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,I
POINTS TO PONDER IN INSURANCE
SURANCE
URANCE LAW

ew
FOR THE 2022 BAR EXAMINATIONS
XAMINATI
AMINA

PROF. ERICKSON
SONON H. BALMES
BAL
B

i
ev
Deputy Commissioner,
oner, Insurance
ner, Insura
Insu Commission

SUPREME

R
EME COURT DECISIONS
E COUR
COU

SUN LIFE OF CANADA

NADA
ADA (PH
al (PHILIPPINES), INC., v. MA. DAISY S.
A et., al. G.
SIBYA G.R. No. 211212, June 08, 2016.
n
Where mattersrs of opinion
opinio or judgment are called for, answers made in good
io

faith and without

thout intent
inte
int to deceive will not avoid a policy even though they
are untrue.
ue.
e.
ss

ie
deed,
eed, the iintent to defraud on the part of the insured must be ascertained
Indeed,
to
o merit rescission
re
r of the insurance contract.
fe

ev
Conc i
Concealment as a defense for the insurer mative
to avoid liability is an affirmative
o

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de
defense and the duty to establish
stablish such defense by satisfactory ctory and
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convincing evidence rests upon

pon the
h p provider or insurer.

r
Ba

HEIRS OF LORETO
TO
OC C.. MA
MARAMAG vs. EVA VERNA DE GUZMAN
GUZM
Ba
s

MARAMAG
MAG
AG et
e
et., a
al., G.R. No. 181132, June 5, 2009.
2009
s

Pursuant to Section 5 53 of the Insurance Code, it is obvious

obvio that the only
e

persons entitled
ntitled to claim the insurance proceedseds
ds are
a either
eit the insured, if
bl

ve;
e; or the beneficiary, if the insured iss already
still alive; alreead deceased, upon the
eady
li

uration
ation of tthe policy. The exception to
maturation o this rul le
rulee is a situation where the
o

surance co
insurance nefit
efit third persons
contract was intended to benefit p who are not parties
r
n

Ba
R

to the sa same in the form of favorableble

e stipul
stipula
stipulat
tip
stipulations or indemnity. In such h a
t
case, third parties may directly suee and clai
claim from the insurer.
O
an

et

The beneficiary in a contractt of insur

T insurance
insu is not the donee spoken n in tthe
he law
s

of donation. The rules on testame

testamentary succession cannot apply ply here, for
pply
h

the insurance indemnity nityy does not partake of a donation. n. As such,

such the
suc
rn
bl
C

insurance indemnity y cannot b be considered as an advance inheritance

e of the inh
in
which can be subject
bject collation
ect to co
col (citing Del Val v. Del ell Val, 29 Phil. 534).
o

FOR EMPHASIS: SIS: The proceeds

p of an insurance policy
olicy belon exclusively to
cy belong
te

the beneficiary
ciary not to the estate of the person
ary and n on whose
son whos life was insured,
R

and thatt such proceeds are the separate and

uch pro nd individual
indivi
individ property of the
In
an

beneficiary
ficiary
ciary and not of the heirs of the person n whose life was insured.

THE INS
INSULAR ASSURANCE CO.,, LTD., V.
IN V THE HEIRS OF JOSE H.
es
h

ALVAREZ, G.R. No. 207526 October

O 3, 2018
C

bl

On Fraudulent Intent:
o
R
an

1
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,I
The Insurance Code dispenses with proof off fraudulent
fraudule
fraudulen intent in cases of

ew
rescission due to concealment but not so in
n cases of rescission due to false
representations.

i
ev
On Concealment:
Concealment exists where the assured h has knowledge of a fact material to
ha
the risk, and honesty, good faith,
aith, and fair dealing requires that he should

R
communicate it to the assured,
ure but
sured, ut he designedly and intentionally withholds
the same.
al
The Principal Question
estion Concealment:
tion on C
n
ssurer
urer misle
Was the assurer mis
misled or deceived into entering a contract obligation or in
io

fixing the
he premium of insurance by a withholding of material information or
facts within
with the assured's knowledge or presumed knowledge?
ss

ie
On
n the Dut
Duty of Insurance Companies:
fe

ev
Insurance companies are imbued
Insur ed with public trust in the sense that at they
o

