▪ the company insured the life of the said Dominador Albay in
G.R. No. L-10436 | January 24, 1916 | TORRES, J. the sum of P5 ,000, payable in the event of his death to
Francisca Eguara
TOPIC: determination of materiality o that on December 6, 1912, said policy being in force, Dominador Albay,
died in the municipality of Santa Cruz, Laguna, and despite the fact that
SUMMARY the beneficiary submitted satisfactory proofs of his death and that the
Eguaras was the beneficiary of the life insurance policy that was obtained by company investigated the event, it refused to pay to the plaintiff the
Dominador Albay. When he died, the company refused to give out the insurance value of the policy
money since they claim that there was fraud committed in obtaining the policy, with ▪ thereby causing damages estimated at P1 ,000.
the assistance of the insurance agent, Remegio. The Court found that there really ● The court was therefore asked to render judgment against the Great Eastern Life
was fraud committed since the person who was examined by the Dr. Vidal was not Assurance Company, Ltd., and its general agent, West G. Smith, by sentencing
Albay who was already super sick at the time the examination was supposed to be them to pay to the plaintiff the sum of P5 ,000, the value of policy No. 5592, plus
conducted + Albay was also not the one who signed the supplementary application. the sum of P1 ,000 for damages inflicted upon them, in addition to the costs of
Thus, SC held that, bc of such fraud, the contract was void. the suit.
DOCTRINE Defendant claims
An insurance contract is fraudulent when a healthy & robust person is substituted in
place of the one to be insured, at the physical examination to determine the state of ● that the insurance policy issued in the name of Dominador had been obtained
health of the person whose life is insured against certain risks. The policy is void, through fraud and deceit known and consented to by the interested parties and
thus the insurer cannot be held liable. is therefore completely illegal, void, and ineffective
Plaintiff claims
A contract is deceitful, for the execution whereof the consent of one of the parties
has been secured by means of fraud, because he was persuaded by words or ● the fraud claim by the company was used as a basis for the crime of frustrated
insidious machinations, statements or false promises, and a defective consent wrung estafa filed against them, but they were already acquitted.
from him, even though such do not constitute estafa or any other criminal act subject
to the penal law. ● CFI Laguna sentenced the company to pay to the plaintiff the sum of P5 ,000, the
value of the insurance policy in question, with legal interest from April 15, 1913,
Where the deceit practiced in the said contract is of a serious nature, the same is the date when the complaint was filed, and the costs.
ipso facto void and ineffective. o W. G. Smith was absolved from the complaint, and the claim for
damages dismissed, as they were not proven.
PROVISIONS
Article 1269 of the Civil Code. "There is deceit when by words or insidious ● Thus, current appeal.
machinations on the part of one of the contracting parties the other is induced to
execute a contract which without them he would not have made."
ISSUES
INSURANCE CODE, Section 31. Materiality is to be determined not by the event, but 1. W/N the life insurance obtained by Dominador Albay, with the assistance of the
solely by the probable and reasonable influence of the facts upon the party to whom insurance agent, Ponciano Remegio, is legal and valid? The insurance policy is
the communication is due, in forming his estimate of the disadvantages of the invalid. There was fraud.
proposed contract or in making his inquiries.
2. (NOT RELEVANT) W/N the final judgement in the estafa case constitutes res
judicata in the current case? No.
FACTS
RATIO
● On April 14, 1913, counsel for Francisca Eguaras filed a written complaint in CFI
1. There was fraud
Laguna, alleging as a cause of action that
● The contract of life insurance executed between The Great Eastern Life
o about October 14, 1912, her son-in-law Dominador Albay had applied in
Assurance Company, Ltd., and Dominador Albay is set forth in the policy itself
writing to the insurance company to insure his life for the sum of P5 .000
and in the original and supplementary applications signed apparently by
▪ she was named as the beneficiary
Dominador Albay, it appearing to have been stipulated that "This insurance is
o that after compliance with the requisites and the investigation carried
granted in consideration of the foregoing statements and agreement in the
on by the defendant company, it accepted the application for insurance
application presented to obtain this policy, which application forms a part of the
and on November 6,1912, issued the policy
present contract." This condition is repeated in Clause VIII of the conditions and
the privileges granted to the insured, that "This policy and the application The Court discussed the f raud committed in the signatures
presented to secure it, taken together, constitute the whole contract, which
cannot be altered except in writing by the general manager or some person ● To secure the insurance on the life of Dominador Albay, the parties interested
expressly appointed therefor by the board of directors." used a person who signed the name of Dominador Albay as the insured in all the
● in the supplementary application presented by the insured on October 14, 1912, documents connected with his application, for the signatures to the letter and the
to the question: "Do you think that you are free from disease and that you have a document relating to the insurance, exhibited at the trial, and signed by
good constitution?" he answered: "Yes;" and to another question: "Have you "Dominador Albay", are different from the authentic signatures of the real
suffered from any affection of * * * (c) Chest Cough, asthma, spitting blood, Dominador Albay which appear in the official documents and the instruments of
pleurisy?" the applicant answered: "No." conveyance of realty.
● The physician of the insurance company in charge of the physical examination of o The signatures on these documents of an official nature are the genuine
the person applying for insurance in Laguna, Dr. Jose A. Vidal, made the physical signatures of the real Dominador Albay
examination of the person who presented himself to him as Dominador Albay ▪ He was accustomed to fashion his letters in the Spanish style
o in his report, he recorded that the development, expansion, percussion, of handwriting.
and auscultation of the applicant's chest were "normal" and ▪ The documents exhibited by the plaintiff, which bear the
recommended to the company that it could "take the risk" of insuring signatures of "Dominador Albay," appear to have been signed
the applicant Dominador Albay, and on said professional report a by the same hand, and therefore it is not strange that the
certain Lunn, who must be the medical officer of the company, placed signatures on these documents are similar, for it is to be
his O. K. observed that the characters in these signatures are firm and
o On the basis of these medical reports and of the exact and faithful strong, demonstrating that the person who made them had
performance of its obligations on the part of the insurance agent, learned to write in the American schools, where the style of
Ponciano Remigio, the company issued the corresponding policy in handwriting taught is very different from the Spanish.
