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fortune

FACTS: The sum was allegedly lost during a robbery of Producer's armored vehicle
while it was in transit to transfer the money from its Pasay City Branch to its
head office in Makati. the driver and securioty guard of the arnored vehicle t
ogether with three others were charged of PD 532 or the Anti Highway Robbery LAw
.Demands by Producers on fortune to pay the amount loss which is under the polic
y is denied by the latter contending that rewcovery is precluded under the gene
ral exceptions clause: "The company shall not be liable under this policy in rep
ort of
xxx xxx xxx
(b) any loss caused by any dishonest, fraudulent or criminal act of the insu
red or any officer, employee, partner, director, trustee or authorized represent
ative of the Insured whether acting alone or in conjunction with others. . . ."
Producers cobntends that Atiga and Magalong are not its "officer, employee, . .
. trustee or authorized representative . . . at the time of the robbery since D
river Magalong was assigned by PRC Management Systems and Security Guard Atiga w
as assigned by Unicorn Security Services, Inc. The trial court renedered decisio
n in favor of Producers and the CA affirmed this decision in toto hence this pet
ition.
ISSUE: Whther or not the recovery is precluded under the general exceptions clau
se of the Money, Security, and Payroll Robbery policy
RULING:
in respect of the transfer of Producer's money from its Pasay City branch to its
head office in Makati, Magalong and Atiga are considered as "authorized represe
ntatives" of the Producers even if PRC Management Systems and Unicorn Security S
ervices were truly independent contractors. Producers entrusted them with the sp
ecific duty to safely transfer the money to its head office, Magalong to drive
the armored vehicle which would carry the money; and Atiga to provide the needed
security for the money, the vehicle, and his two other companions. In short, fo
r these particular tasks, the three acted as agents of Producers. A "representat
ive" is defined as one who represents or stands in the place of another; one who
represents others or another in a special capacity, as an agent, and is interch
angeable with "agent." 23
In view of the foregoing, Fortune is exempt from liability under the general exc
eptions clause of the insurance policy.
A contract of insurance is a contract of adhesion, thus any ambiguity therein sh
ould be resolved against the insurer, 15 or it should be construed liberally in
favor of the insured and strictly against the insurer. 16 Limitations of liabili
ty should be regarded with extreme jealousy and must be construed
in such a way, as to preclude the insurer from non-compliance with its obligatio
n. 17 It goes without saying then that if the terms of the contract are clear an
d unambiguous, there is no room for construction and such terms cannot be enlarg
ed or diminished by judicial construction
edillon vs mla bankers
FACTS:
Sometime in April 1969, Carmen O, Lapuz applied with MANILA BANKERS LIFE INSURA
NCE CORPORATION. for insurance coverage against accident and injuries. She fille
d up the blank application form given to her and filed the same with the respond
ent insurance corporation. In the said application form which was dated April 15
, 1969, she gave the date of her birth as July 11, 1904. On the same date, she p
aid the sum of P20.00 representing the premium for which she was issued the corr
esponding receipt signed by an authorized agent of the respondent insurance corp
oration. A certificate of insurance was issued to Carmen.During the effectivity
of the policy, died in a vehicular accident. Thereafter, petitioner Regina L.
Edillon, a sister of the insured and who was the named beneficiary in the policy
, filed her claim for the proceeds of the insurance, submitting all the necessar
y papers and other requisites with the private respondent. The respondent corpor
ation denied the claim relying on a provision contained in the Certificate of In
surance which excludes its liability to pay claims under the policy in behalf of
"persons who are under the age of sixteen (16) years of age or over the age of
sixty (60) years ..." It is pointed out that the insured being over sixty (60) y
ears of age when she applied for the insurance coverage, the policy was null and
void, and no risk on the part of the respondent insurance corporation had arise
n therefrom. The lower court sustained Manila Banker's contention hence this pet
ition for certiorari.
ISSUE: whether or not the acceptance by the insurance corporation of the premium
and the issuance of the corresponding certificate of insurance is deemed a waiv
er of the exclusionary condition of overage stated in the said certificate of in
surance.
