VDA. DE GABRIEL vs.
CA and FORTUNE INSURANCE which to file an action against an insurer but obviously to the written notice of claim
J. Vitug | Nov. 14, 1996
TOPIC: Prescription of action
FACTS
Marcelino Gabriel was employed by Emerald Construction & Development
Corporation at its construction project in Iraq. He was covered by a personal accident
insurance in the amount of P100,000 under a group policy procured by Emerald for its
OFWs with Fortune Insurance. The insured risk was for “bodily injury caused by
violent accidental external and visible means which injury would solely and
independently of any other cause” result in death or disability.
Within the life of the policy, Gabriel died in Iraq. A year later, Emerald reported
Gabriel’s death to Fortune by telephone. Among the documents submitted to Fortune
were a copy of his death certificate issued by Iraq’s Ministry of Health and an autopsy
report from NBI which both did not state the cause of death. Ultimately, Fortune
denied Emerald’s claim due to prescription.
Vda. de Gabriel’s Argument: Vda. de Gabriel went to the RTC Manila. In her
complaint against Emerald and Fortune, she averred that her husband died of
electrocution while working and prayed for P100,000 as insurance indemnification
among other damages.
Fortune’s Defense: Fortune admitted the genuineness of the policy but since the
death certificate and the autopsy report failed to disclose the cause of Gabriel’s death,
it denied its liability. Also, Fortune raised the defense of prescription invoking Sec.
384 of the Insurance Code.
RTC: In favor of Emerald’s claim. It held that Fortune was deemed to have waived
the defense that the cause of Gabriel’s death was not covered by the policy when
Fortune failed to impugn by evidence Vda. de Gabriel’s averment on the matter. With
regard to prescription, the RTC considered the complaint to have been timely filed
within 1 year from Fortune’s denial of the claim.
CA: Reverse the RTC. It held that Vda. de Gabriel failed to substantiate her
allegation that her husband’s death was caused by a risk insured against. The only
evidence show was her own affidavit and a letter allegedly written by a co-worker of
the deceased which were held to be both hearsay.
ISSUE: WON the action has prescribed – YES
RATIO
On the issue of prescription
Fortune correctly invoked Sec. 384 of the Insurance Code. Here, the notice of death
was given to Fortune more than a year after the death of Gabriel. Fortune, in invoking
prescription, was not referring to the 1-year period from the denial of the claim within
that had to be submitted within six months from the time of the accident.
On Fortune’s waiver of right to controvert the claim
Vda. de Gabriel: Vda. de Gabriel argues that Fortune must be deemed to have
waived its right to controvert the claim, which is to show that the cause of death is an
excepted peril, by failing to have its answers duly verified.
SC: No, the verification, as required by the rules of procedure, is a formal and not a
jurisdictional requirement. It is mainly intended to secure an assurance that matters
which are alleged are done in good faith or are true and correct and not of mere
speculation. When circumstances warrant, the court may simply order the correction
of unverified pleadings or act on it and waive strict compliance with the rules in order
that the ends of justice may thereby be served.
Motor Service Co., Inc. vs. Yellow Taxicab does not apply in this case. Here, Fortune
filed a written answer to the request for admission, sans verification. In Motor Service,
there was an absolute failure on the part of the defendant to answer the request for
admission. As such, there is no basis in law to hold that Fortune was deemed to have
waived the defense that the death of Gabriel was not caused by risks contemplated in
the policy.
On the evidences provided by Vda. de Gabriel
Vda. de Gabriel: In an attempt to prove her husband’s cause of death, Vda. de
Gabriel submitted a letter sent to her by her husband’s co-worker, stating that Gabriel
died when he tried to haul water out of a tank while its submerged motor was still
functioning and her sinumpaang salaysay which merely confirmed the receipt and
stated the contents of the letter.
SC: The affidavit presented suffers from procedural infirmity as it was not even
testified to or identified by Vda. de Gabriel herself. This self-serving affidavit is
therefore a mere hearsay under the rules. In like manner, the letter was never
identified to in court by the supposed author as well.
Neither the death certificate from Iraq nor the NBI autopsy report could give any
probative value to Vda. de Gabriel’s claim. Both did not state any cause of death.
In an accident insurance, the insured’s beneficiary has the burden of proof in showing
that the cause of death is due to the covered peril. Once established, the burden
shifts to the insurer to show any excepted peril. An accident insurance is not to be
likened to an ordinary life insurance where the insured’s death, regardless of the
cause, would normally be compensable. The latter is akin to an “all risk” coverage in
property insurance.
While Vda. de Gabriel failed in establishing her husband’s cause of death,
considering the uncertainty of the real cause, Fortune might find its way clear into still
taking a second look on the matter and perhaps help ease Vda. de Gabriel’s loss.
DISPOSITIVE CA Decision is AFFIRMED