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Republic of the Philippines
SUPREME COURTManila
EN BANC
DECISION
December 16, 1955
G.R. No. L-8151
VIRGINIA CALANOC, petitioner,vs.
COURT OF APPEALS and THE PHILIPPINE AMERICAN LIFEINSURANCE CO., respondents.
Lucio Javillonar for petitioner.
J. A. Wolfson, Manuel Y. Mecias, Emilio Abello and Anselmo A. Reyes
for respondents.
, J.:
This suit involves the collection of P2,000 representing the value of asupplemental policy covering accidental death which was secured by
one Melencio Basilio from the Philippine American Life Insurance
Company. The case originated in the Municipal Court of Manila and
judgment being favorable to the plaintiff it was appealed to the court
of first instance. The latter court affirmed the judgment but on appeal
to the Court of Appeals the judgment was reversed and the case is
now before us on a petition for review.
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 InsuranceCompany in the amount of P2,000 to which was attached a
supplementary contract covering death by accident. On January 25,
1951, 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 o
P2,000, face value of the policy, but when she demanded the paym
of the additional sum of P2,000 representing the value of the
supplemental policy, the company refused alleging, as main defen
that the deceased died because he was murdered by a person wh
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.
The pertinent facts which need to be considered for the determina
of the questions raised are those reproduced in the decision of th
Court of Appeals as follows:
The circumstances surrounding the death of Melencio Basilio sho
that when he was killed at about seven oclock in the night of Jan
25, 1951, he was on duty as watchman of the Manila Auto Supply
the corner of Avenida Rizal and Zurbaran; that it turned out that
Antonio Ojeda who had his residence at the corner of Zurbaran a
Oroquieta, a block away from Basilios station, had come home thnight and found that his house was well-lighted, but with the
windows closed; that getting suspicious that there were culprits in
house, Atty. Ojeda retreated to look for a policeman and finding
Basilio in khaki uniform, asked him to accompany him to the hou
with the latter refusing on the ground that he was not a policema
but suggesting that Atty. Ojeda should ask the traffic policeman o
duty at the corner of Rizal Avenue and Zurbaran; that Atty. Ojeda
went to the traffic policeman at said corner and reported the mat
asking the policeman to come along with him, to which the police
agreed; that on the way to the Ojeda residence, the policeman and
Atty. Ojeda passed by Basilio and somehow or other invited the la
to come along; that as the tree approached the Ojeda residence a
stood in front of the main gate which was covered with galvanized
iron, the fence itself being partly concrete and partly adobe stone
shot was fired; that immediately after the shot, Atty. Ojeda and th
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policeman sought cover; that the policeman, at the request of Atty.
Ojeda, left the premises to look for reinforcement; that it turned out
afterwards that the special watchman Melencio Basilio was hit in the
abdomen, the wound causing his instantaneous death; that the shot
must have come from inside the yard of Atty. Ojeda, the bullet
passing through a hole waist-high in the galvanized iron gate; that
upon inquiry Atty. Ojeda found out that the savings of his children in
the amount of P30 in coins kept in his aparadorcontained in
stockings were taken away, the aparadorhaving been ransacked; that
a month thereafter the corresponding investigation conducted by the
police authorities led to the arrest and prosecution of four persons in
Criminal Case No. 15104 of the Court of First Instance of Manila for
Robbery in an Inhabited House and in Band with Murder.
It is contended in behalf of the company 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. This contention was
upheld by the Court of Appeals and, in reaching this conclusion,made the following comment:
From the foregoing testimonies, we find that the deceased was a
watchman of the Manila Auto Supply, and, as such, he was not boud
to leave his place and go with Atty. Ojeda and Policeman Magsanoc to
see the trouble, or robbery, that occurred in the house of Atty. Ojeda.
In fact, according to the finding of the lower court, Atty. Ojeda finding
Basilio in uniform asked him to accompany him to his house, but the
latter refused on the ground that he was not a policeman and
suggested to Atty. Ojeda to ask help from the traffic policeman on
duty at the corner of Rizal Avenue and Zurbaran, but after Atty. Ojedasecured the help of the traffic policeman, the deceased went with
Ojeda and said traffic policeman to the residence of Ojeda, and while
the deceased was standing in front of the main gate of said residence,
he was shot and thus died. The death, therefore, of Basilio, although
unexpected, was not caused by an accident, being a voluntary an
intentional act on the part of the one wh robbed, or one of those w
robbed, the house of Atty. Ojeda. Hence, it is out considered opin
that the death of Basilio, though unexpected, cannot be considere
accidental, for his death occurred because he left his post and joi
policeman Magsanoc and Atty. Ojeda to repair to the latters resid
to see what happened thereat. Certainly, when Basilio joined
Patrolman Magsanoc and Atty. Ojeda, he should have realized the
danger to which he was exposing himself, yet, instead of remainin
his place, he went with Atty. Ojeda and Patrolman Magsanoc to s
what was the trouble in Atty. Ojedas house and thus he was fata
shot.
We dissent from the above findings of the Court of Appeals. For o
thing, Basilio was a watchman of the Manila Auto Supply which w
block away from the house of Atty. Ojeda where something suspic
was happening which caused the latter to ask for help. While at fi
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
the traffic policeman, and upon approaching the gate of the resid
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
be taken as a capricious desire on his part to expose his life to da
considering the fact that the place he was in duty-bound to guard
only a block away. In volunteering to extend help under the situa
he might have thought, rightly or wrongly, that to know the truth
in the interest of his employer it being a matter that affects the
security of the neighborhood. No doubt there was some risk comi
him in pursuing that errand, but that risk always existed it beinginherent in the position he was holding. He cannot therefore be
blamed solely for doing what he believed was in keeping with his d
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
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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.
Much less can it be pretended that Basilio died in the course of an
assault or murder considering the very nature of these crimes. In the
first place, 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. Perhaps this may be clarified in the criminal
case now pending in court as regards the incident but before that isdone 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 exempt 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.
We take note that these defenses are included among the risks
excluded in the supplementary contract which enumerates the cases
which may exempt the company from liability. 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 against the one
who has caused the obscurity. (Article 1377, new Civil Code) And so it
has been generally held that the terms in an insurance policy, which
are ambiguous, equivocal, or uncertain . . . are to be construed
strictly and most strongly against the insurer, and liberally in favor of
the insured so as to effect the dominant purpose of indemnity or
payment to the insured, especially where a forfeiture is involved
Am. Jur., 181), and the reason for this rule is that he insured us
has no voice in the selection or arrangement of the words employ
and that the language of the contract is selected with great care a
deliberation by experts and legal advisers employed by, and actin
exclusively in the interest of, the insurance company. (44 C. J. S
1174.)
Insurance is, in its nature, complex and difficult for the layman tunderstand. Policies are prepared by experts who know and can
anticipate the bearings and possible complications of every
contingency. So long as insurance companies insist upon the use
ambiguous, intricate and technical provisions, which conceal rath
than frankly disclose, their own intentions, the courts must, in
fairness to those who purchase insurance, construe every ambigu
in favor of the insured. (Algoe vs. Pacific Mut. L. Ins. Co., 91 Wash
324, LRA 1917A, 1237.)
An insurer should not be allowed, by the use of obscure phrases
exceptions, to defeat the very purpose for which the policy wasprocured. (Moore vs. Aetna Life Insurance Co., LRA 1915D, 264.)
We are therefore persuaded to conclude that the circumstances
unfolded in the present case do not warrant the finding that the d
of the unfortunate victim comes within the purview of the excepti
clause of the supplementary policy and, hence, do not exempt the
company from liability.
Wherefore, reversing the decision appealed from, we hereby order
company to pay petitioner-appellant the amount of P2,000, with l
interest from January 26, 1951 until fully paid, with costs.
Paras, C.J. Bengzon, Padilla, Montemayor, Reyes, A., Jugo, Labra
Concepcion, and Reyes, J. B. L., JJ., concur.
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Republic of the PhilippinesSUPREME COURT
Manila
EN BANC
G.R. No. L-25579 March 29, 1972
EMILIA T. BIAGTAN, JUAN T. BIAGTAN, JR., MIGUEL T.BIAGTAN, GIL T. BIAGTAN and GRACIA T. BIAGTAN,plaintiffs-appellees,
vs.THE INSULAR LIFE ASSURANCE COMPANY, LTD., defendant-appellant.
Tanopo, Millora, Serafica, and Saez for plaintiff-appellees.
Araneta, Mendoza and Papa for defendant-appellant.
MAKALINTAL, J.:p
This is an appeal from the decision of the Court of First Instance of
Pangasinan in its Civil Case No. D-1700.
The facts are stipulated. Juan S. Biagtan was insured with defendantInsularLife 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 P5,000.00if "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 aninjury"intentionally inflicted by another party."
