Ulpiano Santa Ana took out multiple fire insurance policies totaling 21k pesos on a house he owned from five different insurance companies between October 1925 and September 1926. However, he did not disclose the existence of the other policies to the insurance companies as required by the policies' terms. After a fire destroyed the house in October 1926, the insurance companies refused to pay out the claims, arguing the policies were void due to Santa Ana's failure to disclose the other insurance policies. The court ruled in favor of the insurance companies, finding the policies were null and void for lack of such disclosure as required by the conditions specified in the policies. Santa Ana and the mortgage holder Rafael Garcia appealed.
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Insurance Digest
Ulpiano Santa Ana took out multiple fire insurance policies totaling 21k pesos on a house he owned from five different insurance companies between October 1925 and September 1926. However, he did not disclose the existence of the other policies to the insurance companies as required by the policies' terms. After a fire destroyed the house in October 1926, the insurance companies refused to pay out the claims, arguing the policies were void due to Santa Ana's failure to disclose the other insurance policies. The court ruled in favor of the insurance companies, finding the policies were null and void for lack of such disclosure as required by the conditions specified in the policies. Santa Ana and the mortgage holder Rafael Garcia appealed.
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Warranties; Exceptions, exclusions, conditions
He also alleged that the CFI erred in holding that his statement regarding the house in question: a
wooden structure 2 stories high, belonging to the first and second groups, with a frontage of 12 meters and a depth of 20 meters, is worth 23k, is false and was made with defendant companies, and Santa Ana v. Commercial Union Insurance therefore annuls the insurance policies issued by them upon the aforesaid property. GR L-32889 ; November 20, 1930 By: BACANI He likewise averred that the court erred in estimating the value of the house at 6k and that it failed to sentence each and every one of the defendant companies to pay the him the value of the several Topic: Warranties; exceptions, exclusions, conditions policies upon the property in question, excepting the amount of 5k claimed by Rafael Garcia. Petitioners: ULPIANO SANTA ANA Respondents: COMMERCIAL UNION ASSURANCE COMPANY LTD. Garcia, for his part, alleged that the court erred dismissing the complaint; in holding that there was Ponente: Villa-real, J. not sufficient notice given to the insurance companies of the other insurance policies covering the DOCTRINE: In the absolute absence of such notice when it is one of the conditions specified in the fire same property; and that the insurance on the building for the total value of 21k was in excess of insurance policy, the policy is null and void. the full value of the property and that, therefore, the policy was annulled.
FACTS: In 1923, Ulpiano Santa Ana built a house of strong materials with a galvanized iron roof in ISSUE: Whether the insurance companies are liable to pay the insurance proceeds the municipality of Pasig, Province of Rizal. On October 1, 1925, Santa Ana took out a 3k fire insurance policy on the house in the Phoenix Assurance Company, and 6k policy in the Guardian HELD: NO. Assurance Company, Limited for a period of 1 year from that date until 4PM of October 1 the CFI found that whereas it has been provided in English and Spanish in notices attached to the following year. He also paid the respective premiums of Php 97.50 and Php 196 to said companies insurance policies issued by the Phoenix Assurance and Guardian Assurance; and by Globe & through their duly authorized Philippine agent, Kerr & Company. Rutgers Fire Insurance and the Commercial Union Company that no other insurance should be admitted upon the property assured without the consent of said companies duly given by On November 19, 1925, Santa Ana mortgaged said house to Rafael Garcia for 5k for a period of 2 endorsement. years, the contract being drawn up as a retro s ale for the sum of 5k, and the policies issued by the Phoenix Assurance and the Guardian Assurance were endorsed to Garcia. On December 16, Santa They also found that the first 2 policies were taken out on one and the same date, namely, October Ana reinsured said house with Globe and Rutgers Fire Insurance Company of New York, and 1st, and the last 2 likewise upon one and the same date, that is, December 16, 1925 — Santa Ana Commercial Union Assurance Company, Limited of London, through their common agent Pacific has not stated in the last 2 policies that his property had previously been insured; and still less in Commercial Company, for the amount of 3k each, paying the Php 90 premium due upon each the insurance policy of the Compania Filipinas taken out on September 20, 1926, nor has he policy, which was to be effective for 1 year until 4PM of December 16, 1926. obtained upon the first 2 policies the necessary endorsements for the 3 subsequent insurance policies. On September 20, 1926, Santa Ana took out another insurance policy on the house for 6k in the Filipinas, Compania de Seguros, which issued the 1-year policy upon receiving the amount of Php It should be noted that clause 3 of the "Filipinas" policy drawn up in Spanish, and the english 195 as premium. About 3AM of October 1, 1926, a fire broke out in the insured house where Santa policies issued by the 4 other companies, provided that any outstanding insurance upon the whole Ana and his family lived, starting in the ceiling of the living room where the plaintiff and his family or a portion of the objects thereby assured must be declared by the insured in writing and he were at that time sleeping, consuming the dwelling and every combustible object within, including must cause the company to add or insert it in the policy, without which such policy shall be null jewelry and clothing. and avoid, and the insured will not be entitled to indemnity in case of loss.
Santa Ana gave notice in due time of the loss to each and every one of the companies in which he Santa Ana maintains that he gave the required notice to all the insurance companies; telling them had insured the house and demanded payment of the respective policies; the assurance companies he had paid for other insurance on the same property. But he has been contradicted in this by all refused payment on the ground that the claim of 21k filed by him was fraudulent, being in excess of the persons mentioned, and this deprives his allegations of probative force, especially the real value of the insured property; that none of said companies had been informed of the considering that such advises or notices, so basic and essential to the existence and validity of existence of the other policies in the other companies, and that the fire was intentional. Santa Ana the policies, must be given in writing as required in the note attached to the 4 policies therefore brought the actions which gave rise to these cases. mentioned, and must be given in writing as required, and must be endorsed upon each of them, so that in case of necessity, as in the instant one, when a loss occurs, the insured may clearly show The CFI rendered a decision absolving all aforementioned companies from liability. From this that he has fulfilled this indispensable requisite, since all companies, to which people apply for decision, four appeals were taken: 3 of them by Ulpiano Santa Ana, in 2 cases, and as an intervenor insurance upon property already assured, have an interest in knowing what other policies issued in a civil case of the same court. The other appeal was taken by Rafael Garcia, the plaintiff in the by other companies the insured already holds, for the purpose of knowing just what interest the civil case Santa Ana intervened in. applicant has in the preservation of the property, and the care and precaution to be taken for the prevention of loss. In support of his appeal, Santa Ana alleges that the CFI erred in finding that he did not advise or notify each and every one of the defendant companies and every one of the insurance policies Thus it is that Mr. Pedro Casas, could not but testify that if he had known 10 days before the loss issued upon the property in question. occurred when he was asked to issue a policy, that the property intended to be assured for 9k with the "Filipinas" Company was already insured in 4 other firms for 15k, he would not have given a
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single centavo; for when he went to inspect the house a few days before issuing the 6k policy, he "This policy is subject to the hereon attached 'Ordinary Short Period Rate Scale' Warranties A appraised the property at that sum, and at first would give no more than 5k. The witness, who is the & F, Co-insurances Clause 'and Three Fourths Loss Clause,' which are forming part of same. manager of said company, has been appraising realty for insurance since 1913. His testimony is Co-insurance declared: therefore of value in this case. "P20,000. — Sun Insurance Office Ltd. (K & S)." (Italics inserted.) Securely pasted on the left We have carefully gone over the record with this point in mind, and have found nothing to justify hand margin of the face of the policy are five warranties and special clauses. One of them is us in departing from the findings of the court below. Without deciding whether notice of other warranty F, specifically referred to on the face of the policy, reading in part as follows: insurance upon the same property must be given in writing, or whether a verbal notice is sufficient to render an insurance valid which requires such notice, whether oral or written, we hold that in "WARRANTY F the absolute absence of such notice when it is one of the conditions specified in the fire insurance policy, the policy is null and void. "It is hereby declared and agreed that during the currency of this policy no hazardous goods be stored in the Building to which this insurance applies or in any building communicating DISPOSITIVE: Wherefore, the judgment appealed from is affirmed, with costs against the therewith, provided, always, however, that the Insured be permitted to store a small quantity appellants. Let a copy of this opinion be united to each of the three cases thus adjudged. So of the hazardous goods specified below, but not exceeding in all 3 percent of the total value of ordered. the whole of the goods or merchandise contained in said warehouse, viz;. . . "
ISSUE Whether or not warranty F referred to in the policy as forming part of the contract of Ang Giok Chip v Springfield Fire & Marine insurance and in the form of a rider to the insurance policy, is null and void because not complying G.R. No: L-33637 ; Date: December 31, 1931 with the Philippine Insurance Act? By: CRUZ HELD: No. Topic: Warranties; Exceptions, exclusions, conditions ● Warranty F is valid. Petitioners: ANG GIOK CHIP, doing business under the name and style of Hua Bee Kong Si ● Applicable law is found in Sec. 65 of Philippine Insurance Act - "Every express warranty, Respondents: SPRINGFIELD FIRE & MARINE INSURANCE COMPANY made at or before the execution of a policy, must be contained in the policy itself, or in another Ponente: Malcolm, J. instrument signed by the insured and referred to in the policy, as making a part of it." DOCTRINE: ● “Must be contained in the policy itself” - When, therefore, the courts speak of a rider attached to the policy, and thus "embodied" therein, or of a warranty "incorporated" in FACTS: the policy, it is believed that the phrase "contained in the policy itself" must necessarily ● Ang Giok Chip, doing business under the name of Hua Bee Kong Si, was formerly the include such rider and warranty. owner of a warehouse located in No. 643 Calle Reina Regente, Manila. ● In the case, the rider, warranty F, is contained in the policy itself, because by the contract ● The contents of the warehouse were insured with 3 insurance companies for the total of insurance agreed to by the parties it is made to form a part of the same, but is not sum of P60,000. another instrument signed by the insured and referred to in the policy as forming a part ● One insurance policy, in the amount of P10,000, was taken out with the Springfield Fire of it. & Marine Insurance Company. ● Also relating to "another instrument," "instrument" as here used could not mean a mere ● The warehouse was destroyed by fire on January 11, 1928, while the policy issued by slip of paper like a rider, but something akin to the policy itself, which in Sec. 48 of the the Springfield was in force. Insurance Act is defined as "The written instrument, in which a contract of insurance is ● Ang Giok Chip filed an action with CFI of Manila against Springfield to recover a set forth." proportional part of the loss coming to P8,170.59. ● 2 well recognized doctrines: ● 4 defenses were interposed on behalf of Springfield, one being planted on a violation of ○ (1) A rider attached to a policy is a part of the contract, to the same extent and warranty F fixing the amount of hazardous goods which might be stored in the building. with like effect as if actually embodied therein. ● CFI ruling: ○ (2) An express warranty must appear upon the face of the policy, or be clearly ○ In favor of Ang Giok Chip incorporated therein and made a part thereof by explicit reference, or by ● Springfield appealed words clearly evidencing such intention. ● Warranty F (slip of paper pasted on the margin of a page of the fire insurance policy) : ● It is admitted that the policy in the case was accepted by Ang Giok Chip. "Ten thousand pesos Philippine Currency. — On general non- hazardous merchandise, chiefly ○ The receipt of this policy by the insured without objection binds both the consisting of chucherias, also produce, Cacao, Flour, all the property of the Insured, or held by acceptor and the insured to the terms thereof. them in trust, on commission or on joint account with others, or for which he is responsible, ○ The insured may not thereafter be heard to say that he did not read the policy while contained during the currency of this policy in the godown, situate No. 643 Calle Reina or know its terms, since it is his duty to read his policy and it will be assumed Regente. . . . that he did so. ● We are further given to understand, and there is no indication to the contrary, that the issuance of the policy in this case with its attached rider conforms to well established practice in the Philippines and elsewhere.
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● We are further given to understand, and there is no indication to the contrary, that there DOCTRINE: The terms of the policy constitute the measure of the insurer's liability, and in order to are no less than 69 insurance companies doing business in the Philippine Islands with recover the insured must show himself within those terms; and if it appears that the contract has been outstanding policies more or less similar to the one involved in this case, and that to terminated by a violation, on the part of the insured, of its conditions, then there can be no right of nullify such policies would place an unnecessary hindrance in the transactions of recovery. The compliance of the insured with the terms of the contract is a condition precedent to the insurance business in the Philippines. right of recovery. If the insured has violated or failed to perform theconditions of the contract, and such ● These are matters of public policy. a violation or want of performance has not been waived by the insurer, then the insured cannot recover. ● We have studied this case carefully and having done so have reached the definite conclusion that warranty F, a rider attached to the face of the insurance policy, and referred to in the contract of insurance, is valid and sufficient under section 65 of the FACTS: Insurance Act. ● The plaintiff conducted a candy and fruit store on the Escolta, in the city of Manila, and occupied a building at 321 Calle Claveria, as a residence and bodega Notes: (storehouse). Dissenting opinions ● On the 29th of May, 1912, the defendant, in consideration of the payment of a Villa-real, J. premium of P60, entered into a contract of insurance with the plaintiff (policy No. ● It would certainly be an absurdity if section 65 of the Insurance Law were construed as 509105) by the terms of which the defendant company, upon certain conditions, requiring that an express warranty be contained only in the policy or in another promised to pay to the plaintiff the sum of P3,000, in case said residence and instrument signed by the insured and referred to therein as making a part thereof for bodega and contends should be destroyed by fire. the protection of such insured, and at the same time permitting that such express ● On the conditions of said contract of insurance is found in "warranty B" and is as warranty be contained in a piece of paper not signed by the insured but simply attached follows: "Waranty B. — It is hereby declared and agreed that during the pendency to the policy and referred to therein as making a part thereof, thus opening the door to of this policy no hazardous goods stored or kept for sale, and no hazardous trade or fraud, — it being easy to detach such rider or slip and change it with another, which is process be carried on, in the building to which this insurance applies, or in any precisely what the law is trying to prevent. It will thus be seen that the attachment of a building connected therewith." rider or slip containing an express warranty to a policy, although referred to therein as ● On the 4th or 5th of February, 1913, the plaintiff placed in said residence and making a part thereof, is contrary to the evident intent and purpose of section 65 of the bodega three boxes, 18 by 18 by 20 inches measurement, which belonged to him Insurance Law. and which were filed with fireworks. ● On the 18th day of March, 1913, said residence and bodega and the contents Imperial, J. thereof were partially destroyed by fire. ● An express warranty, then, made at or before the execution of the policy, like warranty ● Said fireworks had been given to the plaintiff by the former owner of the Luneta F, is valid only if it is contained in the policy itself, or in another instrument signed by the Candy Store; that the plaintiff intended to use the same in the celebration of the insured and referred to in the policy as forming a part thereof. Examining warranty F, it Chinese new year; that the authorities of the city of Manila had prohibited the use may be seen that it does not form an integral part of the policy but appeals on another of fireworks on said occasion, and that the plaintiff then placed the same in said slip of paper pasted on the policy; it is therefore an instrument other than the policy and bodega, where they remained from the 4th or 5th of February, 1913, until after the comes under the second paragraph provided for in section 65. And, according to this fire of the 18th of March, 1913. provision, warranty F cannot be valid or binding, for the simple reason that it is not ● Both of the parties agree that said fireworks come within the phrase "hazardous signed by the insured, and has no weight, notwithstanding the fact that reference is goods," mentioned in said "warranty B" of the policy. made to it in a general way in the body of the policy. ● That said fireworks were found in a part of the building not destroyed by the fire; that they in no way contributed to the fire, or to the loss occasioned thereby. DISPOSITIVE: Accordingly, sustaining the first and fourth errors assigned, and it being ISSUE: Whether or not the placing of said fireworks in the building insured, under the conditions unnecessary to discuss the remaining errors, the result will be to reverse the judgment appealed above enumerated, they being "hazardous goods," is a violation of the terms of the contract of from and to order the dismissal of the complaint, without special pronouncement as to costs in insurance and especially of "warranty B." either instance.Street, Villamor, Ostrand, and Romualdez, JJ., concur. ("Warranty B" provides that "no hazardous goods be stored" in the building insured. It is admitted by both parties that the fireworks are "hazardous goods.")
Young v Midland Textile HELD: YES. G. R. No. L-9370 | March 31, 1915 ● The defendant alleged that they were "stored." The plaintiff contends that under By: GORDON all the facts and circumstances of the case, they were not "stored" in said building, and that the placing of them in the building was not a violation of the terms of the Topic: WARRANTIES contract. Both the plaintiff and defendant agree that if they were "hazardous Petitioners: K.S. Young goods," and if they were "stored," then the act of the plaintiff was a violation of the Respondents: The Midland Textile Insurance Company terms of the contract of insurance and the defendant was justified in repudiating its Ponente: Johnson, J liability thereunder.
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● The plaintiff says that he placed said fireworks in the bodega after he had been ● The defendant had neither been paid nor had issued a policy to cover the increased notified that he could not use them on the Chinese new year, in order that he might risk. An increase of risk which is substantial and which is continued for a later send them to a friend in the provinces. Whether a particular article is "stored" considerable period of time, is a direct and certain injury to the insurer, and or not must, in some degree, depend upon the intention of the parties. The changes the basis upon which the contract of insurance rests. interpretation of the word "stored" is quite difficult, in view of the many decisions upon the various conditions presented. Nearly all of the cases cited by the lower DISPOSITIVE: Therefore and for the foregoing reasons, the judgment of the lower court is court are cases where the article was being put to some reasonable and actual use, hereby revoked and the defendant is hereby relieved from any responsibility under said which might easily have been permitted by the terms of the policy, and within the complaint, and, without any finding as to costs, it is so ordered. intention of the parties, and excepted from the operation of the warranty, like the present. ○ The author of the Century Dictionary defines the world "store" to be a American Home Assurance v Tantuco deposit in a store or warehouse for preservation or safe keeping; o place GR 138941; 6 October 2001 in a warehouse or other place of deposit for safe keeping. See also the By: IGOT definitions given by the Standard Dictionary, to the same effect. Said definitions, of course, do not include a deposit in a store, in small Topic: Warranties; exceptions, exclusions, conditions quantities, for daily use. "Daily use" precludes the idea of a deposit for Petitioners: AMERICAN HOME ASSURANCE COMPANY preservation or safe keeping, as well as a deposit for future consumption, Respondents: TANTUCO ENTERPRISES, INC., or safe keeping. Ponente: PUNO, J.: ● In the present case no claim is made that the "hazardous goods" were placed in the DOCTRINE: : Not only are warranties strictly construed against the insurer, but they should, bodega for present or daily use. It is admitted that they were placed in the bodega likewise, by themselves be reasonably interpreted. That reasonableness is to be ascertained in "for future use," or for future consumption, or for safe keeping. light of the factual conditions prevailing in each case. ● It seems clear to us that the "hazardous goods" in question were "stored" in the FACTS: bodega, as that word is generally defined. ● Respondent Tantuco Enterprises, Inc. is engaged in the coconut oil milling and ● Contracts of insurance are contracts of indemnity upon the terms and conditions refining industry. It owns two oil mills located at a factory compound at Iyam, specified in the policy. The parties have a right to impose such reasonable Lucena City. conditions at the time of the making of the contract as they may deem wise and ● Respondent commenced its business operations with only one oil mill. In 1988, it necessary. The rate of premium is measured by the character of the risk assumed. started operating its second oil mill. The latter came to be commonly referred to as ● The insurance company, for a comparatively small consideration, undertakes to the new oil mill. guarantee the insured against loss or damage, upon the terms and conditions ● The two oil mills were separately covered by fire insurance policies issued by agreed upon, and upon no other, and when called upon to pay, in case of loss, the petitioner American Home Assurance Co., Philippine Branch. insurer, therefore, may justly insist upon a fulfillment of these terms. ○ First oil mill =insured for P3,000,000.00 Policy No. 306-7432324-3 for the ● The terms of the policy constitute the measure of the insurer's liability, and in period March 1, 1991 to 1992. order to recover the insured must show himself within those terms; and if it ○ The new oil mill = insured for P6,000,000.00 Policy No. 306-7432321-9 for appears that the contract has been terminated by a violation, on the part of the the same term. insured, of its conditions, then there can be no right of recovery. The compliance of ● Official receipts indicating payment for the full amount of the premium were issued the insured with the terms of the contract is a condition precedent to the right of by the petitioner's agent. recovery. If the insured has violated or failed to perform the conditions of the ● Fire that broke out in the early morning of September 30,1991 gutted and contract, and such a violation or want of performance has not been waived by the consumed the new oil mill. insurer, then the insured cannot recover. ● Tantuco immediately notified the American Home of the incident. The latter then ● The appellant argues, however, that in view of the fact that the "storing" of the sent its appraisers who inspected the burned premises and the properties fireworks on the premises of the insured did not contribute in any way to the destroyed. damage occasioned by the fire, he should be permitted to recover — that the ● October 15, 1991, in a letter, Petitioner rejected respondent's claim for the "storing" of the "hazardous goods" in no way caused injury to the defendant insurance proceeds on the ground that no policy was issued by it covering the company. burned oil mill. ● The violation of the terms of the contract, by virtue of the provisions of the policy ○ The description of the insured establishment referred to another building itself, terminated, at the election of either party, the contractual relations. thus: "Our policies extend insurance coverage to your oil mill under Building ● The plaintiff paid a premium based upon the risk at the time the policy was issued. No. 5, whilst the affected oil mill was under Building No. 14. Certainly it cannot be denied that the placing of the firecrackers in the building ● A complaint for specific performance and damages was consequently instituted by insured increased the risk. The plaintiff had not paid a premium based upon the the respondent with the RTC of Lucena City. increased risk, neither had the defendant issued a policy upon the theory of a ○ RTC: in favor of the plaintiff ordering defendant to pay different risk. ■ P4,406,536.40 representing damages for loss by fire of its insured property with interest at the legal rate; Insurance | SDUxMigallos |page | 4 ■ P80,000.00 for litigation expenses; ● Respondent was able to comply with the warranty. Within the vicinity of the new ■ P300,000.00 for and as attorney's fees; and oil mill can be found the following devices: numerous portable fire extinguishers, ■ Pay the costs two fire hoses, fire hydrant, and an emergency fire engine. CA: upheld RTC decision ● All of these equipment were in efficient working order when the fire occurred.
PETITIONERS It ought to be remembered that not only are warranties strictly construed against the insurer, ● Petitioner resists the claim of the respondent because the burned oil mill is but they should, likewise, by themselves be reasonably interpreted. That reasonableness is to be allegedly not covered by any insurance policy. According to it, the oil mill insured is ascertained in light of the factual conditions prevailing in each case. specifically described in the policy by its boundaries in the following manner: · Here, we find that there is no more need for an internal hydrant considering that ○ "Front: by a driveway thence at 18 meters distance by Bldg. No. 2. Right: by an inside the burned building were: (1) numerous portable fire extinguishers, (2) an open space thence by Bldg. No. 4. Left: Adjoining thence an imperfect wall by emergency fire engine, and (3) a fire hose which has a connection to one of the Bldg. No. 4. Rear: by an open space thence at 8 meters distance." external hydrants. It argues that this specific boundary description clearly pertains, not to the burned oil mill, but to the other mill. In other words, the oil mill gutted by fire was not the one ISSUE OF MISDESCRIPTION: described by the specific boundaries in the contested policy. ● In construing the words used descriptive of a building insured, the greatest ● Respondent did not have the supposed wrong description or mistake corrected. liberality is shown by the courts in giving effect to the insurance. In view of the Despite the "Important Notice" in the policy that "Please read and examine the policy custom of insurance agents to examine buildings before writing policies upon them, and if incorrect, return it immediately for alteration," and since a mistake as to the identity and character of the building is extremely ● Respondent is "barred by estoppel from claiming that the description of the insured unlikely, the courts are inclined to consider that the policy of insurance covers any oil mill in the policy was wrong, because it retained the policy without having the building which the parties manifestly intended to insure, however inaccurate the same corrected before the fire by an endorsement in accordance with its Condition description may be. No. 28." ● Notwithstanding the misdescription in the policy, what the parties manifestly ● Petitioner contends that respondent violated the express terms of the Fire intended to insure was the new oil mill. This is obvious from the categorical Extinguishing Appliances Warranty. The said warranty provides: statement embodied in the policy, extending its protection: ○ "WARRANTED that during the currency of this Policy, Fire Extinguishing o "On machineries and equipment with complete accessories usual to a Appliances as mentioned below shall be maintained in efficient working order coconut oil mill including stocks of copra, copra cake and copra mills on the premises to which insurance applies: whilst contained in the new oil mill building, situate (sic) at UNNO. ■ PORTABLE EXTINGUISHERS ALONG NATIONAL HIGH WAY, BO. IYAM, LUCENA CITY ■ INTERNAL HYDRANTS UNBLOCKED.'' ■ EXTERNAL HYDRANTS ● If the parties really intended to protect the first oil mill, then there is no need to ■ FIRE PUMP specify it as new. ■ 24-HOUR SECURITY SERVICES ● The imperfection in the description of the insured oil mill's boundaries can be ○ BREACH of this warranty shall render this policy null and void and the attributed to a misunderstanding between the petitioner's general agent, Mr. Company shall no longer be liable for any loss which may occur." Alfredo Borja, and its policy issuing clerk, who made the error of copying the ● Petitioner argues that the warranty clearly obligates the insured to maintain all the boundaries of the first oil mill when typing the policy to be issued for the new one. appliances specified therein. The breach occurred when the respondent failed to As testified to by Mr. Borja: install internal fire hydrants inside the burned building as warranted. This fact was o “…when I presented the existing policy of the old policy, the policy issuing admitted by the oil mill's expeller operator, Gerardo Zarsuela. clerk just merely copied the wording from the old policy and what she typed is that the description of the boundaries from the old policy was copied but ISSUES: WON there was breach of warranty which absolves the petitioner from liability she inserted covering the new oil mill and to me at that time the important thing is that it covered the new oil mill because it is just within one compound HELD: The petition is devoid of merit. and there are only two oil mills and so just enough, I had the policy prepared. BREACH OF WARRANTY: In fact, two policies were prepared having the same date one for the old one ● The argument lacks merit. The aforementioned warranty did not require and the other for the new oil mill and exactly the same policy period, sir." respondent to provide for all the fire extinguishing appliances enumerated therein. ● It is thus clear that the source of the discrepancy happened during the preparation ● Further, neither did it require that the appliances are restricted to those of the written contract. mentioned in the warranty. ● What the warranty mandates is that respondent should maintain in efficient ESTOPPEL: working condition within the premises of the insured property, fire fighting ● Evidence on record reveals that respondent's operating manager, Mr. Edison equipment such as, but not limited to, those identified in the list, which will serve as Tantuco, notified Mr. Borja about the inaccurate description in the policy. the oil mill's first line of defense in case any part of it bursts into flame. However, Mr. Borja assured Mr. Tantuco that the use of the adjective new will distinguish the insured property. The assurance convinced respondent, despite the
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impreciseness in the specification of the boundaries, the insurance will cover the new oil mill. Wilson v. Commercial Union: To allow a company to accept one's money for a policy of insurance which it then knows to be void and of no effect, though it knows as it must, that the assured DISPOSITIVE:IN VIEW WHEREOF, finding no reversible error in the impugned Decision, the believes it to be valid and binding, is so contrary to the dictates of honesty and fair dealing, and so instant petition is hereby DISMISSED. closely related to positive fraud, as to be abhorrent to fairminded men.
It would be to allow the company to treat the policy as valid long enough to get the Qua Chee Gan v Law Union & Rock Insurance premium on it, and leave it at liberty to repudiate it the next moment. G.R. No L-4611 ; Dec. 17, 1955 By: LANZON After the insured had incurred the expense of installing the two hydrants, the company collected the premiums and issued him a policy so worded that it gave the insured a discount much smaller Topic: Warranties than that he was normally entitled to. Petitioners: QUA CHEE GAN Respondents: : LAW UNION AND ROCK INSURANCE CO., LTD., represented by its agent, According to the "Scale of Allowances," a policy subject to a warranty of the existence of one fire WARNER, BARNES AND CO., LTD. hydrant for every 150 feet of external wall entitled the insured to a discount of 7 ½& of the Ponente: Reyes, J.B.L., J. premium; while the existence of "hydrants, in compound" (regardless of number) reduced the DOCTRINE: allowance on the premium to a mere 2 ½ % o The insurer kept the premium discount at the minimum of 2 ½ % thereby giving the FACTS: - Qua Chee Gan owned 4 bodegas (Bodegas Nos. 1 to 4) used for the storage of stocks of insurance company a double benefit. copra and of hemp. o No reason is shown why QCG’s premises, that had been insured with appellant for o The bodegas were insured with Law Union Insurance. several years past, suddenly should be regarded as so hazardous as to be accorded a treatment beyond the limits of appellant's own scale of allowances. - A fire broke out which lasted for a week, and gutted and completely destroyed Bodegas o Such abnormal treatment of the insured strongly points at an abuse of the insurance Nos. 1, 3 and 4 with the merchandise therein. company's selection of the words and terms of the contract, over which it had absolute - Qua Chee Gan filed a claim totaling P398,562.81 (reduced to P370k) control. - Law Union refused payment, claiming violation of warranties and conditions, filing of fraudulent claims, and that the fire had been deliberately caused by Que Chee Gan or by Taking into account the rule that ambiguities or obscurities must be strictly interpreted against the other persons in connivance with him. party that caused them: The "memo of warranty" bars the insurer from questioning the existence - Qua Chee Gan and others were indicted and tried for arson, but were acquitted. The civil of the appliances called for in the insured premises, since its initial expression, "the undernoted suit to collect the insurance money proceeded. appliances for the extinction of fire being kept on the premises insured hereby, . . . it is hereby - Law Union alleges that the policy should have been avoided for breach of warranty (see warranted . . .", admits of interpretation as an admission of the existence of such appliances which warranty on notes): the insurer cannot now contradict. - since the bodegas insured had an external wall perimeter of 500 meters or 1,640 feet, the appellee should have 11 fire hydrants in the compound, and 2) Gasoline is not specifically mentioned among the prohibited articles listed. that he actually had only 2 with a further pair nearby, belonging to the The cause relied upon by the insurer speaks of "oils (animal and/or vegetable and/or mineral municipality of Tabaco. and/or their liquid products having a flash point below 300° Fahrenheit", and is decidedly - Qua Chee Gan violated the “Hemp Warranty” against the storage of gasoline ambiguous and uncertain; for in ordinary parlance, "Oils" mean "lubricants" and not gasoline or since he admitted that there were 36 cans of gasoline in Bodega No. 2. kerosene.
