INSURANCE CASE DIGEST CASUALTY INSURANCE
ROMERO
(1) NFD Manning International Manning Agents vs Illescas
Facts:
- respondent Esmeraldo C. Illescas entered into a Contract of Employment
with petitioner NFD International Manning Agents, Inc., acting for and in
behalf of its foreign principal, co-petitioner Barber Ship Management, Ltd.
Under the contract, respondent was employed as Third Officer of M/V
Shinrei for a period of nine months, with a basic monthly salary of
US$854.00. The employment contract complied with the Philippine
Overseas Employment Administration (POEA) Standard Contract for
Seafarers, and the standard terms and conditions governing the employment
of Filipino seafarers on board ocean-going vessels under Department Order
No. 4, series of 2000.
- After respondent passed the pre-employment medical examination, he
boarded the vessel and started performing his job on October 6, 2002.
- On May 16, 2003, when respondent had been on board the vessel for seven
months, Captain Jaspal Singh and Chief Officer Maydeo Rajev ordered
respondent to carry 25 fire hydrant caps from the deck to the engine
workshop, then back to the deck to refit the caps. The next day, while
carrying a heavy basketful of fire hydrant caps, respondent felt a sudden
snap on his back, with pain that radiated down to the left side of his hips.
He immediately informed the ship captain about his condition, and he was
advised to take pain relievers. As the pain was initially tolerable, he
continued with his work. After a few days, the pain became severe, and
respondent had difficulty walking.
- when the vessel was in Japan, respondent was brought to the
Higashiogishima Clinic. Respondent was diagnosed to be suffering from
lumbago and sprain. The doctor gave respondent medication and advised
him to wear a corset, avoid lifting heavy objects and get further examination
and treatment if the symptoms persisted
- Despite the lighter work assigned to respondent, he continued to experience
excruciating pain. On June 13, 2003, petitioner was referred to a doctor
upon arrival of M/V Shinrei at the port of Hay Point, Australia. The doctor
declared that respondent was unfit to work, and recommended that
respondent return home for further management.
- respondent was repatriated to the Philippines. Thereafter, he underwent
physical rehabilitation. Nevertheless, medical examinations showed that
there was still restriction in respondent’s truncal mobility and in the lifting
power of his trunk.
- petitioners received a letter dated December 16, 2003 from respondent’s
counsel, demanding the payment of disability benefit.
- In a letter dated April 12, 20004, Pandiman Philippines, Inc, in behalf of
petitioners, offered to pay respondent disability benefit in the amount of
US$16,795.00, corresponding to Grade 8 disability under the POEA
Standard Contract for Seafarers. Respondent, through counsel, refused the
offer on the ground that the injury sustained by him was caused by an
CABIOS.ORINDAY.PADRID.PAJARITO.REYES.
accident, which was compensable in the amount of US$90,000.00 under the
Collective Bargaining Agreement (CBA),
Issue: Whether or not the injury sustained was caused by an accident.
Held:
- NO
- Black’s Law Dictionary defines "accident" as "[a]n unintended and
unforeseen injurious occurrence; something that does not occur in the usual
course of events or that could not be reasonably anticipated, x x x [a]n
unforeseen and injurious occurrence not attributable to mistake, negligence,
neglect or misconduct."
- The Court holds that the snap on the back of respondent was not an accident,
but an injury sustained by respondent from carrying the heavy basketful of
fire hydrant caps, which injury resulted in his disability. The injury cannot
be said to be the result of an accident, that is, an unlooked for mishap,
occurrence, or fortuitous event, because the injury resulted from the
performance of a duty. Although respondent may not have expected the
injury, yet, it is common knowledge that carrying heavy objects can cause
back injury, as what happened in this case. Hence, the injury cannot be
viewed as unusual under the circumstances, and is not synonymous with the
term "accident" as defined above.
- Although the disability of respondent was not caused by an accident, his
disability is still compensable under Article 13 of the CBA under the
following provision:
A seafarer/officer who is disabled as a result of any injury, and who is assessed as less
than 50% permanently disabled, but permanently unfit for further service at sea in any
capacity, shall also be entitled to a 100% compensation.