On the night of May 20, 1964, or during the first hours of the
following day a band of robbers entered the house of the insured S. Biagtan. What happened then is related in the decision of the t
court as follows:
...; that on the night of May 20, 1964 or the first houMay 21, 1964, while the said life policy andsupplementary contract were in full force and effect, house of insured Juan S. Biagtan was robbed by a baof robbers who were charged in and convicted by theCourt of First Instance of Pangasinan for robbery withomicide; that in committing the robbery, the robberreaching the staircase landing on the second floor, rutowards the door of the second floor room, where thesuddenly met a person near the door of oneof the roowho turned out to be the insured Juan S. Biagtan whreceived thrusts from their sharp-pointed instrument
causing wounds on the body of said Juan S. Biagtanresulting in his death at about 7 a.m. on the same daMay 21, 1964;
Plaintiffs, as beneficiaries of the insured, filed a claim under thepolicy. The insurance company paid the basic amount of P5,000.but refused to pay the additional sum of P5,000.00 under the
accidental death benefit clause, on the ground that the insured'sdeath resulted from injuries intentionally inflicted by third partiestherefore was not covered. Plaintiffs filed suit to recover, and aftehearing the court a quorendered judgment in their favor. Hence tpresent appeal by the insurer.
The only issue here is whether under the facts are stipulated and
found by the trial court the wounds received by the insured at the
hands of the robbersnine in all, five of them mortal and four nmortalwere inflicted intentionally. The court, in ruling negativ
on the issue, stated that since the parties presented no evidence a
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submitted the case upon stipulation, there was no "proof that the actof receiving thrust (sic) from the sharp-pointed instrument of therobbers was intended to inflict injuries upon the person of the insuredor any other person or merely to scare away any person so as to wardoff any resistance or obstacle that might be offered in the pursuit oftheir main objective which was robbery."
The trial court committed a plain error in drawing the conclusion itdid from the admitted facts. Nine wounds were inflicted upon the
deceased, all by means of thrusts with sharp-pointed instrumentswielded by the robbers. This is a physical fact as to which there is nodispute. So is the fact that five of those wounds caused the death ofthe insured. Whether the robbers had the intent to kill or merely toscare the victim or to ward off any defense he might offer, it cannot bedenied that the act itself of inflicting the injuries was intentional. Itshould be noted that the exception in the accidental benefit clauseinvoked by the appellant does not speak of the purposewhether
homicidal or notof a third party in causing the injuries, but only ofthe 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 constructionis the basic idea expressed in the coverage of the clause itself, namely,that "the death of the insured resulted directly from bodily injuryeffected solely through external and violent means sustained inan accident... and independently of all other causes." A gun which
discharges while being cleaned and kills a bystander; a hunter whoshoots at his prey and hits a person instead; an athlete in a
competitive game involving physical effort who collides with anopponent and fatally injures him as a result: these are instanceswhere the infliction of the injury is unintentional and therefore wouldbe within the coverage of an accidental death benefit clause such asthatin 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 thathis injuries are not intentionally inflicted, regardless of whether theyprove 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 ofCalanoc vs. Court of Appeals, 98 Phil. 79, is relied upothe trial court in support of its decision. The facts in that case,however, are different from those obtaining here. The insured thewas a watchman in a certain company, who happened to be invita policeman to come along as the latter was on his way to investiga reported robbery going on in a private house. As the two of themtogether with the owner of the house, approached and stood in frof the main gate, a shot was fired and it turned out afterwards ththe watchman was hit in the abdomen, the wound causing his de
Under those circumstances this Court held that it could not be sathat the killing was intentional for there was the possibility that tmalefactor had fired the shot to scare people around for his ownprotection and not necessarrily to kill or hit the victim. A similarpossibility is clearly ruled out by the facts in the case now before
For while a single shot fired from a distance, and by a person whonot even seen aiming at the victim, could indeed have been firedwithout intent to kill or injure, nine wounds inflicted with bladedweapons at close range cannot conceivably be considered as innoinsofar as such intent is concerned. The manner of execution of tcrime permits no other conclusion.
Court decisions in the American jurisdiction, where similar provisin accidental death benefit clauses in insurance policies have beeconstrued, may shed light on the issue before Us. Thus, it has beheld that "intentional" as used in an accident policy exceptingintentional injuries inflicted by the insured or any other person, eimplies the exercise of the reasoning faculties, consciousness and
volition. 1 Where a provision of the policy excludes intentional injuit is the intention of the person inflicting the injury that is
controlling. 2 If the injuries suffered by the insured clearly resultefrom the intentional act of a third person the insurer is relieved frliability as stipulated. 3
In the case ofHutchcraft's Ex'r v. Travelers' Ins. Co., 87 Ky. 300, 8
S.W. 570, 12 Am. St. Rep. 484, the insured was waylaid andassassinated for the purpose of robbery. Two (2) defenses wereinterposed to the action to recover indemnity, namely: (1) that theinsured having been killed by intentional means, his death was n
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accidental, and (2) that the proviso in the policy expressly exemptedthe insurer from liability in case the insured died from injuriesintentionally inflicted by another person. In rendering judgment forthe insurance company the Court held that while the assassination ofthe insured was as to him an unforeseen event and thereforeaccidental, "the clause of the proviso that excludes the (insurer's)liability, in case death or injury is intentionally inflicted by anotherperson, applies to this case."
In Butero v. Travelers' Acc. Ins. Co., 96 Wis. 536, 65 Am. St. Rep. 61,71 S.W. 811, the insured was shot three times by a person unknown
late on a dark and stormy night, while working in the coal shed of arailroad company. The policy did not cover death resulting from"intentional injuries inflicted by the insured or any other person." Theinquiry was as to the question whether the shooting that caused theinsured's death was accidental or intentional; and the Court foundthat under the facts, showing that the murderer knew his victim andthat he fired with intent to kill, there could be no recovery under thepolicy which excepted death from intentional injuries inflicted by any
person.
WHEREFORE, the decision appealed from is reversed and thecomplaint dismissed, without pronouncement as to costs.
Zaldivar, Castro, Fernando and Villamor, JJ., concur.
Makasiar, J., reserves his vote.
Separate Opinions
BARREDO, J., concurring
During the deliberations in this case, I entertained some doubts as tothe correctness and validity of the view upheld in the main opinionpenned by Justice Makalintal. Further reflection has convinced me,
however, that there are good reasons to support it.
At first blush, one would feel that every death not suicidal shouldconsidered accidental, for the purposes of an accident insurancepolicy or a life insurance policy with a double indemnity clause incase death results from accident. Indeed, it is quite logical to thinthat any event whether caused by fault, negligence, intent of a thiparty or any unavoidable circumstance, normally unforeseen by tinsured and free from any possible connivance on his part, is anaccident in the generally accepted sense of the term. And if I wereconvinced that in including in the policy the provision in question
both the insurer and the insured had in mind to exclude thereby the coverage of the policy only suicide whether unhelped or helpesomehow by a third party, I would disregard the American decisiocited and quoted in the main opinion as not even persuasiveauthorities. But examining the unequivocal language of the provisin controversy and considering that the insured accepted the poliwithout asking that it be made clear that the phrase "injuryintentionally inflicted by a third party" should be understood to reonly to injuries inflicted by a third party without any wilfulintervention on his part (of the insured) or, in other words, withouany connivance with him (the insured) in order to augment the
proceeds of the policy for his benificiaries, I am inclined to agree tdeath caused by criminal assault is not covered by the policies of kind here in question, specially if the assault, as a matter of fact,could have been more or less anticipated, as when the insuredhappens to have violent enemies or is found in circumstances thawould make his life fair game of third parties.
As to the rest, I have no doubt that the killing of the insured in thcase is as intentional as any intentional act can be, hence thisconcurrence.
TEEHANKEE, J., dissenting:
The sole issue at bar is the correctness in lawof the lower court'sappealed decision adjudging defendant insurance company liableunder its supplementary contract denominated "Accidental DeathBenefit Clause" with the deceased insured, to plaintiffs-beneficiar(excluding plaintiff Emilia T. Biagtan) in an additional amount of
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P5,000.00 (with corresponding legal interest) and ruling thatdefendant company had failed to present any evidence to substantiateits defense that the insured's death came within the stipulatedexceptions.
