to this chapter shall, without any
unnecessary delay, present to the insurance company concerned a written notice of claim setting forth
the amount of his loss, and/or the nature, extent and duration of the injuries sustained as certified by a
duly licensed physician. Notice of claim must be filed within six months from date of the accident,
otherwise, the claim shall be deemed waived. Action or suit for recovery of damage due to loss or
injury must be brought in proper cases, with the Commission or the Courts within one year from date of
accident, otherwise the claimants right of action shall prescribe
It is significant to note that the aforecited Section 384 was amended by B.P. Blg. 874 to categorically
provide that action or suit for recovery of damage due to loss or injury must be brought in proper
cases, with the Commissioner or the Courts within one year from denial of the claim, otherwise the
claimants right of action shall prescribe
We have certainly ruled with consistency that the prescriptive period to bring suit in court under an
insurance policy, begins to run from the date of the insurers rejection of the claim filed by the insured,
the beneficiary or any person claiming under an insurance contract. This ruling is premised upon the
compliance by the persons suing under an
insurance contract, with the indispensable requirement of having filed the written claim mandated by
Section 384 of the Insurance Code before and after its amendment. Absent such written claim filed by
the person suing under an insurance contract, no cause of action accrues under such insurance
contract, considering that it is the rejection of that claim that triggers the running of the one-year
prescriptive period to bring suit in court, and there can be no opportunity for the insurer to even reject a
claim if none has been filed in the first place, as in the instant case.
WHEREFORE, the instant petition is HEREBY GRANTED.
PHIL. AMERICAN LIFE INSURANCE v. PINEDA
175 SCRA 416
PARAS; July 19, 1989
NATURE
Petition for review on certiorari the orders of CFI
Judge Pineda
FACTS
- In 1968, Private Respondent Rodolfo Dimayuga procured an ordinary life insurance policy from
the petitioner company and designated his wife and children as irrevocable beneficiaries. On
Feb. 22, 1980, Dimayuga filed with the CFI a petition to amend the designation of the
beneficiaries in his life policy from irrevocable to revocable. Petitioner filed an Urgent Motion to reset
hearing as well as its comment and/or Opposition to the respondents
petition.
- Respondent Judge denied petitioners Urgent Motion, thus allowing private respondent to adduce
evidence, the consequence of which was the issuance of the questioned Order granting the
petition. Petitioner then filed a MFR which was also denied hence this petition.
ISSUE
1. WON the designation of the irrevocable beneficiaries could be changed or amended without the
consent of all the irrevocable beneficiaries
2. WON the irrevocable beneficiaries herein, one of whom is already deceased while the others are all
minors could validly give consent to the change or amendment in the designation of the irrevocable
beneficiaries
HELD
1. NO
- Based on the provision of their contract and the law applicable, it is only with the consent of all
the beneficiaries that any change or amendment in the policy concerning the irrevocable beneficiaries
may be legally and validly effected. Both the law and the Policy do not provide for any other exception.
Reasoning
- Since the policy was procured in 1968, the applicable law in this case is the Insurance Act and
under that law, the beneficiary designated in a life insurance contract cannot be changed without
the consent of the beneficiary because he has a vested interest in the policy.
- Contracts which are the private laws of the contracting parties should be fulfilled according to
the literal sense of their stipulations, if their terms are clear and leave no room for doubt as to
the intention of the contracting parties, for contracts are obligatory, no matter in what form they may
be, whenever the essential requisites for their validity are present.
- Finally, the fact that the contract of insurance does not contain a contingency when the change in the
designation of beneficiaries could be validly effected means that it was never within the contemplation
of
the parties.
2. NO
- The parent-insured cannot exercise rights and/or privileges pertaining to the insurance contract,
for otherwise, the vested rights of the irrevocable beneficiaries would be rendered inconsequential.
The alleged acquiescence of the 6 children beneficiaries cannot be considered an effective ratification
to the
change of the beneficiaries from irrevocable to revocable. They were minors at the time, and could
not validly give consent. Neither could they act through their father-insured since their interests are
quite divergent from one another.Disposition questioned Orders of respondent judge are nullified and
set aside.
- The Beneficiary Designation Indorsement in the policy in the name of Dimayuga states that
the designation of the beneficiaries is irrevocable: no right or privilege under the Policy may be
exercised, or agreement made with the Company to any change in or amendment to the Policy,
without the consent of the said beneficiary/beneficiaries.
- Rizal Surety & Insurance Company (Rizal Insurance) issued Fire Insurance Policy No. 45727 in
favor of Transworld Knitting Mills, Inc. (Transworld).
- Pertinent portions of subject policy on the buildings insured, and location thereof, read:
"On stocks of finished and/or unfinished products, raw materials and supplies of every kind and
description, the properties of the Insureds and/or held by them in trust, on commission or on
joint account with others and/or for which they (sic) responsible in case
of loss whilst contained and/or stored during the currency of this Policy in the premises occupied
by them forming part of the buildings situate (sic) within own Compound at MAGDALO STREET,
BARRIO UGONG, PASIG, METRO MANILA, PHILIPPINES, BLOCK NO. 601 Said building of fourspan lofty one storey in height with mezzanine portions is constructed of reinforced concrete and
hollow blocks and/or concrete under galvanized iron roof and occupied as hosiery mills, garment
and lingerie factory, transistor-stereo assembly plant, offices, warehouse and caretaker's
quarters. Bounds in front partly by one-storey concrete building under galvanized iron roof occupied as
canteen and guardhouse, partly by building of two and partly one storey constructed of concrete
below, timber above undergalvanized iron roof occupied as garage and quarters and partly by open
space and/or tracking/ packing, beyond which is the aforementioned Magdalo Street; on its right
and left by driveway, thence open spaces, and at the rear by open spaces.'"
- The same pieces of property insured with the petitioner were also insured with New India
Assurance Company, Ltd., (New India).
- Fire broke out in the compound of Transworld, razing the middle portion of its four-span building and
partly gutting the left and right sections thereof. A two-storey building (behind said four-span
building) where fun and amusement machines and spare parts were stored, was also destroyed by
the fire.