ISSUE: 1) W/N Law Union is liable under the insurance policy? --- YES The gasoline kept in Bodega No. 2 was only incidental to his business, being no more 2) W/N there was a violation of the Hemp Warranty - NO than a customary 2 day's supply for the five or six motor vehicles used for transporting of the stored merchandise; hence, policy is not voided
HELD: 1) The insurer is barred by estoppel to claim violation of the so-called fire hydrant warranty where, knowing fully well that the number of hydrants demanded in the warranty never existed NOTES: Memo. of Warranty. — The undernoted Appliances for the extinction of fire being kept from the very beginning, it nevertheless issued the policies subject to such warranty, and received on the premises insured hereby, and it being declared and understood that there is an ample and the corresponding premiums. constant water supply with sufficient pressure available at all seasons for the same, it is hereby warranted that the said appliances shall be maintained in efficient working order during the DOCTRINE: Where the insurer, at the time of the issuance of a policy of insurance, has knowledge currency of this policy, by reason whereof a discount of 2 1/2 per cent is allowed on the premium of existing facts which, if insisted on, would invalidate the contract from its very inception, each chargeable under this policy knowledge constitutes a waiver of conditions in the contract inconsistent with the known facts, and the insurer is stopped thereafter from asserting the breach of such conditions. Insurance | SDUxMigallos |page | 6 Hydrants in the compound, not less in number than one for each 150 feet of external wall 12. Fieldmen's Insurance Company did not even care to rebut Amor Songco's testimony by measurement of building, protected, with not less than 100 feet of hose piping and nozzles for calling on the witness-stand agent Benjamin Sambat, its Pampanga Field Representative every two hydrants kept under cover in convenient places, the hydrants being supplied with water CFI: ruled in favor of the surviving widow and children and the injured passenger Jose pressure by a pumping engine, or from some other source, capable of discharging at the rate of not Manuel. less than 200 gallons of water per minute into the upper story of the highest building protected, 13. Fieldman appealed to the CA, which also affirmed the lower court. and a trained brigade of not less than 20 men to work the same.' Hence, this case. Fieldmen’s claims that: DISPOSITIVE: We find no reversible error in the judgment appealed from, wherefore the same is ● Estoppel cannot be invoked by the heirs as a bar to the alleged breach of warranty and hereby affirmed. Costs against the appellant. So ordered. condition in the policy ● No legal liability was incurred under the policy by Fieldmen’s. Fieldman’s Insurance vs. Songco G.R. No. L-24833; Date: September 23, 1968; ISSUE: W/N Insurer is liable for allegedly inducing the insured to apply for insurance with them, By: Abrigo despite the fact that the vehicle is a private one and not a common carrier, hence, not qualified for such insurance? — YES, after Fieldmen’s led Federico to believe that he could qualify under the Topic: Warranties; exceptions, exclusions, conditions common carrier liability insurance, it could not be permitted to change its stand to the detriment Petitioners: FIELDMEN'S INSURANCE CO., INC., petitioner, of the heirs of the insured. Respondents: MERCEDES VARGAS VDA. DE SONGCO, ET AL. and COURT OF APPEALS, respondents. HELD: Ponente: Fernando, J. On whether Fieldmen’s is liable on the policy DOCTRINE: It is now beyond question that where inequitable conduct is shown by an insurance ● Where inequitable conduct is shown by an insurance firm, it is estopped from firm, it is "estopped from enforcing forfeitures in its favor, in order to forestall fraud or imposition enforcing forfeitures in its favor in order to forestall fraud or imposition on the on the insured insured. ● After Fieldmen’s led Federico to believe that he could qualify under the common carrier FACTS: liability insurance, it could not be permitted to change its stand to the detriment of the 1. Federico Songco of Floridablanca, Pampanga, (a man who just finished a first grade), heirs of the insured. owned a private jeepney for the year 1960. ○ Note that Fieldmen knew all along of the fact that the insured owned a private 2. On September 15, 1960, Songco was induced by Fieldmen's Insurance Company vehicle, not a common carrier, when not once but twice its agent, without Pampanga agent Benjamin Sambat to apply for a Common Carrier's Liability Insurance objection in its part, exerted the utmost pressure on the insured, a man of Policy covering his motor vehicle. scant education, to enter into such a contract. 3. Upon paying an annual premium of P16.50, Fieldmen's Insurance Company, Inc. issued ● Estoppel is primarily based on the doctrine of good faith and the avoidance of harm that Common Carriers Accident Insurance Policy for one (1) year, effective September 15, will befall the innocent party due to its injurious reliance. The failure to apply in this case 1960 to September 15, 1961. would result in a gross travesty of justice. 4. Fieldmen's Insurance Company, Inc., upon payment of the corresponding premium, renewed the policy by extending the coverage from October 15, 1961 to October 15, On whether no legal liability was incurred under the policy 1962. ● As to the issue on breach, CA said (which the SC also agreed with) that, some of the 5. Federico Songco's private jeepney (during the effectiveness of the renewed policy) was conditions contained in the policy were impossible to comply with under the existing being driven by Rodolfo Songco, a duly licensed driver and son of Federico, collided conditions at the time and inconsistent with the known facts, so the insurer (Fieldmen’s) with a car. is estopped from asserting breach of such conditions. 6. Federico, Rodolfo Songco and, Carlos Songco (another son) had died. ● The injured policies, for whose hospital, medical and burial expenses expenses Fieldmen 7. Respondents here were the surviving widow and children of the deceased Federico was being made liable were the passengers and the driver of the vehicle in question at Songco as well as the injured passenger Jose Manuel. the time of the accident. Their status as beneficiaries under the policy must be 8. The injured parties or the heirs wanted to claim from Fieldmen’s under their insurance recognized. policy. However, Fieldmen denied, saying that what was insured was a private vehicle ● Even it be assumed that there was an ambiguity, based on Qua Chee Gan v. Law Union and and not a common carrier. Rock Insurance, taking into account the well-known rule that ambiguities or obscurities 9. During trial in CFI, another son of Federico, Amor, testified: must be strictly interpreted against the party that caused them. This rigid application 10. When Sambat was inducing Federico to insure the vehicle, he butted in saying that they of the rule on ambiguities has become necessary in view of current business practices. can’t insure the vehicle since it is an “owner” private vehicle, not for passengers. A. Nowadays, monopolies, cartels, those with overwhelming economic power, manage to 11. Agent Sambat replied: “whether the vehicle was an “owner” type or for passengers, it impose upon parties dealing with them contracts of adhesion, in contrast to those could be insured because their company is not owned by the Government, and the entered by parties bargaining on equal footing. Government has nothing to do with their company, so they could do as they please B. The weaker party’s participation in the agreement is reduced to the alternative of “take whenever they believe that the vehicle is insurable.” it or leave it”
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C. These kinds of contracts (contract of adhesion) call for greater strictness and vigilance ● Yap filed the present complaint with the CFI, asking for the payment of the face value of her on the part of courts of justice with a view to protecting the weaker party. insurance policy. ● Contract of insurance is one of perfect good faith (uberima fides) not for the insured ● Pioneer Insurance alleged that: alone, but equally so for the insurer; in fact, the insurer’s dominant bargaining position ○ No property belonging to Yap and covered by the insurance policy was destroyed carries with it stricter responsibility. by the fire; ● SC has no choice but to recognize the monetary responsibility of Fieldmen’s Insurance ○ Yap’s claim was filed out of time; and Co. It cannot escape from its liability. ○ Yap took out an insurance policy from another insurance company without Pioneer Insurance’s knowledge and/or endorsement, in violation of the express stipulations in DISPOSITIVE: WHEREFORE, the decision of the CA is AFFIRMED in its entirety. Policy No. 4219, hence, all benefits accruing from the policy were deemed forfeited. ● Trial court ruled in favor of Yap. CA affirmed. The CA reasoned that the other insurance policies are successive or substitutions not taken all at once, and that Pioneer has waived the terms Pioneer Insurance v Yap since they are aware of the other policies. GR No. L-36232 December 19, 1974 By: ANDAL ISSUE: W/N Pioneer Insurance should be absolved from liability on Fire Insurance Policy No. 4219 on account of any violation by Yap of the co-insurance clause. – YES. Topic: WARRANTY THAT THERE SHOULD BE NO OVER-INSURANCE Petitioners: PIONEER INSURANCE AND SURETY CORPORATION HELD: Respondents: OLIVIA YAP, represented by her attorney-in- fact, CHUA SOON POON Where a policy contains a clause providing that the policy shall be void if insured has or shall Ponente: FERNANDEZ, J. procure any other insurance on the property, the procurement of additional insurance without DOCTRINE: the consent of the insurer avoids the policy. FACTS: ● Olivia Yap was the owner of a store in a 2-storey building along Luna Street, Manila, where in Pioneer Insurance was not aware of the other insurance policies since there was absolutely no 1962 she sold shopping bags and footwear, such as shoes, sandals and step-ins. showing that it was aware of said substitution and preferred to continue the policy. ○ Chua Soon Poon, Oliva Yap’s son-in-law, was in charge of the store. ● Yap took out Fire Insurance Policy No. 4219 from Pioneer Insurance w/ a face value of If, with the knowledge of the existence of other insurances which the insurer deemed violations of Php25K covering her stocks, office furniture, fixtures and fittings of every kind and description. the contract, it has preferred to continue the policy, its action amounts to a waiver of the ● Among the conditions in the policy executed by the parties are the following: annulment of the contract . A waiver of violations must be express. ○ “The Insured shall give notice to the Company of any insurance or insurances already effected, or which may subsequently be effected, covering any of the property If it is to be implied from conduct mainly, said conduct must be clearly indicative of a clear intent to hereby insured, and unless such notice be given and the particulars of such insurance or waive such right. insurances be stated in or endorsed on this Policy by or on behalf of the Company before the occurrence of any loss or damage, all benefits under this Policy shall be forfeited.” By the plain terms of the policy, other insurance policies procured without the consent of ○ “It is understood that, except as may be stated on the face of this policy there is no Pioneer would ipso facto avoid the contract. other insurance on the property hereby covered and no other insurance is allowed except by the consent of the Company endorsed hereon. Any false declaration or breach It required no affirmative act of election on the part of the company to make operative the clause or this condition will render this policy null and void.” avoiding the contract, wherever the specified conditions should occur. Its obligations ceased, ● At the time Policy No. 4219 was obtained, an insurance policy for Php20K issued by the unless, being informed of the fact, it consented to the additional insurance. Great American Insurance Company covering the same properties was noted on said policy as co-insurance. Considering the terms of the policy which required the insured to declare its other insurance ● The parties executed Exhibit “1-K”, as an endorsement on Policy No. 4219, stating: policies, the statement in question must be deemed to be a statement (warranty) binding on both ○ “It is hereby declared and agreed that the co-insurance existing at present under insurer and insured, that there were no other insurance on the property. this policy is as follows: Php20K—Northwest Ins., and not asoriginally stated, ○ “Except as varied by this endorsement, all other terms and conditions remain The annotation then, must be deemed to be a warranty that the property was not insured by any unchanged.” other policy. Violation thereof entitled the insurer to rescind. ● Still, Yap took out another fire insurance policy for Php20K covering the same properties, this time from Federal Insurance Company, Inc., which new policy was, however, procured without The obvious purpose of the requirement in the policy is to prevent over-insurance and thus avert notice to and the written consent of petitioner Pioneer Insurance and was not noted as a the perpetration of fraud. The public, as well as the insurer, is interested in preventing the situation co-insurance in Policy No. 4219. in which a fire would be profitable to the insured. ● A fire broke out in the building housing Yap’s store, and the store was burned. ● Yap filed an insurance claim which was denied on the ground of “breach and/or violation of DISPOSITIVE: any and/or all terms and conditions” of Policy No. 4219. WHEREFORE, the appealed judgment of the Court of Appeals is REVERSED and set aside, and the petitioner absolved from all liability under the policy. Costs against private respondent.
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RTC rendered Judgment in favor of Prudential and ruled that a determination of the parties’ liabilities hinged on whether Trans-Asia violated and breached the policy conditions on “warranted Prudential Guarantee v. Trans-Asia vessel classed and class maintained”. It interpreted the provision to mean that Trans-Asia is required GR 151890 ; June 20, 2006 to maintain the vessel at a certain class at all times pertinent during the life of the policy. It By: BACANI ratiocinated that the concealment made by Trans-Asia that the vessel was not adequately maintained to preserve its class was a material concealment sufficient to avoid the policy and, thus, Topic: Warranties; exceptions, exclusions, conditions entitled the injured party to rescind the contract. Petitioners: PRUDENTIAL GUARANTEE AND ASSURANCE INC. Respondents: TRANS-ASIA SHIPPING LINES INC. On appeal, CA reversed the RTC decision. It ruled that Prudential, as the party asserting the Ponente: Chico-Nazario, J. non-compensability of the loss had the burden of proof to show that Trans-Asia breached the DOCTRINE: Breach of a warranty or of a condition renders the contract defeasible at the option of the warranty, which burden it failed to discharge. Prudential cannot rely on the lack of certification to insurer; but if he so elects, he may waive his privilege and power to rescind by the mere expression of an the effect that Trans-Asia was classed and class maintained as its sole basis for reaching the intention so to do. In that event his liability under the policy continues as before. conclusion that the warranty was breached.
FACTS: Trans-Asia is the owner of the vessel M/V Asia Korea. In consideration of payment of CA opined that the lack of a certification does not necessarily mean that the warranty was premiums, Prudential Guarantee insured the vessel for loss/damage of the hull and machinery breached. Instead, it considered Prudential’s admission that at the time the insurance contract was arising from perils of fire and explosion for the sum of 40M beginning on July 1, 1993 until the entered into between the parties, the vessel was properly classed by Bureau Veritas, a same date of the following year. On October 25, while the policy was in force, a fire broke out while classification society recognized by the industry. CA similarly gave weight to the fact that it was the vessel was undergoing repairs at the port of Cebu. the responsibility of Richards Hogg International, the average adjuster, to secure a copy of such certification to support its conclusion that mere absence of a certification does not warrant denial The following day, Trans-Asia filed its notice of claim for damage sustained by the vessel. of Tran’s-Asia’s claim. Trans-Asia reserved its right to subsequently notify Prudential as to the full amount of the claim upon final survey and determination by average adjuster Richard Hogg International of the CA also found the subject warranty allegedly breached by Trans-Asia to be a rider which, while damage sustained by reason of fire. An adjuster’s report on the fire in question was submitted contained in the policy, was inserted by Prudential without the intervention of Trans-Asia. As such, together with the U-Marine Surveyor Report. it partakes of a nature of a contract of adhesion which should be construed against Prudential, the party which drafted the contract. Likewise, Prudential’s renewals of the policy must be deemed a On May 29, 1995, Trans-Asia executed a document denominated "Loan and Trust receipt", which waiver by Prudential of any breach of warranty committed by Trans-Asia. contained a statement saying that it received from Prudential Guarantee the sum of 3M as a loan without interest, repayable only in the event and to the extent that any net recovery is made by Further, it interpreted the transaction as one of subrogation instead of a loan. CA concluded that Trans-Asia from any person/s, corporation/s, or other parties, on account of loss by any casualty Trans-Asia has no obligation to pay back the amount of 3M to Prudential based on its finding that for which they may be liable. the aforesaid amount was Prudential’s partial payment to Trans-Asia’s claim under the policy.
In a letter, Prudential denied Trans-Asia’s claim. It alleged that Trans-Asia was in breach of policy Not satisfied with the judgment, both parties filed an MR and partial MR, which were both denied. conditions, such as “warranted vessel classed and class maintained”. Thus, its claim was not Still aggrieved, both parties separately filed a petition for review which were consolidated. compensable and therefore denied. Trans-Asia then issued a letter requesting the return/payment of the 3M within a period of 10 days from receipt of the letter. ISSUE: Whether Trans-Asia breached the warranty condition
On August 13, 1997, Trans-Asia filed a Complaint for Sum of Money against Prudential with the HELD: NO. Cebu City RTC, wherein they sought the amount of Php 8,395,072.26, alleging that it represents Prudential failed to establish that Trans-Asia violated and breached the policy condition as the balance of the indemnity due upon the insurance policy in the total amount of Php contained in the subject insurance contract. In resisting the claim of Trans-Asia, Prudential posits 11,395,072.26. It similarly sought interest at 42% per annum citing Section 243 of the Insurance that Trans-Asia violated an express and material warranty in the subject insurance contract, Code. specifically Warranty Clause No. 5, which stipulates that the insured vessel, "M/V Asia Korea” is required to be classed and class maintained. In its Answer, Prudential denied the material allegations of the Complaint and interposed the defense that Trans-Asia breached insurance policy conditions. It further alleged that it acted as According to Prudential, at the time of the occurrence of the fire, the vessel was in violation of the facts and law require and incurred no liability; that Trans-Asia has no cause of action; and, that its warranty as it was not classed and class maintained. Prudential submits that the Warranty Clause claim has been effectively waived and/or abandoned, or it is estopped from pursuing the same. By was a condition precedent to the recovery under the policy, the violation of which entitled way of a counterclaim, Prudential sought a refund of 3M, which it allegedly advanced to Trans-Asia Prudential to rescind the contract under Sec. 74 of the Insurance Code. by way of a loan without interest and without prejudice to the final evaluation of the claim, including survey fees and attorney’s fees. At the outset, it must be emphasized that the party which alleges a fact as a matter of defense has the burden of proving it. Prudential, as the party which asserted the claim, has the burden of
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evidence to establish the same. Clearly, if no evidence on the alleged breach of the subject 10% thereof as attorney's fees) shall be imposed double interest at the rate of 24% per annum to warranty is shown, Trans-Asia would be successful in claiming on the policy. be computed from 13 September 1996 until fully paid; and [4] An interest of 12% per annum is similarly imposed on the TOTAL amount of liability adjudged as abovestated in paragraphs [1], [2], Trans-Asia was able to establish proof of loss and the coverage of the loss. Thereafter, the burden and [3] herein, computed from the time of finality of judgment until the full satisfaction thereof. No of evidence shifted to Prudential to counter Trans-Asia’s case, and to prove its special and costs. SO ORDERED. affirmative defense that Trans-Asia was in violation of the particular condition. We sustain the findings of the CA that Prudential was not successful in discharging the burden of evidence that Trans-Asia breached the subject policy condition. General Insurance v Ng Hua G.R. No:L-14373 ; Date: January 30, 1960 Prudential, through its Senior Manager of Marine and Aviation Division, made a categorical By: CRUZ admission that at the time of the procurement of the insurance contract in July 1993, Trans-Asia’s vessel, "M/V Asia Korea" was properly classed by Bureau Veritas. As it is undisputed Topic: Warranties; Exceptions, exclusions, conditions that Trans-Asia was properly classed at the time the contract of insurance was entered into, thus, it Petitioners: GENERAL INSURANCE & SURETY CORPORATION becomes incumbent upon Prudential to show evidence that the status had shifted in violation of Respondents: NG HUA the warranty. Ponente: BENGZON, J. DOCTRINE: Assuming arguendo that Trans-Asia violated the policy condition, Prudential made a valid waiver of the same. Breach of a warranty or of a condition renders the contract defeasible at the option of FACTS: the insurer; but if he so elects, he may waive his privilege and power to rescind by the mere ● On April 15, 1952, General Insurance and Surety Corporation issued its insurance Policy expression of an intention so to do. In that event his liability under the policy continues as before. No. 471, insuring against fire, for 1 year, the stock in trade of the Central Pomade There can be no clearer intention of the waiver of the alleged breach than the renewal of the Factory owned by Ng Hua, the court insured. policy insurance granted by Prudential to Trans-Asia in MH94/1595 and MH95/1788, issued in ● The next day, the Pomade factory building burned, resulting in destruction by fire of the the years 1994 and 1995, respectively. insured properties. ● Ng Hua claimed indemnity from the insurer. To our mind, the argument is made even more credulous by Prudential’s lack of proof to support its ● The policy covered damages up to P10,000.00; but after some negotiations and upon allegation that the renewals of the policies were taken only after a request was made to Trans-Asia suggestion of the Manila Adjustment Company, he reduced the claim of P5,000.00. to furnish them a copy of the certificate attesting that the vessel was classed and class maintained. ● General Insurance refused to pay for various reasons,: Notwithstanding Prudential’s claim that no certification was issued to that effect, it renewed the ○ (a) action was not filed in time; policy, thereby, evidencing an intention to waive the alleged breach. Clearly, by granting the ○ (b) violation of warranty renewal policies twice and successively after the loss, the intent was to benefit the insured, ○ (c) submission of fraudulent claim Trans-Asia, as well as to waive compliance of the warranty. ○ (f) failure to pay the premium. ● The aforesaid Policy No. 471 contains ff on the back: Notwithstanding its designation, the tenor of the "Loan and Trust Receipt" evidences that the real ○ 3. The insured shall give notice to the company of any insurance or insurances nature of the transaction between the parties was that the amount of 3M was not intended as a already affected, or which may subsequently be effected, covering any of the loan whereby Trans-Asia is obligated to pay Prudential, but rather, the same was a partial payment property hereby insured, and unless such notice be given and the particulars of such or an advance on the policy of the claims due to Trans-Asia. insurance or insurances be stated in or endorsed on this Policy by or on behalf of the Company before the occurrence of any loss or damage, all benefits under the Prudential is directed to pay Trans-Asia the amount of Php 8,395,072.26, representing the balance policy shall be forfeited. of the loss suffered by Trans-Asia and covered by the Marine Policy. Likewise, Prudential is ● Ng Hua had obtained fire insurance on the same goods, for the same period of time, in directed to pay damages in the form of attorney’s fees equivalent to 10% of Php 8,395,072.26. the amount of P20,000.00 from General Indemnity Co. ● CFI:General Insurance required to pay DISPOSITIVE: WHEREFORE, the Petition in G.R. No. 151890 is DENIED. However, the Petition in ● CA ruling: affirmed decision of CFI G.R. No. 151991 is GRANTED, thus, we award the grant of attorney's fees and make a clarification ○ Referring to the annotation and overruling the defense, held that there was that the term "double interest" as used in the 6 November 2001 Decision of the Court of Appeals no violation of the above clause, inasmuch as "co-insurance exists when a in CA GR CV No. 68278 should be construed to mean interest at the rate of 24% per annum, with a condition of the policy requires the insured to bear ratable proportion of the further clarification, that the same should be computed from 13 September 1996 until fully paid. loss when the value of the insured property exceeds the face value of the The Decision and Resolution of the Court of Appeals, in CA-G.R. CV No. 68278, dated 6 November policy," 2001 and 29 January 2002, respectively, are, thus, MODIFIED in the following manner, to wit: [1] ○ Hence, there is no co-insurance. PRUDENTIAL is DIRECTED to PAY TRANS-ASIA the amount of P8,395,072.26, representing the balance of the loss suffered by TRANS-ASIA and covered by Marine Policy No. MH93/1363; [2] PRUDENTIAL is DIRECTED further to PAY TRANS-ASIA damages in the form of attorney's fees ISSUE: Whether or not there was a breach of warranty? equivalent to 10% of the amount of P8,395,072.26; [3] The aggregate amount (P8,395,072.26 plus Insurance | SDUxMigallos |page | 10 HELD: Yes. ● Undoubtedly, co-insurance exists under the condition described by CA. But that is one Topic: LOSS kind of co-insurance. It is not the only situation where co-insurance exists. Other Petitioners: MALAYAN INSURANCE COMPANY, INC., insurers of the same property against the same hazard are sometimes referred to as Respondents: PAP CO., LTD. (PHIL. BRANCH) co-insurers and the ensuing combination as coinsurance And considering the terms of Ponente: MENDOZA, J. the policy which required the insured to declare other insurances, the statement in DOCTRINE: question must be deemed to be a statement (warranty) binding on both insurer and FACTS: insured, that there were no other insurance on the property. On May 13, 1996, Malayan Insurance issued Fire Insurance Policy to PAP Co. for the latter’s ● Remember it runs "Co-Insurance declared"; emphasis on the last word. If "Co-insurance" machineries and equipment located at Sanyo Building. The insurance, which was for Fifteen Million means what CA says, the annotation serves no purpose. It would even be contrary to the Pesos (P15,000,000.00) and effective for a period of one (1) year, was procured by PAP Co. for policy itself, which in its clause No. 17 made the insured a co-insurer for the excess of Rizal Commercial Banking Corporation (RCBC), the mortgagee of the insured machineries and the value of the property over the amount of the policy equipment. ● After the passage of almost a year but prior to the expiration of the insurance coverage, PAP Co. ● renewed the policy on an “as is” basis. Pursuant thereto, a renewal policy for the period May 13, ● The annotation then, must be deemed to be a warranty that the property was not 1997 to May 13, 1998 was issued. insured by any other policy. Violation thereof entitles the insurer to rescind. (Sec. 69. On October 12, 1997 and during the subsistence of the renewal policy, the insured machineries Insurance Act) Such misrepresentation is fatal in the light of our views in Santa Ana vs. and equipment were totally lost by fire. Hence, PAP Co. filed a fire insurance claim with Malayan in Commercial Union Assurance Company, Ltd., 55 Phil., 329. The materiality of the amount insured. non-disclosure of other insurance policies is not open to doubt. Malayan denied the claim upon the ground that, at the time of the loss, the insured machineries ● All the above considerations lead to the conclusion that the defendant insurer and equipment were transferred by PAP Co. to a location different from that indicated in the successfully established its defense of warranty breach or concealment of the other policy. Malayan claims that PAP concealed a material fact in violation of Section 27 of the insurance and/or violation of the provision of the policy above mentioned. Insurance Code when it did not inform Malayan of the actual and new location of the insured properties. It adds that PAP is guilty of misrepresentation upon a material fact in violation of Other issue: Section 45 of the Insurance Codewhen it informed Malayan that there would be no changes in the ● Furthermore, even if the annotation were overlooked, the General insurance would still original policy, and that the original policy would be renewed on an “as is” basis. be free from liability because there is no question that the policy issued by General Contesting the denial, PAP Co. argued that Malayan cannot avoid liability as it was informed of the Indemnity has not been stated in nor endorsed on Policy No. 471. And as stipulated in transfer by RCBC, the party duty-bound to relay such information. the above-quoted provisions of such policy "all benefit under this policy shall be forfeited. ISSUE: Whether or not Malayan should be held liable for the loss of the insured properties under ● To avoid the disastrous effect of the misrepresentation or concealment of the other the fire insurance policy insurance policy, Ng Hua alleges "actual knowledge" on the part of General Insurance of the fact that he had taken out additional insurance with General Indemnity. He does not HELD: NO. say when such knowledge was acquired or imparted. If General Insurance knew before The Court agrees with the position of Malayan that it cannot be held liable for the loss of the issuing its policy or before the fire, such knowledge might overcome the insurer's insured properties under the fire insurance policy. defense. However, CA found no evidence of such knowledge. We have read the pages of With the transfer of the location of the subject properties, without notice and without the stenographic notes cited by Ng Hua and all we gather is evidence of the existence of Malayan’s consent, after the renewal of the policy, PAP clearly committed concealment, the insurance with General Indemnity Company. As to knowledge of General Insurance misrepresentation and a breach of a material warranty. Section 26 of the Insurance Code provides: before issuance of its policy or the fire, there was none. Section 26. A neglect to communicate that which a party knows and ought to communicate, is called a ● Indeed, this concealment and violation was expressly set up as a special defense in the concealment. answer. Yet General Insurance did not, in avoidance, reply nor assert such knowledge. Under Section 27 of the Insurance Code, “a concealment entitles the injured party to rescind a And it is doubtful whether evidence on the point would be admissible under the contract of insurance.” pleadings. (See Rule 11, sec. 1.) Moreover, under Section 168 of the Insurance Code, the insurer is entitled to rescind the DISPOSITIVE:Wherefore, the judgment under review will be revoked, and the defendant insurer insurance contract in case of an alteration in the use or condition of the thing insured. Section 168 (herein petitioner) acquitted from all the liability under the policy. Costs against respondent. So of the Insurance Code provides, as follows: ordered. Section 68. An alteration in the use or condition of a thing insured from that to which it is limited by the policy made without the consent of the insurer, by means within the control of the insured, and increasing the risks, entitles an insurer to rescind a contract of fire insurance. Malayan Insurance Co., Inc. v PAP Ltd Accordingly, an insurer can exercise its right to rescind an insurance contract when the following G.R. No. 200784, August 7, 2013 conditions are present, to wit: By: GORDON 1) the policy limits the use or condition of the thing insured; 2) there is an alteration in said use or condition; 3) the alteration is without the consent of the insurer; Insurance | SDUxMigallos |page | 11 4) the alteration is made by means within the insured’s control; and 5) the alteration increases the risk of loss. ISSUE: Whether the policy was still effective even when there was a default in the payment of In the case at bench, all these circumstances are present. It was clearly established that the premiums? renewal policy stipulated that the insured properties were located at the Sanyo factory; that PAP removed the properties without the consent of Malayan; and that the alteration of the location RULING: NO increased the risk of loss. ● In Capital Insurance and Surety Co., Inc. vs. Delgado, this Court said: On the other hand, the preponderance of the evidence shows that appellee issued fire DISPOSITIVE:WHEREFORE, the October 27, 2011 Decision of the Court of Appeals is hereby insurance policy No. C-1137 in favor of appellants covering a certain property belonging REVERSED and SET ASIDE. Petitioner Malayan Insurance Company, Inc. is hereby declared NOT to the latter located in Cebu City; that appellants failed to pay a balance of P583.95 on liable for the loss of the insured machineries and equipment suffered by PAP Co., Ltd. the premium charges due, notwithstanding demands made upon them. As with the issuance of the policy to appellants the same became effective and binding upon the contracting parties, the latter can not avoid the obligation of paying the premiums agreed Premium upon. In fact, appellant Mario Delgado, in a letter marked in the record as Exhibit G, expressly admitted his unpaid account for premiums and asked for an extension of time to pay the same. It is clear from the foregoing that appellants are under obligation to pay the amount sued upon. Arce v Capital Insurance ● Upon the other hand, Sec. 72 of the Insurance Act, as amended by R.A. No. 3540 GR L-28501, 30 September 1985 reads: By: IGOT SEC. 72. An insurer is entitled to payment of premium as soon as the thing Topic: Premium insured is exposed to the perils insured against, unless there is clear Petitioners: PEDRO ARCE agreement to grant credit extension for the premium due. No policy issued by Respondents: THE CAPITAL INSURANCE & SURETY CO., INC., an insurance company is valid and binding unless and until the premium Ponente: ABAD SANTOS, J.: thereof has been paid " DOCTRINE: ● Moreover, the parties in this case had stipulated: FACTS: IT IS HEREBY DECLARED AND AGREED that not. withstanding anything to ● Pedro Arce (INSURED), owner of a residential house in Tondo ,which had been insured the contrary contained in the within policy, this insurance will be deemed with Capital Insurance and Surety Co., Inc. under Fire Policy No. 24204. valid and binding upon the Company only when the premium and ○ On November 27, 1965, Capital sent to Arce a Renewal Certificate To documentary stamps therefor have actually been paid in full and duly cover the period December 5, 1965 - 1966. acknowledged in an official receipt signed by an authorized ○ Capital also requested payment of the corresponding premium in the official/representative of the Company, " (pp. 45-46, Record on Appeal.) amount of P 38.10. ● Anticipating that the premium could not be paid on time, Arce, thru his wife, ● It is obvious from both the Insurance Act, as amended, and the stipulation of the promised to pay it on January 4, 1966. parties that time is of the essence in respect of the payment of the insurance ○ Capital accepted the promise. premium so that if it is not paid the contract does not take effect unless there is ○ Premium was not paid on January 4, 1966. still another stipulation to the contrary. ● On January 8, 1966, Arce’s house was totally destroyed by fire. ○ In the instant case, the INSURED was given a grace period to pay the ● Arce's wife presented a claim for indemnity to Capital. premium but the period having expired with no payment made, he ● She was told that no indemnity was due because the premium on the policy was not cannot insist that the COMPANY is nonetheless obligated to him. paid. ○ Nonetheless, Capital tendered a check for P300.00 as financial aid which ● It is to be noted that Delgado was decided in the light of the Insurance Act before was received by Arce's daughter, Evelina. Sec. 72 was amended by the addition of the underscored portion, supra, Prior to ○ The voucher for the check which Evelina signed stated that it was "in full the amendment, an insurance contract was effective even if the premium had not settlement (ex gratia) of the fire loss under the policy. been paid so that an insurer was obligated to pay indemnity in case of loss and ● Arce and his wife went to Capital’s office to have his signature on the check correlatively he had also the right to sue for payment of the premium. But the Identified preparatory to encashment. amendment to Sec. 72 has radically changed the legal regime in that unless the ○ Capital reiterated that the check was given "not as an obligation, but as premium is paid there is no insurance. a concession" because the renewal premium had not been paid. ○ Arce cashed the check but then sued Capital on the policy. ● With the foregoing, it is not necessary to dwell at length on the trial court's second ● LOWER COURT held that since Capital could have demanded payment of the proposition that the INSURED had not authorized his daughter Evelina to make a premium, mutuality of obligation requires that it should also be liable on its policy. waiver because the INSURED had nothing to waive; his policy ceased to have effect Capital was not bound by the signature of Evelina on the check voucher because he when he failed to pay the premium. did not authorize her to sign the waiver.
