Beruflich Dokumente
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3. Insurance Law; Suicide and willful exposure to needless peril are in pari 2. Insurance; Tendency to eliminate distinction between the terms “accidental”
materia because they both signify a disregard for one’s life.- and “accidental means."-
It should be noted at the outset that suicide and willful exposure to needless
peril are in pari materia because they both signify a disregard for one’s life. The The tendency of court decisions in the United States in recent years is to
only difference is in degree, as suicide imports a positive act of ending such life eliminate the fine distinction between the terms “accidental” and “accidental
whereas the second act indicates a reckless risking of it that is almost suicidal in means” and to consider them as legally synonymous. (Travelers’ Protective
intent. Association vs. Stephens, 185 Ark. 660. 49 S.W. [3d] 364; Equitable Life
Assurance Company vs. Hemenover, 100 Colo. 231, 67 P. [2d] 80, 110 ALR
4. Insurance Law; Contract; There is nothing in the policy that relieves the 1270).
insurer of the responsibility to pay the indemnity agreed upon if the insured is
3. Insurance; Rule as to death or injury resulting from accident or accidental
shown to have contributed to his own accident.-
means.-
Lim was unquestionably negligent and that negligence cost him his own life. But
it should not prevent his widow from recovering from the insurance policy he
The generally accepted rule is that death or injury does not result from accident
obtained precisely against accident. There is nothing in the policy that relieves
or accidental means within the terms of an accident-policy if it is the natural
the insurer of the responsibility to pay the indemnity agreed upon if the insured
result of the insured’s voluntary act, unaccompanied by anything unforeseen
is shown to have contributed to his own accident. Indeed, most accidents are
except the death or injury. (Landress vs. Phoenix Mutual Life Insurance Co., 291
caused by negligence. There are only four exceptions expressly made in the
U.S. 291, 78 L. ed. 934, 54 S. Ct 461, 90 ALR 1382; Davis vs. Jefferson Standard
contract to relieve the insurer from liability, and none of these exceptions is
Life Ins. Co:, 73 F. [2d] 330, 96 ALR 599.) There is no accident when a
applicable in the case at bar.
deliberate act is performed unless some additional, unexpected, independent and
5. Insurance Law; Contract; As a rule, insurance contracts are supposed to be
unforeseen happening occurs which produces or brings about the result of injury
interpreted liberally in favor of the assured.-
or death. (Evans vs, Metropolitan Life Insurance Co., 26 Wash. [2d] 594, 174 P.
It bears noting that insurance contracts are as a rule supposed to be interpreted
[2d] 1961.) In other words, where the death or injury is not the natural or
liberally in favor of the assured. There is no reason to deviate from this rule,
probable result of the insured’s voluntary act, or if something unforeseen occurs
especially in view of the circumstances of this case as above analyzed.
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.
4. Defendant insurer set up the defense that the death of the insured
caused by his participation on a boxing contest was not accidental, and 4. Insurance; Application of the rule.-
therefore, not covered by insurance. After due hearing, the court
rendered decision in favor of the plaintiff which is the subject of the Where the participation of the insured in the boxing contest was voluntary, but
present appeal. Decide. the injury was sustained when he slid, giving occasion to the infliction by his
- Insurance company is liable against the insured. opponent of the blow that threw him to the ropes of the ring and without this
unfortunate incident, perhaps he could not have received that blow in the head
DE LA CRUZ VS. CAPITAL INS. & SURETY CO., INC. 17 SCRA 559 , JUNE and would not have died, and his death may be regarded as accidental, although
30, 1966 boxing is attended with some risks of external injuries.
1. Insurance; Meaning of “accident” and “accidental".- 5. Insurance; Liability for risks not enumerated in the contract.-
The terms “accident” and “accidental”, as used in insurance contracts, have not The failure of the defendant insurance company to include death resulting from a
acquired any technical meaning. They are construed by the courts in their boxing match or other sports among the prohibitive risks leads to the conclusion
ordinary and common acceptation. Thus, the terms have been taken to mean that it did not intend to limit or exempt itself from liability for such death. (Brams
that which happens by chance or fortuitously, without intention and design, and vs. New York Life Ins. Co., 299 Pa. 11, 148 Atl. 855; Jolley vs. Jefferson
which is unexpected, unusual and unforeseen. An accident is an event that takes Standard Life Ins. Co., 95 Wash. 683, 294 Pac. 585.)
place without one’s foresight or expectation—an event that proceeds from an
WEEK 4: Basically, an insurance contract is a contract of indemnity. In it, one undertakes
for a consideration to indemnify another against loss, damage or liability arising
TOPIC: The Business of Insurance, What may be Insured Against, Who may be from an unknown or contingent event.
