Professional Documents
Culture Documents
Insurance Cases
Insurance Cases
SUPREME COURT
Manila
EN BANC
G.R. No. L-1669
xxx
advance during the lifetime and good health of the Insured of the annual
premium of One Hundred fifty-eight and 4/100 pesos Philippine
currency1 and of the payment of a like amount upon each twenty-seventh
day of September hereafter during the term of Twenty years or until the
prior death of the Insured. (Emphasis supplied.)
xxx
xxx
All premium payments are due in advance and any unpunctuality in making
any such payment shall cause this policy to lapse unless and except as kept
in force by the Grace Period condition or under Option 4 below. (Grace of 31
days.)
After that first payment, no further premiums were paid. The insured died on
September 22, 1944.
It is admitted that the defendant, being an American corporation , had to close its
branch office in Manila by reason of the Japanese occupation, i.e. from January 2,
1942, until the year 1945.
Second case. On August 1, 1938, the defendant Asia Life Insurance Company issued
its Policy No. 78145 (Joint Life 20-Year Endowment Participating with Accident
Indemnity), covering the lives of the spouses Tomas Ruiz and Agustina Peralta, for
the sum of P3,000. The annual premium stipulated in the policy was regularly paid
from August 1, 1938, up to and including September 30, 1941. Effective August 1,
1941, the mode of payment of premiums was changed from annual to quarterly, so
that quarterly premiums were paid, the last having been delivered on November 18,
1941, said payment covering the period up to January 31, 1942. No further
payments were handed to the insurer. Upon the Japanese occupation, the insured
and the insurer became separated by the lines of war, and it was impossible and
illegal for them to deal with each other. Because the insured had borrowed on the
policy an mount of P234.00 in January, 1941, the cash surrender value of the policy
was sufficient to maintain the policy in force only up to September 7, 1942. Tomas
Ruiz died on February 16, 1945. The plaintiff Agustina Peralta is his beneficiary. Her
demand for payment met with defendant's refusal, grounded on non-payment of the
premiums.
The policy provides in part:
This POLICY OF INSURANCE is issued in consideration of the written and
printed application herefor, a copy of which is attached hereto and is
hereby made apart hereof, and of the payment in advance during the life
time and good health of the Insured of the annual premium of Two hundred
and 43/100 pesos Philippine currency and of the payment of a like amount
upon each first day of August hereafter during the term of Twenty years or
until the prior death of either of the Insured. (Emphasis supplied.)
xxx
xxx
xxx
All premium payments are due in advance and any unpunctuality in making
any such payment shall cause this policy to lapse unless and except as kept
in force by the Grace Period condition or under Option 4 below. (Grace of
days.) . . .
Plaintiffs maintain that, as beneficiaries, they are entitled to receive the proceeds of
the policies minus all sums due for premiums in arrears. They allege that nonpayment of the premiums was caused by the closing of defendant's offices in Manila
during the Japanese occupation and the impossible circumstances created by war.
Defendant on the other hand asserts that the policies had lapsed for non-payment of
premiums, in accordance with the contract of the parties and the law applicable to
the situation.
The lower court absolved the defendant. Hence this appeal.
The controversial point has never been decided in this jurisdiction. Fortunately, this
court has had the benefit of extensive and exhaustive memoranda including those
of amici curiae. The matter has received careful consideration, inasmuch as it affects
the interest of thousands of policy-holders and the obligations of many insurance
companies operating in this country.
Since the year 1917, the Philippine law on Insurance was found in Act No. 2427, as
amended, and the Civil Code.2Act No. 2427 was largely copied from the Civil Code of
California.3 And this court has heretofore announced its intention to supplement the
statutory laws with general principles prevailing on the subject in the United State. 4
In Young vs. Midland Textile Insurance Co. (30 Phil., 617), we said that "contracts of
insurance are contracts of indemnity upon the terms and conditions specified in the
policy. The parties have a right to impose such reasonable conditions at the time of
the making of the contract as they may deem wise and necessary. The rate of
premium is measured by the character of the risk assumed. The insurance company,
for a comparatively small consideration, undertakes to guarantee the insured
against loss or damage, upon the terms and conditions agreed upon, and upon no
other, and when called upon to pay, in case of loss, the insurer, therefore, may justly
insists upon a fulfillment of these terms. If the insured cannot bring himself within
the conditions of the policy, he is not entitled for the loss. The terms of the policy
constitute the measure of the insurer's liability, and in order to recover the insured
must show himself within those terms; and if it appears that the contract has been
terminated by a violation, on the part of the insured, of its conditions, then there can
be no right of recovery. The compliance of the insured with the terms of the contract
is a condition precedent to the right of recovery."
Recall of the above pronouncements is appropriate because the policies in question
stipulate that "all premium payments are due in advance and any unpunctuality in
making any such payment shall cause this policy to lapse." Wherefore, it would
seem that pursuant to the express terms of the policy, non-payment of premium
produces its avoidance.
The conditions of contracts of Insurance, when plainly expressed in a policy,
are binding upon the parties and should be enforced by the courts, if the
evidence brings the case clearly within their meaning and intent. It tends to
bring the law itself into disrepute when, by astute and subtle distinctions, a
plain case is attempted to be taken without the operation of a clear,
reasonable and material obligation of the contract. Mack vs. Rochester
German Ins. Co., 106 N.Y., 560, 564. (Young vs. Midland Textile Ins. Co., 30
Phil., 617, 622.)
In Glaraga vs. Sun Life Ass. Co. (49 Phil., 737), this court held that a life policy was
avoided because the premium had not been paid within the time fixed, since by its
express terms, non-payment of any premium when due or within the thirty-day
period of grace, ipso facto caused the policy to lapse. This goes to show that
although we take the view that insurance policies should be conserved 5 and should
not lightly be thrown out, still we do not hesitate to enforce the agreement of the
parties.
Forfeitures of insurance policies are not favored, but courts cannot for that
reason alone refuse to enforce an insurance contract according to its
meaning. (45 C.J.S., p. 150.)
Nevertheless, it is contended for plaintiff that inasmuch as the non-payment of
premium was the consequence of war, it should be excused and should not cause
the forfeiture of the policy.
Professor Vance of Yale, in his standard treatise on Insurance, says that in
determining the effect of non-payment of premiums occasioned by war, the
American cases may be divided into three groups, according as they support the socalled Connecticut Rule, the New York Rule, or the United States Rule.
The first holds the view that "there are two elements in the consideration for which
the annual premium is paid First, the mere protection for the year, and second,
the privilege of renewing the contract for each succeeding year by paying the
premium for that year at the time agreed upon. According to this view of the
contract, the payment of premiums is a condition precedent, the non-performance
would be illegal necessarily defeats the right to renew the contract."
The second rule, apparently followed by the greater number of decisions, hold that
"war between states in which the parties reside merely suspends the contracts of
the life insurance, and that, upon tender of all premiums due by the insured or his
representatives after the war has terminated, the contract revives and becomes fully
operative."
The United States rule declares that the contract is not merely suspended, but is
abrogated by reason of non-payments is peculiarly of the essence of the contract. It
additionally holds that it would be unjust to allow the insurer to retain the reserve
value of the policy, which is the excess of the premiums paid over the actual risk
carried during the years when the policy had been in force. This rule was announced
in the well-known Statham6case which, in the opinion of Professor Vance, is the
correct rule.7
The appellants and some amici curiae contend that the New York rule should be
applied here. The appellee and other amici curiae contend that the United States
doctrine is the orthodox view.
We have read and re-read the principal cases upholding the different theories.
Besides the respect and high regard we have always entertained for decisions of the
Supreme Court of the United States, we cannot resist the conviction that the reasons
expounded in its decision of the Statham case are logically and judicially sound. Like
the instant case, the policy involved in the Statham decision specifies that nonpayment on time shall cause the policy to cease and determine. Reasoning out that
punctual payments were essential, the court said:
. . . it must be conceded that promptness of payment is essential in the
business of life insurance. All the calculations of the insurance company are
based on the hypothesis of prompt payments. They not only calculate on
the receipt of the premiums when due, but on compounding interest upon
them. It is on this basis that they are enabled to offer assurance at the
favorable rates they do. Forfeiture for non-payment is an necessary means
of protecting themselves from embarrassment. Unless it were enforceable,
the business would be thrown into confusion. It is like the forfeiture of
shares in mining enterprises, and all other hazardous undertakings. There
must be power to cut-off unprofitable members, or the success of the whole
scheme is endangered. The insured parties are associates in a great
scheme. This associated relation exists whether the company be a mutual
one or not. Each is interested in the engagements of all; for out of the coexistence of many risks arises the law of average, which underlies the
whole business. An essential feature of this scheme is the mathematical
calculations referred to, on which the premiums and amounts assured are
based. And these calculations, again, are based on the assumption of
average mortality, and of prompt payments and compound interest
thereon. Delinquency cannot be tolerated nor redeemed, except at the
option of the company. This has always been the understanding and the
practice in this department of business. Some companies, it is true, accord
a grace of thirty days, or other fixed period, within which the premium in
arrear may be paid, on certain conditions of continued good health, etc. But
this is a matter of stipulation, or of discretion, on the part of the particular
company. When no stipulation exists, it is the general understanding that
time is material, and that the forfeiture is absolute if the premium be not
paid. The extraordinary and even desperate efforts sometimes made, when
an insured person is in extremes to meet a premium coming due,
demonstrates the common view of this matter.
The case, therefore, is one in which time is material and of the essence and
of the essence of the contract. Non-payment at the day involves absolute
forfeiture if such be the terms of the contract, as is the case here. Courts
cannot with safety vary the stipulation of the parties by introducing equities
for the relief of the insured against their own negligence.
In another part of the decision, the United States Supreme Court considers and
rejects what is, in effect, the New York theory in the following words and phrases:
The truth is, that the doctrine of the revival of contracts suspended during
the war is one based on considerations of equity and justice, and cannot be
invoked to revive a contract which it would be unjust or inequitable to
revive.
In the case of Life insurance, besides the materiality of time in the
performance of the contract, another strong reason exists why the policy
should not be revived. The parties do not stand on equal ground in
reference to such a revival. It would operate most unjustly against the
company. The business of insurance is founded on the law of average; that
of life insurance eminently so. The average rate of mortality is the basis on
which it rests. By spreading their risks over a large number of cases, the
companies calculate on this average with reasonable certainty and safety.
Anything that interferes with it deranges the security of the business. If
every policy lapsed by reason of the war should be revived, and all the back
premiums should be paid, the companies would have the benefit of this
average amount of risk. But the good risks are never heard from; only the
bar are sought to be revived, where the person insured is either dead or
dying. Those in health can get the new policies cheaper than to pay
arrearages on the old. To enforce a revival of the bad cases, whilst the
company necessarily lose the cases which are desirable, would be
manifestly unjust. An insured person, as before stated, does not stand
isolated and alone. His case is connected with and co-related to the cases
of all others insured by the same company. The nature of the business, as a
whole, must be looked at to understand the general equities of the parties.
The above consideration certainly lend themselves to the approval of fair-minded
men. Moreover, if, as alleged, the consequences of war should not prejudice the
insured, neither should they bear down on the insurer.
Urging adoption of the New York theory, counsel for plaintiff point out that the
obligation of the insured to pay premiums was excused during the war owing to
impossibility of performance, and that consequently no unfavorable consequences
should follow from such failure.
The appellee answers, quite plausibly, that the periodic payment of premiums, at
least those after the first, is not an obligation of the insured, so much so that it is not
a debt enforceable by action of the insurer.
After perusing the Insurance Act, we are firmly persuaded that the non-payment of
premiums is such a vital defense of insurance companies that since the very
beginning, said Act no. 2427 expressly preserved it, by providing that after the
policy shall have been in force for two years, it shall become incontestable (i.e. the
insurer shall have no defense) except for fraud, non-payment of premiums, and
military or naval service in time of war (sec. 184 [b], Insurance Act). And when
Congress recently amended this section (Rep. Act No. 171), the defense of fraud was
eliminated, while the defense of nonpayment of premiums was preserved. Thus the
fundamental character of the undertaking to pay premiums and the high importance
of the defense of non-payment thereof, was specifically recognized.
In keeping with such legislative policy, we feel no hesitation to adopt the United
States Rule, which is in effect a variation of the Connecticut rule for the sake of
equity. In this connection, it appears that the first policy had no reserve value, and
that the equitable values of the second had been practically returned to the insured
in the form of loan and advance for premium.
For all the foregoing, the lower court's decision absolving the defendant from all
liability on the policies in question, is hereby affirmed, without costs.
Moran, C.J., Ozaeta, Paras, Pablo, Montemayor, Tuason, and Reyes, JJ., concur.
Republic of the Philippines
SUPREME COURT
Manila
It should be noted that the parties contracted not only for peacetime conditions but
also for times of war, because the policies contained provisions applicable expressly
to wartime days. The logical inference, therefore, is that the parties contemplated
uninterrupted operation of the contract even if armed conflict should ensue.
FIRST DIVISION
G.R. No. L-44059 October 28, 1977
For the plaintiffs, it is again argued that in view of the enormous growth of insurance
business since the Statham decision, it could now be relaxed and even disregarded.
It is stated "that the relaxation of rules relating to insurance is in direct proportion to
the growth of the business. If there were only 100 men, for example, insured by a
Company or a mutual Association, the death of one will distribute the insurance
proceeds among the remaining 99 policy-holders. Because the loss which each
survivor will bear will be relatively great, death from certain agreed or specified
causes may be deemed not a compensable loss. But if the policy-holders of the
Company or Association should be 1,000,000 individuals, it is clear that the death of
one of them will not seriously prejudice each one of the 999,999 surviving insured.
The loss to be borne by each individual will be relatively small."
The answer to this is that as there are (in the example) one million policy-holders,
the "losses" to be considered will not be the death of one but the death of ten
thousand, since the proportion of 1 to 100 should be maintained. And certainly such
losses for 10,000 deaths will not be "relatively small."
MARTIN, J.:
This is a novel question in insurance law: Can a common-law wife named as
beneficiary in the life insurance policy of a legally married man claim the proceeds
thereof in case of death of the latter?
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 T.
Ebrado as the revocable beneficiary in his policy. He to her as his wife.
From this judgment, Carponia T. Ebrado appealed to the Court of Appeals, but on July
11, 1976, the Appellate Court certified the case to Us as involving only questions of
law.
We affirm the judgment of the lower court.
1. It is quite unfortunate that the Insurance Act (RA 2327, as amended) or even the
new Insurance Code (PD No. 612, as amended) does not contain any specific
provision grossly resolutory of the prime question at hand. Section 50 of the
Insurance Act which provides that "(t)he insurance shag be applied exclusively to
the proper interest of the person in whose name it is made" 1 cannot be validly
seized upon to hold that the mm includes the beneficiary. The word "interest" highly
suggests that the provision refers only to the "insured" and not to the beneficiary,
since a contract of insurance is personal in character. 2 Otherwise, the prohibitory
laws against illicit relationships especially on property and descent will be rendered
nugatory, as the same could easily be circumvented by modes of insurance. Rather,
the general rules of civil law should be applied to resolve this void in the Insurance
Law. Article 2011 of the New Civil Code states: "The contract of insurance is
governed by special laws. Matters not expressly provided for in such special laws
shall be regulated by this Code." When not otherwise specifically provided for by the
Insurance Law, the contract of life insurance is governed by the general rules of the
civil law regulating contracts. 3 And under Article 2012 of the same Code, "any
person who is forbidden from receiving any donation under Article 739 cannot be
named beneficiary of a fife insurance policy by the person who cannot make a
donation to him. 4 Common-law spouses are, definitely, barred from receiving
donations from each other. Article 739 of the new Civil Code provides: +.wph!1
The following donations shall be void:
1. Those made between persons who were guilty of adultery or
concubinage at the time of donation;
Those made between persons found guilty of the same criminal
offense, in consideration thereof;
3. Those made to a public officer or his wife, descendants or
ascendants by reason of his office.
In the case referred to in No. 1, the action for declaration of nullity
may be brought by the spouse of the donor or donee; and the guilt
of the donee may be proved by preponderance of evidence in the
same action.
2. In essence, a life insurance policy is no different from a civil donation insofar as
the beneficiary is concerned. Both are founded upon the same consideration:
liberality. A beneficiary is like a donee, because from the premiums of the policy
which the insured pays out of liberality, the beneficiary will receive the proceeds or
of the policy are hereby held payable to the estate of the deceased insured. Costs
against Carponia T. Ebrado.
SO ORDERED.
Teehankee (Chairman), Makasiar, Mu;oz Palma, Fernandez and Guerrero, JJ.,
concur.1wph1.t
Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. L-4611
Property Insured
tried in 1940 for the crime of arson, it being claimed that they had set fire to the
destroyed warehouses to collect the insurance. They were, however, acquitted by
the trial court in a final decision dated July 9, 1941 (Exhibit WW). Thereafter, the civil
suit to collect the insurance money proceeded to its trial and termination in the
Court below, with the result noted at the start of this opinion. The Philippine National
Bank's complaint in intervention was dismissed because the appellee had managed
to pay his indebtedness to the Bank during the pendecy of the suit, and despite the
fire losses.
In its first assignment of error, the insurance company alleges that the trial Court
should have held that the policies were avoided for breach of warranty, specifically
the one appearing on a rider pasted (with other similar riders) on the face of the
policies (Exhibits X, Y, JJ and LL). These riders were attached for the first time in
1939, and the pertinent portions read as follows:
Memo. of Warranty. The undernoted Appliances for the extinction of fire
being kept on the premises insured hereby, and it being declared and
understood that there is an ample and constant water supply with sufficient
pressure available at all seasons for the same, it is hereby warranted that
the said appliances shall be maintained in efficient working order during the
currency of this policy, by reason whereof a discount of 2 1/2 per cent is
allowed on the premium chargeable under this policy.
