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G.R. No. L-25579 March 29, 1972 paid the basic amount of P5,000.

00 but refused
EMILIA T. BIAGTAN, JUAN T. BIAGTAN, to pay the additional sum of P5,000.00 under
JR., MIGUEL T. BIAGTAN, GIL T. BIAGTAN the accidental death benefit clause, on the
and GRACIA T. BIAGTAN, plaintiffs- ground that the insured's death resulted from
appellees, injuries intentionally inflicted by third parties
vs. THE INSULAR LIFE ASSURANCE and therefore was not covered. Plaintiffs filed
COMPANY, LTD., defendant-appellant. suit to recover, and after due hearing the court
a quo rendered judgment in their favor. Hence
MAKALINTAL, J.:p the present appeal by the insurer.
This is an appeal from the decision of the Court
of First Instance of Pangasinan in its Civil Case The only issue here is whether under the facts
No. D-1700. are stipulated and found by the trial court the
wounds received by the insured at the hands of
The facts are stipulated. Juan S. Biagtan was the robbers nine in all, five of them mortal
insured with defendant InsularLife Assurance and four non-mortal were inflicted
Company under Policy No. 398075 for the sum intentionally. The court, in ruling negatively on
of P5,000.00 and, under a supplementary the issue, stated that since the parties
contract denominated "Accidental Death presented no evidence and submitted the case
Benefit Clause, for an additional sum of upon stipulation, there was no "proof that the
P5,000.00 if "the death of the Insured resulted act of receiving thrust (sic) from the sharp-
directly from bodily injury effected solely pointed instrument of the robbers was intended
through external and violent means sustained to inflict injuries upon the person of the insured
in an accident ... and independently of all other or any other person or merely to scare away
causes." The clause, however,expressly any person so as to ward off any resistance or
provided that it would not apply where death obstacle that might be offered in the pursuit of
resulted from an injury"intentionally inflicted by their main objective which was robbery."
another party."
On the night of May 20, 1964, or during the first The trial court committed a plain error in
hours of the following day a band of robbers drawing the conclusion it did from the admitted
entered the house of the insured Juan S. facts. Nine wounds were inflicted upon the
Biagtan. What happened then is related in the deceased, all by means of thrusts with sharp-
decision of the trial court as follows: pointed instruments wielded by the robbers.
...; that on the night of May 20, 1964 or the first This is a physical fact as to which there is no
hours of May 21, 1964, while the said life policy dispute. So is the fact that five of those wounds
and supplementary contract were in full force caused the death of the insured. Whether the
and effect, the house of insured Juan S. robbers had the intent to kill or merely to scare
Biagtan was robbed by a band of robbers who the victim or to ward off any defense he might
were charged in and convicted by the Court of offer, it cannot be denied that the act itself of
First Instance of Pangasinan for robbery with inflicting the injuries was intentional. It should
homicide; that in committing the robbery, the be noted that the exception in the accidental
robbers, on reaching the staircase landing on benefit clause invoked by the appellant does
the second floor, rushed towards the door of not speak of the purpose whether homicidal
the second floor room, where they suddenly or not of a third party in causing the injuries,
met a person near the door of oneof the rooms but only of the fact that such injuries have been
who turned out to be the insured Juan S. "intentionally" inflicted this obviously to
Biagtan who received thrusts from their sharp- distinguish them from injuries which, although
pointed instruments, causing wounds on the received at the hands of a third party, are
body of said Juan S. Biagtan resulting in his purely accidental. This construction is the basic
death at about 7 a.m. on the same day, May idea expressed in the coverage of the clause
21, 1964; itself, namely, that "the death of the insured
resulted directly from bodily injury effected
Plaintiffs, as beneficiaries of the insured, filed a solely through external and violent means
claim under the policy. The insurance company sustained in an accident ... and independently
of all other causes." A gun which discharges where similar provisions in accidental death
while being cleaned and kills a bystander; a benefit clauses in insurance policies have been
hunter who shoots at his prey and hits a person construed, may shed light on the issue before
instead; an athlete in a competitive game Us. Thus, it has been held that "intentional" as
involving physical effort who collides with an used in an accident policy excepting intentional
opponent and fatally injures him as a result: injuries inflicted by the insured or any other
these are instances where the infliction of the person, etc., implies the exercise of the
injury is unintentional and therefore would be reasoning faculties, consciousness and
within the coverage of an accidental death volition.1 Where a provision of the policy
benefit clause such as thatin question in this excludes intentional injury, it is the intention of
case. But where a gang of robbers enter a the person inflicting the injury that is
house and coming face to face with the owner, controlling.2 If the injuries suffered by the
even if unexpectedly, stab him repeatedly, it is insured clearly resulted from the intentional act
contrary to all reason and logic to say that his of a third person the insurer is relieved from
injuries are not intentionally inflicted, liability as stipulated.3
regardless of whether they prove fatal or not. In the case of Hutchcraft's Ex'r v. Travelers' Ins.
As it was, in the present case they did prove Co., 87 Ky. 300, 8 S.W. 570, 12 Am. St. Rep.
fatal, and the robbers have been accused and 484, the insured was waylaid and assassinated
convicted of the crime of robbery with for the purpose of robbery. Two (2) defenses
homicide. were interposed to the action to recover
indemnity, namely: (1) that the insured having
The case of Calanoc vs. Court of Appeals, 98 been killed by intentional means, his death was
Phil. 79, is relied upon by the trial court in not accidental, and (2) that the proviso in the
support of its decision. The facts in that case, policy expressly exempted the insurer from
however, are different from those obtaining liability in case the insured died from injuries
here. The insured there was a watchman in a intentionally inflicted by another person. In
certain company, who happened to be invited rendering judgment for the insurance company
by a policeman to come along as the latter was the Court held that while the assassination of
on his way to investigate a reported robbery the insured was as to him an unforeseen event
going on in a private house. As the two of them, and therefore accidental, "the clause of the
together with the owner of the house, proviso that excludes the (insurer's) liability, in
approached and stood in front of the main gate, case death or injury is intentionally inflicted by
a shot was fired and it turned out afterwards another person, applies to this case."