RULING: yes
The judgment of the trial court is reversed. The age of the insured Carmen 0. La
puz was not concealed to the insurance company. Her application for insurance co
verage which was on a printed form furnished by private respondent and which con
tained very few items of information clearly indicated her age of the time of fi
ling the same to be almost 65 years of age. Despite such information which could
hardly be overlooked in the application form, considering its prominence thereo
n and its materiality to the coverage applied for, the respondent insurance corp
oration received her payment of premium and issued the corresponding certificate
of insurance without question. The accident which resulted in the death of the
insured, a risk covered by the policy, occurred on May 31, 1969 or FORTY-FIVE (4
5) DAYS after the insurance coverage was applied for. There was sufficient time
for the private respondent to process the application and to notice that the app
licant was over 60 years of age and thereby cancel the policy on that ground if
it was minded to do so. If the private respondent failed to act, it is either be
cause it was willing to waive such disqualification; or, through the negligence
or incompetence of its employees for which it has only itself to blame, it simpl
y overlooked such fact. Under the circumstances, the insurance corporation is al
ready deemed in estoppel. It inaction to revoke the policy despite a departure f
rom the exclusionary condition contained in the said policy constituted a waiver
of such condition.
perla v cayas
FACTS: ilagros Cayas was the registered owner of a Mazda bus, insured with Perla
Compania de Seguros, Inc. (PCSI). During the effectivity of the policy, the veh
icle encountered in an accident. One of the victims sued Cayas while the three o
thers entered into a settlement worth 120p00/ The victim who sued Cayas won in t
he case and Cayas was ordered to pay 32000. Cayas then filed a claim against PCS
I for the recovery of the total sum she paid in the vitims of the accident.. The
court dismissed the case. She filed an MFR and a motion to declare PCSI in defa
ult for its failure to file an answer.
The court ordered ordering PCSI to pay Cayas P50,000 as compensation.
PCSI appealed to the Court of Appeals, which affirmed the lower court's decision
.
Its motion for reconsideration having been denied, PCSI filed this petition
ISSUE: WON PCSIs liability is limited only to the payment made by Cayas to the vi
ctim
RULING:
the fundamental principle that contracts are respected as the law between the co
ntracting parties finds application in the present case.The insurance policy inv
olved explicitly limits petitioner's liability to P12,000.00 per person and to P
50,000.00 per accident.The insurance policy placed liability for all damages ari
sing out of death or bodily injury sustained by one person as a result of any on
e accident at P12,000.00.
Section 377 of Presidential Decree No. 612, which provided that the liability of
land transportation vehicle operators for bodily injuries sustained by a passen
ger arising out of the use of their vehicles shall not be less than P12,000.
Minimum liability is P12,000 per passenger. Not contrary to law, morals, good cu
stoms, public order or public policy, said stipulation must be upheld as effecti
ve, valid and binding as between the parties.Although Milagros Cayas was able to
prove a total loss of only P44,000.00, petitioner was made liable for the amoun
t of P50,000.00, the maximum liability. This was wrong. An insurance indemnity,
being merely an assistance or restitution insofar as can be fairly ascertained,
cannot be availed of by any accident victim or claimant as an instrument of enri
chment.
aisposrna v ca
FACTS: Petitioner Mapalad Aisporna was charged in the City Court of Cabanatuan f
or violation of Section 189 of the Insurance Act on November 21, 1970 for acting
as an agent in the solicitation or procurement of an application for insurance
of Eugenio S. Isidro, for and in behalf of Perla Compania de Seguros, Inc. In hj
er appeal, Mapald maintains her contendion that she did not violated the law sin
ce it was natural for her as wife of Rodolfo, a duly licensed insurance agent o
f Perla Compania, to help him in his work, as clerk, and that policy was merely
a renewal and was issued because Isidro had called by telephone to renew, and at
that time, her husband, Rodolfo, was absent and so she left a note on top of he
r husband's desk to renew .. She relies on par 2 of the same law she allegedly v
iolated defining an insurance agent as any person who for compensation solicits
or obtains insurance on behalf of any insurance company or transmits for a perso
n other than himself an application for a policy of insurance to or from such co
mpany or offers or assumes to act in the negotiating of such insurance.
ISSUE: w o n the aisporna is considered an insurance agent and therefor not gui
lty of violating the Insurance act.
