TAN VS. COURT OF APPEALS

174 SCRA 403 (G.R. NO. 48049)

JUNE 29, 1989

Petitioner:          Emilio Tan, Juanito Tan, Alberto Tan

                                and Arturo Tan

Respondent:      Court of Appeals and the Philippine American

                                Life Insurance Company

J. Gutierrez Jr.:

FACTS:

On September 23, 1973, Tan Lee Siong, father of herein petitioners, applied for life insurance in the amount of ₱ 80,000.00 with respondent Philippine American Life Insurance Company. Said application was approved and Policy No. 1082467 was issued effective November 6, 1973, with petitioners the beneficiaries thereof.

On April 26, 1975, Tan Lee Siong died of Hepatoma. Petitioner then filed with respondent company their claim for the proceeds of the life insurance policy. However, in a letter dated September 11, 1975, respondent company denied petitioner’s claim and rescinded the policy by reason of the alleged misrepresentation and concealment of material facts made by the deceased Tan Lee Siong in his application for insurance. The premium paid on the policy were thereupon refunded.

Petitioners filed on November 27, 1975, a complaint against the former with Office of the Insurance Commissioner.

The petitioners contend that the respondet company no longer had the right to rescind the contract of insurance as rescission must allegedly be done during the lifetime of the insured within two years and prior to the commencement of action.

ISSUE:

Whether the respondent company had the right to rescind the contract of insurance as rescission must allegedly be done during the lifetime of the insured within two years and prior to the commencement of action.

HELD:

The contention is without merit. The so-called “incontestability clause” precludes the insurer from raising the defenses of false representations or concealment of material facts insofar as health and previous diseases are concerned if the insurance has been in force for at least two years during the insured’s lifetime. The phrase “during the lifetime” found in Section 48 simply means that the policy is no longer considered in force after the insured has died. The key phrase in the second paragraph of Section 48 is “for a period of two years.”

As noted by the Court of Appeals, to wit: “The policy was issued on November 6, 1973 and the insured died on April 26, 1975. The policy was thus in force for a period of only one year and five months. Considering that the insured died before the two-year period had lapsed, respondent company is not, therefore, barred from proving that the policy is void ab initio by reason of the insured’s fraudulent concealment or misrepresentation. Moreover, respondent company rescinded the contract of insurance and refunded the premiums paid on September 11, 1975, previous to the commencement of this action on November 27, 1975.”

The insurer has two years from the date of issuance of the insurance contract or of its last reinstatement within which to contest the policy, whether or not, the insured still lives within such period. After two years, the defenses of concealment or misrepresentation, no matter how patent or well founded, no longer lie. Congress felt this was a sufficient answer to the various tactics employed by insurance companies to avoid liability. The petitioners’ interpretation would give rise to the incongruous situation where the beneficiaries of an insured who dies right after taking out and paying for a life insurance policy, would be allowed to collect on the policy even if the insured fraudulently concealed material facts.

Beginning in 2014, many U.S. insurers will no longer be allowed to charge women higher premiums simply because of their gender, President Barack Obama said.

Obama, in a proclamation for National Women’s Health Week May 13-19, said women often play a leading role in making medical decisions for their families, and their own healthcare needs have too often gone unmet.

“As president, I have made advancing gender equality in health care a top priority. Beginning in 2014, many insurers will no longer be allowed to charge women higher premiums simply because of their gender, and it will be illegal for most insurance companies to deny coverage to women because they have a pre-existing condition, including cancer or pregnancy,” Obama said in the statement.

“Health plans will also be required to cover maternity care. The law already enables women in new insurance plans to see any primary care provider or OB-GYN, or bring their children to any pediatrician in their health plan’s network without a referral.”

Under the Affordable Care Act, out-of-pocket costs for recommended preventive services such as mammograms, cervical cancer screenings, contraception and well-woman visits were eliminated under most plans, Obama said.

In 2011 alone, more than 20 million women received expanded access to these services at no additional cost, Obama added.