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● We commiserate with Arce. We are wen aware that many insurance companies PHOENIX SURETY AND INSURANCE, INC., hereinafter called the Company, the sum of have fallen into the condemnable practice of collecting premiums promptly but — PESOS NINE THOUSAND EIGHT HUNDRED FORTY SIX ONLY — the Premium for resort to all kinds of excuses to deny or delay payment of just claims. Unhappily the the first period hereinafter mentioned. … instant case is one where the insurer has the law on its side. xxx xxx xxx THE COMPANY HEREBY AGREES with the Insured ... that if the Property DISPOSITIVE:WHEREFORE, the decision of the court a quo is reversed; the appellee's complaint above described, or any part thereof, shall be destroyed or damaged by Fire or is dismissed. No special pronouncement as to costs. Lightning after payment of Premium, at any time between 4:00 o'clock in the afternoon of the TWENTY FIRST day of JULY One Thousand Nine Hundred and SIXTY and 4:00 o'clock in the afternoon of the TWENTY FIRST day of Philippine Phoenix v Woodworks, JULY One Thousand Nine Hundred and SIXTY ONE. ... (Emphasis supplied) G.R. No. L-25317 ; August 6, 1979 By: LANZON Paragraph "2" of the Policy further contained the following condition: 2. No payment in respect of any premium shall be deemed to be payment to the Topic: Premiums Company unless a printed form of receipt for the same signed by an Official or Petitioners: PHILIPPINE PHOENIX SURETY & INSURANCE COMPANY duly-appointed Agent of the Company shall have been given to the Insured Respondents: WOODWORKS, INC Ponente: MELENCIO-HERRERA, J.: Paragraph "10" of the Policy also provided: PARTIES: PHILIPPINE PHOENIX SURETY & INSURANCE COMPANY, plaintiff-appellee 10. This insurance may be terminated at any time at the request of the Insured, in which WOODWORKS, INC., defendant-appellant. case the Company will retain the customary short period rate for the time the policy has FACTS: On July 21, 1960, upon defendant's application, plaintiff issued in its favor Fire Insurance been in force. This insurance may also at any time be terminated at the option of the Policy No. 9749 for P500,000.00 whereby plaintiff insured defendant's building, machinery and Company, on notice to that effect being given to the Insured, in which case the Company equipment for a term of one year from July 21, 1960 to July 21, 1961 against loss by fire. The shall be liable to repay on demand a ratable proportion of the premium for the unexpired premium and other charges including the margin fee surcharge of P590.76 and the documentary term from the date of the cancelment. stamps in the amount of P156.60 affixed on the Policy, amounted to P10,593.36. ISSUE: W/N there was a valid insurance contract despite no premium payment was paid and W/N It is undisputed that defendant did not pay the premium stipulated in the Policy when it was issued Phoenix can recover the “unpaid” premiums even though the policy was not used during the period nor at any time thereafter. covered
On April 19, 1961, or before the expiration of the one-year term, plaintiff notified defendant, HELD: No, Sec. 77 of the Insurance Code provides that no contract of insurance issued by an through its Indorsement No. F-6963/61, of the cancellation of the Policy allegedly upon request of insurance company is valid and binding unless and until the premium thereof has been paid, defendant. The latter has denied having made such a request. In said Indorsement, plaintiff notwithstanding any agreement to the contrary. Insurance is "a contract whereby one undertakes credited defendant with the amount of P3,110.25 for the unexpired period of 94 days, and claimed for a consideration to indemnify another against loss, damage or liability arising from an unknown the balance of P7,483.11 representing ,learned premium from July 21, 1960 to 18th April 1961 or, or contingent event." The consideration is the "premium". "The premium must be paid at the time say 271 days." On July 6, 1961, plaintiff demanded in writing for the payment of said amount. and in the way and manner specified in the policy and, if not so paid, the policy will lapse and be Defendant, through counsel, disclaimed any liability in its reply- letter of August 15, 1961, forfeited by its own terms." contending, in essence, that it need not pay premium "because the Insurer did not stand liable for any indemnity during the period the premiums were not paid." Clearly, the Policy provides for pre-payment of premium. Accordingly; "when the policy is tendered the insured must pay the premium unless credit is given or there is a waiver, or some On January 30, 1962, plaintiff commenced action in the Court of First Instance of Manila, Branch agreement obviating the necessity for prepayment." To constitute an extension of credit there IV (Civil Case No. 49468), to recover the amount of P7,483.11 as "earned premium." Defendant must be a clear and express agreement therefore." From the Policy provisions, we fail to find any controverted basically on the theory that its failure "to pay the premium after the issuance of the clear agreement that a credit extension was accorded to the defendant. And even if it were to be policy put an end to the insurance contract and rendered the policy unenforceable." presumed that plaintiff had extended credit from the circumstances of the unconditional delivery of the Policy without prepayment of the premium, yet it is obvious that defendant had not On September 13, 1962, judgment was rendered in plaintiff's favor "ordering defendant to pay accepted the insurer's offer to extend credit, which is essential for the validity of such agreement. plaintiff the sum of P7,483.11, with interest thereon at the rate of 6%, per annum from January 30, An acceptance of an offer to allow credit, if one was made, is as essential to 1962, until the principal shall have been fully paid, plus the sum of P700.00 as attorney's fees of the make a valid agreement for credit, to change a conditional delivery of an plaintiff, and the costs of the suit." From this adverse Decision, defendant appealed to the Court of insurance policy to an unconditional delivery, as it is to make any other Appeals which, as heretofore stated, certified the case to us on a question of law. contract. Such an acceptance could not be merely a mental act or state of mind, but would require a promise to pay made known in some manner to The provisions on premium in the subject Policy read: defendant. THIS POLICY OF INSURANCE WITNESSETH, THAT in consideration of — MESSRS. In this respect, the instant case differs from that involving the same parties entitled Philippine WOODWORKS, INC. — hereinafter called the Insured, paying to the PHILIPPINE Phoenix Surety & Insurance Inc. vs. Woodworks, Inc. (1967), where recovery of the balance of the
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unpaid premium was allowed inasmuch as in that case "there was not only a perfected contract 3. Woodworks paid P3,000.00 on September 22, 1960. Phoenix made several demands on of insurance but a partially performed one as far as the payment of the agreed premium was Woodworks to pay the remaining amount of P3,522.09, but Woodworks failed to pay. concerned." This is not the situation obtaining here where no partial payment of premiums has 4. Phoenix commenced an action in the Municipal Court of Manila to recover from been made whatsoever. Woodworks the sum of P3,522.09, representing the unpaid balance of the premiums on Since the premium had not been paid, the policy must be deemed to have lapsed. the fire insurance policy issued by Phoenix in favor of Woodworks for a term of one year The non-payment of premiums does not merely suspend but put an end to from April 1, 1960 to April 1, 1961. an insurance contract, since the time of the payment is peculiarly of the 5. The Municipal Court ruled in favor of Phoenix. From an adverse decision of said court, essence of the contract. Woodworks, Inc. appealed to the Court of First Instance of Manila. The CFI affirmed and ... the rule is that under policy provisions that upon the failure to make a ordered Woodworks to pay Phoenix the unpaid balance. payment of a premium or assessment at the time provided for, the policy shall 6. Woodworks, Inc. appealed with SC upon a question of law. It claims the lower court become void or forfeited, or the obligation of the insurer shall cease, or words committed the following errors: to like effect, because the contract so prescribes and because such a ● The lower court erred in stating that in fire insurance policies the risk attached upon the stipulation is a material and essential part of the contract. This is true, for issuance and delivery of the policy to the insured. instance, in the case of life, health and accident, fire and hail insurance ● The lower court erred in deciding that in a perfected contract of insurance policies. non-payment of premium does not cancel the policy. In fact, if the peril insured against had occurred, plaintiff, as insurer, would have had a valid defense ● The lower court erred in deciding that the premium in the policy was still collectible against recovery under the Policy it had issued. Explicit in the Policy itself is plaintiff's agreement when the complaint was filed. to indemnify defendant for loss by fire only "after payment of premium," supra. Compliance by the ● The lower court erred in deciding that a partial payment of the premium made the insured with the terms of the contract is a condition precedent to the right of recovery. policy effective during the whole period of the policy. The burden is on an insured to keep a policy in force by the payment of premiums, rather than on the insurer to exert every effort to prevent the ISSUES: insured from allowing a policy to elapse through a failure to make premium 1. Whether or not there was a perfected contract of insurance - YES. payments. The continuance of the insurer's obligation is conditional upon the 2. Whether or not partial payment of the premium made the insurance policy effective - payment of premiums, so that no recovery can be had upon a lapsed policy, YES. the contractual relation between the parties having ceased. Moreover, "an insurer cannot treat a contract as valid for the purpose of collecting premiums RULING: and invalid for the purpose of indemnity." 1. It is clear from the foregoing that on April 1, 1960 Fire Insurance Policy No. 9652 was DISPOSITIVE: WHEREFORE, the judgment appealed from is reversed, and plaintiff's complaint issued by Phoenix and delivered to Woodworks, and that on September 22 of the same hereby dismissed. Teehankee (Chairman), Fernandez, Guerrero and De Castro, JJ., concur. year, the latter paid to the former the sum of P3,000.00 on account of the total premium of P6,051.95 due thereon. There is, consequently, no doubt at all that, as between the insurer and the insured, there was not only a perfected contract of insurance but a Philippine Phoenix v Woodworks partially performed one as far as the payment of the agreed premium was concerned. G.R. No L-22684; August 31 .1967 Thereafter the obligation of the insurer to pay the insured the amount for which the By: ABRIGO policy was issued in case the conditions therefore had been complied with, arose and became binding upon it, while the obligation of the insured to pay the remainder of the Topic: Premiums total amount of the premium due became demandable. Petitioners: PHILIPPINE PHOENIX SURETY & INSURANCE COMPANY Respondents: Woodwork 2. SC did not agree with Woodworks’ theory that non-payment by it of the premium due Ponente: Dizon, J. produced the cancellation of the contract of insurance. Such theory would place Doctrine: Where, between the insurer and the insured, there was not only a perfected contract of exclusively in the hands of one of the contracting parties the right to decide whether the insurance but a partially performed one as far as the payment of the agreed premium was contract should stand or not. Rather the correct view would seem to be this: as the concerned, the obligation of the insurer to pay the insured the amount for which the policy was contract had become perfected, the parties could demand from each other the issued in case the conditions therefor had been complied with arose and became binding upon it, performance of whatever obligations they had assumed. In the case of the insurer, it is while the obligation of the insured to pay the remainder of the total amount of premium due obvious that it had the right to demand from the insured the completion of the became demandable. payment of the premium due or sue for the rescission of the contract. As it chose to demand specific performance of the insured's obligation to pay the balance of the FACTS: premium, the latter's duty to pay is indeed indubitable. 1. On April 1, 1960, Philippine Phoenix Surety & Insurance Co., Inc (Phoenix) issued to Woodworks, Inc. Fire Policy No. 9652 for the amount of P300,000.00. DISPOSITIVE: Wherefore, the appealed decision being in accordance with law and the evidence, 2. The premiums of said policy amounted to P6,051.95; the margin fee pursuant to the the same is hereby affirmed, with costs. adopted plan as an implementation of Republic Act 2609 amounted to P363.72; the documentary stamps attached to the policy was P96.42
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insurance is valid and binding unless the premium thereof has been paid, notwithstanding any Makati Tuscany v CA agreement to the contrary. G.R. No ; November 6, 1992 By: ANDAL As a consequence, Makati Tuscany also seeks a refund of all premium payments made on the alleged invalid insurance policies. Topic: Premiums Petitioners: Makati Tuscany Condominium Corp ISSUE: Respondents: Court of Appeals W/N payment by installment of the premiums due on an insurance policy invalidates the contract Ponente: Bellosillo of insurance, in view of Sec. 77 of the Insurance Code? (NO) DOCTRINE: Section 77 may NOT apply if the parties have agreed to the payment in installments of the HELD: premium and partial payment has been made at the time of loss. In this case, the subject policies are valid even if the premiums were paid on installments. The records clearly show that petitioner and private respondent intended subject insurance policies to FACTS: be binding and effective notwithstanding the staggered payment of the premiums. The initial In 1982, private respondent American Home Assurance Co.,(AHAC) issued in favor of petitioner insurance contract entered into in 1982 was renewed in 1983, then in 1984. In those three (3) Makati Tuscany Condominium Corporation an Insurance Policy on the latter’s building and years, the insurer accepted all the installment payments. Such premises, with a total premium of P466,103.05. acceptance of payments speaks loudly of the insurer’s intention to honor the policies it issued to petitioner. The premium was paid on installments, which were accepted by AHAC. SC sustains CA’s findings which state: In 1983, the policy was again renewed. The premium in the amount of P466,103.05 was again paid "While the import of Section 77 is that prepayment of premiums is strictly required as a on installments. condition to the validity of the contract, We are not prepared to rule that the request to make installment payments duly approved by the insurer, would prevent the entire In 1984, the policy was still renewed. On this renewed policy, petitioner made two contract of insurance from going into effect despite payment and acceptance of the installment payments, both accepted by private respondent, the first on 6 February 1984 for initial premium or first installment. P52,000.00 and the second, on 6 June 1984 for P100,000.00. Section 78 of the Insurance Code in effect allows waiver by the insurer of the condition of prepayment by making an acknowledgment in the insurance policy of receipt of Thereafter, petitioner refused to pay the balance of the premiums. premium as conclusive evidence of payment so far as to make the policy binding despite the fact that premium is actually unpaid. Consequently, AHAC filed an action to recover the unpaid balance of P314,103.05 Section 77 merely precludes the parties from stipulating that the policy is valid even if premiums are not paid, but does not expressly prohibit an agreement granting credit Makati Tuscany explained that it discontinued the payment of premiums because the policy did not extension, and such an agreement is not contrary to morals, good customs, public order contain a credit clause in its favor. or public policy (De Leon, the Insurance Code, at p. 175). So is an understanding to allow insured to pay premiums in installments not so proscribed. At the very least, both parties Makati Tuscany further claimed that the policy was never binding and valid, and no risk attached to should be deemed in estoppel to question the arrangement they have the policy invoking Sec 77 of the Insurance Code: voluntarily accepted."
"SECTION 77. An insurer is entitled to the payment of the premium as soon For the 1984 policy, petitioner paid two (2) installments although it refused to pay the as the thing is exposed to the peril insured against. Notwithstanding any balance. It appearing from the peculiar circumstances that the parties actually agreement to the contrary, no policy or contract of insurance issued by an intended to make the three (3) insurance contracts valid, effective and binding, petitioner may not insurance company is valid and binding unless and until the premium thereof be allowed to renege on its obligation to pay the balance of the premium after the expiration of the has been paid, except in the case of a life or an industrial life policy whenever whole term of the third policy the grace period provision applies." Moreover, as correctly observed by the appellate court, where the risk is entire and the contract is It argues that where the premiums is not actually paid in full, the policy would only be effective if indivisible, the insured is not entitled to a refund of the premiums paid if the there is an acknowledgment in the policy of the receipt of premium pursuant to Sec. 78 of the insurer was exposed to the risk insured for any period, however brief or momentary Insurance Code. The absence of an express acknowledgment in the policies of such receipt of the corresponding premium payments, and petitioner's failure to pay said premiums on or before the DISPOSITIVE: effective dates of said policies rendered them invalid. WHEREFORE, finding no reversible error in the judgment appealed from, the same is AFFIRMED. Costs against petitioner. Makati Tuscany thus concludes that there cannot be a perfected contract of insurance upon mere partial payment of the premiums because under Sec. 77 of the Insurance Code, no contract of
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not so paid, the policy will lapse and be forfeited by its own terms. The pertinent provisions in the Tibay v CA, Policy on premium read: GR 119655 ; May 24, 1996 By: BACANI THIS POLICY OF INSURANCE WITNESSETH THAT only after payment to the Company in accordance with Policy Condition No. 2 of the total premiums by the insured as stipulated Topic: Premium above for the period aforementioned for insuring against Loss or Damage by Fire or Petitioners: SPS. ANTONIO and VIOLETA TIBAY and OFELIA, VICTORINA, VIRGILIO, Lightning as herein appears, the Property herein described . . . MYRNA, and ROSABELLA RORALDO Respondents: COURT OF APPEALS and FORTUNE LIFE AND GENERAL INSURANCE 2. This policy including any renewal thereof and/or any endorsement thereon is not in force Ponente: Bellosillo, J. until the premium has been fully paid to and duly receipted by the Company in the manner DOCTRINE: For as long as the current Insurance Code remains unchanged and partial payment of provided herein. premiums is not mentioned at all as among the exceptions provided in Sees. 77 and 78, no policy of insurance can ever pretend to be efficacious or effective until premium has been fully paid. Any supplementary agreement seeking to amend this condition prepared by agent, broker or Company official, shall be deemed invalid and of no effect. FACTS:On January 22, 1987, Fortune Life and General Insurance Co., Inc. issued a Fire Insurance xxx xxx xxx Policy in favor of Violeta Tibay and/or Nicolas Roraldo on their 2-storey residential building in Except only in those specific cases where corresponding rules and regulations which are Makati City, together with all their personal effects therein. The insurance was for 600k covering or may hereafter be in force provide for the payment of the stipulated premiums in the period of January 23, 1987 to the same date of 1988. On the first day, of the total premium of periodic installments at fixed percentage, it is hereby declared, agreed and warranted Php 2,983.50, Violeta only paid 600, thus leaving a considerable balance unpaid. that this policy shall be deemed effective, valid and binding upon the Company only when the premiums therefor have actually been paid in full and duly acknowledged in a receipt signed On March 8, the insured building was completely destroyed by fire. 2 days later, Violeta paid the by any authorized official or representative/agent of the Company in such manner as balance of the premium. On the same day, she filed with Fortune a claim on the fire insurance provided herein. policy. Her claim was accordingly referred to its adjuster, Goodwill Adjustment Services, Inc. (GASI), which immediately wrote Violeta requesting her to furnish it with the necessary Clearly the Policy provides for payment of premium in full. Accordingly, where the premium has documents for the investigation and processing of her claim. Violeta complied. only been partially paid and the balance paid only after the peril insured against has occurred, the insurance contract did not take effect and the insured cannot collect at all on the policy. This On March 28, she signed a non-waiver agreement with GASI to the effect that any action taken by is fully supported by Sec. 77 of the Insurance Code which provides: the companies or their representatives in investigating the claim made by the claimant for his loss or in the investigating or ascertainment of the amount of actual cash value and loss, shall not waive or invalidate Sec. 77. An insurer is entitled to payment of the premium as soon as the thing insured is any condition of the policies of such companies held by said claimant, nor the rights of either or any of the exposed to the peril insured against. Notwithstanding any agreement to the contrary, no parties to this agreement, and such action shall not be, or be claimed to be, an admission of liability on the policy or contract of insurance issued by an insurance company is valid and binding unless and part of said companies or any of them. until the premium thereof has been paid, except in the case of a life or an industrial life policy whenever the grace period provision applies. In a letter, Fortune denied the claim of Violeta for violation of Policy Condition No. 2 and of Sec. 77 of the Insurance Code. Efforts to settle the case before the Insurance Commission proved futile. Apparently the crux of the controversy lies in the phrase "unless and until the premium thereof has On March 3, 1988 Violeta and the other petitioners sued Fortune for damages in the amount of been paid. " This leads us to the manner of payment envisioned by the law to make the insurance 600k representing the total coverage of the fire insurance policy plus 12% interest per annum, as policy operative and binding. For whatever judicial construction may be accorded the disputed well as for moral damages and attorney's fees equivalent to 20% of the total claim. phrase must ultimately yield to the clear mandate of the law. The principle that where the law does not distinguish the court should neither distinguish assumes that the legislature made no RTC ruled for petitioners and adjudged Fortune liable for the total value of the insured building qualification on the use of a general word or expression. and personal properties in the amount of 600k plus interest at the legal rate of 6% per annum from the filing of the complaint until full payment, and attorney's fees equivalent to 20% of the total Insisting that Fortune is liable on the policy despite partial payment of the premium due and the amount claimed plus costs of suit. CA reversed the RTC by declaring Fortune not to be liable, hence express stipulation thereof to the contrary, petitioners rely heavily on the 1967 case of Philippine this petition for review. Phoenix and Insurance Co., Inc. v. Woodworks, Inc. where the Court sustained the ruling of the trial court that partial payment of the premium made the policy effective during the whole period of the ISSUE: Whether Fortune remains liable under the fire insurance policy in spite of the failure of policy. In that case, the insurance company commenced action against the insured for the unpaid petitioners to pay their premium in full. balance on a fire insurance policy. In its defense the insured claimed that nonpayment of premium produced the cancellation of the insurance contract. HELD: NO. Insurance is a contract whereby one undertakes for a consideration to indemnify another against The 1967 Phoenix case is not persuasive; neither is it decisive of the instant dispute. For one, the loss, damage or liability arising from an unknown or contingent event. The consideration is the factual scenario is different. In Phoenix it was the insurance company that sued for the balance of premium, which must be paid at the time and in the way and manner specified in the policy, and if the premium. In the case before us, there is, quite unlike in Phoenix, a specific stipulation that (t)his
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policy . . . is not in force until the premium has been fully paid and duly receipted by the Company . . . premiums were to be construed as a legal nexus between the applicant and the insurer despite an Resultantly, it is correct to say that in Phoenix a contract was perfected upon partial payment of the express agreement to the contrary. premium since the parties had not otherwise stipulated that prepayment of the premium in full was a condition precedent to the existence of a contract. Interpreting the contract of insurance stringently against the insurer but liberally in favor of the insured despite clearly defined obligations of the parties to the policy can be carried out to In Phoenix, by accepting the initial payment of 3k and then later demanding the remainder of the extremes that there is the danger that we may, so to speak, "kill the goose that lays the golden premium without any other precondition to its enforceability as in the instant case, the insurer in egg." We are well aware of insurance companies falling into the despicable habit of collecting effect had shown its intention to continue with the existing contract of insurance, as in fact it was premiums promptly yet resorting to all kinds of excuses to deny or delay payment of just insurance enforcing its right to collect premium, or exact specific performance from the insured. This is not so claims. But, in this case, the law is manifestly on the side of the insurer. For as long as the current here. By express agreement of the parties, no vinculum juris or bond of law was to be established Insurance Code remains unchanged and partial payment of premiums is not mentioned at all as until full payment was effected prior to the occurrence of the risk insured against. among the exceptions provided in Sees. 77 and 78, no policy of insurance can ever pretend to be efficacious or effective until premium has been fully paid. In Makati Tuscany Condominium Corp. v. CA, the parties mutually agreed that the premiums could be paid in installments, which in fact they did for 3 years, hence, this Court refused to invalidate the DISPOSITIVE: WHEREFORE, the petition is DENIED and the assailed Decision of the Court of insurance policy. These 2 cases, Phoenix and Tuscany, adequately demonstrate the waiver, either Appeals dated 24 March 1995 is AFFIRMED. SO ORDERED. express or implied, of prepayment in full by the insurer: impliedly, by suing for the balance of the premium as in Phoenix, and expressly, by agreeing to make premiums payable in installments as in DISSENTING OPINION OF J. VITUG: It must here be noted that the insured HAD MADE, and the Tuscany. insurer HAD ACCEPTED, a partial premium payment on the policy weeks before the risk insured against took place. An insurance is an aleatory contract which, unlike a conditional agreement But contrary to the stance taken by petitioners, there is no waiver express or implied in the case whose efficacy is dependent on stated condition, is at once effective upon its perfection although at bench. Precisely, the insurer and the insured expressly stipulated that (t)his policy including any the occurrence of a condition or event may later dictate the demandability of certain obligations renewal thereof and/or any indorsement thereon is not in force until the premium has been fully paid to thereunder. Founded on the autonomy of contracts, the parties, of course, are generally not and duly receipted by the Company . . . and that this policy shall be deemed effective, valid and binding prevented from imposing conditions that alone could trigger the contract's obligatory force. These upon the Company only when the premiums therefor have actually been paid in full and duly conditions, however, must not be contrary to law, morals, good customs, public order or public acknowledged. policy.