that the watchman was hit in the abdomen, the
wound causing his death. Under those In Butero v. Travelers' Acc. Ins. Co., 96 Wis.
circumstances this Court held that it could not 536, 65 Am. St. Rep. 61, 71 S.W. 811, the
be said that the killing was intentional for there insured was shot three times by a person
was the possibility that the malefactor had fired unknown late on a dark and stormy night, while
the shot to scare people around for his own working in the coal shed of a railroad company.
protection and not necessarrily to kill or hit the The policy did not cover death resulting from
victim. A similar possibility is clearly ruled out "intentional injuries inflicted by the insured or
by the facts in the case now before Us. For any other person." The inquiry was as to the
while a single shot fired from a distance, and by question whether the shooting that caused the
a person who was not even seen aiming at the insured's death was accidental or intentional;
victim, could indeed have been fired without and the Court found that under the facts,
intent to kill or injure, nine wounds inflicted with showing that the murderer knew his victim and
bladed weapons at close range cannot that he fired with intent to kill, there could be no
conceivably be considered as innocent insofar recovery under the policy which excepted
as such intent is concerned. The manner of death from intentional injuries inflicted by any
execution of the crime permits no other person.
conclusion. WHEREFORE, the decision appealed from is
reversed and the complaint dismissed, without
Court decisions in the American jurisdiction, pronouncement as to costs.
Zaldivar, Castro, Fernando and Villamor, JJ., would make his life fair game of third parties.
concur.
Makasiar, J., reserves his vote. As to the rest, I have no doubt that the killing of
the insured in this case is as intentional as any
intentional act can be, hence this concurrence.

Separate Opinions TEEHANKEE, J., dissenting:


The sole issue at bar is the correctness in law
BARREDO, J., concurring of the lower court's appealed decision
During the deliberations in this case, I adjudging defendant insurance company
entertained some doubts as to the correctness liable, under its supplementary contract
and validity of the view upheld in the main denominated "Accidental Death Benefit
opinion penned by Justice Makalintal. Further Clause" with the deceased insured, to
reflection has convinced me, however, that plaintiffs-beneficiaries (excluding plaintiff
there are good reasons to support it. Emilia T. Biagtan) in an additional amount of
P5,000.00 (with corresponding legal interest)
At first blush, one would feel that every death and ruling that defendant company had failed
not suicidal should be considered accidental, to present any evidence to substantiate its
for the purposes of an accident insurance defense that the insured's death came within
policy or a life insurance policy with a double the stipulated exceptions.
indemnity clause in case death results from
accident. Indeed, it is quite logical to think that Defendant's accidental death benefit clause
any event whether caused by fault, negligence, expressly provides:
intent of a third party or any unavoidable ACCIDENTAL DEATH BENEFIT. (hereinafter
circumstance, normally unforeseen by the called the benefit). Upon receipt and approval
insured and free from any possible connivance of due proof that the death of the Insured
on his part, is an accident in the generally resulted directly from bodily injury effected
accepted sense of the term. And if I were solely through external and violent means
convinced that in including in the policy the sustained in an accident, within ninety days
provision in question, both the insurer and the after the date of sustaining such injury, and
insured had in mind to exclude thereby from the independently of all other causes, this
coverage of the policy only suicide whether Company shall pay, in addition to the sum
unhelped or helped somehow by a third party, insured specified on the first page of this Policy,
I would disregard the American decisions cited a further sum equal to said sum insured
and quoted in the main opinion as not even payable at the same time and in the same
persuasive authorities. But examining the manner as said sum insured, provided, that
unequivocal language of the provision in such death occurred during the continuance of
controversy and considering that the insured this Clause and of this Policy and before the
accepted the policy without asking that it be sixtieth birthday of the Insured."1
made clear that the phrase "injury intentionally
inflicted by a third party" should be understood A long list of exceptions and an Automatic
to refer only to injuries inflicted by a third party Discontinuance clause immediately follow
without any wilful intervention on his part (of the thereafter, thus:
insured) or, in other words, without any EXCEPTIONS. The Benefit shall not apply if
connivance with him (the insured) in order to the Insured's death shall result, either directly
augment the proceeds of the policy for his or indirectly, from any one of the following
benificiaries, I am inclined to agree that death causes:
caused by criminal assault is not covered by (1) Self-destruction or self-inflicted injuries,
the policies of the kind here in question, whether the Insured be sane or insane;
specially if the assault, as a matter of fact, (2) Bodily or mental infirmity or disease of any
could have been more or less anticipated, as kind;
when the insured happens to have violent (3) Poisoning or infection, other than infection
enemies or is found in circumstances that occurring simultaneously with and in
consequence of a cut or wound sustained in an S. Biagtan was robbed by a band of robbers
accident; who were charged in and convicted by the
(4) Injuries of which there is no visible Court of First Instance of Pangasinan for
contusions or wound on the exterior of the robbery with homicide; that in committing the
body, drowning and internal injuries revealed robbery, the robbers, on reaching the staircase
by autopsy excepted; landing of the second floor, rushed towards the
(5) Any injuries received (a) while on police doors of the second floor room, where they
duty in any military, naval or police suddenly met a person near the door of one of
organization; (b) in any riot, civil commotion, the rooms who turned out to be the insured
insurrection or war or any act incident thereto; Juan S. Biagtan who received thrust from their
(c) while travelling as a passenger or otherwise sharp-pointed instruments, causing wounds on
in any form of submarine transportation, or the body of said Juan S. Biagtan resulting in his
while engaging in submarine operations; (d) in death at about 7 a.m. on the same day, May
any violation of the law by the Insured or 21, 1964." 3
assault provoked by the Insured; (e) that has Defendant company, while admitting the
been inflicted intentionally by a third party, above-recited circumstances under which the
either with or without provocation on the part of insured met his death, disclaimed liability under
the Insured, and whether or not the attack or its accidental death benefit clause under
the defense by the third party was caused by a paragraph 5 of its stipulated "Exceptions" on its
violation of the law by the Insured; theory that the insured's death resulted from
(6) Operating or riding in or descending from injuries "intentionally inflicted by a third party,"
any kind of aircraft if the Insured is a pilot, i.e. the robbers who broke into the insured's
officer or member of the crew of the aircraft or house and inflicted fatal injuries on him.
