1. Calanoc vs CA gr no.

L-8151, dec 16, 1955;

Calanoc v. CA
G.R. No. L-8151 December 16, 1955
J. Bautista Angelo
Doctrine: In case of ambiguity in an insurance contract covering accidental death, the Supreme
Court held that such terms shall be construed strictly against the insurer and liberally in favor of
the insured in order to effect the purpose of indemnity.
Facts:
Melencio Basilio, a watchman of the Manila Auto Supply, secured a life insurance policy
from the Philippine American Insurance Company in the amount of P2,000 to which was
attached a supplemental contract covering death by accident. He later died from a gunshot
wound on the occasion of a robbery committed; subsequently, his widow was paid P2,000
representing the face value of the policy. The widow demanded the payment of the additional
sum of P2,000 representing the value of the supplemental policy which the company refused
because the deceased died by murder during the robbery and while making an arrest as an
officer of the law which were expressly excluded in the contract. The companys contention
which was upheld by the Court of Appeals provides that the circumstances surrounding Basilios
death was caused by one of the risks excluded by the supplementary contract which exempts
the company from liability.
Issue:
Is the Philippine American Life Insurance Co. liable to the petitioner for the amount covered by
the supplemental contract?
Held:
Yes. The circumstances of Basilios death cannot be taken as purely intentional on the
part of Basilio to expose himself to the danger. There is no proof that his death was the result of
intentional killing because there is the possibility that the malefactor had fired the shot merely to
scare away the people around. In this case, the companys defense points out that Basilios is
included among the risks excluded in the supplementary contract; however, the terms and
phraseology of the exception clause should be clearly expressed within the understanding of the
insured. Art. 1377 of the New Civil Code provides that in case ambiguity, uncertainty or
obscurity in the interpretation of the terms of the contract, it shall be construed against the party
who caused such obscurity. Applying this to the situation, the ambiguous or obscure terms in
the insurance policy are to be construed strictly against the insurer and liberally in favor of the
insured party. The reason is to ensure the protection of the insured since these insurance
contracts are usually arranged and employed by experts and legal advisers acting exclusively in
the interest of the insurance company. As long as insurance companies insist upon the use of
ambiguous, intricate and technical provisions, which conceal their own intentions, the courts
must, in fairness to those who purchase insurance, construe every ambiguity in favor of the
insured.
2. Biagtan vs The insular life Assurance Co. Ltd 44 SCRA 583;
NATURE
Appeal from CFIs decision
FACTS
- Juan Biagtan was insured with Insular for P5k and a supplementary contract Accidental Death
Benefit clause for another P5k if "the death of the Insured resulted directly from bodily injury
effected solely through external and violent means sustained in an accident . . . and
independently of all other causes." The clause, however, expressly provided that it would not
apply where death resulted from an injury "intentionally inflicted by a third party."
- One night, a band of robbers entered their house. Juan went out of his room and he was met
with 9 knife stabs. He died. The robbers were convicted of robbery with homicide.
- The family was claiming the additional P5k from Insular under the Accidental Death Benefit
clause. Insular refused on the ground that the death resulted from injuries intentionally inflicted
by 3rd parties and was therefore not covered.
- Biagtans filed against Insular. CFI ruled in favor of Biagtans.
ISSUES & ARGUMENTS
WON the injuries were intentionally inflicted by a third party? Yes
RATIONALE
- Whether the robbers had the intent to kill or merely to scare the victim or to ward off any
defense he might offer, it cannot be denied that the act itself of inflicting the injuries was
intentional.
- The exception in the accidental benefit clause invoked by the appellant does not speak of the
purpose
whether homicidal or not of a third party in causing the injuries, but only of the fact that such
injuries have been "intentionally" inflicted this obviously to distinguish them from injuries
which, although received at the hands of a third party, are purely accidental.
- Examples of unintentional:
>> A gun which discharges while being cleaned and kills a bystander;
>> a hunter who shoots at his prey and hits a person instead;
>> an athlete in a competitive game involving physical effort who collides with an
opponent and fatally injures him as a result.
- In Calanoc vs. CA: Where a shot was fired and it turned out afterwards that the
watchman was hit in the abdomen, the wound causing his death, the Court held that it
could not be said that the killing was intentional for there was the possibility that the
malefactor had fired the shot to scare the people around for his own protection and not
necessarily to kill or hit the victim. A similar possibility is clearly ruled out by the facts in
this case. For while a single shot fired from a distance, and by a person who was not even
seen aiming at the victim, could indeed have been fired without intent to kill or injure, nine
wounds inflicted with bladed weapons at close range cannot conceivably be considered
as innocent insofar as such intent is concerned.
- In Hucthcraft's Ex'r vs. Travelers' Ins. Co. (US case): where the insured was waylaid and
assassinated for the purpose of robbery, the court rendered judgment for the insurance
company and held that while the assassination of the insured was as to him an
unforeseen event and therefore accidental, "the clause of the proviso that excludes the
(insurer's) liability, in case death or injury is intentionally inflicted by any other person,
applies to this case."
3. Finman General Insurance Corp vs CA 213 SCRA 398;
Finman General Assurance Corporation vs. Court of Appeals [GR 100970, 2 September 1992]
Second Division, Nocon (J): 4 concur
Facts: On 22 October 1986, deceased Carlie Surposa was insured with Finman General
Assurance
Corporation under Finman General Teachers Protection Plan Master Policy 2005 and Individual
Policy 08924 with his parents, spouses Julia and Carlos Surposa, and brothers Christopher,
Charles, Chester and Clifton, all surnamed Surposa, as beneficiaries. While said insurance
policy was in full force and effect, the insured, Carlie Surposa, died on 18 October 1988 as a
result of a stab wound inflicted by one of 3 unidentified men without provocation and warning on
the part of the former as he and his cousin, Winston Surposa, were waiting for a ride on their
way home along Rizal-Locsin Streets, Bacolod City after attending the celebration of the
"Maskarra Annual Festival." Thereafter, Julia Surposa and the other beneficiaries of said
insurance policy filed a written notice of claim with Finman which denied said claim contending
that murder and assault are not within the scope of the coverage of the insurance policy. On 24
February 1989, Surposa filed a complaint with the Insurance Commission which subsequently
rendered a decision, ordering Finman liable to pay Surposa the sum of P15,000.00 representing
the proceeds of the policy with interest from the date of the
filing of the complaint until fully satisfied. As no evidence was submitted to prove the claim for
mortuary aid in the sum of P1,000.00, the same was not entertained. On 11 July 1991, the
appellate court affirmed said decision. Finman filed the petition for certiorari.