Hydrants in the compound, not less in number than one for each 150 feet
of external wall measurement of building, protected, with not less than 100
feet of hose piping and nozzles for every two hydrants kept under cover in
convenient places, the hydrants being supplied with water pressure by a
pumping engine, or from some other source, capable of discharging at the
rate of not less than 200 gallons of water per minute into the upper story of
the highest building protected, and a trained brigade of not less than 20
men to work the same.'
Total
Fire of undetermined origin that broke out in the early morning of July 21, 1940, and
lasted almost one week, gutted and completely destroyed Bodegas Nos. 1, 2 and 4,
with the merchandise stored theren. Plaintiff-appellee informed the insurer by
telegram on the same date; and on the next day, the fire adjusters engaged by
appellant insurance company arrived and proceeded to examine and photograph the
premises, pored over the books of the insured and conducted an extensive
investigation. The plaintiff having submitted the corresponding fire claims, totalling
P398,562.81 (but reduced to the full amount of the insurance, P370,000), the
Insurance Company resisted payment, claiming violation of warranties and
conditions, filing of fraudulent claims, and that the fire had been deliberately caused
by the insured or by other persons in connivance with him.
With counsel for the insurance company acting as private prosecutor, Que Chee
Gan, with his brother, Qua Chee Pao, and some employees of his, were indicted and
It is argued that since the bodegas insured had an external wall perimeter of 500
meters or 1,640 feet, the appellee should have eleven (11) fire hydrants in the
compound, and that he actually had only two (2), with a further pair nearby,
belonging to the municipality of Tabaco.
We are in agreement with the trial Court that the appellant is barred by waiver (or
rather estoppel) to claim violation of the so-called fire hydrants warranty, for the
reason that knowing fully all that the number of hydrants demanded therein never
existed from the very beginning, the appellant neverthless issued the policies in
question subject to such warranty, and received the corresponding premiums. It
would be perilously close to conniving at fraud upon the insured to allow appellant to
claims now as void ab initio the policies that it had issued to the plaintiff without
warning of their fatal defect, of which it was informed, and after it had misled the
defendant into believing that the policies were effective.
The insurance company was aware, even before the policies were issued, that in the
premises insured there were only two fire hydrants installed by Qua Chee Gan and
two others nearby, owned by the municipality of TAbaco, contrary to the
requirements of the warranty in question. Such fact appears from positive testimony
for the insured that appellant's agents inspected the premises; and the simple
denials of appellant's representative (Jamiczon) can not overcome that proof. That
such inspection was made is moreover rendered probable by its being a prerequisite
for the fixing of the discount on the premium to which the insured was entitled,
since the discount depended on the number of hydrants, and the fire fighting
equipment available (See "Scale of Allowances" to which the policies were expressly
made subject). The law, supported by a long line of cases, is expressed by American
Jurisprudence (Vol. 29, pp. 611-612) to be as follows:
It is usually held that where the insurer, at the time of the issuance of a
policy of insurance, has knowledge of existing facts which, if insisted on,
would invalidate the contract from its very inception, such knowledge
constitutes a waiver of conditions in the contract inconsistent with the
facts, and the insurer is stopped thereafter from asserting the breach of
such conditions. The law is charitable enough to assume, in the absence of
any showing to the contrary, that an insurance company intends to
executed a valid contract in return for the premium received; and when the
policy contains a condition which renders it voidable at its inception, and
this result is known to the insurer, it will be presumed to have intended to
waive the conditions and to execute a binding contract, rather than to have
deceived the insured into thinking he is insured when in fact he is not, and
to have taken his money without consideration. (29 Am. Jur., Insurance,
section 807, at pp. 611-612.)
The reason for the rule is not difficult to find.
The plain, human justice of this doctrine is perfectly apparent. To allow a
company to accept one's money for a policy of insurance which it then
knows to be void and of no effect, though it knows as it must, that the
assured believes it to be valid and binding, is so contrary to the dictates of
honesty and fair dealing, and so closely related to positive fraud, as to the
abhorent to fairminded men. It would be to allow the company to treat the
policy as valid long enough to get the preium on it, and leave it at liberty to
repudiate it the next moment. This cannot be deemed to be the real
intention of the parties. To hold that a literal construction of the policy
expressed the true intention of the company would be to indict it, for
fraudulent purposes and designs which we cannot believe it to be guilty of
(Wilson vs. Commercial Union Assurance Co., 96 Atl. 540, 543-544).
The inequitableness of the conduct observed by the insurance company in this case
is heightened by the fact that after the insured had incurred the expense of
installing the two hydrants, the company collected the premiums and issued him a
policy so worded that it gave the insured a discount much smaller than that he was
normaly entitledto. According to the "Scale of Allowances," a policy subject to a
warranty of the existence of one fire hydrant for every 150 feet of external wall
entitled the insured to a discount of 7 1/2 per cent of the premium; while the
existence of "hydrants, in compund" (regardless of number) reduced the allowance
on the premium to a mere 2 1/2 per cent. This schedule was logical, since a greater
number of hydrants and fire fighting appliances reduced the risk of loss. But the
appellant company, in the particular case now before us, so worded the policies that
while exacting the greater number of fire hydrants and appliances, it kept the
premium discount at the minimum of 2 1/2 per cent, thereby giving the insurance
company a double benefit. No reason is shown why appellant's premises, that had
been insured with appellant for several years past, suddenly should be regarded in
1939 as so hazardous as to be accorded a treatment beyond the limits of appellant's
own scale of allowances. Such abnormal treatment of the insured strongly points at
an abuse of the insurance company's selection of the words and terms of the
contract, over which it had absolute control.
These considerations lead us to regard the parol evidence rule, invoked by the
appellant as not applicable to the present case. It is not a question here whether or
not the parties may vary a written contract by oral evidence; but whether testimony
is receivable so that a party may be, by reason of inequitable conduct shown,
estopped from enforcing forfeitures in its favor, in order to forestall fraud or
imposition on the insured.
Receipt of Premiums or Assessments afte Cause for Forfeiture Other than
Nonpayment. It is a well settled rule of law that an insurer which with
knowledge of facts entitling it to treat a policy as no longer in force,
receives and accepts a preium on the policy, estopped to take advantage of
the forfeiture. It cannot treat the policy as void for the purpose of defense
to an action to recover for a loss thereafter occurring and at the same time
treat it as valid for the purpose of earning and collecting further premiums."
(29 Am. Jur., 653, p. 657.)
It would be unconscionable to permit a company to issue a policy under
circumstances which it knew rendered the policy void and then to accept
and retain premiums under such a void policy. Neither law nor good morals
would justify such conduct and the doctrine of equitable estoppel is
peculiarly applicable to the situation. (McGuire vs. Home Life Ins. Co. 94 Pa.
Super Ct. 457.)
Moreover, taking into account the well known rule that ambiguities or obscurities
must be strictly interpreted aganst the prty that caused them, 1the "memo of
warranty" invoked by appellant bars the latter from questioning the existence of the
appliances called for in the insured premises, since its initial expression, "the
undernoted appliances for the extinction of fire being kept on the premises insured
hereby, . . . it is hereby warranted . . .", admists of interpretation as an admission of
the existence of such appliances which appellant cannot now contradict, should the
parol evidence rule apply.
The alleged violation of the warranty of 100 feet of fire hose for every two hydrants,
must be equally rejected, since the appellant's argument thereon is based on the
assumption that the insured was bound to maintain no less than eleven hydrants
(one per 150 feet of wall), which requirement appellant is estopped from enforcing.
The supposed breach of the wter pressure condition is made to rest on the
testimony of witness Serra, that the water supply could fill a 5-gallon can in 3
seconds; appellant thereupon inferring that the maximum quantity obtainable from
the hydrants was 100 gallons a minute, when the warranty called for 200 gallons a
minute. The transcript shows, however, that Serra repeatedly refused and professed
inability to estimate the rate of discharge of the water, and only gave the "5-gallon
per 3-second" rate because the insistence of appellant's counsel forced the witness
to hazard a guess. Obviously, the testimony is worthless and insufficient to establish
the violation claimed, specially since the burden of its proof lay on appellant.
As to maintenance of a trained fire brigade of 20 men, the record is preponderant
that the same was organized, and drilled, from time to give, altho not maintained as
a permanently separate unit, which the warranty did not require. Anyway, it would
be unreasonable to expect the insured to maintain for his compound alone a fire
fighting force that many municipalities in the Islands do not even possess. There is
no merit in appellant's claim that subordinate membership of the business manager
(Co Cuan) in the fire brigade, while its direction was entrusted to a minor employee
unders the testimony improbable. A business manager is not necessarily adept at
fire fighting, the qualities required being different for both activities.
Under the second assignment of error, appellant insurance company avers, that the
insured violated the "Hemp Warranty" provisions of Policy No. 2637165 (Exhibit JJ),
against the storage of gasoline, since appellee admitted that there were 36 cans
(latas) of gasoline in the building designed as "Bodega No. 2" that was a separate
structure not affected by the fire. It is well to note that gasoline is not specifically
mentioned among the prohibited articles listed in the so-called "hemp warranty."
The cause relied upon by the insurer speaks of "oils (animal and/or vegetable and/or
mineral and/or their liquid products having a flash point below 300o Fahrenheit", and
is decidedly ambiguous and uncertain; for in ordinary parlance, "Oils" mean
"lubricants" and not gasoline or kerosene. And how many insured, it may well be
wondered, are in a position to understand or determine "flash point below 003o
Fahrenheit. Here, again, by reason of the exclusive control of the insurance company
over the terms and phraseology of the contract, the ambiguity must be held strictly
against the insurer and liberraly in favor of the insured, specially to avoid a forfeiture
(44 C. J. S., pp. 1166-1175; 29 Am. Jur. 180).
Insurance is, in its nature, complex and difficult for the layman to
understand. Policies are prepared by experts who know and can anticipate
the hearing and possible complications of every contingency. So long as
insurance companies insist upon the use of ambiguous, intricate and
technical provisions, which conceal rather than frankly disclose, their own
intentions, the courts must, in fairness to those who purchase insurance,
construe every ambiguity in favor of the insured. (Algoe vs. Pacific Mut. L.
Ins. Co., 91 Wash. 324, LRA 1917A, 1237.)
An insurer should not be allowed, by the use of obscure phrases and
exceptions, to defeat the very purpose for which the policy was procured
(Moore vs. Aetna Life Insurance Co., LRA 1915D, 264).
We see no reason why the prohibition of keeping gasoline in the premises could not
be expressed clearly and unmistakably, in the language and terms that the general
public can readily understand, without resort to obscure esoteric expression (now
derisively termed "gobbledygook"). We reiterate the rule stated in Bachrach vs.
British American Assurance Co. (17 Phil. 555, 561):
If the company intended to rely upon a condition of that character, it ought
to have been plainly expressed in the policy.
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 concentrations 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
Baloilles" contracts by adherence" (con tracts 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 examples) 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 unwarry (New Civil Coee, Article 24; Sent. of Supreme Court
of Spain, 13 Dec. 1934, 27 February 1942).
Si pudiera estimarse que la condicion 18 de la poliza de seguro envolvia
alguna oscuridad, habra de ser tenido en cuenta que al seguro es,
junio de 1940 y ha encontrado que Qua Choc Gan ha sufrico una perdida de
P1,750.76 en su negocio en Tabaco. Segun Steward al llegar a este
conclusion el ha tenidoen cuenta el balance de comprobacion Exhibit 'J' que
le ha entregado el mismo acusado Que Choc Gan en relacion con sus libros
y lo ha encontrado correcto a excepcion de los precios de abaca y copra
que alli aparecen que no estan de acuerdo con los precios en el mercado.
Esta comprobacion aparece en el balance mercado exhibit J que fue
preparado por el mismo testigo.
In view of the discrepancy in the valuations between the insured and the adjuster
Stewart for the insurer, the Court referred the controversy to a government auditor,
Apolonio Ramos; but the latter reached a different result from the other two. Not
only that, but Ramos reported two different valuations that could be reached
according to the methods employed (Exhibit WW, p. 35):
La ciencia de la contabilidad es buena, pues ha tenido sus muchos usos
buenos para promovar el comercio y la finanza, pero en el caso presente ha
resultado un tanto cumplicada y acomodaticia, como lo prueba el resultado
del examen hecho por los contadores Stewart y Ramos, pues el juzgado no
alcanza a ver como habiendo examinado las mismas partidas y los mismos
libros dichos contadores hayan de llegara dos conclusiones que difieron
sustancialmente entre si. En otras palabras, no solamente la comprobacion
hecha por Stewart difiere de la comprobacion hecha por Ramos sino que,
segun este ultimo, su comprobacion ha dado lugar a dos resultados
diferentes dependiendo del metodo que se emplea.
Clearly then, the charge of fraudulent overvaluation cannot be seriously entertained.
The insurer attempted to bolster its case with alleged photographs of certain pages
of the insurance book (destroyed by the war) of insured Qua Chee Gan (Exhibits 26A and 26-B) and allegedly showing abnormal purchases of hemp and copra from
June 11 to June 20, 1940. The Court below remained unconvinced of the authenticity
of those photographs, and rejected them, because they were not mentioned not
introduced in the criminal case; and considering the evident importance of said
exhibits in establishing the motive of the insured in committing the arson charged,
and the absence of adequate explanation for their omission in the criminal case, we
cannot say that their rejection in the civil case constituted reversible error.
The next two defenses pleaded by the insurer, that the insured connived at the
loss and that the fraudulently inflated the quantity of the insured stock in the burnt
bodegas, are closely related to each other. Both defenses are predicted on the
assumption that the insured was in financial difficulties and set the fire to defraud
the insurance company, presumably in order to pay off the Philippine National Bank,
to which most of the insured hemp and copra was pledged. Both defenses are fatally
undermined by the established fact that, notwithstanding the insurer's refusal to pay
the value of the policies the extensive resources of the insured (Exhibit WW) enabled
him to pay off the National Bank in a short time; and if he was able to do so, no
motive appears for attempt to defraud the insurer. While the acquittal of the insured
in the arson case is not res judicata on the present civil action, the insurer's
evidence, to judge from the decision in the criminal case, is practically identical in
both cases and must lead to the same result, since the proof to establish the
defense of connivance at the fire in order to defraud the insurer "cannot be
materially less convincing than that required in order to convict the insured of the
crime of arson"(Bachrach vs. British American Assurance Co., 17 Phil. 536).
As to the defense that the burned bodegas could not possibly have contained the
quantities of copra and hemp stated in the fire claims, the insurer's case rests
almost exclusively on the estimates, inferences and conclusionsAs to the defense
that the burned bodegas could not possibly have contained the quantities of copra
and hemp stated in the fire claims, the insurer's case rests almost exclusively on the
estimates, inferences and conclusions of its adjuster investigator, Alexander D.
Stewart, who examined the premises during and after the fire. His testimony,
however, was based on inferences from the photographs and traces found after the
fire, and must yield to the contradictory testimony of engineer Andres Bolinas, and
specially of the then Chief of the Loan Department of the National Bank's Legaspi
branch, Porfirio Barrios, and of Bank Appraiser Loreto Samson, who actually saw the
contents of the bodegas shortly before the fire, while inspecting them for the
mortgagee Bank. The lower Court was satisfied of the veracity and accuracy of these
witnesses, and the appellant insurer has failed to substantiate its charges aganst
their character. In fact, the insurer's repeated accusations that these witnesses were
later "suspended for fraudulent transactions" without giving any details, is a plain
attempt to create prejudice against them, without the least support in fact.
Stewart himself, in testifying that it is impossible to determine from the remains the
quantity of hemp burned (t. s. n., pp. 1468, 1470), rebutted appellant's attacks on
the refusal of the Court below to accept its inferences from the remains shown in the
photographs of the burned premises. It appears, likewise, that the adjuster's
calculations of the maximum contents of the destroyed warehouses rested on the
assumption that all the copra and hemp were in sacks, and on the result of his
experiments to determine the space occupied by definite amounts of sacked copra.
The error in the estimates thus arrived at proceeds from the fact that a large amount
of the insured's stock were in loose form, occupying less space than when kept in
sacks; and from Stewart's obvious failure to give due allowance for the compression
of the material at the bottom of the piles (t. s. n., pp. 1964, 1967) due to the weight
of the overlying stock, as shown by engineer Bolinas. It is probable that the errors
were due to inexperience (Stewart himself admitted that this was the first copra fire
he had investigated); but it is clear that such errors render valueles Stewart's
computations. These were in fact twice passed upon and twice rejected by different
judges (in the criminal and civil cases) and their concordant opinion is practically
conclusive.
The adjusters' reports, Exhibits 9-A and 9-B, were correctly disregarded by the Court
below, since the opinions stated therein were based on ex parte investigations made
at the back of the insured; and the appellant did not present at the trial the original
testimony and documents from which the conclusions in the report were
drawn.lawphi1.net
Appellant insurance company also contends that the claims filed by the insured
contained false and fraudulent statements that avoided the insurance policy. But the
trial Court found that the discrepancies were a result of the insured's erroneous
interpretation of the provisions of the insurance policies and claim forms, caused by
his imperfect knowledge of English, and that the misstatements were innocently
made and without intent to defraud. Our review of the lengthy record fails to
disclose reasons for rejecting these conclusions of the Court below. For example, the
occurrence of previous fires in the premises insured in 1939, altho omitted in the
claims, Exhibits EE and FF, were nevertheless revealed by the insured in his claims
Exhibits Q (filed simultaneously with them), KK and WW. Considering that all these
claims were submitted to the smae agent, and that this same agent had paid the
loss caused by the 1939 fire, we find no error in the trial Court's acceptance of the
insured's explanation that the omission in Exhibits EE and FF was due to
inadvertance, for the insured could hardly expect under such circumstances, that
the 1939 would pass unnoticed by the insurance agents. Similarly, the 20 per cent
overclaim on 70 per cent of the hemo stock, was explained by the insured as caused
by his belief that he was entitled to include in the claim his expected profit on the 70
per cent of the hemp, because the same was already contracted for and sold to
other parties before the fire occurred. Compared with other cases of over-valuation
recorded in our judicial annals, the 20 per cent excess in the case of the insured is
not by itself sufficient to establish fraudulent intent. Thus, in Yu Cua vs. South British
Ins. Co., 41 Phil. 134, the claim was fourteen (14) times (1,400 per cent) bigger than
the actual loss; in Go Lu vs. Yorkshire Insurance Co., 43 Phil., 633, eight (8) times
(800 per cent); in Tuason vs. North China Ins. Co., 47 Phil. 14, six (6) times (600 per
cent); in Tan It vs. Sun Insurance, 51 Phil. 212, the claim totalled P31,860.85 while
the goods insured were inventoried at O13,113. Certainly, the insured's overclaim of
20 per cent in the case at bar, duly explained by him to the Court a quo, appears
puny by comparison, and can not be regarded as "more than misstatement, more
than inadvertence of mistake, more than a mere error in opinion, more than a slight
exaggeration" (Tan It vs. Sun Insurance Office, ante) that would entitle the insurer to
avoid the policy. It is well to note that the overchange of 20 per cent was claimed
only on a part (70 per cent) of the hemp stock; had the insured acted with
fraudulent intent, nothing prevented him from increasing the value of all of his
copra, hemp and buildings in the same proportion. This also applies to the alleged
fraudulent claim for burned empty sacks, that was likewise explained to our
satisfaction and that of the trial Court. The rule is that to avoid a policy, the false
swearing must be wilful and with intent to defraud (29 Am. Jur., pp. 849-851) which
was not the cause. Of course, the lack of fraudulent intent would not authorize the
collection of the expected profit under the terms of the polices, and the trial Court
correctly deducte the same from its award.