is giving or receiving any kind of training or The case was submitted for decision upon the
instruction or has any duties aboard the aircraft parties' stipulation of facts that (1) insurance
or requiring descent therefrom; and companies such as the Lincoln National Life
(7) Atomic energy explosion of any nature Insurance Co. and Sun Life Assurance Co. of
whatsoever. Canada with which the deceased insured Juan
The Company, before making any payment S. Biagtan was also insured for much larger
under this Clause, shall have the right and sums under similar contracts with accidental
opportunity to examine the body and make an death benefit provisions have promptly paid the
autopsy thereof. benefits thereunder to plaintiffs-beneficiaries;
(2) the robbers who caused the insured's death
AUTOMATIC DISCONTINUANCE. This were charged in and convicted by the Court of
Benefit shall automatically terminate and the First Instance of Pangasinan for the crime of
additional premium therefor shall cease to be robbery with homicide; and (3) the injuries
payable when and if: inflicted on the insured by the robbers
(1) This Policy is surrendered for cash, paid-up consisted of five mortal and four non-mortal
insurance or extended term insurance; or wounds.4
(2) The benefit under the Total and Permanent
Disability Waiver of Premium Certificate is The lower court thereafter rendered judgment
granted to the insured; or against defendant, as follows:
(3) The Insured engages in military, naval or
aeronautic service in time of war; or There is no doubt that the insured, Juan S.
(4) The policy anniversary immediately Biagtan, met his death as a result of the
preceding the sixtieth birthday of the Insured is wounds inflicted upon him by the malefactors
reached.2 on the early morning of May 21, 1964 by means
It is undisputed that, as recited in the lower of thrusts from sharp-pointed instruments
court's decision, the insured met his death, as delivered upon his person, and there is likewise
follows: "that on the night of May 20, 1964 or no question that the thrusts were made on the
the first hours of May 21, 1964, while the said occasion of the robbery.
life policy and supplementary contract were in
full force and effect, the house of insured Juan
However, it is defendants' position that the excluded in the contract and have the effect of
killing of the insured was intentionally done by exempting the company from liability.
the malefactors, who were charged with and The facts in the Calanoc case insofar as
convicted of the crime of robbery with homicide pertinent to this case are, as found by the Court
by the Court of First Instance of Pangasinan. of Appeals in its decision which findings of fact
were adopted by the Supreme Court, as
It must be noted here that no evidence follows:
whatsoever was presented by the parties who
submitted the case for resolution upon the "...that on the way to the Ojeda residence
stipulation of facts presented by them. Thus, (which was then being robbed by armed men),
the court does not have before it proof that the the policeman and Atty. Ojeda passed by
act of receiving thrust(s) from the sharp-pointed Basilio (the insured) and somehow or other
instrument of the robbers was intended to inflict invited the latter to come along; that as the
injuries upon the person of the insured or any three approached the Ojeda residence and
other person or merely to scare away any stood in front of the main gate which was
person so as to ward off any resistance or covered by galvanized iron, the fence itself
obstacle that might be offered in the pursuit of being partly concrete and partly adobe stone, a
their main objective which was robbery. It was shot was fired; ... that it turned out afterwards
held that where a provision of the policy that the special watchman Melencio Basilio
excludes intentional injury, it is the intention of was hit in the abdomen, the wound causing his
the person inflicting the injury that is controlling instantaneous death ..."
... and to come within the exception, the act
which causes the injury must be wholly The Court of Appeals arrived at the conclusion
intentional, not merely partly. that the death of Basilio, although unexpected,
was not caused by an accident, being a
The case at bar has some similarity with the voluntary and intentional act on the part of the
case of Virginia Calanoc vs. Court of Appeals, one who robbed, or one of those who robbed,
et al., L-8151, promulgated December 16, the house of Atty. Ojeda.
1965, where the Supreme Court ruled that "the
shot (which killed the insured) was merely to In reversing this conclusion of the Court of
scare away the people around for his own Appeals, the Supreme Court said in part:
protection and not necessarily to kill or hit the "... Nor can it be said that the killing was
victim." intentional for there is the possibility that the
malefactors had fired the shot merely to scare
In the Calanoc case, one Melencio Basilio, a away the people around for his own protection
watchman of a certain company, took out life and not necessarily to kill or hit the victim. In
insurance from the Philippine American Life any event, while the act may not exempt the
Insurance Company in the amount of triggerman from ability for the damage done,
P2,000.00 to which was attached a the fact remains that the happening was a pure
supplementary contract covering death by accidentt on the part of the victim."
accident. Calanoc died of gunshot wounds on
the occasion of a robbery committed in the With this ruling of the Supreme Court, and the
house of a certain Atty. Ojeda in Manila. The utter absence of evidence in this case as to the
insured's widow was paid P2,000.00, the face real intention of the malefactors in making a
value of the policy, but when she demanded thrust with their sharp-pointed instrument on
payment of the additional sum of P2,000.00 any person, the victim in particular, the case
representing the value of the supplemental falls squarely within the ruling in the Calanoc
policy, the company refused alleging, as main vs. Court of Appeals case.
defense, that the deceased died because he It is the considered view of this Court that the
was murdered by a person who took part in the insured died because of an accident which
commission of the robbery and while making happened on the occasion of the robbery being
an arrest as an officer of the law which committed in his house. His death was not
contingencies were (as in this case) expressly sought (at least no evidence was presented to
show it was), and therefore was fortuitous. the first place, there is no proof that the death
"Accident" was defined as that which happens of Basilio is the result of either crime for the
by chance or fortuitously, without intention or record is barren of any circumstance showing
design, and which is unexpected, unusual and how the fatal shot was fired. Perhaps this may
unforeseen, or that which takes place without be clarified in the criminal case now pending in
one's foresight or expectation an event that court a regards the incident but before that is
proceeds from an unknown cause, or is an done anything that might be said on the point
unusual effect of a known cause, and therefore would be a mere conjecture. Nor can it be said
not expected. (29 Am. Jur. 706). that the killing was intentional for there is the
There is no question that the defense set up by possibility that the malefactor had fired the shot
the defendant company is one of those merely to scare away the people around for his
included among the risks excluded in the own protection and not necessarily to kill or hit
supplementary contract. However, there is no the victim. In any event, while the act may not
evidence here that the thrusts with sharp- exempt the triggerman from liability for the
pointed instrument (which led to the death of damage done, the fact remains that the
the insured) was "intentional," (sic) so as to happening was a pure accident on the part of
exempt the company from liability. It could the victim. The victim could have been either
safely be assumed that it was purely accidental the policeman or Atty. Ojeda for it cannot be
considering that the principal motive of the pretended that the malefactor aimed at the
culprits was robbery, the thrusts being merely deceased precisely because he wanted to take
intended to scare away persons who might his life. 7
offer resistance or might obstruct them from
pursuing their main objective which was 2. Defendant company patently failed to
robbery.5 discharge its burden of proving that the fatal
injuries were inflicted upon the deceased
It is respectfully submitted that the lower court intentionally, i.e. deliberately. The lower court
committed no error in law in holding defendant correctly held that since the case was
insurance company liable to plaintiffs- submitted upon the parties' stipulation of facts
beneficiaries under its accidental death benefit which did not cover the malefactors' intent at
clause, by virtue of the following all, there was an "utter absence of evidence in
considerations: this case as to the real intention of the
1. The case of Calanoc cited by the lower court malefactors in making a thrust with their sharp-
is indeed controlling here.6 This Court, there pointed instrument(s) on any person, the victim
construing a similar clause, squarely ruled that in particular." From the undisputed facts,
fatal injuries inflicted upon an insured by a supra,8 the robbers had "rushed towards the
malefactor(s) during the latter's commission of doors of the second floor room, where they
a crime are deemed accidental and within the suddenly met a person ... who turned out to be
coverage of such accidental death benefit the insured Juan S. Biagtan who received
clauses and the burden of proving that the thrusts from their pointed instruments." The
killing was intentional so as to have it fall within thrusts were indeed properly termed "purely
the stipulated exception of having resulted from accidental" since they seemed to be a reflex
injuries "intentionally inflicted by a third party" action on the robbers' part upon their being
must be discharged by the insurance company. surprised by the deceased. To argue, as
This Court there clearly held that in such cases defendant does, that the robbers' intent to kill
where the killing does not amount to murder, it must necessarily be deduced from the four
must be held to be a "pure accident" on the part mortal wounds inflicted upon the deceased is
of the victim, compensable with double- to beg the question. Defendant must suffer the
indemnity, even though the malefactor is consequences of its failure to discharge its
criminally liable for his act. This Court rejected burden of proving by competent evidence, e.g.
the insurance-company's contrary claim, thus: the robbers' or eyewitnesses' testimony, that
Much less can it be pretended that Basilio died the fatal injuries were intentionally inflicted
in the course of an assault or murder upon the insured so as to exempt itself from
considering the very nature of these crimes. In liability.
3. Furthermore, plaintiffs-appellees properly in favor of the insured so as to effect the
assert in their brief that the sole error assigned dominant purpose of indemnity or payment to
by defendant company, to wit, that the fatal the insured, especially where a forfeiture is
injuries were not accidental as held by the involved" (29 AM. Jur., 181), and the reason for
lower court but should be held to have been this rule is that the "insured usually has no
intentionally inflicted, raises a question of fact voice in the selection or arrangement of the
which defendant is now barred from raising, words employed and that the language of the
since it expressly limited its appeal to this Court contract is selected with great care and
purely "on questions of law", per its noitice of deliberation by experts and legal advisers
appeal,9 Defendant is therefore confined to employed by, and acting exclusively in the
"raising only questions of law" and "no other interest of, the insurance company." (44 C.J.S.,
questions" under Rule 42, section 2 of the p. 1174)
Rules of Court 10 and is deemed to have Insurance is, in its nature, complex and difficult
conceded the findings of fact of the trial court, for the layman to understand. Policies are
since he thereby waived all questions of facts. prepared by experts who know and can
11 anticipate the bearing and possible
4. It has long been an established rule of complications of every contingency. So long as
construction of so-called contracts of adhesion insurance companies insist upon the use of
such as insurance contracts, where the insured ambiguous, intricate and technical provisions,
is handed a printed insurance policy whose which conceal rather than frankly disclose, their
fine-print language has long been selected with own intentions, the courts must, in fairness to
great care and deliberation by specialists and those who purchase insurance construe every
legal advisers employed by and acting ambiguity in favor of the insured." (Algoe vs.
exclusively in the interest of the insurance Pacific Mut. L. Ins. Co., 91 Wash. 324 LRA
company, that the terms and phraseology of 1917A, 1237.)
the policy, particularly of any exception "An insurer should not be allowed, by the use
clauses, must be clearly expressed so as to be of obscure phrases and exceptions, to defeat
easily understood by the insured and any the very purpose for which the policy was
"ambiguous, equivocal or uncertain terms" are procured." (Moore vs. Aetna Life Insurance
to be "construed strictly and most strongly Co., LRA 1915D, 164). 12
against the insurer and liberally in favor of the The Court has but recently reiterated this
insured so as to effect the dominant purpose of doctrine in Landicho vs. GSIS 13 and again
indemnity or payment to the insured, especially applied the provisions of Article 1377 of our
where a forfeiture is involved. Civil Code that "The interpretation of obscure
words or stipulations in a contract shall not
The Court so expressly held in Calanoc that: favor the party who caused the obscurity."
