Professional Documents
Culture Documents
Facts:
upon the insurer to establish that the loss arose from a cause of loss which
is excepted or for which it is not liable, or from a cause which limits its
liability. In the present case, CBIC failed to discharge its primordial burden
of establishing that the damage or loss was caused by arson, a limitation in
the policy.
Nevertheless just because the defense failed to prove arson does not
mean that fraud does not exist. In fact, fraud exists in this case. The Court
ruled that the submission of false invoices to the adjusters establishes a
clear case of fraud and misrepresentation which voids the insurers liability
as per condition of the policy.
A fraudulent discrepancy between the actual loss and that claimed in the
proof of loss voids the insurance policy. Mere filing of such a claim will
exonerate the insurer. Considering that all the circumstances point to the
inevitable conclusion that UMC padded its claim and was guilty of fraud,
UMC violated Condition No. 15 of the Insurance Policy. Thus, UMC
forfeited whatever benefits it may be entitled under the Insurance Policy,
including its insurance claim.
FACTS:
E. M. Bachrach insured goods belonging to a general furniture store, such as iron
and brass bedsteads, toilet tables, chairs, ice boxes, bureaus, washstands, mirrors,
and sea-grass furniture stored in the ground floor and first story of house and
dwelling with an authorized agent of the British American Assurance Company
British American Assurance Company denied alleging that:
Ong Guan Can v. The Century Insurance Co. (46 PHIL. 592), December 2, 1924
FACTS:
PLAINTIFFS-APPELLEES: Ong Guan Can and the Bank of the Philippine Islands
DEFENDANT-APPELLANT: The Century Insurance Co., LTD.
PONENTE: Villamor, J.
The plaintiff owned a building that was insured against fire by the defendant in the sum of Php
30,000, including the merchandise therein contained in the sum of Php 15,000. Both the house
and merchandise insured were burned in February 28, 1923 while the policies issued by the
defendant in favor of the plaintiff were still in force.
The CFI of Iloilo granted the case in favor of the plaintiff that The Century Insurance Co. should
pay Ong Guan Can the sum of Php 45,000 as the total value of the insured house and
merchandise. The Insurance Company appealed that the judgment be modified to permit it to
rebuild the house and that they be relieved from the payment of the sum in which the building
was insured.
ISSUE:
Whether the defendant-appellant can rebuild the house burnt as a sufficient idemnity to the
inured for the actual loss suffered by him.
APPLICABLE LAW:
Article 1199:
A person alternatively bound by different prestations shall completely perform one of them.
The creditor cannot be compelled to receive part of one and part of the other undertaking.
(1131)
HELD:
Yes. The defendant may build the house as an alternative prestation, freeing him from the
payment of the sum in which the building was insured. This conclusion is in line with The Civil
Codes Article 1131.
Paying the sum in which the building was insured is one of the 2 prestations provided in one of
the clauses stipulating the conditions of the policies. Based on the same Article of the Civil
Code, the complete performance of one of them is sufficient to extinguish the obligation. While
there are several prestations, only one is due.
FACTS:
While Tanco's automobile was driven by his brother Manuel Tanco, who at the time
didn't have a valid license since it was not renewed until the next week, had
a collision with a pick-up delivery van at the southern approach of the Jones bridge
The repairs cost P2,536.99 so he filed a claim against the insurance company which
was rejected
He filed a claim in the Municipal Court of Manila and elevated to the Court of First
Instance of Manila on Appeal which favored Tanco
exception clause "the company shall not be liable in respect of any accident, loss,
damage or liability caused, sustained or incurred ... whilst (the insured vehicle) is ...
being driven by or is for the purpose of being driven by him in the charge of any
person other than an Authorized Driver.
Authorized Driver" to be the insured himself and "(b) any person driving on the
Insured's order or with his permission, provided that the person driving is permitted
in accordance with the licensing or other laws or regulations to drive the Motor
Vehicle or has been permitted and is not disqualified by order of a court of law or by
reason of any enactment or regulation in that behalf from driving such Motor
Vehicle.