We find no reversible error in the judgment appealed from, wherefore the smae is
hereby affirmed. Costs against the appellant. So ordered.
Paras, C. J., Padilla, Montemayor, Reyes, A., Jugo, Labrador, and Concepcion, JJ.,
concur.
Republic of the Philippines
SUPREME COURT
Manila
Gil Carlos and Associates for defendant-appellee Plaridel Surety and Insurance Co.,
Inc.
BARRERA, J.:
These are appeals instituted by Diosdado C. Ty from a single decision of the Court of
First Instance of Manila (in Civ. Cases Nos. 26343, 26344, 26404, 26405, 26406,
26442, which were tried together), dismissing the six separate complaints he filed
against six insurance companies (Filipinas Compaia de Seguros, People's Surety &
Insurance Co., Inc., South Sea Surety & Insurance Co., Inc., The Philippine Guaranty
Company, Inc., Universal Insurance & Indemnity Co., and Plaridel Surety & Insurance
Co., Inc.) for collection from each of them, of the sum of P650.00, as compensation
for the disability of his left hand.
The facts of these cases are not controverted:
Plaintiff-appellant was an employee of Broadway Cotton Factory at Grace Park,
Caloocan City, working as mechanic operator, with monthly salary of P185.00. In the
latter part of 1953, he took Personal Accident Policies from several insurance
companies, among which are herein defendants-appellees, on different
dates,1 effective for 12 months. During the effectivity of these policies, or on
December 24, 1953, a fire broke out in the factory where plaintiff was working. As he
was trying to put out said fire with the help of a fire extinguisher, a heavy object fell
upon his left hand. Plaintiff received treatment at the National Orthopedic Hospital
from December 26, 1953 to February 8, 1954, for the following injuries, to wit:
(1) Fracture, simple, oraximal phalanx, index finger, left;
(2) Fracture, compound, communite proximal phalanx, middle finger, left
and 2nd phalanx simple;
(3) Fracture, compound, communite phalanx, 4th finger, left;
EN BANC
(4) Fracture, simple, middle phalanx, middle finger, left;
G.R. No. L-21821-22 and L-21824-27
(6) Fracture, simple, chip, head, 1st phalanx 5th digit, left.
which injuries, the attending surgeon certified, would cause temporary total
disability of appellant's left hand.
As the insurance companies refused to pay his claim for compensation under the
policies by reason of the said disability of his left hand, Ty filed motions in the
Municipal Court of Manila, which rendered favorable decision. On appeal to the Court
of First Instance by the insurance companies, the cases were dismissed on the
ground that under the uniform terms of the insurance policies, partial disability of
the insured caused by loss of either hand to be compensable, the loss must result in
the amputation of that hand. Hence, these appeals by the insured.1wph1.t
Plaintiff-appellant is basing his claim for indemnity under the provision of the
insurance contract, uniform in all the cases, which reads:
"INDEMNITY FOR TOTAL OR PARTIAL DISABILITY
If the Insured sustains any Bodily Injury which is effected solely through
violent, external, visible and accidental means, and which shall not prove
fatal but shall result, independently of all other causes and within sixty (60)
days from the occurrence, thereof, in Total or Partial Disability of the
Insured, the Company shall pay, subject to the exceptions as provided for
hereinafter, the amount set opposite such injury.
xxx
xxx
xxx
xxx
xxx
xxx
PARTIAL DISABILITY
While we sympathize with the plaintiff or his employer, for whose benefit
the policies were issued, we can not go beyond the clear and express
conditions of the insurance policies, all of which definite partial disability as
loss of either hand by amputation through the bones of the wrist. There was
no such amputation in the case at bar. All that was found by the trial court,
which is not disputed on appeal, was that the physical injuries "caused
temporary total disability of plaintiff's left hand." Note that the disability of
plaintiff's hand was merely temporary, having been caused by fractures of
the index, the middle and the fourth fingers of the left hand.
We might add that the agreement contained in the insurance policies is the law
between the parties. As the terms of the policies are clear, express and specific that
only amputation of the left hand should be considered as a loss thereof, an
interpretation that would include the mere fracture or other temporary disability not
covered by the policies would certainly be unwarranted.2
We find no reason to depart from the foregoing ruling on the matter.
Plaintiff-appellant cannot come to the courts and claim that he was misled by the
terms of the contract. The provision is clear enough to inform the party entering into
that contract that the loss to be considered a disability entitled to indemnity, must
be severance or amputation of that affected member from the body of the insured.
LOSS OF:
Wherefore, finding no error in the decision appealed from, the same is hereby
affirmed, without costs. So ordered.
Concepcion, Reyes, J.B.L., Dizon, Regala, Makalintal, Bengzon, J.P., Zaldivar and
Sanchez, JJ., concur.
xxx
xxx
The loss of a hand shall mean the loss, by amputation through the bones of
the wrist.
EN BANC
Appellant contends that to be entitled to indemnification under the foregoing
provision, it is enough that the insured is disabled to such an extent that he cannot
substantially perform all acts or duties of the kind necessary in the prosecution of
his business. It is argued that what is compensable is the disability and not the
amputation of the hand. The definition of what constitutes loss of hand, placed in
the contract, according to appellant, consequently, makes the provision ambiguous
and calls for the interpretation thereof by this Court.
This is not the first time that the proper construction of this provision, which is
uniformly carried in personal accident policies, has been questioned. Herein
appellant himself has already brought this matter to the attention of this Court in
connection with the other accident policies which he took and under which he had
tried to collect indemnity, for the identical injury that is the basis of the claims in
these cases. And, we had already ruled:
P1,000.00 to P3,000.00, as indemnity for the death of the insured. The pertinent
provisions of the Policy, recite:
P1,000.
00
P1,500.
00
P2,000.
00
It is hereby declared and agreed that exemption clause Letter (h) embodied in PART
VI of the policy is hereby waived by the company, and to form a part of the provision
covered by the policy.
On February 24, 1957, the insured Francisco del Rosario, alias Paquito Bolero, while
on board the motor launch "ISLAMA" together with 33 others, including his
beneficiary in the Policy, Remedios Jayme, were forced to jump off said launch on
account of fire which broke out on said vessel, resulting in the death of drowning, of
the insured and beneficiary in the waters of Jolo. 1wph1.t
On April 13, 1957, Simeon del Rosario, father of the insured, and as the sole heir,
filed a claim for payment with defendant company, and on September 13, 1957,
defendant company paid to him (plaintiff) the sum of P1,000.00, pursuant to Section
1 of Part I of the policy. The receipt signed by plaintiff reads
RECEIVED of the EQUITABLE INSURANCE & CASUALTY CO., INC.,
the sum of PESOS ONE THOUSAND (P1,000.00) Philippine
Currency, being settlement in full for all claims and demands
against said Company as a result of an accident which occurred on
February 26, 1957, insured under out ACCIDENT Policy No. 7136,
causing the death of the Assured.
In view of the foregoing, this policy is hereby surrendered and
CANCELLED.
LOSS COMPUTATION
xxx
xxx
Amount of Insurance
P3,000.
00
xxx
P1,000.00
__________
vvvvv
On the same date (September 13, 1957), Atty. Vicente J. Francisco, wrote defendant
company acknowledging receipt by his client (plaintiff herein), of the P1,000.00, but
informing said company that said amount was not the correct one. Atty. Francisco
claimed
The amount payable under the policy, I believe should be P1,500.00 under
the provision of Section 2, part 1 of the policy, based on the rule of pari
materia as the death of the insured occurred under the circumstances
similar to that provided under the aforecited section.
Defendant company, upon receipt of the letter, referred the matter to the Insurance
Commissioner, who rendered an opinion that the liability of the company was only
P1,000.00, pursuant to Section 1, Part I of the Provisions of the policy (Exh. F, or 3).
Because of the above opinion, defendant insurance company refused to pay more
than P1,000.00. In the meantime, Atty. Vicente Francisco, in a subsequent letter to
the insurance company, asked for P3,000.00 which the Company refused, to pay.
Hence, a complaint for the recovery of the balance of P2,000.00 more was instituted
with the Court of First Instance of Rizal (Pasay City, Branch VII), praying for it further
sum of P10,000.00 as attorney's fees, expenses of litigation and costs.
Defendant Insurance Company presented a Motion to Dismiss, alleging that the
demand or claim is set forth in the complaint had already been released, plaintiff
having received the full amount due as appearing in policy and as per opinion of the
Insurance Commissioner. An opposition to the motion to dismiss, was presented by
plaintiff, and other pleadings were subsequently file by the parties. On December
28, 1957, the trial court deferred action on the motion to dismiss until termination of
the trial of the case, it appearing that the ground thereof was not indubitable. In the
Answer to the complaint, defendant company practically admitted all the allegations
therein, denying only those which stated that under the policy its liability was
P3,000.00.
On September 1, 1958, the trial court promulgated an Amended Decision, the
pertinent portions of which read
xxx
xxx
". . . . Under the terms of this policy, defendant company agreed to pay
P1,000.00 to P3,000.00 as indemnity for the death of the insured. The
insured died of drowning. Death by drowning is covered by the policy the
pertinent provisions of which reads as follows:
xxx
xxx
xxx
xxx
xxx
xxx
xxx
Since the contemporaneous and subsequent acts of the parties show that it
was not their intention that the payment of P1,000.00 to the plaintiff and
the signing of the loss receipt exhibit "1" would be considered as releasing
the defendant completely from its liability on the policy in question, said
intention of the parties should prevail over the contents of the loss receipt
"1" (Articles 1370 and 1371, New Civil Code).
xxx
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 greater
indemnity.
xxx
Besides, on the face of the policy Exhibit "A" itself, 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 P1000.00 to P3,000.00 as indemnity for
IN VIEW OF THE FOREGOING, the Court hereby reconsiders and sets aside
its decision dated July 21, 1958 and hereby renders judgment, ordering the
defendant to pay plaintiff the sum of Two Thousand (P2,000.00) Pesos and
to pay the costs.
The above judgment was appealed to the Court of Appeals on three (3) counts. Said
Court, in a Resolution dated September 29, 1959, elevated the case to this Court,
stating that the genuine issue is purely legal in nature.
All the parties agree that indemnity has to be paid. The conflict centers on how
much should the indemnity be. We believe that under the proven facts and
circumstances, the findings and conclusions of the trial court, are well taken, for
they are supported by the generally accepted principles or rulings on insurance,
which enunciate that where there is an ambiguity with respect to the terms and
conditions of the policy, the same will be resolved against the one responsible
thereof. It should be recalled in this connection, that 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 cause the obscurity (Art. 1377, N.C.C.), which, in the
case at bar, is the insurance company.
. . . . And so it has been generally held that the "terms in an insurance
policy, which are ambiguous, equivocal or uncertain . . . are to be construed
strictly 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 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 expert and legal advisers
employed by, and acting exclusively in the interest of, the insurance
company" (44 C.J.S. 1174). Calanoc v. Court of Appeals, et al., G.R. No. L8151, Dec. 16, 1955.
. . . . Where two interpretations, equally fair, of languages used in an
insurance policy may be made, that which allows the greater indemnity will
prevail. (L'Engel v. Scotish Union & Nat. F. Ins. Co., 48 Fla. 82, 37 So. 462,
67 LRA 581 111 Am. St. Rep. 70, 5 Ann. Cas. 749).
At any event, the policy under consideration, covers death or disability by accidental
means, and the appellant insurance company agreed to pay P1,000.00 to P3,000.00.
is indemnity for death of the insured.
In view of the conclusions reached, it would seem unnecessary to discuss the other
issues raised in the appeal.
The judgment appealed from is hereby affirmed. Without costs.
Padilla, Bautista Angelo, Labrador, Concepcion, Reyes, J.B.L., Barrera, Dizon and
Regala, JJ., concur.
Makalintal, J., reserves his vote.
xxx
xxx
4. The Insured may authorize the repair of the Motor Vehicle necessitated
by damage for which the Company may be liable under this policy provided
that:
EN BANC
xxx
(a) the estimated cost of such repair does not exceed the
authorized Repair Limit.
3. At its option, the Company may pay in cash the amount of the loss or
damage or may repair, reinstate or replace the Motor Vehicle or any part
thereof or its accessories or spare parts. The liability of the Company shall
not exceed the value of the parts lost or damaged and the reasonable cost
of fitting such parts or the value of the Motor Vehicle at the time of the loss
or damage whichever is the loss. The Insured's estimate of value stated in
the schedule shall be the maximum amount payable by the Company in
respect of any claim for loss or damage.1wph1.t
xxx
xxx
At around eleven o'clock in the evening of 25 November 1961, and while the abovementioned insurance policy was in force, the insured car, while traveling along in
Aurora Boulevard in front of the Pepsi-Cola plant in Quezon City, passed over a water
hole which the driver did not see because an oncoming car did not dim its light. The
crankcase and flywheel housing of the car broke when it hit a hollow block lying
alongside the water hole. At the instance of the plaintiff-appellee, the car was towed
and repaired by Morosi Motors at its shop at 1906 Taft Avenue Extension at a total
cost of P302.27.
On 29 November 1961, when the repairs on the car had already been made, the
plaintiff-appellee made a report of the accident to the defendant-appellant Capital
Insurance & Surety Company.
Since the defendant-appellant refused to pay for the total cost of to wage and
repairs, suit was filed in the municipal court originally.
The case before Us is now a direct appeal on a point of law from the judgment of the
Court of First Instance of Manila finding for the plaintiff and against the defendantinsurer in its Civil Case No. 51757. Per our resolution on 13 February 1964, it was
resolved to proceed with the case without the appellee's brief, which was filed late.
The defendant-appellant admits liability in the amount of P150, but not for any
excess thereof.
The lower court did not exonerate the said appellant for the excess because,
according to it, the company's absolution would render the insurance contract onesided and that the said insurer had not shown that the cost of repairs in the sum of
P302.27 is unreasonable, excessive or padded, nor had it shown that it could have
undertaken the repairs itself at less expense.
The above reasoning is beside the point, because the insurance policy stipulated in
paragraph 4 that if the insured authorizes the repair the liability of the insurer, per
its sub-paragraph (a), is limited to P150.00. The literal meaning of this stipulation
must control, it being the actual contract, expressly and plainly provided for in the
policy (Art. 1370, Civil Code; Young vs. Midland Textile Ins. Co., 30 Phil. 617; Ty vs.
First Nat. Surety & Assur. Co., Inc., L-16138-45, 29 April 1961).
THIRD DIVISION
The lower court's recourse to legal hermeneutics is not called for because paragraph
4 of the policy is clear and specific and leaves no room for interpretation. The
interpretation given is even unjustified because it opposes what was specifically
stipulated. Thus, it will be observed that the policy drew out not only the limits of the
insurer's liability but also the mechanics that the insured had to follow to be entitled
to full indemnity of repairs. The option to undertake the repairs is accorded to the
insurance company per paragraph 2. The said company was deprived of the option
because the insured took it upon itself to have the repairs made, and only notified
the insurer when the repairs were done. As a consequence, paragraph 4, which
limits the company's liability to P150.00, applies.
The insurance contract may be rather onerous ("one-sided", as the lower court put
it), but that in itself does not justify the abrogation of its express terms, terms which
the insured accepted or adhered to and which is the law between the contracting
parties.
Finally, to require the insurer to prove that the cost of the repairs ordered by the
insured is unreasonable, as the appealed decision does, when the insurer was not
given an opportunity to inspect and assess the damage before the repairs were
made, strikes Us as contrary to elementary justice and equity.
For the foregoing reasons, the appealed decision is hereby modified by ordering the
defendant-appellant Capital Insurance & Surety Company, Inc. to pay not more than
P150.00 to the plaintiff-appellee Misamis Lumber Corporation. Each party shall bear
its own costs and attorney's fees.
Bengzon, C.J., Bautista Angelo, Concepcion, Barrera, Dizon, Regala, Makalintal,
Bengzon, J.P., and Sanchez, JJ., concur.
Zaldivar, J., took no part.
Republic of the Philippines
SUPREME COURT
Manila
MELO, J.:
The two consolidated cases involved herein stemmed from the issuance by
Fidelity and Surety Insurance Company of the Philippines (Fidelity for
short) of its Fire Insurance Policy No. F-18876 effective between June 23,
1980 and June 23, 1981 covering Rafael (Rex) Verendia's residential
building located at Tulip Drive, Beverly Hills, Antipolo, Rizal in the amount
of P385,000.00. Designated as beneficiary was the Monte de Piedad &
Savings Bank. Verendia also insured the same building with two other
companies, namely, The Country Bankers Insurance for P56,000.00 under
Policy No. PDB-80-1913 expiring on May 12, 1981, and The Development
Insurance for P400,000.00 under Policy No. F-48867 expiring on June 30,
198l.