... While as a general rule "the parties may limit 5. The accidental death benefit clause assuring
the coverage of the policy to certain particular the insured's beneficiaries of double indemnity,
accidents and risks or causes of loss, and may upon payment of an extra premium, in the
expressly except other risks or causes of loss event that the insured meets violent accidental
therefrom" (45 C.J.S. 781-782), however, it is death is contractually stipulated as follows in
to be desired that the terms and phraseology of the policy: "that the death of the insured
the exception clause be clearly expressed so resulted directly from bodily injury effected
as to be within the easy grasp and solely through external and violent means
understanding of the insured, for if the terms sustained in an accident," supra. The policy
are doubtful or obscure the same must of then lists numerous exceptions, which may be
necessity be interpreted or resolved against the classified as follows:
one who has caused the obscurity. (Article Injuries effected through non-external
1377, new Civil Code) And so it has been means which are excepted: self-destruction,
generally held that the "terms in an insurance bodily or mental infirmity or disease, poisoning
policy, which are ambiguous, equivocal, or or infection, injuries with no visible contusions
uncertain ... are to be construed strictly and or exterior wounds (exceptions 1 to 4 of policy
most strongly against the insurer, and liberally clause);
Injuries caused by some act of the insured Finally, the untenability of herein defendant
which is proscribed by the policy, and are insurer's claim that the insured's death fell
therefore similarly exepted: injuries received within the exception is further heightened by
while on police duty, while travelling in any form the stipulated fact that two other insurance
of submarine transportation, or in any violation companies which likewise covered the insured
of law by the insured or assault provoked by the for which larger sums under similar accidental
insured, or in any aircraft if the insured is a pilot death benefit clauses promptly paid the
or crew member; [exceptions 5 (a), (c) and (d), benefits thereof to plaintiffs-beneficiaries.
and 6 of the policy clause]; and I vote accordingly for the affirmance in toto of
Accidents expressly excluded: where death the appealed decision, with costs against
resulted in any riot, civil commotion, defendant-appellant.
insurrection or war or atomic energy explosion. Concepcion, C.J. and Reyes, J.B.L., J., concur.
(Exceptions 5[b] and 7 of policy clause).
The only exception which is not susceptible of
classification is that provided in paragraph 5 Separate Opinions
(e), the very exception herein involved, which BARREDO, J., concurring
would also except injuries "inflicted During the deliberations in this case, I
intentionally by a third party, either with or entertained some doubts as to the correctness
without provocation on the part of the insured, and validity of the view upheld in the main
and whether or not the attack or the defense by opinion penned by Justice Makalintal. Further
the third party was caused by a violation of the reflection has convinced me, however, that
law by the insured." there are good reasons to support it.
This ambiguous clause conflicts with all the At first blush, one would feel that every death
other four exceptions in the same paragraph 5 not suicidal should be considered accidental,
particularly that immediately preceding it in for the purposes of an accident insurance
item (d) which excepts injuries received where policy or a life insurance policy with a double
the insured has violated the law or provoked indemnity clause in case death results from
the injury, while this clause, construed as the accident. Indeed, it is quite logical to think that
insurance company now claims, would any event whether caused by fault, negligence,
seemingly except also all other injuries, intent of a third party or any unavoidable
intentionally inflicted by a third party, circumstance, normally unforeseen by the
regardless of any violation of law or insured and free from any possible connivance
provocation by the insured, and defeat the very on his part, is an accident in the generally
purpose of the policy of giving the insured accepted sense of the term. And if I were
double indemnity in case of accidental death by convinced that in including in the policy the
"external and violent means" in the very provision in question, both the insurer and the
language of the policy." insured had in mind to exclude thereby from the
It is obvious from the very classification of the coverage of the policy only suicide whether
exceptions and applying the rule of noscitus a unhelped or helped somehow by a third party,
sociis that the double-indemnity policy covers I would disregard the American decisions cited
the insured against accidental death, whether and quoted in the main opinion as not even
caused by fault, negligence or intent of a third persuasive authorities. But examining the
party which is unforeseen and unexpected by unequivocal language of the provision in
the insured. All the associated words and controversy and considering that the insured
concepts in the policy plainly exclude the accepted the policy without asking that it be
accidental death from the coverage of the made clear that the phrase "injury intentionally
policy only where the injuries are self-inflicted inflicted by a third party" should be understood
or attended by some proscribed act of the to refer only to injuries inflicted by a third party
insured or are incurred in some expressly without any wilful intervention on his part (of the
excluded calamity such as riot, war or atomic insured) or, in other words, without any
explosion. connivance with him (the insured) in order to
augment the proceeds of the policy for his
benificiaries, I am inclined to agree that death
caused by criminal assault is not covered by (3) Poisoning or infection, other than infection
the policies of the kind here in question, occurring simultaneously with and in
specially if the assault, as a matter of fact, consequence of a cut or wound sustained in an
could have been more or less anticipated, as accident;
when the insured happens to have violent (4) Injuries of which there is no visible
enemies or is found in circumstances that contusions or wound on the exterior of the
would make his life fair game of third parties. body, drowning and internal injuries revealed
As to the rest, I have no doubt that the killing of by autopsy excepted;
the insured in this case is as intentional as any (5) Any injuries received (a) while on police
intentional act can be, hence this concurrence. duty in any military, naval or police
TEEHANKEE, J., dissenting: organization; (b) in any riot, civil commotion,
The sole issue at bar is the correctness in law insurrection or war or any act incident thereto;
of the lower court's appealed decision (c) while travelling as a passenger or otherwise
adjudging defendant insurance company in any form of submarine transportation, or
liable, under its supplementary contract while engaging in submarine operations; (d) in
denominated "Accidental Death Benefit any violation of the law by the Insured or
Clause" with the deceased insured, to assault provoked by the Insured; (e) that has
plaintiffs-beneficiaries (excluding plaintiff been inflicted intentionally by a third party,
Emilia T. Biagtan) in an additional amount of either with or without provocation on the part of
P5,000.00 (with corresponding legal interest) the Insured, and whether or not the attack or
and ruling that defendant company had failed the defense by the third party was caused by a
to present any evidence to substantiate its violation of the law by the Insured;
defense that the insured's death came within (6) Operating or riding in or descending from
the stipulated exceptions. any kind of aircraft if the Insured is a pilot,
Defendant's accidental death benefit clause officer or member of the crew of the aircraft or
expressly provides: is giving or receiving any kind of training or
ACCIDENTAL DEATH BENEFIT. (hereinafter instruction or has any duties aboard the aircraft
called the benefit). Upon receipt and approval or requiring descent therefrom; and
of due proof that the death of the Insured (7) Atomic energy explosion of any nature
resulted directly from bodily injury effected whatsoever.