an Insurer, Who may be Insured
4. Insurance Law; A marine insurance undertakes to indemnify the assured
NOTE: Sections 3, 4, 6, and 7 of the Insurance Code against marine losses, such as the losses incident to a marine adventure.-
1. Respondents contend that although Steamship Mutual is a P&I Club, it In particular, a marine insurance undertakes to indemnify the assured against
is not engaged in insurance business in the Philippines, it is merely an marine losses, such as the losses incident to a marine adventure. Section 99 of
association of vessel owners who have come together to provide the Insurance Code enumerates the coverage of marine insurance.
mutual protection against liabilities incidental to sip owners. Is the
contention tenable? 5. Insurance Law; Steamship Mutual as a P I Club is a mutual insurance
- No. association engaged in the marine insurance business.-
WHITE GOLD MARINE SERVICES, INC. VS. PIONEER INSURANCE AND A P I Club is “a form of insurance against third party liability, where the third
SURETY CORPORATION 464 SCRA 448 , JULY 28, 2005 party is anyone other than the P I Club and the members.” By definition then,
Steamship Mutual as a P I Club is a mutual insurance association engaged in the
1. Insurance Law; Section 2(2) of the Insurance Code enumerates what marine insurance business.
constitutes “doing an insurance business” or “transacting an insurance business”;
The fact that no profit is derived from the making of insurance contracts, 6. Insurance Law; To continue doing business here, Steamship Mutual or
agreements or transactions or that no separate or direct consideration is received through its agent Pioneer, must secure a license from the Insurance
therefor, shall not preclude the existence of an insurance business.- Commission.-
Section 2(2) of the Insurance Code enumerates what constitutes “doing an The records reveal Steamship Mutual is doing business in the country albeit
insurance business” or “transacting an insurance business.” These are: (a) without the requisite certificate of authority mandated by Section 187 of the
making or proposing to make, as insurer, any insurance contract; (b) making, or Insurance Code. It maintains a resident agent in the Philippines to solicit
proposing to make, as surety, any contract of suretyship as a vocation and not insurance and to collect payments in its behalf. We note that Steamship Mutual
as merely incidental to any other legitimate business or activity of the surety; (c) even renewed its P I Club cover until it was cancelled due to non-payment of the
doing any kind of business, including a reinsurance business, specifically calls. Thus, to continue doing business here, Steamship Mutual or through its
recognized as constituting the doing of an insurance business within the meaning agent Pioneer, must secure a license from the Insurance Commission. Since a
of this Code; (d) doing or proposing to do any business in substance equivalent contract of insurance involves public interest, regulation by the State is
to any of the foregoing in a manner designed to evade the provisions of this necessary. Thus, no insurer or insurance company is allowed to engage in the
Code. . . . The same provision also provides, the fact that no profit is derived insurance business without a license or a certificate of authority from the
from the making of insurance contracts, agreements or transactions, or that no Insurance Commission.
separate or direct consideration is received therefor, shall not preclude the
existence of an insurance business. 7. Insurance Law; Although Pioneer is already licensed as an insurance company,
it needs a separate license to act as insurance agent for Steamship Mutual.-
2. Insurance Law; Test to determine if a contract is an insurance contract or
not.- Pioneer is the resident agent of Steamship Mutual as evidenced by the certificate
of registration issued by the Insurance Commission. It has been licensed to do or
The test to determine if a contract is an insurance contract or not, depends on transact insurance business by virtue of the certificate of authority issued by the
the nature of the promise, the act required to be performed, and the exact same agency. However, a Certification from the Commission states that Pioneer
nature of the agreement in the light of the occurrence, contingency, or does not have a separate license to be an agent/broker of Steamship Mutual.
circumstances under which the performance becomes requisite. It is not by what Although Pioneer is already licensed as an insurance company, it needs a
it is called. separate license to act as insurance agent for Steamship Mutual.
SATURNINO VS. PHILIPPINE AMERICAN LIFE INS. CO. 7 SCRA 316 , NG GAN ZEE VS. ASIAN CRUSADER LIFE ASSURANCE CORP. 122 SCRA
FEBRUARY 28, 1963 461, MAY 30, 1983
1. Insurance; Non-medical insrance; Concealment, whether intentional or
unin-tentional; Ground for rescission.- 1. Mercantile Law; Insurance; Concealment; Misrepresentation; Fraudulent intent
In this jurisdiction, a con-cealment, whether intentional or unintentional, entitles of insured must be established to entitle insurer to rescind insurance contract;
the in-surer to rescind the contract of insurance, concealment being defined as Misrepresentation, as defense of insurer, is an affirmative defense which must be
“negligence to communicate that which a party knows and ought to proved.-
communicate” (Sections 24 and 26, Act No. 2427).