GREAT PACIFIC LIFE ASSURANCE CORP. VS. COURT OF APPEALS

316 SCRA 677 (G.R. NO. 113899)

OCTOBER 13, 1999

Petitioner:          Great Pacific Life Assurance Corp.

Respondent:      Court of Appeals and Medarda v. Eleuterio

J. Quisumbing:

FACTS:

A contract of group life insurance was executed between petitioner Great Pacific Life Assurance Corporation and Development Bank of the Philippines. Grepalife agreed to insure the lives of eligible housing loan mortgagors of DBP.

On November 11, 1983, Dr. Wilfredo Leuterio, a physician and a housing debtor of DBP applied for membership in the group life plan. In an application form, Dr. Leuterio answered the questions concerning his health conditions as follows:

“7. Have you ever had, or consulted, a physiciam for a heart condition, high blood pressure, cancer, diabetes, lung, kidney, or stomach disorder or any other physical impairment?

Answer: No.  If so give details _________

8. Are you now to the the best of your knowledge, in good health?

Answer [x] Yes [  ] No.”

On November 15, 1983, Grepalife issued Certificate No. B-18558 as insurance coverage of Dr. Leuterio, to the extent of his DBP mortgage indebtedness amounting to ₱ 86,200.00.

On August 6, 1984, Dr. Leuterio died due to “massive cerebral hemorrhage.” Consequently, DBP submitted a death claim at Grepalife. Grepalife denied the claim alleging that Dr. Leuterio was not physically healthy when he applied for an insurance coverage on November 15, 1983. Grepalife insisted that Dr. Leuterio  did not disclose he had been suffering from hypertension, which caused his death. Allegedly, such non-disclosure constituted concealment that justified the denial of the claim.

ISSUE:

1)      Whether the Court of Appeals erred in holding petitioner liable to DBP as beneficiary in a group life insurance contract from a complaint filed by the widow of the decedent/mortgagor?

2)      Whether the Court of Appeals erred in not finding that Dr. Leuterio concealed that he had hypertension, which would vitiate the insurance contract?

3)      Whether the Court of Appeals erred in holding Grepalife liable in the amount of eighty six thousand, two hundred (P86,200.00) pesos without proof of the actual outstanding mortgage payable by the mortgagor to DBP.

HELD

On the first issue the Court held, that we must consider the insurable interest in mortgaged properties and the parties to this type of contract. The rationale of a group insurance policy of mortgagors, otherwise known as the “mortgage redemption insurance,” is a device for the protection of both the mortgagee and the mortgagor. On the part of the mortgagee, it has to enter into such form of contract so that in the event of the unexpected demise of the mortgagor during the subsistence of the mortgage contract, the proceeds from such insurance will be applied to the payment of the mortgage debt, thereby relieving the heirs of the mortgagor from paying the obligation. In a similar vein, ample protection is given to the mortgagor under such a concept so that in the event of death; the mortgage obligation will be extinguished by the application of the insurance proceeds to the mortgage indebtedness. Consequently, where the mortgagor pays the insurance premium under the group insurance policy, making the loss payable to the mortgagee, the insurance is on the mortgagor’s interest, and the mortgagor continues to be a party to the contract. In this type of policy insurance, the mortgagee is simply an appointee of the insurance fund, such loss-payable clause does not make the mortgagee a party to the contract.

The insured private respondent did not cede to the mortgagee all his rights or interests in the insurance, the policy stating that: “In the event of the debtor’s death before his indebtedness with the Creditor [DBP] shall have been fully paid, an amount to pay the outstanding indebtedness shall first be paid to the creditor and the balance of sum assured, if there is any, shall then be paid to the beneficiary/ies designated by the debtor.” When DBP submitted the insurance claim against petitioner, the latter denied payment thereof, interposing the defense of concealment committed by the insured. Thereafter, DBP collected the debt from the mortgagor and took the necessary action of foreclosure on the residential lot of private respondent. In Gonzales La O vs. Yek Tong Lin Fire & Marine Ins. Co. we held: “Insured, being the person with whom the contract was made, is primarily the proper person to bring suit thereon. * * * Subject to some exceptions, insured may thus sue, although the policy is taken wholly or in part for the benefit of another person named or unnamed, and although it is expressly made payable to another as his interest may appear or otherwise. * * * Although a policy issued to a mortgagor is taken out for the benefit of the mortgagee and is made payable to him, yet the mortgagor may sue thereon in his own name, especially where the mortgagee’s interest is less than the full amount recoverable under the policy, * * *.’ And in volume 33, page 82, of the same work, we read the following: ‘Insured may be regarded as the real party in interest, although he has assigned the policy for the purpose of collection, or has assigned as collateral security any judgment he may obtain.