solely through external and violent means The Company, before making any payment
sustained in an accident, within ninety days under this Clause, shall have the right and
after the date of sustaining such injury, and opportunity to examine the body and make an
independently of all other causes, this autopsy thereof.
Company shall pay, in addition to the sum AUTOMATIC DISCONTINUANCE. This
insured specified on the first page of this Policy, Benefit shall automatically terminate and the
a further sum equal to said sum insured additional premium therefor shall cease to be
payable at the same time and in the same payable when and if:
manner as said sum insured, provided, that (1) This Policy is surrendered for cash, paid-up
such death occurred during the continuance of insurance or extended term insurance; or
this Clause and of this Policy and before the (2) The benefit under the Total and Permanent
sixtieth birthday of the Insured."1 Disability Waiver of Premium Certificate is
A long list of exceptions and an Automatic granted to the insured; or
Discontinuance clause immediately follow (3) The Insured engages in military, naval or
thereafter, thus: aeronautic service in time of war; or
EXCEPTIONS. The Benefit shall not apply if (4) The policy anniversary immediately
the Insured's death shall result, either directly preceding the sixtieth birthday of the Insured is
or indirectly, from any one of the following reached.2
causes: It is undisputed that, as recited in the lower
(1) Self-destruction or self-inflicted injuries, court's decision, the insured met his death, as
whether the Insured be sane or insane; follows: "that on the night of May 20, 1964 or
(2) Bodily or mental infirmity or disease of any the first hours of May 21, 1964, while the said
kind; life policy and supplementary contract were in
full force and effect, the house of insured Juan convicted of the crime of robbery with homicide
S. Biagtan was robbed by a band of robbers by the Court of First Instance of Pangasinan.
who were charged in and convicted by the It must be noted here that no evidence
Court of First Instance of Pangasinan for whatsoever was presented by the parties who
robbery with homicide; that in committing the submitted the case for resolution upon the
robbery, the robbers, on reaching the staircase stipulation of facts presented by them. Thus,
landing of the second floor, rushed towards the the court does not have before it proof that the
doors of the second floor room, where they act of receiving thrust(s) from the sharp-pointed
suddenly met a person near the door of one of instrument of the robbers was intended to inflict
the rooms who turned out to be the insured injuries upon the person of the insured or any
Juan S. Biagtan who received thrust from their other person or merely to scare away any
sharp-pointed instruments, causing wounds on person so as to ward off any resistance or
the body of said Juan S. Biagtan resulting in his obstacle that might be offered in the pursuit of
death at about 7 a.m. on the same day, May their main objective which was robbery. It was
21, 1964." 3 held that where a provision of the policy
Defendant company, while admitting the excludes intentional injury, it is the intention of
above-recited circumstances under which the the person inflicting the injury that is controlling
insured met his death, disclaimed liability under ... and to come within the exception, the act
its accidental death benefit clause under which causes the injury must be wholly
paragraph 5 of its stipulated "Exceptions" on its intentional, not merely partly.
theory that the insured's death resulted from The case at bar has some similarity with the
injuries "intentionally inflicted by a third party," case of Virginia Calanoc vs. Court of Appeals,
i.e. the robbers who broke into the insured's et al., L-8151, promulgated December 16,
house and inflicted fatal injuries on him. 1965, where the Supreme Court ruled that "the
The case was submitted for decision upon the shot (which killed the insured) was merely to
parties' stipulation of facts that (1) insurance scare away the people around for his own
companies such as the Lincoln National Life protection and not necessarily to kill or hit the
Insurance Co. and Sun Life Assurance Co. of victim."
Canada with which the deceased insured Juan In the Calanoc case, one Melencio Basilio, a
S. Biagtan was also insured for much larger watchman of a certain company, took out life
sums under similar contracts with accidental insurance from the Philippine American Life
death benefit provisions have promptly paid the Insurance Company in the amount of
benefits thereunder to plaintiffs-beneficiaries; P2,000.00 to which was attached a
(2) the robbers who caused the insured's death supplementary contract covering death by
were charged in and convicted by the Court of accident. Calanoc died of gunshot wounds on
First Instance of Pangasinan for the crime of the occasion of a robbery committed in the
robbery with homicide; and (3) the injuries house of a certain Atty. Ojeda in Manila. The
inflicted on the insured by the robbers insured's widow was paid P2,000.00, the face
consisted of five mortal and four non-mortal value of the policy, but when she demanded
wounds.4 payment of the additional sum of P2,000.00
The lower court thereafter rendered judgment representing the value of the supplemental
against defendant, as follows: policy, the company refused alleging, as main
There is no doubt that the insured, Juan S. defense, that the deceased died because he
Biagtan, met his death as a result of the was murdered by a person who took part in the
wounds inflicted upon him by the malefactors commission of the robbery and while making
on the early morning of May 21, 1964 by means an arrest as an officer of the law which
of thrusts from sharp-pointed instruments contingencies were (as in this case) expressly
delivered upon his person, and there is likewise excluded in the contract and have the effect of
no question that the thrusts were made on the exempting the company from liability.