Issue: Whether the death was committed with deliberate intent which, by the very nature of a
personal accident insurance policy, cannot be indemnified.

Held: NO. The terms "accident" and "accidental," as used in insurance contracts have not
acquired any
technical meaning, and are construed by the courts in their ordinary and common acceptation.
Thus, the terms have been taken to mean that which happen by chance or fortuitously, without
intention and design, and which is unexpected, unusual, and unforeseen. An accident is an
event that takes place without one's foresight or expectation an event that proceeds from an
unknown cause, or is an unusual effect of a known cause and, therefore, not expected. The
generally accepted rule is that, death or injury does not result from accident or accidental means
within the terms of an accident-policy if it is, the natural result of the insured's voluntary act,
unaccompanied by anything unforeseen except the death or injury. There is no accident when a
deliberate act is performed unless some additional, unexpected, independent, and unforeseen
happening occurs which
produces or brings about the result of injury or death. In other words, where the death or injury
is not the natural or probable result of the insured's voluntary act, or if something unforeseen
occurs in the doing of the act which produces the injury, the resulting death is within the
protection of the policies insuring against death or injury from accident. Herein, it cannot be
pretended that Carlie Surposa died in the course of an assault or murder as a result of his
voluntary act considering the very nature of these crimes. In the first place, the insured and his
companion were on their way home from attending a festival. They were confronted by
unidentified persons. The record is barren of any circumstance showing how the stab wound
was inflicted.
Nor can it be pretended that the malefactor aimed at the insured precisely because the killer
wanted to take his life. In any event, while the act may not exempt the unknown perpetrator from
criminal liability, the fact remains that the happening was a pure accident on the part of the
victim. The insured died from an event that took place without his foresight or expectation, an
event that proceeded from an unusual effect of a known cause and, therefore, not expected.
Neither can it be said that there was a capricious desire on the part of the accused to expose
his life to danger considering that he was just going home after attending a festival.
Furthermore, the personal accident insurance policy involved specifically enumerated only 10
circumstances wherein no liability attaches to Finamn for any injury, disability or loss suffered by
the insured as a result of
any of the stipulated causes. The principle of "expresso unius exclusio alterius" the mention
of one thing implies the exclusion of another thing is therefore applicable in the present case
since murder and assault, not having been expressly included in the enumeration of the
circumstances that would negate liability in said insurance policy cannot be considered by
implication to discharge Finman from liability for any injury, disability or loss suffered by the
insured. Thus, the failure of Finman to include death resulting from murder or assault among the
prohibited risks leads inevitably to the conclusion that it did not intend to limit or exempt itself
from liability for such death.