Defendant's accidental death benefit clause expressly provides:
ACCIDENTAL DEATH BENEFIT. (hereinafter called thebenefit). Upon receipt and approval of due proof that the
death of the Insured resulted directly from bodily injuryeffected solely through external and violent meanssustained in an accident, within ninety days after thedate of sustaining such injury, and independently of allother causes, this Company shall pay, in addition to thesum insured specified on the first page of this Policy, afurther sum equal to said sum insured payable at thesame time and in the same manner as said sum insured,provided, that such death occurred during thecontinuance of this Clause and of this Policy and beforethe sixtieth birthday of the Insured." 1
A long list of exceptions and an Automatic Discontinuance clauseimmediately follow thereafter, thus:
EXCEPTIONS. The Benefit shall not apply if the Insured's
death shall result, either directly or indirectly, from anyone of the following causes:
(1) Self-destructionor self-inflicted injuries, whether theInsured be sane or insane;
(2) Bodily or mental infirmity or diseaseof any kind;
(3) Poisoning or infection, other than infection occurringsimultaneously with and in consequence of a cut orwound sustained in an accident;
(4) Injuries of which there is no visible contusions orwound on the exteriorof the body, drowning and interinjuries revealed by autopsy excepted;
(5) Anyinjuries received(a) while on police dutyin anymilitary, naval or police organization; (b) in anyriot, ccommotion, insurrectionor waror any act incident the(c) while travellingas a passenger or otherwise in anyof submarine transportation, or while engaging in
submarine operations; (d) in any violation of the law bthe Insured or assault provoked by the Insured; (e) thahas beeninflicted intentionally by a third party, either or without provocation on the part of the Insured, anwhether or not the attack or the defense by the third
party was caused by a violation of the law by the Insu
(6) Operating or riding in or descending from any kind aircraftif the Insured is a pilot, officer or member of tcrew of the aircraft or is giving or receiving any kind otraining or instruction or has any duties aboard the
aircraft or requiring descent therefrom; and
(7) Atomic energy explosionof any nature whatsoever
The Company, before making any payment under thiClause, shall have the right and opportunity to examthe body and make an autopsy thereof.
AUTOMATIC DISCONTINUANCE. This Benefitshall automatically terminateand the additional premtherefor shall cease to be payable when and if:
(1) This Policy is surrendered for cash, paid-up insuror extended term insurance; or
(2) The benefit under the Total and Permanent DisabiWaiver of Premium Certificate is granted to the insuror
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(3) The Insured engages in military, naval or aeronauticservice in time of war; or
(4) The policy anniversary immediately preceding thesixtieth birthday of the Insured is reached. 2
It is undisputed that, as recited in the lower court's decision, theinsured met his death, as follows: "that on the night of May 20, 1964or the first hours of May 21, 1964, while the said life policy and
supplementary contract were in full force and effect, the house ofinsured Juan S. Biagtan was robbed by a band of robbers who werecharged in and convicted by the Court of First Instance of Pangasinanfor robbery with homicide; that in committing the robbery, therobbers, on reaching the staircase landing of the second floor, rushedtowards the doors of the second floor room, where they suddenly meta person near the door of one of the rooms who turned out to be theinsured Juan S. Biagtan who received thrust from their sharp-pointedinstruments, causing wounds on the body of said Juan S. Biagtanresulting in his death at about 7 a.m. on the same day, May 21,1964." 3
Defendant company, while admitting the above-recited circumstancesunder which the insured met his death, disclaimed liability under itsaccidental death benefit clause under paragraph 5 of its stipulated"Exceptions" on its theory that the insured's death resulted frominjuries "intentionally inflicted by a third party," i.e. the robbers whobroke into the insured's house and inflicted fatal injuries on him.
The case was submitted for decision upon the parties' stipulation offacts that (1) insurance companies such as the Lincoln National LifeInsurance Co. and Sun Life Assurance Co. of Canada with which thedeceased insured Juan S. Biagtan was also insured for much larger
sums under similar contracts with accidental death benefit provisionshave promptly paid the benefits thereunder to plaintiffs-beneficiaries;(2) the robbers who caused the insured's death were charged in and
convicted by the Court of First Instance of Pangasinan for the crime ofrobbery with homicide; and (3) the injuries inflicted on the insured bythe robbers consisted of five mortal and four non-mortal wounds. 4
The lower court thereafter rendered judgment against defendant, follows:
There is no doubt that the insured, Juan S. Biagtan,his death as a result of the wounds inflicted upon himthe malefactors on the early morning of May 21, 1964means of thrusts from sharp-pointed instrumentsdelivered upon his person, and there is likewise noquestion that the thrusts were made on the occasion
the robbery. However, it is defendants' position that tkilling of the insured was intentionally done by themalefactors, who were charged with and convicted ofcrime of robbery with homicide by the Court of FirstInstance of Pangasinan.
It must be noted here that no evidence whatsoever wpresented by the parties who submitted the case forresolution upon the stipulation of factspresented by th
Thus, the court does not have before it proofthat the areceiving thrust(s) from the sharp-pointed instrumen
the robbers was intended to inflict injuriesupon theperson of the insured or any other person or merely tscare away any person so as to ward off any resistanobstacle that might be offeredin the pursuit of their mobjective which was robbery. It was held that where a
provision of the policy excludes intentional injury, it is intention of the person inflicting the injury that is
controlling ... and to come within the exception, the actwhich causes the injury must be wholly intentional, nomerely partly.
The case at bar has some similarity with the case
ofVirginia Calanoc vs. Court of Appeals, et al., L-8151promulgated December 16, 1965, where the Supreme
Court ruled that "the shot (which killed the insured) wmerely to scare away the people around for his ownprotection and not necessarily to kill or hit the victim
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In the Calanoc case, one Melencio Basilio, a watchman ofa certain company, took out life insurance from thePhilippine American Life Insurance Company in theamount of P2,000.00 to which was attached asupplementary contract covering death by accident.Calanoc died of gunshot wounds on the occasion of arobbery committed in the house of a certain Atty. Ojeda inManila. The insured's widow was paid P2,000.00, the facevalue of the policy, but when she demanded payment of
the additional sum of P2,000.00 representing the value ofthe supplemental policy, the company refused alleging, asmain defense, that the deceased died because he wasmurdered by a person who took part in the commission ofthe robbery and while making an arrest as an officer ofthe law which contingencies were (as in this case)expressly excluded in the contract and have the effect ofexempting the company from liability.
The facts in the Calanoc case insofar as pertinent to this
case are, as found by the Court of Appeals in its decisionwhich findings of fact were adopted by the SupremeCourt, as follows:
"...that on the way to the Ojeda residence(which was then being robbed by armedmen), the policeman and Atty. Ojeda passedby Basilio (the insured) and somehow orother invited the latter to come along; that asthe three approached the Ojeda residenceand stood in front of the main gate which wascovered by galvanized iron, the fence itselfbeing partly concrete and partly adobe stone,
a shot was fired; ... that it turned outafterwards that the special watchman
Melencio Basilio was hit in the abdomen, thewound causing his instantaneous death ..."
The Court of Appeals arrived at the conclusion that tdeath of Basilio, although unexpected, was not causean accident, being a voluntary and intentional act onpart of the one who robbed, or one of those who robbthe house of Atty. Ojeda.
In reversing this conclusion of the Court of Appeals, tSupreme Court said in part:
"... Nor can it be said that the killing wasintentional for there is the possibility thamalefactors had fired the shot merely to away the people around for his ownprotection and not necessarily to kill or hthe victim. In any event, while the act maexempt the triggerman from ability for thedamage done, the fact remains that thehappening was a pure accidentt on the pathe victim."
With this ruling of the Supreme Court, and the utterabsence of evidence in this case as to the real intentiothe malefactorsin making a thrust with their sharp-pointed instrument on any person, the victim inparticular, the case falls squarely within the ruling inCalanoc vs. Court of Appeals case.
It is the considered view of this Court that theinsured died because of an accidentwhich happened the occasion of the robbery being committed in hishouse. His death was not sought (at least no evidencepresented to show it was), and therefore was fortuitou
"Accident" was defined as that which happens by chaor fortuitously, without intention or design, and which unexpected, unusual and unforeseen, or that which taplace without one's foresight or expectationan eventhat proceeds from an unknown cause, or is an unus
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effect of a known cause, and therefore not expected. (29Am. Jur. 706).