Sec. 27 of the Insurance Law, abovequoted, nevertheless requires that
fraudulent intent on the part of the insured be established to entitle the insurer
2. Same; Same; Concealment of previous operation.-
to rescind the contract. And as correctly observed by the lower court,
The con-cealment of the fact of the operation itself is fraudulent, as there could
“misrepresentation as a defense of the insurer to avoid liability is an ‘affirmative’
not have been any mistake about it, no matter what the ailment.
defense. The duty to establish such a defense by satisfactory and convincing
evidence rests upon the defendant. The evidence before the Court does not
clearly and satisfactorily establish that defense.”
4. What is a non-medical insurance?
1. Commercial Law; Insurance; Concealment of age, not a case of; Estoppel; 3. Id.; Id.-
Acceptance by insurance corporation of the premium and issuance of When Evaristo Feliciano, the applicant for insurance, signed the application in
corresponding certificate of insurance in favor of the insured was deemed a blank and authorized the soliciting agent and/or the medical examiner of the
Company to write the answers for him, he made them his own agents for that after the insured has died. The key phrase in the second paragraph of Section 48
pur-pose, and he was responsible for their acts in that connection. If they is “for a period of two years.”
falsified the answers for him, he could not evade the responsibility for the
falsification. He was not supposed to sign the application in blank. He knew that 2. Commercial Law; Insurance; Respondent company not barred from proving
the answers to the questions therein, contained would be "the basis of the that the policy is void ab initio by reason of the insured’s fraudulent concealment
pol-icy," and for that very reason he was required with his signature to vouch for or misrepresentation.-
the truth thereof. As noted by the Court of Appeals, to wit: “The policy was issued on November 6,
1973 and the insured died on April 26, 1975. The policy was thus in force for a
3. The defendant contended that Section 47 does not apply to the matters period of only one year and five months. Considering that the insured died
alleged in the special defense if in legal effect, defendant’s special before the two-year period had lapsed, respondent company is not, therefore,
defense is in a nature of an act to rescind a contract of insurance, and barred from proving that the policy is void ab initio by reason of the insured’s
then such right must be exercised prior to the commencement of an fraudulent concealment or misrepresentation. Moreover, respondent company
action… rescinded the contract of insurance and refunded the premiums paid on
- Section 47 does not apply in the present case. September 11, 1975, previous to the commencement of this action on November
27, 1975.”
TAN CHAY HENG VS. WEST COAST LIFE INSURANCE CO. 51 PHIL. 80 ,
NOVEMBER 21, 1927 3. Commercial Law; Insurance; Incontestability clause is a sufficient answer to
1. Nature Of Action To Rescind.— the various tactics employed by insurance companies to avoid liability.-
An action to rescind a contract is founded upon and presupposes the existence The insurer has two years from the date of issuance of the insurance contract or
of the contract which is sought to be rescinded. of its last reinstatement within which to contest the policy, whether or not, the
insured still lives within such period. After two years, the defenses of
2. When Section 47 Of Insurance Act Is Not A Bar.— concealment or misrepresentation, no matter how patent or well founded, no
A defense to an action to recover insurance that the policy was obtained through longer lie. Congress felt this was a sufficient answer to the various tactics
false representations, fraud and deceit is not in the nature of an action to rescind employed by insurance companies to avoid liability. The petitioners’
and, hence, is not barred by section 47 of the Insurance Act. interpretation would give rise to the incongruous situation where the
beneficiaries of an insured who dies right after taking out and paying for a life
3. Nature Of That Defense.— insurance policy, would be allowed to collect on the policy even if the insured
A defense of that nature is founded upon the theory that, through fraud in its fraudulently concealed material facts.
execution, the policy is void ab initio, and that no valid contract was ever made.
TAN VS. COURT OF APPEALS 174 SCRA 403 , JUNE 29, 1989
1. Commercial Law; Insurance; Essence of the phrase “Incontestability clause.”-
The so-called “incontestability clause” precludes the insurer from raising the
defenses of false representations or concealment of material facts insofar as
health and previous diseases are concerned if the insurance has been in force for
at least two years during the insured’s lifetime. The phrase “during the lifetime”
found in Section 48 simply means that the policy is no longer considered in force