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De la Cruz v.

Capital Insurance
Facts:
Eduardo de la Cruz, employed as a mucker in the Itogon-Suyoc
Mines, Inc. in Baguio, was the holder of an accident insurance policy
by the Capital Insurance & Surety Co.
In celebration of the New Year, the Itogon-Suyoc Mines, Inc.
sponsored a boxing contest wherein Eduardo.
In the course of his bout with another person of the same height,
weight, and size, Eduardo slipped and was hit by his opponent on
the left part of the back of the head, causing Eduardo to fall, with
his head hitting the rope of the ring. He was brought to the Baguio
General Hospital the following day. The cause of death was
reported as hemorrhage, intracranial, left.
Simon de la Cruz, the father of the insured and the beneficiary
under the policy, filed a claim with the Capital Insurance for
payment of the indemnity under the insurance policy.
As the claim was denied, De la Cruz instituted the action in the CFI-
Pangasinan for specific performance.
Eduardo was insured "against death or disability caused by
accidental means".
Appellant insurer contends that while the death of the insured was
due to head injury, said injury was sustained because of his
voluntary participation in the contest. It is claimed that the
participation in the boxing contest was the "means" that produced
the injury which, in turn, caused the death of the insured. And, since
his inclusion in the boxing card was voluntary on the part of the
insured, he cannot be considered to have met his death by
"accidental means".

Issue: Whether the insurance company can be held liable for the death of
Eduardo.

Held: YES.
In the present case, while the participation of the insured in the
boxing contest is voluntary, the unintentional slipping of the
deceased, was accidental.
In boxing, death is not ordinarily anticipated to result. If it ever
does, the injury or death can only be accidental or produced by
some unforeseen happening or event as what occurred in this case.
Besides, the policy involved herein specifically excluded from its
coverage
o (e) Death or disablement consequent upon the Insured
engaging in football, hunting, pigsticking, steeplechasing,
polo-playing, racing of any kind, mountaineering, or
motorcycling.
Failure of the defendant insurance company to include death
resulting from a boxing match or other sports among the prohibitive
risks leads inevitably to the conclusion that it did not intend to limit
or exempt itself from liability for such death.

Ratio:
The terms "accident" and "accidental", as used in insurance
contracts, are construed by the courts in their ordinary and
common acceptation.
An accident is an event that takes place without one's foresight or
expectation an event that proceeds from an unknown cause, or is
an unusual effect of a known cause and, therefore, not expected.
What is required to be accidental is the means that caused or
brought the death and not the death itself.
US court decisions eliminate the fine distinction between the terms
"accidental" and "accidental means" and consider them as legally
synonymous.
The generally accepted rule is that, death or injury does not result
from accident or accidental means within the terms of an accident-
policy if it is the natural result of the insured's voluntary act,
unaccompanied by anything unforeseen except the death or injury.
There is no accident when a deliberate act is performed unless
some additional, unexpected, independent, and unforeseen
happening occurs which produces or brings about the result of
injury or death.
In other words, where the death or injury is not the natural or
probable result of the insured's voluntary act, or if something
unforeseen occurs in the doing of the act which produces the injury,
the resulting death is within the protection of policies insuring
against death or injury from accident.



Sun Life Insurance v. Court of Appeals 211 SCRA 554 (1990)
Facts:
Issue:
Held:
An accident is an event which happens without any human agency or, if
happening through human agency, an event which, under the
circumstances is unusual to and not expected by the person to whom it
happens. There is no accident when a deliberate act is performed unless
some additional, unexpected, independent and unforeseen happening
occurs which produces or brings about their injury or death. There is
nothing in the policy that relieves the insurer of the responsibility to pay the
indemnity agreed upon if the insured is shown to have contributed to his
own accident.


Ty v. First National Surety Assurance, 1 SCRA 1324 (1961)
Facts:
Plaintiff Ty, employed as operator mechanic foreman in the
Broadway Cotton Factory, having a monthly salary of P185.00,
insured himself in 18 local insurance companies, which issued to
him personal accident policies, upon payment of the premium of
P8.12 for each policy.
The companies include First National Surety, Associated Insurance,
United Insurance, Phil. Surety & Insurance, Reliance Surety &
Insurance, Far Eastern Surety, and Capital Insurance.
Plaintiff's beneficiary was his employer, Broadway Cotton Factory,
which paid the insurance premiums.
On December 24, 1953, a fire broke out which totally destroyed the
Broadway Cotton Factory.
Fighting his way out of the factory, plaintiff was injured on the left
hand by a heavy object. He was brought to the hospital for
treatment of his injuries.
Said physical injuries have caused temporary total disability of
plaintiff's left hand. Plaintiff then filed the corresponding notice of
accident and notice of claim with all of the insurance companies to
recover indemnity under Part II of the policy.
Defendants rejected plaintiff's claim for indemnity saying no
severance of amputation of the left hand, the disability suffered by
him was not covered by his policy.
Issue: Whether Ty may recover on the insurance policies issued to him for
the loss of his left hand.