favor of Dominador Albay, insuring his life for P5 ,000. ▪ The signatures that appear on the papers referring to the
▪ The first premium, amounting to P8 2.25, was paid on insurance are so different from those which appear on the
November 6, 1912, and while said policy was in full force and other documents which unquestionably bear the signature of
effect the death of the insured Albay occurred the next month. the real Dominador Albay
● It appears from the record that the insured had knowledge of the false replies ● they compared it to his latest signature which was on
contained in the two applications for insurance and knowingly permitted fraud a sale of a tract of land
to be practised upon the insurance company ● they noted that there was “great difference” between
o for in his acknowledgment and consent his mother-in-law was the two signatures
designated as the beneficiary of the insurance, despite the fact that he ● as such,SC said “we can do no less than reach the
had children and his mother was still living. conclusion already stated that there was a person
● In the present case, the fraud consisted in the fact that a healthy and robust who passed himself off as Dominador Albay and said
person was substituted in place of the insured when Dr. Vidal made the physical person was the one who went on signing the
examination of the one who was seeking to be insured, for the real person who documents relating to the alleged insurance of
desired to be insured and who ought to have been examined was in bad health Dominador Albay, who died on December 6,191”
on and before the date of executing the insurance contract, of which facts the ● Moreover, Dominador Albay's age, according to the application and the insurance
insured Dominador Albay and the insurance agent Ponciano Remigio had full policy, was 40 years in 1912, while according to his personal cedulas he was only
knowledge. 32 years of age in 1911, so that when he was insured he must have been only 33.
● It is unquestionable that the person who on October 14, 1912, presented himself ● It is therefore proven that the signatures on the insurance applications reading
to Dr. Vidal to be examined under the name of Dominador Albay, and who "Dominador Albay" are false and forged; that the person who presented himself
signed the supplementary application before said physician, was not the real to Dr. Vidal to be examined was not the real Dominador Albay, but another
Dominador Albay, who died on December 6, 1912. different person; that at the time of the application for insurance and the
issuance of the policy which is the subject matter of this suit the real
Summary of testimonies from the estafa case which was used in this case: basically Dominador Albay was informed of all those machinations, wherefore it is plain
they were saying that Remigio made arrangements so that Dominador Albay, who that the insurance contract between the defendant and Dominador Albay is null
was already sick with TB, would be replaced by someone when the medical exam is and void because it is false, fraudulent and illegal.
done so they could get the insurance policy. [see notes for full details of the
testimonies]
The contract is void
● Article 1269 of the Civil Code states:
o "There is deceit when by words or insidious machinations on the part of physician Vidal in place of Dominador Albay, serious deceit occurred in
one of the contracting parties the other is induced to execute a contract perfecting the insurance contract, for had the agent of the company not been
which without them he would not have made." deceived it would not have granted the insurance applied for by Albay, nor
● It is essential to the nature of the deceit, to which the foregoing article refers, that would it have executed the contract by virtue whereof payment is claimed of the
said deceit be prior to or contemporaneous with the consent that is a necessary value of the policy obtained through fraud; and consequently on such
requisite for perfecting the contract, but not that it may have occurred or assumptions it is improper, nor is it permitted by the law, to order collection of
happened thereafter. the amount claimed.
o A contract is therefore deceitful, for the execution whereof the consent
of one of the parties has been secured by means of fraud, because he
was persuaded by words or insidious machinations, statements or 2. (NOT RELEVANT) The final judgement in the estafa case does not give rise to
false promises, and a defective consent wrung from him, even though presumption of res adjudicata in this case
such do not constitute estafa or any other criminal act subject to the
penal law. o for the reason that said case was instituted by virtue of an information on the
● The company only accepted the application for insurance in view of the favorable charge that the deceitful acts executed by the company's agent and others
report of the said physician, who reported and certified that the person examined interested in the result of the fraud constitute the crime of estafa to the injury of
by him under the name of Dominador Albay was in good health and possessed the said insurance company, even though the court acquitted the accused on
the qualifications required by said insurance company for perfecting the contract, account of the lack of satisfactory proof of the acts ascribed to them and of their
so the company freely and willingly consented to the execution guilt, while the exception taken by the defendant company is based on the nullity
o thus, company was induced by the result of the medical examination of the insurance contract because deceit occurred in the perfecting and
and of the favorable professional report issued in view of the execution thereof.
appearance of an individual who was in good health, but different from o The judgment of acquittal rendered in the criminal case for estafa against the
the invalid who was seeking to be insured and who died one month and said Francisca Eguaras does not produce the effect of res adjudicata in the
twenty-three days after the insurance had been granted. present suit to the extent that because she was acquitted of the crime of estafa
● The fraud which gave rise to the mistaken consent, given by the defendant she has necessarily acquired as a plaintiff the right to collect the value of the
company to the application for insurance made by Albay and to the execution of insurance, or that the insurance company cannot contend that the insurance
the contract through deceit, is plain and unquestionable. contract is null and void because it was executed by means of deceit, which
o This fraud consisted in the substitution at the examination of Castor upon being proven, as it has been in this case, invalidates the contract that gave
Garcia in place of the insured Dominador Albay, and as the deceit rise to the obligation to pay the value of said policy.
practiced in the said contract is of a serious nature, the same is ipso o In the said criminal case the question raised was whether the acts
facto void and ineffective, in accordance with the provisions of article performed by Eguaras and her co-accused partook of the nature of the
1270 of the Civil Code. crime of estafa, and when it was decided in the negative, the said
● If there had been no substitution, if the insured Dominador Albay had been the Eguaras was not therefore unquestionably entitled to collect the value
person who appeared and was examined by the physician Vidal, said Albay being of the insurance, for after deceit had once been proven in the contract,
manifestly different from Castor Garcia, the said physician would not have no obligation rested upon the insurance company to pay the sum
affirmed at the trial that it was Garcia who presented himself for the physical stipulated.
examination, accompanied by the insurance company's agent, at his residence in o In the present civil suit it is not a question whether the acts performed
San Pablo, and he would have failed to recognize him when he saw him in the by Eguaras and others interested in the proceeds of the insurance were
court, nor is any mistake on the physician's part possible as the inspection and criminal, but whether in taking out the insurance on the life of
physical examination of the individual lasted for something like the space of an Dominador Albay there occurred in the operation deceit and fraud of a
hour. civil nature, in the form and under the conditions defined by the Civil
● The supposition that Dominador Albay was not ill in October, 1912, would not Code.