- Transworld filed its insurance claims with Rizal Surety & Insurance Company and New India
Assurance Company but to no avail.
- Private respondent brought against the said insurance companies an action for collection of
sum of money and damages.
- Petitioner Rizal Insurance countered that its fire insurance policy sued upon covered only the
contents of the four-span building, which was partly burned, and not the damage caused by the fire
on the two-storey annex building.
- The trial court dismissed the case as against The New India Assurance Co., Ltd. but ordered
defendant Rizal Surety And Insurance Company to pay Transwrold (sic) Knitting Mills, Inc.
- Both the petitioner, Rizal Insurance Company, and private respondent, Transworld Knitting Mills,
Inc., went to the Court of Appeals, which required New India Assurance Company to pay plaintiffappellant the amount of P1,818,604.19 while the Rizal Surety has to pay the plaintiff-appellant
P470,328.67.
- New India appealed to the Court theorizing inter alia that the private respondent could not be
compensated for the loss of the fun and amusement machines and spare parts stored at the
two-storey building because it (Transworld) had no insurable interest in said goods or items.
- The Court denied the appeal with finality.
- Petitioner Rizal Insurance and private respondent Transworld, interposed a Motion for
Reconsideration before the Court of Appeals, which reconsidered its decision of July 15, 1993, as
regards the imposition of interest.
- Undaunted, petitioner Rizal Surety & Insurance Company found its way to the Court.
ISSUE
WON the fire insurance policy litigated upon protected only the contents of the main building
(four-span), and did not include those stored in the two-storey annex building
HELD
NO
- Resolution of the issue posited hinges on the proper interpretation of the stipulation in subject fire
insurance policy regarding its coverage, which reads:
"xxx contained and/or stored during the currency of this Policy in the premises occupied by them
forming part of the buildings situate (sic) within own Compound xxx"
- It can be gleaned unerringly that the fire insurance policy in question did not limit its coverage to what
were stored in the four-span building. As opined by the trial court of origin, two requirements must
concur in order that the said fun and amusement machines and spare parts would be deemed
protected by the fire insurance policy under scrutiny, to wit:
"First, said properties must be contained and/or stored in the areas occupied by Transworld and
second, said areas must form part of the building described in the policy xxx"
- Said building of four-span lofty one storey in height with mezzanine portions is constructed of
reinforced concrete and hollow blocks and/or concrete under galvanized iron roof and occupied as
hosiery mills, garment and lingerie factory, transistor-stereo assembly plant, offices, ware house and
caretaker's quarter.
- The Court is mindful of the well-entrenched doctrine that factual findings by the Court of Appeals
are conclusive on the parties and not reviewable by this Court, and the same carry even more weight
when the Court of Appeals has affirmed the findings of fact arrived at by the lower court.
- In the case under consideration, both the trial court and the Court of Appeals found that the so called
"annex " was not an annex building but an integral and inseparable part of the four-span building
described in the policy and consequently, the machines and spare parts stored therein were
covered by the fire insurance in dispute.
- Verily, the two-storey building involved, a permanent structure which adjoins and
intercommunicates with the "first right span of the lofty storey building", formed part thereof, and
meets the requisites for compensability under the fire insurance policy sued upon.
- So also, considering that the two-storey building aforementioned was already existing when
subject fire insurance policy contract was entered into, petitioner should have specifically excluded
the said two-storey building from the coverage of the fire insurance if minded to exclude the same
but if did not, and instead, went on to provide that such fire insurance policy covers the products,
raw materials and supplies stored within the premises of respondent Transworld which was an
integral part of the four-span building occupied by Transworld, knowing fully well the existence of
such building adjoining and intercommunicating with the right section of the four-span building.
- Indeed, the stipulation as to the coverage of the fire insurance policy under controversy has created
a doubt regarding the portions of the building insured thereby. Article 1377 of the New Civil Code
provides:
"Art.1377. The interpretation of obscure words or stipulations in a contract shall not favor the party who
caused the obscurity"
- Conformably, it stands to reason that the doubt should be resolved against the petitioner, Rizal
Surety Insurance Company, whose lawyer or managers drafted the fire insurance policy contract
under scrutiny. Citing the aforecited provision of law in point, the Court in Landicho vs. Government
Service Insurance System, ruled:
"This is particularly true as regards insurance policies, in respect of which it is settled that the terms
in an insurance policy, which are
ambiguous, equivocal, or uncertain x x x are to be construed strictly and most strongly against the
insurer, and liberally in favor of the insured so as to effect the dominant purpose of indemnity or
payment to the insured, especially where forfeiture is involved' and the reason for this is that the
'insured usually has no voice in
the selection or arrangement of the words employed and that the language of the contract is
selected with great care and deliberation by experts and legal advisers employed by, and acting
exclusively in the interest of, the insurance company.' "
- Equally relevant is the following disquisition of the Court in Fieldmen's Insurance Company, Inc.
vs. Vda. De Songco, to wit:
"'This rigid application of the rule on ambiguities has become necessary in view of current business
practices. The courts cannot ignore that nowadays monopolies, cartels and concentration of
capital, endowed with overwhelming economic power, manage to impose upon parties dealing
with them cunningly prepared 'agreements' that the weaker party may not change one whit, his
participation in the 'agreement' being reduced to the alternative to 'take it or leave it' labelled since
Raymond Saleilles 'contracts by adherence' (contrats [sic] d'adhesion), in
contrast to these entered into by parties bargaining on an equal footing, such contracts (of which
policies of insurance and international bills of lading are prime example) obviously call for greater
strictness and vigilance on the part of courts of justice with a view to protecting the weaker party from
abuses and imposition, and
prevent their becoming traps for the unwary.'"
- The issue of whether or not Transworld has an insurable interest in the fun and amusement
machines and spare parts, which entitles it to be indemnified for the loss thereof, had been settled
in G.R. No. L-111118, entitled New India Assurance
Company, Ltd., vs. Court of Appeals, where the appeal of New India from the decision of the Court
of Appeals under review, was denied with finality by this Court on February 2, 1994.