R
ha
hav
have the obligation to ensure that
hat they will be able to provide succorr to
o those
r

that enter into contracts withh them

th hem by being both frugal and, att the sa same
am
m
Pr

r
time, diligent in their asse
ass
assessment
sessment of the risk which they take
sessment ake
ke with e every
Ba

insurance contract.
Ba
s

N INSUR
MALAYAN INSURA
RA
INSURANCE LIPP
IP NES FIRST
CO., INC., vs. PHILIPPINES
s

INSURANCE
CE CO., INC.
NCE IN and REPUTABLE FORWARDER
RW
RWARDE SERVICES,
e

INC
INC.
INC., G.R. NO. 184300, July
ly 11,
11 201
2012.
bl

n Geag
Geagonia
ago
go , the Court ruled that
li

In interpreting
terpreting
rpreting tthe “other insurance clause” in
o

the prohibition applies only in case of double

e prohibiti
prohibitio ble insurance.
insu
r
n

Ba
R

The Court
Co ruled that in order to constitute
stitute a violation of the clause, the o
nstitute other
her
er
O
an

insurance must be upon same subj

ins
insu subject
ect
ct ma
matter, the same interest therein,
ein,
in, a
an
and
the same risk.
th
et
s
h

in
Thus, even though the multiple insurance policies involved werere all issued
issu in
rn
bl
C

the name of the same me

e assured,
assured over the same subject matteratter and covering
as ruled that
the same risk, it was tth there was no violation off the “other
“othe insurance
here
ere was no
clause” since there n double insurance.
o

te
R

MILAGROS
OS P. ENRIQUEZ,
GROS EN
E VS. THE MERCANTILE
CANTILE
ANTILE INSURANCE
I CO.
In

INC.,
an

G.R. 210950, August

ugust
gus 15, 2
2018
es
h

On Effec
Effectivity of Surety Bonds:
surety bond remains effective
A sur ve until the action or proceeding is finally
C

bl

decided, resolved, or terminated,

dec ted, regardless of whether the applicant fails to
d, regard
renew the bond. As a result, applicant will be liable to the surety for any
t, the appl
o

payment the surety makes kes on the bond, but only up to the amount of this
bond.
R
an

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n
,I
PEOPLE’S TRANS-EAST ASIA INSURANCE
NCE
CE CORPORATION,
CORP
CORPO A.K.A.

ew
PEOPLE’S GENERAL INSURANCE CORPORATION,
RPORAT
RPORATIO VS. DOCTORS OF
NEW MILLENNIUM HOLDINGS, INC.
M HOLDING
HOLDIN
G.R. No. 172404,
4,, August
Augus 113, 2014

i
ev
On Surety Bonds:
The liabilities of an insurer under ssurety bond are not extinguished when
der the su

R
princip
in
the modifications in the principal l contract
con
co do not substantially or materially
alter the principal’s obligations.
igations.
gations. The surety is jointly and severally liable with
al
its principal when thehe
e latter de
defaults from its obligations under the principal
contract.
n
io

By its very nature,

ature, under
un
u the laws regulating suretyship, the liability of the
surety is joint
oint and several but is limited to the amount of the bond, and its
terms are determ
determined strictly by the terms of the contract of suretyship in
ss

ie
relation
tion to the principal contract between the obligor and the 3blige.
ation
fe

ev
Although the contract of suretyship is, in essence, secondary only to a valid lid
principal obligation, the surety’s liab
princi liability to the creditor is direct, primary,
ry, and
o

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absolute; he becomes liable for
ab or the debt
d and duty of another although
hou
ugh
gh he
r

possesses no direct or personal al interest

rsonal
onal
nal inte
in
int over the obligations nor or does he
h
Pr

r
receive any benefit therefrom.
efrrrom.
om.
Ba

Ba
r, is no
A surety, however, nott released
re
rel ontract w
by a change in the contract which does
s

fect
ect of ma
not have the effect erous.
rous
making its obligation more onerous.
e s

SUN INSURANCE V. CA,

A,
bl

54
211 SCRA 554
li
o

THE
HE MERE ACT
A OF THE INSURED OF POINTING
OINTING
NTING T
THE GUN TO HIS TEMPLE,
r
n

Ba
BELIEVING THAT THE GUN WAS NOT
BELIEVIN T LOADED
LOADE
LOAD
OADED AND THE GUN FIRED WHENEN
R

HE PULLED
PU THE TRIGGER RESULTING
LTING
TING IN HIS DEATH WAS HELD AS S AN
N
O
an

AC
ACC
ACCIDENT.
et
s

DELA CRUZ
RUZ V. C
CA
CAPITAL INSURANCE
h

17 SCRA 559
rn
bl
C

DEATH ARISING FROM

ROM A BOXING
BO
B MATCH IS AN ACCIDENT.
DENT..
DENT
o

te

PHILIPPINE
NE HEALTH
HEALT CARE PROVIDERS, INC.
NC.
C. vs. COMMISSIONER
CO
R

OF INTERNAL REVENUE
ENUE
NUE
In

G.R. No. 167330,

30,
an

8, 2009
September 18, 2 09
es
h

An HMO is NOT engaged in the business

usiness
siness of in
insurance.
C

bl

NOTE:
NO
o

This case must be read side by side with EXECUTIVE ORDER

NO. 192
R
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12 NOVEMBER 2015, Transferring the Regulation
Regulatio and Supervision

ew
over HMOs from the DOH to the Insurance
urance Commission
rance Com
C

WHEREAS, insurance companies, pre-need

e-need companies, and HMOs function
need com

i
ev
under a common concept of receiving
eceiving ccompensation, either through
premiums or contribution, and in turn, promise
pro
p certain contractual benefits
in the future,

