According to Merriam-Webster

dictionary, it is the act of

killing someone, especially as
punishment for a crime.
A: General Rule: Recovery is
prohibited for beneficiary
when insured is executed for
wrongful conduct.
 TITLE 2
PARTIES TO THE CONTRACT
"Section 7. Anyone except a public
enemy may be insured.
 Sec. 64. No policy of insurance other than life
shall be cancelled by the insureron one or
more of the following:
(b) Conviction of a crime arising
out of acts increasing the hazard
insured against.
 Here, courts are attempting to
distinguish an intentionally caused
death, which is not covered and an
accidental death.
According to the outline of Chris
Brown, there is no G/R, just use
facts and circumstances to rule
based on whats fair.
 The insured uses an illegal drug,
such as heroin, and dies as a result.
It might be argued that the insureds
act of injecting the drug was
intentional and that the dangers
posed by illicit drugs are so well
known that the insureds death
cannot be described as accidental.
Since in this case, the effects of
heroin are already widely
known that it is bad for the
health. Therefore, knowing of
the effects, there is no
accidental death to speak of.
 The insured uses an illegal drug,
such as heroin, and dies as a
result. While it is true that the act
of the insured in using illegal drug
was intentional, he probably had
used heroin safely before and
did not expect that the next use
would be fatal.
In this case, the insureds death,
following a self-administered
injection, was accidental. While
the insured intentionally
injected himself but he neither
anticipated that this would
have caused his death.
 "Section 236. In the case of industrial life insurance, the policy shall
contain in substance the following provisions:
"(b) A provision that the policy shall be incontestable after it has
been in force during the lifetime of the insured for a specified
period, not more than two (2) years from its date of issue, .and
except as to provisions relating to benefits in the event of disability
as defined in the policy, and those granting additional insurance
specifically against death by accident or by accidental
means, or to additional insurance against loss of, or loss of use of,
specific members of the body;
 Someone could expect to cause
injury in a situation where none
was intended.
Plain-meaning analysis =
the provision has two separate
prongs, but BOTH refer to the
INSUREDS STATE OF MIND
 When bodily injury or property damage
is INTENDED, the insured has a desire
that the injury or damage will occur.
When bodily injury or property damage
is EXPECTED, the insured anticipates that
the injury or damage will occur but he
has no desire that it occurred.
An insured can INTEND and
EXPECT harm to occur
An insured can INTEND but
NOT EXPECT harm to occur
An insured can EXPECT but NOT
INTEND harm to occur
 What the EXPECTED prong adds to the
INTENDED prong is an exclusion from
coverage in circumstances where the
insureds state of mind with respect to
desire is not clear, but the circumstances
are such that the insured, even if not
clearly desiring to cause harm, should
surely have anticipated that harm
would result.
An insured who EXPECTS injury
or damage must be aware that
the injury or damage has HIGH
PROBABILITY OF OCCURING
as a CONSEQUENCE of the
INSUREDs ACT or NEGLECT.
 When the insured knows that harm
is probable, the awareness
element is present and upon
awareness of harm, the
specificity of the expectation of
harm may be identified.
Here, we are deciding if the
injury or damage caused by the
insured was caused
intentionally so as to deprive
the insured of insurance
coverage, thereby possibly
depriving the victim of
compensation.
MAJORITY G/R: The insured
must have intended both the
act and to cause some kind
of injury or damage.
MINORITY G/R: If intentional act
by insured results in injuries or
damage that are a natural and
probable result of the act, the
loss is considered intentional and
there is no coverage existing.
 THIRD G/R: For exclusion to
apply, the insured must have
had specific intent not only to
injure but also cause the
particular type of injury
suffered.
 Section 89. An insurer is not liable for a loss
caused by the willful act or through the
connivance of the insured; but he is not
exonerated by the negligence of the
insured, or of the insureds agents or other.
Is the insured entitled
to coverage for
injuries inflicted in
self-defense?
G/R (1) : allows recovery for
an intentional act, if acting out
of self-defense
G/R (2) : prevents recovery for
any intentional act, even if
acting out of self-defense
The insured is attempting to avoid
a calamity thrust upon him.
The insured, acting in self defense,
does so spontaneously and
instinctively, rather than with
purpose that typically characterizes
assault or battery.
 Section 89. An insurer is not liable for a loss
caused by the willful act or through the
connivance of the insured; but he is not
exonerated by the negligence of the
insured, or of the insureds agents or other.
REVISED PENAL CODE

Art. 11: Justifying Circumstances those

wherein the acts of the actor are in accordance
with law, hence, he is justified. There is no
criminal and civil liability because there is no
crime.
Will the insureds diminished
mental capacity render the
intentional conduct unintentional
for the purposes of exclusion?
 G/R (1) : If an insured suffered
from a lack of mental capacity
when he acted with apparent
intent to injure another, the
insured's act cannot be treated as
intentional within the meaning
of exclusion and coverage.
A woman drove her automobile
directly into a pickup truck
occupied by the victims. The
womans insurer sought a
declaratory judgment that it was
not liable under the policy.
 The victims argued that she did not act
intentionally because she suffered from
mental illness that rendered her
incapable of distinguishing right from
wrong and that she was actually having
hallucinations. The insurer argued that
mental capacity was irrelevant for
purposes of policy exclusion.
G/R (2) : An injury inflicted
by an insane person is
intentional if the actor
understands the physical
nature and consequences of
the act.
POLICY: Insurance is purchased for
fortuitous losses; where the insured has
some control over the risk no coverage
should exist, but in other cases no good
reason exists to deny the victim access
to the resources necessary to reimburse
the victims loss.
 "Section 183. The insurer in a life insurance contract shall be
liable in case of suicide only when it is committed after the
policy has been in force for a period of two (2) years from the
date of its issue or of its last reinstatement, unless the policy
provides a shorter period: Provided, however, That
suicide
committed in the state of insanity shall be
compensable regardless of the date of
commission.
REVISED PENAL CODE
Art. 12. CIRCUMSTANCES WHICH EXEMPT FROM
CRIMINAL LIABILITY. The following are exempt from
criminal liability:
1. An imbecile or insane person, unless the latter has
acted during a lucid interval.

