Philippine American Insurance vs Hon Judge Pineda and Rodolfo Dimayuga

G.R. No. L-54216 July 19, 1989

Facts:
Rodolfo Dimayuda procured an ordinary life insurance policy from the petitioner company and designated his wife and
children as irrevocable beneficiaries of said policy. Private respondent filed a petition to amend the designation of the beneficiaries in
his life policy from irrevocable to revocable. Petitioner filed an Urgent Motion to Reset Hearing. Also on the same date, petitioner
filed its Comment and/or Opposition to Petition. Judge Gregorio G. Pineda denied petitioner's Urgent Motion, thus allowing the
private respondent to adduce evidence, the consequence of which was the issuance of the questioned Order granting the petition.
Petitioner promptly filed a Motion for Reconsideration but the same was denied. Hence this petition.

Issue:
1. whether or not the Dimayuga can validly revoke the designations of the irrevocable beneficiaries without the consent of
the beneficiaries.
2. whether or not the irrevocable beneficiaries, one whom is already dead, can validly give consent to the change of such
designation

Ruling.

1. No. The beneficiary designated in a life insurance contract cannot be changed without the consent of the beneficiary because
he has a vested interest in the policy. Moreover there is a provision in the policy which states: It is hereby understood and
agreed that, notwithstanding the provisions of this policy to the contrary, inasmuch as the designation of the
primary/contingent beneficiary/beneficiaries in this Policy has been made without reserving the right to change said
beneficiary/ beneficiaries, such designation may not be surrendered to the Company, released or assigned; and no right or
privilege under the Policy may be exercised, or agreement made with the Company to any change in or amendment to the
Policy, without the consent of the said beneficiary/beneficiaries. Inevitably therefore, based on the aforequoted provision of
the contract, not to mention the law then applicable, it is only with the consent of all the beneficiaries that any change or
amendment in the policy concerning the irrevocable beneficiaries may be legally and validly effected. Both the law and the
policy do not provide for any other exception, thus, abrogating the contention of the private respondent that said designation
can be amended if the Court finds a just, reasonable ground to do so.

2. No. The alleged acquiescence of the six (6) children beneficiaries of the policy (the beneficiary-wife predeceased the insured)
cannot be considered an effective ratification to the change of the beneficiaries from irrevocable to revocable. Indubitable is
the fact that all the six (6) children named as beneficiaries were minors at the time, for which reason, they could not validly
give their consent. Neither could they act through their father insured since their interests are quite divergent from one
another.

According to Campos, he insured can do nothing to divest the beneficiary of his rights without his consent. He
cannot assign his policy, nor even take its cash surrender value without the consent of the beneficiary. Neither can the
insured's creditors seize the policy or any right thereunder. The insured may not even add another beneficiary because by
doing so, he diminishes the amount which the beneficiary may recover and this he cannot do without the beneficiary's
consent. Therefore, the parent-insured cannot exercise rights and/or privileges pertaining to the insurance contract, for
otherwise, the vested rights of the irrevocable beneficiaries would be rendered inconsequential.

Biagtan vs. The Insular Life Assurance Co.

G.R. No. L-25579 March 29, 1972

Facts:
Juan S. Biagtan was insured with defendant InsularLife Assurance Company under and under a supplementary contract
denominated "Accidental Death Benefit Clause, for an additional sum 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."
Susbequently, the house of insured Juan Biagtan was robbed by a band of robbers who were charged in and convicted by the Court of
First Instance of Pangasinan for robbery with homicide for killing and robbing Juan Biagtan. Plaintiffs, as beneficiaries of the insured,
filed a claim under the policy. The insurance company paid the basic amount but refused to pay the additional sum 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. Plaintiffs filed suit to recover, and after due hearing the court a quo rendered judgment in their favor.

Issue:
Whether or not the insurer is absolved from liability under the insurance.