While the three fire insurance policies were in force, the insured property
was completely destroyed by fire on the early morning of December 28,
1980. Fidelity was accordingly informed of the loss and despite demands,
refused payment under its policy, thus prompting Verendia to file a
complaint with the then Court of First Instance of Quezon City, praying for
payment of P385,000.00, legal interest thereon, plus attorney's fees and
litigation expenses. The complaint was later amended to include Monte de
Piedad as an "unwilling defendant" (P. 16, Record).
Answering the complaint, Fidelity, among other things, averred that the
policy was avoided by reason of over-insurance; that Verendia maliciously
represented that the building at the time of the fire was leased under a
contract executed on June 25, 1980 to a certain Roberto Garcia, when
actually it was a Marcelo Garcia who was the lessee.
On May 24, 1983, the trial court rendered a decision, per Judge Rodolfo A.
Ortiz, ruling in favor of Fidelity. In sustaining the defenses set up by
Fidelity, the trial court ruled that Paragraph 3 of the policy was also
violated by Verendia in that the insured failed to inform Fidelity of his
other insurance coverages with Country Bankers Insurance and
Development Insurance.
Verendia appealed to the then Intermediate Appellate Court and in a
decision promulgated on March 31, 1986, (CA-G.R. No. CV No. 02895,
Coquia, Zosa, Bartolome, and Ejercito (P), JJ.), the appellate court reversed
for the following reasons: (a) there was no misrepresentation concerning
the lease for the contract was signed by Marcelo Garcia in the name of
Roberto Garcia; and (b) Paragraph 3 of the policy contract requiring
Verendia to give notice to Fidelity of other contracts of insurance was
waived by Fidelity as shown by its conduct in attempting to settle the
claim of Verendia (pp. 32-33, Rollo of G.R. No. 76399).
Fidelity received a copy of the appellate court's decision on April 4, 1986,
but instead of directly filing a motion for reconsideration within 15 days
therefrom, Fidelity filed on April 21, 1986, a motion for extension of 3 days
within which to file a motion for reconsideration. The motion for extension
was not filed on April 19, 1986 which was the 15th day after receipt of the
decision because said 15th day was a Saturday and of course, the
following day was a Sunday (p. 14., Rollo of G.R. No. 75605). The motion
for extension was granted by the appellate court on April 30, 1986 (p.
15. ibid.), but Fidelity had in the meantime filed its motion for
reconsideration on April 24, 1986 (p. 16, ibid.).
Verendia filed a motion to expunge from the record Fidelity's motion for
reconsideration on the ground that the motion for extension was filed out
of time because the 15th day from receipt of the decision which fell on a
Saturday was ignored by Fidelity, for indeed, so Verendia contended, the
Intermediate Appellate Court has personnel receiving pleadings even on
Saturdays.
The motion to expunge was denied on June 17, 1986 (p. 27, ibid.) and after
a motion for reconsideration was similarly brushed aside on July 22, 1986
(p. 30, ibid .), the petition herein docketed as G.R. No. 75605 was initiated.
Subsequently, or more specifically on October 21, 1986, the appellate
court denied Fidelity's motion for reconsideration and account thereof.
Fidelity filed on March 31, 1986, the petition for review on certiorari now
docketed as G.R. No. 76399. The two petitions, inter-related as they are,
were consolidated
(p. 54, Rollo of G.R. No. 76399) and thereafter given due course.
Before we can even begin to look into the merits of the main case which is
the petition for review oncertiorari, we must first determine whether the
decision of the appellate court may still be reviewed, or whether the same
is beyond further judicial scrutiny. Stated otherwise, before anything else,
inquiry must be made into the issue of whether Fidelity could have legally
asked for an extension of the 15-day reglementary period for appealing or
for moving for reconsideration.
As early as 1944, this Court through Justice Ozaeta already pronounced the
doctrine that the pendency of a motion for extension of time to perfect an
appeal does not suspend the running of the period sought to be extended
(Garcia vs. Buenaventura 74 Phil. 611 [1944]). To the same effect were the
rulings in Gibbs vs. CFI of Manila (80 Phil. 160 [1948]) Bello vs.
Fernando (4 SCRA 138 [1962]), and Joe vs. King (20 SCRA 1120 [1967]).
The above cases notwithstanding and because the Rules of Court do not
expressly prohibit the filing of a motion for extension of time to file a
motion for reconsideration in regard to a final order or judgment,
magistrates, including those in the Court of Appeals, held sharply divided
opinions on whether the period for appealing which also includes the
period for moving to reconsider may be extended. The matter was not
definitely settled until this Court issued its Resolution in Habaluyas
Enterprises, Inc. vs. Japson (142 SCRA [1986]), declaring that beginning
one month from the promulgation of the resolution on May 30, 1986
. . . the rule shall be strictly enforced that no motion for
extension of time to file a motion for new trial or
reconsideration shall be filed . . . (at p. 212.)
In the instant case, the motion for extension was filed and granted before
June 30, 1986, although, of course, Verendia's motion to expunge the
motion for reconsideration was not finally disposed until July 22, 1986, or
after the dictum in Habaluyas had taken effect. Seemingly, therefore, the
filing of the motion for extension came before its formal proscription
under Habaluyas, for which reason we now turn our attention to G.R. No.
76399.
Reduced to bare essentials, the issues Fidelity raises therein are: (a)
whether or not the contract of lease submitted by Verendia to support his
claim on the fire insurance policy constitutes a false declaration which
would forfeit his benefits under Section 13 of the policy and (b) whether or
not, in submitting the subrogation receipt in evidence, Fidelity had in
effect agreed to settle Verendia's claim in the amount stated in said
receipt. 1
Verging on the factual, the issue of the veracity or falsity of the lease
contract could have been better resolved by the appellate court for, in a
petition for review on certiorari under Rule 45, the jurisdiction of this
Court is limited to the review of errors of law. The appellate court's
findings of fact are, therefore, conclusive upon this Court except in the
following cases: (1) when the conclusion is a finding grounded entirely on
speculation, surmises, or conjectures; (2) when the inference made is
manifestly absurd, mistaken, or impossible; (3) when there is grave abuse
of discretion in the appreciation of facts; (4) when the judgment is
premised on a misapprehension of facts; (5) when the findings of fact are
conflicting; and (6) when the Court of Appeals in making its findings went
beyond the issues of the case and the same are contrary to the admissions
of both appellant and appellee (Ronquillo v. Court of Appeals, 195 SCRA
433 [1991]). In view of the conflicting findings of the trial court and the
appellate court on important issues in these consolidated cases and it
appearing that the appellate court judgment is based on a
misapprehension of facts, this Court shall review the evidence on record.
monthly rental of P6,500 when in fact, the Provincial Assessor of Rizal had
assessed the property's fair market value to be only P40,300.00, insured
the same property with two other insurance companies for a total
coverage of around P900,000, and created a dead-end for the adjuster by
the disappearance of Robert Garcia.
The contract of lease upon which Verendia relies to support his claim for
insurance benefits, was entered into between him and one Robert Garcia,
married to Helen Cawinian, on June 25, 1980 (Exh. "1"), a couple of days
after the effectivity of the insurance policy. When the rented residential
building was razed to the ground on December 28, 1980, it appears that
Robert Garcia (or Roberto Garcia) was still within the premises. However,
according to the investigation report prepared by Pat. Eleuterio M.
Buenviaje of the Antipolo police, the building appeared to have "no
occupant" and that Mr. Roberto Garcia was "renting on the otherside (sic)
portion of said compound"
(Exh. "E"). These pieces of evidence belie Verendia's uncorroborated
testimony that Marcelo Garcia, whom he considered as the real lessee, was
occupying the building when it was burned (TSN, July 27, 1982, p.10).
Robert Garcia disappeared after the fire. It was only on October 9, 1981
that an adjuster was able to locate him. Robert Garcia then executed an
affidavit before the National Intelligence and Security Authority (NISA) to
the effect that he was not the lessee of Verendia's house and that his
signature on the contract of lease was a complete forgery. Thus, on the
strength of these facts, the adjuster submitted a report dated December 4,
1981 recommending the denial of Verendia's claim (Exh. "2").
Ironically, during the trial, Verendia admitted that it was not Robert Garcia
who signed the lease contract. According to Verendia, it was signed by
Marcelo Garcia, cousin of Robert, who had been paying the rentals all the
while. Verendia, however, failed to explain why Marcelo had to sign his
cousin's name when he in fact was paying for the rent and why he
(Verendia) himself, the lessor, allowed such a ruse. Fidelity's conclusions
on these proven facts appear, therefore, to have sufficient bases; Verendia
concocted the lease contract to deflect responsibility for the fire towards
an alleged "lessee", inflated the value of the property by the alleged
rider, Insurance Policy No. 31944 covers all damages to the properties within its
resort caused by earthquake. Respondent contends that the rider limits its liability
for loss to the two swimming pools of petitioner.
The facts as established by the court a quo, and affirmed by the appellate
court are as follows:
SO ORDERED.
Gutierrez, Jr., Bidin, Davide, Jr. and Romero, JJ., concur.
# Footnotes
1 Fidelity appears to have agreed with the appellate court
that it had waived Verendia's failure to abide by policy
condition No. 3 on disclosure of other insurance policies by
its failure to assign it as an error in the petition in G.R. No.
76399. It must have likewise realized the futility of
assigning it as an error because on the first page of the
policy the following is typewritten: "Other insurances
allowed, the amounts to be declared in the event of loss or
when required."
[P]laintiff is the owner of the Plaza Resort situated at Agoo, La Union and had its
properties in said resort insured originally with the American Home Assurance
Company (AHAC-AIU). In the first four insurance policies issued by AHAC-AIU from
1984-85; 1985-86; 1986-1987; and 1987-88 (Exhs. C, D, E and F; also Exhs.
1, 2, 3 and 4 respectively), the risk of loss from earthquake shock was
extended only to plaintiffs two swimming pools, thus, earthquake shock endt.
(Item 5 only) (Exhs. C-1; D-1, and E and two (2) swimming pools only (Exhs.
C-1; D-1, E and F-1). Item 5 in those policies referred to the two (2)
swimming pools only (Exhs. 1-B, 2-B, 3-B and F-2); that subsequently
AHAC(AIU) issued in plaintiffs favor Policy No. 206-4182383-0 covering the period
March 14, 1988 to March 14, 1989 (Exhs. G also G-1) and in said policy the
earthquake endorsement clause as indicated in Exhibits C-1, D-1, Exhibits E
and F-1 was deleted and the entry under Endorsements/Warranties at the time of
issue read that plaintiff renewed its policy with AHAC (AIU) for the period of March
14, 1989 to March 14, 1990 under Policy No. 206-4568061-9 (Exh. H) which carried
the entry under Endorsement/Warranties at Time of Issue, which read
Endorsement to Include Earthquake Shock (Exh. 6-B-1) in the amount
of P10,700.00 and paidP42,658.14 (Exhs. 6-A and 6-B) as premium thereof,
computed as follows:
Item -P7,691,000.00 -
SECOND DIVISION
@ .392%;
[G.R. No. 156167. May 16, 2005]
1,500,000.00 GULF
PHILIPPINE
CHARTER
INSURANCE
contained in the building
DECISION
PUNO, J.:
above-mentioned@ .490%;
393,000.00-
Before the Court is the petition for certiorari under Rule 45 of the Revised Rules
of Court by petitioner GULF RESORTS, INC., against respondent PHILIPPINE CHARTER
INSURANCE CORPORATION. Petitioner assails the appellate court decision [1] which
dismissed its two appeals and affirmed the judgment of the trial court.
For review are the warring interpretations of petitioner and respondent on the
scope of the insurance companys liability for earthquake damage to petitioners
properties. Petitioner avers that, pursuant to its earthquake shock endorsement
116,600.00-
as follows:
a) Tilter House-
P19,800.00- 0.551%
b) Power House-
P41,000.00- 0.551%
c) House Shed-
P55,000.00 -0.540%
P100,000.00
that plaintiff agreed to insure with defendant the properties covered by AHAC (AIU)
Policy No. 206-4568061-9 (Exh. H) provided that the policy wording and rates in
said policy be copied in the policy to be issued by defendant; that defendant issued
Policy No. 31944 to plaintiff covering the period of March 14, 1990 to March 14,
1991 for P10,700,600.00 for a total premium of P45,159.92 (Exh. I); that in the
computation of the premium, defendants Policy No. 31944 (Exh. I), which is the
policy in question, contained on the right-hand upper portion of page 7 thereof, the
following:
Rate-Various
Premium
P37,420.60 F/L
2,061.52 Typhoon
1,030.76 EC
393.00 ES
Doc. Stamps
2.)
3.)
4.)
3,068.10
F.S.T.
776.89
Prem. Tax
409.05
TOTAL
45,159.92;
that the above break-down of premiums shows that plaintiff paid only P393.00 as
premium against earthquake shock (ES); that in all the six insurance policies (Exhs.
C, D, E, F, G and H), the premium against the peril of earthquake shock
is the same, that is P393.00 (Exhs. C and 1-B; 2-B and 3-B-1 and 3-B-2; F-
5.)
Costs.[11]
Respondent filed its Answer with Special and Affirmative Defenses with Compulsory
Counterclaims.[12]
On February 21, 1994, the lower court after trial ruled in favor of the
respondent, viz:
The above schedule clearly shows that plaintiff paid only a premium of P393.00
against the peril of earthquake shock, the same premium it paid against earthquake
shock only on the two swimming pools in all the policies issued by AHAC(AIU)
(Exhibits C, D, E, F and G). From this fact the Court must consequently
agree with the position of defendant that the endorsement rider (Exhibit 7-C)
means that only the two swimming pools were insured against earthquake shock.
Plaintiff correctly points out that a policy of insurance is a contract of adhesion
hence, where the language used in an insurance contract or application is such as to
create ambiguity the same should be resolved against the party responsible
therefor, i.e., the insurance company which prepared the contract. To the mind of
[the] Court, the language used in the policy in litigation is clear and unambiguous
hence there is no need for interpretation or construction but only application of the
provisions therein.
From the above observations the Court finds that only the two (2) swimming pools
had earthquake shock coverage and were heavily damaged by the earthquake which
struck on July 16, 1990. Defendant having admitted that the damage to the
swimming pools was appraised by defendants adjuster at P386,000.00, defendant
must, by virtue of the contract of insurance, pay plaintiff said amount.
Because it is the finding of the Court as stated in the immediately preceding
paragraph that defendant is liable only for the damage caused to the two (2)
swimming pools and that defendant has made known to plaintiff its willingness and
readiness to settle said liability, there is no basis for the grant of the other damages
prayed for by plaintiff. As to the counterclaims of defendant, the Court does not
agree that the action filed by plaintiff is baseless and highly speculative since such
action is a lawful exercise of the plaintiffs right to come to Court in the honest belief
that their Complaint is meritorious. The prayer, therefore, of defendant for damages
is likewise denied.
WHEREFORE, premises considered, defendant is ordered to pay plaintiffs the sum of
THREE HUNDRED EIGHTY SIX THOUSAND PESOS (P386,000.00) representing
damage to the two (2) swimming pools, with interest at 6% per annum from the date
of the filing of the Complaint until defendants obligation to plaintiff is fully paid.
No pronouncement as to costs.[13]
award (Country Bankers Insurance Corp. v. Lianga Bay and Community Multi-Purpose
Coop., Inc., G.R. No. 136914, January 25, 2002). Therefore, holding that the plaintiffappellants action is not baseless and highly speculative, We find that the Court a
quo did not err in granting the same.
WHEREFORE, in view of all the foregoing, both appeals are hereby DISMISSED and
judgment of the Trial Court hereby AFFIRMED in toto. No costs.[15]
Petitioner filed the present petition raising the following issues: [16]
A.
coverage on the two swimming pools from 1990-1991. No additional premium was
paid to warrant coverage of the other properties in the resort.
Endorsement. However, the words of the policy reflect the parties clear intention to
limit earthquake shock coverage to the two swimming pools.
Third, the deletion of the phrase pertaining to the limitation of the earthquake
shock endorsement to the two swimming pools in the policy schedule did not
expand the earthquake shock coverage to all of petitioners properties. As per its
agreement with petitioner, respondent copied its policy from the AHAC-AIU policy
provided by petitioner. Although the first five policies contained the said
qualification in their riders title, in the last two policies, this qualification in the title
was deleted. AHAC-AIU, through Mr. J. Baranda III, stated that such deletion was a
mere inadvertence. This inadvertence did not make the policy incomplete, nor did it
broaden the scope of the endorsement whose descriptive title was merely
enumerated. Any ambiguity in the policy can be easily resolved by looking at the
other provisions, specially the enumeration of the items insured, where only the two
swimming pools were noted as covered for earthquake shock damage.
Before petitioner accepted the policy, it had the opportunity to read its
conditions. It did not object to any deficiency nor did it institute any action to reform
the policy. The policy binds the petitioner.
Fourth, in its Complaint, petitioner alleged that in its policies from 1984
through 1988, the phrase Item 5 P393,000.00 on the two swimming pools only
(against the peril of earthquake shock only) meant that only the swimming pools
were insured for earthquake damage. The same phrase is used in toto in the
policies from 1989 to 1990, the only difference being the designation of the two
swimming pools as Item 3.
Fifth, in order for the earthquake shock endorsement to be effective,
premiums must be paid for all the properties covered. In all of its seven insurance
policies, petitioner only paid P393.00 as premium for coverage of the swimming
pools against earthquake shock. No other premium was paid for earthquake shock
coverage on the other properties. In addition, the use of the qualifier ANY instead
of ALL to describe the property covered was done deliberately to enable the parties
to specify the properties included for earthquake coverage.