There is no question that the defense set up by thedefendant company is one of those included among therisks excluded in the supplementary contract. However,there is no evidence here that the thrusts with sharp-pointed instrument(which led to the death of theinsured) was "intentional," (sic) so as to exempt the
company from liability. It could safely be assumed that itwas purely accidentalconsidering that the principal
motive of the culprits was robbery, the thrusts beingmerely intended to scare away persons who might offerresistance or might obstruct them from pursuing theirmain objective which was robbery. 5
It is respectfully submitted that the lower court committed no error inlaw in holding defendant insurance company liable to plaintiffs-beneficiaries under its accidental death benefit clause, by virtue of thefollowing considerations:
1. The case ofCalanoccited by the lower court is indeed controlling
here. 6 This Court, there construing a similar clause, squarely ruledthat fatal injuries inflicted upon an insured by a malefactor(s) duringthe latter's commission of a crime are deemed accidental and withinthe coverage of such accidental death benefit clauses and the burdenof proving that the killing was intentional so as to have it fall withinthe stipulated exception of having resulted from injuries "intentionallyinflicted by a third party" must be discharged by the insurancecompany. This Court there clearly held that in such cases where the
killing does not amount to murder, it must be held to be a "pureaccident" on the part of the victim, compensable with double-
indemnity, even though the malefactor is criminally liable for his act.This Court rejected the insurance-company's contrary claim, thus:
Much less can it be pretended that Basilio died in thecourse of an assault or murder considering the verynature of these crimes. In the first place, there is no proof
that the death of Basilio is the result of either crimefor the record is barren of any circumstance showing hthe fatal shot was fired. Perhaps this may be clarifiedthe criminal case now pending in court a regards theincident but before that is done anything that might bsaid on the point would be a mere conjecture. Nor ca
be said that the killing was intentional for there is thepossibility that the malefactor had fired the shot merelscare away the people aroundfor his own protection
not necessarily to kill or hit the victim. In any event,the act may not exempt the triggerman from liabilityfodamage done, the fact remains that the happening wapure accident on the part of the victim. The victim couhave been either the policeman or Atty. Ojeda for itcannot be pretended that the malefactor aimed at thedeceased precisely because he wanted to take his life
2. Defendant company patently failed to discharge its burden ofproving that the fatal injuries were inflicted upon thedeceased intentionally, i.e. deliberately. The lower court correctly that since the case was submitted upon the parties' stipulation offacts which did not cover the malefactors' intent at all, there was "utter absence of evidence in this case as to the real intention of tmalefactors in making a thrust with their sharp-pointed instrumeon any person, the victim in particular." From the undisputedfacts, supra, 8 the robbers had "rushed towards the doors of thesecond floor room, where they suddenly met a person ... who turnout to be the insured Juan S. Biagtan who received thrusts from pointed instruments." The thrusts were indeed properly termed"purely accidental" since they seemed to be a reflex action on therobbers' part upon their being surprised by the deceased. To argudefendant does, that the robbers' intent to kill must necessarily b
deduced from the four mortal wounds inflicted upon the deceasedto beg the question. Defendant must suffer the consequences of itfailure to discharge its burden of proving by competent evidence, the robbers' or eyewitnesses' testimony, that the fatal injurieswere intentionally inflicted upon the insuredso as to exempt itself liability.
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3. Furthermore, plaintiffs-appellees properly assert in their brief thatthe sole error assigned by defendant company, to wit, that the fatalinjuries were not accidental as held by the lower court but should beheld to have been intentionally inflicted, raises a question of factwhich defendant is now barred from raising, since it expressly limitedits appeal to this Court purely "on questions of law", per its noitice ofappeal, 9 Defendant is therefore confined to "raising only questions oflaw" and "no other questions" under Rule 42, section 2 of the Rules ofCourt 10 and is deemed to have conceded the findings of fact of the
trial court, since he thereby waived all questions of facts. 11
4. It has long been an established rule of construction of so-calledcontracts of adhesion such as insurance contracts, where the insuredis handed a printed insurance policy whose fine-print language haslong been selected with great care and deliberation by specialists andlegal advisers employed by and acting exclusively in the interest of theinsurance company, that the terms and phraseology of the policy,particularly of any exception clauses, must be clearly expressed so asto be easily understood by the insured and any "ambiguous, equivocal
or uncertain terms" are to be "construed strictly and most stronglyagainst the insurer and liberally in favor of the insured so as to effect
the dominant purpose of indemnity or payment to the insured,especially where a forfeiture is involved.
The Court so expressly held in Calanocthat:
... While as a general rule "the parties may limit thecoverage of the policy to certain particular accidents andrisks or causes of loss, and may expressly except otherrisks or causes of loss therefrom" (45 C.J.S. 781-782),
however, it is to be desired that the terms andphraseology ofthe exception clause be clearly expressed
so as to be within the easy grasp and understanding of theinsured, for if the terms are doubtful or obscure the samemust of necessity be interpreted or resolved against theone who has caused the obscurity. (Article 1377, newCivil Code) And so it has been generally held that the"terms in an insurance policy, which are ambiguous,
equivocal, or uncertain ... are to be construed strictly most strongly against the insurer, and liberally in favothe insured so as to effect the dominant purpose ofindemnity or payment to the insured, especially whereforfeiture is involved" (29 AM. Jur., 181), and the reasfor this rule is that the "insured usually has no voice i
selection or arrangement of the words employedand tthe language of the contract is selected with great carand deliberation by experts and legal advisers employ
by, and acting exclusively in the interest of, the insurcompany." (44 C.J.S., p. 1174)
Insurance is, in its nature, complex and difficult for thelayman to understand. Policies are prepared byexpertswho know and can anticipate the bearing andpossible complications of every contingency.So long ainsurance companies insist upon the use of ambiguousintricate and technical provisions, which conceal rathethan frankly disclose, their own intentions, the courtsmust, in fairness to those who purchase insuranceconstrue every ambiguity in favor of the insured." (Algvs. Pacific Mut. L. Ins. Co., 91 Wash. 324 LRA 1917A1237.)
"An insurershould not be allowed, by the use ofobscphrases and exceptions, to defeat the very purpose forwhich the policy was procured." (Moore vs. Aetna Life
Insurance Co., LRA 1915D, 164). 12
The Court has but recently reiterated this doctrine in Landicho vsGSIS13 and again applied the provisions of Article 1377 of our CivCode that "The interpretation of obscure words or stipulations in
contract shall not favor the party who caused the obscurity."
5. The accidental death benefit clause assuring the insured'sbeneficiaries of double indemnity, upon payment of an extrapremium, in the event that the insured meets violent accidental dis contractually stipulated as follows in the policy: "that the death
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the insured resulted directly from bodily injuryeffected solely throughexternal and violent meanssustained in an accident," supra. Thepolicy then lists numerous exceptions, which may be classified asfollows:
Injuries effected through non-external meanswhich are excepted:self-destruction, bodily or mental infirmity or disease, poisoning orinfection, injuries with no visiblecontusions or exterior wounds(exceptions 1 to 4 of policy clause);
Injuries caused by some act of the insured which is proscribedbythe policy, and are therefore similarly exepted: injuries received whileon police duty, while travelling in any form of submarinetransportation, or in any violation of law by the insured or assaultprovoked by the insured, or in any aircraft if the insured is a pilot orcrew member; [exceptions 5 (a), (c) and (d), and 6 of the policy clause];and
Accidents expressly excluded: where death resulted in any riot, civilcommotion, insurrection or war or atomic energy explosion.(Exceptions 5[b] and 7 of policy clause).
The only exception which is notsusceptible of classification is thatprovided in paragraph 5 (e), the very exception herein involved, whichwould also except injuries "inflicted intentionally by a third party,either with or without provocationon the part of the insured,and whether or notthe attack or the defense by the third partywas caused by a violation of the law by the insured."
This ambiguous clause conflicts with all the other four exceptions inthe same paragraph 5 particularly that immediately preceding it initem (d) which excepts injuries received where the insured has
violated the law or provoked the injury, while this clause, construedas the insurance company now claims, would seemingly exceptalso all other injuries, intentionally inflicted by a third party, regardlessof any violation of law or provocation by the insured, and defeat thevery purpose of the policy of giving the insured double indemnity in
case of accidental death by "external and violent means"in the language of the policy."
It is obvious from the very classification of the exceptions andapplying the rule ofnoscitus a sociisthat the double-indemnity pocovers the insured against accidental death, whether caused by fanegligence or intent of a third party which is unforeseen andunexpected by the insured. All the associated words and conceptsthe policy plainly exclude the accidental death from the coverage
the policy only where the injuries are self-inflicted or attended bysome proscribed act of the insured or are incurred in some expre
excluded calamity such as riot, war or atomic explosion.
Finally, the untenability of herein defendant insurer's claim that tinsured's death fell within the exception is further heightened by stipulated fact that two other insurance companies which likewiscovered the insured for which larger sums under similar accidentdeath benefit clauses promptly paid the benefits thereof to plaintibeneficiaries.
I vote accordingly for the affirmance in totoof the appealed decisiowith costs against defendant-appellant.
Concepcion, C.J. and Reyes, J.B.L., J., concur.
Separate Opinions
BARREDO, J., concurring
During the deliberations in this case, I entertained some doubts athe correctness and validity of the view upheld in the main opiniopenned by Justice Makalintal. Further reflection has convinced m
however, that there are good reasons to support it.