(2) Biagtan vs The Insular Life Assurance Corporation
Facts:
- The facts are stipulated. Juan S. Biagtan was insured with defendant
InsularLife Assurance Company under Policy No. 398075 for the sum of
P5,000.00 and, under a supplementary contract denominated "Accidental
Death Benefit Clause, for an additional sum of P5,000.00 if "the death of
the Insured resulted directly from bodily injury effected solely through
external and violent means sustained in an accident ... and independently of
all other causes." The clause, however,expressly provided that it would not
apply where death resulted from an injury"intentionally inflicted by another
party."
- on the night of May 20, 1964 or the first hours of May 21, 1964, while the
said life policy and supplementary contract were in full force and effect, the
house of insured Juan S. Biagtan was robbed by a band of robbers who were
charged in and convicted by the Court of First Instance of Pangasinan for
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robbery with homicide; that in committing the robbery, the robbers, on
reaching the staircase landing on the second floor, rushed towards the door
of the second floor room, where they suddenly met a person near the door
of one of the rooms who turned out to be the insured Juan S. Biagtan who
received thrusts from their sharp-pointed instruments, causing wounds on
the body of said Juan S. Biagtan resulting in his death at about 7 a.m. on the
same day, May 21, 1964;
- Plaintiffs, as beneficiaries of the insured, filed a claim under the policy. The
insurance company paid the basic amount of P5,000.00 but refused to pay
the additional sum of P5,000.00 under the accidental death benefit clause,
on the ground that the insured's death resulted from injuries intentionally
inflicted by third parties and therefore was not covered.
Issue: Whether or not the injuries inflicted to the insured were intentional.
Held:
- YES
- It has been held that "intentional" as used in an accident policy excepting
intentional injuries inflicted by the insured or any other person, etc., implies
the exercise of the reasoning faculties, consciousness and volition. Where a
provision of the policy excludes intentional injury, it is the intention of the
person inflicting the injury that is controlling. If the injuries suffered by the
insured clearly resulted from the intentional act of a third person the insurer
is relieved from liability as stipulated.
- In the case of Hutchcraft's Ex'r v. Travelers' Ins. Co., 87 Ky. 300, 8 S.W.
570, 12 Am. St. Rep. 484, the insured was waylaid and assassinated for the
purpose of robbery. Two (2) defenses were interposed to the action to
recover indemnity, namely: (1) that the insured having been killed by
intentional means, his death was not accidental, and (2) that the proviso in
the policy expressly exempted the insurer from liability in case the insured
died from injuries intentionally inflicted by another person. In rendering
judgment for the insurance company the Court held that while the
assassination of the insured was as to him an unforeseen event and therefore
accidental, "the clause of the proviso that excludes the (insurer's) liability,
in case death or injury is intentionally inflicted by another person, applies
to this case."
(3) Calanoc vs Court of Appeals
FACTS:
 The suit involves the collection of P2,000 representing the value of a
supplemental policy covering accidental death which was secured by one
Melencio Basilio from the Philippine American Life Insurance Company.
 Melencio Basilio was a watchman of the Manila Auto Supply located at the
corner of Avenida Rizal and Zurbaran. He secured a life insurance policy
from the Philippine American Life Insurance Company in the amount of
CABIOS.ORINDAY.PADRID.PAJARITO.REYES. ROMERO
P2,000 to which was attached a supplementary contract covering death by
accident.
 Later on, he died of a gunshot wound on the occasion of a robbery.
 Virginia Calanoc, the widow, was paid the sum of P2,000, face value of the
policy, but when she demanded the payment of the additional sum of P2,000
representing the value of the supplemental policy.
 the company refused alleging, as main defense, that the deceased died
because he was murdered by a person who took part in the commission of
the robbery and while making an arrest as an officer of the law which
contingencies were expressly excluded in the contract and have the effect
of exempting the company from liability.
 It is contended in behalf of the company that Basilio was killed which
"making an arrest as an of officer of the law" or as a result of an "assault or
murder" committed in the place and therefore his death was caused by one
of the risks excluded by the supplementary contract which exempts the
company from liability.
ISSUE: Whether or not the insurance company is liable.
