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* SECOND DIVISION.
600
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601
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Mitsubishi Motors Philippines Salaried Employees Union (MMPSEU) vs.
Mitsubishi Motors Philippines Corporation
it must be shown that a party was unjustly enriched in the sense that the
term unjustly could mean illegally or unlawfully. A claim for unjust
enrichment fails when the person who will benefit has a valid claim to such
benefit. The CBA has provided for MMPC’s limited liability which extends
only up to the amount to be paid to the hospital and doctor by the
employees’ dependents, excluding those paid by other insurers.
Consequently, the covered employees will not receive more than what is due
them; neither is MMPC under any obligation to give more than what is due
under the CBA. Moreover, since the subject CBA provision is an insurance
contract, the rights and obligations of the parties must be determined in
accordance with the general principles of insurance law. Being in the nature
of a non-life insurance contract and essentially a contract of indemnity, the
CBA provision obligates MMPC to indemnify the covered employees’
medical expenses incurred by their dependents but only up to the extent of
the expenses actually incurred. This is consistent with the principle of
indemnity which proscribes the insured from recovering greater than the
loss. Indeed, to profit from a loss will lead to unjust enrichment and
therefore should not be countenanced. As aptly ruled by the CA, to grant the
claims of MMPSEU will permit possible abuse by employees.
ents, shall pay the hospitalization expenses incurred for the same.
The conflict arose when a portion of the hospitalization expenses of
the covered employees’ dependents were paid/shouldered by the
dependent’s own health insurance. While the company refused to
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1 Rollo, pp. 11-35.
2 CA Rollo, pp. 215-223; penned by Associate Justice Edgardo P. Cruz and
concurred in by Associate Justices Rosalinda Asuncion-Vicente and Sesinando E.
Villon.
3 Id., at p. 274.
4 Id., at pp. 30-38; penned by Voluntary Arbitrator Atty. Rodolfo M. Capocyan.
5 Annex “A” of MMPC’s Position Paper before the Voluntary Arbitrator, id., at
pp. 85-87.
603
604
When the CBA expired on July 31, 1999, the parties executed
another CBA7 effective August 1, 1999 to July 31, 2002
incorporating the same provisions on dependents’ hospitalization
insurance benefits but in the increased amount of P50,000.00. The
room and board expenses, as well as the doctor’s call fees, were also
increased to P375.00.
On separate occasions, three members of MMPSEU, namely,
Ernesto Calida (Calida), Hermie Juan Oabel (Oabel) and Jocelyn
Martin (Martin), filed claims for reimbursement of hospitalization
expenses of their dependents.
MMPC paid only a portion of their hospitalization insurance
claims, not the full amount. In the case of Calida, his wife, Lanie,
was confined at Sto. Tomas University Hospital from September 4 to
9, 1998 due to Thyroidectomy. The medical expenses incurred
totalled P29,967.10. Of this amount, P9,000.00 representing
professional fees was paid by MEDICard Philippines, Inc.
(MEDICard) which provides health
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6 Id., at pp. 86-87.
7 Annex “B,” id., at pp. 88-90.
605
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8 Annexes “C” and “D,” id., at pp. 91-94.
9 Annex “E,” id., at pp. 95-96.
10 P12,148.63 + P9,000.00 + P6,278.47.
11 Annex “F,” CA Rollo, pp. 97-100.
12 Id.
13 Annex “G,” id., at pp. 101-102.
14 Annex “H,” id., at pp. 103-107.
15 Annex “I,” id., at p. 108.
16 Annex “J,” id., at p. 109.
606
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17 Annex “A” of MMPSEU’s Position Paper before the Voluntary Arbitrator, id.,
at p. 152.
18 Annex “E,” id., at p. 156.
19 Annex “F,” id., at p. 157.
20 Annex “G,” id., at p. 158.
607
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21 See MMPSEU’s Position Paper and Reply to MMPC’s Position Paper before
the Voluntary Arbitrator, id., at pp. 144-151 and 139-142, respectively.
22 See MMPC’s Position Paper and Reply to MMPSEU’s Position Paper before
the Voluntary Arbitrator, id., at pp. 74-84 and 110-121, respectively.
23 Annex “L” of MMPC Petition for Review filed before the CA, id., at pp. 64-65.
608
January 8, 2002
Ms. Cecilia L. Paras
President
Mitsubishi Motors Phils.
[Salaried] Employees Union
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24 See October 24, 2000 letter of the Insurance Commission, Annex “M”, id., at p. 66.
25 See November 14, 2001 letter of MMPSEU, id., at pp. 182-185.
26 Annex “A” of MMPSEU Reply to MMPC’s Position Paper before the Voluntary
Arbitrator, id., at p. 143.
609
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27 Id., at pp. 30-38.
28 Id., at pp. 2-29.
29 Id., at pp. 170-181.
610
will unjustly enrich itself and profit from the monthly premiums paid
if full reimbursement is not made.
On March 31, 2006, the CA found merit in MMPC’s Petition. It
ruled that despite the lack of a provision which bars recovery in case
of payment by other insurers, the wordings of the subject provision
of the CBA showed that the parties intended to make MMPC liable
only for expenses actually incurred by an employee’s qualified
dependent. In particular, the provision stipulates that payment should
be made directly to the hospital and that the claim should be
supported by actual hospital and doctor’s bills. These mean that the
employees shall only be paid amounts not covered by other health
insurance and is more in keeping with the principle of indemnity in
insurance contracts. Besides, a contrary interpretation would “allow
unscrupulous employees to unduly profit from the x x x benefits”
and shall “open the floodgates to questionable claims x x x.”30
The dispositive portion of the CA Decision31 reads:
SO ORDERED.32
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30 Id., at p. 222.
31 Id., at pp. 215-223.
32 Id., at p. 223.
611
A.
THE COURT OF APPEALS SERIOUSLY ERRED WHEN IT REVERSED
THE DECISION DATED 03 [DECEMBER] 2002 OF THE VOLUNTARY
ARBITRATOR BELOW WHEN THE SAME WAS SUPPORTED BY
SUBSTANTIAL EVIDENCE, INCLUDING THE OPINION OF THE
INSURANCE COMMISSION THAT RECOVERY FROM BOTH THE
CBA AND SEPARATE HEALTH CARDS IS NOT PROHIBITED IN THE
ABSENCE OF ANY SPECIFIC PROVISION IN THE CBA.
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33 Id., at pp. 229-244.
34 59 P.3d 281 (Ariz. 2002).
35 CA Rollo, pp. 264-272.
36 Id., at p. 274.
612
B.
THE COURT OF APPEALS COMMITTED REVERSIBLE ERROR IN
OVERTURNING THE DECISION OF THE VOLUNTARY
ARBITRATOR WITHOUT EVEN GIVING ANY LEGAL OR
JUSTIFIABLE BASIS FOR SUCH REVERSAL.
C.
THE COURT OF APPEALS COMMITTED GRAVE ERROR IN
REFUSING TO CONSIDER OR EVEN MENTION ANYTHING ABOUT
THE AMERICAN AUTHORITIES CITED IN THE RECORDS THAT DO
NOT PROHIBIT, BUT IN FACT ALLOW, RECOVERY FROM TWO
SEPARATE HEALTH PLANS.
D.
THE COURT OF APPEALS GRAVELY ERRED IN GIVING MORE
IMPORTANCE TO A POSSIBLE, HENCE MERELY SPECULATIVE,
ABUSE BY EMPLOYEES OF THE BENEFITS IF DOUBLE
RECOVERY WERE ALLOWED INSTEAD OF THE REAL INJURY TO
THE EMPLOYEES WHO ARE PAYING FOR THE CBA
HOSPITALIZATION BENEFITS THROUGH MONTHLY SALARY
DEDUCTIONS BUT WHO MAY NOT BE ABLE TO AVAIL OF THE
SAME IF THEY OR THEIR DEPENDENTS HAVE OTHER HEALTH
INSURANCE.37
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37 Rollo, pp. 16-17.
613
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38 YOUNG, MELISSA. TORT REFORM AND THE COLLATERAL SOURCE RULE
<www.google.com; www.aaos.org/news/aaosnow/mar09/managing
4.asp.>, (visited March 1, 2013).
39 BLACK’S LAW DICTIONARY WITH PRONUNCIATIONS, (Sixth ed. 1990/Centennial
Edition).
40 Wills v. Foster, Jr., 229 Ill. 2d 393, 399 (Ill. 2008).
41 Id.
614
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42 883 A.2d 32, 37-38 (Del. 2005).
43 PERILLO, JOSEPH M., THE COLLATERAL SOURCE RULES IN CONTRACT CASES, San
Diego Law Review, 46 San Diego L. Rev. 705, 709-710 (Summer, 2009);
<www.lexis.com.>
615
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44 Wills v. Foster, Jr., supra note 40 at p. 397.
45 BLACK’S LAW DICTIONARY, (Fifth ed. 273, 1979).
616
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46 Asiatic Petroleum Co. v. De Pio, 46 Phil. 167, 170 (1924).
47 New Life Enterprises v. Court of Appeals, G.R. No. 94071, March 31, 1992,
207 SCRA 669, 676.
48 Supra note 34 at p. 290.
617
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49 CA Rollo, p. 87.
50 University of the Philippines v. Philab Industries, Inc., 482 Phil. 693, 709; 439
SCRA 467, 484 (2004).
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51 Car Cool Phils., Inc. v. Ushio Realty & Development Corporation, 515 Phil.
376, 384; 479 SCRA 404, 413 (2006).
618
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52 Fortune Insurance and Surety, Inc. v. Court of Appeals, 314 Phil. 184, 196; 244
SCRA 308, 316 (1995).
53 Philamcare Health Systems, Inc. v. Court of Appeals, 429 Phil. 82, 90; 379
SCRA 356, 363 (2002).
54 The principle of indemnity in property insurance is based on Section 18 of the
Insurance Code which provides that no contract or policy of insurance on property
shall be enforceable except for the benefit of some person having an insurable interest
in the property insured.
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