DELA CRUZ vs CAPITAL

Lessons Applicable: Liability of Insurer for

Suicide and Accidental Death (Insurance)
Laws Applicable:

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 "against
death or disability caused by accidental
means"

January
1,
1957:
For
the
celebration of the New Year, the ItogonSuyoc Mines, Inc. sponsored a boxing
contest for general entertainment
wherein Eduardo, a non-professional
boxer participated

In the course of his bout with

another non-professional boxer 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. He
died due to hemorrhage, intracranial.

Simon de la Cruz, the father of the

insured
and
who
was
named
beneficiary under the policy, thereupon
filed
a
claim
with
the insurance company

The Capital Insurance and Surety

co., inc denied stating that the death
caused by his participation in a boxing
contest was not accidental

RTC: favored Simon

ISSUE: W/N the cause of death was
accident

Eduardo
slipped,
which
unintentional
The
terms
"accident"
"accidental"

HELD:YES.

was
and

as
used
in insurance contracts,
have
not
acquired any technical meaning and
are construed by the courts in their
ordinary and common acceptation
happen by
chance
or
fortuitously, without intention and
design, and which is unexpected,
unusual, and unforeseen
event that takes place
without one's foresight or expectation
event that proceeds from an
unknown cause, or is an unusual effect
of a known cause and, therefore, not
expected
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
while the participation of the
insured in the boxing contest is
voluntary, the injury was sustained
when he slid, giving occasion to the
infliction by his opponent of the blow
that threw him to the ropes of the ring
is not
The fact that boxing is attended
with some risks of external injuries
does not make any injuries received in
the course of the game not accidental
In boxing as in other equally
physically rigorous sports, such as
basketball or baseball, death is not
ordinarily anticipated to result. If,
therefore, 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
Furthermore, the policy involved
herein specifically excluded from its
coverage
(e) Death or disablement consequent
upon the Insured engaging in football,
hunting, pigsticking, steeplechasing,

polo-playing, racing of any kind,

mountaineering, or motorcycling.
Death
or
disablement
resulting from engagement in boxing
contests was not declared outside of
the
protection
of
the insurance contract

FINMAN
GENERAL
ASSURANCE
CORPORATION vs. THE HONORABLE
COURT OF APPEALS 213 SCRA 493,
September 2, 1992 NOCON, J.:

FACTS:
On October 22, 1986, deceased, Carlie
Surposa was insured with petitioner
Finman General Assurance Corporation
with his parents, spouses Julia and Carlos
Surposa,
and
brothers
Christopher,
Charles, Chester and Clifton, all surnamed,
Surposa, as beneficiaries. While said
insurance policy was in full force and
effect, the insured, Carlie Surposa, died on
October 18, 1988 as a result of a stab
wound inflicted by one of the three (3)
unidentified men. Private respondent and
the other beneficiaries of said insurance
policy filed a written notice of claim with
the petitioner insurance company which
denied said claim contending that murder
and assault are not within the scope of the
coverage of the insurance policy. Private
respondent filed a complaint with the
Insurance Commission which rendered a
favorable response for the respondent.
The appellate court ruled likewise.
Petitioner filed this petition alleging grave
abuse of discretion on the part of the
appellate court in applying the principle of
"expresso unius exclusio alterius" in a
personal accident insurance policy, since
death resulting from murder and/or
assault are impliedly excluded in said
insurance policy considering that the
cause of death of the insured was not
accidental but rather a deliberate and
intentional act of the assailant. Therefore,
said death was committed with deliberate
intent which, by the very nature of a

personal accident insurance policy, cannot

be indemnified.

ISSUE: Whether or not the insurer is liable

for the payment of the insurance
premiums

HELD:

Yes, the insurer is still liable. Contracts of

insurance are to be construed liberally in
favor of the insured and strictly against
the insurer. Thus ambiguity in the words of
an
insurance
contract
should
be
interpreted in favor of its beneficiary. The
terms "accident" and "accidental" as used
in insurance contracts have not acquired
any technical meaning, and are construed
by the courts in their ordinary and
common acceptation. Thus, the terms
have been taken to mean that which
happen by chance or fortuitously, without
intention and design, and which is
unexpected, unusual, and unforeseen.
Where the death or injury is not the
natural or probable result of the insured's
voluntary act, or if something unforeseen
occurs in the doing of the act which
produces the injury, the resulting death is
within the protection of the policies
insuring against death or injury from
accident. In the case at bar, it cannot be
pretended that Carlie Surposa died in the
course of an assault or murder as a result
of his voluntary act considering the very
nature of these crimes. Neither can it be
said that where was a capricious desire on
the part of the accused to expose his life
to danger considering that he was just
going home after attending a festival.
Furthermore,
the
personal
accident
insurance
policy
involved
herein
specifically enumerated only ten (10)
circumstances
wherein
no
liability
attaches to petitioner insurance company
for any injury, disability or loss suffered by
the insured as a result of any of the
stimulated causes. The principle of "
expresso unius exclusio alterius" the

