Summary: Vda. de Gabriel vs. Court of Appeals (GR 103883, 14 November 1996)

Vda. de Gabriel vs. Court of Appeals
[GR 103883, 14 November 1996]
First Division, Vitug (J): 4 concur

Facts: Marcelino Gabriel, the insured, was employed by Emerald Construction & Development Corporation (ECDC) at its construction project in Iraq. He was covered by a personal accident insurance in the amount of P100,000.00 under a group policy procured from Fortune Insurance & Surety Company Inc. by ECDC for its overseas workers. The insured risk was for "bodily injury caused by violent accidental external and visible means which injury would solely and independently of any other cause" result in death or disability. On 22 May 1982, within the life of the policy, Gabriel died in Iraq. A year later, or on 12 July 1983, ECDC reported Gabriel's death to Fortune by telephone. Among the documents thereafter submitted to Fortune were a copy of the death certificate 5 issued by the Ministry of Health of the Republic of Iraq — which stated "REASON OF DEATH: UNDER EXAMINATION NOW — NOT YET KNOWN " and an autopsy report of the National Bureau of Investigation (NBI) to the effect that "due to advanced state of postmortem decomposition, cause of death could not be determined." Fortune referred the insurance claim to Mission Adjustment Service, Inc. Following a series of communications between Jacqueline Jimenez vda. de Gabriel and Fortune, the latter, on 22 September 1983, ultimately denied the claim of ECDC on the ground of prescription. Vda. De Gabriel went to the Regional Trial Court of Manila. In her complaint against ECDC and Fortune, she averred that her husband died of electrocution while in the performance of his work and prayed for the recovery of P100,000.00 for insurance indemnification and of various other sums by way of actual, moral, and exemplary damages, plus attorney's fees and costs of suit. Fortune filed its answer, which was not verified, admitting the genuineness and due execution of the insurance policy; it alleged, however, that since both the death certificate issued by the Iraqi Ministry of Health and the autopsy report of the NBI failed to disclose the cause of Gabriel's death, it denied liability under the policy. In addition, Fortune raised the defense of "prescription," invoking Section 384 10 of the Insurance Code. Later, Fortune filed an amended answer, still unverified, reiterating its original defenses but, this time, additionally putting up a counterclaim and a crossclaim. The trial court dismissed the case against ECDC for the failure of Vda. de Gabriel to take steps to cause the service of the fourth alias summons on ECDC. The dismissal was without prejudice. The case proceeded against Fortune alone. On 28 May 1987, the trial court rendered its decision in favor (partly) of Vda. de Gabriel's claim. In arriving at its conclusion, the trial court held that Fortune was deemed to have waived the defense, i.e., that the cause of Gabriel's death was not covered by the policy, when the latter failed to impugn by evidence Vda. de Gabriel's averment on the matter. With regard to the defense of prescription, the court considered the complaint to have been timely filed or within 1 year from Fortune's denial of the claim. Vda. de Gabriel and Fortune both appealed to the Court of Appeals. The Court of Appeals, on 18 September 1991, reversed the decision of the lower court. The appellate court held that Vda. de Gabriel had failed to substantiate her allegation that her husband's death was caused by a risk insured against. The motion for reconsideration was denied. Vda. de Gabriel filed the petition for review on certiorari.

Issue [1]: Whether prescription was properly invoked by Fortune in this case.

Held [1]: YES. On the issue of "prescription," Fortune correctly invoked Section 384 of the Insurance Code which provides that "Any person having any claim upon the policy issued pursuant to this chapter shall, without any unnecessary delay, present to the insurance company concerned a written notice of claim setting forth the nature, extent and duration of the injuries sustained as certified by a duly licensed physician. Notice of claim must be filed within six months from date of the accident, otherwise, the claim shall be deemed waived. Action or suit for recovery of damage due to loss or injury must be brought, in proper cases, with the Commissioner or the Courts within one year from denial of the claim, otherwise, the claimant's right of action shall prescribe." The notice of death was given to Fortune, concededly, more than a year after the death of Vda. de Gabriel's husband. Fortune, in invoking prescription, was not referring to the one-year period from the denial of the claim within which to file an action against an insurer but obviously to the written notice of claim that had to be submitted within six months from the time of the accident. On the other hand, there is absolutely no basis in fact and in law to hold that the insurance company was deemed to have waived -- by failing to have its answers (to the Request for Admission) duly verified -- the defense, that the death of Vda. de Gabriel's husband was not caused by violent accidental external and visible means' as contemplated in the insurance policy. The Death Certificate and the Autopsy Report, more than controverted the allegation of Vda. de Gabriel as to the cause of death of her husband.

Issue [2]: Whether Vda. De Gabriel is required to present proof that the insured’s demise was from an accidental death, unlike in ordinary life insurance where the insured's death, regardless of the cause thereof, would normally be compensable.

Held [2]: YES. The insurance policy expressly provided that to be compensable, the injury or death should be caused by "violent accidental external and visible means." In attempting to prove the cause of her husband's death, all that Vda. de Gabriel could submit were a letter sent to her by her husband's co-worker, stating that Gabriel died when he tried to haul water out of a tank while its submerged motor was still functioning, and Vda. de Gabriel's sinumpaang salaysay which merely confirmed the receipt and stated contents of the letter. Said the appellate court in this regard: "It must be noted that the only evidence presented by her to prove the circumstances surrounding her husband's death were her purported affidavit and the letter allegedly written by the deceased co-worker in Iraq. The said affidavit however suffers from procedural infirmity as it was not even testified to or identified by the affiant (Vda. De Gabriel) herself. This self-serving affidavit therefore is a mere hearsay under the rules. In like manner, the letter allegedly written by the deceased's co-worker which was never identified to in court by the supposed author, suffers from the same defect as the affidavit of the plaintiff-appellant." Not one of the other documents submitted, to wit, the POEA decision, dated 06 June 1984, the death certificate issued by the Ministry of Health of Iraq and the NBI autopsy report, could give any probative value to Vda. de Gabriel's claim. The POEA decision did not make any categorical holding on the specific cause of Gabriel's death. Neither did the death certificate issued by the health authorities in Iraq nor the NBI autopsy report provide any clue on the cause of death. All that appeared to be clear was the fact of Gabriel's demise on 22 May 1982 in Iraq. Evidence, in fine, is utterly wanting to establish that the insured suffered from an accidental death, the risk covered by the policy. In an accident insurance, the insured "s beneficiary has the burden of proof in demonstrating that the cause of death is due to the covered peril. Once the fact is established, the burden then shifts to the insurer to show any excepted peril that may have been stipulated by the parties. An "accident insurance" is not thus to be likened to an ordinary life insurance where the insured's death, regardless of the cause thereof, would normally be compensable. The latter is akin in property insurance to an "all risk" coverage where the insured, on the aspect of burden of proof, has merely to show the condition of the property insured when the policy attaches and the fact of loss or damage during the period of the policy and where, thereafter, the burden would be on the insurer to show any "excluded peril." When, however, the insured risk is specified, it lies with the claimant of the insurance proceeds to initially prove that the loss is caused by the covered peril.

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