The second assigned error refers to an alleged concealment that the petitioner interposed as its defense to annul the insurance contract. Petitioner contends that Dr. Leuterio failed to disclose that he had hypertension, which might have caused his death. Concealment exists where the assured had knowledge of a fact material to the risk, and honesty, good faith, and fair dealing requires that he should communicate it to the assured, but he designedly and intentionally withholds the same.

The fraudulent intent on the part of the insured must be established to entitle the insurer to rescind the contract. Misrepresentation as a defense of the insurer to avoid liability is an affirmative defense and the duty to establish such defense by satisfactory and convincing evidence rests upon the insurer. In the case at bar, the petitioner failed to clearly and satisfactorily establish its defense, and is therefore liable to pay the proceeds of the insurance.

On the third issue in the case at bar. Petitioner claims that there was no evidence as to the amount of Dr. Leuterio’s outstanding indebtedness to DBP at the time of the mortgagor’s death. Hence, for private respondent’s failure to establish the same, the action for specific performance should be dismissed. Petitioner’s claim is without merit. A life insurance policy is a valued policy. Unless the interest of a person insured is susceptible of exact pecuniary measurement, the measure of indemnity under a policy of insurance upon life or health is the sum fixed in the policy.

We noted that the Court of Appeals’ decision was promulgated on May 17, 1993. In private respondent’s memorandum, she states that DBP foreclosed in 1995 their residential lot, in satisfaction of mortgagor’s outstanding loan. Considering this supervening event, the insurance proceeds shall inure to the benefit of the heirs of the deceased person or his beneficiaries. Equity dictates that DBP should not unjustly enrich itself at the expense of another (Nemo cum alterius detrimenio protest). Hence, it cannot collect the insurance proceeds, after it already foreclosed on the mortgage. The proceeds now rightly belong to Dr. Leuterio’s heirs represented by his widow, herein private respondent Medarda Leuterio.

Trade unions can be defined as union of personnel that look for, through communal negotiation with company to:

• progress and provide job security
• advance and look after the real salary of their members
• provide a hall for improved working environment or conditions
• Protect workforce against undue discharge and other issues relating to employment legislation
• recommend a range of other work-related services

With specific professions, industries, trades, individual trade unions have previously been linked. Certain examples of trade unions which are still on the go comprise of those linked with flight attendants, teachers and lecturers, bakers, food and allied workers, communication workers and those linked to the transport and general workers. All these work for the welfare of the people and community as a whole.

Trade unions play varied roles but the two chief roles or functions of a trade union are to symbolize their associates and to better bargain with the company.  Augmented bargaining and cooperation authority which is emerged from acting together as a group or a union is the basic notion behind a trade union.

 “Unity is strength” is basically the statement for trade unions. The affiliation between employer/trade unions has always been one of disagreement. Nevertheless, in other cases or situations, unions and employers council have a positive productive bond. From the company’s point of view, unionization can have many advantages/pros, as well.

In helping a business undergo significant change the trade union can be a supportive partner. In between the employees and the business, unions are part of the communiqué progression.  Also, rather than talking it out or discussing with all employees separately, bargaining with trade unions save time and cost.  If employees know that their wellbeing is being confined by trade unions, their self-esteem and incentive may be enhanced.