At first blush, one would feel that every death not suicidal shouldconsidered accidental, for the purposes of an accident insurancepolicy or a life insurance policy with a double indemnity clause in
case death results from accident. Indeed, it is quite logical to thin
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that any event whether caused by fault, negligence, intent of a thirdparty or any unavoidable circumstance, normally unforeseen by theinsured and free from any possible connivance on his part, is anaccident in the generally accepted sense of the term. And if I wereconvinced that in including in the policy the provision in question,both the insurer and the insured had in mind to exclude thereby fromthe coverage of the policy only suicide whether unhelped or helpedsomehow by a third party, I would disregard the American decisionscited and quoted in the main opinion as not even persuasive
authorities. But examining the unequivocal language of the provisionin controversy and considering that the insured accepted the policywithout asking that it be made clear that the phrase "injuryintentionally inflicted by a third party" should be understood to referonly to injuries inflicted by a third party without any wilfulintervention on his part (of the insured) or, in other words, withoutany connivance with him (the insured) in order to augment theproceeds of the policy for his benificiaries, I am inclined to agree thatdeath caused by criminal assault is not covered by the policies of thekind here in question, specially if the assault, as a matter of fact,could have been more or less anticipated, as when the insuredhappens to have violent enemies or is found in circumstances thatwould make his life fair game of third parties.
As to the rest, I have no doubt that the killing of the insured in thiscase is as intentional as any intentional act can be, hence this
concurrence.
TEEHANKEE, J., dissenting:
The sole issue at bar is the correctness in lawof the lower court'sappealed decision adjudging defendant insurance company liable,under its supplementary contract denominated "Accidental Death
Benefit Clause" with the deceased insured, to plaintiffs-beneficiaries(excluding plaintiff Emilia T. Biagtan) in an additional amount ofP5,000.00 (with corresponding legal interest) and ruling thatdefendant company had failed to present any evidence to substantiateits defense that the insured's death came within the stipulatedexceptions.
Defendant's accidental death benefit clause expressly provides:
ACCIDENTAL DEATH BENEFIT. (hereinafter called thbenefit). Upon receipt and approval of due proof that death of the Insured resulted directly from bodily injueffected solely through external and violent meanssustained in an accident, within ninety days after thedate of sustaining such injury, and independently of other causes, this Company shall pay, in addition to
sum insured specified on the first page of this Policy,further sum equal to said sum insured payable at thesame time and in the same manner as said sum insuprovided, that such death occurred during thecontinuance of this Clause and of this Policy and befothe sixtieth birthday of the Insured." 1
A long list of exceptions and an Automatic Discontinuance clauseimmediately follow thereafter, thus:
EXCEPTIONS. The Benefit shall not apply if the Insur
death shall result, either directly or indirectly, from aone of the following causes:
(1) Self-destructionor self-inflicted injuries, whether thInsured be sane or insane;
(2) Bodily or mental infirmity or diseaseof any kind;
(3) Poisoning or infection, other than infection occurrisimultaneously with and in consequence of a cut orwound sustained in an accident;
(4) Injuries of which there is no visible contusions orwound on the exteriorof the body, drowning and interinjuries revealed by autopsy excepted;
(5) Anyinjuries received(a) while on police dutyin anymilitary, naval or police organization; (b) in anyriot, c
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commotion, insurrectionor waror any act incident thereto;(c) while travellingas a passenger or otherwise in any formof submarine transportation, or while engaging insubmarine operations; (d) in any violation of the law bythe Insured or assault provoked by the Insured; (e) thathas beeninflicted intentionally by a third party, either with
or without provocation on the part of the Insured, andwhether or not the attack or the defense by the third
party was caused by a violation of the law by the Insured;
(6) Operating or riding in or descending from any kind ofaircraftif the Insured is a pilot, officer or member of thecrew of the aircraft or is giving or receiving any kind oftraining or instruction or has any duties aboard theaircraft or requiring descent therefrom; and
(7) Atomic energy explosionof any nature whatsoever.
The Company, before making any payment under thisClause, shall have the right and opportunity to examinethe body and make an autopsy thereof.
AUTOMATIC DISCONTINUANCE. This Benefitshall automatically terminateand the additional premiumtherefor shall cease to be payable when and if:
(1) This Policy is surrendered for cash, paid-up insurance
or extended term insurance; or
(2) The benefit under the Total and Permanent DisabilityWaiver of Premium Certificate is granted to the insured;or
(3) The Insured engages in military, naval or aeronauticservice in time of war; or
(4) The policy anniversary immediately preceding thesixtieth birthday of the Insured is reached. 2
It is undisputed that, as recited in the lower court's decision, theinsured met his death, as follows: "that on the night of May 20, 1or the first hours of May 21, 1964, while the said life policy andsupplementary contract were in full force and effect, the house ofinsured Juan S. Biagtan was robbed by a band of robbers who wecharged in and convicted by the Court of First Instance of Pangasfor robbery with homicide; that in committing the robbery, therobbers, on reaching the staircase landing of the second floor, rustowards the doors of the second floor room, where they suddenly
a person near the door of one of the rooms who turned out to be tinsured Juan S. Biagtan who received thrust from their sharp-poinstruments, causing wounds on the body of said Juan S. Biagtanresulting in his death at about 7 a.m. on the same day, May 21,1964." 3
Defendant company, while admitting the above-recited circumstaunder which the insured met his death, disclaimed liability under
accidental death benefit clause under paragraph 5 of its stipulate"Exceptions" on its theory that the insured's death resulted from
injuries "intentionally inflicted by a third party," i.e. the robbers wbroke into the insured's house and inflicted fatal injuries on him.
The case was submitted for decision upon the parties' stipulationfacts that (1) insurance companies such as the Lincoln National LInsurance Co. and Sun Life Assurance Co. of Canada with which deceased insured Juan S. Biagtan was also insured for much largsums under similar contracts with accidental death benefit provishave promptly paid the benefits thereunder to plaintiffs-beneficia(2) the robbers who caused the insured's death were charged in aconvicted by the Court of First Instance of Pangasinan for the crimrobbery with homicide; and (3) the injuries inflicted on the insurethe robbers consisted of five mortal and four non-mortal wounds
The lower court thereafter rendered judgment against defendant, follows:
There is no doubt that the insured, Juan S. Biagtan,his death as a result of the wounds inflicted upon him
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the malefactors on the early morning of May 21, 1964 bymeans of thrusts from sharp-pointed instrumentsdelivered upon his person, and there is likewise noquestion that the thrusts were made on the occasion ofthe robbery. However, it is defendants' position that thekilling of the insured was intentionally done by themalefactors, who were charged with and convicted of thecrime of robbery with homicide by the Court of FirstInstance of Pangasinan.
It must be noted here that no evidence whatsoever was
presented by the parties who submitted the case forresolution upon the stipulation of factspresented by them.
Thus, the court does not have before it proofthat the act ofreceiving thrust(s) from the sharp-pointed instrument ofthe robbers wasintended to inflict injuriesupon the personof the insured or any other person or merely to scareaway any person so as to ward off any resistance orobstacle that might be offeredin the pursuit of their mainobjective which was robbery. It was held that where aprovision of the policy excludes intentional injury, it is theintention of the person inflicting the injury that iscontrolling ... and to come within the exception, the actwhich causes the injury must be wholly intentional, notmerely partly.
The case at bar has some similarity with the case
ofVirginia Calanoc vs. Court of Appeals, et al., L-8151,promulgated December 16, 1965, where the Supreme
Court ruled that "the shot (which killed the insured) wasmerely to scare away the people around for his ownprotection and not necessarily to kill or hit the victim."
In the Calanoc case, one Melencio Basilio, a watchman of
a certain company, took out life insurance from thePhilippine American Life Insurance Company in theamount of P2,000.00 to which was attached asupplementary contract covering death by accident.
Calanoc died of gunshot wounds on the occasion of arobbery committed in the house of a certain Atty. OjeManila. The insured's widow was paid P2,000.00, thevalue of the policy, but when she demanded paymentthe additional sum of P2,000.00 representing the valuthe supplemental policy, the company refused alleginmain defense, that the deceased died because he wasmurdered by a person who took part in the commissithe robbery and while making an arrest as an officer
the law which contingencies were (as in this case)expressly excluded in the contract and have the effecexempting the company from liability.
The facts in the Calanoc case insofar as pertinent to case are, as found by the Court of Appeals in its deciswhich findings of fact were adopted by the SupremeCourt, as follows:
"...that on the way to the Ojeda residence(which was then being robbed by armedmen), the policeman and Atty. Ojeda pasby Basilio (the insured) and somehow orother invited the latter to come along; thathe three approached the Ojeda residencand stood in front of the main gate whichcovered by galvanized iron, the fence itsebeing partly concrete and partly adobe sta shot was fired; ... that it turned outafterwards that the special watchmanMelencio Basilio was hit in the abdomen,wound causing his instantaneous death
The Court of Appeals arrived at the conclusion that tdeath of Basilio, although unexpected, was not causean accident, being a voluntary and intentional act onpart of the one who robbed, or one of those who robbthe house of Atty. Ojeda.