mention of one thing implies the exclusion

of another thing is therefore applicable
in the instant case since murder and
assault, not having been expressly
included in the enumeration of the
circumstances that would negate liability
in said insurance policy cannot be
considered by implication to discharge the
petitioner insurance company from liability
for, any injury, disability or loss suffered
by the insured. Thus, the failure of the
petitioner insurance company to include
death resulting from murder or assault
among the prohibitedd risks leads
inevitably to the conclusion that it did not
intend to limit or exempt itself from
liability for such death.
GALLARDO VS MORALES
Lessons
Applicable: Definition
and
Coverage of Life Insurance (Insurance)
Laws
Applicable: Rule
39,
section
12, subdivision (k) of the Rules of Court
(old law)

FACTS:

CFI: Hermenegilda S. Morales to

pay P7,000 to a creditor Francisca
Gallardo

writ of execution was issued and

delivered to the Sheriff who garnished
and levied execution on the sum of
P7,000 out of the P30,000 due from the
CapitalInsurance &
Surety
Co. Inc.,
to Morales
as
beneficiary
whose
husband Luis
Morales
died
by assassination.

Morales asked the sheriff to quash

and lift said garnishment or levy on
execution invoking Rule 39, section 12,
subdivision (k) of the Rules of Court but
it was denied.

All
moneys, benefits, privileges,
or
annuities accruing or in any manner
growing out of any life insurance, if
the annual premiums paid do not
exceed five hundred pesos, and if they
exceed that sum a like exemption shall
exist which shall bear the same

proportion
to
the
moneys, benefits, privileges,
and
annuities so accruing or growing out of
such insurance that said five hundred
pesos
bears
to
the
whole annual premiums paid.
Morales appealed maintaining that
it was a life insurance for it insured her
husband for injuries and/or death as a
result of murder or assault or attempt
thereat

ISSUE:
W/N
the insurance is
life insurance and
not
accident insurance

a
an

HELD:
NO. order
appealed from
is
reversed, and the garnishment in dispute
hereby set aside and quashed

the annual premium was for P15

If it were an ordinary
life insurance policy,
taking
into
account that the insured, Luis G.
Morales, was 38 years of age and the
amount of the policy was for
P50,000.00 the annual premium would
have been around P1,206
the period for the policy was
stipulated
for
one
year,
and
considerations as to age, health,
occupation
and
other
personal
circumstances were not taken into
account in an accident insurance policy
Annex "1" of the opposition, shows
that the Capital Insurance and Surety
Company
Inc.
is
a
nonlife insurance company and that the
only authority granted to it to transact
business covers fire, marine, surety,
fidelity,
accident, motor
car,
and
miscellaneous insurance,
except
life insurance
Accident vs Life Insurance Policy
accident policy - merely
insures the person from injury and or
death resulting from murder, assault,
or an attempt thereat
Accident insurance

indemnity

or

casualty contract
life insurance policy - what
is insured is the life of the subject for a
definite number of years
life insurance
investment
contract
contract
by
which the insurer, for a stipulated sum,
engages to pay a certain amount of
money if another dies within the time
limited by the policy
contract
for insurance for
one
year
in
consideration of an advanced premium,
with the right of assured to continue it
from year to year upon payment of a
premium as stipulated
includes
accident insurance, since life is insured
under either contract
includes
all
policies of insurance in which payment
of insurance money is contingent upon
loss of life
"any life insurance"
applies
to
ordinary
life insurance contracts, as well as to
those
which,
although
intended
primarily to indemnify for risks arising
from accident, likewise, insure against
loss of life due, either to accidental
causes, or to the willful and criminal
act of another, which, as such, is not
strictly accidental in nature
statutes of this nature seek
to enable the head of the family to
secure his widow and children from
becoming
a
burden
upon
the
community
and,
accordingly,
should merit a liberal interpretation.

PINEDA vs CA
Lessons Applicable: Who Exercises Rights
of
Minor
Insured
or
Beneficiaries (Insurance)

Laws Applicable: Art. 225 Family Code

FACTS:

Prime Marine Services, Inc. (PMSI),

a crewing/manning outfit, procured
Group PoIicy
from Insular Life Assurance Co., Ltd. to
provide life insurance coverage to its
sea-based employees enrolled under
the plan.