- The rule on conclusiveness of judgment, which obtains under the premises, precludes the
relitigation of a particular fact or issue in another action between the same parties based on a different
claim or cause of action. "xxx the judgment in the prior action operates as estoppel only as to
those matters in issue or points controverted, upon the determination of which the finding or judgment
was rendered. In fine, the previous judgment is conclusive in the second case, only as those
matters actually and directly controverted and determined and not as to matters merely involved
therein."
Disposition Decision, and the Resolution of the CA
WERE AFFIRMED in toto. No pronouncement as to
costs.
FACTS
-Geagonia is the owner of Norman's Mart located in the public market of San Francisco, Agusan del
Sur. On 22 Dec 1989, he obtained from the private respondent fire insurance policy for
P100,000.00.
The period of the policy was from 22 Dec 1989 to 22 Dec 1990 and covered the ff: "Stock-in-trade
consisting principally of dry goods such as RTW's for men and women wear and other usual to
assured's
business.
-The policy contained the following condition:
"3. The insured shall give notice to the Company of any insurance or insurances already effected,
or which may subsequently be effected, covering any of the property or properties consisting of
stocks in
trade, goods in process and/or inventories only hereby insured, and unless notice be given and the
particulars of such insurance or insurances be stated therein or endorsed in this policy pursuant to
Section 50 of the Insurance Code, by or on behalf of the Company before the occurrence of any
loss or damage, all benefits under this policy shall be deemed forfeited, provided however, that
this condition shall not apply when the total insurance or insurances in force at the time of the loss or
damage is not more than P200,000.00."
-On 27 May 1990, fire of accidental origin broke out at around 7:30 p.m. at the public market of San
Francisco, Agusan del Sur. The petitioner's insured stocks-in-trade were completely destroyed
prompting him to file w/ the private respondent a claim under the policy. On 28 Dec 1990, the private
respondent denied the claim because it found that at the time of the loss the petitioner's stocks-in-trade
were likewise covered by two fire insurance policies for
P100,000.00 each, issued by the Cebu Branch of the Philippines First Insurance Co., Inc. (PFIC).
claims that the time he obtained the private respondent's fire insurance policy he knew that the two
policies issued by the PFIC were already in existence; however, he had no knowledge of the
provision in the private respondent's policy requiring him to inform it
of the prior policies; this requirement was not mentioned to him by the private respondent's agent;
and had it been so mentioned, he would not have withheld such information. He further asserted that
the total of the amounts claimed under the three policies was below the actual value of his stocks
at the time of loss, w/c was P1M.
- The Insurance Commission found that the petitioner did not violate Condition 3 as he had no
knowledge of the existence of the two fire insurance policies obtained from the PFIC; that it was
Cebu Tesing Textiles w/c procured the PFIC policies w/o informing him or securing his consent; and
that Cebu Tesing Textile, as his creditor, had insurable interest on the stocks. These findings were
based on the petitioner's testimony that he came to know of the
PFIC policies only when he filed his claim with the private respondent and that Cebu Tesing Textile
obtained them and paid for their premiums w/o informing him. The Insurance Commission then
ordered the respondent company to pay complainant the sum of P100,000.00 with legal interest from
the time the complaint was filed until fully satisfied plus the amount of P10,000.00 as attorney's fees.
-CA reversed the decision of the Insurance Commission because it found that the petitioner
knew of the existence of the two other policies issued by the PFIC
ISSUES
1. WON the petitioner had prior knowledge of the two insurance policies issued by the PFIC when he
obtained the fire insurance policy from the private respondent, thereby, for not disclosing such fact,
violating Condition 3 of the policy
2. if he had, WON he is precluded from recovering therefrom
-The basis of the private respondent's denial was the petitioner's alleged violation of Condition 3 of
the policy.
HELD
1. YES
- We agree w/ the CA that the petitioner knew of the prior policies issued by the PFIC. His letter of
18 January 1991 to the private respondent conclusively proves this knowledge. His testimony to the
contrary before the Insurance Commissioner and which the latter relied upon cannot prevail over a
written admission made ante litem motam. It was, indeed, incredible that he did not know about
the prior policies since these policies were not new or original.
- Geagonia then filed a complaint against the private respondent w/ the Insurance Commission for
the recovery of P100,000.00 under fire insurance policy, for attorney's fees, and costs of litigation. He
2. NO
- It must, however, be underscored that unlike the "other insurance" clauses involved in General
Insurance and Surety Corp. vs. Ng Hua or in Pioneer Insurance & Surety Corp. vs. Yap, which
read:
"The insured shall give notice to the company of any insurance or insurances already effected, or
which may subsequently be effected covering any of the property hereby insured, and unless such
notice be given and the particulars of such insurance or insurances be stated in or endorsed on this
Policy by or on behalf of the Company before the occurrence of any loss or damage, all benefits under
this Policy shall be forfeited." or in the 1930 case of Santa Ana vs. Commercial Union Assurance Co.
which provided "that any outstanding insurance upon the whole or a portion of the objects thereby
assured must be declared by the insured in writing and he
must cause the company to add or insert it in the policy, without which such policy shall be null and
void, and the insured will not be entitled to indemnity in case of loss," Condition 3 in the
private respondent's policy No. F-14622 does not absolutely declare void any violation thereof. It
expressly provides that the condition "shall not apply when the total insurance or insurances in
force at the time of the loss or damage is not more than P200,000.00."