Sixth, petitioner did not inform respondent of its requirement that all of its
properties must be included in the earthquake shock coverage. Petitioners own
evidence shows that it only required respondent to follow the exact provisions of its
previous policy from AHAC-AIU. Respondent complied with this requirement.
Respondents only deviation from the agreement was when it modified the
provisions regarding the replacement cost endorsement. With regard to the issue
under litigation, the riders of the old policy and the policy in issue are identical.
Seventh, respondent did not do any act or give any assurance to petitioner as
would estop it from maintaining that only the two swimming pools were covered for
earthquake shock. The adjusters letter notifying petitioner to present certain
documents for its building claims and repair costs was given to petitioner before the
adjuster knew the full coverage of its policy.
Petitioner anchors its claims on AHAC-AIUs inadvertent deletion of the phrase
Item 5 Only after the descriptive name or title of the Earthquake Shock
Eighth, there is no basis for petitioner to claim damages, attorneys fees and
litigation expenses. Since respondent was willing and able to pay for the damage
caused on the two swimming pools, it cannot be considered to be in default, and
therefore, it is not liable for interest.
We hold that the petition is devoid of merit.
In Insurance Policy No. 31944, four key items are important in the resolution of
the case at bar.
First, in the designation of location of risk, only the two swimming pools were
specified as included, viz:
ITEM 3 393,000.00 On the two (2) swimming pools only (against the peril of
earthquake shock only)[20]
Second, under the breakdown for premium payments, [21] it was stated that:
PREMIUM RECAPITULATION
ITEM NOS.
AMOUNT
RATES
PREMIUM
xxx
3
393,000.00
0.100%-E/S
393.00[22]
Yes, sir.
A.
A.
Yes, sir.
A.
Yes, sir. The final action is still with us although they can recommend
what insurance to take.
Q. In the procurement of the insurance police (sic) from March 14, 1988
to March 14, 1989, did you give written instruction to Forte
Insurance Agency advising it that the earthquake shock coverage
must extend to all properties of Agoo Playa Resort in La Union?
Petitioner also cited and relies on the attachment of the phrase Subject to:
Other Insurance Clause, Typhoon Endorsement, Earthquake Shock
Endorsement, Extended Coverage Endorsement, FEA Warranty & Annual
Payment Agreement on Long Term Policies [29] to the insurance policy as proof
of the intent of the parties to extend the coverage for earthquake shock. However,
this phrase is merely an enumeration of the descriptive titles of the riders, clauses,
warranties or endorsements to which the policy is subject, as required under Section
50, paragraph 2 of the Insurance Code.
We also hold that no significance can be placed on the deletion of the
qualification limiting the coverage to the two swimming pools. The earthquake
shock endorsement cannot stand alone. As explained by the testimony of Juan
Baranda III, underwriter for AHAC-AIU:
DIRECT EXAMINATION OF JUAN BARANDA III[30]
A.
No, sir. We did not make any written instruction, although we made
an oral instruction to that effect of extending the coverage on (sic)
the other properties of the company.
Yes, sir.
Q. And you wanted to protect all your properties against similar tremors
in the [future], is that correct?
A.
Yes, sir.
Q. Now, after this policy was delivered to you did you bother to check
the provisions with respect to your instructions that all properties
must be covered again by earthquake shock endorsement?
A.
Atty. Mejia:
We respectfully manifest that the same exhibits C to H inclusive have
been previously marked by counsel for defendant as Exhibit[s] 1-6
inclusive. Did you have occasion to review of (sic) these six (6)
policies issued by your company [in favor] of Agoo Playa Resort?
WITNESS:
Yes[,] I remember having gone over these policies at one point of
time, sir.
Q. Now, wach (sic) of these six (6) policies marked in evidence as
Exhibits C to H respectively carries an earthquake shock
endorsement[?] My question to you is, on the basis on (sic) the
wordings indicated in Exhibits C to H respectively what was the
extent of the coverage [against] the peril of earthquake shock as
provided for in each of the six (6) policies?
xxx
WITNESS:
The extent of the coverage is only up to the two (2) swimming pools, sir.
Q. Is that for each of the six (6) policies namely: Exhibits C, D, E, F, G
and H?
A.
Yes, sir.
ATTY. MEJIA:
What is your basis for stating that the coverage against earthquake
shock as provided for in each of the six (6) policies extend to the
two (2) swimming pools only?
WITNESS:
COURT:
They are the same, the premium rates?
WITNESS:
COURT:
They are the same in the sence (sic), in the amount of the
coverage. If you are going to do some computation based on the
rates you will arrive at the same premiums, your Honor.
pp. 4-6
ATTY. ANDRES:
WITNESS:
No, we dont, sir.
Q. That is why the phrase earthquake shock to the two (2) swimming
pools only was placed, is it not?
A.
pp. 4-5
Yes, sir.
A.
ATTY. ANDRES:
A.
Will you not also agree with me that these exhibits, Exhibits G and H
which you have pointed to during your direct-examination, the
phrase Item no. 5 only meaning to (sic) the two (2) swimming
pools was deleted from the policies issued by AIU, is it not?
A.
ATTY. ANDRES:
As an insurance executive will you not attach any significance to the
deletion of the qualifying phrase for the policies?
WITNESS:
My answer to that would be, the deletion of that particular phrase is
inadvertent. Being a company underwriter, we do not cover. . it was
inadvertent because of the previous policies that we have issued
with no specific attachments, premium rates and so on. It was
inadvertent, sir.
The Court also
rejects
petitioners contention
that respondents
contemporaneous and subsequent acts to the issuance of the insurance policy
falsely gave the petitioner assurance that the coverage of the earthquake shock
endorsement included all its properties in the resort. Respondent only insured the
properties as intended by the petitioner. Petitioners own witness testified to this
agreement, viz:
CROSS EXAMINATION OF LEOPOLDO MANTOHAC
Q. So, all the provisions here will be the same except that of the
premium rates?
xxx
I told him that the insurance that they will have to get will have the
same provisions as this American Home Insurance Policy No. 2064568061-9.
No, sir, I did not discover any difference inasmuch (sic) as I was
assured already that the policy wordings and rates were copied from
the insurance policy I sent them but it was only when this case
erupted that we discovered some discrepancies.
Q. With respect to the items declared for insurance coverage did you
notice any discrepancy at any time between those indicated in
Exhibit I and those indicated in Exhibit H respectively?
A.
A.
With regard to the wordings I did not notice any difference because it
was exactly the same P393,000.00 on the two (2) swimming pools
only against the peril of earthquake shock which I understood before
that this provision will have to be placed here because this
particular provision under the peril of earthquake shock only is
requested because this is an insurance policy and therefore cannot
be insured against fire, so this has to be placed.
xxx
In sum, there is no ambiguity in the terms of the contract and its riders.
Petitioner cannot rely on the general rule that insurance contracts are contracts of
adhesion which should be liberally construed in favor of the insured and strictly
against the insurer company which usually prepares it. [31] A contract of adhesion is
one wherein a party, usually a corporation, prepares the stipulations in the contract,
while the other party merely affixes his signature or his "adhesion" thereto. Through
the years, the courts have held that in these type of contracts, the parties do not
bargain on equal footing, the weaker party's participation being reduced to the
alternative to take it or leave it. Thus, these contracts are viewed as traps for the
weaker party whom the courts of justice must protect.[32] Consequently, any
ambiguity therein is resolved against the insurer, or construed liberally in favor of
the insured.[33]
The case law will show that this Court will only rule out blind adherence to
terms where facts and circumstances will show that they are basically one-sided.
[34]
Thus, we have called on lower courts to remain careful in scrutinizing the factual
circumstances behind each case to determine the efficacy of the claims of
contending parties. In Development Bank of the Philippines v. National
Merchandising Corporation, et al.,[35] the parties, who were acute businessmen
of experience, were presumed to have assented to the assailed documents with full
knowledge.
We cannot apply the general rule on contracts of adhesion to the case at bar.
Petitioner cannot claim it did not know the provisions of the policy. From the
inception of the policy, petitioner had required the respondent to copy verbatim the
provisions and terms of its latest insurance policy from AHAC-AIU. The testimony of
Mr. Leopoldo Mantohac, a direct participant in securing the insurance policy of
petitioner, is reflective of petitioners knowledge, viz:
DIRECT EXAMINATION OF LEOPOLDO MANTOHAC[36]
TSN, September 23, 1991
xxx
pp. 20-21
Q. Now, may we know from you Engr. de Leon your basis, if any, for
stating that except for the swimming pools all affected items have
no coverage for earthquake shock?
Q. Did you indicate to Atty. Omlas (sic) what kind of policy you would
want for those facilities in Agoo Playa?
A.
Yes, sir. I told him that I will agree to that renewal of this policy under
Philippine Charter Insurance Corporation as long as it will follow the
same or exact provisions of the previous insurance policy we had
with American Home Assurance Corporation.
Q. Did you take any step Mr. Witness to ensure that the provisions which
you wanted in the American Home Insurance policy are to be
incorporated in the PCIC policy?
A.
QUIASON, J.:
Yes, sir.
This is a petition for certiorari and prohibition under Rule 65 of the Revised Rules of
Court, with preliminary injunction or temporary restraining order, to annul and set
aside the Order dated November 6, 1986 of the Insurance Commissioner and the
entire proceedings taken in I.C. Special Case No. 1-86.
We grant the petition.
Respondent, in compliance with the condition set by the petitioner, copied AIU
Policy No. 206-4568061-9 in drafting its Insurance Policy No. 31944. It is true that
there was variance in some terms, specifically in the replacement cost endorsement,
but the principal provisions of the policy remained essentially similar to AHAC-AIUs
policy. Consequently, we cannot apply the "fine print" or "contract of adhesion" rule
in this case as the parties intent to limit the coverage of the policy to the two
swimming pools only is not ambiguous.[37]
SO ORDERED.
Austria-Martinez, Callejo, Sr., Tinga, and Chico-Nazario, JJ., concur.
In a letter dated April 29, 1986 to respondent Commissioner, petitioner De los Reyes
suggested that private respondent "submit some sort of a 'bill of particulars' listing
and citing actual cases, facts, dates, figures, provisions of law, rules and regulations,
and all other pertinent data which are necessary to enable him to prepare an
intelligent reply" (Rollo, p. 37). A copy of this letter was sent by the Insurance
Commissioner to private respondent for his comments thereon.
On May 16, 1986, respondent Commissioner received a letter from private
respondent maintaining that his letter-complaint of April 17, 1986 was sufficient in
form and substance, and requested that a hearing thereon be conducted.
FIRST DIVISION
Petitioner De los Reyes, in his letter to respondent Commissioner dated June 6,
1986, reiterated his claim that private respondent's letter of May 16, 1986 did not
supply the information he needed to enable him to answer the letter-complaint.
G.R. No. 76452 July 26, 1994
In the Order dated November 6, 1986, respondent Commissioner denied the Motion
to Quash. The dispositive portion of said Order reads:
NOW, THEREFORE, finding the position of complainant thru
counsel tenable and considering the fact that the instant case is
an informal administrative litigation falling outside the operation of
the aforecited memorandum circular but cognizable by this
Commission, the hearing officer, in open session ruled as it is
hereby ruled to deny the Motion to Quash Subpoena/Notice for
lack of merit (Rollo, p. 109).
Hence, this petition.
II
The main issue to be resolved is whether or not the resolution of the legality of the
Contract of Agency falls within the jurisdiction of the Insurance Commissioner.
Private respondent contends that the Insurance Commissioner has jurisdiction to
take cognizance of the complaint in the exercise of its quasi-judicial powers. The
Solicitor General, upholding the jurisdiction of the Insurance Commissioner, claims
that under Sections 414 and 415 of the Insurance Code, the Commissioner has
authority to nullify the alleged illegal provisions of the Contract of Agency.
III
The general regulatory authority of the Insurance Commissioner is described in
Section 414 of the Insurance Code, to wit:
The Insurance Commissioner shall have the duty to see that all
laws relating to insurance, insurance companies and other
insurance matters, mutual benefit associations and trusts for
charitable uses are faithfully executed and to perform the duties
imposed upon him by this Code, . . .
On the other hand, Section 415 provides:
In addition to the administrative sanctions provided elsewhere in
this Code, the Insurance Commissioner is hereby authorized, at his
discretion, to impose upon insurance companies, their directors
and/or officers and/or agents, for any willful failure or refusal to
comply with, or violation of any provision of this Code, or any
order, instruction, regulation or ruling of the Insurance
Commissioner, or any commission of irregularities, and/or
conducting business in an unsafe and unsound manner as may be
determined by the the Insurance Commissioner, the following:
While the subject of Insurance Agents and Brokers is discussed under Chapter IV,
Title I of the Insurance Code, the provisions of said Chapter speak only of the
licensing requirements and limitations imposed on insurance agents and brokers.
Have you or any of your family members ever consulted or been treated for high
blood pressure, heart trouble, diabetes, cancer, liver disease, asthma or peptic
ulcer? (If Yes, give details).[1]
The Insurance Code does not have provisions governing the relations between
insurance companies and their agents. It follows that the Insurance Commissioner
cannot, in the exercise of its quasi-judicial powers, assume jurisdiction over
controversies between the insurance companies and their agents.
The application was approved for a period of one year from March 1, 1988 to
March 1, 1989. Accordingly, he was issued Health Care Agreement No.
P010194. Under the agreement, respondents husband was entitled to avail of
hospitalization benefits, whether ordinary or emergency, listed therein. He was also
entitled to avail of out-patient benefits such as annual physical examinations,
preventive health care and other out-patient services.
We have held in the cases of Great Pacific Life Assurance Corporation v. Judico, 180
SCRA 445 (1989), andInvestment Planning Corporation of the Philippines v. Social
Security Commission, 21 SCRA 904 (1962), that an insurance company may have
two classes of agents who sell its insurance policies: (1) salaried employees who
keep definite hours and work under the control and supervision of the company; and
(2) registered representatives, who work on commission basis.
Under the first category, the relationship between the insurance company and its
agents is governed by the Contract of Employment and the provisions of the Labor
Code, while under the second category, the same is governed by the Contract of
Agency and the provisions of the Civil Code on the Agency. Disputes involving the
latter are cognizable by the regular courts.
WHEREFORE, the petition is GRANTED. The Order dated November 6, 1986 of the
Insurance Commission is SET ASIDE.
SO ORDERED.
Cruz, Davide, Jr. and Kapunan, JJ., concur.
Bellosillo, J,. is on leave.
FIRST DIVISION
Upon the termination of the agreement, the same was extended for another
year from March 1, 1989 to March 1, 1990, then from March 1, 1990 to June 1,
1990. The amount of coverage was increased to a maximum sum of P75,000.00 per
disability.[2]
During the period of his coverage, Ernani suffered a heart attack and was
confined at the Manila Medical Center (MMC) for one month beginning March 9,
1990. While her husband was in the hospital, respondent tried to claim the benefits
under the health care agreement. However, petitioner denied her claim saying that
the Health Care Agreement was void. According to petitioner, there was a
concealment regarding Ernanis medical history. Doctors at the MMC allegedly
discovered at the time of Ernanis confinement that he was hypertensive, diabetic
and asthmatic, contrary to his answer in the application form. Thus, respondent
paid the hospitalization expenses herself, amounting to about P76,000.00.
After her husband was discharged from the MMC, he was attended by a
physical therapist at home. Later, he was admitted at the Chinese General
Hospital. Due to financial difficulties, however, respondent brought her husband
home again. In the morning of April 13, 1990, Ernani had fever and was feeling very
weak. Respondent was constrained to bring him back to the Chinese General
Hospital where he died on the same day.
On July 24, 1990, respondent instituted with the Regional Trial Court of Manila,
Branch 44, an action for damages against petitioner and its president, Dr. Benito
Reverente, which was docketed as Civil Case No. 90-53795. She asked for
reimbursement of her expenses plus moral damages and attorneys fees. After trial,
the lower court ruled against petitioners, viz:
WHEREFORE, in view of the forgoing, the Court renders judgment in favor of the
plaintiff Julita Trinos, ordering:
1.
Defendants to pay and reimburse the medical and hospital coverage of the
late Ernani Trinos in the amount of P76,000.00 plus interest, until the amount is fully
paid to plaintiff who paid the same;
2.
Defendants to pay the reduced amount of moral damages of P10,000.00 to
plaintiff;
3.
Defendants to pay the reduced amount of P10,000.00 as exemplary damages
to plaintiff;
Section 3 of the Insurance Code states that any contingent or unknown event,
whether past or future, which may damnify a person having an insurable interest
against him, may be insured against. Every person has an insurable interest in the
life and health of himself. Section 10 provides:
4.
SO ORDERED.[3]
(1)
On appeal, the Court of Appeals affirmed the decision of the trial court but
deleted all awards for damages and absolved petitioner Reverente. [4] Petitioners
motion for reconsideration was denied. [5]Hence, petitioner brought the instant
petition for review, raising the primary argument that a health care agreement is not
an insurance contract; hence the incontestability clause under the Insurance
Code[6]does not apply.
(2)
(3)
(4)
of any person upon whose life any estate or interest vested in him
depends.
Petitioner argues that the agreement grants living benefits, such as medical
check-ups and hospitalization which a member may immediately enjoy so long as he
is alive upon effectivity of the agreement until its expiration one-year
thereafter. Petitioner also points out that only medical and hospitalization benefits
are given under the agreement without any indemnification, unlike in an insurance
contract where the insured is indemnified for his loss. Moreover, since Health Care
Agreements are only for a period of one year, as compared to insurance contracts
which last longer,[7] petitioner argues that the incontestability clause does not apply,
as the same requires an effectivity period of at least two years. Petitioner further
argues that it is not an insurance company, which is governed by the Insurance
Commission, but a Health Maintenance Organization under the authority of the
Department of Health.