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Ruling:
Yes. It should be noted that the exception in the accidental benefit clause invoked by the appellant does not speak of the
purpose whether homicidal or not of a third party in causing the injuries, but only of the fact that such injuries have been
"intentionally" inflicted this obviously to distinguish them from injuries which, although received at the hands of a third party, are
purely accidental. This construction is the basic idea expressed in the coverage of the clause itself, namely, that "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." A gun which discharges while being cleaned and kills a bystander; a hunter who shoots at his prey
and hits a person instead; an athlete in a competitive game involving physical effort who collides with an opponent and fatally injures
him as a result: these are instances where the infliction of the injury is unintentional and therefore would be within the coverage of an
accidental death benefit clause such as thatin question in this case. But where a gang of robbers enter a house and coming face to face
with the owner, even if unexpectedly, stab him repeatedly, it is contrary to all reason and logic to say that his injuries are not
intentionally inflicted, regardless of whether they prove fatal or not. As it was, in the present case they did prove fatal, and the robbers
have been accused and convicted of the crime of robbery with homicide.

The case of Calanoc vs. Court of Appeals, 98 Phil. 79, is relied upon by the trial court in support of its decision. The facts in
that case, however, are different from those obtaining here. The insured there was a watchman in a certain company, who happened to
be invited by a policeman to come along as the latter was on his way to investigate a reported robbery going on in a private house. As
the two of them, together with the owner of the house, approached and stood in front of the main gate, a shot was fired and it turned
out afterwards that the watchman was hit in the abdomen, the wound causing his death. Under those circumstances this Court held that
it could not be said that the killing was intentional for there was the possibility that the malefactor had fired the shot to scare people
around for his own protection and not necessarrily to kill or hit the victim. A similar possibility is clearly ruled out by the facts in the
case now before Us. For while a single shot fired from a distance, and by a person who was not even seen aiming at the victim, could
indeed have been fired without intent to kill or injure, nine wounds inflicted with bladed weapons at close range cannot conceivably be
considered as innocent insofar as such intent is concerned. The manner of execution of the crime permits no other conclusion.

Sun Insurance Office vs Court of Appeals

G.R. No. 92383 July 17, 1992

Facts:
Petitioner issued Personal Accident Policy No. 05687 to Felix Lim, Jr. with a face value of P200,000.00. Two months later,
he was dead with a bullet wound in his head. As beneficiary, his wife Nerissa Lim sought payment on the policy but her claim was
rejected. The petitioner agreed that there was no suicide. It argued, however that there was no accident either. Pilar Nalagon, Lim's
secretary, was the only eyewitness to his death. According to Nalagon, in the evening, after his mother's birthday party, Lim was in a
happy mood (but not drunk) and was playing with his handgun, from which he had previously removed the magazine. As she watched
television, he stood in front of her and pointed the gun at her. She pushed it aside and said it might he loaded. He assured her it was
not and then pointed it to his temple. The next moment there was an explosion and Lim slumped to the floor. He was dead before he
fell. Thus, Nerissa Lim sued Sun insurance to claim benefits under the policy. The court rule in favour of lim and the same was
affirmed by CA on appeal.

Issue:
1. Whether or not the death of Felix is accidental.
2. Whether ot not the petitioner is engaged in unfair claim settlement

Ruling:
1. Yes. The words "accident" and "accidental" have never acquired any technical signification in law, and when used in an
insurance contract are to be construed and considered according to the ordinary understanding and common usage and
speech of people generally. In-substance, the courts are practically agreed that the words "accident" and "accidental"
mean that which happens by chance or fortuitously, without intention or design, and which is unexpected, unusual,
and unforeseen. The definition that has usually been adopted by the courts is that an accident is an event that takes place
without one's foresight or expectation an event that proceeds from an unknown cause, or is an unusual effect of a
known case, and therefore not expected. An accident is an event which happens without any human agency or, if
happening through human agency, an event which, under the circumstances, is unusual to and not expected by
the person to whom it happens. It has also been defined as an injury which happens by reason of some violence or
casualty to the injured without his design, consent, or voluntary co-operation.