- Interpretation: It is a cardinal rule on insurance that a policy or insurance contract is to be
interpreted liberally in favor of the insured and strictly against the company, the reason being,
undoubtedly, to afford the greatest protection which the insured was endeavoring to secure when
he applied for insurance. It is also a cardinal principle of law that forfeitures are not favored and that
any construction which would result in the forfeiture of the policy benefits for the person claiming
thereunder, will be avoided, if it is possible to construe the policy in a manner which would permit
recovery, as, for example, by finding a waiver for such forfeiture. Stated differently, provisions,
conditions or exceptions in policies which tend to work a forfeiture of insurance policies should be
construed most strictly against those for whose benefits they are inserted, and most favorably
toward those against whom they are
intended to operate. The reason for this is that, except for riders which may later be inserted, the
insured sees the contract already in its final form and has had no voice in the selection or arrangement
of
the words employed therein. On the other hand, the language of the contract was carefully chosen
and deliberated upon by experts and legal advisers who had acted exclusively in the interest of the
insurers
and the technical language employed therein is rarely understood by ordinary laymen.
- With these principles in mind, we are of the opinion that Condition 3 of the subject policy is not totally
free from ambiguity and must be
meticulously analyzed. Such analysis leads us to conclude that (a) the prohibition applies only to
double insurance, and (b) the nullity of the policy shall only be to the extent exceeding P200,000.00
of the total policies obtained.
- Furthermore, by stating within Condition 3 itself that such condition shall not apply if the
insurance in force at the time of loss does not exceed P200,000.00, the private respondent was
amenable
to assume a co-insurer's liability up to a loss not exceeding P200,000.00. What it had in mind was to
discourage over-insurance. Indeed, the rationale behind the incorporation of "other insurance" clause
in fire policies is to prevent over-insurance and thus avert the perpetration of fraud. When a
property owner obtains insurance policies from two or more insurers in a total amount that exceeds
the property's value, the insured may have an inducement to destroy the property for the purpose of
collecting the insurance. The public as well as the insurer is interested in preventing a situation in
which a fire would be profitable to the insured.Disposition Petition granted. The decision of the Court
of Appeals in CA-G.R. SP No. 31916 is SET ASIDE and the decision of the Insurance Commission
in Case No. 3340 is REINSTATED.
administration building while the Insured is therein at the commencement of the fire P2000
- CFI ruled in favor of petitioner, ordering the company to pay P2000 to del Rosario.
Section 4. Injury sustained by the wrecking or disablement of a regular passenger elevator car
in which the Insured is being conveyed as a passenger (Elevator in mines exluded) P2500
ISSUE
How much should the indemnity be
HELD
- All the parties agree that indemnity has to be paid, but the conflict centers on how much it should be.
- Where there is ambiguity with respect to the terms and conditions of the policy, the same will be
resolved against the one responsible thereof. Generally, the insured has little, if any, participation in
the preparation of the policy, together with the
drafting of its terms and conditions. The interpretation of obscure stipulations in a contract should
not favor the party who caused the obscurity.
- SC agreed with the ruling of the lower court: x x x death by drowning is a ground for recovery apart
from the bodily injury because death by
bodily injury is covered by Part I of the policy while death by drowning is covered by Part VI thereof.
But while the policy mentions specific amounts that may be recovered for death for
bodily injury, yet, there is not specific amount mentioned in the policy for death thru drowning
although the latter is, under Part VI of the policy, a ground for recovery thereunder. Since the
defendant has bound itself to pay P1000 to P3000 as indemnity for the death of the insured but the
policy does not positively state any
definite amount that may be recovered in case of death by drowning, there is an ambiguity in this
respect in the policy, which ambiguity must be interpreted in favor of the insured and strictly against
the insurer so as to allow a greater indemnity. x x x plaintiff is therefore entitled to recover P3000.
Disposition Judgment appealed from is affirmed.
FIRST QUEZON CITY INSURANCE CO. v. CA (DE
DIOS MARIKINA TRANSPORT CO)
218 SCRA 526
GRINO-AQUINO; February 28, 1993
NATURE
PETITION for review of the decision of the Court of Appeals. FQCIC seeks to limit to P12000, the
amount specified in the insurance contract, its liability to indemnify the respomdemt DMTC, for
the damages suffered by a passenger, who accidentally fell off the
bug.
- A complaint for recovery of the balance of P2000 was instituted with the CFI Rizal, praying for a
further sum of P10000 as attorneys fees, expenses of litigation and costs.
FACTS
- After sending off certain seamen at the departure area of MIA, Jose V. del Rosario proceeded to
the public utility bus stop. While at the bus stop, the plaintiff saw a DMTC bus. While moving at a
crawling
pace, it was taking several passengers, all of whom managed to board the bus while it was already at
the bus stop; plaintiff was the last one to board the bus.While the plaintiff was still on the bus with his
hand
on the bus door, the slowly moving bus sped forward at a high speed, as a result of which, the plaintiff
lost balance and fell from the bus. As plaintiff clung instinctively to the handle bar, he was dragged
by
the bus along the asphalted road. The bus driver, Gil Agpalo, abruptly stopped the bus. Then fled from
the scene, leaving the bus and the injured plaintiff behind.
- The plaintiff was brought to the Manila Sanitarium and Hospital where the doctors performed 2 major
surgical operations on plaintiffs right leg.
- Plaintiff was confined at the hospital for (40) days, from June 10, 1984 to August 26, 1984.
Medical expenses totaled the amount of P69,444.41. Plaintiffs medical expenses were advanced
by his
employer Maglines but he was required to reimburse Maglines on a staggered basis by way of
salary deductions. After his release from the hospital, he returned to the hospital for further
treatment and checkup. The injuries had left plaintiff with a huge scar on his right leg. Also, the
plaintiff incurred lost earning by way of unearned salaries amounting to P7,500.00 due to said
physical injuries and the consequent hospital confinement.
- Plaintiff filed on June 26, 1985 the complaint against DMTC and its driver. Agpalo was later
dropped as a party defendant because he could not be served with summons. Upon filing its
answer, defendant DMTC filed a thirdparty complaint against
First Quezon City Insurance Co., Inc. September 17, 1985, third-party defendant filed its answer to
the third-party complaint.
- TC held DMTC complaint dismissed for lack of merit and as regards the third-party complaint First
Quezon City Insurance Co., Inc. was to indemnify third-party plaintiff DMTC in the sum of
P12,000.00
with interest. There being no satisfactory warrant the court dismissed the rest of the claims in the
complaint and third-party complaint.