explain why he did not present himself in person to be examined by the physician o In a contract executed with the requisites fixed in article 1261, one of the
Vidal; and when he failed to do so and by agreement with the agent Remigio was contracting parties may have given his consent through error, violence,
willing to be substituted by Castor Garcia to the end that in any event no defect or intimidation, or deceit, and in any of such cases the contract is void, even though,
personal quality should be discovered to hinder the perfecting of the insurance despite this nullity, no crime was committed. (Article 1265, Civil Code.)
contract, such a change in the person constitutes one of the means of fraud o There may not have been estafa in the case at bar, but it was
which, although it may not partake of the nature of a crime, essentially nullifies conclusively demonstrated by the trial that deceit entered into the
the insurance contract executed. insurance contract, fulfillment whereof is claimed, and therefore the
● With this array of circumstantial evidence derived from facts duly proven as a conclusions reached by the court in the judgment it rendered in the
result of the present suit, we get, if not a moral certainty, at least a full criminal proceedings for estafa do not affect this suit, nor do they
conviction that when Castor Garcia presented himself to be examined by the
influence the decision proper herein, nor can they produce in the present said affidavit was not admitted as evidence because she
suit, over the exception of the defendant, the force of res adjudicata. repudiated its contents in the court.
▪ The motive for this change of front on the part of the said
NOTES Manuela Flores seems to have been due to the fact that the
insurance company was unwilling to give her and her husband
● In case No. 2616, prosecuted against Ponciano Remegio, Castor Garcia, and money for the statements they would make in the court, for in
Francisca Eguaras for frustrated estafa, part of which was exhibited at the the letter of Leodegario V. Lambonga, Manuela Flores'
hearing in this suit husband, addressed to Jose D. Arce on August 26,1914,
o Dr. Vidal testified that the person he examined, who claimed to be Lambonga informed Arce that they would not appear the next
Dominador, was actually accused Castor Garcia. day, not saying where, because they first wanted to agree upon
▪ Upon examination of Garcia’s body, Dr. Vidal reaffirmed that, the sum that they would receive in the event Smith, defendant's
judging from the general appearance of the accused, Castor agent, should win the case, and accordingly to execute "an
Garcia was the very person he had examined in San Pablo instrument we can hold to" (literal).
▪ He further stated that about March 24, 1913, Ponciano Remigio o Jose Valencia testified that on November 27, 1912, he went to the
had visited his house in Manila to request that he should testify municipal building to sign a declaration in the name of Dominador Albay
in favor of said Remigio, who at the same time had offered because the latter was then ill and could not leave his house a fact
him P6 00 not to identify the person of Castor Garcia at the
admitted by the plaintiff.
trial. ▪ Attorney O'Brien also testified that Ponciano Remigio had
o Attorney O'Brien stated in a sworn declaration that Ponciano Remigio assured him that Dominador Albay was suffering from
interviewed him in his office telling him that the signatures affixed to the tuberculosis, and also that Remigio had told him that there was
original application for insurance and the supplementary application a physician in Santa Cruz, who must have been Dr. Reyes, that
signed before Dr. Vidal at the time of the physical examination were could attest that said Albay was really affected with
false, and then indicated where he could get documents with authentic tuberculosis
signatures of the said Albay.
▪ Remigio further told him that he (Remigio) was disgusted with ● It is immaterial that Albay may have died of intestinal occlusion, as Dr. Kamatoy
his accomplices because they could not reach an agreement affirms in the death certificate, because said ailment does not demonstrate that
regarding the distribution among them of the amount of the Albay was not suffering from some other chronic disease; or that in the month of
policy when it should be collected. October, 1912, when he applied for insurance on his life, he was not affected by a
o Jose D. Arce corroborated the statements of O’Brien, and added that as malady that would have been sufficient cause for his rejection by the physicians
the said Ponciano Remigio lodged in his house, the latter had told him of the insurance company.
the details of the substitution of another person in place of Dominador
Albay at the examination made by the physician of the company, and
that the cedulas of said Albay and two letters in which authentic
signatures of Albay appeared, were delivered to Attorney O'Brien by
Albay's mother, named Manuela Flores.
o Captain Barrows of the Constabulary testified how Ponciano Remigio
had promised O'Brien in a conference held by the three in his house in
Santa Cruz some ten days before the trial, that on the day of the trial he
would testify that the person who had signed the applications with the
name of Dominador Albay was Castor Garcia, who was then outside of
the Philippine Islands.
o Dr. Gertrudo Reyes stated at the trial that he had been consulted by
Dominador Albay regarding the cough he had and after a medical
examination witness had reached the conclusion that the person
concerned was suffering from tuberculosis in the first stage, although it
does not appear that said physician made a microscopic analysis of the
patient's sputum
▪ but there is circumstantial evidence in the case that Dominador
Albay died of tuberculosis, for his own mother, Manuela Flores,
so affirmed in the affidavit drawn up before a notary, although
[23] Argente v. West Coast Life Insurance Co. a. For Bernardo Argente, he denied having consulted a physician for any
No. 28499 | March 19, 1928 | Malcolm, J. ailment or disease of the brain or nervous system and that he had never
consulted or been treated of any ailiment within the last 5 years. He only
Plaintiff-appellant: Bernardo Argente declared that he consulted a physician in 1911 for scabies. However, it
Defendant-appellee: West Coast Life Insurance Co. is not disputed that on January 10, 11, and 13, 1923, Bernardo Argente
was confined in the Philippine General Hospital where he was treated
TOPIC: Determination of Materiality for cerebral congestion and Bell's Palsy
SUMMARY: Bernardo Argente and his wife signed an application for joint insurance b. For Vincenta de Ocampo, when asked how frequent she took alchoholic
wherein all information came from plaintiff and his wife. They were both medically beverages, she only decared that she drank “beer only in small
examined by the examiner from West Coast wherein all information also came from quantities.” When asked about any ailments or diseases, she said she
them. The wife died of cerebral aplopexy so Bernardo presented a claim but was was treated for none and that she was in good health. However, it is not
refused by the company because the answers in their examinations were done with disputed that she was brought to San Lazaro Hospital where she was
fraud and misrepresentation. The Court held that the insurance policy was null and initially diagnosed with “alcoholism” but later was diagnosed with
void since the policy was procured by fraudulent representations and that the “manic-depressive psychosis” and later in Mary Chiles Hospital, a final
company may exercise its right to rescind. diagnosis of “psycho-neurosis.”