The Court is convinced that the incident that resulted in Lim's death was indeed an accident. The petitioner,
invoking the case of De la Cruz v. Capital Insurance, says that "there is no accident when a deliberate act is performed
unless some additional, unexpected, independent and unforeseen happening occurs which produces or brings
about their injury or death." There was such a happening. This was the firing of the gun, which was the additional
unexpected and independent and unforeseen occurrence that led to the insured person's death. The petitioner maintains
that by the mere act of pointing the gun to hip temple, Lim had willfully exposed himself to needless peril and so came
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 under the exception. The theory is that a gun is per se dangerous and should therefore be handled cautiously in every
case. That posture is arguable. But what is not is that, as the secretary testified, Lim had removed the magazine from the
gun and believed it was no longer dangerous. He expressly assured her that the gun was not loaded. It is submitted that
Lim did not willfully expose himself to needless peril when he pointed the gun to his temple because the fact is that he
thought it was not unsafe to do so. The act was precisely intended to assure Nalagon that the gun was indeed harmless.

2. No. It is evident that the petitioner was acting in good faith then it resisted the private respondent's claim on the ground
that the death of the insured was covered by the exception. The issue was indeed debatable and was clearly not raised
only for the purpose of evading a legitimate obligation. We hold therefore that the award of moral and exemplary
damages and of attorney's fees is unjust and so must be disapproved

Virginia Calanoc vs Court of Appeals

G.R. No. L-8151 December 16, 1955

Facts:
Melencio Basilio was insured by Philippine American Life Insurance for accidental death under a supplementary policy for
covering accidental death. Melencio Basilio was a watchman of the Manila Auto Supply. Subsequently he died of a gunshot wound on
the occasion of a robbery committed in the house of Atty. Ojeda at the corner of Oroquieta and Zurbaan streets. 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 on the ground 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.

While Basilio was on Duty, Atty. Ojeda sought formers help as his house was being robbed. However, Basilio declined
telling Atty. Ojeda that he isnt a police. Basilio referred Atty Ojeda to the traffic police in Rizal Avenue. While the traffic police and
Atty Ojeda were on the way to the latters house, Basilio went with the two. While they were approaching the house, Atty Ojeda and
the traffic police heard gunshots and they immediately retreated. It turns out that Basilio was shot in the abdomen causing his death
instantaneously. The perpetrators was arrested and was prosecuted in the CFI of manila (the case is silent whether they were
convicted) To escape liability, Philam life contended that Basilio was killed which "making an arrest as an 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 there is accidental death.

Ruling:
Yes. 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. 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 officer of the law, as contended, simply because he went with
the traffic policeman, for certainly he did not go there for that purpose nor was he asked to do so by the policeman. Moreover, 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. Perhaps this may be clarified in the criminal case now pending in court as regards the incident but before that is done anything
that might be said on the point would be a mere conjecture. Nor can it be said that the killing was intentional for there is the possibility
that the malefactor had fired the shot merely to scare away the people around for his own protection and not necessarily to kill or hit
the victim. In any event, while the act may not excempt the triggerman from liability for the damage done, the fact remains that the
happening was a pure accident on the part of the victim. The victim could have been either the policeman or Atty. Ojeda for it cannot
be pretended that the malefactor aimed at the deceased precisely because he wanted to take his life.

While as a general rule "the parties may limit the coverage of the policy to certain particular accidents and risks or causes of
loss, and may expressly except other risks or causes of loss therefrom" (45 C. J. S. 781-782), however, it is to be desired that the terms
and phraseology of the exception clause be clearly expressed so as to be within the easy grasp and understanding of the insured, for if
the terms are doubtful or obscure the same must of necessity be interpreted or resolved aganst the one who has caused the obscurity.
The circumstances unfolded in the present case do not warrant the finding that the death of the unfortunate victim comes within the
purview of the exception clause of the supplementary policy and, hence, do not exempt the company from liability.