- The bus company appealed to the CA, which modified the dispositive as regards the third-party
complaint, that the third-party defendant First Quezon City Insurance Co., Inc. be ordered to
indemnify third-party plaintiff DMTC the SUM of P50,000.00 with legal interest. Insurance company
filed a MFR which was denied.
Hence, this petition for review, assailing the appellate courts' interpretation of the provision of the
insurance contract on the limit of the insurer's liability.
ISSUE
WON the CA erred in the interpretation of the insurance contract on the limit of the insurers
liability
HELD
YES
- The insurance policy clearly placed the maximum limit of the petitioner's liability for damages arising
from death or bodily injury at P12,000.00 per passenger and its maximum liability per accident at
P50,000.00. Since only one passenger was injured in the accident, the insurer's liability for the
damages suffered by said passenger is pegged to the amount of P12,000.00 only.
- The limit of P50,000.00 per accident means that the insurer's maximum liability for any single
accident will not exceed P50,000.00 regardless of the number of passengers killed or injured therein.
The bus company may not recover from the insurance company more than P12,000.00 per
passenger killed or injured, or (P50,000.00) per accident even if under the judgment of the court,
the erring bus operator will have to pay more than P12,000.00 to each injured passenger. The
trial court's interpretation of the insurance contract was the correct interpretation.
Disposition petition for review is GRANTED. The decision promulgated by the CA, ordering the third
party defendent, First Quezon City Insurance Co., Inc. to indemnify theI private respondent,
(DMTC), the sum of P50,000.00 for the damages of the passenger, Jose V. Del Rosario, is hereby
modified by reducing the award to 12,000.00 only. Costs against the private respondent De Dios
Marikina
FACTS:
May 15, 1981: Western Guaranty Corporation issued Fire Insurance Policy
to New Life Enterprises foar P350,000
Availmentof
October 19, 1982 2 am: fire electrical in nature destroyed the stock in trade
insured
to
express any
the
terms
disagreement
vital
one
of
the
with
because
to
where
reveal
but did not, that was deception - guilty of clear fraud total absence of such notice nullifies the
RTC: favored New Life and against the three insurance companies
policy
assuming arguendo that petitioners felt the
legitimate need to be clarified as to the policy condition violated, there was a considerable
W/N
Sy
can
claim
against
the
three
insurance
companies
for
violating
lapse of time from their receipt of the insurer's clarificatory letter dated March 30, 1983, up to
the
time
the
complaint
terms
insurer
any
other
insurance
and
from
its
the
HELD:
of
ISSUE:
conformity
The
worth P1,550,000
Corporation issued Fire Insurance Policy to New Life Enterprises for P200,000
the
the
was
filed in court
on
let
the
The knowledge of such insurance by the insurer's agents, even assuming the acquisition
thereof by the former, is not the "notice" that would estop the insurers from denying
FACTS:
the claim.
conclusion of
RCBC Binondo Branch initially granted a credit facility of P30M to Goyu &
companies" is an unfounded conjecture drawn from the mere fact that Yap Kam
Sons, Inc. GOYUs applied again and through Binondo Branch key officer's Uys and Laos
Chuan
recommendation, RCBCs executive committee increased its credit facility to P50M to P90M
was
also
had
the
favor of RCBC.
from Malayan Insurance Company, Inc. (MICO). In February 1992, he was issued 8
ISSUE: W/N RCBC as mortgagee, has any right over the insurance policies taken by GOYU, the
April 27, 1992: One of GOYUs factory buildings was burned so he claimed
against MICO for the loss who denied contending that the insurance policies were
HELD: YES.
GOYU filed a complaint for specific performance and damages at the RTC
RCBC, one of GOYUs creditors, also filed with MICO its formal claim over
RTC and CA: endorsements do not bear the signature of any officer of
the proceeds of the insurance policies, but said claims were also denied for the same reasons
naming itself as the sole payee, the intentions of the parties as shown by their
contemporaneous acts, must be given due consideration in order to better serve the interest of
and Philippine Trust Company) obtained their writs of attachment covering an aggregate
amount of P14,938,080.23 and ordered that 10 insurance policies be deposited with the court
GOYU continued to enjoy the benefits of the credit facilities extended to it by RCBC.
GOYU is at the very least estopped from assailing their operative effects.
RTC: favored GOYU against MICO for the claim, RCBC for damages and to
The two courts below erred in failing to see that the promissory notes which
In G.R. No. 128834, RCBC seeks right to intervene in the action between
Alfredo C. Sebastian (the creditor) and GOYU (the debtor), where the subject insurance
they ruled should be excluded for bearing dates which are after that of the fire, are mere
renewals of previous ones
RCBC has the right to claim the insurance proceeds, in substitution of the
property lost in the fire. Having assigned its rights, GOYU lost its standing as the beneficiary of
RULING:
The fact that the insured owned a private vehicle, not a common carrier, was something which the
company knew all along. In fact, it exerted the utmost pressure on the insured, a man of scant
education, to enter into the contract of insurance. The Court of Appeals also
held that since some of the conditions contained in the policy were impossible to comply with under
the existing conditions at the time, the insurer is estopped from asserting breach of such conditions.
The Supreme Court, in affirming the decision of the Court of Appeals, took judicial notice of the fact
that nowadays, monopolies, cartels and concentration of capital, endowed with overwhelming
economic power, manage to impose upon parties dealing with them cunningly prepared
agreements that the weaker party may not change one whit, his participation in the agreement being
reduced to the alternative of take it or leave it labelled since Raymond Saleilles as contracts by
adherence (contrats d'adhesion), in
contrast to those entered into by parties bargaining on an equal footing, such contracts (i.e. insurance
policies & international bills of lading) obviously call for greater strictness and vigilance on the part of
courts of justice with a view to protecting the weaker party from
abuses. Citing the case of Qua Chee Gan vs. Law Union & Rock
Insurance, "The contract of insurance is one of perfect good faith (uberima fides) not for the
insured alone but equally so for the insurer; in fact, it is more so for the latter, since its dominant
bargaining position carries with it stricter responsibility."