occasion of the robbery. However, it is The facts in the Calanoc case insofar as
defendants' position that the killing of the pertinent to this case are, as found by the Court
insured was intentionally done by the of Appeals in its decision which findings of fact
malefactors, who were charged with and were adopted by the Supreme Court, as
follows: the defendant company is one of those
"...that on the way to the Ojeda residence included among the risks excluded in the
(which was then being robbed by armed men), supplementary contract. However, there is no
the policeman and Atty. Ojeda passed by evidence here that the thrusts with sharp-
Basilio (the insured) and somehow or other pointed instrument (which led to the death of
invited the latter to come along; that as the the insured) was "intentional," (sic) so as to
three approached the Ojeda residence and exempt the company from liability. It could
stood in front of the main gate which was safely be assumed that it was purely accidental
covered by galvanized iron, the fence itself considering that the principal motive of the
being partly concrete and partly adobe stone, a culprits was robbery, the thrusts being merely
shot was fired; ... that it turned out afterwards intended to scare away persons who might
that the special watchman Melencio Basilio offer resistance or might obstruct them from
was hit in the abdomen, the wound causing his pursuing their main objective which was
instantaneous death ..." robbery.5
The Court of Appeals arrived at the conclusion It is respectfully submitted that the lower court
that the death of Basilio, although unexpected, committed no error in law in holding defendant
was not caused by an accident, being a insurance company liable to plaintiffs-
voluntary and intentional act on the part of the beneficiaries under its accidental death benefit
one who robbed, or one of those who robbed, clause, by virtue of the following
the house of Atty. Ojeda. considerations:
In reversing this conclusion of the Court of 1. The case of Calanoc cited by the lower court
Appeals, the Supreme Court said in part: is indeed controlling here.6 This Court, there
"... Nor can it be said that the killing was construing a similar clause, squarely ruled that
intentional for there is the possibility that the fatal injuries inflicted upon an insured by a
malefactors had fired the shot merely to scare malefactor(s) during the latter's commission of
away the people around for his own protection a crime are deemed accidental and within the
and not necessarily to kill or hit the victim. In coverage of such accidental death benefit
any event, while the act may not exempt the clauses and the burden of proving that the
triggerman from ability for the damage done, killing was intentional so as to have it fall within
the fact remains that the happening was a pure the stipulated exception of having resulted from
accidentt on the part of the victim." injuries "intentionally inflicted by a third party"
With this ruling of the Supreme Court, and the must be discharged by the insurance company.
utter absence of evidence in this case as to the This Court there clearly held that in such cases
real intention of the malefactors in making a where the killing does not amount to murder, it
thrust with their sharp-pointed instrument on must be held to be a "pure accident" on the part
any person, the victim in particular, the case of the victim, compensable with double-
falls squarely within the ruling in the Calanoc indemnity, even though the malefactor is
vs. Court of Appeals case. criminally liable for his act. This Court rejected
It is the considered view of this Court that the the insurance-company's contrary claim, thus:
insured died because of an accident which Much less can it be pretended that Basilio died
happened on the occasion of the robbery being in the course of an assault or murder
committed in his house. His death was not considering the very nature of these crimes. In
sought (at least no evidence was presented to the first place, there is no proof that the death
show it was), and therefore was fortuitous. of Basilio is the result of either crime for the
"Accident" was defined as that which happens record is barren of any circumstance showing
by chance or fortuitously, without intention or how the fatal shot was fired. Perhaps this may
design, and which is unexpected, unusual and be clarified in the criminal case now pending in
unforeseen, or that which takes place without court a regards the incident but before that is
one's foresight or expectation an event that done anything that might be said on the point
proceeds from an unknown cause, or is an would be a mere conjecture. Nor can it be said
unusual effect of a known cause, and therefore that the killing was intentional for there is the
not expected. (29 Am. Jur. 706). possibility that the malefactor had fired the shot
There is no question that the defense set up by merely to scare away the people around for his
own protection and not necessarily to kill or hit Rules of Court 10 and is deemed to have
the victim. In any event, while the act may not conceded the findings of fact of the trial court,
exempt the triggerman from liability for the since he thereby waived all questions of facts.
11
damage done, the fact remains that the
happening was a pure accident on the part of 4. It has long been an established rule of
the victim. The victim could have been either construction of so-called contracts of adhesion
the policeman or Atty. Ojeda for it cannot be such as insurance contracts, where the insured
pretended that the malefactor aimed at the is handed a printed insurance policy whose
deceased precisely because he wanted to take fine-print language has long been selected with
his life. 7 great care and deliberation by specialists and
2. Defendant company patently failed to legal advisers employed by and acting
discharge its burden of proving that the fatal exclusively in the interest of the insurance
injuries were inflicted upon the deceased company, that the terms and phraseology of
intentionally, i.e. deliberately. The lower court the policy, particularly of any exception
correctly held that since the case was clauses, must be clearly expressed so as to be
submitted upon the parties' stipulation of facts easily understood by the insured and any
which did not cover the malefactors' intent at "ambiguous, equivocal or uncertain terms" are
all, there was an "utter absence of evidence in to be "construed strictly and most strongly
this case as to the real intention of the against the insurer and liberally in favor of the
malefactors in making a thrust with their sharp- insured so as to effect the dominant purpose of
pointed instrument(s) on any person, the victim indemnity or payment to the insured, especially
in particular." From the undisputed facts, where a forfeiture is involved.