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In reversing this conclusion of the Court of Appeals, theSupreme Court said in part:
"... Nor can it be said that the killing wasintentional for there is the possibility that themalefactors had fired the shot merely to scareaway the people around for his ownprotection and not necessarily to kill or hitthe victim. In any event, while the act may not
exempt the triggerman from ability for thedamage done, the fact remains that the
happening was a pure accidentt on the part ofthe victim."
With this ruling of the Supreme Court, and the utterabsence of evidence in this case as to the real intention ofthe malefactorsin making a thrust with their sharp-pointed instrument on any person, the victim inparticular, the case falls squarely within the ruling in theCalanoc vs. Court of Appeals case.
It is the considered view of this Court that theinsured died because of an accidentwhich happened onthe occasion of the robbery being committed in hishouse. His death was not sought (at least no evidence waspresented to show it was), and therefore was fortuitous."Accident" was defined as that which happens by chanceor fortuitously, without intention or design, and which isunexpected, unusual and unforeseen, or that which takesplace without one's foresight or expectationan event
that proceeds from an unknown cause, or is an unusualeffect of a known cause, and therefore not expected. (29
Am. Jur. 706).
There is no question that the defense set up by thedefendant company is one of those included among therisks excluded in the supplementary contract. However,there is no evidence here that the thrusts with sharp-
pointed instrument(which led to the death of theinsured) was "intentional," (sic) so as to exempt thecompany from liability. It could safely be assumed thawas purely accidentalconsidering that the principalmotive of the culprits was robbery, the thrusts beingmerely intended to scare away persons who might off
resistance or might obstruct them from pursuing themain objective which was robbery. 5
It is respectfully submitted that the lower court committed no errlaw in holding defendant insurance company liable to plaintiffs-
beneficiaries under its accidental death benefit clause, by virtue ofollowing considerations:
1. The case ofCalanoccited by the lower court is indeed controllihere. 6 This Court, there construing a similar clause, squarely rulthat fatal injuries inflicted upon an insured by a malefactor(s) durthe latter's commission of a crime are deemed accidental and withthe coverage of such accidental death benefit clauses and the burof proving that the killing was intentional so as to have it fall withthe stipulated exception of having resulted from injuries "intentio
inflicted by a third party" must be discharged by the insurancecompany. This Court there clearly held that in such cases where killing does not amount to murder, it must be held to be a "pureaccident" on the part of the victim, compensable with double-
indemnity, even though the malefactor is criminally liable for his This Court rejected the insurance-company's contrary claim, thu
Much less can it be pretended that Basilio died in thecourse of an assault or murder considering the very
nature of these crimes. In the first place, there is no pthat the death of Basilio is the result of either crime
for the record is barren of any circumstance showing hthe fatal shot was fired. Perhaps this may be clarifiedthe criminal case now pending in court a regards theincident but before that is done anything that might bsaid on the point would be a mere conjecture. Nor cabe said that the killing was intentional for there is the
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possibility that the malefactor had fired the shot merely toscare away the people aroundfor his own protection andnot necessarily to kill or hit the victim. In any event, whilethe act may not exempt the triggerman from liabilityfor thedamage done, the fact remains that the happening was apure accident on the part of the victim. The victim could
have been either the policeman or Atty. Ojeda for itcannot be pretended that the malefactor aimed at the
deceased precisely because he wanted to take his life. 7
2. Defendant company patently failed to discharge its burden ofproving that the fatal injuries were inflicted upon thedeceased intentionally, i.e. deliberately. The lower court correctly heldthat since the case was submitted upon the parties' stipulation offacts which did not cover the malefactors' intent at all, there was an"utter absence of evidence in this case as to the real intention of themalefactors in making a thrust with their sharp-pointed instrument(s)on any person, the victim in particular." From the undisputedfacts, supra, 8 the robbers had "rushed towards the doors of thesecond floor room, where they suddenly met a person ... who turnedout to be the insured Juan S. Biagtan who received thrusts from their
pointed instruments." The thrusts were indeed properly termed"purely accidental" since they seemed to be a reflex action on therobbers' part upon their being surprised by the deceased. To argue, asdefendant does, that the robbers' intent to kill must necessarily bededuced from the four mortal wounds inflicted upon the deceased isto beg the question. Defendant must suffer the consequences of itsfailure to discharge its burden of proving by competent evidence, e.g.the robbers' or eyewitnesses' testimony, that the fatal injurieswere intentionally inflicted upon the insuredso as to exempt itself fromliability.
3. Furthermore, plaintiffs-appellees properly assert in their brief thatthe sole error assigned by defendant company, to wit, that the fatalinjuries were not accidental as held by the lower court but should beheld to have been intentionally inflicted, raises a question of factwhich defendant is now barred from raising, since it expressly limited
its appeal to this Court purely "on questions of law", per its noitice of
appeal, 9 Defendant is therefore confined to "raising only questionlaw" and "no other questions" under Rule 42, section 2 of the RulCourt 10 and is deemed to have conceded the findings of fact of thtrial court, since he thereby waived all questions of facts. 11
4. It has long been an established rule of construction of so-calledcontracts of adhesion such as insurance contracts, where the insis handed a printed insurance policy whose fine-print language hlong been selected with great care and deliberation by specialists
legal advisers employed by and acting exclusively in the interest oinsurance company, that the terms and phraseology of the policyparticularly of any exception clauses, must be clearly expressed sto be easily understood by the insured and any "ambiguous, equior uncertain terms" are to be "construed strictly and most stronglagainst the insurer and liberally in favor of the insured so as to efthe dominant purpose of indemnity or payment to the insured,especially where a forfeiture is involved.
The Court so expressly held in Calanocthat:
... While as a general rule "the parties may limit the
coverage of the policy to certain particular accidents risks or causes of loss, and may expressly except othrisks or causes of loss therefrom" (45 C.J.S. 781-782however, it is to be desired that the terms andphraseology ofthe exception clause be clearly expressso as to be within the easy grasp and understanding oinsured, for if the terms are doubtful or obscure the smust of necessity be interpreted or resolved against tone who has caused the obscurity. (Article 1377, new
Civil Code) And so it has been generally held that the"terms in an insurance policy, which are ambiguous,
equivocal, or uncertain ... are to be construed strictly most strongly against the insurer, and liberally in favothe insured so as to effect the dominant purpose ofindemnity or payment to the insured, especially whereforfeiture is involved" (29 AM. Jur., 181), and the reasfor this rule is that the "insured usually has no voice i
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selection or arrangement of the words employedand thatthe language of the contract is selected with great careand deliberation by experts and legal advisers employedby, and acting exclusively in the interest of, the insurancecompany." (44 C.J.S., p. 1174)
Insurance is, in its nature, complex and difficult for thelayman to understand. Policies are prepared byexpertswho know and can anticipate the bearing and
possible complications of every contingency.So long asinsurance companies insist upon the use of ambiguous,intricate and technical provisions, which conceal ratherthan frankly disclose, their own intentions, the courtsmust, in fairness to those who purchase insuranceconstrue every ambiguity in favor of the insured." (Algoevs. Pacific Mut. L. Ins. Co., 91 Wash. 324 LRA 1917A,1237.)
"An insurershould not be allowed, by the use ofobscurephrases and exceptions, to defeat the very purpose forwhich the policy was procured." (Moore vs. Aetna Life
Insurance Co., LRA 1915D, 164). 12
The Court has but recently reiterated this doctrine in Landicho vs.GSIS13 and again applied the provisions of Article 1377 of our CivilCode that "The interpretation of obscure words or stipulations in acontract shall not favor the party who caused the obscurity."
5. The accidental death benefit clause assuring the insured'sbeneficiaries of double indemnity, upon payment of an extrapremium, in the event that the insured meets violent accidental deathis contractually stipulated as follows in the policy: "that the death of
the insured resulted directly from bodily injuryeffected solely throughexternal and violent meanssustained in an accident," supra. Thepolicy then lists numerous exceptions, which may be classified asfollows:
Injuries effected through non-external meanswhich are excepteself-destruction, bodily or mental infirmity or disease, poisoning oinfection, injuries with no visiblecontusions or exterior wounds(exceptions 1 to 4 of policy clause);
Injuries caused by some act of the insured which is proscribedbthe policy, and are therefore similarly exepted: injuries received won police duty, while travelling in any form of submarinetransportation, or in any violation of law by the insured or assault
provoked by the insured, or in any aircraft if the insured is a pilotcrew member; [exceptions 5 (a), (c) and (d), and 6 of the policy claand
Accidents expressly excluded: where death resulted in any riotcommotion, insurrection or war or atomic energy explosion.(Exceptions 5[b] and 7 of policy clause).