The insane is not so exempt if it can be shown that he acted

during a lucid interval. In the latter, loss of consciousness of
ones acts and not merely abnormality of mental faculties
will qualify ones acts as those of an insane.
The dispute arises over
the manner in which the
death occurred.
How did the insured die?
 An unusual event that the
insured does not foresee; the
event happens unexpectedly
and without the insureds
intent.
Determining whether a death
was accidental involves:
(1) deciding if the event was
fortuitous
(2) the question of causation
G/R: Determining if the
insureds death was
accidental is determined
from the point of view
of the insured.
What if death was caused by
falling off a cliff?
What if a brain tumor caused
the hiker to lose consciousness
and then fell off the cliff?
 What if the fall from a cliff produces
a disease that results in death?
What if fall results in hospitalization
which results in the insured getting an
infection that causes death?
 Look to particular facts and circumstances
of the case, etc.
The only test, is:
(1) determine whether the death
producing event was an accident, i.e. was
the event unforeseen and unexpected from
the viewpoint of the insured?
(2) if the event was accidental, did the
accident cause the death
 If there are multiple causes of
death, ask,
(1) was the accident not too
remote
(2) was the accident the
dominant cause of the loss
 Accidental Death:
Limits on the Time Between the Accident and the
Death
The Provisions in accidental death endorsements
requiring that the insureds death be within a
specified number of days of the death-inducing
injury are controversial and will become more
so as the medical professions ability to prolong
life improves
 Sec. 86. Unless otherwise provided by the policy, an
insurer is liable for a loss of which a peril insured
against was the proximate cause, although a
peril not contemplated by the contract may have been
a remote cause of the loss; but he is liable for
loss of which the peril insured against was only a
remote cause.
 TITLE 5
LIFE INSURANCE
"Section 181. Life insurance is insurance on
human lives and insurance appertaining thereto
or connected therewith.
 A professional football player
suffered a career-ending knee
injury and cannot anymore play on
the field. But he can actually be a
football coach instead. Is he
disabled?
A pianist who lost one hand unable
to perform recitals but can be a
music teacher. Is he disabled?
BOTH ARE NOT
COMPLETELY DISABLED. But,
what determines or covers a
disabled within the meaning
of disability insurance
policy?
 Disability insurance coverage
provisions are defined in terms of
the loss of ones capacity to
work, not ones loss of income
Provide coverage if the
insured is disabled from
transacting duties of the
particular occupation in
which the insured is then
engaged.
 A college professor who suffers
from dermatitis is not totally
disabled because he can still teach
despite his illness which is actually
not connected to his profession.
 Provides that the insured must be
unable to pursue an occupation for
profit for which he is reasonably
suited by education, training or
experience
But a dermatologist who suffers
from dermatitis, as a common
sense, may be terminated from
being a dermatologist and
therefore be disabled.
 "Section 193. (8) "No insurance company may
be authorized to transact in the Philippines the
business of life and non-life insurance
concurrently, unless specifically authorized to do
so by the Commissioner: Provided, That the
terms life and non-life insurance shall be
deemed to include health, accident and
disability insurance.
 "Section 237"(2) Military or naval service: Provided, That if the
liability of the company is limited as herein provided, such
liability shall in no event be fixed at an amount less than the
reserve on the policy (excluding the reserve for any additional
benefits in the event of death by accident or accidental means
or for benefits in the event of any type of disability),
less any indebtedness on or secured by such policy; nor shall
any provision of this section apply to any provision in an
industrial life insurance policy for additional benefits in the
event of death by accident or accidental means.
 No G/R, just general
policy to assure adequate
access to health care is
there at an affordable
cost.
 G/R(1): preexisting illnesses
are exclusions
G/R(2): the insured must prove
that the illness or injury for which
he seeks coverage arose during
the term that the policy was in
effect.
 G/R: no coverage for
experimental treatments
POLICY: cost-containment.
treatment which does not
comport with medically
accepted medical care
protocols is not medically
necessary
these statutes require
that health of disability
insurance policies sold in
the state contain certain
minimum coverages
 TITLE 3
CASUALTY INSURANCE
"Section 176. Casualty insurance is insurance covering loss or
liability arising from accident or mishap, excluding certain types
of loss which by law or custom are considered as falling
exclusively within the scope of other types of insurance such as
fire or marine. It includes, but is not limited to, employers
liability insurance, motor vehicle liability insurance, plate glass
insurance, burglary and theft insurance, personal accident and
health insurance as written by non-life insurance
companies, and other substantially similar kinds of insurance.
 TITLE 3
INSURABLE INTEREST
Section 10. Every person has an insurable
interest in the life and health:
(a) Of himself, of his spouse and of his children;
(b) Of any person on whom he depends wholly or in part
for education or support, or in whom he has a pecuniary interest;
(c) Of any person under a legal obligation to him for the
payment of money, or respecting property or services, of which
death or illness might delay or prevent the performance; and
(d) Of any person upon whose life any estate or interest
vested in him depends.
 INSURANCE
Article 2011. The contract of insurance
is governed by special laws. Matters
not expressly provided for in such
special laws shall be regulated by this
Code.