Malayan Insurance vs Court of Appeals

G.R. No. L-36413 September 26, 1988

Facts:
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 Petitioner, Malayan Insurance Co., Inc., issued in favor of private respondent Sio Choy Private Car Comprehensive Policy,
covering a Willys jeep. The insurance coverage was for "own damage" not to exceed P600.00 and "third-party liability" in the amount
of P20,000.00. During the effectivity of said insurance policy, a passenger bus belonging to the respondent Pangasinan Transportation
Co., Inc. (PANTRANCO, for short) at Pangasinan, causing damage to the insured vehicle and injuries to the driver, Juan P. Campollo,
and the respondent Martin C. Vallejos, who was riding in the ill-fated jeep. As a result, Martin C. Vallejos filed an action for damages
against Sio Choy, Malayan Insurance Co., Inc. and the PANTRANCO before the Court of First Instance of Pangasinan.
PANTRANCO claimed that the jeep of Sio Choy was then operated at an excessive speed and bumped the PANTRANCO bus which
had moved to, and stopped at, the shoulder of the highway in order to avoid the jeep. Defendant Sio Choy and the petitioner insurance
company, in their answer, also denied liability to the plaintiff, claiming that the fault in the accident was solely imputable to the
PANTRANCO. Sio Choy, however, later filed a separate answer with a cross-claim against the herein petitioner wherein he alleged
that he had actually paid the plaintiff, Martin C. Vallejos for hospitalization and other expenses, and, in his cross-claim against the
herein petitioner, he alleged that the petitioner had issued in his favor a private car comprehensive policy wherein the insurance
company obligated itself to indemnify Sio Choy, as insured, for the damage to his motor vehicle, as well as for any liability to third
persons arising out of any accident. Also later, the herein petitioner filed a third-party complaint against the San Leon Rice Mill, Inc.
for the reason that the person driving the jeep of Sio Choy, at the time of the accident, was an employee of the San Leon Rice Mill,
Inc. performing his duties within the scope of his assigned task, and not an employee of Sio Choy. The trial court ruled that Sio Choy,
Malayan Insurance, and San Leon Milling was jointly and severally liable to Vallejos. The same was affirmed by the CA. It further
ruled that the San Leon Rice Mill, Inc. has no obligation to indemnify or reimburse the petitioner insurance company for whatever
amount it has been ordered to pay on its policy, since the San Leon Rice Mill, Inc. is not a privy to the contract of insurance between
Sio Choy and the insurance company.

Issues:
1. Whether or not the trial court correctly ruled that Sio Choy, Malayan and San Leon Jointly and severally liable
2. Whether or not Malayan is entitled to be reimbursed by San Leon

Ruling.
1. No. only respondents Sio Choy and San Leon Rice Mill, Inc, (to the exclusion of the petitioner) that are solidarily liable
to respondent Vallejos for the damages awarded to Vallejos. It must be observed that respondent Sio Choy is made
liable to said plaintiff as owner of the ill-fated Willys jeep, pursuant to Article 2184 of the Civil Code. On the other hand,
it is noted that the basis of liability of respondent San Leon Rice Mill, Inc. to plaintiff Vallejos, the former being the
employer of the driver of the Willys jeep at the time of the motor vehicle mishap, is Article 2180 of the Civil Code
(Basta based on their respective liability for torts). It thus appears that respondents Sio Choy and San Leon Rice Mill,
Inc. are the principal tortfeasors who are primarily liable to respondent Vallejos. The law states that the responsibility of
two or more persons who are liable for a quasi-delict is solidarily. On the other hand, the basis of petitioner's liability is
its insurance contract with respondent Sio Choy. If petitioner is adjudged to pay respondent Vallejos, this is on account
of its being the insurer of respondent Sio Choy under the third party liability clause included in the private car
comprehensive policy existing between petitioner and respondent Sio Choy at the time of the complained vehicular
accident.

While it is true that where the insurance contract provides for indemnity against liability to third persons, such third
persons can directly sue the insurer, 6 however, the direct liability of the insurer under indemnity contracts against third
party liability does not mean that the insurer can be held solidarily liable with the insured and/or the other parties found
at fault. The liability of the insurer is based on contract; that of the insured is based on tort.

2. Yes. Subrogation is a normal incident of indemnity insurance. Upon payment of the loss, the insurer is entitled to be
subrogated pro tanto to any right of action which the insured may have against the third person whose negligence or
wrongful act caused the loss. When the insurance company pays for the loss, such payment operates as an equitable
assignment to the insurer of the property and all remedies which the insured may have for the recovery thereof. That
right is not dependent upon , nor does it grow out of any privity of contract or upon written assignment of claim, and
payment to the insured makes the insurer assignee in equity.

Geronimo, Francis 2017