ISSUE: W/N the Tanco can claim because it was not covered by the exemption
clause
HELD: NO. appealed from is reversed, with costs
The exclusion clause in the contract invoked by appellant is clear. It does not refer
to violations of law in general, which indeed would tend to render automobile
insurance practically a sham, but to a specific situation where a person other than
the insured himself, even upon his order or with his permission, drives the motor
vehicle without a license or with one that has already expired. No principle of law or
of public policy militates against the validity of such a provision.
Labels: 1965, Case Digest, Definition and Coverage of Casualty Insurance, G.R. No.L17312, insurance,insurance case digest, insurance code, Juris Doctor, November
29, Tanco Jr v Philippine Guaranty Co
FACTS:
Carlos F. Robes insured with the CCC Insurance Corporation his Dodge Kingsway car
against loss or damage through accident for an amount not exceeding P8,000
June 25 1961: Carlos' driver Domingo Reyes met a vehicular collision along Rizal
Avenue Extension, Potrero, Malabon, Rizal
Ccc Insurance Corporation denied his claim reasoning that the driver was not
an "authorized driver"
Reyes, who cannot read and write, who has never passed any examination for
drivers, and has not applied for a license from the duly constituted government
agency entrusted with the duty of licensing drivers, cannot be considered an
authorized driver
AUTHORIZED DRIVER:
Any of the following:
(a) The insured;
(b) Any person driving on the Insured's order or with his permission, provided
that the person driving is permitted in accordance with licensing laws or regulations
to drive the motor vehicle covered by this Policy, or has been so permitted and is
not disqualified by order of a court of law or by reason of any enactment or
regulation from driving such Motor Vehicle.
RTC: favored Robes and CCC was order to pay
ISSUE: W/N Domingo Reyes was an authorized driver
Section 24 of the Revised Motor Vehicles Law, Act 3992 of the Philippine Legislature,
as amended by Republic Acts Nos. 587, 1204 and 2863,1
SEC. 26. Issuance of chauffeur's license; professional badge: If, after examination,
or without the same, the Chief, Motor Vehicles Office or his deputies, believe the
applicant to possess the necessary qualifications and knowledge, they shall issue to
such applicant a license to operate as chauffeur ...
There is no proof that the owner of the automobile knew that the circumstance
surrounding such issuance showed that it was irregular
the weight of authority is in favor of a liberal interpretation of the insurance policy
for the benefit of the party insured, and strictly against the insurer
Labels: 1970, Authoried Driver Clause, Case Digest, G.R. No. L25920, insurance, insurance case digest,January 30, Motor Vehicle Liability Insurance
FACTS:
Plaintiff (herein Petitioner) Association of Baptists for World Evangelism, Inc., a domestic
religious corporation, insured with the Fieldmens Insurance Co., Inc under its Private Car
Comprehensive Policy a Chevrolet Carry-all, up to a maximum indemnity of 5,000.00, in
case of loss or damage to the vehicle. In 1961, Dr. Antonio Lim, the representative of the
association, displayed the Chevrolet for sale at the Jones Monument Mobilgas Service
Station at Davao City, under the care of the stations operator. However, on January 1962,
instead of keeping it safe, one of the boys at the Jones Monument Mobilgas Service Station,
Romeo Catiben, took the Chevrolet for a joy ride without the prior permission of Lim. On its
way back to Davao City, the Chevrolet, allegedly due to some mechanical defect, accidentally
bumped an electric post causing actual damages to the tune of 5,518.61.
When defendant resisted payment, suit was brought by plaintiff to recover on the insurance
indemnity. As per the terms of the contract, the trial court ordered the defendant insurance
company to indemnify the association the amount of P5,000.00 for the damage sustained by
the vehicle. On appeal, defendant interposed the defense that Catiben had not yet been
proven to be guilty of theft, so recovery on the policy cannot be had.
ISSUE:
Is a prior conviction for theft required in order to recover on a comprehensive policy payable
upon loss or damage to the vehicle?
HELD:
No. Prior conviction of Catiben is not necessary. The insurance company is liable to
pay the association.
The comprehensive policy issued by the insurance company includes loss of or damage to
the motor vehicle by burglary or theft. It is settled that the act of Catiben in taking the
vehicle for a joy ride to Toril, Davao City, constitutes theft within the meaning of the
insurance policy and that recovery for damage to the car is not barred by the illegal use of
the car by one of the station boys. There need be no prior conviction for the crime of theft to
make an insurer liable under the theft clause of the policy. Upon the facts stipulated by the
parties it is admitted that Catiben had taken the vehicle for a joy ride and while the same
was in his possession he bumped it against an electric post resulting in damages. The act is
theft within a policy of insurance.