Section 2 (1) of the Insurance Code defines a contract of insurance as an
agreement whereby one undertakes for a consideration to indemnify another
against loss, damage or liability arising from an unknown or contingent event. An
insurance contract exists where the following elements concur:
inducing the acceptance of the risk, or its acceptance at a lower rate of premium,
and this is likewise the rule although the statement is material to the risk, if the
statement is obviously of the foregoing character, since in such case the insurer is
not justified in relying upon such statement, but is obligated to make further
inquiry. There is a clear distinction between such a case and one in which the
insured is fraudulently and intentionally states to be true, as a matter of expectation
or belief, that which he then knows, to be actually untrue, or the impossibility of
which is shown by the facts within his knowledge, since in such case the intent to
deceive the insurer is obvious and amounts to actual fraud.[15] (Underscoring ours)
The fraudulent intent on the part of the insured must be established to warrant
rescission of the insurance contract. [16] Concealment as a defense for the health care
provider or insurer to avoid liability is an affirmative defense and the duty to
establish such defense by satisfactory and convincing evidence rests upon the
provider or insurer. In any case, with or without the authority to investigate,
petitioner is liable for claims made under the contract. Having assumed a
responsibility under the agreement, petitioner is bound to answer the same to the
extent agreed upon. In the end, the liability of the health care provider attaches
once the member is hospitalized for the disease or injury covered by the agreement
or whenever he avails of the covered benefits which he has prepaid.
Under Section 27 of the Insurance Code, a concealment entitles the injured
party to rescind a contract of insurance. The right to rescind should be exercised
previous to the commencement of an action on the contract. [17] In this case, no
rescission was made. Besides, the cancellation of health care agreements as in
insurance policies require the concurrence of the following conditions:
1.
2.
Notice must be based on the occurrence after effective date of the policy of
one or more of the grounds mentioned;
3.
Must be in writing, mailed or delivered to the insured at the address shown in
the policy;
4.
Must state the grounds relied upon provided in Section 64 of the Insurance
Code and upon request of insured, to furnish facts on which cancellation is based. [18]
None of the above pre-conditions was fulfilled in this case. When the terms of
insurance contract contain limitations on liability, courts should construe them in
such a way as to preclude the insurer from non-compliance with his obligation.
[19]
Being a contract of adhesion, the terms of an insurance contract are to be
construed strictly against the party which prepared the contract the insurer. [20] By
reason of the exclusive control of the insurance company over the terms and
phraseology of the insurance contract, ambiguity must be strictly interpreted
against the insurer and liberally in favor of the insured, especially to avoid forfeiture.
[21]
This is equally applicable to Health Care Agreements. The phraseology used in
medical or hospital service contracts, such as the one at bar, must be liberally
FIRST DIVISION
[G.R. No. 154514. July 28, 2005]
WHITE GOLD MARINE SERVICES, INC., petitioner, vs. PIONEER INSURANCE
AND SURETY CORPORATION AND THE STEAMSHIP MUTUAL
UNDERWRITING ASSOCIATION (BERMUDA) LTD., respondents.
DECISION
QUISUMBING, J.:
This petition for review assails the Decision[1] dated July 30, 2002 of the Court
of Appeals in CA-G.R. SP No. 60144, affirming the Decision[2] dated May 3, 2000 of
the Insurance Commission in I.C. Adm. Case No. RD-277. Both decisions held that
there was no violation of the Insurance Code and the respondents do not need
license as insurer and insurance agent/broker.
The facts are undisputed.
White Gold Marine Services, Inc. (White Gold) procured a protection and
indemnity coverage for its vessels from The Steamship Mutual Underwriting
Association (Bermuda) Limited (Steamship Mutual) through Pioneer Insurance and
Surety Corporation (Pioneer). Subsequently, White Gold was issued a Certificate of
Entry and Acceptance.[3] Pioneer also issued receipts evidencing payments for the
coverage. When White Gold failed to fully pay its accounts, Steamship Mutual
refused to renew the coverage.
Steamship Mutual thereafter filed a case against White Gold for collection of
sum of money to recover the latters unpaid balance. White Gold on the other hand,
filed a complaint before the Insurance Commission claiming that Steamship Mutual
violated Sections 186[4] and 187[5] of the Insurance Code, while Pioneer violated
Sections 299,[6] 300[7] and 301[8] in relation to Sections 302 and 303, thereof.
The Insurance Commission dismissed the complaint. It said that there was no
need for Steamship Mutual to secure a license because it was not engaged in the
insurance business. It explained that Steamship Mutual was a Protection and
Indemnity Club (P & I Club). Likewise, Pioneer need not obtain another license as
insurance agent and/or a broker for Steamship Mutual because Steamship Mutual
was not engaged in the insurance business. Moreover, Pioneer was already
licensed, hence, a separate license solely as agent/broker of Steamship Mutual was
already superfluous.
The Court of Appeals affirmed the decision of the Insurance Commissioner. In
its decision, the appellate court distinguished between P & I Clubs vis-vis conventional insurance. The appellate court also held that Pioneer merely acted
as a collection agent of Steamship Mutual.
In this petition, petitioner assigns the following errors allegedly committed by
the appellate court,
FIRST ASSIGNMENT OF ERROR
THE COURT A QUO ERRED WHEN IT RULED THAT RESPONDENT STEAMSHIP IS NOT
DOING BUSINESS IN THE PHILIPPINES ON THE GROUND THAT IT COURSED . . . ITS
TRANSACTIONS THROUGH ITS AGENT AND/OR BROKER HENCE AS AN INSURER IT
NEED NOT SECURE A LICENSE TO ENGAGE IN INSURANCE BUSINESS IN THE
PHILIPPINES.
The records reveal Steamship Mutual is doing business in the country albeit
without the requisite certificate of authority mandated by Section 187 [20] of the
Insurance Code. It maintains a resident agent in the Philippines to solicit insurance
and to collect payments in its behalf. We note that Steamship Mutual even renewed
its P & I Club cover until it was cancelled due to non-payment of the calls. Thus, to
continue doing business here, Steamship Mutual or through its agent Pioneer, must
secure a license from the Insurance Commission.
SO ORDERED.
Davide, Jr., C.J., (Chairman), Ynares-Santiago, Carpio, and Azcuna, JJ., concur.
EN BANC
G.R. No. L-2294
pressure. After trial, the Court of First Instance of Manila dismissed the action
without pronouncement as to costs. Upon appeal to the Court of Appeals, the
judgment of the Court of First Instance of Manila was affirmed, with costs. The case
is now before us on appeal by certiorari from the decision of the Court of Appeals.
The Court of Appeals overruled the contention of the petitioner that the respondent
corporation became an enemy when the United States declared war against
Germany, relying on English and American cases which held that a corporation is a
citizen of the country or state by and under the laws of which it was created or
organized. It rejected the theory that nationality of private corporation is determine
by the character or citizenship of its controlling stockholders.
There is no question that majority of the stockholders of the respondent corporation
were German subjects. This being so, we have to rule that said respondent became
an enemy corporation upon the outbreak of the war between the United States and
Germany. The English and American cases relied upon by the Court of Appeals have
lost their force in view of the latest decision of the Supreme Court of the United
States in Clark vs. Uebersee Finanz Korporation, decided on December 8, 1947, 92
Law. Ed. Advance Opinions, No. 4, pp. 148-153, in which the controls test has been
adopted. In "Enemy Corporation" by Martin Domke, a paper presented to the Second
International Conference of the Legal Profession held at the Hague (Netherlands) in
August. 1948 the following enlightening passages appear:
Since World War I, the determination of enemy nationality of corporations
has been discussion in many countries, belligerent and neutral. A
corporation was subject to enemy legislation when it was controlled by
enemies, namely managed under the influence of individuals or
corporations, themselves considered as enemies. It was the English courts
which first the Daimler case applied this new concept of "piercing the
corporate veil," which was adopted by the peace of Treaties of 1919 and
the Mixed Arbitral established after the First World War.
The United States of America did not adopt the control test during the First
World War. Courts refused to recognized the concept whereby Americanregistered corporations could be considered as enemies and thus subject to
domestic legislation and administrative measures regarding enemy
property.
World War II revived the problem again. It was known that German and
other enemy interests were cloaked by domestic corporation structure. It
was not only by legal ownership of shares that a material influence could
be exercised on the management of the corporation but also by long term
loans and other factual situations. For that reason, legislation on enemy
property enacted in various countries during World War II adopted by
statutory provisions to the control test and determined, to various degrees,
the incidents of control. Court decisions were rendered on the basis of such
newly enacted statutory provisions in determining enemy character of
domestic corporation.
The United States did not, in the amendments of the Trading with the
Enemy Act during the last war, include as did other legislations the
applications of the control test and again, as in World War I, courts refused
to apply this concept whereby the enemy character of an American or
neutral-registered corporation is determined by the enemy nationality of
the controlling stockholders.
Measures of blocking foreign funds, the so called freezing regulations, and
other administrative practice in the treatment of foreign-owned property in
the United States allowed to large degree the determination of enemy
interest in domestic corporations and thus the application of the control
test. Court decisions sanctioned such administrative practice enacted under
the First War Powers Act of 1941, and more recently, on December 8, 1947,
the Supreme Court of the United States definitely approved of the control
theory. In Clark vs. Uebersee Finanz Korporation, A. G., dealing with a Swiss
corporation allegedly controlled by German interest, the Court: "The
property of all foreign interest was placed within the reach of the vesting
power (of the Alien Property Custodian) not to appropriate friendly or
neutral assets but to reach enemy interest which masqueraded under those
innocent fronts. . . . The power of seizure and vesting was extended to all
property of any foreign country or national so that no innocent appearing
device could become a Trojan horse."
It becomes unnecessary, therefore, to dwell at length on the authorities cited in
support of the appealed decision. However, we may add that, in Haw Pia vs. China
Banking Corporation,* 45 Off Gaz., (Supp. 9) 299, we already held that China
Banking Corporation came within the meaning of the word "enemy" as used in the
Trading with the Enemy Acts of civilized countries not only because it was
incorporated under the laws of an enemy country but because it was controlled by
enemies.
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.
Effect of war, generally. All intercourse between citizens of belligerent
powers which is inconsistent with a state of war is prohibited by the law of
nations. Such prohibition includes all negotiations, commerce, or trading
with the enemy; all acts which will increase, or tend to increase, its income
or resources; all acts of voluntary submission to it; or receiving its
protection; also all acts concerning the transmission of money or goods;
and all contracts relating thereto are thereby nullified. It further prohibits
insurance upon trade with or by the enemy, upon the life or lives of aliens
engaged in service with the enemy; this for the reason that the subjects of
one country cannot be permitted to lend their assistance to protect by
insurance the commerce or property of belligerent, alien subjects, or to do
anything detrimental too their country's interest. The purpose of war is to
cripple the power and exhaust the resources of the enemy, and it is
inconsistent that one country should destroy its enemy's property and
repay in insurance the value of what has been so destroyed, or that it
should in such manner increase the resources of the enemy, or render it
aid, and the commencement of war determines, for like reasons, all trading
intercourse with the enemy, which prior thereto may have been lawful. All
individuals therefore, who compose the belligerent powers, exist, as to each
other, in a state of utter exclusion, and are public enemies. (6 Couch, Cyc.
of Ins. Law, pp. 5352-5353.)
only the equivalent, in actual Philippines currency of P92,650 paid on April 19, 1943,
in accordance with the rate fixed in the Ballantyne scale.
In the case of an ordinary fire policy, which grants insurance only from
year, or for some other specified term it is plain that when the parties
become alien enemies, the contractual tie is broken and the contractual
rights of the parties, so far as not vested. lost. (Vance, the Law on
Insurance, Sec. 44, p. 112.)
Feria, Pablo, Bengzon, Tuason, Montemayor, Jugo and Bautista Angelo, JJ., concur.
The respondent having become an enemy corporation on December 10, 1941, the
insurance policy issued in its favor on October 1, 1941, by the petitioner (a
Philippine corporation) had ceased to be valid and enforcible, and since the insured
goods were burned after December 10, 1941, and during the war, the respondent
was not entitled to any indemnity under said policy from the petitioner. However,
elementary rules of justice (in the absence of specific provision in the Insurance
Law) require that the premium paid by the respondent for the period covered by its
policy from December 11, 1941, should be returned by the petitioner.
The Court of Appeals, in deciding the case, stated that the main issue hinges on the
question of whether the policy in question became null and void upon the
declaration of war between the United States and Germany on December 10, 1941,
and its judgment in favor of the respondent corporation was predicated on its
conclusion that the policy did not cease to be in force. The Court of Appeals
necessarily assumed that, even if the payment by the petitioner to the respondent
was involuntary, its action is not tenable in view of the ruling on the validity of the
policy. As a matter of fact, the Court of Appeals held that "any intimidation resorted
to by the appellee was not unjust but the exercise of its lawful right to claim for and
received the payment of the insurance policy," and that the ruling of the Bureau of
Financing to the effect that "the appellee was entitled to payment from the appellant
was, well founded." Factually, there can be no doubt that the Director of the Bureau
of Financing, in ordering the petitioner to pay the claim of the respondent, merely
obeyed the instruction of the Japanese Military Administration, as may be seen from
the following: "In view of the findings and conclusion of this office contained in its
decision on Administrative Case dated February 9, 1943 copy of which was sent to
your office and the concurrence therein of the Financial Department of the Japanese
Military Administration, and following the instruction of said authority, you are
hereby ordered to pay the claim of Messrs. Christern, Huenefeld & Co., Inc. The
payment of said claim, however, should be made by means of crossed check."
(Emphasis supplied.)
It results that the petitioner is entitled to recover what paid to the respondent under
the circumstances on this case. However, the petitioner will be entitled to recover
Wherefore, the appealed decision is hereby reversed and the respondent corporation
is ordered to pay to the petitioner the sum of P77,208.33, Philippine currency, less
the amount of the premium, in Philippine currency, that should be returned by the
petitioner for the unexpired term of the policy in question, beginning December 11,
1941. Without costs. So ordered.
upon the mortgage debt, and upon the cancellation of the mortgage, the plaintiff be
absolved from liability to the defendants or any of them. The peculiar form of the
latter part of the prayer is evidently due to the design of the plaintiff to lay a
foundation for Harding to recover the difference between the plaintiff's credit and
the amount for which the property was insured. Accordingly, as was to be expected,
Harding answered, admitting the material allegations of the complaint and claiming
for himself the right to recover the difference between the plaintiff's mortgage credit
and the face value of the policies. The two insurance companies also answered,
admitting in effect their liability to the San Miguel Brewery to the extent of its
mortgage credit, but denying liability to Harding on the ground that under the
contracts of insurance the liability of the insurance companies was limited to the
insurable interest of the plaintiff therein. Soon after the action was begun the
insurance companies effected a settlement with the San Miguel Brewery by paying
the full amount of the credit claimed by it, with the result that the litigation as
between the original plaintiff and the two insurance companies came to an end,
leaving the action to be prosecuted to final judgement by the defendant Harding
with respect to the balance claimed to be due to him upon the policies.
Upon hearing the evidence the trial judge came to the conclusion that Harding had
no right of action whatever against the companies and absolved them from liability
without special finding as to costs. From this decision the said Henry Harding has
appealed.
The two insurance companies who are named as defendants do not dispute their
liability to the San Miguel Brewery, to the extent already stated, and the only
question here under discussion is that of the liability of the insurance companies to
Harding. It is therefore necessary to take account of such facts only as bear upon
this aspect of the case.
In this connection it appears that on January 12, 1916, D. P. Dunn, then the owner of
the property to which the insurance relates, mortgaged the same to the San Miguel
Brewery to secure a debt of P10,000. In the contract of mortgage Dunn agreed to
keep the property insured at his expense to the full amount of its value in companies
to be selected by the Brewery Company and authorized the latter in case of loss to
receive the proceeds of the insurance and to retain such part as might be necessary
to cover the mortgage debt. At the same time, in order more conveniently to
accomplish the end in view, Dunn authorized and requested the Brewery Company
to effect said insurance itself. Accordingly on the same date Antonio Brias, general
manager of the Brewery, made a verbal application to the Law Union and Rock
Insurance Company for insurance to the extent of P15,000 upon said property. In
reply to a question of the company's agent as to whether the Brewery was the
owner of the property, he stated that the company was interested only as a
mortgagee. No information was asked as to who was the owner of the property, and
no information upon this point was given.
It seems that the insurance company to whom this application was directed did not
want to carry more than one-half the risk. It therefore issued its own policy for
P7,500 and procured a policy in a like amount to be issued by the
"Filipinas" Compania de Seguros. Both policies were issued in the name of the San
Miguel Brewery as the assured, and contained no reference to any other interest in
the property. Both policies contain the usual clause requiring assignments to be
approved and noted on the policy. The premiums were paid by the Brewery and
charged to Dunn. A year later the policies were renewed, without change, the
renewal premiums being paid by the Brewery, supposedly for the account of the
owner. In the month of March of the year 1917 Dunn sold the insured property to the
defendant Henry Harding, but not assignment of the insurance, or of the insurance
policies, was at any time made to him.
We agree with the trial court that no cause of action in Henry Harding against the
insurance companies is show. He is not a party to the contracts of insurance and
cannot directly maintain an action thereon. (Uy Tam and Uy Yetvs. Leonard, 30 Phil.
Rep., 471.) His claim is merely of an equitable and subsidiary nature and must be
made effective, if at all, through the San Miguel Brewery in whose name the
contracts are written. Now the Brewery, as mortgagee of the insured property,
undoubtedly had an insurable interest therein; but it could not, in any event, recover
upon these policies an amount in excess of its mortgage credit. In this connection it
will be remembered that Antonio Brias, upon making application for the insurance,
informed the company with which the insurance was placed that the Brewery was
interested only as a mortgagee. It would, therefore, be impossible for the Brewery
mortgage on the insured property.
This conclusion is not only deducible from the principles governing the operation and
effect of insurance contracts in general but the point is clearly covered by the
express provisions of sections 16 and 50 of the Insurance Act (Act No. 2427). In the
first of the sections cited, it is declared that "the measure of an insurable interest in
property is the extent to which the insured might be damnified by loss or injury
thereof" (sec. 16); while in the other it is stated that "the insurance shall be applied
exclusively to the proper interest of the person in whose name it is made unless
otherwise specified in the policy" (sec. 50).