Conformably with the aforesaid stipulations explicitly worded and taken in conjunction with Sec. To say that the provisions in the policy issued by Fortune, i.e. , that the insurance shall not "be . . . in 77 of the Insurance Code the payment of partial premium by the assured in this particular instance force until the premium has been fully paid," and that it "shall be deemed effective, valid and should not be considered the payment required by the law and the stipulation of the parties. binding upon the company only when the premiums therefor have actually been paid in full and duly Rather, it must be taken in the concept of a deposit to be held in trust by the insurer until such time acknowledged," override the efficaciousness of the insurance contract despite the payment and that the full amount has been tendered and duly receipted for. In other words, as expressly agreed acceptance of a part of the premium would be opposed not only to the precepts heretofore upon in the contract, full payment must be made before the risk occurs for the policy to be adverted to on the correct application of Section 77, but also to the intent and spirit of Section 78, considered effective and in force. of the Insurance Code —
Thus, no vinculum juris whereby the insurer bound itself to indemnify the assured according to law An acknowledgment in a policy or contract of insurance of the receipt of premium is ever resulted from the fractional payment of premium. The insurance contract itself expressly conclusive evidence of its payment, so far as to make the policy binding, notwithstanding provided that the policy would be effective only when the premium was paid in full. It would any stipulation therein that it shall not be binding until the premium is actually paid. have been altogether different were it not so stipulated. Ergo, petitioners had absolute freedom of choice whether or not to be insured by Fortune under the terms of its policy and they freely which, like Section 77 of the Code, is not dependent on how much premium has been paid. It seems opted to adhere thereto. quite clear to me that on the day premium payment is made by the insured, albeit only a portion of it, so long as it is accepted by the insurer, the insurance coverage becomes effective and binding, In the desire to safeguard the interest of the assured, it must not be ignored that the contract of any stipulation in the policy to the contrary notwithstanding. The insurer is not without recourse; insurance is primarily a risk distributing device, a mechanism by which all members of a group all that it needs is not to accept, if it wants to, any premium payment of less than full. But if it does exposed to a particular risk contribute premiums to an insurer. From these contributory funds are accept payment, reason dictates that it should not be allowed to deny the insurance contract upon paid whatever losses occur due to exposure to the peril insured against. Each party therefore takes which very existence that payment is predicated. a risk: the insurer, that of being compelled upon the happening of the contingency to pay the entire sum agreed upon, and the insured, that of parting with the amount required as premium, without receiving anything therefor in case the contingency does not happen. UCPB General v Masagana Telamart G.R. No137172 ; Date: April 4, 2001 To ensure payment for these losses, the law mandates all insurance companies to maintain a legal By: CRUZ reserve fund in favor of those claiming under their policies. It should be understood that the integrity of this fund cannot be secured and maintained if by judicial fiat partial offerings of Topic: Premium
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○ SC ruled in the negative in view of Sec. 77 of the Insurance Code and our Petitioners: UCPB GENERAL INSURANCE CO., INC. decisions in Valenzuela v. CA. Respondents: MASAGANA TELAMART, INC. ● Masagana filed a MR. Ponente: DAVIDE, JR., C.J.: ○ alleges RTC and CA correctly found that no notice of non-renewal was made DOCTRINE: within 45 days before the expiration date of the fire insurance policies. FACTS: ○ Thus, the policies in question were renewed by operation of law and were ● Masagana obtained from UCPB General Insurance (5) insurance policies on its effective and valid on 30 June 1992 when the fire occurred, since the properties in Pasay City and Manila. premiums were paid within the 60- to 90-day credit term. ● All (5) policies reflect on their face the effectivity term: "from 4:00 P.M. of 22 May 1991 ● Masagana urges SC to take judicial notice of the fact that despite the express provision to 4:00 P.M. of 22 May 1992." of Sec. 77 of the Insurance Code, extension of credit terms in premium payment has ● On June 13, 1992, Masagana’s properties located at 2410-2432 and 2442-2450 Taft been the prevalent practice in the insurance industry. Avenue, Pasay City were razed by fire. ● Also, Masagana asserts that the principle of estoppel applies to UCPB. Despite its ● On July 13, 1992, Masagana tendered, and UCPB accepted, (5) Equitable Bank MCs in awareness of Sec. 77, UCPB persuaded and induced Masagana to believe that payment the total amount of P225,753.45 as renewal premium payments for which Official of premium on the 60- to 90-day credit term was perfectly alright; in fact it accepted Receipt Direct Premium No. 62926 was issued by UCPB. payments within 60 to 90 days after the due dates. ● On July 14, 1992, Masagana made its formal demand for indemnification for the burned ● On the other hand, UCPB alleges that: insured properties. ○ Both RTC and CA overlooked the fact that on 6 April 1992 UCPB sent by ● UCPB returned the (5) MCs stating in its letter that it was rejecting Masagana's claim on ordinary mail to Masagana a notice of non-renewal and sent by personal the following grounds: delivery a copy thereof to Masagana’s broker, Zuellig. ○ "a) Said policies expired last May 22, 1992 and were not renewed for another ○ Both courts ignored the fact that Masagana was fully aware of the notice of term; non-renewal. ○ b) UCPB had put Masagana and its alleged broker on notice of non-renewal ○ Sec. 66 IC readily shows that in order for an insured to be entitled to a earlier; renewal of a non-life policy, payment of the premium due on the effective ○ c) The properties covered by the said policies were burned in a fire that took date of renewal should first be made. Masagana’s argument that Sec. 77 is not place last June 13, 1992, or before tender of premium payment." a prohibitive provision finds no authoritative support. ● Hence, Masagana filed this case. ● CA ruling: ISSUE: Whether or not Sec. 77 must be strictly applied to UCPB’s advantage despite its practice of ○ In favor of Masagana. granting a 60- to 90-day credit term for the payment of premiums? ○ Held that sufficient proof exists that Masagana, which had procured insurance coverage from UCPB for a number of years, had been granted a 60 HELD: No. to 90-day credit term for the renewal of the policies. Such a practice had ● In favor of Masagana. MR granted. existed up to the time the claims were filed. ● The following facts, as found by RTC and CA , are indeed duly established: ○ he following circumstances constitute preponderant proof that no timely 1. For years, UCPB had been issuing fire policies to Masagana , and these notice of non-renewal was made by UCPB: policies were annually renewed. ■ 1) UCPB received the confirmation from Ultramar Reinsurance 2. UCPB had been granting Masagana a 60- to 90-day credit term within which Brokers that plaintiff's reinsurance facility had been confirmed up to pay the premiums on the renewed policies. to 67.5% only on April 15, 1992 as indicated on Exhibit "11". 3. There was no valid notice of non-renewal of the policies in question, as there Apparently, the notice of non-renewal was sent not earlier than is no proof at all that the notice sent by ordinary mail was received by said date, or within 45 days from the expiry dates of the policies as Masagana, and the copy thereof allegedly sent to Zuellig was ever transmitted provided under Policy Condition No. 26; to Masagana . ■ (2) UCPB insurer unconditionally accepted, and issued an official 4. The premiums for the policies in question in the aggregate amount of receipt for, the premium payment on July 13, 1992 which indicates P225,753.95 were paid by Masasgana within the 60- to 90-day credit term UCPB’s willingness to assume the risk despite only a 67.5% and were duly accepted and received by UCPB’s cashier. reinsurance coverage ● Sec. 77 An insurer is entitled to payment of the premium as soon as the thing insured is ■ (3) UCPB appointed Esteban Adjusters and Valuers to investigate exposed to the peril insured against. Notwithstanding any agreement to the contrary, no policy plaintiff's claim as shown by the letter dated July 17, 1992. or contract of insurance issued by an insurance company is valid and binding unless and until ● SC decision of 15 June 1999, SC defined the main issue to be "whether the fire insurance the premium thereof has been paid, except in the case of a life or an industrial life policy policies issued by UCBP to the Masagana covering the period from May 22, 1991 to May whenever the grace period provision applies. 22, 1992 had been extended or renewed by an implied credit arrangement though ● There are exceptions: actual payment of premium was tendered on a later date and after the occurrence of the ○ 1st EXCEPTION: provided by Sec. 77 IC , in case of a life or industrial life (fire) risk insured against." policy whenever the grace period provision applies.
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○ 2ND EXCEPTION: covered by Sec. 78 IC, which provides that Any contends that the rider limits its liability for loss to the two swimming pools of acknowledgment in a policy or contract of insurance of the receipt of premium is petitioner. conclusive evidence of its payment, so far as to make the policy binding, ● Gulf owns Plaza Resort located in Agoo, La Union. It had its properties insured first notwithstanding any stipulation therein that it shall not be binding until premium is by American Home Assurance Company (American Home). In the first four policies actually paid. issued by American Home, the risk of loss due to earthquakes was extended only to ○ 3rd EXCEPTION: in Makati Tuscany Condominium Corporation vs. CA, SC ruled Gulf’s two swimming pools. Gulf renewed its insurance policy with American Home, that Sec. 77 may not apply if the parties have agreed to the payment in the policy carried the entry under "Endorsement/Warranties at Time of Issue", installments of the premium and partial payment has been made at the time which read "Endorsement to Include Earthquake Shock in the amount of of loss. P10,700.00 and paid P42,658.14 as premium thereof, which included a ○ 4th EXCEPTION: In Tuscany, SC held that exception to Sec. 77, namely, that computation breakdown (see notes “A”) the insurer may grant credit extension for the payment of the premium. Thus, ● Gulf agreed to insure its properties with Philippine Charter provided that the if the insurer has granted the insured a credit term for the payment of the policy wording and rates in said policy be copied in the policy issued by American premium and loss occurs before the expiration of the term, recovery on the Home. American Home issued the policy which included the computation of the policy should be allowed even though the premium is paid after the loss but premium to be paid. (see notes). The breakdown of premiums shows that Gulf paid within the credit term. only P393.00 as against earthquake shock (ES). The policy issued had a provision ● Moreover, there is nothing in Sec. 77 which prohibits the parties in an insurance regarding the earthquake shock endorsement: contract to provide a credit term within which to pay the premiums. That agreement is ○ “In consideration of the payment by the insured to the company of the not against the law, morals, good customs, public order or public policy. The agreement sum included additional premium the Company agrees, notwithstanding binds the parties. (Art. 1360 NCC see notes) what is stated in the printed conditions of this policy due to the contrary, ● 5th EXCEPTION: Estoppel. In the case, it would be unjust and inequitable if recovery on that this insurance covers loss or damage to shock to any of the property the policy would not be permitted against Petitioner, which had consistently granted a insured by this Policy occasioned by or through or in consequence of 60- to 90-day credit term for the payment of premiums despite its full awareness of earthquake” Section 77. Estoppel bars it from taking refuge under Sec. 77, since Respondent relied ● In one of the copies of the policy, the word ‘included’ was deleted. July 16, 1990, an in good faith on such practice. Estoppel then is the fifth exception to Sec 77. earthquake struck central and northern Luzon, damaging the Gulf’s properties NOTES: including the two swimming pools. Gulf tried to collect on the policy for the ARTICLE 1306. The contracting parties may establish such stipulations clauses, terms and damages on all its properties, but American Home denied the claim, averring that conditions as they may deem convenient, provided they are not contrary to law, morals, good the policy inly covered earthquake shock on the two pools. Thus, Gulf filed a customs, public order, or public policy. collection suit. The trial court ruled in favor of American Home, stating that the payment schedule clearly shows that the Gulf paid only a premium of P393.00 DISPOSITIVE: WHEREFORE, the Decision in this case of 15 June 1999 is RECONSIDERED and against ES covering only the two pools. The CA affirmed said decision. SET ASIDE, and a new one is hereby entered DENYING the instant petition for failure of Petitioner ● Elevating the case to the SC, Gulf contends: that the policy’s earthquake shock to sufficiently show that a reversible error was committed by the Court of Appeals in its challenged endorsement clearly covers all of the properties insured and not only the decision, which is hereby AFFIRMED in toto. No pronouncement as to cost. swimming pools. It used the words "any property insured by this policy," and it should be interpreted as all inclusive; that the qualification referring to the two swimming pools had already been deleted in the earthquake shock endorsement; Gulf Resorts v. Philippine Charter Insurance that any ambiguity in the earthquake shock endorsement should be resolved in G.R. No. 156167 ; May 16, 2005 favor of petitioner and against respondent. It was respondent which caused the By: GORDON ambiguity when it made the policy in issue; that there is no basis for the lower court to hold that the additional premium was not paid under the extended coverage. Topic: Premium The premium for the earthquake shock coverage was already included in the Petitioners: GULF RESORTS, INC. premium paid for the policy. ( see notes “B”) Respondents: PHILIPPINE CHARTER INSURANCE CORPORATION ● American Home argues among other points: that none of the previous policies Ponente: PUNO, J.. issued by them from 1983 to 1990 explicitly extended coverage against DOCTRINE: An insurance premium is the consideration paid an insurer for undertaking to indemnify earthquake shock to petitioner’s insured properties other than on the two the insured against a specified peril. swimming pools; that Gulf admitted that from 1984 to 1988, only the two swimming pools were insured against earthquake shock. From 1988 until 1990, the FACTS: provisions in its policy were practically identical to its earlier policies, and there ● For review (Rule 45) are the warring interpretations of petitioner and respondent was no increase in the premium paid; that petitioner’s payment of additional on the scope of the insurance company’s liability for earthquake damage to premium in the amount of P393.00 shows that the policy only covered earthquake petitioner’s properties. Petitioner (Gulf) avers that, pursuant to its earthquake shock damage on the two swimming pools. The amount was the same amount paid shock endorsement rider, Insurance Policy No. 31944 covers all damages to the by petitioner for earthquake shock coverage on the two swimming pools from properties within its resort caused by earthquake. Respondent (PH Charter) 1990-1991. No additional premium was paid to warrant coverage of the other
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properties in the resort. (That basically the P393.00 reflected on the premium insured against a specified peril. In the subject policy, no premium payments were breakdown only pertained to the two swimming pools) made with regard to earthquake shock coverage, except on the two swimming ● Summary: Gulf was previously insured with American Home, with only the former’s pools. There is no mention of any premium payable for the other resort properties two pools being covered. Gulf then wanted to enter into an insurance contract with with regard to earthquake shock. This is consistent with the history of petitioner’s Philippine Charter on the condition that the latter merely copy the exact provisions previous insurance policies from American Home. under the policy previously issued by American Home. Gulf then got insured with ● Gulf also cited and relies on the attachment of the phrase "Subject to: Other Philippine Charter thinking that the latter’s policy covered all its properties, but the Insurance Clause, Typhoon Endorsement, Earthquake Shock Endorsement, fact was that only the two pools were covered as Philippine Charter merely copied Extended Coverage Endorsement, FEA Warranty & Annual Payment Agreement (or duplicated) the policy of American Home. An earthquake hit, damaging on Long Term Policies" to the insurance policy as proof of the intent of the parties properties of Gulf. Gulf claimed proceeds covering all its damaged properties, but to extend the coverage for earthquake shock. However, this phrase is merely an Philippine Insurance were only willing to pay an amount covering the two pools as enumeration of the descriptive titles of the riders, clauses, warranties or per their policy. endorsements to which the policy is subject, as required under Section 50, paragraph 2 of the Insurance Code. Also, no significance can be placed on the ISSUE: W/N the premium paid extended to all the other properties of Gulf. deletion of the qualification limiting the coverage to the two swimming pools. The earthquake shock endorsement cannot stand alone (not read as piecemeal) HELD: NO. ● Moreover, Gulf cannot claim that the policy was ambiguous and that such ● There were four key items considered in this case: 1.) in the designation of location ambiguity must be resolved against the insurer as there was really none. Gulf of risk, only the two swimming pools were specified as included; 2.) under the cannot claim it did not know the provisions of the policy. From the inception of the premium breakdown, the premium amount only corresponded to “Item No. 3” (the policy, petitioner had required the respondent to copy verbatim the provisions and two pools); 3.) Policy condition No. 6 stated that “This insurance does not cover any terms of its latest insurance policy from American Home. American Home, in loss or damage occasioned by or through or in consequence, directly or indirectly compliance with the condition set by the Gulf, copied the previous policies the of any of the following occurrences, namely: (a) Earthquake, volcanic eruption or parties have entered into in drafting the current policy in dispute. It is true that other convulsion of nature”; and 4.) the rider attached to the policy titled there was variance in some terms, specifically in the replacement cost “Extended Coverage Endorsement” stated: endorsement, but the principal provisions of the policy remained essentially similar to American Home’s policy. Consequently, we cannot apply the "fine print" or Earthquake Endorsement "contract of adhesion" rule in this case as the parties’ intent to limit the coverage of the policy to the two swimming pools only is not ambiguous. In consideration of the payment by the Insured to the Company of the sum of P. . . . . . . . . . . . . . . . . additional premium the Company agrees, notwithstanding what is stated in the DISPOSITIVE: the judgment of the Court of Appeals is affirmed. The petition for certiorari is printed conditions of this Policy to the contrary, that this insurance covers loss or dismissed. No costs. SO ORDERED. damage (including loss or damage by fire) to any of the property insured by this Policy occasioned by or through or in consequence of Earthquake. NOTES A. Provided always that all the conditions of this Policy shall apply (except in so far as they may be hereby expressly varied) and that any reference therein to loss or damage by fire should be deemed to apply also to loss or damage occasioned by or through or in consequence of Earthquake. ● Petitioner contends that pursuant to this rider, no qualifications were placed on the scope of the earthquake shock coverage. Thus, the policy extended earthquake shock coverage to all of the insured properties. It is basic that all the provisions of the insurance policy should be examined and interpreted in consonance with each other. All its parts are reflective of the true intent of the parties. The policy cannot be construed piecemeal. ● A careful examination of the premium recapitulation will show that it is the clear intent of the parties to extend earthquake shock coverage only to the two swimming pools. Sec. 2(1) of the Insurance Code shows that an insurance contract exists where the following concur: 1.) the insured has an insurable interest; 2.) the insured is subject to a risk of loss by the happening of a designated peril; 3.) the insurer assumes the risk; 4.) such assumption of risk is part of a general scheme to distribute actual losses among a large group of people similarly situated; and 5.) in consideration of the insurer’s promise, the insured pays a premium. An insurance premium is the consideration paid an insurer for undertaking to indemnify the
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with the representatives of other insurance companies who found no irregularity therein. In fact, Pioneer Insurance and Surety Corporation and Prudential Guarantee and Assurance, Inc. promptly paid the claims filed by respondent. ● CA affirmed, found that respondent’s claim was substantially proved and petitioner’s unjustified refusal to pay the claim entitled respondent to the award of damages. ● American Home: ● reiterates its stand that there was no existing insurance contract between the parties ● It invokes Section 77 of the Insurance Code, which provides: B An insurer is entitled to payment of the premium as soon as the thing insured is American Home Ins. v Chua, exposed to the peril insured against. Notwithstanding any agreement to the G.R. No. 130421. June 28, 1999 contrary, no policy or contract of insurance issued by an insurance company is valid By: IGOT and binding unless and until the premium thereof has been paid, except in the case of life or an industrial life policy whenever the grace period provision applies. Topic: Premium Petitioners: AMERICAN HOME ASSURANCE COMPANY ● and cites the case of Arce v. Capital Insurance & Surety Co., Inc., 2 where we Respondents: ANTONIO CHUA, Respondent. ruled that unless and until the premium is paid there is no insurance. Ponente: DAVIDE, JR., C.J.: ● no insurance contract yet when payment was done by check since it can only effect payment once it has been cashed and the OR was dated Apr 10, 4 days DOCTRINE: after the fire. FACTS: ● that respondent's non-disclosure of the other insurance contracts rendered ● Chua obtained from American Home a fire insurance covering the stock-in-trade of the policy void. his business, Moonlight Enterprises, located at Valencia, Bukidnon. Due to expire ● That the BIR receipts submitted by respondent were, in effect, fake since they on Mar 25 1990 were issued to other persons ● On Apr 5 1990, American Home issued PCI Bank Check to American Home’s agent, ● the award of damages was excessive and unreasonable considering that it did James Uy, as payment for renewal of the policy. In turn, James delivered renewal not act in bad faith in denying respondent's claim. certificate to Chua. The check was deposited in American Home’s bank account and an official receipt was issued on Apr 10. ISSUE: ● Subsequently, a new insurance policy was issued, whereby American Home (1) Whether there was a valid payment of premium, considering that the check was cashed undertook to indemnify Chua for any damage from fire up to P200,000 for the after the occurrence of the fire. YES period 25 March 1990 to 25 March 1991. (2) whether respondent violated the policy by his submission of fraudulent documents and ● On Apr 6 1990, Moonlight was completely razed by fire. Total loss was estimated non-disclosure of the other existing insurance contracts.NO between P4-5M. Chua filed a claim with American Home and 4 other co-insurers – (3) whether respondent is entitled to the award of damages. YES but no to all. Pioneer, Prudential, Filipino Merchants, and Domestic Insurance Company. o American Home refused to honor the claim so Chua filed an action HELD: YES. ● In defense, American Home claimed there was no existing contract when fire ▪ The general rule is that unless premium is paid the insurance policy is not valid and occurred since Chua did not pay the premium; binding. The only exceptions are life and industrial life insurance. ● also alleged that even assuming there was a contract, Chua ▪ Whether payment was indeed made is a question of fact which is best determined violation conditions of the policy – 1) submission of fraudulent by the trial court. The trial court found, as affirmed by the Court of Appeals, that income tax return and financial statements, 2) failure to establish there was a valid check payment by respondent to petitioner. Well-settled is the the actual loss which American Home assessed at 70k, and 3) rule that the factual findings and conclusions of the trial court and the Court of failure to notify American Home of any insurance already effected Appeals are entitled to great weight and respect, and will not be disturbed on ● Trial Court ruled in favor of Chua : appeal in the absence of any clear showing that the trial court overlooked certain ● found that Chua paid by way of check before fire occurred and was facts or circumstances which would substantially affect the disposition of the case. acknowledged by the agent; We see no reason to depart from this ruling. ● also declared that the alleged fraudulent documents were limited to the ▪ According to the trial court the renewal certificate issued to respondent contained disparity between the official receipts issued by the Bureau of Internal the acknowledgment that premium had been paid. It is not disputed that the check Revenue (BIR) and the income tax returns for the years 1987 to 1989; drawn by respondent in favor of petitioner and delivered to its agent was honored ● as to the notification of other insurance contracts, American Home failed to when presented and petitioner forthwith issued its official receipt to respondent show that such omission was intentional and fraudulent. Finally, it noted that on 10 April 1990. Section 306 of the Insurance Code provides that any insurance petitioner's investigation of respondent's claim was done in collaboration Insurance | SDUxMigallos |page | 21 company which delivers a policy or contract of insurance to an insurance agent or object of insurance, which was the stock-in-trade, and not the expected loss in income or insurance broker shall be deemed to have authorized such agent or broker to profit. receive on its behalf payment of any premium which is due on such policy or ● Under Article 2220 of the Civil Code, moral damages may be awarded in breaches of contract of insurance at the time of its issuance or delivery or which becomes due contracts where the defendant acted fraudulently or in bad faith. There was no fraud to thereon.8 In the instant case, the best evidence of such authority is the fact that justify moral damages. When awarded, moral damages must not be palpably and petitioner accepted the check and issued the official receipt for the payment. It is, scandalously excessive as to indicate that it was the result of passion, prejudice or as well, bound by its agent's acknowledgment of receipt of payment. corruption on the part of the trial court judge. Sec. 78 of the Insurance Code explicitly provides: An acknowledgment in ● Exemplary damages can’t be awarded because the defendant never acted in a reckless a policy or contract of insurance of the receipt of premium is conclusive manner to claim insurance, it merely tried to resist what it claimed to be an unfounded evidence of its payment, so far as to make the policy binding, notwithstanding claim for enforcement of the fire insurance policy. any stipulation therein that it shall not be binding until the premium is ● The law is likewise clear that in contracts and quasi-contracts the court may award actually paid. exemplary damages if the defendant acted in a wanton, fraudulent, reckless, oppressive, ● This Section establishes a legal fiction of payment and should be interpreted as an or malevolent manner exception to Section 77. ● Attorney’s fees can’t be recovered as part of damages because no premium should be placed on the right to litigate. The general rule is that attorney's fees cannot be (2) NO. The submission of the alleged fraudulent documents pertained to respondent’s income tax recovered as part of damages because of the policy that no premium should be placed on returns for 1987 to 1989. Respondent, however, presented a BIR certification that he had paid the the right to litigate. proper taxes for the said years. Since this is a question of fact, the finding is conclusive. ● In short, the grant of attorney's fees as part of damages is the exception rather than the rule; counsel's fees are not awarded every time a party prevails in a suit. It can be Ordinarily, where the insurance policy specifies as a condition the disclosure of existing awarded only in the cases enumerated in Article 2208 of the Civil Code, and in all cases co-insurers, non-disclosure thereof is a violation that entitles the insurer to avoid the policy. This it must be reasonable. Thereunder, the trial court may award attorney's fees where it condition is common in fire insurance policies and is known as the "other insurance clause." The deems just and equitable that it be so granted. While we respect the trial court's purpose for the inclusion of this clause is to prevent an increase in the moral hazard.We have exercise of its discretion in this case, the award of P50,000 is unreasonable and ruled on its validity and the case of Geagonia v. Court of Appeals clearly illustrates such principle. excessive. It should be reduced to P10,000. However, we see an exception in the instant case. DISPOSITIVE: WHEREFORE, the instant petition is partly GRANTED. The challenged decision of ● Citing Section 29 of the Insurance Code, the trial court reasoned that respondent's the Court of Appeals in CA-G.R. No. 40751 is hereby MODIFIED by a) deleting the awards of failure to disclose was not intentional and fraudulent. The application of Section 29 is P200,000 for loss of profit, P200,000 as moral damages and P100,000 as exemplary damages, and misplaced. Section 29 concerns concealment which is intentional. The relevant provision b) reducing the award of attorney’s fees from P50,000 to P10,000.chanroblesvirtuallawlib is Section 75, which provides that: ● A policy may declare that a violation of specified provisions thereof shall avoid it, otherwise the breach of an immaterial provision does not avoid the policy. Great Pacific Life v CA ● To constitute a violation the other existing insurance contracts must be upon the same G.R. No. L-57308 ; April 23, 1990 subject matter and with the same interest and risk. Indeed, respondent acquired several By: LANZON co-insurers and he failed to disclose this information to petitioner. Nonetheless, petitioner is estopped from must invoking this argument. The trial court cited the Topic: Premium testimony of petitioner's loss adjuster who admitted previous knowledge of the Petitioners: Great Pacific Life Insurance Corp. co-insurers. Respondents: CA and Teodoro Cortez ● It cannot be said that American Home was deceived by Chua by the latter's Ponente: Grino-Aquino, J. non-disclosure of the other insurance contracts when petitioner actually had prior DOCTRINE: Since his policy was in fact inoperative or ineffectual from the beginning, the company was knowledge thereof. American Home’s loss adjuster had known all along of the other never at risk, hence, it is not entitled to keep the premium. existing insurance contracts, yet, he did not use that as basis for his recommendation of denial. The loss adjuster, being an employee of American Home, is deemed a FACTS: Private respondent Teodoro Cortez, upon the solicitation of Margarita Siega an representative of the latter whose awareness of the other insurance contracts binds underwriter for the petitioner Great Pacific Insurance Corporation, applied for a 20-year petitioner. We, therefore, hold that there was no violation of the "other insurance" endowment policy for P30,000. His application, with the requisite medical examination, was clause by Chua. accepted and approved by the company and in due course, Endowment Policy No. 221944 was (3) YES but not to all. issued in his name. ● Petitioner is liable to pay its share of the loss. The TC and the CA were correct in awarding P200,000 for this. There is, however, merit in the petitioner's grievance It was released for delivery on January 24, 1973, and was actually delivered to him by the against the damages and attorney's fees awarded. underwriter, Mrs. Siega on January 25, 1973. The effective date indicated on the face of the policy ● No legal and factual basis for the award of P200K for loss of profit. The fire totally in question was December 25, 1972. gutted the respondent's business; thus, Chua no longer had any business to operate. His - The annual premium was P1,416.60. loss of profit cannot be shouldered by petitioner whose obligation is limited to the Insurance | SDUxMigallos |page | 22 