Landicho vs. GSIS
[G.R. No. L-28866 March 17, 1972]
FACTS:
On June 1, 1964, the GSIS issued in favor of Flaviano Landicho, a civil engineer of the Bureau of
Public Works, stationed at Mamburao, Mindoro Occidental, optional additional life insurance policy
No. OG-136107 in the sum of P7,900.
Before the issuance of said policy, Landicho had filed an application, by filing and signing a printed form
of the GSIS on the basis of which the policy was issued. Paragraph 7 of said application States:
This is particularly true as regards insurance policies, in respect of which it is settled that the " "terms in
an insurance policy, which are ambiguous, equivocal, or uncertain ... are to be construed strictly
and most strongly against the insurer, and liberally in favor of
the insured so as to effect the dominant purpose of indemnity or payment to the insured, especially
where a forfeiture is involved" (29 Am. Jur., 181), and the reason for this rule is the "insured usually
has no voice in the selection or arrangement of the words employed
and that the language of the contract is selected with great care and deliberation by experts and
legal advisers employed by, and acting exclusively in the interest of, the insurance company." (44
C.J.S., p. 1174.)
The equitable and ethical considerations justifying the foregoing view are bolstered up by two (2)
factors, namely:
(a) The aforementioned subdivision (c) states "that this application serves as a letter of authority to
the Collecting Officer of our Office" the Bureau of Public Works "thru the GSIS to deduct from my
salary the monthly premium in the amount of P33.36." No such
deduction was made and, consequently, not even the first premium "paid" because the
collecting officer of the Bureau of Public Works was not advised by the GSIS to make it (the deduction)
pursuant to said authority. Surely, this omission of the GSIS should
not inure to its benefit.
(b) The GSIS had impliedly induced the insured to believe that Policy No. OG-136107 was in force,
he having been paid by the GSIS the dividends corresponding to said policy. Had the insured had
the slightest inkling that the latter was not, as yet, effective for non-payment of the first
premium, he would have, in all probability, caused the same to be forthwith satisfied.
WHEREFORE, the decision appealed from should be, it is hereby affirmed, with costs against the
defendant-appellant, Government Service Insurance System. It is so ordered.
(T)he language, of subdivisions (c), (d) and (e) is such as to create an ambiguity that should be
resolved against the party responsible therefor defendant GSIS, as the party who prepared and
furnished the application form and in favor of the party misled
thereby, the insured employee.
PALILEO v. COSIO
[G.R. No. L-7667 November 28, 1955]
FACTS:
On Dec. 18, 1951, Palileo obtained from Cosio a loan in
the sum of 12,000. Pursuant to their agreement,
THE INSULAR LIFE ASSURANCE COMPANY, LTD. vs. CARPONIA T. EBRADO and PASCUALA
VDA. DE EBRADO
[G.R. No. L-44059 October 28, 1977]
Facts of the Case:
On September 1, 1968, Buenaventura Cristor Ebrado
was issued by The Life Assurance Co., Ltd., Policy No.
009929 on a whole-life for P5,882.00 with a, rider for
Accidental Death for the same amount Buenaventura
C. Ebrado designated Carpponia T. Ebrado as the
revocable beneficiary in his policy. He to her as his
wife.
On October 21, 1969, Buenaventura C. Ebrado died
when he was hit by a failing branch of a tree. As the
policy was in force, The Insular Life Assurance Co.,
Ltd. liable to pay the coverage in the total amount of
P11,745.73, representing the face value of the policy
in the amount of P5,882.00 plus the additional benefits
for accidental death also in the amount of P5,882.00
and the refund of P18.00 paid for the premium due
November, 1969, minus the unpaid premiums and
interest thereon due for January and February, 1969,
in the sum of P36.27.
Carponia T. Ebrado filed with the insurer a claim for
the proceeds of the Policy as the designated
beneficiary therein, although she admits that she and
the insured Buenaventura C. Ebrado were merely living
as husband and wife without the benefit of marriage.
In the caw before Us, the requisite proof of commonlaw relationship between the insured and the
beneficiary has been conveniently supplied by the
stipulations between the parties in the pre-trial
conference of the case. It case agreed upon and
stipulated therein that the deceased insured
Buenaventura C. Ebrado was married to Pascuala
Ebrado with whom she has six legitimate children; that
during his lifetime, the deceased insured was living
with his common-law wife, Carponia Ebrado, with
whom he has two children. These stipulations are
nothing less than judicial admissions which, as a
consequence, no longer require proof and cannot be
contradicted. A fortiori, on the basis of these
admissions, a judgment may be validly rendered
without going through the rigors of a trial for the sole
purpose of proving the illicit liaison between the
insured and the beneficiary. In fact, in that pretrial,
the parties even agreed "that a decision be rendered
based on this agreement and stipulation of facts as to
who among the two claimants is entitled to the policy."
ACCORDINGLY, the appealed judgment of the lower
court is hereby affirmed. Carponia T. Ebrado is hereby
declared disqualified to be the beneficiary of the late
Buenaventura C. Ebrado in his life insurance policy. As
a consequence, the proceeds of the policy are hereby
held payable to the estate of the deceased insured.
Costs against Carponia T. Ebrado.
SO ORDERED.
SOUTHERN LUZON EMPLOYEES ASSN. VS GOLPEO
Note:
A common law wife of the insured who has a legal wife
is disqualified as beneficiary. It is not required that
there be a previous conviction for adultery or
concubinage for the prohibition to apply. However, in
an earlier case (such as the present case), the
common-law wife designated prevailed over the legal
wife because the case took place while the Old Civil
Code was still applicable, under which there was no
of summons is intended to give notice to the defendant that an action has been commenced against it.
Petitioners contention that
it was not properly served with summons and that Atty. Gloria was not authorized to appear for and in
its behalf are untenable. Although petitioner questioned the propriety of the service of summons, it
however, failed to substantiate its allegation that it was not properly served with summons. Hence, the
disputable presumption that official duty has been regularly performed prevails.