7. The plaintiff pleads in defense that they revealed all of the information but Doctor
DOCTRINE: In an action on a life insurance policy where the evidence conclusively Sta. Ana and the insurance agent, Jose Geronimo del Rosario, failed to record
shows that the answers to questions 'concerning diseases were untrue, the truth or them in the medical reports.
falsity of the answers become the determining factor. If the policy was procured by 8. The trial court ruled in favor of defendant company and said that the spouses lied
fraudulent representations, the contract of insurance was never legally existent. in their application forms.
The concealment must, in the absence of inquiries, be not only material, but
fraudulent, or the fact must have been intentionally withheld thus if no inquiries are ISSUE/HELD
made and no fraud or design to conceal enters into the concealment the contract is W/N the insurance policy was null and void - YES
not avoided 1. One ground for the rescission of a contract of insurance under the Insurance Act
is "a concealment," which in section 25 is defined as "A neglect to communicate
that which a party knows and ought to communicate."
FACTS 2. The contention of appellant that concealment was immaterial and insufficient to
1. On February 9, 1925, plaintiff-appellant Bernardo Argente and his deceased wife avoid the policy is untenable.
Vicenta de Ocampo, signed an application for joint insurance in the sum of 3. In an action on a life insurance policy where the evidence conclusively shows
Php2k. All information in the both applications were written by the defendant that the answers to questions 'concerning diseases were untrue, the truth or
company’s agent, except the signature and name of plaintiff. However, all falsity of the answers become the determining factor. If the policy was procured
information came from the plaintiff and his wife. by fraudulent representations, the contract of insurance was never legally
2. On February 10, 1925, Bernardo and his wife were examined by Dr. Cesareo Sto. existent
Tomas, a medical examiner from West Coast. The report was written by the 4. It can be assumed that had the true facts been disclosed by the assured, the
doctor except for the signature of plaintiff-appellant. All information were insurance would never have been granted
provided by the spouses. 5. Court quotes Joyce, The Law on Insurance, 2nd edition
3. On May 9, 1925, plaintiff Bernardo and his wife submitted to defendant insurance CONCEALMENT: a. Concealment exists where the assured has knowledge of a fact material
company an amended application, increasing the amount to Php15k. A 1. knowledge of fact to the risk, and honesty, good faith, and fair dealing requires that he
2. duty to communicate
temporary policy was issued to them on May 15. Policy was delivered to them said fact should communicate it to the assured, but he designedly and
only July 2, 1925, when the first quarterly premium was paid. 3. intentionally does intentionally withholds the same.
NOT communicate it
4. Since it had been more than 30 days since they were examined by the company’s b. Another rule is that if the assured undertakes to state all the
physician, a certificate of health was needed before the policy would be circumstances affecting the risk, a full and fair statement of all is
delivered. required
5. On November 18, 1925, Vicenta de Ocampo died of cerebral aploplexy. c. The concealment must, in the absence of inquiries, be not only material,
6. Bernardo presented a claim for the payment of Php15k but was refused by the but fraudulent, or the fact must have been intentionally withheld thus if
defendant company because the answers given by the insured in their medical no inquiries are made and no fraud or design to conceal enters into the
examinations with regard to their health and previous illnesses and medical concealment the contract is not avoided
attendance were untrue. The company said it was rejected because of fraud and d. Under a stipulation voiding the policy for concealment or
misrepresentation. It appears from the investigation of said company that: misrepresentation of any material fact or if his interest is not truly
stated or is other than the sole and unconditional ownership, the facts
are unimportant that insured did not intend to deceive or withhold
information as to encumbrances even though no questions were asked
6. Court continues to quote Joyce and explains why it is necessary to reveal
material facts
a. It misleads or deceives the insurer into accepting the risk, or accepting
it at the rate of premium agreed upon
b. The insurer, relying upon the belief that the assured will disclose every
material fact within his actual or presumed knowledge, is misled into a
belief that the circumstance withheld does not exist, and he is thereby
induced to estimate the risk upon a false basis that it does not exist
c. The principal question must be: “Was the assurer misled or deceived
into entering a contract obligation or in fixing the premium of
insurance by a withholding of material information or facts within the
assured's knowledge or presumed knowledge?”
d. It does not seem to be necessary that the suppression of the truth
should have been willful. If it were but an inadvertent omission, yet if it
were material to the risk and such as the plaintiff should have known to
be so, it would render the policy void.
e. If the assured has exclusive knowledge of material facts, he should fully
and fairly disclose the same, whether he believes them material or not.
However, it may frequently happen that the assured believes that the
facts are not material.
f. Test to determine whether there has or has not been a material
concealment must rest largely in all cases upon the form of the
questions propounded and the exact terms of the contract
i. Must be left to jury to decide (English law)
g. Such a matter cannot rest alone upon the assured's belief irrespective
of what is a reasonable belief, but that it ought to be judged by the
criterion whether the belief is one fairly warranted by the circumstances
W/N the insurance company can exercise its right to rescind given section 47 of the
Insurance Act - YES
1. Section 47, Insurance Act: “Whenever a right to rescind a contract of
insurance is given to the insurer by any provision of this chapter, such right
must be exercised previous to the commencement of an action on the
contract.”
2. 1st answer: California law code examiners say: A failure to exercise the right
(of rescission), cannot, of course, prejudice any defense to the action which
the concealment may furnish
3. 2nd answer: the insurance company more than one month previous to the
commencement of the present action wrote the plaintiff and informed him
that the insurance contract was void because it had been procured through
fraudulent representations, and offered to refund to the plaintiff the premium
which the latter had paid upon the return of the policy for cancellation
a. California jurisprudence: where any of the material representations
are false, the insurer's tender of the premium and notice that the
policy is canceled, before the commencement of suit thereon,
operate to rescind the contract of insurance
Judgment AFFIRMED.