These provisions would have been fatal to any attempt at recovery even by D. P.
Dunn, if the ownership of the property had continued in him up to the time of the
loss; and as regards Harding, an additional insuperable obstacle is found in the fact
that the ownership of the property had been charged, prior to the loss, without any
corresponding change having been effected in the policy of insurance. In section 19
of the Insurance Act we find it stated that "a change of interest in any part of a thing
insured unaccompanied by a corresponding change of interest in the insurance,
suspends the insurance to an equivalent extent, until the interest in the thing and
the interest in the insurance are vested in the same person." Again in section 55 it is
declared that "the mere transfer of a thing insured does not transfer the policy, but
suspends it until the same person becomes the owner of both the policy and the
thing insured."
Undoubtedly these policies of insurance might have been so framed as to have been
"payable to the Sane Miguel Brewery, mortgagee, as its interest may appear,
remainder to whomsoever, during the continuance of the risk, may become the
owner of the interest insured." (Sec 54, Act No. 2427.) Such a clause would have
proved an intention to insure the entire interest in the property, not merely the
insurable interest of the San Miguel Brewery, and would have shown exactly to
whom the money, in case of loss, should be paid. But the policies are not so written.
It is easy to collect from the facts stated in the decision of the trial judge, no less
than from the testimony of Brias, the manager of the San Miguel Brewery, that, as
the insurance was written up, the obligation of the insurance companies was
different from that contemplated by Dunn, at whose request the insurance was
written, and Brias. In the contract of mortgage Dunn had agreed, at his own
expense, to insure the mortgaged property for its full value and to indorse the
policies in such manner as to authorize the Brewery Company to receive the
proceeds in case of loss and to retain such part thereof as might be necessary to
satisfy the remainder then due upon the mortgage debt. Instead, however, of
effecting the insurance himself Dunn authorized and requested the Brewery
Company to procure insurance on the property in the amount of P15,000 at Dunn's
expense. The Brewery Company undertook to carry this mandate into effect, and it
of course became its duty to procure insurance of the character contemplated, that
is, to have the policies so written as to protect not only the insurable interest of the
Brewery, but also the owner. Brias seems to have supposed that the policies as
written had this effect, but in this he was mistaken. It was certainly a hardship on
the owner to be required to pay the premiums upon P15,000 of insurance when he
was receiving no benefit whatever except in protection to the extent of his
indebtedness to the Brewery. The blame for the situation thus created rests,
however, with the Brewery rather than with the insurance companies, and there is
nothing in the record to indicate that the insurance companies were requested to
write insurance upon the insurable interest of the owner or intended to make
themselves liable to that extent.
If during the negotiations which resulted in the writing of this insurance, it had been
agreed between the contracting parties that the insurance should be so written as to
protect not only the interest of the mortgagee but also the residuary interest of the
owner, and the policies had been, by inadvertence, ignorance, or mistake written in
the form in which they were issued, a court would have the power to reform the
contracts and give effect to them in the sense in which the parties intended to be
bound. But in order to justify this, it must be made clearly to appear that the minds
of the contracting parties did actually meet in agreement and that they labored
under some mutual error or mistake in respect to the expression of their purpose.
Thus, in Bailey vs. American Central Insurance Co. (13 Fed., 250), it appeared that a
mortgage desiring to insure his own insurable interest only, correctly stated his
interest, and asked that the same be insured. The insurance company agreed to
accept the risk, but the policy was issued in the name of the owner, because of the
mistaken belief of the company's agent that the law required it to be so drawn. It
was held that a court of equity had the power, at the suit of the mortgage, to reform
the instrument and give judgment in his favor for the loss thereunder, although it
had been exactly as it was. Said the court: "If the applicant correctly states his
interest and distinctly asks for an insurance thereon, and the agent of the insurer
agrees to comply with his request, and assumes to decide upon the form of the
policy to be written for that purpose, and by mistake of law adopts the wrong form, a
court of equity will reform the instrument so as to make it insurance upon the
interest named." (See also Fink vs. Queens Insurance Co., 24 Fed., 318;
Esch vs. Home Insurance Co., 78 Iowa, 334; 16 Am. St. Rep., 443; Woodbury Savings
etc., Co., vs.Charter Oak Insurance Co., 31 Conn., 517; Balen vs. Hanover Fire
Insurance Co., 67 Mich., 179.)
Similarly, in cases where the mortgage is by mistake described as owner, the court
may grant reformation and permit a recovery by the mortgage in his character as
such. (Dalton vs. Milwaukee etc. Insurance Co., 126 Iowa, 377; Spare vs. Home
Mutual Insurance Co., 17 Fed., 568.) In Thompson vs. Phoenix Insurance Co. (136
U.S., 287; 34 L. 3d., 408), it appeared that one Kearney made application to an
insurance company for insurance on certain property in his hands as receiver and it
was understood between him and the company's agent that, in case of loss, the
proceeds of the policy should accrue to him and his successors as receiver and to
others whom it might concern. However, the policy, as issued, was so worded as to
be payable only to him as receiver. In an action brought on the policy by a successor
of Kearney, it was alleged that the making of the contract in this form was due to
inadvertence, accident, and mistake upon the part of both Kearney and the
company.
Said the court:
If by inadvertence, accident, or mistake the terms of the contract were not
fully set forth in the policy, the plaintiff is entitled to have it reformed.
In another case the same court said:
We have before us a contract from which by mistake, material stipulations have
been omitted, whereby the true intent and meaning of the parties are not fully or
accurately expressed. There was a definite concluded agreement as to insurance,
which, in point of time, preceded the preparation and delivery of the policy, and this
is demonstrated by legal and exact evidence, which removes all doubt as to the
sense and undertaking of the parties. In the agreement there has been a mutual
mistake, caused chiefly by that contracting party who now seeks to limit the
insurance to an interest in the property less than that agreed to be insured. The
written agreement did not effect that which the parties intended. That a court of
equity can afford relief in such a case, is, we think, well settled by the authorities.
(Smell vs. Atlantic, etc., Ins. Co., 98 U.S., 85, 89; 25 L. ed., 52.)
But to justify the reformation of a contract, the proof must be of the most
satisfactory character, and it must clearly appear that the contract failed to express
the real agreement between the parties. (Philippine Sugar Estates Development
Company vs. Government of the Philippine Islands, 62 L. ed.,
1177, reversing Government of Philippine Island vs. Philippine Sugar Estates
Development Co., 30 Phil. Rep., 27.)
In the case now before us the proof is entirely insufficient to authorize the
application of the doctrine state in the foregoing cases, for it is by means clear from
the testimony of Brias and none other was offered that the parties intended for
the policy to cover the risk of the owner in addition to that of the mortgagee. It
results that the defendant Harding is not entitled to relief in any aspect of the case.
The judgment is therefore affirmed, with costs against the appellant. So ordered.
Arellano, C.J., Johnson, Araullo, Malcolm and Avancea, JJ., concur.
Republic of the Philippines
SUPREME COURT
Manila
Loss if any, payable to the Philippine National Bank as their interest may
appear, subject to the terms, conditions and warranties of this policy (Exh.
A).
EN BANC
G.R. No. L-15184
xxx
Erected on the land mortgaged, was a building of strong materials owned by the
mortgagor Saura Import & Export Co., Inc., which had always been covered by
insurance, many years prior to the mortgage contract. Pursuant to the requirement,
Saura insured the building and its contents with the Philippine International Surety,
an insurance firm acceptable to mortgagee Bank, for P29,000.00 against fire for the
period of one year from October 2, 1954. As required therefor, the insurance policy
was endorsed to the mortgagee PNB, in a Memo which states
xxx
The policy was delivered to the mortgagee Bank by Saura. On October 15, 1954,
barely thirteen (13) days after the issuance of the fire insurance policy (October 2,
1954), the insurer cancelled the same, effective as of the date of issue (Exh. A-2).
Notice of the cancellation was given to appellee bank in writing, sent by Registered
Mail and personally addressed to Fortunato Domingo, Branch Manager of the
appellee Bank's Davao Branch, and was received by the Bank on November 8, 1954.
On April 6, 1955, the building and its contents, worth P40,685.69 were burned. On
April 11, 1955, Saura filed a claim with the Insurer and mortgagee Bank. Upon the
presentation of notice of loss with the PNB, Saura learned for the first time that the
policy had previously been cancelled on October 2, 1954, by the insurer, when
Saura's folder in the Bank's filed was opened and the notice of cancellation (original
and duplicate) sent by the Insurer to the Bank, was found. Upon refusal of the
Insurer Philippine International Surety to pay the amount of the insurance, Civil Case
No. 26847 was filed with the Manila CFI against the Insurer, and the PNB was later
included as party defendant, after it had refused to prosecute the case jointly with
Saura Import & Export Co., Inc.
At the trial, it was established that neither the Insurer nor the mortgagee Bank
informed the plaintiff Saura of the cancellation of the policy. On April 30, 1957, the
court a quo rendered the following judgment
. . . IN VIEW WHEREOF, complaint dismissed; costs against the plaintiff; but
as there is no proof on the counterclaim of the Philippines International
Surety, the same is also dismissed.
Wherefore, the parties respectfully pray that the foregoing stipulation of
facts be admitted and approved by this Honorable Court, without prejudice
to the parties adducing other evidence to prove their case not covered by
this stipulation of facts. 1wph1.t
A motion to reconsider the above judgment, seasonably presented on May 14, 1957,
was subsequently denied. The decision rendered and the resolution denying the
motion for reconsideration constitute the subject of the instant appeal by plaintiff
Saura on the three alleged errors, which converge on the correctness of the ruling,
wholly dismissing the complaint absolving both the insurance company and the
bank from liability.
In the determination of liabilities of the parties herein, let us look into the general
principles of insurance, in matters of cancellations of policy by the insurer. Fire
insurance policies and other contracts of insurance upon property, in addition to the
common provision for cancellation of the policy upon request of the insured,
generally provide for cancellation by the insurer by notice to the insured for a
prescribed period, which is usually 5 days, and the return of the unearned portion of
the premium paid by the insured, such provision for cancellation upon notice being
authorized by statutes in some jurisdiction, either specifically or as a provision of an
adopted standard form of policy. The purpose of provisions or stipulations for notice
to the insured, is to prevent the cancellation of the policy, without allowing the
insured ample opportunity to negotiate for other insurance in its stead. The form
and sufficiency of a notice of cancellation is determined by policy provisions. In
order to form the basis for the cancellation of a policy, notice to the insured n not be
in any particular form, in the absence of a statute or policy provision prescribing
such form, and it is sufficient, so long as it positively and unequivocally indicates to
the insured, that it is the intention of the company that the policy shall cease to be
binding. Where the policy contains no provisions that a certain number of days
notice shall be given, a reasonable notice and opportunity to obtain other insurance
must be given. Actual personal notice to the insured is essential to a cancellation
under a provision for cancellation by notice. The actual receipt by the insured of a
notice of cancellation is universally recognized as a condition precedent to a
cancellation of the policy by the insurer, and consequently a letter containing notice
of cancellation which is mailed by the insurer but not received by the insured, is
ineffective as cancellation (29 Am. Jur. pp. 732-741).
The policy in question (Exh. A), does not provide for the notice, its form or period.
The Insurance Law, Act No. 2427, does not likewise provide for such notice. This
being the case, it devolves upon the Court to apply the generally accepted principles
of insurance, regarding cancellation of the insurance policy by the insurer. From
what has been heretofore stated, actual notice of cancellation in a clear and
unequivocal manner, preferably in writing, in view of the importance of an insurance
contract, should be given by the insurer to the insured, so that the latter might be
given an opportunity to obtain other insurance for his own protection. The notice
should be personal to the insured and not to and/or through any unauthorized
person by the policy. In the case at bar, the defendant insurance company, must
have realized the paramount importance of sending a notice of cancellation, when it
sent the notice of cancellation of the policy to the defendant bank (as mortgagee),
but not to the insured with which it (insurance company) had direct dealing. It was
the primary duty of the defendant-appellee insurance company to notify the insured,
but it did not. It should be stated that the house and its contents were burned on
April 6, 1955, at the time when the policy was enforced (October 2, 1954 to October
2, 1955); and that under the facts, as found by the trial court, to which We are
bound, it is evident that both the insurance company and the appellee bank failed,
wittingly or unwittingly, to notify the insured appellant Saura of the cancellation
made.
Of course, the defendant insurance company contends that it gave notice to the
defendant-appellee bank as mortgagee of the property, and that was already a
substantial compliance with its duty to notify the insured of the cancellation of the
policy. But notice to the bank, as far appellant herein is concerned, is not effective
notice.
If a mortgage or lien exists against the property insured, and the policy
contains a clause stating that loss, if any, shall be payable to such
mortgagee or the holder of such lien as interest may appear, notice of
cancellation to the mortgagee or lienholder alone is ineffective as a
cancellation of the policy to the owner of the property. (Connecticut Ins. Co.
v. Caumisar, 218 Ky. 378, 391 SW 776, cited in 29 Am. Jur. p. 743).
Upon authority of the above case, therefore, the liability of the insurance company
becomes a fact.
It may be argued that in the appeal brief of appellant, no error has been assigned
against the insurance company and no prayer is found therein asking that it be
made liable. It must be noted, however, that the case was dismissed the lower court
and the main object of the appeal is to secure a reversal of the said judgment. This
Court is clothed with ample authority to review matters, even if they are not
assigned as errors in the appeal, if it finds that their consideration is necessary in
arriving at a just decision of the case. Thus it was held:
While an assignment of error which is required by law or rule of court has
been held essential to appellate review, only those assigned will be
considered, there are a number of cases which appear to accord to the
appellate court a broad discretionary power to waive the lack of proper
assignment of errors and consider errors not assigned. And an unassigned
error closely related to an error properly assigned, or upon which the
determination of the question raised by the error properly assigned is
dependent, will be considered by the appellate court notwithstanding the
failure to assign it as error. (Hernandez v. Andal, 78 Phil. 198-199).
Although assigned errors apparently appear to be directed against the appellee bank
alone, they in essence, seek a reversal of the decision on dismissal, entered by the
lower court, which in the main has for its purpose the finding of liability on the
policy. In the course of our examination of the records of the case, the decision and
the errors assigned, We found that liability attached principally the insurance
company, for its failure to give notice of the cancellation of the policy to herein
appellant itself.
Because of the conclusions reached, We find it unnecessary to discuss the errors
assigned against appellee bank.
WHEREFORE, the decision appealed from is hereby reversed, and another is entered,
condemning the defendant-appellee Philippine International Surety Co., Inc., to pay
Saura Import & Export Co., Inc., appellant herein, the sum of P29,000.00, the
amount involved in Policy No. 429, subject-matter of the instant case. Without costs.
Bengzon, C.J., Padilla, Bautista Angelo, Concepcion, Reyes, J.B.L., Barrera, Dizon,
Regala and Makalintal, JJ., concur.
Labrador, J., took no part.
the defendant be ordered to pay to plaintiff the difference between the alleged
indebtedness of plaintiff and the sum received by defendant from the
aforementioned insurance company, plus the sum allegedly paid to defendant as
interest on the alleged indebtedness.
On December 19, 1952, defendant filed her answer setting up as special defense
that the transaction entered into between the plaintiff and defendant is one of sale
with option to repurchase but that the period for repurchase had expired without
EN BANC
plaintiff having returned the price agreed upon as a result of which the ownership of
the property had become consolidated in the defendant. Defendant also set up
On April 7, 1953, the case was set for trial on the merits, but because of several
postponements asked by the parties, the same has to be set anew for trial on
vs.
January 12, 1954. On this date, neither the defendant nor her counsel appeared,
even if the latter had been notified of the postponement almost a month earlier, and
so the court received the evidence of the plaintiff. On January 18, 1954, the court,
Plaintiff filed a complaint against defendant in the Court of First Instance of Manila
praying that (1) the transaction entered into between them on December 18, 1951
be declared as one of loan, and the document executed covering the transaction as
one of equitable mortgage to secure the payment of said loan; (2) the defendant be
ordered to credit to the plaintiff with the necessary amount from the sum received
by the defendant from the Associated Insurance & Surety Co., Inc. and to apply the
same to the payment of plaintiff's obligation thus considering it as fully paid; and (3)
having in view the evidence presented, rendered judgment granting the relief
prayed for in the complaint.
On February 2, 1954, the original counsel for the defendant was substituted and the
new counsel immediately moved that the judgment be set aside on the ground that,
due to mistake or excusable negligence, defendant was unable to present her
evidence and the decision was contrary to law, and this motion having been denied,
defendant took the present appeal.
The important issue to be determined in this appeal is whether the lower court
committed a grave abuse of discretion in not reopening the case to give defendant
an opportunity to present her evidence considering that the failure of her original
when the case was called for trial." These reasons, it is intimated, constitute
excusable negligence which ordinary prudence could not have guarded against and
should have been considered by the trial court as sufficient justification to grant the
petition of defendant for a rehearing.
The original counsel of defendant was Atty. Leon Ma. Guerrero. As early as February
11, 1953, said counsel showed interest in the early disposal of this case by moving
It is a well-settled rule that the granting of a motion to set aside a judgment or order
the court to have it set for trial. The first date set was April 7, 1953, but no hearing
was had on that date because plaintiff had moved to postpone it. The case was next
discretion of the court (see Coombs vs. Santos, 24 Phil., 446; Daipan vs. Sigabu, 25,
set for hearing on April 28, 1953, but on motion again of plaintiff, the hearing was
Phil., 184). And an order issued in the exercise of such discretion is ordinarily not to
transferred to November 6, 1953. Then, upon petition of defendant, the trial had to
be disturbed unless it is shown that the court has gravely abused such discretion.
be moved to December 15, 1953, and because Atty. Guerrero could not appear on
(See Tell vs. Tell, 48 Phil., 70; Macke vs. Camps, 5 Phil., 185; Calvo vs. De Gutierrez,
said date because of a case he had in Cebu City, the hearing was postponed to
4 Phil., 203; Manzanares vs.Moreta, 38 Phil., 821; Salva vs. Palacio and Leuterio, 90
Phil., 731.) In denying the motion for reopening the trial court said: "After going over
the same arguments, this Court is of the opinion, and so holds that the decision of
And on January 4, 1954, or nineteen days after receiving the notice of hearing, Atty.
