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s CASE
DIGESTS
FOR
INSURANCE

1. Enriques v. FACTS:
Sunlife  Joaquin Herrer applied at Sun Life Assurance Co. on Sep 1917 for life aNnuity thru Manila office
 Paid 6,000 to the manager and a receipt were issued. Application was forwarded to Canada.
 Acceptance was made on Nov 1917 thru cable
 December 4 policy was issued at Canada
 Dec 18 – Atty. Torres wrote to Manila office stating J. Herrer is withdrawing its application
 Dec 19 – office replied saying policy have already been issued
 Dec 20 – J. Herrer died
 Dec 21 – Atty. Torres received policy
ISSUE:
 Whether or not the contract for a life annuity was perfected?
RULING:
 Art. 1262 of Civil code
HELD:
 No.That the contract for a life annuity was not perfected because it had not been proved satisfactorily that the acceptance of
the application ever came to the knowledge of the applicant
 As provided in article 1262 of the Civil Code three things had to be accomplished by the insurance company before there was
a contract
 (1) There had to be a medical examination of the applicant;
 (2) there had to be approval of the application by the head office of the company
 (3) this approval had in some way to be communicated by the company to the applicant
2. Eternal FACTS:
Gardens  Dec 10 1980 PhilamLIfe Insurance Company (PhilamLife) entered agreement with Eternal Gardens Memorial Park (Eternal
Memorial Gardens)denominated as Policy No. 1920
Park Corp v.  Policy contains the ff:
The  Clients who purchased burial lots on installment would be insured by Philamlife
Philippine  Amount of insurance will depend upon the existing balance of purchased burial ots
American  Policy is effective for a period of one year renewable on a yearly basis
Life  Policy says that Any Lot Purchaser of the Assured who is at least 18 but not more than 65 years of age, is indebted to th e
assured for the unpaid balance of his loan with the Assured, and is accepted for Life Insurance coverage by the Company on
its effective date is eligible for insurance under the Policy
 No med exam shall be required for amount of insurance up to 50K but a declaration of good health shall be required.
 That the insurance company reserves the right to require further evidence w/ respect to insurance in excess of 50K and any lot
purchaser above 55y/o
 Benefit: amount paid of the unpaid balance of the loan or 100K whichever is lower
 Effectivity: on the date the contract of loan with eternal gardens
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 John Chuang one of the “new businesses” of Eternal gardens died, so the latter sent an insurance claim letter to Philamlife.
 Philam asked for the cert of claim, assured cert, application for insurance accomplished by chuang & statement of account
showing unpaid balance of chuang.
 Philamlife received required documents on nov 15, 1984 but after a year no reply was sent to eternal gardens
 A demand letter was sent to philamlife and in reply the latter said that they do not approve the insurance of chuang due to the
ff:
o Chuang was 59 y/o
o No application for group insurance was submitted prior his death
o Mr. Chuang is not covered under the agreed policy
 RTC ruled in favor of Eternal Gardens, CA reversed the decision. Eternal gardenssubmitted a petition for certiorari
ISSUE:
 W/n Chuang is covered the in the policy?
RULING:

HELD:
 Yes, Mr Chuang is covered by the group insurance policy. Philamlife stamped as received the list of burial buyers without
checking id indeed the application of Mr.Chuang was in the attachment.
 Also the effectivity statement of the insurance policy is ambiguous: The first sentence appears to state that the insurance
coverage of the clients of Eternal already became effective upon contracting a loan with Eternal while the second sentence
appears to require Philamlife to approve the insurance contract before the same can become effective.
 Court ruled that since a contract of insurance is a contract of adhesion, any ambiguity should be resolved strictly against the
insurer and in favor of the insured
3. Philamcare FACTS:
Health  Ernani Trinos (deceased) application for a HealthCare agreement for a healthcare coverage was approved for a period of one
Systems vs. year.
CA & Julita  Agreement provides that was entitled to avail of hospitalization benefits, whether ordinary or emergency, listed therein. He was
Trinos also entitled to avail of "out-patient benefits" such as annual physical examinations, preventive health care and other out-
patient services.
 Agreement was then extended for 1 year with increased coverage up to 75,000 per disability.
 During the period of his coverage Ernani suffered a heart attack and was confined in MMC for 1 month, Julita(wife) tried to
claim the benefits of the health care agreement however Philamcare said that the agreement was void due to the concealment
regarding Ernani’s medical history.
 Ernani was then discharged at MMC and was attended by a physical therapist at home.
 He was again hospitalized this time at the Chines General Hospital but due to financial difficulties, he was brought home
again. Thereafter he died.
 Ernani Trinos filed a case against Philamcare where she asked for reimbursement for her expenses. RTC and CA ruled in
favor of Ernani
 Philamcare argues that the agreement grants living benefits that the member may enjoy so long as he is alive upon the
effectivity of the agreement
 Philamcare further argues that it is not an insurance company
ISSUE:
 Whether or not Ernani Trinos is entitled to reimbursement under the agreement signed b
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 y his deceased husband?

RULING: Sec 27 of Insurance Code
HELD:
 Yes, Julita Trinos is entitled to reimbursement.
 Sec 27 of the insurance code provides that concealment entitles the injured party to rescind a contract of insurance however in
this case no rescission was made. It is required that the ff condition occurred:
o Prior notice of cancelation
o Notice must be based on the occurrence after effective date of policy
o Must be in writing, mailed or delivered to the insured at the address shown in the policy
o Must state the grounds where cancellation is based
 Being a contract of adhesion it must be noted that whenever there are ambiguity in the terms & condition of the contract must
be construed strictly against the insurer and liberally in favor of the insured
 Finally on the issue that Julita is not the legal wife of Ernani, the court ruled that the health care agreement is in the nature of a
contract of indemnity hence payment should be made to the party who incurred the expenses.