Mrs. Siega assured him that the first premium may be paid within the grace period of thirty (30) 2 other installments on March 28, 1973. To the mind of this Court, this acknowledgments are the days from date of delivery of the policy. The first premium of P1,416.60 was paid by him in three most eloquent proofs that at such time the policy was already in full force and effect. (3) installments: o (1) P400 evidenced by Temporary Receipt No. 19422, dated February 5, 1973 issued The SC held that: by Mrs. Siega and confirmed by Official Receipt No. 43543 dated March 6, 1973, issued When the petitioner advised private respondent on June 1, 1973, four months after he by the Home Office of the defendant in Makati, Rizal had paid the first premium, that his policy had never been in force, and that he must pay o P350 evidenced by Temporary Receipt No. 19448 dated February 17, 1973 issued by another premium and undergo another medical examination to make the policy Mrs. Siega and confirmed by Official Receipt No. 43559 dated March 28, 1973 issued by effective, the petitioner committed a serious breach of the contract of insurance. defendant's Home Office o (3) P666.60 evidenced by Temporary Receipt No. 19702 dated February 21, 1973, Sections 79, 81 and 82 of P.D. 612 of the Insurance Code of 1978 provide when the issued by the underwriter Mrs. Siega and confirmed by Official Receipt No. 43563 dated insured is entitled to the return of premium paid. March 28, 1973 issued by defendant's Home Office o SECTION 79. A person insured is entitled to a return of premium, as In a letter dated June 1, 1973, defendant advised plaintiff that Policy No. 221944 was not in force. follows: To make it enforceable and operative, plaintiff was asked to remit the balance of P1,015.60 to § (a) To the whole premium, if no part of his interest in the thing complete his initial annual premium due December 15, 1972, and to see Dr. Felipe V. Remollo for insured be exposed to any of the perils insured against. another full medical examination at his own expense. § (b) Where the insurance is made for a definite period of time and the insured surrenders his policy, to such portion of the Cortez' reaction to the company's act was to immediately inform it that he was cancelling the premium as corresponds with the unexpired time, at a pro rata policy and he demanded the return of his premium plus damages. rate, unless a short period rate has been agreed upon and o The company ignored his demand so Cortez filed a complaint for damages and prayed appears on the face of the policy, after deducting from the for the refund of the insurance premium which he paid plus P45,000 as moral damages whole premium any claim for loss or damage under the policy and P2,000 as atty’s fees. which has previously accrued: Provided, That no holder of a life insurance policy may avail himself of the privileges of this RTC: Ruled in favor of Cortez paragraph without sufficient causes as otherwise provided by CA: Affirmed RTC ruling but lowered moral damages to P10,000 from P30,000 law. o SECTION 81. A person insured is entitled to a return of the premium ISSUE: W/N Cortez is entitled to a refund of his premium when the contract is voidable on account of the fraud or misrepresentation of the insurer or of his agent or on account of facts HELD: YES. the existence of which the insured was ignorant without his fault; or when, by any default of the insured other than actual fraud, the insurer The CA explained: never incurred any liability under the policy. The policy was issued on December 25, 1972 and was delivered on January 25, 1973 o SECTION 82. In case of an over-insurance by several insurers, the and the appellee was given by the appellant thru its underwriter Mrs. Margarita Siega a insured is entitled to a ratable return of the premium, proportioned to grace period of 30 days from said date within which the premium was to be paid. Record the amount by which the aggregate sum insured in all the policies shows that the premium was paid fully on February 21, 1973 or within the grace period. exceeds the insurable value of the thing at risk. This being so, the policy was already enforceable. Since his policy was in fact inoperative or ineffectual from the beginning, the company was never at risk, hence, it is not entitled to keep the premium. The award of moral damages to Cortez was The company had sufficient time to examine the result of their medical examination on proper for there can hardly be any doubt that he must have suffered moral shock, serious anxiety the person of the appellee. They would not have delivered the policy on January 24, and wounded feelings upon being informed by the petitioner six (6) months after it issued the 1973 if the appellee was unacceptable. policy to him and four (4) months after receiving the full premium, that his policy was in fact worthless for it never took effect, hence, he and his family never received the protection that he Moreover, if premiums were to be paid within 90 days then the reckoning period should paid for. be the date the policy was delivered and not the date the appellee was physically DISPOSITIVE: WHEREFORE, the petition for review is denied for lack of merit. In the interest of examined. The 90-day period from the date of physical examination as provided for in justice, in view of the serious delay the private respondent's claim has suffered on account of the the receipts of payment is of' no moment, since said receipts are an integral part of the petitioner's intransigence in refusing to pay its just debt, the petitioner is ordered to pay legal rate insurance policy (contract). The official receipts issued by the company's agent can only of interest of 6% per annum on the premium of P1,416.60 refundable to the private respondent mean that the company ratified the act of Mrs. Margarita Siega in giving the appellee a from the filing of the complaint until the judgment is fully paid. As thus modified, the decision of the grace period of 30 days from January 25, 1973 within which to pay the annual premium. Court of Appeals is affirmed. Costs against the petitioner. This decision is immediately executory. SO ORDERED. Indeed, record shows that the three (3) installment payments were paid for within 30-days period and all 3 partial payments were officially acknowledged by the company, on March 6, 1973, and the Jaime T. Gaisano v Development Insurance & Surety
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Trans-Pacific for P140,893.50 was deposited with Metrobank for encashment on G.R. No. 97642 ; Date: February 27, 2017 October 1, 1996. By: ABRIGO 8. On October 1, 1996, Pacquing informed Gaisano of the vehicle's loss. Thereafter, Topic: Premium Gaisano reported the loss and filed a claim with Development Insurance for the Petitioner: Jaime T. Gaisano insurance proceeds of P1,500,000.00. Respondents: Development Insurance and Surety Corporation 9. After investigation, Development Insurance denied Gaisano's claim on the ground Ponente: Jardaleza, J that there was no insurance contract. Gaisano, through counsel, sent a final DOCTRINE: The general rule in insurance laws is that unless the premium is paid, the insurance demand on July 7, 1997. Development Insurance, however, refused to pay the policy is not valid and binding. UCPB General Insurance Co., Inc. summarized the exceptions to the insurance proceeds or return the premium paid on the vehicle. rule: 10. On October 9, 1997, Gaisano filed a complaint for collection of sum of money and (1) in case of life or industrial life policy, whenever the grace period provision applies, as damages with the RTC where it sought to collect the insurance proceeds from expressly provided by Section 77 itself; Development Insurance. In its Answer, Development Insurance asserted that the (2) where the insurer acknowledged in the policy or contract of insurance itself the receipt of non-payment of the premium rendered the policy ineffective. The premium was premium, even if premium has not been actually paid, as expressly provided by Section 78 itself; received by the Development Insurance only on October 2, 1996, and there was no (3) where the parties agreed that premium payment shall be in installments and partial payment known loss covered by the policy to which the payment could be applied. has been made at the time of loss, as held in Makati Tuscany Condominium Corp. v. Court of 11. RTC ruled in favor of Gaisano. It considered the premium paid as of September 27, Appeals; even if the check was received only on September 28 because (1) agent of (4) where the insurer granted the insured a credit term for the payment of the premium, and loss Development Insurance, Trans-Pacific, acknowledged payment of the premium on occurs before the expiration of the term, as held in Makati Tuscany Condominium Corp.; and that date, September 27, and (2) the check that Gaisano issued was honored by (5) where the insurer is in estoppel as when it has consistently granted a 60 to 90-day credit term Development Insurance in acknowledgment of the authority of the agent to for the payment of premiums. receive it. FACTS: 12. The CA granted the appeal of Development Insurance. The CA upheld Development 1. Petitioner Jaime Gaisano was the registered owner of a 1992 Mitsubishi Montero Insurance’s position that an insurance contract becomes valid and binding only with plate number GTJ-777 (vehicle), while respondent Development Insurance after the premium is paid pursuant to Section 77 of the Insurance Code and Surety Corporation is a domestic corporation engaged in the insurance (Presidential Decree No. 612, as amended by Republic Act No. 10607). It found business. that the premium was not yet paid at the time of the loss on September 27, but only 2. On September 27, 1996, Development Insurance issued a comprehensive a day after or on September 28, 1996, when the check was picked up by commercial vehicle policy to Gaisano for P1,500,000.00 over the vehicle for a Trans-Pacific. It also found that none of the exceptions to Section 77 obtains in this period of one year commencing on September 27, 1996 up to September 27, 1997. case. They also issued 2 other commercial vehicle policies to Gaisano for the same 13. Hence Gaisano filed this petition. He argues that there was a valid and binding period. insurance contract between him and Development Insurance. He submits that it 3. To collect the premiums and other charges on the policies, agent of Development comes within the exceptions to the rule in Section 77 of the Insurance Code that no Insurance, Trans-Pacific Underwriters Agency (Trans-Pacific), issued a statement contract of insurance becomes binding unless and until the premium thereof has of account to Gaisano’s company, Noah's Ark Merchandising (Noah's Ark). been paid. The prohibitive tenor of Section 77 does not apply because the parties 4. Noah's Ark immediately processed the payments and issued a Far East Bank check stipulated for the payment of premiums. The parties intended the contract of dated September 27, 1996 payable to Trans-Pacific on the same day. The check of insurance to be immediately effective upon issuance, despite non-payment of the P140,893.50 represented payment for the 3 insurance policies, with P55,620.60 premium, because Development Insurance trusted Gaisano. He adds that for the premium and other charges over the vehicle. Development Insurance waived its right to a pre-payment in full of the terms of the 5. However, nobody from Trans-Pacific picked up the check that day (September 27) policy, and is in estoppel. because its president and general manager, Rolando Herradura, was celebrating his birthday. Trans-Pacific informed Noah's Ark that its messenger would get the ISSUE: WON there is a binding insurance contract between Gaisano and Development check the next day, September 28. Insurance– NO. 6. In the evening of September 27, 1996, while under the official custody of Noah's Ark marketing manager Achilles Pacquing (Pacquing) as a service company vehicle, RULING: the vehicle was stolen in the vicinity of SM Megamall at Ortigas, Mandaluyong City. 1. Insurance is a contract whereby one undertakes for a consideration to indemnify Pacquing reported the loss to the PNP Traffic Management Command at Camp another against loss, damage or liability arising from an unknown or contingent Crame in Quezon City. Despite search and retrieval efforts, the vehicle was not event. Just like any other contract, it requires a cause or consideration. The recovered. consideration is the premium, which must be paid at the time and in the way and 7. Oblivious of the incident, Trans-Pacific picked up the check the next day, manner specified in the policy. If not so paid, the policy will lapse and be forfeited September 28. It issued an official receipt dated September 28 acknowledging the by its own terms. receipt for the premium and other charges over the vehicle. The check issued to
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2. The law, however, limits the parties' autonomy as to when payment of premium premium but merely a statement of account on its face; and (3) no payment of an may be made for the contract to take effect. The general rule in insurance laws is installment was made at the time of loss on September 27. that unless the premium is paid, the insurance policy is not valid and binding. 8. Gaisano argues that his case falls under the fourth and fifth exceptions because the 3. Section 77 of the Insurance Code, applicable at the time of the issuance of the parties intended the contract of insurance to be immediately effective upon policy, provides: issuance, despite non-payment of the premium. This waiver to a pre-payment in full Sec. 77. An insurer is entitled to payment of the premium as soon as the thing insured is exposed to of the premium places Development Insurance in estoppel. The fourth and fifth the peril insured against. Notwithstanding any agreement to the contrary, no policy or contract of exceptions to Section 77 operate under the facts obtaining in Makati Tuscany insurance issued by an insurance company is valid and binding unless and until the premium Condominium Corp. and UCPB General Insurance Co., Inc. Both contemplate thereof has been paid, except in the case of a life or an industrial life policy whenever the grace situations where the insurers have consistently granted the insured a credit period provision applies. extension or term for the payment of the premium. 4. In Tibay v. Court of Appeals, we emphasized the importance of this rule. We 9. Here, Gaisano failed to establish the fact of a grant by Development Insurance of explained that in an insurance contract, both the insured and insurer undertake a credit term in his favor, or that the grant has been consistent. While there was risks. On one hand, there is the insured, a member of a group exposed to a mention of a credit agreement between Trans-Pacific and Development particular peril, who contributes premiums under the risk of receiving nothing in Insurance, such arrangement was not proven and was internal between agent return in case the contingency does not happen; on the other, there is the insurer, and principal. Under the principle of relativity of contracts, contracts bind the who undertakes to pay the entire sum agreed upon in case the contingency parties who entered into it. It cannot favor or prejudice a third person, even if he happens. This risk-distributing mechanism operates under a system where, by is aware of the contract and has acted with knowledge. prompt payment of the premiums, the insurer is able to meet its legal obligation to 10. We cannot sustain Gaisano's claim that the parties agreed that the insurance maintain a legal reserve fund needed to meet its contingent obligations to the contract is immediately effective upon issuance despite non-payment of the public. The premium, therefore, is the elixir vitae or source of life of the insurance premiums. Even if there is a waiver of pre-payment of premiums, that in itself does business. not become an exception to Section 77, unless the insured clearly gave a credit 5. Here, there is no dispute that the check was delivered to and was accepted by term or extension. This is the clear import of the fourth exception in the UCPB Trans- Pacific, only on September 28, 1996. No payment of premium had thus General Insurance Co., Inc. To rule otherwise would render nugatory the been made at the time of the loss of the vehicle on September 27, 1996. While requirement in Section 77 that "[n]otwithstanding any agreement to the contrary, Gaisano claims that Trans-Pacific was informed that the check was ready for no policy or contract of insurance issued by an insurance company is valid and pick-up on September 27, 1996, the notice of the availability of the check, by binding unless and until the premium thereof has been paid, x x x." itself, does not produce the effect of payment of the premium. Trans-Pacific could 11. Moreover, the policy itself states: not be considered in delay in accepting the check because when it informed WHEREAS THE INSURED, by his corresponding proposal and declaration, and which shall be the Gaisano that it will only be able to pick-up the check the next day, Gaisano did not basis of this Contract and deemed incorporated herein, has applied to the company for the protest to this, but instead allowed Trans-Pacific to do so. Thus, at the time of loss, insurance hereinafter contained, subject to the payment of the Premium as consideration for such there was no payment of premium yet to make the insurance policy effective. insurance. (Emphasis supplied.) 6. There are, of course, exceptions to the rule that no insurance contract takes 12. The policy states that the insured's application for the insurance is subject to the effect unless premium is paid. In UCPB General Insurance Co., Inc., we summarized payment of the premium. There is no waiver of pre-payment, in full or in the exceptions as follows: installment, of the premiums under the policy. Consequently, Development Insurance cannot be placed in estoppel. (1) in case of life or industrial life policy, whenever the grace period provision applies, 13. Thus, we find that Gaisano is not entitled to the insurance proceeds because no as expressly provided by Section 77 itself; insurance policy became effective for lack of premium payment. (2) where the insurer acknowledged in the policy or contract of insurance itself the 14. The consequence of this declaration is that Gaisano is entitled to a return of the receipt of premium, even if premium has not been actually paid, as expressly provided premium paid for the vehicle in the amount of P55,620.60 under the principle of by Section 78 itself; unjust enrichment. There is unjust enrichment when a person unjustly retains a (3) where the parties agreed that premium payment shall be in installments and partial benefit to the loss of another, or when a person retains money or property of payment has been made at the time of loss, as held in Makati Tuscany Condominium another against the fundamental principles of justice, equity and good conscience. Corp. v. Court of Appeals; Gaisano cannot claim the full amount of P140,893.50, which includes the payment (4) where the insurer granted the insured a credit term for the payment of the of premiums for the two other vehicles. These two policies are not affected by our premium, and loss occurs before the expiration of the term, as held in Makati Tuscany ruling on the policy subject of this case because they were issued as separate and Condominium Corp.; and independent contracts of insurance. (5) where the insurer is in estoppel as when it has consistently granted a 60 to 90-day credit term for the payment of premiums. DISPOSITIVE: WHEREFORE, the petition is DENIED. The assailed Decision of the CA dated 7. The insurance policy in question does not fall under the first to third exceptions laid September 11, 2009 and the Resolution dated November 24, 2009 are AFFIRMED with the out in UCPB General Insurance Co., Inc.: (1) the policy is not a life or industrial life MODIFICATION that respondent should return the amount of P55,620.60 with the legal interest policy; (2) the policy does not contain an acknowledgment of the receipt of computed at the rate of 6% per annum reckoned from July 7, 1997 until finality of this judgment.
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Thereafter, the total amount shall earn interest at the rate of 6% per annum from the finality of this whether the fire was started before or after the explosion. Neither is there any competent judgment until its full satisfaction. SO ORDERED. testimony as to the cause of the explosion.
Loss, Notice and Proof of Loss The factory where the fire occurred was filed with numerous kinds of essences and oils used in the manufacture of perfumery and with a quantity of alcohol and manufactured perfumes, all of which were of a highly inflammable nature, and the fire may have started from any one of a number of Paris-Manila Perfume v Phoenix Assurance reasons. But in the final analysis, the fact remains that there was a fire, and that the property was G.R. No ; Date destroyed. It is true that it may be that the explosion was the primary cause of the fire, but that is By: ANDAL only a matter of conjecture, and upon that point, the burden of proof was upon the Phoenix.
Topic: Loss Phoenix relies upon section 6 of the policy, as follows: Petitioners: Paris-Manila Perfume Co., AKA Paris-Manila Perfumery Co. 6. Unless otherwise expressly stated in the policy the insurance does not cover - Respondents: Phoenix Assurance Co. Ponente: Johns (h) Loss or damage occasioned by the explosion; but loss or damage by explosion of gas DOCTRINE: for illuminating or domestic purposes in a building in which gas is not generated and FACTS: which does not form a part of any gas works, will be deemed to be loss by fire within the Paris-Manila Perfume is a domestic corporation engaged in the manufacture of perfumery and meaning of this policy. toilet articles. - In answer to that, Paris-Manila relies upon section 5, which is as follows: 5. The insurance does not cover - Phoenix Assurance issued to Paris-Manila a fire insurance policy in the sum of P13,000 upon the ( d) Loss or damage occasioned directly or indirectly, approximately or remotely by or latter’s property at No. 1 Calle Cisneros, Cavite, insuring plaintiff's property against fire for that through or in consequence of: amount; the property was also insured in two other companies (one for P1,200, and the other for P5,000) (1) Earthquake, hurricane, volcanic eruption or other convulsion of nature, and the company shall not be liable for loss or damage arising during or within a reasonable time The property covered by insurance was completely destroyed by fire for the total loss to after any of the said occurrences, unless it be proved by the insured to the satisfaction of Paris-Manila of P38,025.56. Paris-Manila filed a claim but Phoenix refused to pay it. the company that such loss or damage was not in any way occasioned by or through or in consequence of any of the said occurrences. Paris-Manila requested Phoenix to appoint an arbitrator under the provisions of section 17 of the policy, which was also denied. It will be noted that section 5 excludes not only the damages which may immediately result from an earthquake, but also any damage which may follow the earthquake, and that section 6 excludes Paris-Manila now prays for judgment against Phoenix for P13,000 only the damages which are the direct result of the explosion itself, and that it does not except damages which occurred from the fire occurring after the explosion, even though the explosion Phoenix prays that the complaint be dismissed, arguing that: may have been the primary cause of the fire. 1. The policy in question was issued "to one Peter Johnson, as proprietor of Paris-Manila Perfumery Co.," The company was not the insured named in the policy, and that the But assuming, without deciding, that if it be a fact that the fire resulted from an explosion that fact, insurance was of no legal force and effect with the company. if proven, would be a complete defense, the burden of the proof of that fact is upon the Phoenix, 2. The policy of insurance did not cover any loss or damage occasioned by explosion, and and upon that point, there is a failure of proof. There is no competent evidence as to whether the that the loss was occasioned by an explosion, and was not covered by the policy. explosion caused the fire or the fire caused the explosion. 3. The policy provides that, if the claim is fraudulent, and that any false declaration was made or used to obtain it, all benefits are thereby forfeited the claim of Paris-Manila is The defendant having issued its policy which was in legal force and effect at the time of the fire, it is fraudulent as to the quantity and value of the insured property at the time of the fire. bound by its terms and conditions, and the property having been destroyed, the burden of proof 4. The policy becomes forfeited if a loss is occasioned by the willful act or connivance of the was upon the defendant to show that it was exempt from liability under the terms and conditions insured, and that the loss in question was caused by the willful act of Peter Johnson of the policy, and upon that point, there is a failure of proof.
CFI ruled in favor of Paris-Manila DISPOSITIVE: The judgment of the lower court is affirmed, with costs. So ordered. ISSUE: W/N Phoenix Assurance is liable? (YS) Prats v Phoenix Assurance GR L-28607 ; February 21, 1929 HELD: By: BACANI Both Johnson and Banta (the only persons in the building at the time) testified that they heard an explosion, and when they looked around, they saw fire and felt heat. There is no evidence as to Insurance | SDUxMigallos |page | 26 Prats procured from the agent of the defendant a policy of insurance in the amount of 200k on Topic: Loss merchandise stored in the same place. Petitioners: PRATS & COMPANY Respondents: PHOENIX INSURANCE COMPANY, HARTFORD, CONNECTICUT The 9 policies already procured had been taken out, but when Prats applied to the agent of the Ponente: Street, J. defendant for the 200k policy, the agent told him that if Hanna or Bejar had any interest in the TBH di ko naintindihan yung case :) :) :) gulo niya hahaha stock to be insured, the policy could not be issued for the reason that, in such case, the defendant would not be able to obtain reinsurance for any part of the policy, owing to the bad reputation of FACTS: Hanna and Bejar. On July 10, 1923, Francisco Prats, Elias Hanna, and Isidro Bejar registered 2 mercantile partnerships in the Bureau of Commerce and Industry for the purpose of engaging in mercantile Accordingly, at the request of Prats & Co.; and Prats at the same time assured the agent that business. The articles of copartnership of these 2 entities were the same except in the firm names. Hanna and Bejar were not partners in Prats & Co. With the writing of this policy the amount of insurance on the merchandise was increased to 360k, while the value of the stock at that time was It was apparently contemplated, in so far as any legitimate function may have been intended, that not probably much in excess of 158k. Prats & Co. should be an importing firm, while Hanna, Bejar & Co. should engage in retail business. As events show, the existence of the parallel entities, controlled by the same individuals, supplied, On August 11, 1924, Prats took out an additional policy for 50k in the name of Prats & Co. on the undeniably, suitable engines for accomplishing an exploit of the kind that was here attempted. same stock. This made a total insurance of 410k on the contents of the store. At the time, according to Prats himself, the evaluation of the merchandise then in the place was not in excess of 230k. Of the 3 individuals mentioned, Elias Hanna and Isidro Bejar were Turkish subjects of unsavory Furthermore, Prats, about this time, caused the first 9 policies to be indorsed to Prats & Co., reputation in insurance circle of Manila, while Francisco Prats was a Spanish subject who had had thereby making this firm the sole insured firm with respect to this stock of merchandise. some success as a merchant and, prior to his connection with the two associates, apparently enjoyed a fair reputation. This action was instituted in the Manila CFI by Prats & Co., a mercantile partnership, for the purpose of recovering from Phoenix Insurance the sum of Php 117,800.60, with interest, by reason Another individual, who figures in the case as an instrument of the partners, is one Domingo of a loss alleged to have been sustained by the plaintiff on August 21, 1924 from a fire, it being Romero, who at that the time which we are here concerned, was an employee of the BIR, with a alleged that said loss was covered by a policy of insurance for the sum of 200k issued by Phoenix to salary of Php 150 per month. Ramon Prats, a son of Francisco, was united in marriage to a daughter the plaintiff. of Domingo Romero, with the result that social relations between Francisco Prats and Domingo Romero were close. Francisco Prats appears to have acted as manager for both Prats & Co. and Phoenix Insurance admitted the insurance of the policy but, by way of special defense, alleged, Hanna, Bejar & Co. among other things, that the fire in question had been set by the plaintiff, or with its connivance, and that the plaintiff had submitted under oath to the defendant a fraudulent claim of loss, in On May 27, 1924, Prats, acting for Hanna, Bejar, & Co., purchased a 1-story building in Manila; and contravention of the express terms of the policy. Upon hearing the cause, RTC absolved the soon thereafter he begun to assemble in this place the stock of merchandise which was the subject defendant from the complaint with respect to the obligation created by the policy which was the of insurance in this case. The building referred to was purchased outright for the sum of 1.6k. It was subject of the suit, but ordered the defendant to pay to the plaintiff the sum of Php 11,731.93, with old and was scarcely more than a shed but had been used in times past for human habitation. It was interest from the filing of the complaint, upon account of moneys received from salvage sales, located in a part of the city which was inconvenient of success to traders and out of the ordinary conducted by the defendant, of remnants of the insured stock. From this judgment the plaintiff channels of business activity. appealed.
After purchasing the building, Prats knocked out the partitions, removed the floor, and laid along ISSUE: Whether Phoenix Assurance is liable to Prats for the loss the center. The main part of the structure was thus converted into a single store, or bodega, though certain adjuncts, consisting of kitchen and closets, remained unchanged in the rear of the building. HELD: NO. A sign was then set up over the entrance bearing the firm name "Hanna, Bejar, & Co." In effecting So far as liability under the policy of insurance which is the subject of this action is concerned, we the purchase of this building Prats availed himself of the service of Domingo Romero, who lived are of the opinion that the defendant has sufficiently established 2 defenses, either of which would only two doors away. be fatal to the right of recovery.
By August 21, 1924, there had been assembled and stored by Prats in the place above described a First, t hat the fire was set by the procurance or connivance of the plaintiff for the purpose of stock of goods which, according to the documents exhibited by him, had a valuation of Php defrauding the insurer; and second, that the plaintiff, after the fire, submitted to the defendant a 211,329.72, on which he had taken out insurance to the extent of 410k. At midnight of the day fraudulent claim supported by the false proof, in violation of the terms of the policy. Of these mentioned a fire occurred, which destroyed the building and ruined its contents, the amount defenses, the trial judge sustained the second but passed the first without express finding. realized from the salvage of the stock being Php 11,731.93. With respect to the origin of the stock thus assembled, we find that part had been purchased in In June, preceeding the fire, 9 policies aggregating 160k were taken out by Prats in the name of Europe by Prats; and in connection with its importation from abroad it is noteworthy that on June Hanna, Bejar & Co. on merchandise stored at the building. At the time these policies were taken 18, 1924, Prats & Co. procured a policy of marine insurance to be issued by Meerkamp & Co., Ltd., out, the valuation of the goods then could not have been more than Php 68,753. On June 28, 1924, as agents of the India Insurance Co., Ltd.
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The proof submitted by the defendant tends to show that obscure manipulations were used by In the course of long experience we have observed that justice is most effectively and the plaintiff in the storing of merchandise and in the removal of part of the contents of the expeditiously administered in the courts where trivial objections to the admission of proof are bodega before the fire. In this connection it appears that 45 cases of old stock of Hanna, Bejar & received with least favor. The practice of excluding evidence on doubtful objection to its Co., were shipped to Manila before the fire, but they were housed for a time in the back part of the materiality or technical objection to the form of the questions should be avoided. lower floor of the Bazar Filipino in which Prats & Co. and Hanna, Bejar & Co. had their offices. In a case of any intricacy it is impossible for a judge of first instance, in the early stages of the The finding of the trial court in the effect that the plaintiff had submitted false proof in the support development of the proof, to know with any certainty whether testimony is relevant or not; and of his claim is also, in our opinion, well founded. That conclusion appears to have been based upon where there is no indication of bad faith on the part of the attorney offering the evidence, the court 3 items of proof, and with respect to at least 2 of these, we think that the conclusion of his Honor may as a rule safely accept the testimony upon the statement of the attorney that the proof was correctly drawn. offered will be connected later.