Guerrero was appointed Undersecretary of Foreign Affairs. It is now contended that
the appointment was so sudden and unexpected that Atty. Guerrero, after taking his
oath, was unable to wind up his private cases or make any preparation at all. It is
this Court of January 18, 1954 should not be disturbed." Considering the stature,
ability and experience of counsel Leon Ma. Guerrero, and the fact that he was given
almost one month notice before the date set for trial, we are persuaded to conclude
that the trial court did not abuse its discretion in refusing to reconsider its decision.
averred that "The days that followed his appointment were very busy days for
defendant's former counsel. There was an immediate need for clearing the backlog
Coming now to the merits of the case, we note that the lower court made the
following findings: On December 18, 1951, plaintiff obtained from defendant a loan
and our Foreign Service, and more importantly, he had to assist the Secretary of
in the sum of P12,000 subject to the following conditions: (a) that plaintiff shall pay
to defendant an interest in the amount of P250 a month; (b) that defendant shall
and the revision of the trade agreement with the United States, that, Atty. Guerrero
deduct from the loan certain obligations of plaintiff to third persons amounting to
had to work as much as fourteen hours daily . . . Because of all these unavoidable
P4,550, plus the sum of P250 as interest for the first month; and (c) that after
confusion that followed in the wake of Atty. Guerrero's sudden and unexpected
making the above deductions, defendant shall deliver to plaintiff only the balance of
appointment, the trial of this case scheduled for January 18, 1954 escaped his
memory, and consequently, Atty. Guerrero and the defendant were unable to appear
months as interest on the sum of P12,000 loaned to plaintiff and the legal interest
total of P2,250.00 corresponding to nine months from December 18, 1951, on the
allowed by law in this transaction does not exceed 12 per cent per annum, or the
basis of P250.00 a month, which is more than the maximum interest authorized by
sum of P1,440 for one year, so the herein plaintiff and overpaid the sum of P810 to
law. To secure the payment of the aforesaid loan, defendant required plaintiff to sign
the defendant, which this Court hereby likewise orders the said defendant to refund
to herein plaintiff, plus the balance of P1,107 representing the difference of the sum
loan of P12,000 and the collected insurance of P13,107 from the insurance company
materials belonging to plaintiff. This document did not express the true intention of
abovementioned to which the herein plaintiff is entitled to receive, and to pay the
the parties which was merely to place said property as security for the payment of
costs.
the loan.
The question that now arises is: Is the trial court justified in considering the
After the execution of the aforesaid document, defendant insured the building
against fire with the Associated Insurance & Surety Co., Inc. for the sum of P15,000,
defendant to refund to plaintiff the sum of P1,107 representing the difference of the
the insurance policy having been issued in the name of defendant. The building was
loan of P12,000 and the sum of P13,107 collected by said defendant from the
partly destroyed by fire and, after proper demand, defendant collected from the
insurance company notwithstanding the fact that it was not proven that the
that she be credited with the necessary amount to pay her obligation out of the
insurance proceeds but defendant refused to do so. And on the strength of these
facts, the court rendered decision the dispositive part of which reads as follows:
Is is our opinion that on this score the court is in error for its ruling runs counter to
the rule governing an insurance taken by a mortgagee independently of the
mortgagor. The rule is that "where a mortgagee, independently of the mortgagor,
insures the mortgaged property in his own name and for his own interest, he is
entitled to the insurance proceeds in case of loss, but in such case, he is not allowed
payment of the sum of P12,000 loaned by the defendant to plaintiff; ordering the
to retain his claim against the mortgagor, but is passed by subrogation to the insurer
defendant to credit the sum of P13,107 received by the defendant from the
to the extent of the money paid." (Vance on Insurance, 2d ed., p. 654) Or, stated in
Associated Insurance & surety Co., Inc. to the payment of plaintiff's obligation in the
another way, "the mortgagee may insure his interest in the property independently
of the mortgagor. In that event, upon the destruction of the property the insurance
December 18, 1951 between the herein plaintiff and defendant completely paid and
money paid to the mortgagee will not inure to the benefit of the mortgagor, and the
leaving still a balance in the sum of P1,107 from the insurance collected by
defendant; that as plaintiff had paid to the defendant the sum of P2,250.00 for nine
mortgagee, however, is not allowed to retain his claim against the mortgagor, but it
passes by subrogation to the insurer, to the extent of the insurance money paid."
property mortgaged inured to the benefit of the plaintiff and in ordering said
(Vance on Insurance, 3rd ed., pp. 772-773) This is the same rule upheld by this Court
defendant to deliver to the plaintiff the difference between her indebtedness and the
in a case that arose in this jurisdiction. In the case mentioned, an insurance contract
amount of insurance received by the defendant, for, in the light of the majority rule
was taken out by the mortgagee upon his own interest, it being stipulated that the
we have above enunciated, the correct solution should be that the proceeds of the
proceeds would be paid to him only and when the case came up for decision, this
insurance should be delivered to the defendant but that her claim against the
Court held that the mortgagee, in case of loss, may only recover upon the policy to
the extent of his credit at the time of the loss. It was declared that the mortgaged
subrogated to the rights of the defendant to the extent of the money paid as
had no right of action against the mortgagee on the policy. (San Miguel
indemnity.
the lower court as follows:(1) the transaction had between the plaintiff and
insurance on his separate interest at his own expense and for his own benefit,
without any agreement with the mortgagor with respect thereto, the mortgagor has
the payment of the loan of P12,000;(2) that the proceeds of the insurance
no interest in the policy, and is not entitled to have the insurance proceeds applied
in reduction of the mortgage debt" (19 R.C.L., p. 405), and that, furthermore, the
account for it to the plaintiff; (3) that the collection of said insurance proceeds shall
mortgagee "has still a right to recover his whole debt of the mortgagor."
not be deemed to have compensated the obligation of the plaintiff to the defendant,
(King vs. State Mut. F. Ins. Co., 7 Cush. 1; Suffolk F. Ins. Co. vs. Boyden 9 Allen, 123;
but bars the latter from claiming its payment from the former; and (4) defendant
See also Loomis vs. Eagle Life & Health Ins. Co., 6 Gray, 396; Washington Mills
shall pay to the plaintiff the sum of P810.00 representing the overpayment made by
Emery Mfg. Co. vs. Weymouth & B. Mut. F. Ins. Co., 135 Mass. 506;
Foster vs. Equitable Mut. F. Ins. Co., 2 Gray 216.) But these authorities merely
represent the minority view (See case note, 3 Lawyers' Report Annotated, new
series, p. 79). "The general rule and the weight of authority is, that the insurer is
Bengzon, Montemayor, Reyes, A., Jugo, Labrador , Concepcion, and Reyes, J.B.L., JJ.,
concur.
thereupon subrogated to the rights of the mortgagee under the mortgage. This is
SECOND DIVISION
put upon the analogy of the situation of the insurer to that of a surety." (Jones on
Considering the foregoing rules, it would appear that the lower court erred in
declaring that the proceeds of the insurance taken out by the defendant on the
DECISION
QUISUMBING, J.:
This petition for review, under Rule 45 of the Rules of Court, assails the
Decision[1] dated May 17, 1993, of the Court of Appeals and its Resolution [2] dated
January 4, 1994 in CA-G.R. CV No. 18341. The appellate court affirmed in toto the
judgment of the Misamis Oriental Regional Trial Court, Branch 18, in an insurance
claim filed by private respondent against Great Pacific Life Assurance Co. The
dispositive portion of the trial courts decision reads:
WHEREFORE, judgment is rendered adjudging the defendant GREAT PACIFIC LIFE
ASSURANCE CORPORATION as insurer under its Group policy No. G-1907, in relation
to Certification B-18558 liable and ordered to pay to the DEVELOPMENT BANK OF
THE PHILIPPINES as creditor of the insured Dr. Wilfredo Leuterio, the amount of
EIGHTY SIX THOUSAND TWO HUNDRED PESOS (P86,200.00); dismissing the claims
for damages, attorneys fees and litigation expenses in the complaint and
counterclaim, with costs against the defendant and dismissing the complaint in
respect to the plaintiffs, other than the widow-beneficiary, for lack of cause of
action.[3]
The facts, as found by the Court of Appeals, are as follows:
A contract of group life insurance was executed between petitioner Great
Pacific Life Assurance Corporation (hereinafter Grepalife) and Development Bank of
the Philippines (hereinafter DBP). Grepalife agreed to insure the lives of eligible
housing loan mortgagors of DBP.
On November 11, 1983, Dr. Wilfredo Leuterio, a physician and a housing debtor
of DBP applied for membership in the group life insurance plan. In an application
form, Dr. Leuterio answered questions concerning his health condition as follows:
7. Have you ever had, or consulted, a physician for a heart condition, high
blood pressure, cancer, diabetes, lung, kidney or stomach disorder or any
other physical impairment?
Answer: No. If so give details ___________.
insurance coverage on November 15, 1983. Grepalife insisted that Dr. Leuterio did
not disclose he had been suffering from hypertension, which caused his
death. Allegedly, such non-disclosure constituted concealment that justified the
denial of the claim.
On October 20, 1986, the widow of the late Dr. Leuterio, respondent Medarda V.
Leuterio, filed a complaint with the Regional Trial Court of Misamis Oriental, Branch
18, against Grepalife for Specific Performance with Damages. [5] During the trial, Dr.
Hernando Mejia, who issued the death certificate, was called to testify. Dr. Mejias
findings, based partly from the information given by the respondent widow, stated
that Dr. Leuterio complained of headaches presumably due to high blood
pressure. The inference was not conclusive because Dr. Leuterio was not autopsied,
hence, other causes were not ruled out.
On February 22, 1988, the trial court rendered a decision in favor of respondent
widow and against Grepalife. On May 17, 1993, the Court of Appeals sustained the
trial courts decision. Hence, the present petition. Petitioners interposed the
following assigned errors:
"1. THE LOWER COURT ERRED IN HOLDING DEFENDANT-APPELLANT
LIABLE TO THE DEVELOPMENT BANK OF THE PHILIPPINES (DBP)
WHICH IS NOT A PARTY TO THE CASE FOR PAYMENT OF THE
PROCEEDS OF A MORTGAGE REDEMPTION INSURANCE ON THE LIFE OF
PLAINTIFFS HUSBAND WILFREDO LEUTERIO ONE OF ITS LOAN
BORROWERS, INSTEAD OF DISMISSING THE CASE AGAINST
DEFENDANT-APPELLANT [Petitioner Grepalife] FOR LACK OF CAUSE OF
ACTION.
2. THE LOWER COURT ERRED IN NOT DISMISSING THE CASE FOR WANT
OF JURISDICTION OVER THE SUBJECT OR NATURE OF THE ACTION AND
OVER THE PERSON OF THE DEFENDANT.
3. THE LOWER COURT ERRED IN ORDERING DEFENDANT-APPELLANT TO
PAY TO DBP THE AMOUNT OF P86,200.00 IN THE ABSENCE OF ANY
EVIDENCE TO SHOW HOW MUCH WAS THE ACTUAL AMOUNT PAYABLE
TO DBP IN ACCORDANCE WITH ITS GROUP INSURANCE CONTRACT
WITH DEFENDANT-APPELLANT.
] No.[4]
The insured private respondent did not cede to the mortgagee all his rights or
interests in the insurance, the policy stating that: In the event of the debtors
death before his indebtedness with the Creditor [DBP] shall have been fully paid, an
amount to pay the outstanding indebtedness shall first be paid to the creditor and
the balance of sum assured, if there is any, shall then be paid to the beneficiary/ies
designated by the debtor.[10] When DBP submitted the insurance claim against
petitioner, the latter denied payment thereof, interposing the defense of
concealment committed by the insured. Thereafter, DBP collected the debt from the
mortgagor and took the necessary action of foreclosure on the residential lot of
private respondent.[11] In Gonzales La O vs. Yek Tong Lin Fire & Marine Ins. Co. [12] we
held:
Insured, being the person with whom the contract was made, is primarily the
proper person to bring suit thereon. * * * Subject to some exceptions, insured may
thus sue, although the policy is taken wholly or in part for the benefit of another
person named or unnamed, and although it is expressly made payable to another as
his interest may appear or otherwise. * * * Although a policy issued to a mortgagor
is taken out for the benefit of the mortgagee and is made payable to him, yet the
mortgagor may sue thereon in his own name, especially where the mortgagees
interest is less than the full amount recoverable under the policy, * * *.
And in volume 33, page 82, of the same work, we read the following:
Insured may be regarded as the real party in interest, although he has assigned the
policy for the purpose of collection, or has assigned as collateral security any
judgment he may obtain.[13]
And since a policy of insurance upon life or health may pass by transfer, will or
succession to any person, whether he has an insurable interest or not, and such
person may recover it whatever the insured might have recovered, [14] the widow of
the decedent Dr. Leuterio may file the suit against the insurer, Grepalife.
The second assigned error refers to an alleged concealment that the petitioner
interposed as its defense to annul the insurance contract. Petitioner contends that
Dr. Leuterio failed to disclose that he had hypertension, which might have caused his
death. Concealment exists where the assured had knowledge of a fact material to
the risk, and honesty, good faith, and fair dealing requires that he should
communicate it to the assured, but he designedly and intentionally withholds the
same.[15]
Petitioner merely relied on the testimony of the attending physician, Dr.
Hernando Mejia, as supported by the information given by the widow of the
decedent. Grepalife asserts that Dr. Mejias technical diagnosis of the cause of
death of Dr. Leuterio was a duly documented hospital record, and that the widows
declaration that her husband had possible hypertension several years ago should
not be considered as hearsay, but as part of res gestae.
On the contrary the medical findings were not conclusive because Dr. Mejia did
not conduct an autopsy on the body of the decedent. As the attending physician, Dr.
Mejia stated that he had no knowledge of Dr. Leuterios any previous hospital
confinement.[16] Dr. Leuterios death certificate stated that hypertension was only
the possible cause of death. The private respondents statement, as to the
medical history of her husband, was due to her unreliable recollection of
events. Hence, the statement of the physician was properly considered by the trial
court as hearsay.
The question of whether there was concealment was aptly answered by the
appellate court, thus:
The insured, Dr. Leuterio, had answered in his insurance application that he was in
good health and that he had not consulted a doctor or any of the enumerated
ailments, including hypertension; when he died the attending physician had certified
in the death certificate that the former died of cerebral hemorrhage, probably
secondary to hypertension. From this report, the appellant insurance company
refused to pay the insurance claim. Appellant alleged that the insured had
concealed the fact that he had hypertension.
Contrary to appellants allegations, there was no sufficient proof that the insured
had suffered from hypertension. Aside from the statement of the insureds widow
who was not even sure if the medicines taken by Dr. Leuterio were for hypertension,
the appellant had not proven nor produced any witness who could attest to Dr.
Leuterios medical history...
xxx
Appellant insurance company had failed to establish that there was concealment
made by the insured, hence, it cannot refuse payment of the claim. [17]
The fraudulent intent on the part of the insured must be established to entitle
the insurer to rescind the contract. [18] Misrepresentation as a defense of the insurer
to avoid liability is an affirmative defense and the duty to establish such defense by
satisfactory and convincing evidence rests upon the insurer. [19] In the case at bar,
the petitioner failed to clearly and satisfactorily establish its defense, and is
therefore liable to pay the proceeds of the insurance.
indebtedness to DBP at the time of the mortgagors death. Hence, for private
respondents failure to establish the same, the action for specific performance
should be dismissed. Petitioners claim is without merit. A life insurance policy is a
valued policy.[20] Unless the interest of a person insured is susceptible of exact
pecuniary measurement, the measure of indemnity under a policy of insurance upon
life or health is the sum fixed in the policy. [21] The mortgagor paid the premium
according to the coverage of his insurance, which states that:
The policy states that upon receipt of due proof of the Debtors death during the
terms of this insurance, a death benefit in the amount of P86,200.00 shall be paid.
In the event of the debtors death before his indebtedness with the creditor shall
have been fully paid, an amount to pay the outstanding indebtedness shall first be
paid to the Creditor and the balance of the Sum Assured, if there is any shall then be
paid to the beneficiary/ies designated by the debtor. [22] (Emphasis omitted)
However, we noted that the Court of Appeals decision was promulgated on
May 17, 1993. In private respondents memorandum, she states that DBP
foreclosed in 1995 their residential lot, in satisfaction of mortgagors outstanding
loan. Considering this supervening event, the insurance proceeds shall inure to the
benefit of the heirs of the deceased person or his beneficiaries. Equity dictates that
DBP should not unjustly enrich itself at the expense of another (Nemo cum alterius
detrimenio protest). Hence, it cannot collect the insurance proceeds, after it already
foreclosed on the mortgage. The proceeds now rightly belong to Dr. Leuterios heirs
represented by his widow, herein private respondent Medarda Leuterio.
WHEREFORE, the petition is hereby DENIED. The Decision and Resolution of
the Court of Appeals in CA-G.R. CV 18341 is AFFIRMED with MODIFICATION that the
petitioner is ORDERED to pay the insurance proceeds amounting to Eighty-six
thousand, two hundred (P86,200.00) pesos to the heirs of the insured, Dr. Wilfredo
Leuterio (deceased), upon presentation of proof of prior settlement of mortgagors
indebtedness to Development Bank of the Philippines. Costs against petitioner.
SO ORDERED.
Mendoza, Buena, and De Leon Jr., JJ., concur.
Bellosillo, (Chairman), J., on official leave.
And that brings us to the last point in the review of the case at bar. Petitioner
claims that there was no evidence as to the amount of Dr. Leuterios outstanding