In a civil action for recovery on an automobile insurance, the question whether a person
using a certain automobile at the time of the accident stole it or not is to be determined by a
fair preponderance of evidence and not by the rule of criminal law requiring proof of
guilt beyond reasonable doubt. Besides, there is no provision in the policy requiring prior
criminal conviction for theft, in the absence of any provision in the policy to the contrary.
JAMES STOKES vs. MALAYAN INSURANCE CO., INC. G.R. No. L-34768, 24 February 1984
127 SCRA 766
FACTS:
Daniel Adolfson had a subsisting Malayan car insurance policy with coverage against own
damage as well as 3rd party liability when his car figured in a vehicular accident with another
car, resulting to damage to both vehicles. At the time of the accident, Adolfsons car was being
driven by James Stokes, who was authorized to do so by Adolfson. Stokes, an Irish tourist who
had been in the Philippines for only 90 days, had a valid and subsisting Irish drivers license but
without a Philippine drivers license. Adolfson filed a claim with Malayan but the latter refused to
pay contending that Stokes was not an authorized driver under the Authorized Driver clause of
the insurance policy in relation to Section 21 of the Land Transportation Office.
ISSUE: Whether or not Malayan is liable to pay the insurance claim of Adolfson
HELD:
was therefore not an authorized driver under the terms of the insurance policy in
question, and Malayan was right in denying the claim of the insured. Acceptance of
premium within the stipulated period for payment thereof, including the agreed
period of grace, merely assures continued effectivity of the insurance policy in
accordance with its terms. Such acceptance does not estop the insurer from
interposing any valid defense under the terms of the insurance policy. The principle
of estoppel is an equitable principle rooted upon natural justice which prevents a
person from going back on his own acts and representations to the prejudice of
another whom he has led to rely upon them. The principle does not apply to the
instant case. In accepting the premium payment of the insured, Malayan was not
guilty of any inequitable act or representation. There is nothing inconsistent
between acceptance of premium due under an insurance policy and the
enforcement of its terms. WHEREFORE, the appealed judgment is reversed. The
complaint is dismissed. Costs against appellees.
FACTS:
Aurelio Lacson ,owner of a Toyota NP Land Cruiser, Model 1972, bearing Plate No.
NY-362 and with engine Number F-374325 insured with Malayan Insurance Co
Dec. 1, 1975: Aurelio brought it to the shop of Carlos Jamelo for repair
Dec. 2, 1975: Rogelio Mahinay, together with Johnny Mahinay, Rogelio Macapagong
and Rogelio Francisco took and drove the Toyota Land Cruiser and it met an
accident with Bo
Carlos reported the incident to the police and instituted a criminal case for Qualified
Theft against his employees
Rogelio Mahinay pleaded guilty and was convicted of theft
Aurelio was not allowed to claim on the ground that the claim is not covered by the
policy inasmuch as the driver of the insured vehicle at the time of the accident was
not a duly licensed driver
HELD: YES.
The damages therefore were sustained in the course of the unlawful taking
Bacolod IFCs interest in the insured vehicle was in the amount of P2,000.00 only
compared to plaintiff's P26,000.00 it is well to presume that Bacolod IFC did not
deem it wise to be impleaded as party-plaintiff in this case. This inaction on the part
of BIFC will only show that it was not really interested to intervene.
ANDREW PALERMO, plaintiff-appellee, vs. PYRAMID INSURANCE CO., INC., defendant- appellant.
G.R. No. L-36480 May 31, 1988 ANDREW PALERMO, plaintiff-appellee, vs. PYRAMID INSURANCE CO., INC.,
defendant- appellant.
FACTS:
On March 7, 1969, the insured, appellee Andrew Palermo, filed a complaint in the Court of First
Instance of Negros Occidental against Pyramid Insurance Co., Inc., for payment of his claim
under a Private Car Comprehensive Policy MV-1251 issued by the defendant (Exh. A). In its
answer, the appellant Pyramid Insurance Co., Inc., alleged that it disallowed the claim because
at the time of the accident, the insured was driving his car with an expired driver's license. After
the trial, the court a quo rendered judgment on October 29, 1969 ordering the defendant "to pay
the plaintiff the sum of P20,000.00, value of the insurance of the motor vehicle in question and
to pay the costs." On November 26, 1969, the plaintiff filed a "Motion for Immediate Execution
Pending Appeal." It was opposed by the defendant, but was granted by the trial court on
December 15, 1969.