Fidelity waived such provision. Moreover, Verendia reprehensibly disregarded the principle that
insurance contracts are uberrimae fidae and demand the most abundant good faith.
Development Bank of the Philippines v Court of Appeals and the Estate of the late Juan B. Dans
March 21, 1994
FACTS: In May 1987, Juan Dans, 76 years of age, together with his wife Candida, applied for a loan
of P500, 000 with the DBP. The DBP advised him to obtain a mortgage redemption insurance (MRI)
with the DBP MRI Pool. Aloan of P300, 000 was approved and released on 11 August 1987. From the
proceeds of the loan, the DBP
deducted P1, 476 as payment for the MRI premium. On 15 August 1987, Dans accomplished and
submitted the MRI Application for Insurance and the Health Statement for DBP MRI Pool. On 20
August, The MRI premium was credited by DBP to the savings account of the DBP MRI Pool. On 3
September, Dans died. On 23 September, The DBP MRI Pool notified DBP that Dans was not
eligible for MRI coverage, being over the acceptance limit of 60 years at the time of the application.
Candida, then, filed a complaint with the RTC for Collection of Sum of Money with Damages. The RTC
ruled in favor of respondent Estate but absolved the DBP MRI
Pool from liability.
During the Japanese Occupation, the building and insured merchandise were burned. Respondent
submitted to the petitioner its
claim. The salvaged goods were sold at public auction and, after deducting their value, the total loss
suffered was fixed at P92, 650. Petitioner refused to pay on the ground that the policy in favor of the
respondent had ceased to be in force on the date the US declared war against Germany, the
respondent corporation being controlled by German subjects and the petitioner being a company
under American jurisdiction. Pursuant to an order of the Director of the Bureau of Financing, petitioner
paid to respondent the sum of P92, 650 on April 19, 1943. Petitioner then filed an action in the CFI for
the purpose of recovering the amount paid. The CFI dismissed the
petition and the CA affirmed.
ISSUE: Whether or not the insurance contract between petitioner and respondent, automatically
ceased to be in force, upon the declaration of war by the US against Germany.
HELD: Yes. The Philippine Insurance Law (Act No. 2427, as amended) in section 8, provides that
anyone except a public enemy may be insured. It stands to reason that an insurance policy ceases to
be allowable as soon as an insured becomes a public enemy.
ISSUE: Whether or not DBP and DBP MRI Pool are equally liable.
HELD: No. Where there was no perfected contract of insurance, DBP MRI Pool cannot be held liable on
the contract that does not exist. The liability of DBP is another matter. In dealing with Dans, DBP was
wearing two legal hats: the first as lender and the second as insurance agent. The DBP is not
authorized to accept applications for MRI when its clients are more than 60 years of age. Knowing all
the while that Dans was ineligible for MRI coverage because of his advanced age, DBP exceeded
the scope of its authority when it accepted Dans application for MRI collecting the insurance
premium, and deducting its agents commission and fee service.
Filipinas Compania de Seguros v Christern, Huenfeld and Co.
GR No. L-2294 May 25, 1951
FACTS: On October 1, 1941, respondent, after payment of corresponding premium, obtained from the
petitioner, a fire policy in the sum P100, 000, covering merchandise contained in a building.
FACTS: On 10 January 1963, respondent Desiderio spouses applied for a retailers loan with the PNB,
which was approved and secured by a chattel mortgage consisting of the inventory of stocks in the
store of the spouses. In addition, the merchandise subject of the mortgage, were insured with the
Cosmopolitan Insurance Co. for P4, 000, with the PNB as beneficiary. On 1 August 1964, the spouses
paid P1,089.60 as partial payment of the loan, however, the insured building and merchandise were
totally destroyed by fire. The PNB sent several demand letters to the insurance company for the
purpose of recovering the proceeds of the insurance but to no avail.
Sometime in 1966, the said insurance company became the subject of liquidation. Seven years after
the fire, the PNB filed a complaint for collection against the spouses. The City Court dismissed the
petition and declared the amount of P1, 089.60 unrecoverable. The CFI and the CA affirmed.
ISSUE: Whether the PNB, as attorney-in-fact of the spouses, is bound to successfully collect the
insurance proceeds of the mortgaged property of the latter.
HELD: No. The PNB could have collected the insurance proceeds if only it were not negligent. It had
ample time and enough legal remedies to collect when the same became due, yet, it merely sent
demand letters to the insurance company. It did not even file a suit for the recovery of the insurance
proceeds against the insurance
company before and even during the liquidation. Realizing that it could no longer collect from the
insurance company, it directed the collection suit against the spouses whose obligation with the PNB
had long been extinguished.
El Oriente Fabrica de Tabacos, Inc. v Juan Posadas
GR No. 34774 September 21, 1931
FACTS: On 18 March 1925, plaintiff, in order to protect itself against the loss that it might suffer by
reason of the death of its manager, A. Velhagen, procured from the Manufacturers Life Insurance Co.,
an insurance policy on the life of said manager for $50, 000. The plaintiff is designated as the sole
beneficiary. The plaintiff charged as expenses of its business all the said premiums and deducted the
same from its gross incomes as reported in its annual income tax returns, which deductions were
allowed by defendant were allowed by defendant upon a showing made by the plaintiff that such
premiums were legitimate expenses. Upon the death of Velhagen in 1929,
plaintiff received the proceeds amounting P104, 957.88. Over the protest of the plaintiff, which
claimed exemption under Section 4 of the Income Tax Law, the defendant Collector of Internal
Revenue assessed and levied the sum of P3, 148.74 as income tax on the proceeds of the insurance
policy, which plaintiff paid under protest.
ISSUE: Whether the proceeds of an insurance taken by a corporation on the life of an important official
to indemnify it against loss in case of his death, are taxable as income under the Philippine Income
Tax Law.