[24] SEGUNDINA MUSÑGI, ET AL. v. WEST COAST LIFE INSURANCE CO. o Aug. 5, 1930 – treated for chronic pyelocystitis & incipient pulmonary
G.R. No. L-41794 | 1935 | Imperial, J. tuberculosis
o Aug. 13, 1930 – treatemd for chronic suppurative pyelocystitis &
SUMMARY: Arsenio Garcia was insured by two insurance policies from West Coast, chronic bronchitis
worth P5,000 and P10,000. Segundina Musngi and Buenaventura Garcia were named o Aug. 20, 1930 – treated for acute tracheo-bronchitis & chronic
his beneficiaries in case of death. When he died, West Coast refused pay the suppurative pyelocystitis
o Aug. 27, 1930; Dec. 11, 18 & 28, 1930; Jan. 11, 1930 – treated for the
proceeds of the policy as they discovered that it was obtained fraudulently. When same ailments
asked whether he had been consulted or treated for any illness or ailment, Arsenio 5. Appealed decision: defendant company to pay the plaintiffs the amount of
categorically answered “none” and “no”, when in fact he had been treated for several said policies
ailments such as peptic ulcer, pulmonary tuberculosis, acute tracheo-bronchitis, etc. o Garcia’s health before the acceptance of his applications and the
The Supreme Court ruled that cuch concealment constituted fraud. West Coast, by issuance of the policies could neither be discussed nor questioned by
reason of the categorical denials, accepted the risk of insuring Arsenio’s life which it the defendant because the insured was examined by 3 physicians of
the company and all of them unanimously certified that he was in good
would otherwise have refused. The insurance contracts are null and void, and did not
health and that he could be properly insured.
give rise to any right on the part of Musngi, et. al. to recover their value or amount. 6. In the instant case, the defendant contends that the 2 policies did not create
any valid obligation because they were fraudulently obtained by the insured.
DOCTRINE: It is held that the concealment must, in the absence of inquiries, be not
only material, but fraudulent, or the fact must have been intentionally withheld ISSUES:
WON the 2 answers given by Garcia in his applications are false -- YES
FACTS: WON the answers were the cause, or one of the causes, w/c induced the defendant to
issue the policies -- YES
1. Arsenio T. Garcia was insured by West Coast Life Insurance Co. in the sum
of P5,000 effective as of July 25, 1931 (Policy No. 129454). He was again RULING: A ppealed judgment is REVERSED; defendant ABSOLVED from complaint.
insured by the defendant company in the sum of P10,000 effective as of 1. Garcia knew that he had suffered from a number of ailments before
October 20, 1931 (Policy No. 130381). These policies were valid and subscribing the applications, yet he concealed them and omitted the hospital
subsisting at the time of his death on December 30, 1932. where he was confined as well as the name of the physician who treated
2. The plaintiffs are the beneficiaries in said policies - Segundina Musñgi for him.
129454, and Buenaventura Garcia for 130381. They made a demand upon 2. Such concealment and the false statements constituted FRAUD. The
the defendant company for the payment of the two policies but the latter defendant by reason thereof accepted the risk which it would otherwise have
refused to do so. flatly refused.
3. When Garcia applied for both insurance policies, he answered inquiries as 3. When not otherwise specially provided for by the Insurance Law, the contract
to his state of health and that of his family. In each application, he following of life insurance is governed by the general rules of the civil law regarding
question was asked: "1. What physician or practitioner or any other person contracts. Art. 1261 of the CC provides that there is no contract unless there
not named above have you consulted or been treated by, and for what illness, should be, in addition to consent and a definite object, a consideration for
or ailment? (If none, so state.)" In the first application, Garcia answered the obligation established. And Art. 1276 provides that the statement of a
"None", and in the second, "No". false consideration shall render the contract void. The two answers being
4. After Garcia’s death and as a result of the tdemand made by the one of the considerations of the policies, and it appearing that they are
beneficiaries upon the defendant to pay the value of the policies, the latter false and fraudulent, it is evident that the insurance contracts were null and
discovered that the aforementioned answers were false a Mand void and did not give rise to any right to recover their value or amount.
fraudulent, because the truth was that Garcia, before answering and signing 4. A similar case was already decided by the court in Argente vs. West Coast
the applications and before the issuance of the uu, had been treated in the Life Insurance Co. In that case, the insured concealed from the physician
General Hospital by Dr. Pilar Cruz for different ailments. who examined her that she had consulted and had been treated by another
physician for cerebral congestion and Bell's Palsy, and that she was addicted
o May 13 & 19, 1929 – treated for peptic ulcer & chronic catarrhal
nasopharyngitis to alcohol. In fact, she was previously confined in the San Lazaro Hospital
due to alcoholism. This court held that such concealments and false and information or facts within the assured's knowledge or
fraudulent statements rendered the policy null and void. The Court said: presumed knowledge?
▪ It therefore follows that the assurer in assuming a risk is
o One ground for the rescission of a contract of insurance under the entitled to know every material fact of which the assured
Insurance Act is a "concealment", which in Sec. 25 (of the Insurance has exclusive or peculiar knowledge, as well as all material
Law) is defined as "A neglect to communicate that which a party facts which directly tend to increase the hazard or risk
knows and ought to communicate." which are known by the assured, or which ought to be or
o In an action on a life insurance policy where the evidence conclusively are presumed to be known by him. And a concealment of
shows that the answers to questions concerning diseases were untrue, such facts vitiates the policy. "It does not seem to be
the truth or falsity of the answers become the determining factor. If the necessary ... that the ... suppression of the truth should
policy was procured by fraudulent representations, the contract of have been willful." If it were but an inadvertent omission,
insurance set forth was never legally existent. It can fairly be assumed yet if it were material to the risk and such as the
that had the true facts been disclosed by the assured, the insurance plaintiff should have known to be so, it would render the
would never have been granted. policy void.