RULING:
The second paragraph of Section 189 is a definition and interpretative clause in
tended to qualify the term "agent". Considering that the definition of an insura
nce agent is also applicable to the agent mentioned in the first paragraph, to r
eceive a compensation by the agent is an essential element for a violation of th
e first paragraph of the aforesaid section. The appellate court has established
ultimately that the petitioner-accused did not receive any compensation for the
issuance of the insurance policy of Eugenio Isidro. Nevertheless, the accused wa
s convicted by the appellate court for, according to the latter, the receipt of
compensation for issuing an insurance policy is not an essential element for a v
iolation of the first paragraph of Section 189 of the Insurance Act. It must be
noted that the information, in the case at bar, does not allege that the negotia
tion of an insurance contracts by the accused with Eugenio Isidro was one for co
mpensation. This allegation is essential, and having been omitted, a conviction
of the accused could not be sustained. It is well-settled in Our jurisprudence t
hat to warrant conviction, every element of the crime must be alleged and proved
.
country bankers
COUNTRY BANKERS INSURANCE CORPORATION and IANGA BAY AND COMMUNITY MULTI-PURPOSE
COOPERATIVE, INC. entered into a contract of fire insurance. the petitioner insu
red the respondents stocks-in-trade against fire loss, damage or liability for t
he sum of Two Hundred Thousand Pesos (P200,000.00). During the effectivity of th
e policy, the insured building was gutted by fire and reduced to ashes, resulti
ng in the total loss of the respondents stocks-in-trade, pieces of furnitures and
fixtures, equipments and records. Due to the loss, the respondent filed an insu
rance claim with the petitioner under its Fire Insurance Policy but it was denie
d by country bankers contending that building was set on fire by two (2) NPA re
bels who wanted to obtain canned goods, rice and medicines as provisions for the
ir comrades in the forest, and that such loss was an excepted risk under paragra
ph No. 6 of the policy conditions of Fire Insurance which provides:
That insurance does not cover any loss or damage occasioned by or through or in
consequence, directly or indirectly,any Mutiny, riot, military or popular uprisi
ng, insurrection, rebellion, revolution, military or usurped power.
ISSUE: WON the cause of the loss was an excepted risk under the terms of the fir
e insurance policy and hence exempts the insurance company from liability.
RULING: The petitioners evidence to prove its defense is sadly wanting and thus,
gives rise to its liability to the respondent under Fire Insurance Policy.
since the petitioner is defending on the ground of non-coverage and relying upon
an exception clause in the fire insurance policy, it has the burden of proving
the facts upon which such excepted risk is based. In this case, petitioner faile
d to do so. Where a risk is excepted by the terms of a policy which insures agai
nst other perils or hazards, loss from such a risk constitutes a defense which t
he insurer may urge, since it has not assumed that risk, and from this it follow
s that an insurer seeking to defeat a claim because of an exception or limitatio
n in the policy has the burden of proving that the loss comes within the purview
of the exception or limitation set up. If a proof is made of a loss apparently
within a contract of insurance, the burden is upon the insurer to prove that th
e loss arose from a cause of loss which is excepted or for which it is not liabl
e, or from a cause which limits its liability.
american home
FACTS:
Respondent Tantuco Enterprises, Inc owns two oil mills which were separately cov
ered by fire insurance policies issued by petitioner American Home Assurance Co.
, The first oil mill was insured for three million pesos (P3,000,000.00) and the
other for (P6,000,000.00. A fire that broke out and gutted and consumed the ne
w oil mill. Respondent immediately notified the petitioner of the incident. Th
e latter then sent its appraisers who inspected the burned premises and the prop
erties destroyed. Thereafter, petitioner rejected respondents claim for the ins
urance proceeds on the ground that no policy was issued by it covering the burne
d oil mill. t stated that the description of the insured establishment referred
to another building. A complaint for specific performance and damages was conse
quently instituted by the respondent with the RTC, Branch 53 of Lucena City. aft
er trial, the lower court rendered a Decision finding the petitioner liable on t
he insurance policy.
ISSUE: WON misdescription of of the insured establishment bars the insurer from
recovery of the loss from the insured.
RULING: no. the object of the court in construing a contract is to ascertain the
intent of the parties to the contract and to enforce the agreement which the pa
rties have entered into. In determining what the parties intended, the courts w
ill read and construe the policy as a whole and if possible, give effect to all
the parts of the contract, keeping in mind always, however, the prime rule that
in the event of doubt, this doubt is to be resolved against the insurer.
In construing the words used descriptive of a building insured, the greatest lib
erality is shown by the courts in giving effect to the insurance.[11] In view of
the custom of insurance agents to examine buildings before writing policies upo
n them, and since a mistake as to the identity and character of the building is
extremely unlikely, the courts are inclined to consider that the policy of insur
ance covers any building which the parties manifestly intended to insure, howeve
r inaccurate the description may be.[12]
Notwithstanding, therefore, the misdescription in the policy, it is beyond dispu
te, to our mind, that what the parties manifestly intended to insure was the new
oil mill. This is obvious from the categorical statement embodied in the polic
y, extending its protection. If the parties really intended to protect the first
oil mill, then there is no need to specify it as new.