HELD: No. It is true that the Income Tax Law, in exempting individual beneficiaries, speaks of the
proceeds of life insurance policies as income, but this is a very slight indication of legislative intention.
In reality, what the plaintiff received was in the nature of an indemnity for the loss which it actually
suffered because of the death of its manager.
Basilia Berdin Vda. De Consuegra, et al. v GSIS, et al.
GR No. L-28093 January 30, 1971
FACTS: The late Jose Consuegra, at the time of his death, was employed as a shop foreman of the
Office of the District Engineer in Surigao del Norte. In his lifetime, he contracted two marriages, the first
with respondent Rosario Diaz, and the second, which was contracted in good faith while the first
marriage was subsisting, with
petitioner, Basilia Berdin. Being a member of the GSIS when he died, the proceeds of his life
insurance policy were paid to Basilia and her children who were the beneficiaries named in the
policy. Having been in government service for more than 20 years, Consuegra was entitled to
retirement insurance benefits worth P6, 304.47.
Consuegra did not designate any beneficiary who would receive the retirement insurance benefits
due to him. Respondent Rosario then filed a claim with the GSIS asking that the retirement insurance
benefits be paid to her as the only legal heir, considering that the deceased did not designate any
beneficiary with respect to his
retirement insurance benefits. Petitioner Basilia and her children, likewise, filed a similar claim,
asserting that being the beneficiaries named in the life insurance policy, they are the only ones entitled
to receive the retirement insurance benefits due. The GSIS ruled that the legal heirs were Rosario
Diaz, who is entitled to 8/16 of the
retirement insurance; and Basilia Berdin and her seven children, who are entitled to the remaining 8/16,
each of them to receive an equal share of 1/16. Dissatisfied, Basilia filed a case before the CFI
which, however, upheld the decision of the GSIS.
ISSUE: (1) Whether or not the system of life insurance and the system of retirement insurance are
complementary to each other such that whoever is named beneficiary in the life insurance is also the
beneficiary in the retirement insurance when no such beneficiary is named in the retirement insurance.
(2) To whom should the retirement benefits of Jose Consuegra be paid, because he did not, or failed to
designate the beneficiary of his retirement insurance?
HELD: No. Subsection (b) of Section 11 of Commonwealth Act 186, as amended by Rep. Act 660,
clearly indicate that there is need for the employee to file an application for retirement
insurance benefits when he becomes a member of the GSIS, and he should state in his
application the beneficiary of his retirement
insurance. Hence, the beneficiary named in the life insurance does not automatically become the
beneficiary in the retirement insurance unless the same beneficiary in the life insurance is so
designated in the application for retirement insurance. In the case of the proceeds of a life insurance,
the same are paid to whoever is named the beneficiary in the life insurance policy. As in the case of a
life insurance provided for in the Insurance Act (Act 2427, as amended), the beneficiary in a life
insurance under the GSIS may not necessarily be an heir of the insured. The insured in a life insurance
may designate any person as beneficiary unless disqualified to be so under the provisions of the Civil
Code. And in the absence of any beneficiary named in the life insurance policy, the proceeds of the
insurance will go to the estate of the insured.
Therefore, the respondent GSIS had correctly acted when it ruled that the proceeds of the retirement
insurance of the late Jose Consuegra should be divided equally between his first living wife
Rosario Diaz, on the one hand, and his second wife Basilia Berdin and his children by her, on the other.
Hilario Gercio v Sun Life Assurance of Canada, et al.
GR No. 23703 September 28, 1925
FACTS: Hilario Gercio, the insured, is the plaintiff. The Sun Life Assurance Co. of Canada, the
insurer, and Andrea Zialcita, the beneficiary, are the defendants. The complaint is in the nature of
mandamus. Its purpose is to compel the defendant Sun Life Assurance Co. of Canada to change the
beneficiary in the policy issued by the defendant company on the life of the plaintiff Hilario Gercio, with
one Andrea Zialcita as beneficiary. The judgment of the trial court was in favor of the plaintiff without
costs, and ordered the defendant company to eliminate from the insurance policy the
name of Andrea Zialcita as beneficiary and to substitute therefor such name as the plaintiff might furnish
to the defendant for that purpose. On the date the policy was issued, Andrea Zialcita was the lawful wife
of Hilario Gercio. Towards the end of the year 1919, she was convicted of the crime of adultery. On
September 4, 1920, a
decree of divorce was issued in civil case no. 17955, which had the effect of completely
dissolving the bonds of matrimony contracted by Hilario Gercio and Andrea Zialcita. On March 4,
1922, Hilario Gercio formally notified the Sun Life Assurance Co. of Canada that he had revoked his
donation in favor of Andrea Zialcita,
and that he had designated in her stead his present wife, Adela Garcia de Gercio, as the beneficiary of
the policy. Gercio requested the insurance company to eliminate Andrea Zialcita as beneficiary. This,
the insurance company has refused and still refuses to do.
ISSUE:
Whether the insured the husband has the power to change the beneficiary the former
wife and to name instead his actual wife, where the insured and the beneficiary have been divorced
and where the policy of insurance does not expressly reserve to the insured the right to change the
beneficiary.
HELD: No. The wife has an insurable interest in the life of her husband. The beneficiary has an
absolute vested interest in the policy from the date of its issuance and delivery. So when a policy of life
insurance is taken out by the husband in which the wife is named as beneficiary, she has a subsisting
interest in the policy. If the
husband wishes to retain to himself the control and ownership of the policy he may so provide in the
policy. But if the policy contains no provision authorizing a change of beneficiary without the
beneficiary's consent, the insured cannot make such change.
Accordingly, it is held that a life insurance policy of a husband made payable to the wife as beneficiary,
is the separate property of the beneficiary and beyond the control of the husband. Also, there is no
provision in the Philippine Law permitting the beneficiary in a policy for the benefit of the wife of the
husband to be changed after a divorce. It must follow, therefore, in the absence of a statute to the
contrary, that if a policy is taken out upon a husband's life the wife is named as beneficiary therein, a
subsequent divorce does not destroy her rights under the policy.