These two facts are, first, that the plaintiff had submitted a claim for jewelry lost in the fire as of a On the other hand, the admission of proof in a court of first instance, even if the question as to its value of 12.8k when the rule value of said jewelry was about Php 600; and, secondly, that the form, materiality, or relevancy is doubtful, can never result in much harm to either litigant, because plaintiff had sought to recover from the insurance company the value of goods which had been the trial judge is supposed to know the law; and it is its duty, upon final consideration of the case, to surreptitiously withdrawn by it from the bodega prior to the fire. Neither of these facts are distinguish the relevant and material from the irrelevant and immaterial. If this course is followed consistent with good faith on the part of the plaintiff, and each constituted a breach of the and the cause is prosecuted to the Supreme Court upon appeal, this court then has all the material stipulations of the policy against the use of fraudulent devices and false proof with respect to the before it necessary to make a correct judgment. loss. In this connection it should be remembered that many of the technical rules of evidence which are The other point relied upon by his Honor to sustain the conclusion that the plaintiff had attempted often invoked in our courts were originally worked out in England and the United States, where the to deceive the defendant with respect to the extent of the loss was at least competent in its general jury system prevails. bearing on the good faith of the plaintiff, even if, as is probably true, not alone sufficient to constitute a breach of the same stipulations. DISPOSITIVE: The appealed decision will therefore be affirmed, and it is also ordered, with costs against the appellant. The point is this: After the fire the plaintiff presented to the adjuster certain cost sheets and cpies of supposed invoices in which the prices and expenses of importation of a quantity of goods were stated at double the true amount. The adjuster soon discovered the artificial nature Country Bankers v Lianga Bay Multipurpose of these documents, and, with his consent, they were withdrawn by Prats and subsequently G.R. No: 136914 ; Date: January 25, 2002 destroyed. By: CRUZ
At the hearing Prats stated that these documents had been fabricated in order that they might be Topic: Loss, Notice and Proof of Loss - Loss exhibited to intending purchasers of the goods, thereby making it appear to them that the cost of Petitioners: COUNTRY BANKERS INSURANCE CORPORATION, the merchandise had been much greater than it in fact was — a ruse which is supposed to have Respondents: LIANGA BAY AND COMMUNITY MULTI-PURPOSE COOPERATIVE, INC. been entirely innocent or at least not directed against the insurer. But a question naturally arises Ponente: DE LEON, JR., J. as to the purpose which these documents might have been made to serve if the fire, as doubtless DOCTRINE: intended by its designers, had been so destructive as to remove all vestiges of the stock actually FACTS: involved. Upon the whole we are forced to state the conclusion, not only that the plaintiff caused ● Country Bankers Insurance corporation is a domestic corporation principally engaged the fire to be set, or connived therein, but also that it submitted fraudulent proof as the trial judge in the insurance business. It undertakes, for a consideration, to indemnify another found. against loss, damage or liability from an unknown or contingent event including fire ● Lianga Bay and Community Multi-purpose Cooperative,Inc is a duly registered Before concluding this opinion we are constrained to make a few observations with reference to cooperative judicially declared insolvent and represented by the elected assignee, the trial of this case and the inordinate amount of time consumed in the proceedings. We are told Cornelio Jamero. in the appellant's brief that the trial of this case covered a period of almost 2 years, in which 50 ● In 1989, Country Bankers and Lianga Bay entered into a contract of fire insurance. separate sessions were held, without counting the numerous hearings upon the taking of the ○ Under Fire Insurance Policy No. F-1397, Country Bankers insured Lianga deposition of Francisco Prats, a partner in the plaintiff firm, whose testimony was taken at the Bay’s stocks-in-trade against fire loss, damage or liability during the period instance of the defendant. starting from June 20, 1989 at 4:00 p.m. to June 20, 1990 at 4:00 p.m., for the sum of (₱200,000.00). Taken all together, the time thus consumed was out of all proportion to the difficulties of the case. ● July 1, 1989, at or about 12:40 a.m., Lianga Bay’s building located at Barangay Diatagon, An examination of the voluminous transcript reveals at least part of the reason for this inordinate Lianga, Surigao del Sur was gutted by fire and reduced to ashes, resulting in the total loss consumption of time; since we find that far too much of the space in the transcript is taken up with of the Lianga Bay’s stocks-in-trade, pieces of furnitures and fixtures, equipments and the record of petty skirmishes in court resulting from objections over the admission of evidence. records. Insurance | SDUxMigallos |page | 28 ● Due to the loss, Lianga Bay filed an insurance claim with the Country Bankers under its 2. that it was made by the public officer in the performance of his duties, or by Fire Insurance Policy submitting: such other person in the performance of a duty specially enjoined by law ○ (a) the Spot Report of Pfc. Arturo V. Juarbal, INP Investigator, dated July 1, 3. “that the public officer or other person had sufficient knowledge of the facts 1989; by him stated, which must have been acquired by him personally or through ○ (b) the Sworn Statement of Jose Lomocso; official information” ○ (c) the Sworn Statement of Ernesto Urbiztondo. ● The 3rd requisite was not met since no investigation, independent of the statements ● Country Bankers, denied the insurance claim on the ground that the building was set on gathered from Lomocso, was conducted by Pfc. Juarbal. fire by (2) NPA rebels who wanted to obtain canned goods, rice and medicines as ● The said Spot Report is admissible only insofar as it constitutes part of the testimony of provisions for their comrades in the forest, and that such loss was an excepted risk Pfc. Juarbal since he himself took the witness stand and was available for under paragraph No. 6 of the policy conditions of Fire Insurance Policy: (see notes) cross-examination. The portions of his Spot Report which were of his personal ● Lianga Bay filed a complaint for recovery of loss, damage, or liability against Country knowledge or which consisted of his perceptions and conclusions are not hearsay. Bankers. ● The Country bankers’ evidence to prove its defense is sadly wanting and thus, gives rise ● According to Country Bankers, it denied the claim because the loss was due to NPA to its liability to Lianga Bay under Fire Insurance Policy No. F-1397. rebels, which is an expected risk under the fire insurance policy. ● RTC ruling In favor of Liangay Bay. NOTES: ● CA affirmed RTC ruling in favor of Lianga Bay Paragraph 6 This insurance does not cover any loss or damage occasioned by or through or in consequence, directly or ISSUE: Whether or not the burning of Lianga Bay’s stock-in-trade by NPA rebels is an excepted risk indirectly, of any of the following occurrences, namely: under the fire insurance policy? xxx xxx xxx (d) Mutiny, riot, military or popular uprising, insurrection, rebellion, revolution, military or usurped power. HELD: No. Any loss or damage happening during the existence of abnormal conditions (whether physical or ● Where a risk is excepted by the terms of a policy which insures against other perils or otherwise) which are occasioned by or through or in consequence, directly or indirectly, of any of said hazards, loss from such a risk constitutes a defense which the insurer may urge, since it occurrences shall be deemed to be loss or damage which is not covered by this insurance, except to the has not assumed that risk. extent that the Insured shall prove that such loss or damage happened independently of the existence of ○ From this it follows that an insurer seeking to defeat a claim because of an such abnormal conditions. exception or limitation in the policy has the burden of proving that the loss comes within the purview of the exception or limitation set up. DISPOSITIVE: WHEREFORE, the appealed Decision is MODIFIED. The rate of interest on the ○ If a proof is made of a loss apparently within a contract of insurance, the adjudged principal amount of Php200K shall be 6% per annum computed from the date of filing of burden is upon the insurer to prove that the loss arose from a cause of loss the Complaint in the trial court. The awards in the amounts of Php50K as actual damages, Php50K which is excepted or for which it is not liable, or from a cause which limits its as exemplary damages, Php5K as litigation expenses, Php10K as attorney’s fees are hereby liability. DELETED. Costs against the petitioner. ● In the case, since Country Bankers is defending on the ground of non-coverage and relying upon an exemption or exception clause in the fire insurance policy, Country Bankers has the burden of proving the facts upon which such excepted risk is based, by a Heirs of Coscolluela v Rico General preponderance of evidence. G.R. No. 84628 16 Nov. 1989 ● Country Bankers relies on the Sworn Statements and the Spot Report, more particularly By: GORDON this statement: “x x x investigation revealed by Jose Lomocso that those armed men wanted to get can goods and rice for their consumption in the forest PD investigation Topic: LOSS; WILLFUL ACT OF INSURED; NEGLIGENCE OF INSURED – SEC. 89, CODE further disclosed that the perpetrator are member (sic) of the NPA PD end . . . x x x” Petitioners: HEIRS OF ILDEFONSO COSCOLLUELA, SR., INC. ● A witness can testify only to those facts which he knows of his personal knowledge, Respondents: RICO GENERAL INSURANCE CORPORATION, COURT OF APPEALS (11th which means those facts which are derived from his perception. Consequently, a witness Division), and HON. ENRIQUE T. JOCSON, Judge, Regional Trial Court of Negros Occidental may not testify as to what he merely learned from others either because he was told or Branch read or heard the same. Such testimony is considered hearsay and may not be received Ponente: GUTIERREZ, JR., J. as proof of the truth of what he has learned (hearsay rule). DOCTRINE: ○ The Sworn Statements of Lomocso and Urbiztondo are inadmissible in FACTS: evidence, for being hearsay, inasmuch as they did not take the witness stand ● Heirs of Ildefonso Coscoluella, Inc. is a domestic corporation and the registered and could not therefore be cross-examined owner of an Isuzu KBD Pick-up truck ● There are exceptions to the hearsay rule, but 3 requisites must concur in order to be ● The vehicle was insured with Rico General Insurance Corporation for a considered an exception. REQUISITES: consideration of P100,000.00 excluding third party liability under Commercial 1. that the entry was made by a public officer, or by another person specially Vehicle Policy No. CV-122415 enjoined by law to do so; o The premiums and other expenses paid covered the period from October 1, 1986 to October 1, 1987 Insurance | SDUxMigallos |page | 29 ● On August 28, 1987, the insured vehicle was severely damaged and rendered rebellion or insurrection constitutes reversible error on the part of the unserviceable when fired upon by a group of unidentified armed persons at trial court. Hacienda Puyas, Barangay Blumentritt, Murcia, Negros Occidental. ● The Court stresses that it would be a grave and dangerous procedure for the ● Heirs of Coscoluella filed its claim of P80,000.00 for the repair of the vehicle courts to permit insurance companies to escape liability through a motion to o Rico refused to grant it dismiss without the benefit of hearing and evidence every time someone is killed, ● Heirs of Coscoluella filed a complaint with the RTC at Bacolod City to recover the or as in this case, property is damaged in an ambush. claim of P80,000.00 plus interest and attorney's fees. o The question on the nature of the firing incident for the purpose of ● Rico filed a motion to dismiss alleging that the complaint lacks a cause of action determining whether or not the insurer is liable must first be threshed because the firing by armed men is a risk excepted under the insurance policy: out and resolved in a full-blown trial. o "The Company shall not be liable under any Section of the Policy in respect of: —…any accident, loss, damage or liability directly or indirectly, proximately or remotely occasioned by, contributed to by or traceable DISPOSITIVE: WHEREFORE, considering the foregoing, the petition is hereby GRANTED. The to, or arising out of, or in connection with…civil commotion, mutiny, decision of the respondent Court of Appeals affirming the dismissal order by the Regional Trial rebellion, insurrection, military or usurped power, or by any direct or Court is hereby REVERSED and SET ASIDE. Let the case be remanded to the lower court for trial indirect consequences of any of the said occurrences…” on the merits. o alleged that the firing was "an indirect consequence of rebellion, insurrection or civil commotion." ● RTC dismissed the complaint for lack of cause of action stating that the damage FGU Insurance v CA arose from a civil commotion or was a direct result thereof. GR 137775, 31 March 2005 ● Heirs of Coscoluella file a motion for reconsideration By: IGOT o denied by the RTC ● Heirs of Coscoluella filed a petition for certiorari with the CA Topic: Loss: Sections 85-89, Code ● CA affirmed RTC’s dismissal Petitioners: FGU INSURANCE CORPORATION ● Hence, this petition to review Respondents: THE COURT OF APPEALS, SAN MIGUEL CORPORATION, and ESTATE OF ANG o maintains that the order of dismissal was erroneous in that no trial was GUI, represented by LUCIO, JULIAN, and JAIME, all surnamed ANG, and CO TO, held for the reception of proof that the firing incident was a direct or Ponente: indirect result of a civil commotion, mutiny, insurrection or rebellion DOCTRINE: o argues that Rico had the burden of proof to show that the cause was really FACTS: an excepted risk ● Anco Enterprises Company (ANCO), a partnership between Ang Gui and Co To, was engaged in the shipping business operating two common carriers. It owned the M/T ANCO tugboat and the D/B Lucio barge which were operated as common carriers. ISSUE: W/N Rico’s invocation of the exceptions clause in the insurance policy as the basis for its ○ M/T ANCO tugboat non-liability and the consequent dismissal of the complaint is without merit. ○ D/B Lucio barge - no engine of its own, it could not maneuver by itself and had to be towed by a tugboat for it to move from one place to another. HELD: YES. ● September 23 1979: San Miguel Corporation (SMC) shipped from Mandaue City, Cebu, ● A policy of insurance with a narration of exceptions tending to work a forfeiture of on board the D/B Lucio, for towage by M/T ANCO: the policy shall be interpreted liberally in favor of the insured and strictly against ○ Bill of Lading #1: 25,000 cases Pale Pilsen and 350 cases Cerveza Negra - the insurance company or the party for whose benefit they are inserted. consignee SMC’s Beer Marketing Division (BMD)-Estancia Beer Sales Office, ● The facts alleged in the complaint do not give a complete scenario of the real Estancia, Iloilo nature of the firing incident. Hence, it was incumbent upon the trial judge to have ○ Bill of Lading #2: 15,000 cases Pale Pilsen and 200 cases Cerveza Negra - made a deeper scrutiny into the circumstances of the case by receiving evidence consignee SMC’s BMD-San Jose Beer Sales Office, San Jose, Antique instead of summarily disposing of the case. ● September 30, 1979: D/B Lucio was towed by the M/T ANCO arrived and M/T ● The burden of proof to show that the insured is not liable because of an excepted ANCO left the barge immediately risk is on Rico ○ The clouds were dark and the waves were big so SMC’s District Sales o Section 1, Rule 131, Rules of Court: "Each party must prove his affirmative Supervisor, Fernando Macabuag, requested ANCO’s representative to allegations." transfer the barge to a safer place but it refused so around the midnight, ● DOCTRINE: Where the insurer denies liability for a loss alleged to be due to a risk the barge sunk along with 29,210 cases of Pale Pilsen and 500 cases of not insured against, but fails to establish the truth of such fact by concrete proofs, Cerveza Negra totalling to P1,346,197 the Court rules that the insurer is liable under the terms and conditions of the ● When SMC claimed against ANCO it stated that they agreed that it would not be policy by which it has bound itself. liable for any losses or damages resulting to the cargoes by reason of fortuitous o In this case, the dismissal order without hearing and reception of evidence event and it was agreed to be insured with FGU for 20,000 cases or P858,500 to prove that the firing incident was indeed a result of a civil commotion, ● ANCO filed against FGU Insurance | SDUxMigallos |page | 30 ○ FGU alleged that ANCO and SMC failed to exercise ordinary diligence or Such extraordinary diligence in vigilance over the goods is further expressed in Articles the diligence of a good father of the family in the care and supervision of 1734, 1735, and 1745 Nos. 5, 6, and 7 . . . the cargoes ● Art. 1734. Common carriers are responsible for the loss, destruction, or deterioration of ● RTC: ANCO liable to SMC and FGU liable for 53% of the lost cargoes the goods, unless the same is due to any of the following causes only: (1) Flood, storm, ○ ANCO claimed however that it had an agreement with SMC that ANCO earthquake, lightning, or other natural disaster or calamity; ... would not be liable for any losses or damages resulting to the cargoes by reason of fortuitous event. ● Art. 1739. In order that the common carrier may be exempted from responsibility, the ■ cases of beer Pale Pilsen and Cerveza Negra were lost by reason of a natural disaster must have been the proximate and only cause of the loss. However, the storm, a fortuitous event common carrier must exercise due diligence to prevent or minimize loss before, during ■ ANCO further asserted that there was an agreement between them and after the occurrence of flood, storm, or other natural disaster in order that the and SMC to insure the cargoes in order to recover indemnity in case common carrier may be exempted from liability for the loss, destruction, or deterioration of loss. of the goods . . . ● Pursuant to that agreement, the cargoes to the extent of ● Caso fortuito or force majeure Twenty Thousand (20,000) cases was insured with FGU ○ extraordinary events not foreseeable or avoidable, events that could not be Insurance Corporation (FGU) for the total amount of Eight foreseen, or which though foreseen, were inevitable Hundred Fifty-Eight Thousand Five Hundred Pesos ○ not enough that the event should not have been foreseen or anticipated, as is (P858,500.00) per Marine Insurance Policy No. 29591. commonly believed but it must be one impossible to foresee or to avoid - not in ○ Subsequently, ANCO, with leave of court, filed a Third-Party Complaint this case against FGU, alleging that before the vessel of ANCO left for San Jose, ○ other vessels in the port of San Jose, Antique, managed to transfer to another Antique with the cargoes owned by SMC place ■ the cargoes, to the extent of Twenty Thousand (20,000) cases, were ● To be exempted from responsibility, the natural disaster should have been the proximate and insured with FGU under Marine Insurance Policy No. 29591. only cause of the loss. There must have been no contributory negligence on the part of the ■ by reason of very strong winds and heavy waves brought about by a common carrier. passing typhoon, as a result of which, the vessel was totally wrecked ○ there was blatant negligence on the part of M/T ANCO’s crewmembers, first in and its cargoes owned by SMC were lost and/or destroyed. leaving the engine-less barge D/B Lucio at the mercy of the storm without the ■ According to ANCO, the loss of said cargoes occurred as a result of assistance of the tugboat, and again in failing to heed the request of SMC’s risks insured against in the insurance policy and during the existence representatives to have the barge transferred to a safer place and lifetime of said insurance policy. ● When evidence show that the insured’s negligence or recklessness is so gross as to be ■ ANCO went on to assert that in the remote possibility that the court sufficient to constitute a willful act, the insurer must be exonerated. will order ANCO to pay SMC's claim, the third-party defendant ● ANCO’s employees is of such gross character that it amounts to a wrongful act which corporation should be held liable to indemnify or reimburse ANCO must exonerate FGU from liability under the insurance contract whatever amounts, or damages, it may be required to pay to SMC. ○ both the D/B Lucio and the M/T ANCO were blatantly negligent ○ According to FGU, it is only liable under the policy to Third-party Plaintiff ANCO and/or Plaintiff SMC in case of any of the following: DISPOSITIVE:WHEREFORE, premises considered, the Decision of the Court of Appeals dated 24 a) total loss of the entire shipment; February 1999 is hereby AFFIRMED with MODIFICATION dismissing the third-party complaint. b) loss of any case as a result of the sinking of the vessel; or c) loss as a result of the vessel being on fire. ○ The trial court found that while the cargoes were indeed lost due to fortuitous event, there was failure on ANCO's part, through their representatives, to East Furniture v Globe & Rutgers Fire observe the degree of diligence required that would exonerate them from G.R. No L-35848 ; Nov. 22, 1932 liability By: LANZON ● CA affirmed Topic: Loss, Notice and Proof of Loss ISSUE: Whether or not FGU should be exempted from liability to ANCO for the lost cargoes Petitioners: The East Furniture Inc. because of a fortuitous event and negligence of ANCO? Respondents: The Globe and Rutgers Fire Insurance Co. of New York Ponente: Ostrand HELD: YES. Affirmed with modification. Third-party complaint is dismissed. DOCTRINE: ● Art. 1733. Common carriers, from the nature of their business and for reasons of public policy are bound to observe extraordinary diligence in the vigilance over the goods and FACTS: Three consolidated cases for the recovery of the full amount of three fire insurance policies for the safety of the passengers transported by them, according to all the circumstances aggregating P20,000 of each case.
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● East Furniture insured against fire the articles existing in its establishment situated at offered in evidence as Exhibit 5, contains 202 pieces of furniture, the cost price of which Nos. 626 and 628 Manila with the 3 defendants for the respective amounts: according to Guevara's appraisal is the total sum of P4,184.60. It will be recalled that the ○ Globe & Rutgers, P5,000, in force from July 12, 1928, to July 12, 1929; plaintiff claimed that at the time of the fire there were 506 pieces of furniture in the ○ Commercial Union, P5,000, in force during the same period; and building of the total value of P52,061.99. ○ The Continental, P10,000, in force from August 16, 1928, to August 16, 1929 Was it possible that the plaintiff had 506 pieces of furniture in the building at the time of the fire ● Each policy contained this stipulation: Condition 12 when after the fire only 202 pieces were found in the premises? Considering the undisputed fact "if the claim be in any respect fraudulent, or if any false declaration be made that most of the insured furniture was located in the ground floor of the building, which was not or used in support thereof, or if any fraudulent means or devices are used by damaged by the fire, and that the fire lasted only twelve minutes and damaged only the second the Insured or anyone acting on his behalf to obtain any benefit under this floor where comparatively few pieces of furniture were found at the time of the fire; and policy; or, if the loss or damage be occasioned by the wilful act, or with the considering the testimony of Captain Lorenzo and Isidro Guevara to the effect that, judging from connivance of the Insured, — all benefit under this policy shall be forfeited." the condition of the remains of the fire, they believed not a single piece of furniture was completely consumed by the fire, we do not hesitate to answer that question in the negative. ● March 2, 1929: Fire broke out in East Furniture’s establishment, the insured ○ During the twelve minutes the fire lasted, an enormous quantity of water was articles were destroyed by the fire; being pumped in by the firemen to extinguish it. ○ East Furniture presented its claim with the insurance companies stating ○ Judging, then, from the duration and intensity of the fire in question, we cannot that the value of the articles, before or at the time of the fire, amounted to bring ourselves to believe it possible for some 304 pieces of wooden furniture to have P52,061.99 and that of the furniture destroyed by the fire some was saved, of been entirely consumed without leaving any vestige. the value of P5,000, more or less. Regardless of any difference of opinion as to the value of the insured furniture and the extent of ● The defendants interposed a general denial and as special defenses alleged in the damage caused thereto by the fire in question, the fact that the insured only had approximately substance: 202 pieces of furniture in the building at the time of the fire and sought to compel the insurance (1) that the fire in question was of intentional origin; companies to pay for 506 pieces conclusively shows that its claim was not honestly conceived. The (2) that the claims of loss presented by the plaintiff were false and fraudulent; trial court's conclusion that said claim is notoriously fraudulent, is correct. ● RTC: In favor of the Insurance Companies. Dismissed. ○ East Furniture’s claims were notoriously fraudulent. Condition 12 of each of the insurance policies sued upon provides that "if the claim be in any ● East Furniture appealed contending that RTC erred: respect fraudulent, or if any false declaration be made or used in support thereof, or if any ○ in finding that the claims presented were fraudulent; fraudulent means or devices are used by the Insured or anyone acting on his behalf to obtain any ○ in giving weight to the testimony of Captain Lorenzo, deputy chief of benefit under this policy; or, if the loss or damage be occasioned by the wilful act, or with the the Manila Fire Department, and Isidro Guevara, a furniture manufacturer, as connivance of the Insured, — all benefit under this policy shall be forfeited." This case is governed to the value of the articles found in the premises after the fire; by the decisions of this court in Yu Cua vs. South British Insurance Co. ○ in dismissing the complaints. DISPOSITIVE: The judgment appealed from is affirmed, with costs against the appellant. So ISSUE: W/N the claims of East Furniture are fraudulent ordered.
HELD: YES. (2ND SPECIAL DEFENSE OF DEFENDANTS: that the claims of loss presented by the DBP Pool of Accredited Insurance Companies v Radio Mindanao Network, plaintiff were false and fraudulent) G.R. No. 147039 ; Date: January 27, 2006 By: ABRIGO To each of the proofs of loss which East Furniture presented to the respective insurance companies four days after the fire was attached an inventory of the furniture claimed to have been Topic: Loss in the building at the time of the fire. This inventory contains 506 pieces of furniture and 3,700 Petitioners: D BP POOL OF ACCREDITED INSURANCE COMPANIES board feet of lumber of the alleged total value of P52,061.99. This amount was the total loss Respondent: RADIO MINDANAO NETWORK, INC. claimed to have been suffered by the plaintiff, although we note that in its complaints in these Ponente: Austria-Martinez, J. cases amended it is conceded that some furniture of the value of about P5,000 was saved. DOCTRINE: An insurer seeking to defeat a claim because of an exception or limitation in the policy has the burden of proving that the loss comes within the purview of the exception or limitation set The record shows that from March 2, 1929, the date of the fire, to April 20, 1929, when the sheriff up. It is sufficient for Radio to prove the fact of damage or loss. Once it makes out a prima facie sold the furniture left in the building, the Manila Finance & Discount Corporation, the premises in case in its favor, the duty or the burden of evidence shifts to the insurance companies to question were guarded by an Indian watchman whom the insurance companies placed thereto to controvert Radio’s prima facie case. prevent anybody from taking away any part of its contents. ○ a furniture manufacturer named Isidro Guevara, with the assistance of Julian FACTS: Dacanay, an employee of the adjusters, made an inventory of all the damaged and undamaged furniture found in the building after the fire. That inventory, which was
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1. Radio Mindanao Network’s (Radio) station was razed by fire causing damage. It sought 7. If a proof is made of a loss apparently within a contract of insurance, the burden is recovery under the 2 insurance policies but the claims were denied on the ground that upon the insurer to prove that the loss arose from a cause of loss which is excepted or the cause of loss was an excepted risk: for which it is not liable, or from a cause which limits its liability. 2. This insurance does not cover any loss or damage occasioned by or through or in 8. Consequently, it is sufficient for Radio to prove the fact of damage or loss. Once it consequence, directly or indirectly, of any of the following consequences, namely: makes out a prima facie case in its favor, the duty or the burden of evidence shifts to a. War, invasion, act of foreign enemy, hostilities, or warlike operations the insurance companies to controvert Radio’s prima facie case. (whether war be declared or not), civil war. 9. In this case, since the insurance companies alleged an excepted risk, then the burden b. (Mutiny, riot, military or popular rising, insurrection, rebellion, revolution, of evidence shifted to it to prove such exception. It is only when it has sufficiently military or usurped power. proven that the damage or loss was caused by an excepted risk does the burden of 3. The insurance companies maintained that the evidence showed that the fire was caused evidence shift back to Radio (insured) who is then under a duty of producing evidence by the Communist Party of the PH/ New People’s Army; and consequently, denied the to show why such excepted risk does not release petitioner from any liability. claims. Hence, Radio filed a Civil Case against the insurance companies. 10. The insurance companies failed to discharge its primordial burden of proving that the 4. RTC ruled in favor of Radio and directed the insurance companies to pay. CA affirmed damage or loss was caused by an excepted risk. the decision. (not important, it just shows that the testimonies of the witnesses presented by the insurance 5. The insurance companies assail the factual finding of both the RTC and CA that its companies does not prove that the cause of fire was the CPP/NPA) evidence failed to support its allegation that the loss was caused by an excepted risk, the 11. The insurance companies insist that the evidence on record established the identity of members of the CPP/NPA caused the fire. the author of the damage. It argues that the RTC and the CA erred in not appreciating the reports of witnesses Lt. Col Torres and SFO II Rochar that the bystanders they ISSUE: Whether or not the insurance companies failed to prove that the loss was caused by an interviewed claimed that the perpetrators were members of the CPP/NPA as an excepted risk. - YES. exception to the hearsay rule as part of res gestae. 12. The Court is not convinced to accept the declarations as part of res gestae. While it may HELD: concede that these statements were made by the bystanders during a startling 1. The insurance companies argue that Radio is responsible for proving that the cause of occurrence, it cannot be said however, that these utterances were made spontaneously the damage/loss is covered by the insurance policy. The insurance policy states: by the bystanders and before they had the time to contrive or devise a falsehood. a. In any action, suit or other proceeding where the Companies allege that by 13. Both SFO III Rochar and Lt. Col. Torres received the bystanders' statements while they reason of the provisions of this condition any loss or damage is not covered by were making their investigations during and after the fire. It cannot therefore be this insurance, the burden of proving that such loss or damage is covered shall be ascertained whether these utterances were the products of truth. That the utterances upon the Insured. may be mere idle talk is not remote. 2. An insurance contract, being a contract of adhesion, should be so interpreted as to carry 14. At best, the testimonies of SFO III Rochar and Lt. Col. Torres that these statements were out the purpose for which the parties entered into the contract which is to insure against made may be considered as independently relevant statements gathered in the course risks of loss or damage to the goods. Limitations of liability should be regarded with of their investigation, and are admissible not as to the veracity thereof but to the fact extreme jealousy and must be construed in such a way as to preclude the insurer from that they had been thus uttered. noncompliance with its obligations. 3. The "burden of proof" contemplated by the aforesaid provision actually refers to the DISPOSITIVE: WHEREFORE, the petition is DISMISSED. The Court of Appeals Decision dated "burden of evidence" (burden of going forward). As applied in this case, it refers to the November 16, 2000 and Resolution dated January 30, 2001 rendered in CA-G.R. CV No. 56351 duty of the insured to show that the loss or damage is covered by the policy. are AFFIRMED in toto. 4. The foregoing clause notwithstanding, the burden of proof still rests upon the insurance companies to prove that the damage or loss was caused by an excepted risk in order to escape any liability under the contract. Vda. de Gabriel v CA 5. Burden of proof is the duty of any party to present evidence to establish his claim or GR 103883, 14 November 1996 defense by the amount of evidence required by law, which is preponderance of evidence By: ANDAL in civil cases. The party, whether plaintiff or defendant, who asserts the affirmative of the issue has the burden of proof to obtain a favorable judgment. For the plaintiff, the Topic: Notice and Proof of Loss burden of proof never parts. For the defendant, an affirmative defense is one which is Petitioners: JACQUELINE JIMENEZ VDA. DE GABRIEL not a denial of an essential ingredient in the plaintiff's cause of action, but one which, if Respondents: HON. COURT OF APPEALS and FORTUNE INSURANCE & SURETY COMPANY, established, will be a good defense — i.e. an "avoidance" of the claim. INC 6. Particularly, in insurance cases, where a risk is excepted by the terms of a policy which Ponente: Vitug insures against other perils or hazards, loss from such a risk constitutes a defense which DOCTRINE: the insurer may urge, since it has not assumed that risk, and from this it follows that an FACTS: insurer seeking to defeat a claim because of an exception or limitation in the policy has Marcelino Gabriel was employed by Emerald Construction & Development Corporation (Emerald the burden of proving that the loss comes within the purview of the exception or Construction for brevity) at its construction project in Iraq. He was covered by a personal accident limitation set up. insurance in the amount of P100,000.00 under a group policy procured from Fortune Insurance Insurance | SDUxMigallos |page | 33 and Surety Company (Fortune Insurance for brevity) by Emerald Construction for its overseas While petitioner did fail in substantiating her allegation that the death of her husband was due to workers. The insured risk was for bodily injury caused by violent accidental external and visible an accident, considering, however, the uncertainty on the real cause of death, private respondent means which injury would solely and independently of any other cause result in death or disability. might find its way clear into still taking a second look on the matter and perhaps help ease the load of petitioner's loss. On May 22, 1982, within the life of the policy, Gabriel died in Iraq. On July 12, 1983, Emerald Construction reported Gabriel’s death to Fortune Insurance by telephone. Among the documents In summary, evidence is utterly wanting to establish that the insured suffered from an accidental thereafter submitted to Fortune Insurance were a copy of the death certificate issued by the death, the risk covered by the policy. Ministry of Health of the Republic of Iraq which stated that an autopsy report by the National Bureau of Investigation was conducted to the effect that due to advanced state of post-mortem DISPOSITIVE: decomposition, the cause of death of Gabriel could not be determined. WHEREFORE, the decision appealed from is AFFIRMED. No costs. SO ORDERED. Because of this development, Fortune Insurance ultimately denied the claim of Emerald Construction on the ground of prescription. Gabriel’s widow, Jacqueline Jimenez, went to the lower court. In her complaint against Emerald Construction and Fortune Insurance, she averred Malayan Insurance v Cruz-Arnaldo that her husband died of electrocution while in the performance of his work. GR L-67835 ; October 12, 1987 By: BACANI Fortune Insurance alleged that since both the death certificate issued by the Iraqi Ministry of Health and the autopsy report of the NBI failed to disclose the cause of death of Gabriel, it denied Topic: Notice and proof of loss liability under the policy. In addition, private respondent raised the defense of prescription, Petitioners: MALAYAN INSURANCE CO. INC. invoking section 384 of the Insurance Code. Respondents: GREGORIA CRUZ-ARNALDO, in her capacity as the INSURANCE COMMISSIONER, and CORONACION PINCA Ponente: Cruz, J. ISSUE: W/N Jacqueline Jimenez vda. De Gabriel’s claim against Fortune Insurance should be DOCTRINE: Insurance Code Section 65 denied on the ground of prescription? (YES) FACTS: On June 7, 1981, the Malayan issued a fire insurance policy to Coronacion Pinca on her HELD: property for the amount of 100k effective for 1 year starting from July 22, 1981. On October 15, The notice of death was given to Fortune Insurance, concededly, more than a year after the death Malayan allegedly cancelled the policy for non-payment of the premium and sent a notice to Pinca. of Gabriel. The prescription referred to was not the one-year period from denial of the claim within which to file an action against an insurer but obviously to the written notice of claim that had to be On December 24, payment of the premium for Pinca was received by Domingo Adora, agent of submitted within six months from the time of the accident. Malayan. On January 15, 1982, Adora remitted this payment to Malayan together with other payments. 3 days later, Pinca’s property was completely burned. The insurance policy expressly provides that to be compensable, the injury or death should be caused by violent accidental external and visible means. In attempting to prove the cause of On February 5, Pinca’s payment was returned by Malayan to Adora on the ground that her policy Gabriel’s death, all that Jacqueline could submit were a letter sent to her by her husband’s had been cancelled earlier, but Adora refused to accept it. In due time, Pinca made the requisite co-worker, stating that her husband died when he tried to haul water out of a tank while its demands for payment, which Malayan rejected. She then went to the Insurance Commission. It is submerged motor was still functioning and her sworn affidavit. The said affidavit were considered because she was ultimately sustained by the Commission that Malayan has come to the SC for hearsay under the law for it suffers from procedural infirmity as it was not even testified to or relief. identified by Jacqueline herself. ISSUE: Whether Malayan could rightfully cancel the policy Evidence, in fine, is utterly wanting to establish that the insured suffered from an accidental death, the risk covered by the policy. In an accident insurance, the insured's beneficiary has the burden of HELD: NO. proof in demonstrating that the cause of death is due to the covered peril. Once that fact is Malayan’s arguments that there was no payment of premium and that the policy had been established, the burden then shifts to the insurer to show any excepted peril that may have been cancelled before the occurrence of the loss are not acceptable. Its contention that the claim was stipulated by the parties. An "accident insurance" is not thus to be likened to an ordinary life allowed without proof of loss is also untenable. Malayan relies heavily on Section 77 of the insurance where the insured's death, regardless of the cause thereof, would normally be Insurance Code providing that: compensable. The latter is akin in property insurance to an "all risk" coverage where the insured, on the aspect of burden of proof, has merely to show the condition of the property insured when SEC. 77. An insurer is entitled to payment of the premium as soon as the thing is exposed the policy attaches and the fact of loss or damage during the period of the policy and where, to the peril insured against. Notwithstanding any agreement to the contrary, no policy or thereafter, the burden would be on the insurer to show any "excluded peril." When, however, the contract of insurance issued by an insurance company is valid and binding unless and insured risk is specified, like in the case before us, it lies with the claimant of the insurance until the premium thereof has been paid, except in the case of a life or an industrial life proceeds to initially prove that the loss is caused by the covered peril. policy whenever the grace period provision applies.