ISSUE: WON
plaintiff was not authorized to drive the insured motor vehicle because his driver's
license had expired.
RULING:
There is no merit in the appellant's allegation that the plaintiff was not authorized to drive the
insured motor vehicle because his driver's license had expired. The driver of the insured motor
vehicle at the time of the accident was, the insured himself, hence an "authorized driver" under
the policy. While the Motor Vehicle Law prohibits a person from operating a motor vehicle on the
highway without a license or with an expired license, an infraction of the Motor Vehicle Law on
the part of the insured, is not a bar to recovery under the insurance contract. It however renders
him subject to the penal sanctions of the Motor Vehicle Law. The requirement that the driver be
"permitted in accordance with the licensing or other laws or regulations to drive the Motor
Vehicle and is not disqualified from driving such motor vehicle by order of a Court of Law or by
reason of any enactment or regulation in that behalf," applies only when the driver" is driving on
the insured's order or with his permission." It does not apply when the person driving is the
insured himself.
complaint for damages against private respondents is hereby REINSTATED. Let the
case be remanded to the lower court for trial on the merits.
Issues:
1.Was there grave abuse of discretion on the part of the appellate court in holding that private
respondents did not violate the insurance contract because the authorized driver clause is not
applicable to the "Theft" clause of said Contract?
2. Whether or not the loss of the collateral exempted the debtor from his admitted obligations
under the promissory note particularly the payment of interest, litigation expenses and attorney's
fees.
Ratio:
1. The car was insured against a malicious act such as theft. Therefore the Theft clause in the
contract should apply and not the authorized driver clause. The risk against accident is different
from the risk against theft.
The appellate court stated: The "authorized driver clause" in a typical insurance policy is in
contemplation or anticipation of accident in the legal sense in which it should be understood,
and not in contemplation or anticipation of an event such as theft. The distinction often seized
upon by insurance companies in resisting claims from their assureds between death
occurring as a result of accident and death occurring as a result of intent may, by analogy, apply
to the case at bar.
There was no connection between valid possession of a license and the loss of a vehicle.
Ruling in a different way would render the policy a sham because the company can then easily
cite restrictions not applicable to the claim.
2. The Supreme Court stated:
The chattel mortgage constituted over the automobile is merely an accessory contract to the
promissory note. Being the principal contract, the promissory note is unaffected by whatever
befalls the subject matter of the accessory contract. Therefore, the unpaid balance on the
promissory note should be paid, and not just the installments due and payable before the
automobile was carnapped, as erronously held by the Court of Appeals.
The court, however, construed the insurance, chattel mortgage, and promissory note as
interrelated contracts, hence eliminating the payment of interests, litigation expenses, and
attorneys fees stated in the promissory note. The promissory note required securing a chattel
mortage which in turn required opening an insurance contract. The insurance was made as an
accessory to the principal contract, making sure that the value in the promissory note will be
paid even if the car was lost. The insurance company promised to pay FCP for loss or damage
of the property.
CA didnt err in requiring Perla to pay the spouses, but the spouses must pay FCP for the
balance in the note.
Sun v CA G.R. No. 92383 July 17, 1992
J. Cruz
Facts:
Lim accidentally killed himself with his gun after removing the magazine, showing off, pointing
the gun at his secretary, and pointing the gun at his temple. The widow, the beneficiary, sued the
petitioner and won 200,000 as indemnity with additional amounts for other damages and
attorneys fees. This was sustained in the Court of Appeals then sent to the Supreme court by
the insurance company.
Issue:
1. Was Lims widow eligible to receive the benefits?
2. Were the other damages valid?
Held:
1. Yes 2. No
Ratio: 1. There was an accident.
De la Cruz v. Capital Insurance says that "there is no accident when a deliberate act is
performed unless some additional, unexpected, independent and unforeseen happening occurs
which produces or brings about their injury or death." This was true when he fired the gun.