o According to Joyce, The Law of Insurance: ▪ However, if the assured may have a knowledge actual or
▪ Concealment exists where the assured has knowledge of presumed of material facts, and yet entertain an honest
a fact material to the risk, and honesty, good faith and belief that they are not material…The determination of the
fair dealing requires that he should communicate it to the point whether there has or has not been a material
assured, but he designedly and intentionally withholds the concealment must rest largely in all cases upon the form
same. of the questions propounded and the exact terms of the
▪ If the assured undertakes to state all the circumstances contract. Thus, where in addition to specifically named
affecting the risk, a full and fair statement of all is diseases the insured was asked whether he had had any
required. sickness within 10 years, to which he answered "No", and
▪ The concealment must, in the absence of inquiries, be not it was proven that within that period he had had a
only material, but fraudulent, or the fact must have slight attack of pharyngitis, it was held a question properly
been intentionally withheld; so it is held under English law for the jury
that if no inquiries are made and no fraud or design to
conceal enters into the concealment the contract is not
avoided. And it is determined that even though
silence may constitute misrepresentation or concealment
it is not of itself necessarily so as it is a question of
fact. Nor is there a concealment justifying a forfeiture
where the fact of insanity is not disclosed no questions
being asked concerning the same.
▪ If a material fact is actually known to the assured, its
concealment must of itself necessarily be a fraud, a nd if
the fact is one which the assured ought to know,
or is presumed to know, the presumption of knowledge
ought to place the assured in the same position
as in the former case with relation to material facts; and if
the jury in such cases find the fact material, and
one tending to increase the risk, it is difficult to see how
the inference of a fraudulent intent or intentional
concealment can be avoided.
▪ The basis of the rule vitiating the contract in cases of
concealment is that it misleads or deceives the insurer
into accepting the risk, or accepting it at the rate
of premium agreed upon. The principal question, therefore,
must be, Was the assurer misled or deceived into
entering a contract obligation or in fixing the premium of
insurance by a withholding of material
[25] Qua Chee Gan vs. Law Union and Rock Insurance Co., Ltd. a. LU arguments:
i. The bodegas insured had an external wall perimeter of
SUMMARY: Qua Chee Gan (QCG) owned 4 warehouses or bodegas used for the 500 m. or 1640 ft. so QCG should have had 11 fire
storage of copra and hemp, which were insured with Law Union (LU), and the lose hydrants in the compound, but he only had 2, with
made payable to PNB as mortgage of the hemp and copra. Fire broke out and another 2 nearby owned by the municipality of Tabaco;
destroyed bodegas 1, 3 and 4. QCG informed LU of the fire by telegram and the ii. QCG should have 100-ft of fire hose for every two
latter sent fire adjusters to investigate. LU resisted payment, claiming violation of hydrants; and
warranties and conditions, filing of fraudulent claims, and that the fire had been iii. QCG should have maintained a trained fire brigade of
deliberately caused by QCG or by other persons in connivance with him. QCG, his 20 men.
brother, and some employees were indicted and tried for arson, but they were b. Court:
acquitted. Thereafter, the civil suit to collect the insurance money proceeded to its i. LU is barred by ESTOPPEL to claim violation for the fire
trial. CFI rendered a decision in QCG’s favor. LU appeals this decision directly to hydrants warranty.
this Court; SC affirms CFI decision. 1. It knew that the number of hydrants never
existed from the beginning since it conducted
FACTS a inspection of QCG premises prior to issuance
1. Qua Chee Gan (QCG) owned four warehouses in Tabaco, Albay used for of the policies in question as a prerequisite for
the storage of copra and of hemp. These bodegas and their contents were the determination of the discount on the
insured with Law Union (LU), and the lose payable to PNB as a mortgage premium.
of the hemp and cobra. 2. Despite knowledge of this, LU still issued the
2. Fire of an undetermined origin broke out and lasted for a week. This policies; and even gave the insured a discount
completely destroyed bodega nos. 1, 2, and 4 and their contents. much smaller when the latter incurred
3. QCG informed LU of the fire by telegram; and the next day, fire adjusters expenses installing two more hydrants. Such
arrived to conduct an investigation. knowledge constitutes a waiver of conditions
4. QCG claimed for damages but LU resisted payment claiming violation of in the contract inconsistent with the facts, and
warranties and conditions, filing of fraudulent claims, and that the fire had the insurer is stopped thereafter from
been deliberately caused by the insured or by other persons in connivance asserting the breach of such conditions.
with him. 3. Ambiguities and obscurities must be strictly
5. QCG, his brother, and some employees were indicted and tried for arson, implemented against the party that caused
but were eventually acquitted by the trial court. them, the "memo of warranty" invoked by
6. QCG then proceeded with the civil suit to collect insurance money from appellant bars the latter from questioning the
LU, and the CFI ruled in favor of QCG. existence of the appliances called for in the
7. LU appeals in this present action to the SC. insured premises.
ii. Re: fire hose - This must equally be rejected because it is
ISSUE with HOLDING based on the assumption that insured was bound to
1. W/N the policies were void for breach of warranty, specifically the one maintain 11 hydrants.
1
appearing on a rider pasted on the face of the policies - NO
1
Memo of Warranty. - The undernoted Appliances for the extinction of fire being kept on the Hydrants in the compound, not less in number that one for each 150 ft. of external
premises insured hereby, and it being declared and understood that there is an ample and wall measurement of buildings, protected, with not less than 100 ft. of hose piping and nozzles
constant water supply with sufficient pressure available at all seasons for the same, it is for every two hydrants kept under cover in convenient places, the hydrants being supplied
hereby warranted that the said appliances shall be maintained in efficient working order during with water pressure by a pumping engine, or from some other source, capable of discharging
the currency of this policy, by reason whereof a discount of 2.5% is allowed on the premium at the rate of not less than 200 gal. of water/min. Into the upper story of the highest building
chargeable under this policy. protected, and a trained brigade of not less than 20 men to work the same.
iii. Re: fire brigade - Records show that the same was balance sheet that did not differ from that submitted by
maintained, although not as a permanently separate the insured.
unit, as the policy did not require it. 4. W/N the insured connived at the loss and fraudulently inflated the
2. W/N the insured violated the “Hemp Warranty” provisions of the policy quantity of the insured stock in the burnt bodegas - NO
against the storage of gasoline - NO a. This is based on the assumption that the insured was in financial
a. LU: QCG admitted that there were 36 cans of gasoline in Bodega difficulties and set fire to the bodegas in order to defraud the
No. 2. insurer.
b. Court: b. Despite LU's refusal to pay the value of the policies, QCG was
i. “Gasoline” is not specifically mentioned among the able to pay PNB, to whom the insured goods were pledged.
prohibited articles in the “Hemp Warranty”; rather it Seeing as he was able to do so, no motive appears for attempting
speaks of “oils” and is decidedly ambiguous and to defraud the insurer.
uncertain. c. Acquittal of QCG from criminal case is not res judicata on this
1. “Oils” mean “lubricants” in ordinary parlance, civil action, but evidence presented for both are practically
not gasoline or kerosene. identical and must lead to the same result or finding.
