Summary: Sun Insurance Office Ltd. vs. Court of Appeals (GR 92383, 17 July 1992)

Sun Insurance Office Ltd. vs. Court of Appeals
[GR 92383, 17 July 1992]
First Division, Cruz (J): 3 concur

Facts: Sun Insurance Office Ltd. issued Personal Accident Policy 05687 to Felix Lim, Jr. with a face value of P200,000.00. Two months later, he was dead with a bullet wound in his head. As beneficiary, his wife Nerissa Lim sought payment on the policy but her claim was rejected. Sun Insurance agreed that there was no suicide. It argued, however, that there was no accident either. Pilar Nalagon, Lim's secretary, was the only eyewitness to his death. It happened on 6 October 1982, at about 10 p.m., after his mother's birthday party. According to Nalagon, Lim was in a happy mood (but not drunk) and was playing with his handgun, from which he had previously removed the magazine. As she watched the television, he stood in front of her and pointed the gun at her. She pushed it aside and said it might be loaded. He assured her it was not and then pointed it to his temple. The next moment there was an explosion and Lim slumped to the floor. He was dead before he fell. The widow sued Sun Insurance in the Regional Trial Court of Zamboanga City and was sustained. Sun Insurance was sentenced to pay her P200,000.00, representing the face value of the policy, with interest at the legal rate; P10,000.00 as moral damages; P5,000.00 as exemplary damages; P50,000.00 as actual and compensatory damages; and P5,000.00 as attorney's fees, plus the cost of the suit. This decision was affirmed on appeal, and the motion for reconsideration was denied. Sun Insurance then came to the Supreme Court.

Issue: Whether the insured willfully exposed himself to needless peril and thus removed himself from the coverage of the insurance policy.

Held: NO. An accident is an event which happens without any human agency or, if happening through human agency, an event which, under the circumstances, is unusual to and not expected by the person to whom it happens. It has also been defined as an injury which happens by reason of some violence or casualty to the insured without his design, consent, or voluntary co-operation. Herein, the incident that resulted in Lim's death was indeed an accident. On the other hand, the parties agree that Lim did not commit suicide. Nevertheless, Sun Insurance contends that the insured willfully exposed himself to needless peril and thus removed himself from the coverage of the insurance policy. It should be noted at the outset that suicide and willful exposure to needless peril are in pari materia because they both signify a disregard for one's life. The only difference is in degree, as suicide imports a positive act of ending such life whereas the second act indicates a reckless risking of it that is almost suicidal in intent. The posture -- that by the mere act of pointing the gun to his temple, Lim had willfully exposed himself to needless peril and so came under the exception -- is arguable. But what is not is that Lim had removed the magazine from the gun and believed it was no longer dangerous. He expressed assured her that the gun was not loaded. It is submitted that Lim did not willfully expose himself to needless peril when he pointed the gun to his temple because the fact is that he thought it was not unsafe to do so. The act was precisely intended to assure Nalagon that the gun was indeed harmless. Lim was unquestionably negligent and that negligence cost him his own life. But it should not prevent his widow from recovering from the insurance policy he obtained precisely against accident. There is nothing in the policy that relieves the insurer of the responsibility to pay the indemnity agreed upon if the insured is shown to have contributed to his own accident. Indeed, most accidents are caused by negligence. There are only four exceptions expressly made in the contract to relieve the insurer from liability, and none of these exceptions is applicable in the present case. It bears noting that insurance contracts are as a rule supposed to be interpreted liberally in favor of the assured. There is no reason to deviate from this rule, especially in view of the circumstances of the case.

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