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This is not applicable because payment of the premium was in fact eventually made in this case. a. non-payment of premium; Notably, the premium invoice issued to Pinca at the time of the delivery of the policy was b. conviction of a crime arising out of acts increasing the hazard insured against; stamped "Payment Received" of the amount of Php 930.60 on "12-24-81" by Domingo Adora. c. discovery of fraud or material misrepresentation; This is important because it suggests an understanding between Malayan and the insured that d. discovery of willful or reckless acts or commissions increasing the hazard insured such payment could be made later, as agent Adora had assured Pinca. In any event, it is not against; denied that this payment was actually made by Pinca to Adora, who remitted the same to e. physical changes in the property insured which result in the property becoming Malayan. uninsurable; or f. a determination by the Commissioner that the continuation of the policy would violate It would seem from Malayan’s own theory, that the policy would have become effective only upon or would place the insurer in violation of this Code. payment, if accepted, and so would have been valid only from December 24, 1981, but only up to July 22, 1982, according to the original terms. In other words, the policy would have run for only 8 As for cancellation found in Section 65, a valid cancellation must, therefore, require concurrence of months although the premium paid was for a whole year. the following conditions:
It is not disputed that the premium was actually paid by Pinca to Adora on December 24, 1981, a. There must be prior notice of cancellation to the insured; who received it on behalf of Malayan, to which it was remitted on January 15, 1982. What is b. The notice must be based on the occurrence, after the effective date of the policy, of one questioned is the validity of Pinca’s payment and of Adora’s authority to receive it. or more of the grounds mentioned. c. The notice must be [a] in writing, [b] mailed, or delivered to the named insured, [c] at the Malayan’s acknowledgment of Adora as its agent defeats its contention that he was not address shown in the policy; authorized to receive the premium payment on its behalf. It is clearly provided in Section 306 of d. It must state [a] which of the grounds mentioned in Section 64 is relied upon and [b] that the Insurance Code that: upon written request of the insured, the insurer will furnish the facts on which the cancellation is based. "Any insurance company which delivers to an insurance agent or insurance broker a policy or contract of insurance shall be deemed to have authorized such agent or broker Malayan claims it cancelled the policy on October 15, 1981, for non-payment of premium. To to receive on its behalf payment of any premium which is due on such policy or contract support this assertion, it presented one of its employees who testified that "the original of the of insurance at the time of its issuance or delivery or which becomes due thereon." endorsement and credit memo were sent to the assured by mail through our mailing section." However, there is no proof that the notice, assuming it complied with the other requisites And it is a well-known principle under the law of agency that payment to an agent having authority mentioned above, was actually mailed to and received by Pinca. to receive or collect payment is equivalent to payment to the principal himself; and such payment is complete when the money delivered is into the agent’s hands and is a discharge of the On the other hand, there is the flat denial of Pinca, who says she never received the claimed indebtedness owing to the principal. cancellation and who, of course, did not have to prove such denial considering the strict language of Section 64 that no insurance policy shall be cancelled except upon prior notice, it behooved There is the petitioner’s argument, however, that Adora was not authorized to accept the premium Malayan to make sure that the cancellation was actually sent to and received by the insured. The payment because 6 months had elapsed since the issuance of the insurance policy and such presumption cited is unavailing against the positive duty enjoined by Section 64 upon Malayan and acceptance was prohibited by the policy itself. It is argued that this prohibition was binding upon the flat denial made by the private respondent that she had received notice of the claimed Pinca, who made the payment to Adora at her own risk as she was bound to first check his cancellation. authority to receive it. It stands to reason that if Pinca had really received the said notice, she would not have made Malayan is taking an inconsistent stand. While contending that acceptance of the premium payment on the original policy on December 24, 1981. Instead, she would have asked for a new payment was prohibited by the policy, it at the same time insists that the policy never came into insurance, effective on that date and until one year later, and so taken advantage of the extended force because the premium had not been paid. One surely cannot have his cake and eat it too. period. The Court finds that if she did pay on that date, it was because she honestly believed that the policy was still in effect and she was willing to make her payment retroact to July 22, 1981, its We do not share Malayan’s view that there was no existing insurance at the time of the loss stipulated commencement date. After all, agent Adora was very accommodating and had earlier sustained by Pinca because her policy never became effective for non-payment of premium. told her "to call him up any time" she was ready with her payment on the policy earlier issued. She Payment was in fact made, rendering the policy operative as of June 22, 1981, and removing it was obviously only reciprocating in kind when she paid her premium for the period beginning July from the provisions of Article 77. Thereafter, the policy could be cancelled on any of the 22, 1981, and not December 24, 1981. supervening grounds enumerated in Section 64 (except non-payment of premium) provided the cancellation was made in accordance therewith and with Section 65. Malayan suggests that Pinca knew the policy had already been cancelled and that when she paid the premium on December 24, 1981, her purpose was "to renew it." As this could not be done by SEC. 64. No policy of insurance other than life shall be cancelled by the insurer except upon prior the agent alone under the terms of the original policy, the renewal thereof did not legally bind it, notice thereof to the insured, and no notice of cancellation shall be effective unless it is based on which had not ratified it. the occurrence, after the effective date of the policy, of one or more of the following:
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Pinca meant to renew the policy if it had really been already cancelled, but not if it was still ○ Noda had no COA; effective. It was all conditional. As it has not been shown that there was a valid cancellation of the ○ Policy No. F-03724 was not in full force and effect at the time of the fire policy, there was consequently no need to renew it but to pay the premium thereon. Payment was because the premium on the policy was not paid; thus legally made on the original transaction and it could be, and was, validly received on behalf of ○ its liability under Policy No. F-03734 was limited to P15,472.50 in view of the the insurer by its agent Adora. Adora, incidentally, had not been informed of the cancellation either co-insurance; and saw no reason not to accept the said payment. ○ Noda failed to substantiate his claim as to the value of the goods reputedly destroyed by fire. DISPOSITIVE: WHEREFORE, the petition is DENIED. The decision of the Insurance Commission ● While the case was pending with the Insurance Commission, Zenith settled Noda’s fire dated April 10, 1981, and its Order of June 4, 1981, are AFFIRMED in full, with costs against the loss claim under Item 1 of Policy No. 03734 in the amount of P15,472.50. petitioner. This decision is immediately executory. SO ORDERED. ● Insurance Commissioner ruling: ○ In favor of Noda. ○ Noda’s claim under Policy 2, the payment of P15,472.50 to Noda fully Nodan v Cruz Arnaldo, Zenith Insurance discharged Zenith of its liability under the Policy 2 which covered the G.R. No L-57322 ; Date: June 22, 1987 furniture and other personal belongings By: CRUZ ● Noda filed an MR. According to Noda: ○ The Insurance Commission failed to take into account that there were 2 Topic: Notice and proof of loss: separate items under Policy 2 and that his P60,000 claim under Item 2, Petitioners: NORMAN NODA covering stocks in trade at Barreda Street, still remained unresolved despite Respondents: HONORABLE GREGORIA CRUZ-ARNALDO, in her capacity as Insurance payment to Noda of P15,472.50, Commissioner, and ZENITH INSURANCE CORPORATION ● Insurance Commission denied MR of Noda. Ponente: FERNAN, J.: ● Item number 2 of policy 2 was denied by the Insurance Commission on the ground DOCTRINE: While the insurer, and the Insurance Commissioner for that matter, have the right to reject that Noda allegedly relied merely on the report of Zenith's adjuster without bothering to proofs of loss if they are unsatisfactory, they may not set up for themselves an arbitrary standard of produce supporting documents indicating that he had made several purchases and satisfaction. Substantial compliance with the requirements will always be deemed sufficient. suffered immense losses by reason of the fire.
FACTS: ISSUE: Whether or not Insurance Commission erred in discharging Zenith from liability on the ● In 1977, Norman R. Noda obtained from Zenith Insurance Corporation, through its ground that there was insufficient proof from Noda? general agent, Alico General Insurance Agency, 2 fire insurance policies: ○ [1] No. F-03724 (Policy 1) HELD: Yes. ■ face value of P30,000 ● To prove the existence of the stocks in trade covered by Policy 2, Noda offered his ■ covering the goods and stocks in trade in his business testimony and that of his wife as well as documentary exhibits. establishment at the market site in Mangagoy, Bislig, Surigao del ● SC ruled that the said evidence preponderantly showed the presence of some P590,000 Sur worth of goods in his retail store during the fire of November 9, 1977. ■ period from March 3, 1977 to March 3, 1978 ● While the insurer, and the Insurance Commissioner for that matter, have the right to ○ [2] No. F-03734 (Policy 2) reject proofs of loss if they are unsatisfactory, they may not set up for themselves an ■ face value of P100,000 arbitrary standard of satisfaction. Substantial compliance with the requirements will ■ period from May 10, 1977 to May 10, 1978 always be deemed sufficient. ■ Item 1 for P40,000 ● In the case, Zenith introduced in evidence the final report on Policy 2 submitted by its ● on household furniture, fixtures, fittings and other own adjuster, Dela Merced Adjustment Corporation. personal effects, ● Commissioner however ignored such report, reasoning that with regard to Item 2 of ■ Item 2 for P60,000 Policy 2 the claim for loss of the stocks in trade was not successfully proven in view of ● on stocks in trade usual to petitioner's retail business Noda’s failure to present evidence; that the adjuster's report deserved scant situated in a two-storey building at 039 Barreda St., also consideration since the allegations therein were not substantiated, and that said report in Mangagoy, Bislig, Surigao del Sur, the ground floor of did not even make a recommendation for payment. (SC held that Commissioner’s which the Noda used as store and the 2nd floor as family reason is wrong) quarters. ● SC held that in the case, together with the formal demand for full indemnity, Noda ● While both policies were in force, fire destroyed Noda’s insured properties at the submitted his ITR for 1978, purchase invoices, certification from his suppliers as to his market site on September 5, 1977 and at Barreda St. on November 9, 1977. purchases, and other supporting papers. ● When Noda failed to obtain indemnity on his claims from Zenith, Noda filed a complaint ○ The report took into account the appraisals of the other adjusters and with the Insurance Commission praying that Zenith be ordered to pay him "the sum of concluded that the total loss sustained by Noda in his household effects and P130,000 representing the value of the [2] policies. stocks in trade reached P379,302.12. ● Zenith alleged that Insurance | SDUxMigallos |page | 36 ○ But after apportioning said amount among Noda’s 6 different in surers [the 1. Formal claim accompanied by a detailed inventory of the documents co-insurance being known to Zenith], the liability of Zenith was placed at submitted P60,592.10. 2. Certification from the appropriate government office indicating the ○ It therefore recommended that Zenith pay the Noda the amount of P60, date of the occurrence of the fire, the property involved, its 592.10 location and possible point of origin. ● Noda had every reason to expect that the Commissioner would give equal weight and 3. Proof of premium payment. credence to the adjuster's report as she had done with the other. 4. Three color photographs of the debris properly ● The said document was offered as evidence by Zenith itself and could very well be captioned/identified/dated and initiated by the claimant at the considered as an admission of its liability up to the amount recommended. back. ● It would have been pointless for Zenith to have introduced said report as its evidence if 5. Copies of purchase invoices. it did not agree with its findings and ultimate proposals. Being in the nature of an 6. In the absence of No. 5, suppliers’ certificates of sales and delivery. admission against interest, it is the best evidence which affords the greatest certainty of 7. Appraisal report, if any. the facts in dispute. 8. Where initial estimated loss is exceeding P20,000.00, submit ● Noda has satisfactorily established his claim for indemnity under Policy 2. estimate by at least 2 contractors/suppliers. 9. Others (to be specified) DISPOSITIVE: WHEREFORE, judgment is hereby rendered ordering respondent Zenith Insurance 9.1 Repairs cost of the affected items including quotation or Corporation to pay petitioner Norman R. Noda the sum of P60,592.10 with legal interest from the invoices in support thereof; filing of the complaint until full payment, but deducting therefrom the amount of P15,472.50 which 9.2 Complete lists of furniture, fixtures & fittings including date it had earlier paid to petitioner. and cost of acquisition, and; 9.3 Statement of salvage on burned items. 9.4 Statement of salvage of the affected stocks in trade - Trial court ruled in favor of Usiphil, CA affirmed. Finman General Assurance v CA GR NO. 138737 By: GORDON ISSUE: W/N Finman is liable
Topic: Notice and Proof of Loss HELD: YES Petitioners: Finman General Assurance Corp - Usiphil substantially complied with Policy Condition No. 13. Respondents: Court of Appeals and Usiphil Incorporated o It immediately notified Finman after the occurrence of the fire and Ponente: Kapunan submitted a Sworn Statement of Loss and Formal Claim and Proof of DOCTRINE: Loss. FACTS: - Indeed, as regards the submission of documents to prove loss, substantial, not strict - On Sept 15, 1981, Usiphil obtained a fire insurance policy from Finman (who was as urged by Finman, compliance with the requirements will always be deemed then doing business under the name of Summa Insurance) covering certain sufficient. properties, e.g., office, furniture, fixtures, shop machinery and other trade - Finman itself acknowledged its liability through its finance manager Maghirang equipment signing the document that the amount due to Usiphil was P842,683.40. - Sometime in 1982, Usiphil filed an insurance claim for the loss of the insured o Hence, even assuming that plaintiff-appellee indeed failed to submit properties due to fire. certain required documents as proof of loss per Section 13, such o As required by the adjuster H.H. Bayne, Usiphil submitted a Sworn violation was waived by the insurer Summa when it signed the Statement of Loss and Formal Claim signed by its manager. document. o A Proof of Loss signed by the Accounting Manager Pallalos and o Maghirang was clothed with an apparent authority since Ortega, Finman’s countersigned by the adjuster was also submitted. president, summoned him to reconcile the claims of Usiphil - Pallalos followed-up Usiphil’s claim with Finman’s president, Ortega. ▪ Hence, his actions bound Finman o They then signed a Statement/Agreement which indicated that the amount - Anent the payment of 24% interest per annum computed from May 3, 1985 until due to Usiphil was P842,673.40. fully paid, suffice it to say that the same is authorized by Sections 243 and 244 of - However, despite repeated demands, Finman refused to pay the insurance claim. the Insurance Code - Usiphil then filed a complaint for the recovery of the unpaid insurance claim. o 243: The amount of any loss or damage for which an insurer may be liable, - Finman contended that the claim could not be allowed since Usiphil failed to comply under any policy other than life insurance policy, shall be paid within thirty with Policy Condition No. 13 regarding the submission of certain documents to days after proof of loss is received by the insurer and ascertainment of the loss prove the loss. or damage is made either by agreement between the insured and the insurer o Said requirements were allegedly communicated to Usiphil in the two or by arbitration; but if such ascertainment is not had or made within sixty letters of H.H. Bayne which required: days after such receipt by the insurer of the proof of loss, then the loss or
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damage shall be paid within ninety days after such receipt. Refusal or failure to pay the loss or damage within the time prescribed herein will entitle the assured to collect interest on the proceeds of the policy for the duration of the Topic: Notice and proof of loss: Sections 90-94, Code; Sec. 384, Code delay at the rate of twice the ceiling prescribed by the Monetary Board, unless Petitioners: E. M. BACHRACH such failure or refusal to pay is based on the ground that the claim is Respondents: BRITISH AMERICAN ASSURANCE COMPANY fraudulent. Ponente: o 244: … duty of the Commissioner or the Court to make a finding as to whether DOCTRINE: the payment of the claim of the insured has been unreasonably denied or FACTS: withheld; and in the affirmative case, the insurance company shall be 1. E. M. Bachrach insured goods belonging to a general furniture store, such as iron and adjudged to pay damages which shall consist of attorney’s fees and other brass bedsteads, toilet tables, chairs, ice boxes, bureaus, washstands, mirrors, and expenses incurred by the insured person by reason of such unreasonable sea-grass furniture stored in the ground floor and first story of house and dwelling, with denial or withholding of payment plus interest of twice the ceiling prescribed an authorized agent of the British American Assurance Company, for the amount of by the Monetary Board of the amount of the claim due the insured … 10K. - Under Section 244, a prima facie evidence of unreasonable delay in payment of the 2. The policy also covered a "Calalac" automobile to the extent of P1,250. claim is created by the failure of the insurer to pay the claim within the time fixed in 3. British American Assurance Company denied the liability, alleging that: both Sections 243 and 244. ○ First. That the plaintiff maintained a paint and varnish shop in the said building where the goods which were insured were stored. DISPOSITIVE: WHEREFORE, the instant petition is hereby DENIED for lack of merit. The ○ Second. That the plaintiff transferred his interest in and to the property Decision, dated January 14, 1999, of the Court of Appeals in CA-G.R. CV No. 46721 and its covered by the policy to H. W. Peabody & Co. to secure certain indebtedness Resolution, dated May 13, 1999, are AFFIRMED IN TOTO. due and owing to said company, and also that the plaintiff had transferred his interest in certain of the goods covered by the said policy to one Macke, to NOTES secure certain obligations assumed by the said Macke for and on behalf of the Policy Condition 13. The insured shall give immediate written notice to the Company of any loss, insured. protect the property from further damage, forthwith separate the damaged and undamaged ■ That the sanction (approval) of the said defendant had not been personal property, put it in the best possible order, furnish a complete inventory of the destroyed, obtained by the plaintiff, as required by the said policy. damaged, and undamaged property, showing in detail quantities, costs, actual cash value and the ○ Third. That the plaintiff, on the 18th of April, 1908, and immediately amount of loss claimed; AND WITHIN SIXTY DAYS AFTER THE LOSS, UNLESS SUCH TIME IS preceding the outbreak of the alleged fire, wilfully placed a gasoline can EXTENDED IN WRITING BY THE COMPANY, THE INSURED SHALL RENDER TO THE containing 10 gallons of gasoline in the upper story of said building in close COMPANY A PROOF OF LOSS, signed and sworn to by the insured, stating the knowledge and proximity to a portion of said goods, wares, and merchandise, which can was belief of the insured as to the following: the time and origin of the loss, the interest of the insured so placed by the plaintiff as to permit the gasoline to run on the floor of said and of all others in the property, the actual cash value of each item thereof and the amount of loss second story, and after so placing said gasoline, he, the plaintiff, placed in thereto, all encumbrances thereon, all other contracts of insurance, whether valid or not, covering close proximity to said escaping gasoline a lighted lamp containing alcohol, any of said property, any changes in the title, use, occupation, location, possession or exposures of thereby greatly increasing the risk of fire. said property since the issuing of this policy by whom and for what purpose any buildings herein ○ Fourth. That the plaintiff made no proof of the loss within the time required described and the several parts thereof were occupied at the time of loss and whether or not it by condition five of said policy, nor did the insured file a statement with the then stood on leased ground, and shall furnish a copy of all the descriptions and schedules in all municipal or any other judge or court of the goods alleged to have been in said policies, and if required verified plans and specifications of any building, fixtures, or machinery building at the time of the alleged fire, nor of the goods saved, nor the loss destroyed or damaged. The insured, as often as may be reasonably required, shall exhibit to any suffered. person designated by the company all that remains of any property herein described, and submit to 4. The plaintiff, after denying nearly all of the facts set out in the special answer of the examination under oath by any person named by the Company, and subscribe the same; and, as defendant, alleged: often as may be reasonably required, shall produce for examination all books of account, bills, ○ First. That he had been acquitted in a criminal action against him, after a trial invoices, and other vouchers or certified copies thereof if originals be lost, at such reasonable time duly and regularly had, upon a charge of arson, based upon the same alleged and place as may be designated by the Company or its representative and shall permit extracts and facts set out in the answer of the defendant. copies thereof to be made. ○ Second. That he had made no proof of the loss set up in his complaint for the reason that immediately after he had, on the 20th of April, 1908, given the No claim under this policy shall be payable unless the terms of this condition have been complied defendant due notice in writing of said loss, the defendant, on the 21st of with. April, 1908, and thereafter on other occasions, had waived all right to require proof of said loss by denying all liability under the policy and by declaring Bachrach v British American Insurance said policy to be null and void. L-5715, 20 December 1910 5. The lower court found that the defendant was liable to the plaintiff and rendered a By: IGOT judgment against the defendant for the sum of P9,841.50, with interest for a period of one year at 6 per cent, making a total of P10,431.99, with costs. Insurance | SDUxMigallos |page | 38
By: LANZON ISSUE:Can Bachrach claim against the insurance company? Topic: Notice and proof of loss HELD: Petitioners: Yu Ban Chuan YES. The lower court’s decision is affirmed Respondents: Fieldmen’s Insurance Co., Inc., ET AL. 1. The keeping of inflammable oils on the premises, though prohibited by the policy, does Ponente: Reyes, J. not void it if such keeping is incidental to the business (furniture store kasi kaya DOCTRINE: kailangan ang paints, varnish and other oils). FACTS: Yu Ban Chuan is a chinese man doing business of wholesale dealing in general merchandise 2. It may be added that there was no provision in the policy prohibiting the keeping of and school supplies under the name of CMC Trading. His business was first situated in Nueva paints and varnishes upon the premises where the insured property was stored. Street, Manila. ○ If the company intended to rely upon a condition of that character, it ought to While at this place, the plaintiff insured against fire the stock merchandise contained therein with have been plainly expressed in the policy. Fieldmen's Insurance Co., for which the latter issued, on 14 December 1959, an “open" policy 3. It is claimed that the execution of a chattel mortgage on the insured property by limiting the insurer's liability to the amount of P200,000 for a period of one (1) year. BACHRACH to H. W. Peabody & Co. without permission of the insurance company violated what is known as the “alienation clause” -> forfeiture if the interest in the Plaintiff again insured against fire the same stock of merchandise covered by Fieldmen's policy property pass from the insured to another person. with defendant Paramount Surety & Insurance Co., being also issued, on 7 January 1960, an "open" ○ There is no provision in said policy prohibiting the plaintiff from placing a policy limiting liability thereunder to P140,000 for a one-year period. mortgage upon the property insured. ○ Admitting that such a provision was intended, it is held by the great weight On 14 January 1960, Fieldmen's agreed to transfer the coverage of its insurance policy to of authority that the interest in property insured does not pass by the mere plaintiff's store at 680 Muelle de Binondo, Manila, to which plaintiff transferred his business execution of a chattel mortgage and that while a chattel mortgage is a establishment on the 15th or 16th of January 1960; that on 21 January 1960 Paramount also conditional sale, there is no alienation within the meaning of the insurance agreed to have the coverage of its insurance policy transferred to the same new premises and law until the mortgage acquires a right to take possession by default under acknowledged the existence of its co-insurance with Fieldmen's; that on 23 January 1960 the terms of the mortgage. Fieldmen's also acknowledged its co-insurance with Paramount. ○ No such right is claimed to have accrued in the case at bar, and the alienation clause is therefore inapplicable. Less than a month after his transfer, Yu Buan’s business establishment in Binondo was totally 4. We cannot find that there is a preponderance of evidence showing that the plaintiff did destroyed by fire. actually set fire or cause fire to be set to the goods in question. ○ Plaintiff was acquitted of the crime of arson. Because of Yu Ban’s non-compliance or failure to submit the required documents and the 5. It does not positively appear of record that the automobile in question was not included adjusters’ demand in subsequent letters that he submit additional papers, the adjusters and Yu Ban in the other policies. engaged in an exchange of communications, until finally Fieldman’s Insurance rejected Yu Ban’s ○ It does appear that the automobile was saved and was considered as a part of claims, and denied liability under their respective policies, evidently upon their respective the salvaged. adjusters’ recommendations. ○ It is alleged that the salvage amounted to P4,000, including the automobile. ○ This amount (P4,000) was distributed among the different insurers and the The plaintiff commenced suit and the defendants answered the complaint with identical special amount of their responsibility was proportionately reduced. defenses; to wit: (1) insured's failure to prove the loss claimed; (2) false and fraudulent claim; and ○ The defendant and appellant in the present case made no objection at any (3) arson or causes not independent of the will of the insured; and counterclaims for the annulment time in the lower court to that distribution of the salvage. of the policies. After trial, the court below upheld the claim of the plaintiff, but refused to award ○ The claim is now made for the first time. damages or interest at more than the legal rate. Both parties appealed
In proving the value of his loss, the plaintiff relied upon a merchandise inventory as of 31 DISPOSITIVE: For all the foregoing reasons, we are of the opinion that the judgment of the lower December 1959, which he had allegedly submitted on 15 January 1960 to the Bureau of Internal court should be affirmed, and it is hereby ordered that judgment be entered against the defendant Revenue. The inventory reflected the total value of stocks at P328,202.67. The plaintiff claims and in fa purchases for the month of January 1960 in the amount of P34,505.08 and sales in the amount of vor of the plaintiff for the sum of P9,841.50, with interest at the rate of 6 per cent from the 13th of P12,000, thus the resulting balance of the stocks allegedly burned was estimated by the plaintiff to July, 1908, with costs. So ordered. be P350,707.75.
ISSUE: Whether Yu Ban is bound to provide the insurance company a proof of loss. Yu Ban Chan v Fieldmen’s Insurance, G.R. No. L-19851; June 29, 1965 HELD: NO.