2. Ambiguity must be held strictly against the d. Allegation of inflation of quantity of the insured stock in the burnt
insurer and liberally in favor of the insured. bodegas merely rests on the estimates of the insurer’s adjuster
ii. The gasoline kept in Bodega No. 2 was only incidental after the fire, but these must yield to the contrary testimony of
to his business, not being more than a 2-day supply. people who actually saw the contents of the bodegas before the
1. It is well-settled that the keeping of fire.
inflammable oils on the premises, although
prohibited by policy, does not void it if such DISPOSITIVE PORTION
keeping is incidental to the business. CFI decision AFFIRMED.
iii. Prohibition on storage applies to that “in the building to
which this insurance applies and/or in any building
communicating therewith”
1. Bodega No. 2 was not burned and was isolated
from the other insured bodegas burned down.
3. On the charge that insured failed to submit to the examiner books,
vouchers, and records demanded by the latter (not really an issue pero
siningit ng court yung discussion after the second issue and baka
concealment din ‘to so relevant to first lesson for this digest)
a. The insured gave the insurance examiner all the data he asked
for, and the examiner even kept and photographed some of the
examined books in his possession.
b. What does appear to have been rejected by the insured was the
demand that he should submit "a list of all books, vouchers,
receipts and other records"
i. Justified since a demand for ALL these records would
be unreasonable since QCG ran a large business; and
ii. LU already had all the data needed since its adjuster,
Alexander Stewart, was able to prepare his own
26 YU PANG v CA ○ his demand was refused so he brought the present action.
G.R. No. L-12465 | May 29, 1959 | Bautista-Angelo, J. ● The insurance company’s defense was that the insured was guilty of
misrepresentation and concealment of material facts in that he gave false
PROVISIONS and untruthful answers to questions asked him in his application;
● Section 30, Insurance Code. Materiality is to be determined not by the event, ○ hence, the effect is the avoiding of the policy.
but solely by the probable and reasonable influence of the facts upon the ● It appears that the insured entered the Chinese General Hospital for medical
party to whom the communication is due, in forming his estimate of the treatment on January 1950 [before application for insurance policy],
disadvantages of the proposed contract, or in making his inquiries. complaining of dizziness, anemia, abdominal pains and tarry stools.
○ His illness history shows that this started a year ago as frequent
SUMMARY: Yu Pang Eng applied for, and was granted an insurance policy from dizziness. An x-ray picture of his stomach and the diagnosis was
defendant insurance company. He said he did not have any previous illnesses, from that he suffered from peptic ulcer, bleeding.
his medical history. He went to St. Luke’s for treatment, but died two months after
from medullary carcinoma, Grade 4, advanced and lesser curvature.. His brother, as ISSUES W/ HELD & RATIO
beneficiary, is now claiming the insurance policy. The Court here ruled whether or not [1] W/N the insured is guilty of concealment, and therefore, the insurance policy is
the insurance policy is void for concealment done by the insured. The SC held that void - YES.
yes, it was void because Yu Pang lied about his medical history, which are facts ● Concealment is a neglect to communicate that which a party knows and
material to the insurance contract. ought to communicate. Whether intentional or not, concealment entitles the
insurer to rescind the contract. The law requires the insured to communicate
DOCTRINE: A neglect to communicate that which a party knows and ought to to the insurer all facts within his knowledge which are material to the
communicate, is called concealment" (Section 25, Act No. 2427). Whether intentional contract and which the other party has not the means of ascertaining. The
or unintentional, the concealment entitles the insurer to rescind the contract of materiality is determined not by the event but by the probable and
insurance (Section 26). Our law even requires the insured to communicate to the reasonable influence of the facts upon the party to whom the
insurer all facts within his knowledge which are material to the contract and which the communication is due.
other party has not the means of ascertaining (Section 27), and the materiality is to be ● The insured’s negative answers to the questions on his previous ailments, or
determined not by the event but solely by the probable and reasonable influence of his concealment of his hospitalization deprived the insurance company of
the facts upon the party to whom the communication is due (Section 30). the opportunity to make the necessary inquiry as to the nature of his past
illness so that it may form its estimate relative to the approval of his
FACTS: application. Had the insurance company been given such opportunity, it
● On September 1950, Yu Pang Eng submitted his application for insurance to would not probably consent to the policy issuance.
an insurance company [defendant].
● He answered “no” to questions on his medical history (stomach diseases,
dizziness, ulcers, vertigo, cancer, tumors, etc.) as well as to the question of RULING: CA decision affirmed.Insurance contract is void because the insured is
whether or not he consulted any physician regarding said diseases. GUILTY of concealment of material facts. Thus, insurer is relieved of its liability.
● Upon payment of the first premium, the company issued to him an insurance
policy.
● On December 1950, he went to St. Luke’s for medical treatment but he died
two months later.
● According to the death certificate, he died of infiltrating medullary carcinoma,
Grade 4, advanced cardiac and of lesser curvature, stomach metastases
spleen.
● His brother and beneficiary, Yu Pang Cheng [petitioner], demanded from the
insurance company the payment of the policy proceeds [10k].