Held: NO.
The Court cannot go beyond the clear and express conditions of the
insurance policies, all of which define partial disability as loss of
either hand by amputation through the bones of the wrist." There
was no such amputation in the case at bar.
The disability of plaintiff's hand was merely temporary, having been
caused by fracture of the index, the middle and the fourth fingers of
the left hand.
"Total disability" in relation to one's occupation means that the
condition of the insurance is such that common prudence requires
him to desist from transacting his business or renders him incapable
of working.
The agreement contained in the insurance policies is the law
between the parties.
As the terms of the policies are clear, express and specific that only
amputation of the left hand should be considered as a loss thereof,
an interpretation that would include the mere fracture or other
temporary disability not covered by the policies would certainly be
unwarranted.

Calanoc v. Court of Appeals, GR L-1851, 16 Dec. 1955
Facts:
Melencio Basilio was a watchman of the Manila Auto Supply. He
secured a life insurance policy from the Philippine American Life
Insurance Company in the amount of P2,000 to which was attached
a supplementary contract covering death by accident.
On January 25, 1951, he died of a gunshot wound on the occasion of
a robbery.
Virginia Calanoc, the widow, was paid the sum of P2,000, face value
of the policy, but when she demanded the payment of the
additional sum of P2,000 representing the value of the
supplemental policy, the company refused alleging that the
deceased died because he was murdered by a person who took part
in the commission of the robbery and while making an arrest as an
officer of the law which contingencies were expressly excluded in
the contract and have the effect of exempting the company from
liability.

Issue: Whether Virginia may demand payment under the supplemental
policy.

Held: YES.
The Court held that the circumstances in the present case do not
warrant the finding that the death of the unfortunate victim comes
within the purview of the exception clause of the supplementary
policy and, hence, do not exempt the company from liability.
The circumstance that he was a mere watchman and had no duty to
heed the call of Atty. Ojeda should not be taken as a capricious
desire on his part to expose his life to danger considering the fact
that the place he was in duty-bound to guard was only a block away.
In volunteering to extend help under the situation, he might have
thought, rightly or wrongly, that to know the truth was in the
interest of his employer it being a matter that affects the security of
the neighborhood. No doubt there was some risk coming to him in
pursuing that errand, but that risk always existed it being inherent
in the position he was holding. He cannot therefore be blamed
solely for doing what he believed was in keeping with his duty as a
watchman and as a citizen.
The Supreme Court ruled that there was no proof that it was
intentional, that the robber had aimed for Basilio, because there
was nothing on record that showed how the fatal shot was fired
while it was an accident on the part of Basilio. The house being
robbed was not the one he was guarding, and he had earlier refused
to go to the house without a policeman.
The circumstances of Basilios death cannot be taken as purely
intentional on the part of Basilio to expose himself to the danger.
There is no proof that his death was the result of intentionalkilling
because there is the possibility that the malefactor had fired the
shot merely to scare away the people around.
As a general rule "the parties may limit the coverage of the policy to
certain particular accidents and risks or causes of loss, and may
expressly except other risks or causes of loss therefrom.
However, the terms and phraseology of the exception clause must
be clearly expressed so as to be within the easy grasp and
understanding of the insured, for if the terms are doubtful or
obscure the same must of necessity be interpreted or resolved
against the one who has caused the obscurity.
The "terms in an insurance policy, which are ambiguous, equivacal,
or uncertain . . . are to be construed strictly and most strongly
against the insurer, and liberally in favor of the insured so as to
effect the dominant purpose of indemnity or payment to the
insured, especially where a forfeiture is involved", and the reason
for this rule is that he "insured usually has no voice in the selection
or arrangement of the words employed and that the language of
the contract is selected with great care and deliberation by experts
and legal advisers employed by, and acting exclusively in the
interest of, the insurance company."


Biagtan v. Insular Life 41 SCRA 58 (1972)
Facts:
Issue: Whether the wounds received by the insured at the hands of the
robbers nine in all, five of them mortal and four non-mortal were
inflicted intentionally.
Held: