Professional Documents
Culture Documents
1.Perfection
-Written form-Section 232
SEC. 232. No policy, certificate or contract of insurance shall be issued or delivered within
the Philippines unless in the form previously approved by the Commissioner, and no
application form shall be used with, and no rider, clause, warranty or endorsement shall be
attached to, printed or stamped upon such policy, certificate or contract unless the form of
such application, rider, clause, warranty or endorsement has been approved by the
Commissioner.
Grace Period Sec. 233 a
SEC. 233. In the case of individual life or endowment insurance, the policy shall contain in
substance the following conditions:
(a) A provision that the policyholder is entitled to a grace period either of thirty (30) days or
of one (1) month within which the payment of any premium after the first may be made,
subject at the option of the insurer to an interest charge not in excess of six percent (6%) per
annum for the number of days of grace elapsing before the payment of the premium, during
which period of grace the policy shall continue in full force, but in case the policy becomes a
claim during the said period of grace before the overdue premium is paid, the amount of such
premium with interest may be deducted from the amount payable under the policy in
settlement;
Non-default Option Sec. 233 f and h
(f) A provision specifying the options to which the policyholder is entitled to in the event of
default in a premium payment after three (3) full annual premiums shall have been paid. Such
option shall consist of:
(1) A cash surrender value payable upon surrender of the policy which shall not be less
than the reserve on the policy, the basis of which shall be indicated, for the then current
policy year and any dividend additions thereto, reduced by a surrender charge which shall not
be more than one-fifth (1/5) of the entire reserve or two and one-half percent (2%) of the
amount insured and any dividend additions thereto; and
(2) One or more paid-up benefits on a plan or plans specified in the policy of such value as
may be purchased by the cash surrender value.
(h) A table showing in figures cash surrender values and paid-up options available under the
policy each year upon default in premium payments, during at least twenty (20) years of the
policy beginning with the year in which the values and options first become available,
together with a provision that in the event of the failure of the policyholder to elect one of the
said options within the time specified in the policy, one of said options shall automatically
take effect and no policyholder shall ever forfeit his right to same by reason of his failure to so
elect;
Reinstatement of lapsed policy-Section 233(j)
(j) A provision that the policyholder shall be entitled to have the policy reinstated at any
time within three (3) years from the date of default of premium payment unless the cash
surrender value has been duly paid, or the extension period has expired, upon production of
evidence of insurability satisfactory to the company and upon payment of all overdue
premiums and any indebtedness to the company upon said policy, with interest rate not
exceeding that which would have been applicable to said premiums and indebtedness in the
policy years prior to reinstatement.
Andres vs. Crown Life Insurance, G.R. No. L-10874 Petition for Review on Certiorari
Facts: 1. Andres and his wife applied for a policy for Php 5,000. Premiums were paid semiannually, and the amount of P165.15 was paid for two semesters. The third wasnt paid.
Crown Life advised Andres that the policy lapsed and reinstatement is in 60 days. The policy
was allowed to lapse.
2. Andres and his wife applied for reinstatement. He mailed 100. There was a balance of 65
pesos. The company assented on the condition that he pay the 65 pesos. Then he paid.
3. Andreswife passed away. The insurance company, however, didnt pay indemnity. They
enclosed a Death Claim Discharge but the Andres refused to sign. The company returned Php
165.
4. Andres filed a complaint in the CFI against Crown Life Insurance Company for the recovery
of the amount of P5,000, as the face value of a joint 20-year endowment insurance policy.
5. Andres presented his death claim as survivor-beneficiary but denied of payment.
6. The court rendered decision absolving the defendant from any liability on the ground that
the policy having lapsed, it was not reinstated at the time the plaintiffs wife died.
7. Not satisfied with the decision, plaintiff appealed to the Court of Appeals, but the appeal
was later certified to this Court.
Issue: Whether or not the lapsed policy has been validly and completely reinstated
Held: No.
The conditions set forth in the policy for reinstatement are the following:
(a) application shall be made within three years from the date of lapse;
(b) there should be a production of evidence of the good health of the insured:
(c) if the rate of premium depends upon the age of the Beneficiary, there should likewise be a
production of evidence of his or her good health;
(d) there should be presented such other evidence of insurability at the date of application for
reinstatement;
(e) there should be no change which has taken place in such good health and insurability
subsequent to the date of such application and before the policy is reinstated; and
(f) all overdue premiums and other indebtedness in respect of the policy, together
with interest at six per cent, compounded annually, should first be paid.
Andres did not comply with the last condition; for he only paid P100 before his wifes
death; and, despite the Companys reminders, he only remitted the balance 2 days after his
wife died. The company had the right to treat the contract as lapsed and refuse payment of
the policy.
2.Formal Acceptance-Stipulations
Perez vs. CA, G.R. No. 112329(2000) Petition for review on certiorari
Facts: 1. Primitivo B. Perez had been insured with the BF Lifeman Insurance Corporation for
P20,000.00. An agent of the insurance corporation, visited Perez in Quezon and convinced
him to apply for additional insurance coverage of P50,000.00.
2. Virginia A. Perez, Primitivos wife, paid P2,075.00 to the agent. The receipt issued indicated
the amount received was a "deposit." Unfortunately, the agent lost the application form
accomplished by Perez and he asked the latter to fill up another application form. The agent
sent the application for additional insurance of Perez to the Quezon office. Such was supposed
to forwarded to the Manila office.
3. Perez drowned. His application papers for the additional insurance of P50,000.00 were still
with the Quezon. It was only after some time that the papers were brought to Manila.
4. Without knowing that Perez died, BF Lifeman Insurance Corporation approved the
application and issued the corresponding policy for the P50,000.00. Virginia Perez went to
Manila to claim the benefits under the insurance policies of the deceased.
5. She was paid P40,000.00 under the first insurance policy for P20,000.00 but the insurance
company refused to pay the claim under the additional policy coverage of P50,000.00, the
proceeds of which amount to P150,000.00.
6. The insurance company maintained that the insurance for P50,000.00 had not been
perfected at the time of the death of Primitivo Perez. Consequently, the insurance company
refunded the amount paid.
7. BF Lifeman Insurance Corporation filed a complaint against Virginia Perez seeking the
rescission and declaration of nullity of the insurance contract in question.
8. Petitioner Virginia A. Perez, on the other hand, averred that the deceased had fulfilled all
his prestations under the contract and all the elements of a valid contract are present.
9. Trial court rendered a decision in favor of petitioner ordering respondent to pay 150,000
pesos.The Court of Appeals, however, reversed the decision of the trial court saying that the
insurance contract for P50,000.00 could not have been perfected since at the time that the
policy was issued, Primitivo was already dead.
10. Petitioners motion for reconsideration having been denied by respondent court, the
instant petition for certiorari was filed on the ground that there was a consummated contract
of insurance between the deceased and BF Lifeman Insurance Corporation.
Issue: WON the widow can receive the proceeds of the 2nd insurance policy
Held: No.
Perezs application was subject to the acceptance of private respondent BF Lifeman Insurance
Corporation. The perfection of the contract of insurance between the deceased and
respondent corporation was further conditioned with the following requisites stated in the
application form:
"there shall be no contract of insurance unless and until a policy is issued on this
application and that the said policy shall not take effect until the premium has
been paid and the policy delivered to and accepted by me/us in person while I/We,
am/are in good health."
BF Lifeman didnt give its assent when it merely received the application form and all the
requisite supporting papers of the applicant. This happens only when it gives a policy.
As stated above, a contract of insurance, like other contracts, must be assented to by both
parties either in person or by their agents. So long as an application for insurance has not
been either accepted or rejected, it is merely an offer or proposal to make a contract. The
contract, to be binding from the date of application, must have been a completed contract.
3.Premium payments(Sections 77-78,64,66,306)
SEC. 77. An insurer is entitled to payment of the premium as soon as the thing insured is
exposed to the peril insured against. Notwithstanding any agreement to the contrary, no
policy or contract of insurance issued by an insurance company is valid and binding unless
and 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, or whenever under the broker and agency
agreements with duly licensed intermediaries, a ninety (90)-day credit extension is given. No
credit extension to a duly licensed intermediary should exceed ninety (90) days from date of
issuance of the policy.
SEC. 78. Employees of the Republic of the Philippines, including its political subdivisions
and instrumentalities, and government-owned or -controlled corporations, may pay their
insurance premiums and loan obligations through salary deduction: Provided, That the
treasurer, cashier, paymaster or official of the entity employing the government employee is
authorized, notwithstanding the provisions of any existing law, rules and regulations to the
contrary, to make deductions from the salary, wage or income of the latter pursuant to the
agreement between the insurer and the government employee and to remit such deductions
to the insurer concerned, and collect such reasonable fee for its services.
SEC. 64. No policy of insurance other than life shall be cancelled by the insurer except upon
prior notice thereof to the insured, and no notice of cancellation shall be effective unless it is
based on the occurrence, after the effective date of the policy, of one or more of the
following:
(a) Nonpayment of premium;
(b) Conviction of a crime arising out of acts increasing the hazard insured against;
(c) Discovery of fraud or material misrepresentation;
(d) Discovery of willful or reckless acts or omissions increasing the hazard insured against;
(e) Physical changes in the property insured which result in the property becoming
uninsurable;
(f) Discovery of other insurance coverage that makes the total insurance in excess of the
value of the property insured; or
(g) A determination by the Commissioner that the continuation of the policy would violate or
would place the insurer in violation of this Code.
SEC. 66. In case of insurance other than life, unless the insurer at least forty-five (45) days
in advance of the end of the policy period mails or delivers to the named insured at the
address shown in the policy notice of its intention not to renew the policy or to condition its
renewal upon reduction of limits or elimination of coverages, the named insured shall be
entitled to renew the policy upon payment of the premium due on the effective date of the
renewal. Any policy written for a term of less than one (1) year shall be considered as if
written for a term of one (1) year. Any policy written for a term longer than one (1) year or
any policy with no fixed expiration date shall be considered as if written for successive policy
periods or terms of one (1) year.
SEC. 306. In addition to any other penalty provided by law, the Commissioner may, upon
the willful failure of any person within a holding company system to comply with this title or
any regulation or order promulgated hereunder:
(a) Proceed under Title 14 or Title 15, Chapter III of this Code with respect to insurer within
the holding company system; or
(b) Revoke or refuse to renew the authority to do business in this country of an insurer within
the holding company system or refuse to issue such authority to any other insurer in the
system; or
(c) Direct that, in addition to any other penalty provided by law, such person forfeit to the
people of this country a sum not less than Five thousand pesos (P5,000.00) for a first violation
and Twenty-five thousand pesos (P25,000.00) for any subsequent violation. An additional sum
not less than Twenty-five thousand pesos (P25,000.00) shall be imposed for each month
during which any such violation shall continue.
Tibay et al., vs. CA, G.R. No. 119655
Facts: 1. Violeta Tibay (and Nicolas Roralso) obtained a fire insurance policy for their 2-storey
from Fortune Life Insurance Co. The said policy covers the period from January 23, 1987 until
January 23, 1988 or one year for P600,000 and at the agreed premium of P2,983.50. On
January 23,1987 petitioner made a partial payment of the premium with P600.
2 March 1987, the said building was burned to the ground. It was only two days after the fire
insurance that Violeta advanced the full payment of the policy premium which was accepted
by the insurer. On this same day, petitioner likewise filed the claim that was then referred to
the insurer's adjuster. Investigation of the cause of fire commenced and the petitioner
submitted the required proof of loss.
3. Despite that, the Fortune Insurance refused to pay the insurance claim saying it as not
liable due to the non-payment by petitioner of the full amount of the premium as stated in the
policy.
4. The petitioner then brought the matter to the Insurance Commission but nothing good
came out. Hence this case filed.
5. Trial court rule in favor of the petitioner. CA reversed the lower court's decision and held
that Fortune is not liable but ordered it to return the premium paid with interest to the
petitioner. Hence, this petition for review.
Issue: W/N the partial payment of the premium rendered the insurance policy ineffective?
Held: YES.
1.
Insurance is a contract whereby one undertakes for a consideration to indemnify
another against loss, damage or liability arising from an unknown or contingent event. The
consideration is the premium, which must be paid at the time, way and manner as stated in
the policy, and if not so paid as in this case, the policy is therefore forfeited by its own terms.
In this case, the policy taken out by the petitioner provides for payment of
premium in full. Since the petitioner only made partial payment with the remaining
balance paid only after the fire or peril insured against has occurred, the insurance
contract therefore did not take effect barring the insured from claiming or
collecting from the loss of her building.
2.
Under Section 77 of the Insurance Code (Philippine), it provides therein that "An insurer
is entitled to payment of the premium as soon as the thing insured is exposed to the peril
insured against. Notwithstanding any agreement to the contrary, no policy or contract of
insurance issued by an insurance company is valid and binding unless and 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." Herein case, the controversy is on the payment of the
premium. It cannot be disputed that premium is the elixir vitae of the insurance
business because the insurer is required by law to maintain a reserve fund to meet
its contingent obligations to the public. Due to this, it is imperative that the
premium is paid fully and promptly. To allow the possibility of paying the premium
even after the peril has ensued will surely undermine the foundation of the
insurance business.
Issues:
Whether there was a valid payment of premium, considering that respondents check was
cashed after the occurrence of the fire
Held: Yes. No. Yes, but not all damages valid. Petition granted. Damages modified.
Ratio:
Yes. The renewal certificate issued to respondent contained the acknowledgment that
premium had been paid.
In the instant case, the best evidence of such authority is the fact that petitioner
accepted the check and issued the official receipt for the payment. It is, as well,
bound by its agents acknowledgment of receipt of payment.
Section 78 of the Insurance Code explicitly provides:
An acknowledgment in a policy or contract of insurance of the receipt of premium is
conclusive evidence of its payment, so far as to make the policy binding, notwithstanding any
stipulation therein that it shall not be binding until the premium is actually paid.
At the very least, both parties should be deemed in estoppel to question the arrangement
they have voluntarily accepted.
Moreover, as correctly observed by the appellate court, where the risk is entire and the
contract is indivisible, the insured is not entitled to a refund of the premiums paid if the
insurer was exposed to the risk insured for any period, however brief or momentary. The
obligation to pay premiums when due is ordinarily as indivisible obligation to pay the entire
premium.
4.Effect of Non-Payment
Philippine Phoenix Surety vs. Woodworks, Inc., G.R. No. L-22684(1967)
Facts: 1. Woodworks, Inc. was issued a fire policy for its building machinery and equipment by
Philippine Phoenix Surety & Insurance Co. for P500K covering July 21, 1960 to July 21, 1961.
Woodworks did not pay the premium totaling to P10,593.36.
2. Woodworks notified Philippine Phoenix the cancellation of the Policy so Philippine Phoenix
credited P3,110.25 for the unexpired period of 94 days and demanded in writing the payment
of P7,483
3. Woodworks refused stating that it need not pay premium "because the Insurer did not
stand liable for any indemnity during the period the premiums were not paid."
4. Philippine Phoenix filed with the CFI to recover its earned premium of P7,483. Woodworks
contends that to pay the premium after the issuance of the policy put an end to the insurance
contract and rendered the policy unenforceable
5. CFI: favored Philippine Phoenix
ISSUE: W/N there was a valid insurance contract despite no premium payment was paid
HELD: NO. Reversed. Policy provides for pre-payment of premium. To constitute an extension
of credit there must be a clear and express agreement therefor and there must be acceptance
of the extension.
Since the premium had not been paid, the policy must be deemed to have lapsed. Failure to
make a payment of a premium or assessment at the time provided for, the policy shall
become void or forfeited, or the obligation of the insurer shall cease, or words to like effect,
because the contract so prescribes and because such a stipulation is a material and essential
part of the contract. This is true, for instance, in the case of life, health and accident, fire and
hail insurance policies
Explicit in the Policy itself is plaintiff's agreement to indemnify defendant for loss
by fire only "after payment of premium" Compliance by the insured with the terms
of the contract is a condition precedent to the right of recovery.
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 insured from allowing a policy to
elapse through a failure to make premium payments.
have agreed to the payment in installments of the premium and partial payment
has been made at the time of loss.
Tuscany case has provided a fourth exception to Section 77, namely, that the insurer
may grant credit extension for the payment of the premium. This simply means that if the
insurer has granted the insured a credit term for the payment of the premium and loss occurs
before the expiration of the term, recovery on the policy should be allowed even though the
premium is paid after the loss but within the credit term.
Finally in the instant case, it would be unjust and inequitable if recovery on the policy
would not be permitted against UCPB, which had consistently granted a 60- to 90day credit term for the payment of premiums despite its full awareness of Section
77. Estoppel bars it from taking refuge under said Section, since Respondent relied in good
faith on such practice. Estoppel then is the fifth exception to Section 77.
ISSUES
1. WON a contract of insurance has been duly perfected between petitioner and respondent
2. WON the dishonored check constituted payment
HELD: 1. YES. Tender of draft or check in order to effect payment that would extinguish the
debtor's liability should be actually cashed. If the delivery of the check of Plastic Era to Capital
Insurance were to be viewed in the light of the foregoing, no payment of the premium had
been effected. Significantly, Capital Insurance accepted the promise of Plastic Era to
pay the insurance premium within 30 days from the effective date of policy. By so
doing, it has implicitly agreed to modify the tenor of the insurance policy and in
effect, waived the provision therein that it would only pay for the loss or damage in
case the same occurs after the payment of the premium. Considering that the
insurance policy is silent as to the mode of payment, Capital Insurance is deemed to have
accepted the promissory note in payment of the premium. This rendered the policy
immediately operative on the date it was delivered.
2. YES. Although the check was due for payment on January 16, 1961 and Plastic Era had
sufficient funds to cover it as of January 19, 1961, Capital Insurance decided to hold the same
for thirty-five (35) days before presenting it for payment. Having held the check for such
an unreasonable period of time, Capital Insurance was estopped from claiming a
forfeiture of its policy for non-payment even if the check had been dishonored
later. Where the check is held for an unreasonable time before presenting it for payment, the
insurer may be held estopped from claiming a forfeiture if the check is dishonored.
6. The trial court rendered judgment in favor of plaintiff Valenzuela. The Court of Appeals
affirmed the judgment only against the insurance corporation and absolved the shipping
entity from liability. The court held that there was a stipulation in the charter party exempted
the ship owner from liability in case of loss.
In the SC petition, petitioner argues that it should have been freed from any liability to
Hardwood. It faults the appellate court (a) for having disregarded Section 77 of the insurance
Code and (b) for holding Victorio Chua to have been an authorized representative of the
insurer.
Issue: WON Mr. Chua acted as an agent of the surety company or of the insured when he
received the check for insurance premiums.
Held: Yes. Agent of the surety.
To determine if there was a valid contract of insurance, it must be determine if the premium
was validly paid to the company or its agents at the time of the loss.
Sec. 306 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 to
receive on its behalf payment of any premium which is due on such policy of contract of
insurance at the time of its issuance or delivery or which becomes due thereon.
When South Sea delivered to Mr. Chua the marine cargo insurance policy for Valenzuelas
logs, he is deemed to have been authorized by former to receive the premium which is due on
its behalf.
When the logs were lost, the insured had already paid the premium to an agent of the South
Sea Surety and Insurance Co., Inc., which is consequently liable to pay the insurance
proceeds under the policy it issued to the insured.
on its behalf. It is a well-known principle under the law of agency that payment to an
authorized agent is equivalent to payment to the principal himself. MICOs acknowledgement
of Adora as its agent thus defeats its contention that he was not authorized to receive
payments on its behalf.
2. Yes. Sec 77 of the Insurance Code is not applicable in the instant case as payment was
eventually made. It is to be noted that the premium invoice was stamped Payment
Received, indicating an understanding between the parties that payment could be made
later. This is furthered by the fact that Adora had earlier told her to call him anytime she was
ready with her payment.
Payment was legally made on the original transaction and validly received by Adora, who was
not informed of the alleged cancellation and thus saw no reason to reject the payment.
A person insured is not entitled to a return of premium if the policy is annulled, rescinded or
if a claim is denied by reason of fraud.
SEC. 83. In case of an over insurance by several insurers other than life, the insured is
entitled to a ratable return of the premium, proportioned to the amount by which the
aggregate sum insured in all the policies exceeds the insurable value of the thing at risk.
9. Insurer never incurred liability due to default of insured
American Home Assurance vs. Chua, G.R. No. 130421(1999)
(refer to above case)
10.Recission
Areola vs. CA, G.R. No. 95641(1994)
Facts: 1. 7 months after the issuance of Santos Areola's Personal Accident Insurance Policy
(covering a period of one year), Prudential Guarantee unilaterally cancelled the same since
company records revealed that Areola failed to pay his premiums.
2. Under the terms of the statement of account issued by Prudential, Areola was supposed
to pay the total amount of P1,609.65 which included the premium of P1,470.00,
documentary stamp of P110.25 and 2% premium tax of P29.40.
3. The statement of account stated that it must not be considered a receipt as an official
receipt will be issued upon payment of the account. And if payment was made to a
representative, the client must demand for a Provisional Receipt and if Official Receipts arent
received within 7 days, Prudential should be notified. If payment is made to their office,
clients should demand for an OR.
4. Prudential offered to reinstate same policy it had previously cancelled and even proposed
to extend its lifetime to December 17, 1985, upon a finding that the cancellation was
erroneous and that the premiums were paid in full by Areola but were not remitted by Teofilo
M. Malapit, Prudential's branch manager.
5. Areola claims that the fraudulent act of misappropriating his premium payments is the
proximate cause of the cancellation of the insurance policy. Areola theorized that Malapit's act
of signing and even sending the notice of cancellation himself, notwithstanding his personal
knowledge of petitioner-insured's full payment of premiums, further reinforces the allegation
of bad faith. Such fraudulent act committed by Malapit is attributable to Prudential.
6. Malapit's acts are therefore not separate and distinct from that of Prudentials. They must
bear the consequences of the erroneous cancellation of subject insurance policy caused by
the non-remittance by its own employee of the premiums paid. The subsequent reinstatement
could not possibly absolve respondent insurance company from liability, there being an
obvious breach of contract.
8. Prudential argues that where reinstatement, the equitable relief sought by Areola was
granted at the right moment, and Areola is left without a cause of action on which to
predicate his claim for damages. Reinstatement effectively restored Areola to all his rights
under the policy.
ISSUES
1. WON the erroneous act of canceling the insurance policy would entitle Areola to payment
of damages
2. WON the subsequent act of reinstating the wrongfully cancelled insurance policy obliterate
whatever liability for damages Prudential has
HELD
1. YES. Malapit's fraudulent act of misappropriating the premiums paid by petitioner-insured
is beyond doubt directly imputable to Prudential. A corporation, such as respondent insurance
company, acts solely thru its employees. The latters acts are considered as its own for which
it can be held to account.
Thus, his receipt of said premiums is receipt by private respondent insurance company who,
by provision of law, particularly under Article 1910 of the Civil Code, is bound by the acts of
its agent.
Article 1910 thus reads:
Art. 1910. The principal must comply with all the obligations which the agent may have
contracted within the scope of his authority.
As for any obligation wherein the agent has exceeded his power, the principal is not bound
except when he ratifies it expressly or tacitly.
Malapit's failure to remit the premiums he received cannot constitute a defense for private
respondent insurance company; no exoneration from liability could result therefrom.
2. NO. Prudentials act of reinstating the insurance policy cannot obliterate the injury inflicted
on Areola.
Under the law governing reciprocal obligations, particularly the second paragraph of Article
1191, the injured party, Areola in this case, is given a choice between fulfillment or rescission
of the obligation in case one of the obligors, such as respondent insurance company, fails to
comply with what is incumbent upon him.
However, said article entitles the injured party to payment of damages, regardless of whether
he demands fulfillment or rescission of the obligation.
It is untenable that reinstatement is equivalent to fulfillment of its obligation, which divests
the petitioner-insured of a rightful claim for payment of damages.