There had been a major decline in union membership in the UK sometime back in 2008. Among the masses in the UK, only 28 percent of the people had been trade union’s members. The aforementioned percentage is from varied sectors whereas; in private sector the percentage is much lower than 28 percent even. In private sector less than one in six employees is the member of the union. Nonetheless, Unionization is much elevated in the public sector which is over 50 percent.

 There are many reasons for the turn down in trade unions’ membership but most important are mentioned below.

 There has been an elevated expansion in the number of small firms which don’t feel the need for the trade union. They don’t believe in recognizing the necessity of it. Fewer perceived need for communal bartering due to an enhanced employee participation in the administrative center. A downfall in service in manufacturing is seen where union membership stands out as it plays a pretty vital role. Also, boost in service in the service sector where unions are less well recognized. Lastly, noteworthy expansion in lithe working places which may be temporary, part-time or seasonal. At these places employees require less need for union security.

Contacting a trade union in your country wil help you to understand more about the unemployment benefits for 2012 (Danish agents say dagpenge 2012). Good luck!

80 SCRA 181 (G.R. NO. L-44059)

OCTOBER 28, 1977

Petitioner/Appellant:     Carponia T. Ebrado and Pascuala Vda. De Ebrado

Respondent/Appellee:  The Insular Life Assurance Company, Ltd.

J. Martin:

FACTS:

Buenaventura Ebrado was issued by the Insurance Life Assurance Co. Ltd, a whole life plan for ₱ 5,882.00 with a rider for Accidental Benefits for the same amount. Buenaventura Ebrado designated Carponia T. Ebrado as the revocable beneficiary in his policy. He referred to her as his wife.

Buenaventura C. Ebrado died when he was accidentally hit by a falling branch of a tree. As the insurance policy was in force, the insurer stands liable for ₱ 11,745.73.

Carponia T. Ebrado filed her claim although she admits that she and the insured were merely living as husband and wife without the benefits of marriage.

Pascuala Vda. de Ebrado also filed her claim as the widow of the deceased insured.

ISSUE:

Whether Carponia T. Ebrado is entitled to the benefits even she was only the common law wife of the insured.

HELD

The general rules of civil law should be applied to resolve this void in the Insurance Law. Article 2011 of the New Civil Code states: “The contract of insurance is governed by special laws. Matters not expressly provided for in such special laws shall be regulated by this Code.” When not otherwise specifically provided for by the Insurance Law, the contract of life insurance is governed by the general rules of the civil law regulating contracts. And under Article 2012 of the same Code, “any person who is forbiden from receiving any donation under Article 739 cannot be named beneficiary of a life insurance policy by the person who cannot make a donation to him.” Common-law spouses are, definitely, barred from receiving donations from each other.

In essence, a life insurance policy is no different from a civil donation insofar as the beneficiary is concerned. Both are founded upon the same consideration: liberality. A beneficiary is like a donee, because from the premiums of the policy which the insured pays out of liberality, the beneficiary will receive the proceeds or profits of said insurance. As a consequence, the proscription in Article 739 of the new Civil Code should equally operate in life insurance contracts. The mandate of Article 2012 cannot be laid aside: any person who cannot receive a donation cannot be named as beneficiary in the life insurance policy of the person who cannot make the donation. Under American law, a policy of life insurance is considered as a testament and in construing it, the courts will, so far as possible treat it as a will and determine the effect of a clause designating the beneficiary by rules under which wills are interpreted.

BIAGTAN VS. THE INSULAR LIFE ASSURANCE COMPANY LTD.

44 SCRA 58 (G.R. NO. L-25579)

MARCH 29, 1972

Petitioner/Appellant:     The Insular Life Assurance Company Ltd.

Respondent/Appellee: Emilia T. Biagtan, Juan T. Biagtan, Jr., Miguel T.

                                                Biagtan, Gil T. Biagtan and Gracia T. Biagtan

J. Makalintal:

FACT:

Juan S. Biagtan was insured with defendant Insular Life Assurance Company Ltd. for the sum of ₱ 5,000.00 and under a supplementary contract denominated “Accidental Death Benefit Clause, for an additional sum of ₱ 5,000.00 if the death of the insured resulted directly from bodily injury effected solely through external and violent means sustained in an accident… and independently of all other causes.” The clause, however, expressly provided that it would not apply where death resulted from an injury “intentionally inflicted by another party.”