The only exception which is notsusceptible of classification is thaprovided in paragraph 5 (e), the very exception herein involved, wwould also except injuries "inflicted intentionally by a third party,either with or without provocationon the part of the insured,
and whether or notthe attack or the defense by the third partywas caused by a violation of the law by the insured."
This ambiguous clause conflicts with all the other four exceptionsthe same paragraph 5 particularly that immediately preceding it iitem (d) which excepts injuries received where the insured hasviolated the law or provoked the injury, while this clause, construas the insurance company now claims, would seemingly exceptalso all other injuries, intentionally inflicted by a third party, regard
of any violation of law or provocation by the insured, and defeat thvery purpose of the policy of giving the insured double indemnity
case of accidental death by "external and violent means"in the language of the policy."
It is obvious from the very classification of the exceptions andapplying the rule ofnoscitus a sociisthat the double-indemnity pocovers the insured against accidental death, whether caused by fa
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negligence or intent of a third party which is unforeseen andunexpected by the insured. All the associated words and concepts inthe policy plainly exclude the accidental death from the coverage ofthe policy only where the injuries are self-inflicted or attended bysome proscribed act of the insured or are incurred in some expresslyexcluded calamity such as riot, war or atomic explosion.
Finally, the untenability of herein defendant insurer's claim that theinsured's death fell within the exception is further heightened by the
stipulated fact that two other insurance companies which likewisecovered the insured for which larger sums under similar accidentaldeath benefit clauses promptly paid the benefits thereof to plaintiffs-beneficiaries.
I vote accordingly for the affirmance in totoof the appealed decision,with costs against defendant-appellant.
Concepcion, C.J. and Reyes, J.B.L., J., concur.
Footnotes
1 Berger v. Pacific Mut. life Ins. Co., 88 F. 241, 242.
2 Traveler's Protective Ass'n. of America vs. Fawcett, 104N.E. 991, 50 Ind. App. 111.
3 Continental Cas. Co. v. Klinge, 82 Ind. App. 277, 144N.E. 246; Washington v. Union C. & Sur. Co., 115 Mo.App. 627, 91 S.C. 998; National L & Accidents Co. v. DeLopez (Tex. Civ. App.), 207 S.W. 160.
Teehankee, J., dissenting.
1 Rec. on Appeal, pp. 7-8, emphasis furnished.
2 Idem, pp. 8-10, emphasis furnished.
3 Idem, pp. 46-47.
4 Idem, pp. 37-38.
5 Idem, pp. 49-54, emphasis furnished.
6 98 Phil. 79.
7 Idem, at page 83, emphasis furnished.
8 At page 3.
9 Rec. on Appeal, p. 56.
10 "SEC 2. Appeal on pure question of law.Where appellant states in his notice of appeal or record onappeal that he will raise only questions of law, no othquestions shall be allowed, and the evidence need noelevated." (Rule 42).
11 See 2 Moran's Comments on Rules of Court, 1970pp. 456-457 and cases cited therein.
12 Emphasis furnished.
13 L-28866, prom. March 17, 1972, per Concepcion,
and cases cited therein.
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Republic of the PhilippinesSUPREME COURT
Manila
SECOND DIVISION
G.R. No. 100970 September 2, 1992
FINMAN GENERAL ASSURANCE CORPORATION, petitioner,vs.THE HONORABLE COURT OF APPEALS and JULIASURPOSA, respondents.
Aquino and Associates for petitioner.
Public Attorney's Office for private respondent.
NOCON, J.:
This is a petition for certiorariwith a prayer for the issuance of arestraining order and preliminary mandatory injunction to annul andset aside the decision of the Court of Appeals dated July 11,1991, 1 affirming the decision dated March 20, 1990 of the InsuranceCommission 2 in ordering petitioner Finman General AssuranceCorporation to pay private respondent Julia Surposa the proceeds ofthe personal accident Insurance policy with interest.
It appears on record that on October 22, 1986, deceased, CarlieSurposa was insured with petitioner Finman General AssuranceCorporation under Finman General Teachers Protection Plan MasterPolicy 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, asbeneficiaries. 3
While said insurance policy was in full force and effect, the insureCarlie Surposa, died on October 18, 1988 as a result of a stab woinflicted by one of the three (3) unidentified men without provocatand warning on the part of the former as he and his cousin, WinsSurposa, were waiting for a ride on their way home along Rizal-LoStreets, Bacolod City after attending the celebration of the "Maska
Annual Festival."
Thereafter, private respondent and the other beneficiaries of saidinsurance policy filed a written notice of claim with the petitionerinsurance company which denied said claim contending that murand assault are not within the scope of the coverage of the insurapolicy.
On February 24, 1989, private respondent filed a complaint with Insurance Commission which subsequently rendered a decision, pertinent portion of which reads:
In the light of the foregoing. we find respondent liablepay complainant the sum of P15,000.00 representingproceeds of the policy with interest. As no evidence wsubmitted to prove the claim for mortuary aid in the
of P1,000.00, the same cannot be entertained.
WHEREFORE, judgment is hereby rendered orderingrespondent to pay complainant the sum of P15,000.0with legal interest from the date of the filing of thecomplaint until fully satisfied. With costs. 4
On July 11, 1991, the appellate court affirmed said decision.
Hence, petitioner filed this petition alleging grove abuse of discreton the part of the appellate court in applying the principle of"expresso unius exclusio alterius" in a personal accident insurancepolicy since death resulting from murder and/or assault are impl
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excluded in said insurance policy considering that the cause of deathof the insured was not accidental but rather a deliberate andintentional act of the assailant in killing the former as indicated bythe location of the lone stab wound on the insured. Therefore, saiddeath was committed with deliberate intent which, by the very natureof a personal accident insurance policy, cannot be indemnified.
We do not agree.
The terms "accident" and "accidental" as used ininsurance contracts have not acquired any technicalmeaning, and are construed by the courts in theirordinary and common acceptation. Thus, the terms havebeen taken to mean that which happen by chance orfortuitously, without intention and design, and which isunexpected, unusual, and unforeseen. An accident is anevent that takes place without one's foresight orexpectationan event that proceeds from an unknowncause, or is an unusual effect of a known cause and,therefore, not expected.
. . . The generally accepted rule is that, death or injurydoes not result from accident or accidental means withinthe terms of an accident-policy if it is the natural result ofthe insured's voluntary act, unaccompanied by anythingunforeseen except the death or injury. There is noaccident when a deliberate act is performed unless someadditional, unexpected, independent, and unforeseenhappening occurs which produces or brings about theresult of injury or death. In other words, where the deathor injury is not the natural or probable result of theinsured's voluntary act, or if something unforeseenoccurs in the doing of the act which produces the injury,the resulting death is within the protection of the policiesinsuring against death or injury from accident. 5
As correctly pointed out by the respondent appellate court in itsdecision:
In the case at bar, it cannot be pretended that CarlieSurposa died in the course of an assault or murder aresult of his voluntary act considering the very naturthese crimes. In the first place, the insured and hiscompanion were on their way home from attending afestival. They were confronted by unidentified person
The record is barren of any circumstance showing hothe stab wound was inflicted. Nor can it be pretendedthe malefactor aimed at the insured precisely becaus
killer wanted to take his life. In any event, while the amay not exempt the unknown perpetrator from crimiliability, the fact remains that the happening was a paccident on the part of the victim. The insured died fran event that took place without his foresight orexpectation, an event that proceeded from an unusuaeffect of a known cause and, therefore, not expected.Neither can it be said that where was a capricious deon the part of the accused to expose his life to dangerconsidering that he was just going home after attendifestival. 6
Furthermore, the personal accident insurance policy involved herspecifically enumerated only ten (10) circumstances wherein noliability attaches to petitioner insurance company for any injury,disability or loss suffered by the insured as a result of any of the
stimulated causes. The principle of " expresso unius exclusio alterthe mention of one thing implies the exclusion of another thing
is therefore applicable in the instant case since murder and assaunot having been expressly included in the enumeration of thecircumstances that would negate liability in said insurance policycannot be considered by implication to discharge the petitionerinsurance company from liability for, any injury, disability or losssuffered by the insured. Thus, the failure of the petitioner insurancompany to include death resulting from murder or assault amonthe prohibited risks leads inevitably to the conclusion that it did nintend to limit or exempt itself from liability for such death.
Article 1377 of the Civil Code of the Philippines provides that:
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The interpretation of obscure words or stipulations in acontract shall not favor the party who caused theobscurity.