[27] FIELDMEN'S INSURANCE CO., INC. v. VDA. DE SONGCO, ET AL. and CA ● CFI decided in favor of the respondents. Affirmed by CA. Citing Qua Chee
G.R. No. L-24833 | September 23, 1968 | Fernando, J. Gan v. Law Union and Rock Insurance Co., Ltd., the court stated that where
inequitable conduct is shown by an insurance firm, it is "estopped from
TOPIC: Concealment > Determination of Materiality enforcing forfeitures in its favor, in order to forestall fraud or imposition on
the insured." In this case, the court held that petitioner was not allowed to
SUMMARY escape liability under a common carrier insurance policy on the pretext that
Songco, owner of a private jeepney and a man of scant education, was induced by an what was insured was a private vehicle and not a common carrier, the policy
agent of the Petitioner to apply for a Common Carrier’s Liability Insurance. Such being issued upon the insistence of its agent who discounted fears of 2
the
insurance was renewed by the petitioner at least twice. Later on, Songco figured in an insured that his privately owned vehicle might not fall within its terms , the
accident. His wife is not seeking to collect the insurance claim. Petitioner denied the insured moreover being "a man of scant education," finishing only the first
application on the ground that a private jeepney cannot be covered by a Common grade.
Carrier’s Liability Insurance because it is not used as a public utility vehicle. The Court
held that the doctrine of estoppel applies. After petitioner had led the insured to ISSUES/HELD/RATIO
believe that he could qualify under the common carrier liability insurance policy, and 1. W/N estoppel could be invoked by the heirs of the insured as a bar to the alleged
to enter into contract of insurance paying the premiums due, it could not, later on, be breach of warranty and condition in the policy – Y ES.
permitted to change its stand to the detriment of the heirs of the insured. ● The doctrine of estoppel applies. After petitioner had led the insured to
believe that he could qualify under the common carrier liability insurance
DOCTRINE policy, and to enter into contract of insurance paying the premiums due, it
● Since some of the conditions contained in the policy issued by Fieldmen’s could not, thereafter, in any litigation arising out of such representation, be
Insurance were impossible to be complied with under the existing conditions permitted to change its stand to the detriment of the heirs of the insured.
at the time and 'inconsistent with the known facts,' the insurer 'is estopped ● As estoppel is primarily based on the doctrine of good faith and the
from asserting breach of such conditions.’ avoidance of harm that will befall the innocent party due to its injurious
● Ambiguities or obscurities must be strictly interpreted against the party that reliance, the failure to apply it in this case would result in a gross travesty of
caused them. The contract of insurance is one of perfect good faith justice.
(uberrimae fides) not for the insured alone, but equally so for the insurer; in
fact, it is more so for the latter, since its dominant bargaining position 2. W/N there was legal liability incurred under the policy by the petitioner – YES.
carries with it stricter responsibility. ● As held by the CA: "Since some of the conditions contained in the policy
● (from reviewer) Another inequitable situation, just like in Qua Chee Gan v. issued by Fieldmen’s Insurance were impossible to comply with under the
Law Union. existing conditions at the time and 'inconsistent with the known facts,' the
insurer 'is estopped from asserting breach of such conditions."
PROVISION o The injured parties, for whose hospital and medical expenses the
Sec. 31. Materiality is to be determined not by the event, but solely by the probable defendant company was being made liable, were passengers of the
and reasonable influence of the facts upon the party to whom the communication is jeepney at the time of the occurrence, and Rodolfo Songco, for
due, in forming his estimate of the disadvantages of the proposed contract or in whose burial expenses the defendant company was also being
making his inquiries. made liable, was the driver of the vehicle in question. Except for the
fact that they were not fare paying passengers, their status as
FACTS beneficiaries under the policy is recognized therein.
● Federico Songco, owner of a private jeepney, was induced by Fieldmen's ● Even if it be assumed that there was an ambiguity, an excerpt from the Qua
Insurance Company agent Benjamin Sambat to apply for a Common Chee Gan decision would reveal anew the weakness of petitioner's
Carrier's Liability Insurance Policy. 1
contention. Thus: "...ambiguities or obscurities must be strictly interpreted
● The petitioner issued him a Common Carriers Accident Insurance policy , against the party that caused them, the 'memo of warranty' invoked by
effective Sept 15, 1960 to Sept 15, 1961 (1 year). The petitioner renewed the appellant bars the latter from questioning the existence of the appliances
policy by extending the coverage from October 15, 1961 to Oct 15, 1962. On called for in the insured premises, since its initial expression, 'the undernoted
Oct 29, 1961, during the effectivity of the renewed policy, the insured vehicle, appliances for the extinction of fire being kept on the premises insured
while being driven by Rodolfo Songco (son of Federico) collided with a car in hereby, ... it is hereby warranted ...,' admits of interpretation as an admission
Bulacan. As a result, Federico and Rodolfo died and 3 people sustained
physical injuries.
2
The policy provided as follows: "The company will, subject to the limits of liability and under terms of this
1
The agent discounted the fears of the insured that his privately owned vehicle might not fall within its terms, policy, indemnify the insured in the event of accident caused by or arising out of the use of motor vehicle
and said that "whether [their] vehicle was an 'owner' type or for passengers it could be insured because their against all sums which the insured will become liable to pay in respect of: death or bodily injury to any
company is not owned by the government... So they could do whatever they please whenever they believe a fare-paying passenger including the driver, conductor, and/or inspector who is riding in the motor vehicle
vehicle is insurable" insured at the time of the accident or injury (RA
of the existence of such appliances which appellant cannot now contradict,
should the parol evidence rule apply."
● To the same effect is the following citation from (again) the case of Qua
Chee Gan: "This rigid application of the rule on ambiguities has become
necessary in view of current business practices. The courts cannot ignore
that nowadays monopolies, cartels and concentration of capital, endowed
with overwhelming economic power, manage to impose upon parties dealing
with them cunningly prepared 'agreements' that the weaker party may not
change one whit, his participation in the 'agreement' being reduced to the
alternative to 'take it or leave it' … 'contracts by adherence' (contrats
d'adhesion), in contrast to those entered into by parties bargaining on an
equal footing, such contracts (e.g., insurance policies) obviously call for
greater strictness and vigilance on the part of courts of justice with a view to
protecting the weaker party from abuses and imposition, and prevent their
becoming traps for the unwary.
● The conclusion that emerges from the above is the correctness of the
decision of the CA. For, to borrow once again from the language of the Qua
Chee Gan opinion: "The contract of insurance is one of perfect good faith
(uberima fides) not for the insured alone, but equally so for the insurer; in
fact, it is more so for the latter, since its dominant bargaining position
carries with it stricter responsibility."
RULING
CA decision affirmed in its entirety.