supra,8 the robbers had "rushed towards the The Court so expressly held in Calanoc that:
doors of the second floor room, where they ... While as a general rule "the parties may limit
suddenly met a person ... who turned out to be the coverage of the policy to certain particular
the insured Juan S. Biagtan who received accidents and risks or causes of loss, and may
thrusts from their pointed instruments." The expressly except other risks or causes of loss
thrusts were indeed properly termed "purely therefrom" (45 C.J.S. 781-782), however, it is
accidental" since they seemed to be a reflex to be desired that the terms and phraseology of
action on the robbers' part upon their being the exception clause be clearly expressed so
surprised by the deceased. To argue, as as to be within the easy grasp and
defendant does, that the robbers' intent to kill understanding of the insured, for if the terms
must necessarily be deduced from the four are doubtful or obscure the same must of
mortal wounds inflicted upon the deceased is necessity be interpreted or resolved against the
to beg the question. Defendant must suffer the one who has caused the obscurity. (Article
consequences of its failure to discharge its 1377, new Civil Code) And so it has been
burden of proving by competent evidence, e.g. generally held that the "terms in an insurance
the robbers' or eyewitnesses' testimony, that policy, which are ambiguous, equivocal, or
the fatal injuries were intentionally inflicted uncertain ... are to be construed strictly and
upon the insured so as to exempt itself from most strongly against the insurer, and liberally
liability. in favor of the insured so as to effect the
3. Furthermore, plaintiffs-appellees properly dominant purpose of indemnity or payment to
assert in their brief that the sole error assigned the insured, especially where a forfeiture is
by defendant company, to wit, that the fatal involved" (29 AM. Jur., 181), and the reason for
injuries were not accidental as held by the this rule is that the "insured usually has no
lower court but should be held to have been voice in the selection or arrangement of the
intentionally inflicted, raises a question of fact words employed and that the language of the
which defendant is now barred from raising, contract is selected with great care and
since it expressly limited its appeal to this Court deliberation by experts and legal advisers
purely "on questions of law", per its noitice of employed by, and acting exclusively in the
appeal,9 Defendant is therefore confined to interest of, the insurance company." (44 C.J.S.,
"raising only questions of law" and "no other p. 1174)
questions" under Rule 42, section 2 of the Insurance is, in its nature, complex and difficult
for the layman to understand. Policies are The only exception which is not susceptible of
prepared by experts who know and can classification is that provided in paragraph 5
anticipate the bearing and possible (e), the very exception herein involved, which
complications of every contingency. So long as would also except injuries "inflicted
insurance companies insist upon the use of intentionally by a third party, either with or
ambiguous, intricate and technical provisions, without provocation on the part of the insured,
which conceal rather than frankly disclose, their and whether or not the attack or the defense by
own intentions, the courts must, in fairness to the third party was caused by a violation of the
those who purchase insurance construe every law by the insured."
ambiguity in favor of the insured." (Algoe vs. This ambiguous clause conflicts with all the
Pacific Mut. L. Ins. Co., 91 Wash. 324 LRA other four exceptions in the same paragraph 5
1917A, 1237.) particularly that immediately preceding it in
"An insurer should not be allowed, by the use item (d) which excepts injuries received where
of obscure phrases and exceptions, to defeat the insured has violated the law or provoked
the very purpose for which the policy was the injury, while this clause, construed as the
procured." (Moore vs. Aetna Life Insurance insurance company now claims, would
Co., LRA 1915D, 164). 12 seemingly except also all other injuries,
The Court has but recently reiterated this intentionally inflicted by a third party,
doctrine in Landicho vs. GSIS 13 and again regardless of any violation of law or
applied the provisions of Article 1377 of our provocation by the insured, and defeat the very
Civil Code that "The interpretation of obscure purpose of the policy of giving the insured
words or stipulations in a contract shall not double indemnity in case of accidental death by
favor the party who caused the obscurity." "external and violent means" in the very
5. The accidental death benefit clause assuring language of the policy."
the insured's beneficiaries of double indemnity, It is obvious from the very classification of the
upon payment of an extra premium, in the exceptions and applying the rule of noscitus a
event that the insured meets violent accidental sociis that the double-indemnity policy covers
death is contractually stipulated as follows in the insured against accidental death, whether
the policy: "that the death of the insured caused by fault, negligence or intent of a third
resulted directly from bodily injury effected party which is unforeseen and unexpected by
solely through external and violent means the insured. All the associated words and
sustained in an accident," supra. The policy concepts in the policy plainly exclude the
then lists numerous exceptions, which may be accidental death from the coverage of the
classified as follows: policy only where the injuries are self-inflicted
Injuries effected through non-external or attended by some proscribed act of the
means which are excepted: self-destruction, insured or are incurred in some expressly
bodily or mental infirmity or disease, poisoning excluded calamity such as riot, war or atomic
or infection, injuries with no visible contusions explosion.
or exterior wounds (exceptions 1 to 4 of policy Finally, the untenability of herein defendant
clause); insurer's claim that the insured's death fell
Injuries caused by some act of the insured within the exception is further heightened by
which is proscribed by the policy, and are the stipulated fact that two other insurance
therefore similarly exepted: injuries received companies which likewise covered the insured
while on police duty, while travelling in any form for which larger sums under similar accidental
of submarine transportation, or in any violation death benefit clauses promptly paid the
of law by the insured or assault provoked by the benefits thereof to plaintiffs-beneficiaries.
insured, or in any aircraft if the insured is a pilot I vote accordingly for the affirmance in toto of
or crew member; [exceptions 5 (a), (c) and (d), the appealed decision, with costs against
and 6 of the policy clause]; and defendant-appellant.
Accidents expressly excluded: where death Concepcion, C.J. and Reyes, J.B.L., J., concur.
resulted in any riot, civil commotion,
insurrection or war or atomic energy explosion.
(Exceptions 5[b] and 7 of policy clause).