Insurance | SDUxMigallos |page | 39 Shielding himself under Section 82 of the Insurance Act, the plaintiff asserts that in submitting Building, J. Luna, Manila", but there is no such room in the building mentioned nor any such his proof of loss he was “not bound to give such proof as would be necessary in a court of justice”. company registered with the Securities and Exchange Commission. The assertion is correct, but does not give him any justification for submitting false proofs. Their falsity is the best evidence of the fraudulent character and the unmeritoriousness of the Another fictitious invoice is that supposedly issued by Cosmopolitan Commercial Enterprises for plaintiff's claim. P37,800.00 for sales of "mechanical pencil plastic body,"fountain pens, and tape measures. This establishment is a single proprietorship belonging to Trinidad M. Lim; it is not engaged in the kind The fact of the filing of the inventory as of 15 January 1960 should be considered as true, since of merchandise purportedly sold, there is no evidence to the contrary. However, it was an error of the trial court to accept as true the actual existence at the burned premises of the stocks mentioned in the inventory. There are two (2) invoices supposedly issued by Nelina Trading on 2 October 1959 and 17 October 1959, respectively, for purchases aggregating P63,069.00. A check at the company's supposed Six (6) of the many copies of the invoices submitted by the plaintiff to the adjusters uncover a address failed to show the existence of the company, and the records of the Bureau of Commerce clear case of fraud and misrepresentation show that it went out of business on 13 April 1959.
Manager of one of the suppliers denied signing the purchase invoice in favor of the petitioner. The plaintiff, Yu Ban Chuan, adopted a uniform, too uniform, in fact, to be believed, explanation for There were dubious invoices issued by fictitious companies. There were invoices indicating that all the invoices: that he did not buy the merchandise at the companies' addresses but bought from merchandise were delivered to the new place of business even way before it transferred on 15 the agents who brought the goods to him; that the originals of the invoices were burned and that January 1960. he requested for true copies from the agents whom he met casually in the streets after the fire and these agents delivered the exhibits to him; but he did not remember, or know the names of these The plaintiff, Yu Ban Chuan, adopted a uniform, too uniform, in fact, to be believed, explanation for agents, nor did he know their whereabouts. all the invoices: that he did not buy the merchandise at the companies’ addresses but bought from the agents who brought the goods to him; that the originals of the invoices were burned and that It will be noted that the plaintiff transferred to his new business address at 680 Muelle de Binondo, he requested for true copies from the agents whom he met casually in the streets after the fire and Manila, on 15 or 16 January 1960, but he offered no satisfactory explanation on the purported these agents delivered the exhibits to him; but he did not remember, or know the names of these dates of the following exhibits: An invoice (Exh. "L-29") from Standard Manufacturing Company for agents, nor did he know their whereabouts. P6,750.00 is dated 10 September 1959, but the address of the purchaser, CMC Trading, is shown as already at 680 Muelle de Binondo; Another invoice from the same company, (Exh. "I-40") is In other words, he wants the court to believe also that these agents performed a vanishing act dated 14 December 1959, but the CMC Trading appears as at its new location; The same is true after each one of them had turned in the copy of each invoice to the plaintiff. with still five (5) more invoice, from the same company, all bearing dates before the transfer of the CMC Trading to 680 Muelle de Binondo. The plaintiff adheres to the inventory as the immaculate basis for the actual worth of stocks that were burned, on the ground that it was made from actual count, and in compliance with law. But this inventory is not binding on the defendants, since it was prepared without their intervention. DISPOSITIVE: For the foregoing reasons, the appealed judgment is hereby reversed, and the It is well to note that plaintiff had every reason to show that the value of his stock of goods appellee's action dismissed, with costs against the plaintiff-appellant Yu Ban Chuan. IN VIEW OF exceeded the amount of insurance that he carried. And the inventory, having been made prior to THE CONCLUSIONS REACHED, the plaintiff's appeal against the non-award of damages to him the fire, was no proof of the existence of these goods at the store when the fire occurred. must be necessarily dismissed.
True, there were merchandise that were actually destroyed by fire. But when fraud is conceived, what is true is subtly hidden by the schemer beneath proper and legal appearances, including the preparation of the inventory. Go Lu v Yorkshire Insurance G.R. No. L- 18090 ; Date: July 25, 1922 The filing of collection suits for unpaid purchases against Yu Ban Chuan, however valid these By: ABRIGO may be, do not legitimize his fraudulent claim against the insurers in the present case, nor show that the goods allegedly delivered were at the store when the fire occurred. Topic: Notice and proof of loss Petitioners: GO LU, plaintiff-appellee NOTES: Copies of invoices were said to be fake Respondents: YORKSHIRE INSURANCE COMPANY, defendant-appellant. Ponente: Johns, J. These five invoices alone inflate the supposed stocks by P248,370.00. The purchase invoice from DOCTRINE: In an action on a fire insurance policy to recover the value of bolt goods alleged to have Western Pacific Industrial Development Co. for powder puffs, ballpen filler, rubber band and been destroyed by fire, it devolves upon the plaintiff to prove the amount of his loss by a ballpen plastic body totalling P76,525.00 was denounced as fake by the former manager, Pablo S. preponderance of the evidence; Where the proof shows that all of plaintiff's bolt goods were Sison, and he denied that the signature appearing thereon is his. together in one corner of the building, and the plaintiff claims that there were sixty-six different boxes or bales of goods destroyed in the fire, it devolves upon him to prove by a preponderance of The invoice from Victoria Commercial Corporation for P33,800.00 is, likewise, dubious. Again, the the evidence that the sixty-six bales were consumed or destroyed by the fire, and he can only MJC Trading Enterprise's invoice for P37,176.00 indicates the company's address to be "308 T & C recover for the number of bales shown to have been destroyed Insurance | SDUxMigallos |page | 40 months a total of 137 cases of piece goods, during which time he sold 71 cases, and FACTS: hence, it is claimed that at the time of the fire, he had 66 cases, of which 16 only were 1. Go Lu was a merchant engaged in the purchase and sale of bolt goods in Manila, with his salvaged. place of business in a bodega, which he occupied in common with the Eastern Asia 2. It appears that the trial court attached much importance to the original entries in the Commercial Company. plaintiff's books. It may be that he did purchase 87 other cases in the months of April, 2. The building was constructed of stone with an upper framework of wood and an iron May, and June, and that form and out of the total, he sold only 71 cases, but the vital roof. question here is the number of cases of piece goods that were in the bodega at the time 3. Northern Assurance Company, for a premium of P250, issued its policy against loss of the fire. The books offered in evidence might tend to prove that, during the months of from fire for the period of one year to and in favor of Go Lu for P10,000 on his stock of April, May, and June, the plaintiff purchase 87 cases of goods, and that he had 50 cases piece goods in the bodega. in stock in the month of March, from and out of which he sold 71 cases, but the entries 4. On the same day and for a like premium, the Commercial Assurance Company, Limited, made in the books are not any evidence that the goods when purchased were issued its policy on the same property for the same period for P10,000. delivered to, and placed in, this particular bodega, or that when sold, they were taken 5. Yorkshire Insurance Company issued its policy on the same goods for another P10,000 from, and out of, that bodega. for the same period. 3. It appears that the fire alarm was promptly turned in, and that the fire department 6. Scottish Union and National Insurance Company also issued its policy to him on the reached the building within two or three minutes after the alarm, and that it guarded same goods for P10,000 for the period of one year. and remained in possession of the premises for about three days, and that at intervals 7. In the morning of June 24, 1919, while all of the policies were in force and effect, a fire during that period, it threw water on the remains of the building to prevent the fire from occurred in that portion of the building occupied by the Eastern Asia Commercial spreading. All witnesses, both for the plaintiff and the defendant, agree that, after the Company, resulting in a loss and damage to the plaintiff's goods, which were insured. fire, there were about 16 cases of piece goods found, 3 of which were in a burned 8. At the time of the fire, Go Lu claims that he was the owner of 66 cases of bolt goods in condition. the bodega, and that there was a total loss of 50 cases, and that the remaining 16 were 4. The stubborn fact remains that 16 cases were found, 3 of which were a total loss as to seriously damage. the value of the goods which they contained, but there is no evidence anywhere in the 9. After making proof of his claims and the failure to agree with the insurance companies record that, after the fire, anything was found or remained of the 50 cases, and after some negotiations as to the amount of his loss, the plaintiff commenced this action consumed by the fire, and, for such reason, there was not any physical evidence left of against the Yorkshire Insurance Company and the Scottish Union and National their destruction. Insurance Company, in which he seeks to recover from each of them the full amount of 5. The burden was upon the plaintiff to prove the amount of his loss by a preponderance their respective policies. of the evidence. It is admitted that 16 cases were found in the building after the fire, 3 of 10. Companies admit the issuance of the policies and they were in force and effect, but which were seriously damaged, and that, outside of the damage from smoke and water, contend that not more than 16 cases of plaintiff's goods were destroyed from which he the other 13 were intact. The record shows that all of the 66 cases were together in one received P6,888, the amount of their salvage value, and, in substance, admit their and the same portion of the building. There is no evidence which shows or tends to show liability for the difference between the actual value of the 16 cases and their salvage why all of the 50 cases in dispute were completely consumed by the fire, and no particle value. of any one of them was left remaining, and why the other 16 cases were found in the 11. They further allege that Go Yu submitted fraudulent proof of the amount of his loss, building after the fire and were not totally destroyed, and, yet, it is admitted that 16 and that, for such reason, he is not entitled to recover anything. cases were found in the building after the fire. It is common, ordinary, horse sense that, 12. They also contend that Go Yu violated the express terms of the policies in keeping his in a fire of that nature, something would have been left or found after the fire, which goods in the same building where hemp was stored. would tend to show the loss and destruction of portions of some of the other 50 cases, 13. Lower court rendered judgment against each defendant for P8,373.10, from which and destruction of portions of some of the other 50 cases, and that all evidence of the both appeal, assigning eight different errors, the first four of which go to the weight of existence of everyone of them would not be completely destroyed and consumed by the the evidence. Fifth, that the court should have found that plaintiff made a fraudulent fire. claim. Sixth, that the court erred in not finding that the policies were violated by the 6. In other words, it is not reasonable that the identity of the 50 cases would be storing of plaintiff's goods in the same building where hemp was stored. Seventh, that completely destroyed and wiped out of existence, and that the identity of the other 16 the policies should have been forfeited, because of the storage of gasoline in violation of should remain, 13 of which were intact. It stands to reason that, if the 50 cases were their terms, and, eighth, in denying the defendants' motion for a new trial. totally destroyed, the other 16 cases would also have been destroyed, and that there would not have been any evidence left of their identity. It is not reasonable that a fire ISSUE: Whether or not Go Lu submitted fraudulent proof of the amount of his loss, and that, for of that nature and volume would destroy every identity and particle of 50 cases of such reason, he is not entitled to recover anything. bolt, piece goods, and leave 16 other cases in the same part of the building partially injured, only three of which were a total loss as to their value. HELD: YES. 7. Although it is true that, where there is a sharp conflict in the evidence, the decision of 1. For the purpose of proving the number of cases of goods in the building, the plaintiff the trial court, which saw and heard the witnesses testify, should have some weight, yet, offered and introduced in evidence certain original books of entry which were kept in after careful thought, as we construe the records, the plaintiff has failed to prove his the Chinese language, together with a translation of the into Spanish, from which it case by a preponderance of the evidence, except as to the 16 cases, the loss of which is appears that in the month of March 1919, he had 50 cases in stock, and that during the admitted by the defendants. The fire was seen by a large number of people, and if it be a
Insurance | SDUxMigallos |page | 41
fact that the plaintiff had 66 cases of piece goods in the building at the time, it was his was fraudulent at the time it was made, and that, for such reason, he is not entitled to duty to have offered the evidence of some disinterested eyewitness as to the identity recover anything. of the pieces or particles remaining of the 50 cases, and of the physical facts, for the purpose of showing that the 50 cases were in the bodega at the time of the fire. DISPOSITIVE: The judgment of the lower court is reversed, and the complaint dismissed, with 8. Although the original entries in plaintiff's books would be evidence which should have costs in favor of the appellants. So ordered. some weight as to the amount of stock which he had in March, and which he purchased during the months of April, May, and June, and what he sold during that time, such entries are of but little, if any, value as to the amount of goods which he had in the Pacific Timber v CA bodega at the time of the fire. G.R. No ; Date 9. In any event, they are not sufficient to overcome the absence of any evidence of the By: ANDAL physical facts existing after the fire, and the rule of reason that the 50 cases of goods would not be consumed and completely wiped out of existence, without leaving some Topic: evidence of their destruction, which could be found among the remains and debris in the Petitioners: building after the fire. Respondents: 10. The plaintiff did not offer any evidence of the remains or physical conditions of the 50 Ponente: cases after the fire, or anything which was found or left from the effects of the fire, DOCTRINE: tending to show that the 50 cases were destroyed and consumed by the fire. His FACTS: evidence was confined and limited to proof of the number of cases which from time to March 19, 1963, the plaintiff secured temporary insurance from the defendant for its exportation time were in the bodega before the fire for the purpose of proving the number of cases of 1,250,000 board feet of Philippine Lauan and Apitong logs to be shipped from the Diapitan. Bay, which were in the building at the time of the fire, and upon that point there is a Quezon Province to Okinawa and Tokyo, Japan. material conflict in the evidence of his own witnesses, and their testimony is not clear or convincing. The defendant issued on said date Cover Note No. 1010, insuring the said cargo of the plaintiff 11. The defendants' evidence was largely confined to the physical conditions existing at the "Subject to the Terms and Conditions of the WORKMEN'S INSURANCE COMPANY, INC. printed time of the fire, and on that question all of their witnesses are clear and emphatic, that Marine Policy form as filed with and approved by the Office of the Insurance Commissioner no evidence remained tending to show the existence and loss of the 50 cases. 12. George B. Blake was foreman of the fire department, testified that he did not see more The regular marine cargo policies were issued by the defendant in favor of the plaintiff on April 2, than 16 cases, and that there was no evidence of any loss, destruction, or damage of any 1963. The total cargo insured under the two marine policies accordingly consisted of 1,395 logs, or more than 16 cases. the equivalent of 1,195.498 bd. Ft.: 13. Among other conditions of the policy, section 13 provides: Policy No. 53 H0 1032 was for 542 pieces of logs equivalent to 499,950 board feet. a. If the claim be in any respect fraudulent, or if any false declaration be made or Policy No. 53 H0 1033 was for 853 pieces of logs equivalent to 695,548 board feet used in support thereof, or if any fraudulent means or devices are used by the Insured or anyone acting on his behalf to obtain any benefit under this Policy; After the issuance of Cover Note No. 1010 (Exhibit A), but before the issuance of the two marine or, if the loss or damage be occasioned by the wilfull act, or with the policies Nos. 53 HO 1032 and 53 HO 1033, some of the logs intended to be exported were lost connivance of the Insured; or, if the Insured or anyone acting on his behalf during loading operations in the Diapitan Bay. The logs were to be loaded on the 'SS Woodlock' shall hinder or obstruct the Company in doing any of the acts referred to in which docked about 500 meters from the shoreline of the Diapitan Bay. March 29, 1963: While the Condition 12; or, if the claim be made and rejected and an action or suit be not logs were alongside the vessel, bad weather developed resulting in 75 pieces of logs which were commenced within three months after such rejection, or (in case of an rafted together co break loose from each other. 45 pieces of logs were salvaged, but 30 pieces Arbitration taking place in pursuance of the 18th Condition of this Policy) were verified to have been lost or washed away as a result of the accident. within three months after the Arbitrators or Umpire shall have made their award, al benefit under this Policy shall be forfeited. April 4, 1963: through a letter the plaintiff informed the defendant about the loss of 'appropriately 14. Under all of the surrounding facts and circumstances, it is the opinion of the writer that 32 pieces of log's during loading of the 'SS Woodlock.” The letter was received in the office of the this section should not be enforced, and that the plaintiff should have judgment for the defendant only on April 15, 1963. The plaintiff subsequently submitted a 'Claim Statement amount of his actual loss. Be that as it may, the majority of the court are of the opinion demanding payment of the loss under Policies Nos. 53 HO 1032 and 53 HO 1033, in the total that the above analysis of the facts not only establishes the amount of plaintiff's actual amount of P19,286.79 loss, but that it also is conclusive that plaintiff's claim was fraudulent, and that he knew it was fraudulent when he made it. His proof of claim was for 66 cases of piece July 17, 1963: The defendant requested the First Philippine Adjustment Corporation to inspect the goods of the actual loss to be P7,594.67. loss and assess the damage. 15. The validity of the clause above quoted is sustained by numerous uniform decisions, and is valid. The adjustment company submitted its 'Report on August 23, 1963.The adjuster found that 'the 16. Here, the facts existing at and after the fire are conclusive evidence that there were loss of 30 pieces of logs is not covered by Policies Nos. 53 HO 1032 and 1033 inasmuch as said only 16 cases of goods in the bodega at the time of the fire, and the majority of this policies covered the actual number of logs loaded on board the 'SS Woodlock' However, the loss of court are of the opinion that plaintiff's claim is not only fraudulent, but that he knew it 30 pieces of logs is within the 1,250,000 bd. ft. covered by Cover Note 1010 insured for Insurance | SDUxMigallos |page | 42 $70,000.00. The adjustment company submitted a computation of the defendant's probable The law requires this ground of delay to be promptly and specifically asserted when a claim on the liability on the loss sustained by the shipment, in the total amount of Pl1,042.04 insurance agreement is made.
January 13, 1964: The defendant wrote the plaintiff denying the latter's claim, on the ground that The undisputed facts show that instead of invoking the ground of delay in objecting to petitioner's the defendant's investigation revealed that the entire shipment of logs covered by the two marine claim of recovery on the cover note, it took steps clearly indicative that this particular ground for policies No. 53 110 1032 and 713 HO 1033 were received in good order at their point of objection to the claim was never in its mind. destination. The nature of this specific ground for resisting a claim places the insurer on duty to inquire when It was further stated that the said loss may not be considered as covered under Cover Note No. the loss took place, so that it could determine whether delay would be a valid ground upon which 1010 because the said Note had become 'null and void by virtue of the issuance of Marine Policy to object to a claim against it. Nos. 53 HO 1032 and 1033 Private respondent's reaction upon receipt of the notice of loss, which was on April 15, 1963, was June 26, 1964 : The defendant informed the Insurance Commissioner that, on advice of their to set in motion from July 1963 what would be necessary to determine the cause and extent of the attorneys, the claim of the plaintiff is being denied on the ground that the cover note is null and loss, with a view to the payment thereof on the insurance agreement. void for lack of valuable consideration From April 1963 to July, 1963, enough time was available for private respondent to determine if CA: Cover Note Null and Void for lack of valuable consideration plus respondent is released from petitioner was guilty of delay in communicating the loss to respondent company. liability under the cover note due to unreasonable delay in giving notice of loss In the proceedings that took place later in the Office of the Insurance Commissioner, private ISSUE: respondent should then have raised this ground of delay to avoid liability. – It did not 1.W/N the Cover Note is null and void for lack of consideration (YES 2.W/N there was a delay in giving notice of loss (NO) It must be because it did not find any delay, as this Court fails to find a real and substantial sign thereof But even on the assumption that there was delay, this Court is satisfied and convinced that Held: as expressly provided by law, waiver can successfully be raised against private respondent. Based 1. on Section 84 of the Insurance Act which provides: Petitioner contends that the Cover Note was issued with a consideration when, by express stipulation, the cover note is made subject to the terms and conditions of the marine policies, and Section 84.—Delay in the presentation to an insurer of notice or proof of loss is waived if the payment of premiums is one of the terms of the policies. From this undisputed fact, caused by any act of his or if he omits to take objection promptly and specifically upon that ground. We uphold petitioner's submission that the Cover Note was not without consideration for which the respondent court held the Cover Note as null and void, and denied recovery therefrom. DISPOSITIVE: ACCORDINGLY, the appealed decision is set aside and the decision of the Court of First Instance is The fact that no separate premium was paid on the Cover Note before the loss insured against reinstated in toto with the affirmance of this Court. No special pronouncement as to costs. occurred, does not militate against the validity of petitioner's contention, for no such premium could have been paid, since by the nature of the Cover Note, it did not contain, as all Cover Notes do not contain particulars of the shipment that would serve as basis for the computation of the BPI and FGU v Laingo premiums. GR 205206 ; March 16, 2016 · As a logical consequence, no separate premiums are intended or required to be paid on a By: BACANI Cover Note. This is a fact admitted by an official of respondent company, Juan Jose Camacho, in charge of issuing cover notes of the respondent company Topic: Notice and proof of loss · At any rate, it is not disputed that petitioner paid in full all the premiums as called for by Petitioners: BANK OF THE PHILIPPINE ISLANDS AND FGU INSURANCE CORPORATION the statement issued by private respondent after the issuance of the two regular marine insurance (PRESENTLY KNOWN AS BPI/MS INSURANCE CORPORATION) policies, thereby leaving no account unpaid by petitioner due on the insurance coverage, which Respondents: YOLANDA LAINGO must be deemed to include the Cover Note. Ponente: Carpio, J. · If the Note is to be treated as a separate policy instead of integrating it to the regular DOCTRINE: An insurance company has the duty to communicate with the beneficiary upon receipt of policies subsequently issued, the purpose and function of the Cover Note would be set at naught or notice of the death of the insured. This notification is how a good father of a family should have acted rendered meaningless, for it is in a real sense a contract, not a mere application for insurance which within the scope of its business dealings with its clients. BPI is expected not only to provide utmost is a mere offer. customer satisfaction in terms of its own products and services but also to give assurance that its business concerns with its partner entities are implemented accordingly. 2. The defense of delay as raised by private respondent in resisting the claim cannot be sustained. FACTS: On July 20, 1999, Rheozel Laingo, the son of respondent Yolanda, opened a "Platinum 2-in-1 Savings and Insurance" account with BPI in its Claveria, Davao City branch. The account is a Insurance | SDUxMigallos |page | 43 savings account where depositors are automatically covered by an insurance policy against As the main proponent of the 2-in-1 deposit account, BPI tied up with its affiliate, FGU Insurance, disability or death issued by FGU Insurance Corporation, now known as BPI/MS Insurance as its partner. Any customer interested to open a deposit account under this 2-in-1 product, after Corporation. BPI issued a Passbook to Rheozel. A Personal Accident Insurance Coverage submitting all the required documents to BPI and obtaining BPI's approval, will automatically be Certificate was also issued by FGU Insurance in the name of Rheozel with Yolanda as his named given insurance coverage. Thus, BPI acted as agent of FGU Insurance with respect to the beneficiary. insurance feature of its own marketed product.
On September 25, 2000, Rheozel died due to a vehicular accident. Since Rheozel came from a Under the law, an agent is one who binds himself to render some service or to do something in reputable and affluent family, the Daily Mirror headlined the story in its newspaper the following representation of another. In Doles v. Angeles, it was held that the basis of an agency is day. 2 days later, Yolanda instructed the family's personal secretary, Alice Torbanos to go to BPI representation. The question of whether an agency has been created is ordinarily a question which and inquire about the savings account of Rheozel. She wanted to use the money in the savings may be established in the same way as any other fact, either by direct or circumstantial evidence. account for Rheozel's burial and funeral expenses. The question is ultimately one of intention.
Alice went to BPI and talked to Jaime Ibe Rodriguez, its Branch Manager. Due to Yolanda’s credit In this case, since the Platinum 2-in-1 Savings and Insurance account was BPI's commercial standing and relationship with BPI, BPI accommodated her and was allowed to withdraw 995k product, offering the insurance coverage for free for every deposit account opened, Rheozel from the account of Rheozel. A certain Ms. Laura Cabico, an employee of BPI, went to Rheozel's directly communicated with BPI, the agent of FGU Insurance. BPI not only facilitated the wake at the Cosmopolitan Funeral Parlor to verify some information from Alice and brought with processing of the deposit account and the collection of necessary documents but also the her a number of documents for Yolanda to sign for the withdrawal of the 995k. necessary endorsement for the prompt approval of the insurance coverage without any other action on Rheozel's part. Rheozel did not interact with FGU Insurance directly and every More than 2 years later or on January 21, 2003, Rheozel's sister Rhealyn, while arranging transaction was coursed through BPI. Rheozel's personal things in his room at their residence, found the Personal Accident Insurance Coverage Certificate issued by FGU Insurance. Rhealyn immediately conveyed the information to BPI, as agent of FGU Insurance, had the primary responsibility to ensure that the 2-in-1 account be Yolanda. reasonably carried out with full disclosure to the parties concerned, particularly the beneficiaries. Thus, it was incumbent upon BPI to give proper notice of the existence of the insurance coverage Yolanda then sent 2 letters to BPI and FGU Insurance requesting them to process her claim as and the stipulation in the insurance contract for filing a claim to Yolanda, as Rheozel's beneficiary of Rheozel's insurance policy. On February 19, 2004, FGU Insurance sent a reply beneficiary, upon his death. denying her claim. FGU Insurance stated that she should have filed the claim within 3 calendar months from the death of Rheozel as required under Paragraph 15 which states: Articles 1884 and 1887 of the Civil Code state:
15. Written notice of claim shall be given to and filed at FGU Insurance Corporation within three Art. 1884. The agent is bound by his acceptance to carry out the agency and is liable for calendar months of death or disability. the damages which, through his non-performance, the principal may suffer.
The following day, Yolanda filed a Complaint for Specific Performance with Damages and He must also finish the business already begun on the death of the principal, should Attorney's Fees with the Davao City RTC against BPI and FGU Insurance. The RTC decided the delay entail any danger. case in favor of respondents and ruled that the prescriptive period of 90 days shall commence from the time of death of the insured and not from the knowledge of the beneficiary. Art. 1887. In the execution of the agency, the agent shall act in accordance with the instructions of the principal. Yolanda filed an appeal with the CA, which reversed the RTC. The CA ruled that Yolanda could not be expected to do an obligation which she did not know existed. The CA added that she was not a In default, thereof, he shall do all that a good father of a family would do, as required by party to the insurance contract entered into between Rheozel and petitioners. Thus, she could not the nature of the business. be bound by the 90-day stipulation. Petitioners filed an MR which was denied by the CA. Hence, the instant petition. The provision is clear that an agent is bound to carry out the agency. The relationship existing between principal and agent is a fiduciary one, demanding conditions of trust and confidence. It is ISSUE: Whether Yolanda is bound by the 90-day prescription period and thus not entitled to claim the duty of the agent to act in good faith for the advancement of the interests of the principal. the insurance benefits In this case, BPI had the obligation to carry out the agency by informing the beneficiary, who HELD: NO. appeared before BPI to withdraw funds of the insured who was BPI's depositor, not only of the BPI offered a deposit savings account with life and disability insurance coverage to its customers existence of the insurance contract but also the accompanying terms and conditions of the called the Platinum 2-in-1 Savings and Insurance account. This was a marketing strategy promoted insurance policy in order for the beneficiary to be able to properly and timely claim the benefit. by BPI in order to entice customers to invest their money with the added benefit of an insurance policy. Rheozel was one of those who availed of this account, which not only included banking Upon Rheozel's death, which was properly communicated to BPI by his mother, BPI, in turn, convenience but also the promise of compensation for loss or injury, to secure his family's future. should have fulfilled its duty, as agent of FGU Insurance, of advising Yolanda that there was an added benefit of insurance coverage in Rheozel's savings account. An insurance company has
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the duty to communicate with the beneficiary upon receipt of notice of the death of the insured. This notification is how a good father of a family should have acted within the scope of its business dealings with its clients. BPI is expected not only to provide utmost customer satisfaction in terms of its own products and services but also to give assurance that its business concerns with its partner entities are implemented accordingly.
The records show that BPI had ample opportunity to inform Yolanda, whether verbally or in writing, regarding the existence of the insurance policy attached to the deposit account. First, Rheozel's death was headlined in a daily major newspaper a day after his death. Second, not only was Yolanda, through her representative, able to inquire about Rheozel's deposit account with BPI 2 days after his death but she was also allowed by BPI's Claveria, Davao City branch to withdraw from the funds in order to help defray Rheozel's funeral and burial expenses. Lastly, an employee of BPI visited Rheozel's wake and submitted documents for her to sign in order to process the withdrawal request. These circumstances show that despite being given many opportunities to communicate with Laingo regarding the existence of the insurance contract, BPI neglected to carry out its duty.
Since BPI, as agent of FGU Insurance, fell short in notifying Yolanda of the existence of the insurance policy, she had no means to ascertain that she was entitled to the insurance claim. It would be unfair for Laingo to shoulder the burden of loss when BPI was remiss in its duty to properly notify her that she was a beneficiary.
Thus, as correctly decided by the CA, BPI and FGU Insurance shall bear the loss and must compensate Yolanda for the actual damages suffered by her family plus attorney's fees. Likewise, FGU Insurance has the obligation to pay the insurance proceeds of Rheozel's personal accident insurance coverage to Yolanda, as Rheozel's named beneficiary.
DISPOSITIVE: WHEREFORE, we DENY the petition. We AFFIRM the Decision dated 29 June 2012 and Resolution dated 11 December 2012 of the Court of Appeals in CA-G.R. CV No. 01575. SO ORDERED.