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    G.R. No. 186983

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    1. Manuel Florendo applied for a comprehensive pension plan with Philam Plans in 1997. However, when he died in 1998, Philam Plans denied the claim from Manuel's wife Lourdes, as Manuel had concealed illnesses like heart conditions and diabetes. 2. The court ruled that Manuel was guilty of concealing his illnesses by leaving blank the questions about treatments in the application. He was also bound by the false information his friend Perla provided, as he certified she was authorized to fill it out. 3. However, the one-year contestability period in the plan had not expired, so Philam Plans was not precluded from denying the claim despite initially approving the application.

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    G.R. No. 186983

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    1. Manuel Florendo applied for a comprehensive pension plan with Philam Plans in 1997. However, when he died in 1998, Philam Plans denied the claim from Manuel's wife Lourdes, as Manuel had concealed illnesses like heart conditions and diabetes. 2. The court ruled that Manuel was guilty of concealing his illnesses by leaving blank the questions about treatments in the application. He was also bound by the false information his friend Perla provided, as he certified she was authorized to fill it out. 3. However, the one-year contestability period in the plan had not expired, so Philam Plans was not precluded from denying the claim despite initially approving the application.

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    1. Manuel Florendo applied for a comprehensive pension plan with Philam Plans in 1997. However, when he died in 1998, Philam Plans denied the claim from Manuel's wife Lourdes, as Manuel had concealed illnesses like heart conditions and diabetes. 2. The court ruled that Manuel was guilty of concealing his illnesses by leaving blank the questions about treatments in the application. He was also bound by the false information his friend Perla provided, as he certified she was authorized to fill it out. 3. However, the one-year contestability period in the plan had not expired, so Philam Plans was not precluded from denying the claim despite initially approving the application.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    52 views3 pages

    G.R. No. 186983

    Uploaded by

    Abby
    1. Manuel Florendo applied for a comprehensive pension plan with Philam Plans in 1997. However, when he died in 1998, Philam Plans denied the claim from Manuel's wife Lourdes, as Manuel had concealed illnesses like heart conditions and diabetes. 2. The court ruled that Manuel was guilty of concealing his illnesses by leaving blank the questions about treatments in the application. He was also bound by the false information his friend Perla provided, as he certified she was authorized to fill it out. 3. However, the one-year contestability period in the plan had not expired, so Philam Plans was not precluded from denying the claim despite initially approving the application.

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    © All Rights Reserved
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    of 3

    G.R. No.

    186983, February 22, 2012

    FACTS:

    On October 23, 1997 Manuel Florendo filed an application for comprehensive pension
    plan with respondent Philam Plans after some convincing by respondent Perla Abcede.
    The plan had a pre-need price of ₱997,050.00, payable in 10 years, and had a maturity
    value of ₱2,890,000.00 after 20 years. Manuel signed the application and left to Perla
    the task of supplying the information needed in the application.Respondent Ma. Celeste
    Abcede, Perla’s daughter, signed the application as sales counselor.

    Aside from pension benefits, the comprehensive pension plan also provided life
    insurance coverage to Florendo.This was covered by a Group Master Policy that Philam
    Life issued to Philam Plans. Under the master policy, Philam Life was to automatically
    provide life insurance coverage, including accidental death, to all who signed up for
    Philam Plans’ comprehensive pension plan.

    On September 15, 1998, Manuel died of blood poisoning. Subsequently, Manuel’s wife
    Lourdes filed a claim with Philam Plans for the payment of the benefits under her
    husband’s plan. However, Philam Plans declined Lourdes’ claim. Apparently, Philam Life
    found that Manuel was on maintenance medicine for his heart and had an implanted
    pacemaker. Further, he suffered from diabetes mellitus and was taking insulin.

    Lourdes renewed her demand for payment under the planbut Philam Plans rejected
    it,prompting her to file action against the pension plan company.
    The RTC ruled in favor of Lourdes. However, the Court of Appeals (CA) reversed the
    RTC decision, holding that insurance policies are traditionally contracts uberrimae fidae
    or contracts of utmost good faith. As such, it required Manuel to disclose to Philam
    Plans conditions affecting the risk of which he was aware or material facts that he knew
    or ought to know.

    ISSUES:

    1. Whether or not Manuel is guilty of concealing his illness when he kept blank and did
    not answer questions in his pension plan application regarding the ailments he suffered
    from

    2. Whether or not Manuel was bound by the failure of respondents Perla and Ma.
    Celeste to declare the condition of his health in the pension plan application; and

    3. Whether or not Philam Plans’ approval of Manuel’s pension plan application and
    acceptance of his premium payments precluded it from denying Lourdes’ claim.

    RULING:

    Yes, Manuel is guilty of concealing his illness.

    Since Manuel signed the application without filling in the details regarding his continuing
    treatments for heart condition and diabetes, the assumption is that he has never been
    treated for the said illnesses in the last five years preceding his application. This is
    implicit from the phrase “If your answer to any of the statements above (specifically,
    the statement: I have never been treated for heart condition or diabetes) reveal
    otherwise, please give details in the space provided for.” But this is untrue since he had
    been on “Coumadin,” a treatment for venous thrombosis,and insulin, a drug used in the
    treatment of diabetes mellitus, at that time.

    2. Yes, Manuel was bound by the failure of respondents Perla and Ma. Celeste to
    declare the condition of his health in the pension plan application.

    Lourdes contends that the mere fact that Manuel signed the application in blank and let
    Perla fill in the required details did not make her his agent and bind him to her
    concealment of his true state of health. But, Manuel forgot that in signing the pension
    plan application, he certified that he wrote all the information stated in it or had
    someone do it under his direction.

    Assuming that it was Perla who filled up the application form, Manuel is still bound by
    what it contains since he certified that he authorized her action. Philam Plans had every
    right to act on the faith of that certification.

    3. No, Philam Plans’ approval of Manuel’s pension plan application and acceptance of
    his premium payments precluded it from denying Lourdes’ claim.

    The comprehensive pension plan that Philam Plans issued contains a one-year
    incontestability period. Since Manuel died on the eleventh month following the issuance
    of his plan, the one year incontestability period has not yet set in. Consequently, Philam
    Plans was not barred from questioning Lourdes’ entitlement to the benefits of her
    husband’s pension plan.

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