HELD: YES
 Basilio was a watchman of the Manila Auto Supply which was a block away
from the house of Atty. Ojeda where something suspicious was happening
which caused the latter to ask for help. While at first he declined the
invitation of Atty. Ojeda to go with him to his residence to inquire into what
was going on because he was not a regular policeman, he later agreed to
come along when prompted by the traffic policeman, and upon approaching
the gate of the residence he was shot and died.
 The circumstance that he was a mere watchman and had no duty to heed the
call of Atty. Ojeda should not be taken as a capricious desire on his part to
expose his life to danger considering the fact that the place he was in duty-
bound to guard was only a block away. In volunteering to extend help under
the situation, he might have thought, rightly or wrongly, that to know the
truth was in the interest of his employer it being a matter that affects the
security of the neighborhood. No doubt there was some risk coming to him
in pursuing that errand, but that risk always existed it being inherent in the
position he was holding.
 He cannot therefore be blamed solely for doing what he believed was in
keeping with his duty as a watchman and as a citizen. And he cannot be
considered as making an arrest as an of cer of the law, as contended, simply
because he went with the traf c policeman, for certainly he did not go there
for that purpose nor was he asked to do so by the policeman.
 there is no proof that the death of Basilio is the result of either crime for the
record is barren of any circumstance showing how the fatal shot was fired.
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 The circumstances of Basilio’s death cannot be taken as purely intentional
on the part of
Basilio to expose himself to the danger. There is no proof that his death was
the result of intentionalkilling because there is the possibility that the
malefactor had fired the shot merely to scare away the
people around. In this case, the company’s defense points out that Basilio’s
is included among the risks excluded in the supplementary contract;
however, the terms and phraseology of the exception clause should be
clearly expressed within the understanding of the insured. Art. 1377 of the
New Civil Code provides that in case ambiguity, uncertainty or obscurity in
the interpretation of the terms of the contract, it shall be construed against
the party who caused such obscurity. Applying this to the situation, the
ambiguous or obscure terms in the insurance policy are to be construed
strictly against the insurer and liberally in favor of the insured party. The
reason is to ensure the protection of the insured since these insurance
contracts are usually arranged and employed by experts and legal advisers
acting exclusively in the interest of the insurance company. As long as
insurance companies insist upon the use of ambiguous, intricate and
technical provisions, which conceal their own intentions, the courts must,
in fairness to those who purchase insurance, construe every ambiguity in
favor of the insured.
DOCTRINE: In case of ambiguity in an insurance contract covering accidental death,
the Supreme Court held that such terms shall be construed strictly against the insurer
and liberally in favor of the insured in order to effect the purpose of indemnity.
(4) Finman General Assurance Corporation vs. Court of Appeals
FACTS;
 This is a petition for certiorari with a prayer for the issuance of a restraining
order and preliminary mandatory injunction to annul and set aside the
decision of the Court of Appeals affirming the decision of the Insurance
Commission in ordering petitioner to pay private respondent Julia Surposa
the proceeds of the personal accident insurance policy with interest.
 deceased Carlie Surposa was insured with petitioner Finman General
Assurance Corporation under Finman General Teachers Protection Plan
Master Policy No. 2005 and Individual Policy No. 08924 with his parents,
spouses Julia and Carlos Surposa, and brothers Christopher, Charles,
Chester and Clifton, all surnamed Surposa, as beneficiaries.
 While said insurance was in full force and effect, the insured, Carlie
Surposa, died as a result of a stab wound inflicted by one of the three
unidentified men without provocation and warning on the part of the former
as he and his cousin, Winston Surposa, were waiting for a ride on their way
home after attending the celebration of the Maskarra Annual Festival.
CABIOS.ORINDAY.PADRID.PAJARITO.REYES. ROMERO
 Thereafter, 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.
 petitioner filled 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 in killing the former
as indicated by the location of the lone stab wound on the insured.
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.
FACTS: YES
 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 stipulated 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.
 the failure of the petitioner insurance company to include death resulting
from murder or assault among the prohibited risks leads inevitably to the
conclusion that it did not intend to limit or exempt itself from liability for
such death.
 Article 1377 of the Civil Code of the Philippines provides that:
"The interpretation of obscure words or stipulations in a contract shall not
favor the party who caused the obscurity."
 Moreover, "it is well settled that 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."