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 Juan Biagtan, and that in committing the robbery, the robbers, on reaching the staircase landing on the second floor, rushed towards the door of the second floor room, where they suddenly met a person… who turned to be insured who received nine wounds (five mortal wounds and four non-mortal wounds) from their sharp pointed instruments resulting in Mr. Biagtan’s death.

Beneficiaries of the insured then filed a claim under the policy the insurance company paid the basic amount of ₱ 5,000.00 but refused to pay additional sum of ₱ 5,000.00 under the accidental benefit clause, on the ground that the insured’s death resulted from injuries intentionally inflicted by third parties and therefore was not covered. (Respondent) Beneficiaries then filed suit to recover in the CFI of Pangasinan who rendered a decision in their favor. Hence the present appeal by the petitioner.

ISSUE:

Whether under the facts stipulated and found by the trial court the wounds received by the insured at the hands of the robbers were inflicted intentionally, hence the benefit clause cannot apply.

HELD:

Under an “Accidental Death Benefit Clause” providing for an additional sum of P5,000.00 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” but expressly excepting therefrom a case where death resulted from an injury “intentionally inflicted by a third party”, the insured who died under the following circumstances is not entitled to the said additional sum, to wit: That on the night… while the said life policy and supplementary contract were in full force and effect the house of the insured . . . was robbed by a band of robbers who-were charged in and convicted by the Court of First Instance of Pangasinan for robbery with homicide; that in committing the robbery, the robbers, on reaching the staircase landing of the second floor, rushed towards the doors of the second floor room, where they suddenly met a person near the door of one of the rooms who turned out to be the insured . . . who received thrusts from their sharp-pointed instruments, causing wounds on the body . . . resulting in his death…”

Every program launched, be it for workers or employers, is there to cater their many needs at the time of avoiding stress. Workers’ compensation is one of them. It is designed specifically for the well-being of those workers who suffered from some sort of serious injury while they were performing their daily duty at work. Whenever an employee gets injured, the employer sends the injured person to a picked medical expert. These claims are there for a reason, to put the wounded person back on the road of recovery.

In olden days, when any worker was injured on the job, they hardly had any legal protection. It is only after the industrial age when a huge manufacturing jobs surge was experienced because of technological advancements when the workforce started experiencing far more serious injuries that cost them their entire jobs. They had to work alongside heavy machinery which resulted in injuries and their families were left struggling on their own without any means of earning. In certain cases, the injuries where so serious as a result of which the worker died. Workers’ compensation is a voice against this injustice which took place in the past.

Times have changed now. Today the workforce is recognized with the respect and dignity they deserve. Now the rules and general principles have changed, and new ones have been introduced to cater the growing needs of the workers. Now the law requires for the employers to assist their employees with these claims and benefits in case of any misfortune. If they sustain any sort of injury while they are at work, the employer will have to compensate the workers for their loss.

At any workplace, these claims play an extremely vital role for the working force. It doesn’t matter whether your job is seemingly harmless or potentially dangerous; an injury is an injury and it may cause the worker to lose their job. Even the smallest act of misconduct can cause serious harm to the health of the employee. In such an event, the employee may be handicapped or suffer from a disease that is potentially serious for their health. At a time like this, if the company is not willing to comply and compensate for this loss, where will the poor worker go? This is the reason why these claims have been set as a general principle at any workplace so as to protect the rights of the working class.

If any company wants to legally run their business they will have to include such benefits in their policy for the well-being of their employees. After all, employees are the backbone of any company. Without them, an organization cannot run efficiently and effectively. As a result, most of the employees are covered with insurance in case of an injury. Regardless of the injury being serious or slightly serious, the company has to cover it, if as a result you are unable to perform your work.

Workers’ compensation is a means for catering to the needy ones when they are injured while working for their boss. Workers’ compensation can bring any employee back on the road to recovery. 