Indeed, it would be absurd to assume that respondent would protect its first oil
mill for different amounts and leave uncovered its second one.
enriquez vs sun life
FACTS: Petitioner is the administrator of the estate of the late Joaquin Ma. Her
rer. The latter made application to the Sun Life Assurance Company of Canada thr
ough its office in Manila for a life annuity. Two days later he paid the sum of
P6,000 to the manager of the company's Manila office. The application was immed
iately forwarded to the head office of the company at Montreal, Canada. On Novem
ber 26, 1917, the head office gave notice of acceptance by cable to Manila. On D
ecember 4, 1917, the policy was issued at Montreal. On December 18, 1917, attorn
ey Aurelio A. Torres wrote to the Manila office of the company stating that Herr
er desired to withdraw his application. The following day the local office repli
ed to Mr. Torres, stating that the policy had been issued, and called attention
to the notification of November 26, 1917. This letter was received by Mr. Torres
on the morning of December 21, 1917. Mr. Herrer died on December 20, 1917.
ISSUE: whether or not Herrer received notice of acceptance of his application f
or insurance policy and hence there is a perfected contract of insurance.
RULING:
he contract for a life annuity in the case at bar was not perfected because it h
as not been proved satisfactorily that the acceptance of the application ever ca
me to the knowledge of the applicant.
article 1262 of the Civil Code, 5the applicable law in the case provides that an
acceptance made by letter shall not bind the person making the offer except fro
m the time it came to his knowledge. The pertinent fact is, that according to th
e provisional receipt, three things had to be accomplished by the insurance comp
any before there was a contract: (1) There had to be a medical examination of th
e applicant; (2) there had to be approval of the application by the head office
of the company; and (3) this approval had in some way to be communicated by the
company to the applicant. The further admitted facts are that the head office in
Montreal did accept the application, did cable the Manila office to that effect
, did actually issue the policy and did, through its agent in Manila, actually w
rite the letter of notification and place it in the usual channels for transmiss
ion to the addressee. The fact as to the letter of notification thus fails to co
ncur with the essential elements of the general rule pertaining to the mailing a
nd delivery of mail matter as announced by the American courts, namely, when a l
etter or other mail matter is addressed and mailed with postage prepaid there is
a rebuttable presumption of fact that it was received by the addressee as soon
as it could have been transmitted to him in the ordinary course of the mails. Bu
t if any one of these elemental facts fails to appear, it is fatal to the presum
ption. For instance, a letter will not be presumed to have been received by the
addressee unless it is shown that it was deposited in the post-office, properly
addressed and stamped.
great pacific
Great Pacific Life Assurance Co. v Court of Appeals89 SCRA 543April 30, 1979
Facts:Respondent Ngo Hing filed an application with petitioner Great Pacific Lif
e Assurance Company(Pacific Life) for a twenty-year endowment policy in the life
of Helen Go, his one year olddaughter. Petitioner Lapulapu D. Mondragon, the br
anch manager, prepared application formusing the essential data supplied by resp
ondent. The latter paid the annual premium andMondragon retained a portion of it
as his commission. The binding deposit receipt was issued torespondent.Mondrago
n wrote his strong recommendation for the approval of the insurance application.
However, Pacific Life disapproved the application since the plan was not availab
le for minorsbelow 7 years old but it can consider the same under another plan.
The non-acceptance of theinsurance plan was allegedly not communicated by Mondra
gon to respondent. Mondragon againasserted his strong recommendation.Helen Go di
ed of influenza. Thereupon, respondent sought the payment of the proceeds of the
insurance, but having failed in his effort, he filed an action for the recovery
of thesame. Hencethe case at bar.
Issue:Whether or not the insurance contract has been perfected on the ground tha
t a binding receipthas been issued?
Held:NO, it was not perfected. The binding deposit receipt is merely an acknowle
dgement, on behalf of the company, that the latters branch office had received fr
om the applicant the insurancepremium and had accepted the application subject f
or processing by the insurance company; andthat the latter will either approve o
r reject the same on the basis of whether or not the applicant isinsurable on st
andard rates.The binding deposit receipt is merely conditional and does not insu
re outright. Where anagreement is made between the applicant and the agent, no l
iability shall attach until the principalapproves the risk and a receipt is give
n by the agent. The acceptance is merely conditional, andis subordinated to the
act of the company in approving or rejecting the application. Thus, in lifeinsur
ance, a binding slip or binding receipt does not insure by itself

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