Moreover,
it is well settled that contracts of insurance are to beconstrued liberally in favor of the insured and strictlyagainst the insurer. Thus ambiguity in the words of an
insurance contract should be interpreted in favor of itsbeneficiary. 7
WHEREFORE, finding no irreversible error in the decision of therespondent Court of Appeals, the petition forcertiorariwith restrainingorder and preliminary injunction is hereby DENIED for lack of merit.
SO ORDERED.
Narvasa, C.J., Padilla, Regalado and Melo, JJ., concur.
Footnotes
1 Rollo, pp. 12-17. Ponente: Justice Luis L. Victor with theconcurrence of Justice Santiago M. Kapunan and JusticeSegundino G. Chua.
2 Original Record, pp. 50-54. Penned by InsuranceCommissioner Adelita A. Vergel de Dios.
3 Id., at pp. 2-5.
4 Id.. at p. 50.
5 De la Cruz vs. Capital Insurance & Surety Co., Inc., 17SCRA 559 [1966].
6 Rollo, pp. 15-16.
7 National Power Corporation vs. Court of Appeals, 1
SCRA 533 [1986].
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Republic of the PhilippinesSUPREME COURT
Manila
FIRST DIVISION
G.R. No. 85296 May 14, 1990
ZENITH INSURANCE CORPORATION, petitioner,vs.COURT OF APPEALS and LAWRENCE FERNANDEZ, respondents.
Vicente R. Layawen for petitioner.
Lawrence L. Fernandez & Associates for private respondent.
MEDIALDEA, J.:
Assailed in this petition is the decision of the Court of Appeals in CA-G.R. C.V. No. 13498 entitled, "Lawrence L. Fernandez, plaintiff-appellee v. Zenith Insurance Corp., defendant-appellant" whichaffirmed in totothe decision of the Regional Trial Court of Cebu,Branch XX in Civil Case No. CEB-1215 and the denial of petitioner'sMotion for Reconsideration.
The antecedent facts are as follows:
On January 25, 1983, private respondent Lawrence Fernandezinsured his car for "own damage" under private car Policy No. 50459
with petitioner Zenith Insurance Corporation. On July 6, 1983, thecar figured in an accident and suffered actual damages in the amountof P3,640.00. After allegedly being given a run around by Zenith for
two (2) months, Fernandez filed a complaint with the Regional TriCourt of Cebu for sum of money and damages resulting from therefusal of Zenith to pay the amount claimed. The complaint wasdocketed as Civil Case No. CEB-1215. Aside from actual damagesinterests, Fernandez also prayed for moral damages in the amounP10,000.00, exemplary damages of P5,000.00, attorney's fees ofP3,000.00 and litigation expenses of P3,000.00.
On September 28, 1983, Zenith filed an answer alleging that it off
to pay the claim of Fernandez pursuant to the terms and conditiothe contract which, the private respondent rejected. After the issuhad been joined, the pre-trial was scheduled on October 17, 1983the same was moved to November 4, 1983 upon petitioner's motioallegedly to explore ways to settle the case although at an amounlower than private respondent's claim. On November 14, 1983, thtrial court terminated the pre-trial. Subsequently, Fernandezpresented his evidence. Petitioner Zenith, however, failed to prese
its evidence in view of its failure to appear in court, without justifreason, on the day scheduled for the purpose. The trial court issu
an order on August 23, 1984 submitting the case for decision witZenith's evidence (pp. 10-11, Rollo). Petitioner filed a petition
for certiorariwith the Court of Appeals assailing the order of the tcourt submitting the case for decision without petitioner's evidenc
The petition was docketed as C.A.-G.R. No. 04644. However, thepetition was denied due course on April 29, 1986 (p. 56, Rollo).
On June 4, 1986, a decision was rendered by the trial court in favprivate respondent Fernandez. The dispositive portion of the trialcourt's decision provides:
WHEREFORE, defendant is hereby ordered to pay to plaintiff:
1. The amount of P3,640.00 representing the damageincurred plus interest at the rate of twice the prevaili
interest rates;
2. The amount of P20,000.00 by way of moral damag
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3. The amount of P20,000.00 by way of exemplarydamages;
4. The amount of P5,000.00 as attorney's fees;
5. The amount of P3,000.00 as litigation expenses; and
6. Costs. (p. 9, Rollo)
Upon motion of Fernandez and before the expiration of the period toappeal, the trial court, on June 20, 1986, ordered the execution of thedecision pending appeal. The order was assailed by petitioner in apetition forcertiorariwith the Court of Appeals on October 23, 1986 inC.A. G.R. No. 10420 but which petition was also dismissed onDecember 24, 1986 (p. 69, Rollo).
On June 10, 1986, petitioner filed a notice of appeal before the trialcourt. The notice of appeal was granted in the same order grantingprivate respondent's motion for execution pending appeal. The appealto respondent court assigned the following errors:
I. The lower court erred in denying defendant appellant toadduce evidence in its behalf.
II. The lower court erred in ordering Zenith Insurance
Corporation to pay the amount of P3,640.00 in itsdecision.
III. The lower court erred in awarding moral damages,
attorneys fees and exemplary damages, the worst is that,the court awarded damages more than what are prayedfor in the complaint. (p. 12,Rollo)
On August 17, 1988, the Court of Appeals rendered its decisionaffirming in totothe decision of the trial court. It also ruled that thematter of the trial court's denial of Fernandez's right to adduceevidence is a closed matter in view of its (CA) ruling in AC-G.R. 04644wherein Zenith's petition questioning the trial court's order
submitting the case for decision without Zenith's evidence, wasdismissed.
The Motion for Reconsideration of the decision of the Court of Apdated August 17, 1988 was denied on September 29, 1988, for lamerit. Hence, the instant petition was filed by Zenith on October 1988 on the allegation that respondent Court of Appeals' decisionresolution ran counter to applicable decisions of this Court and ththey were rendered without or in excess of jurisdiction. The issue
raised by petitioners in this petition are:
a) The legal basis of respondent Court of Appeals inawarding moral damages, exemplary damages andattomey's fees in an amount more than that prayed fthe complaint.
b) The award of actual damages of P3,460.00 insteadonly P1,927.50 which was arrived at after deductingP250.00 and P274.00 as deductible franchise and 20depreciation on parts as agreed upon in the contract
insurance.
Petitioner contends that while the complaint of private respondenprayed for P10,000.00 moral damages, the lower court awarded tthe amount, or P20,000.00 without factual or legal basis; while
private respondent prayed for P5,000.00 exemplary damages, thecourt awarded P20,000.00; and while private respondent prayed P3,000.00 attorney's fees, the trial court awarded P5,000.00.
The propriety of the award of moral damages, exemplary damagesattorney's fees is the main issue raised herein by petitioner.
The award of damages in case of unreasonable delay in the paymof insurance claims is governed by the Philippine Insurance Codewhich provides:
Sec. 244. In case of any litigation for the enforcementany policy or contract of insurance, it shall be the du
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the Commissioner or the Court, as the case may be, tomake a finding as to whether the payment of the claim ofthe insured has been unreasonably denied or withheld;and in the affirmative case, the insurance company shallbe adjudged to pay damages which shall consist ofattomey's fees and other expenses incurred by theinsured person by reason of such unreasonable denial orwithholding of payment plus interest of twice the ceilingprescribed by the Monetary Board of the amount of the
claim due the insured, from the date following the timeprescribed in section two hundred forty-two or in sectiontwo hundred forty-three, as the case may be, until theclaim is fully satisfied; Provided, That the failure to payany such claim within the time prescribed in saidsections shall be consideredprima facieevidence ofunreasonable delay in payment.
It is clear that under the Insurance Code, in case of unreasonabledelay in the payment of the proceeds of an insurance policy, the
damages that may be awarded are: 1) attorney's fees; 2) otherexpenses incurred by the insured person by reason of such
unreasonable denial or withholding of payment; 3) interest at twicethe ceiling prescribed by the Monetary Board of the amount of theclaim due the injured; and 4) the amount of the claim.
As regards the award of moral and exemplary damages, the rulesunder the Civil Code of the Philippines shall govern.
"The purpose of moral damages is essentially indemnity or reparation,not punishment or correction. Moral damages are emphatically not
intended to enrich a complainant at the expense of a defendant, theyare awarded only to enable the injured party to obtain means,diversions or amusements that will serve to alleviate the moralsuffering he has undergone by reason of the defendant's culpableaction." (J. Cezar S. Sangco, Philippine Law on Torts and Damages,Revised Edition, p. 539) (See also R and B Surety & Insurance Co.,Inc. v. IAC, G.R. No. 64515, June 22, 1984; 129 SCRA 745). While itis true that no proof of pecuniary loss is necessary in order that moral
damages may be adjudicated, the assessment of which is left to thdiscretion of the court according to the circumstances of each cas(Art. 2216, New Civil Code), it is equally true that in awarding modamages in case of breach of contract, there must be