Learn more how to use your trade union following the link in Danish Hvordan kan jeg bruge min fagforening.

Think Outside the Box

If you don’t like the idea of being in a box, six feet underground, cremation can offer the perfect alternative. The big bonus of cremation is that you can have your ashes scattered pretty much anywhere you choose, whereas there are a lot of laws and restrictions regarding where you can bury a body and how it needs to be done.

Religious Concerns

Depending on what religion you are part of, if any, there are sometimes very strict guidelines relating to the way you should be buried and the type of funeral service that is deemed appropriate. If you are a religious person, you should know what these stipulations are for your belief system. If you are organising a funeral for someone else, it is vital that you know what their religion says about the matter. You don’t want to ruin someone’s chances at eternal paradise because you gave them the wrong send-off.

Cost

If you are on a pretty tight budget and aren’t fussy about how you go, cremation is always cheaper than burial, as you eliminate some of the most expensive elements of the funeral, like buying a casket. After cremation, it is still possible to have your remains placed in a cemetery so that your friends and loved ones can visit after you’re gone. The cost of this is much less after cremation, simply because an urn takes less space than a coffin. If you really want a traditional burial, but you are worried that you’ll never be able to afford it, funeral insurance is a fantastic option, and even some life insurance policies will cover some, if not all, of the funeral-related expenses.

Tradition

Some families have very strong lines of tradition, making it almost mandatory that you opt for a certain type of funeral. Whether it is cremation or burial, if you don’t have a strong preference, it is wise to avoid upsetting your relatives and go with the traditional family funeral.

Whether you are buried or cremated, the important thing is to be sure that you aren’t neglecting any of your religious obligations or offending those that matter to you. Making the decision yourself, well in advance, is key, because if you die unexpectedly, your loved ones will want to know that they are handling the arrangements the way that you would have wanted.

In every workplace, there is an organization which represents its members. This organization is known as a trade union (in Danish they use fagforening). You can always be a part of a union that represents you. When you join a union, you become a part of that particular worker’s group in your profession. There are all types of workers in a company or organization, and different types of unions are there for different types of workers. This ranges from medical professionals to construction laborers. There is always a head of this union who represents you. If you are a union member, your head will represent you in any sort of negotiations with the employer. Similarly, being a part of this group, you allow the leader to represent you. Any issue that occurs like wages, working environment and conditions, benefits and incentives is dealt directly with your employer, and the leader is the one who negotiates these factors with higher authorities. Other than that, if you personally have any issue going on with your employer, your union can represent on your behalf at any sort of grievance or disciplinary hearing.

There are many ways through which you can be a part of a trade union. All you need to do is keep in consideration certain factors and you can easily be a part of an organization that represents the working class. To be part of a union, you first need to look for a group that does the same kind of work that you do, and has somewhat similar interests. You can always look for a union at your workplace, or ask your co-workers. To get more information on related unions in your local area, you can visit certain websites. These websites represent a wide range of unions that cover a huge number of professions.

Every union has certain requirements; certain criteria should be fulfilled in order to be eligible. You need to ensure that you meet these requirements before you apply for a membership. You can always visit the desired union’s official webpage to get a firsthand insight on the criteria or requirements that will allow you to be a part of their group. The union might have an official headquarter as well. You can always make a call there to get to know about every bit of detail you have in mind. To be a part of that union, you need to fill out an application form and pay the dues required for membership. If you feel the dues are a bit more than you can handle, you can ask for a reduction as a new member. The union may be happy to comply with this as it is there to help and serve the working class.

There may be certain workplaces that don’t any trade union at all. If there isn’t any, you can always form one. There is a paragraph under the National Labors Act which allows workers to form a union if there isn’t any. Talk to your co-workers about forming a union that can represent them when there is an issue or conflict going on between the employers and employees.

A trade union is there to help and represents all those workers who face a hard time at work or with their employers. Being a part of any trade union (fagforeninger in Danish), you need to take privileges that come along with it, but at the same time, don’t go about making a mockery of the system.