R
Section 1. Jurisdiction over HMO
H
HMOs
MO shall be transferred from the DOH to the
al
IC in order to regulateulate
late and supervise the establishment, operations and
financial activitiess of HMOs.
HMOs
n
io

IC LEGAL OPINION
NO. 2020-20,
04 MARCH
ARCH 2020
RCH 202
ss

ie
Onn the right
righ of the insured to designate a beneficiary, particularly the right ht
fe

ev
of members
memb of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+)Q+)
+)
comm ome
community to designate their domestic heir life
partners as beneficiaries of their
o

R
ins
insurance.
r
Pr

r
ped
There is NO legal impedimentd
diment
iment to the designation as beneficiary
benef
eneficiar
iciar of
Ba

the domestic partnerr off an in insured who has secured a life e insurance
insuranc policy
Ba
on his or her own life.
fe The
he IInsurance Commission affirms mss the po
position that
s

the insured who o secures a life insurance policy on hiss oro herer own
o life may
s

desiqnate any
ny individual
y individu
individ as beneficiary. Subjectt only to the exceptions
e

provided in
n Article 20
2012 in relation to Article 739
9 off the Ci
Civil Code.
bl

n
li

IC Circular
ircular Letter 2019-30, 21 June 2019
cular Le 019
o

Guidelines in the HMO Underwriting

iting
ng of Applicants
A with Actual,
r
n

Perceived or Suspected Human

Perceive an Immunodeficiency Virus (HIV)
n Imm
Immun IV)
V)
Ba
R

Status. (Read in tandem with

Status Republic Act no. 11166, Philippine
h Republi ppine
ne
O
an

HI and AIDS Policy Act)

HIV
et
s

A health maintenance organization

ganization
nization (HMO) cannot decline an application
pplicatio of
h

person living with HIV (PLHIV)

PLHIV) on the sole basis of his or her
er HIV status.
statu
stat
rn
bl
C

Circular Letter
Le
Let no. 2018-10
23 January 2018
o

te

On Compulsory
Compulso Motor Vehicle Insurance
R

In

RULES AND R REGULATIONS IN THE USE

SE OF TRAFFIC ACCIDENT
an

ESTIGATIO
TIGATI
INVESTIGATION RNA
NA IVE
VE TO POLICE REPORT
REPORT AS ALTERNATIVE
REQUIREMENT
REQUIREM
EQUIREM IN PROCESSING INSURANCE
INSURAN
NSURA CLAIMS IN MOTOR
es
h

INSURANCE.
INSURAN
C

bl

Section 4. Authorized Person

Sec on to Prepare
rson P Report - Traffic Officers,
Personnel and Constables off MMDA o or Traffic Bureau/s or its equivalent of
o

local government units duly certifi

certified by the LTO that such officer, personnel
certifie
or constable have undergone,
ergone, ccompleted and passed the necessary course
dergone,
R
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for Traffic Accident Investigation
Investigatio
nvestigatio Reporting.

ew
Section 5. Traffic Accident Investigation on Report
Repor shall
s only be used as an
alternative to police report in processingsing
ing insurance
insuran
insura claims for motor vehicles

i
ev
resulting in bodily injury to any partyty or loss or
rty o damage to such motor vehicle
or property arising from the operation
eration of a motor vehicle in public highways,
roads or streets of Metro Manila,ila, Metro Cebu and Metro Davao where traffic

R
officers, personnel or constables,
nstabl
st a provided in section 4 of this circular,
s, as
exercise their regular duty
uty as such.
su
al
Provided however,
er, that this
th Circular shall not be applicable to any claim
thi
n
arising from fire,
ire, ext
exte
external explosion, self-ignition or lightning or
burglary, housebre
housebr
housebreaking, theft, malicious act, whilst in transit or
io

for death
th injury to any passenger or third- party pursuant to the
h or injur
ions
ons of Section
provisions Sec 391 of The lnsurance Code, as amended by R.A. 10607,
ss

ie
ere
re the claim
where cla
cl shall be paid without the necessity of proving fault or
egligence of any kind which requires police report to substantiate a
negligence
fe

ev
claim. (underscoring
(u and highlighting supplied).
o

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GO
GOOD LUCK!
r

GOD BLESS
Pr

r
C
CONGR
CONGRATULATIONS!
ONGR
Ba

Ba
NO HONEST
HO ES
HON EST
ST EFFORTS ARE EVER WASTED
STED
s

FFERED
FERED FOR THE GREATER GLORY
IF OFFERED RY
Y OF
O GOD!
GOD
e s

Ad Majorem DEI Gloriam

riam
m
bl

n
li

*****
o

r
n

Ba
R

O
an

et
s
h

rn
bl
C

te
R

In
an

es
h
C

bl
o
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