Under the insurance contract, the company wasnt liable for bodily injury caused by attempted
suicide or by one needlessly exposing himself to danger except to save anothers life.
Lim wasnt thought to needlessly expose himself to danger due to the witness testimony that he
took steps to ensure that the gun wasnt loaded. He even assured his secretary that the gun
was loaded.
There is nothing in the policy that relieves the insurer of the responsibility to pay the indemnity
agreed upon if the insured is shown to have contributed to his own accident.
2. In order that a person may be made liable to the payment of moral damages, the law
requires that his act be wrongful. The adverse result of an action does not per se make the act
wrongful and subject the act or to the payment of moral damages. The law could not have
meant to impose a penalty on the right to litigate; such right is so precious that moral damages
may not be charged on those who may exercise it erroneously. For these the law taxes costs.
If a party wins, he cannot, as a rule, recover attorney's fees and litigation expenses, since it is
not the fact of winning alone that entitles him to recover such damages of the exceptional
circumstances enumerated in Art. 2208. Otherwise, every time a defendant wins, automatically
the plaintiff must pay attorney's fees thereby putting a premium on the right to litigate which
should not be so. For those expenses, the law deems the award of costs as sufficient.
FACTS:
On October 22, 1986, deceased, Carlie Surposa was insured with petitioner Finman General
Assurance Corporation with his parents, spouses Julia and Carlos Surposa, and brothers
Christopher, Charles, Chester and Clifton, all surnamed, Surposa, as beneficiaries. While said
insurance policy was in full force and effect, the insured, Carlie Surposa, died on October 18,
1988 as a result of a stab wound inflicted by one of the three (3) unidentified men. Private
respondent and the other beneficiaries of said insurance policy filed a written notice of claim
with the petitioner insurance company which denied said claim contending that murder and
assault are not within the scope of the coverage of the insurance policy. Private respondent filed
a complaint with the Insurance Commission which rendered a favorable response for the
respondent. The appellate court ruled likewise. Petitioner filed this petition alleging grave abuse
of discretion on the part of the appellate court in applying the principle of "expresso unius
exclusio alterius" in a personal accident insurance policy, since death resulting from murder
and/or assault are impliedly excluded in said insurance policy considering that the cause of
death of the insured was not accidental but rather a deliberate and intentional act of the
assailant. Therefore, said death was committed with deliberate intent which, by the very nature
of a personal accident insurance policy, cannot be indemnified.
ISSUE: Whether or not the insurer is liable for the payment of the insurance premiums
HELD:
Yes, the insurer is still liable. Contracts of insurance are to be construed liberally in favor of the
insured and strictly against the insurer. Thus ambiguity in the words of an insurance contract
should be interpreted in favor of its beneficiary. The terms "accident" and "accidental" as used in
insurance contracts have not acquired any technical meaning, and are construed by the courts
in their ordinary and common acceptation. Thus, the terms have been taken to mean that which
happen by chance or fortuitously, without intention and design, and which is unexpected,
unusual, and unforeseen. Where the death or injury is not the natural or probable result of the
insured's voluntary act, or if something unforeseen occurs in the doing of the act which
produces the injury, the resulting death is within the protection of the policies insuring against
death or injury from accident. In the case at bar, it cannot be pretended that Carlie Surposa died
in the course of an assault or murder as a result of his voluntary act considering the very nature
of these crimes. Neither can it be said that where was a capricious desire on the part of the
accused to expose his life to danger considering that he was just going home after attending a
festival. Furthermore, the personal accident insurance policy involved herein specifically
enumerated only ten (10) circumstances wherein no liability attaches to petitioner insurance
company for any injury, disability or loss suffered by the insured as a result of any of the
stimulated causes. The principle of " expresso unius exclusio alterius" the mention of one
thing implies the exclusion of another thing is therefore applicable in the instant case since
murder and assault, not having been expressly included in the enumeration of the
circumstances that would negate liability in said insurance policy cannot be considered by
implication to discharge the petitioner insurance company from liability for, any injury, disability
or loss suffered by the insured. Thus, the failure of the petitioner insurance company to include
death resulting from murder or assault among the prohibited risks leads inevitably to the
conclusion that it did not intend to limit or exempt itself from liability for such death.