February 17 1986: 6 employees of

the PMSI perished at sea when M/V
Nemos, a Greek cargo vessel, sunk
somewhere in El Jadida, Morocco

The beneficiaries asked President

and General Manager of PMSI, Capt.
Roberto Nuval and issued him special
powers of attorney authorizing him to
"follow up, ask, demand, collect and
receive" for their benefit indemnities.
It only verbally pertained to the
sinking of the fatal vessel

Unknown to them, however, the

PMSI, in its capacity as employer and
policyholder of the life insurance of its
deceased workers, filed with formal
claims with their special power of
attorney

Capt. Nuval, upon receipt of these

checks from the treasurer, who
happened to be his son-in-law,
endorsed and deposited them in his
account with the Commercial Bank of
Manila, now Boston Bank

Upon learning that they are entitled

to the claim, they sought to recover
from Insular Life but it denied on the
ground that they already delivered to
PMSI

The fact that there was a verbal

agreement
between
complainantsappellees and Capt. Nuval limiting the
authority of the latter to claiming
specified
deathbenefits cannot
prejudice the insurance company which
relied on the terms of the powers of
attorney which on their face do not
disclose such limitation

Section
180
of
the Insurance Code has been amended

by the Family Code 17 which grants the

father
and
mother
joint
legal
guardianship over the property of their
unemancipated common child without
the necessity of a court appointment;
however, when the market value of the
property or the annual income of the
child exceeds P50,000.00, the parent
concerned shall be required to put up a
bond in such amount as the court may
determine.

Insurance Commission:
favored
petitioners

The
Insular
Life
Assurance
Company appealed stating that

(a) had no jurisdiction over

the case considering that the claims
exceeded P100,000

(b) erred in holding that the

powers of attorney relied upon by
Insular Life were insufficient to convey
absolute authority to Capt. Nuval to
demand, receive and take delivery of
the insurance proceeds pertaining to
the petitioners

(c) erred in not giving credit

to the version of Insular Life that the
power of attorney supposed to have
been executed in favor of the Alarcons
was missing, and

(d) erred in holding that

Insular Life was liable for violating
Section 180 of theInsurance Code for
having released to the surviving
mothers
the insuranceproceeds
pertaining to the beneficiaries who
were still minors despite the failure of
the
former
to
obtain
a
court
authorization or to post a bond.

CA: eliminated the award to minor

beneficiaries Dina Ayo and Lucia Lontok
ISSUE: W/N the minor beneficiaries award
should
be
eliminated

HELD: YES. petition is GRANTED. CA

Reversed. Insurance Commission Reinstat
ed.

Being special powers of attorney,

they must be strictly construed.
Insular Life knew that a power of
attorney in favor of Capt. Nuval for the
collection and receipt of such proceeds
was a deviation from its practice with
respect to group policies.
Group Insurance
coverage terms for group
insurance are usually stated in a
master agreement or policy that is
issued
by
the
insurer
to
a
representative of the group or to an
administrator of the insurance program
employer
acts
as
a
functionary in the collection and
payment
of
premiums
and
in
performing related duties
falling within the ambit of
administration of a group policy is the
disbursement
of insurance payments
by the employer to the employees
employee is in the position
of a real party to the master policy
employees is the true
source of the benefits, which are a
form of additional compensation to
them
enables the employees to
carry
a
larger
amount
of insurance than they could otherwise,
and helps to attract and hold a
permanent class of employees
Even granting for the sake of
argument that the special powers of
attorney were in due form, Insular Life
was grossly negligent in delivering the
checks, drawn in favor of the
petitioners, to a party who is not the
agent mentioned in the special power
of attorney
Nor can we agree with the opinion
of the public respondent that since the
shares
of
the
minors
in
the insurance proceeds are less than
P50,000.00, then under Article 225 of
the Family Code their mothers could
receive such shares without need of
either court appointments as guardian
or the posting of a bond

Art. 225.
The father and the
mother shall jointly exercise legal
guardianship over the property of their
unemancipated common child without
the necessity of a court appointment.
In case of disagreement, the father's
decision shall prevail, unless there is
judicial order to the contrary.

Where the market value of the property or

the annual income of the child exceeds
P50,000, the parent concerned shall be
required to furnish a bond in such amount
as the court may determine, but not less
than ten per centum (10%) of the value of
the property or annual income, to
guarantee the performance of the
obligations
prescribed
for
general
guardians.
It is clear from the said Article that
regardless
of
the
value
of
the
unemancipated common child's property,
the father and mother ipso jure become
the legal guardian of the child's property.
However, if the market value of the
property or the annual income of the child
exceeds P50,000.00, a bond has to be
posted by the parents concerned to
guarantee the performance of the
obligations of a general guardian.

It must, however, be noted that the

second paragraph of Article 225 of the
Family Code speaks of the "market
value of the property or the annual
income of the child," which means,
therefore, the aggregate of the child's
property or annual income; if this
exceeds P50,000.00, a bond is
required.
There is no evidence that the share
of each of the minors in the proceeds
of the group policy in question is the
minor's
only
property.
Without
such evidence, it would not be safe to
conclude that, indeed, that is his only
property.