3. Sun Insurance Office vs. CA 211 SCRA 554;
Facts: Sun Insurance Office Ltd. issued Personal Accident Policy 05687 to Felix Lim, Jr. with a
face value of P200,000.00. Two months later, he was dead with a bullet wound in his head. As
beneficiary, his wife Nerissa Lim sought payment on the policy but her claim was rejected. Sun
Insurance agreed that there was no suicide. It argued, however, that there was no accident
either. Pilar Nalagon, Lim's secretary, was the only eyewitness
to his death. It happened on 6 October 1982, at about 10 p.m., after his mother's birthday party.
According to Nalagon, Lim was in a happy mood (but not drunk) and was playing with his
handgun, from which he had previously removed the magazine. As she watched the television,
he stood in front of her and pointed the gun at her. She pushed it aside and said it might be
loaded. He assured her it was not and then pointed it to his temple. The next moment there was
an explosion and Lim slumped to the floor. He was dead before he fell. The widow sued Sun
Insurance in the Regional Trial Court of Zamboanga City and was sustained. Sun Insurance was
sentenced to pay her P200,000.00, representing the face value of the policy, with interest at the
legal rate; P10,000.00 as moral damages; P5,000.00 as exemplary damages; P50,000.00 as
actual and compensatory damages; and P5,000.00 as attorney's fees, plus the cost of the suit.
This decision was affirmed on appeal, and the motion for reconsideration was denied. Sun
Insurance then came to the Supreme Court.
Issue: Whether the insured willfully exposed himself to needless peril and thus removed himself
from the coverage of the insurance policy.
Held: NO. An accident is an event which happens without any human agency or, if happening
through human agency, an event which, under the circumstances, is unusual to and not
expected by the person to whom it happens. It has also been defined as an injury which
happens by reason of some violence or casualty to the insured without his design, consent, or
voluntary co-operation. Herein, the incident that resulted in Lim's death was indeed an accident.
On the other hand, the parties agree that Lim did not commit suicide.
Nevertheless, Sun Insurance contends that the insured willfully exposed himself to needless peril
and thus removed himself from the coverage of the insurance policy. It should be noted at the
outset that suicide and willful exposure to needless peril are in pari materia because they both
signify a disregard for one's life. The only difference is in degree, as suicide imports a positive
act of ending such life whereas the second act indicates a reckless risking of it that is almost
suicidal in intent. The posture -- that by the mere act of pointing the gun to his temple, Lim had
willfully exposed himself to needless peril and so came under the exception -- is arguable. But
what is not is that Lim had removed the magazine from the gun and believed it was no longer
dangerous. He expressed assured her that the gun was not loaded. It is submitted that Lim did
not willfully expose himself to needless peril when he pointed the gun to his temple because the
fact is that he thought it was not unsafe to do so. The act was precisely intended to assure
Nalagon that the gun was indeed harmless. Lim was unquestionably negligent and that
negligence cost him his own life. But it should not prevent his widow from recovering from the
insurance policy he obtained precisely against accident. There is nothing in the policy that
relieves the insurer of the responsibility to pay the indemnity agreed upon if the insured is shown
to have contributed to his own accident. Indeed, most accidents are caused by negligence.
There are only four exceptions expressly made in the contract to relieve the insurer from liability,
and none of these exceptions is applicable in the present case. It bears noting that insurance
contracts are as a rule supposed to be interpreted liberally in favor of the assured. There is no
reason to deviate from this rule, especially in view of the circumstances of the case.

4. Villacorta vs Insurance Commission 100 SCRA 467;
FACTS: Villacorta had her Colt Lancer car insured with Empire Insurance Company against own
damage, theft and 3rd party liability. While the car was in the repair shop, one of the employees
of the said repair shop took it out for a joyride after which it figured in a vehicular accident. This
resulted to the death of the driver and some of the passengers as well as to extensive damage
to the car.Villacorta filed a claim for total loss with the said insurance company. However, it
denied the claim on the ground that the accident did not fall within the provisions of the policy
either for the Own Damage or Theft coverage, invoking the policy provision on Authorized Driver
Clause.This was upheld by the Insurance Commission further stating that the car was not stolen
and therefore not covered by the Theft Clause because it is not evident that the person who took
the car for a joyride intends to permanently deprive the insured of his/ her car.
ISSUE:
Whether or not the insurer company should pay the said claim
HELD:
Yes. Where the insureds car is wrongfully taken without the insureds consent from the car
service and repair shop to whom it had been entrusted for check-up and repairs (assuming that
such taking was for a joy ride, in the course of which it was totally smashed in an accident),
respondent insurer is liable and must pay insured for the total loss of the insured vehicle under
the Theft Clause of the policy.
Assuming, despite the totally inadequate evidence, that the taking was temporary and for a joy
ride, the Court sustains as the better view that which holds that when a person, either with the
object of going to a certain place, or learning how to drive, or enjoying a free ride, takes
possession of a vehicle belonging to another, without the consent of its owner, he is guilty of
theft because by taking possession of the personal property belonging to another and using it,
his intent to gain is evident since he derives therefrom utility, satisfaction, enjoymet and
pleasure. ACCORDINGLY, the appealed decision is set aside and judgment is hereby rendered
sentencing private respondent to pay petitioner the sum of P35,000.00 with legal interest from
the filing of the complaint until full payment is made and to pay the costs of suit.
6. Palermo vs. Pyramid Insurance Co. 161 SCRA 677;
7. Traveller's Ins & Surety Corp vs. CA gr no. 82036, May 22, 1997
8. Geagonia vs. CA 241 SCRA 153;
9. Aisporna vs CA gr no. L-39419, Apr 12, 1982;
10. County Bankers Insurance Corp. vs Lianga Bay, gr no. 136914, Jan. 25, 2002