Midterm Exam Flashcards
REPUBLIC v DEL MONTE MOTORS, INC
The Insurance Code has vested the Office of the Insurance Commission with both regulatory and adjudicatory authority over insurance matters.
To allow the garnishment of that deposit would impair the fund by decreasing it to less than the percentage of paid-up capital that the law requires to be maintained
An implied trust is created by the law for the benefit of all claimants under subsisting insurance contracts issued by the insurance company.” He believed that the security deposit was exempt from execution to protect the policy holders. The business of insurance is imbued with public interest. It is subject to regulation by the State, with respect not only to the relations between the insurer and the insured, but also to the internal affairs of insurance companies.
PHILIPPINE HEALTH CARE PROVIDERS, INC. v CIR
One test that they have applied is whether the assumption of risk and indemnification of loss (which are elements of an insurance business) are the principal object and purpose of the organization or whether they are merely incidental to its business. If these are the principal objectives, the business is that of insurance. But if they are merely incidental and service is the principal purpose, then the business is not insurance.
WHITE GOLD MARINE SERVICES vs. PIONEER INSURANCE
A marine insurance undertakes to indemnify the assured against marine losses. A mutual insurance company is a cooperative enterprise where the members are both the insurer and the insured. In it, members all co ntribute, by a system of premiums or assessments, to the creation of a fund from which all losses and liabilities are paid, and where the profits are divided among themselves, in proportion to their interest.
RIZAL SURETY AND INSURANCE CO. v CA
This is particularly true as regards insurance policies, in respect of which it is settled that the ‘terms in an insurance policy, which are ambiguous, equivocal, or uncertain . . . are to be construed strictly and most strongly against the insurer, and liberally in favor of the insured so as to effect the dominant purpose of indemnity or payment to the insured, especially where forfeiture is involved’
VERENDIA v CA
Having presented a false declaration to support his claim for benefits in the form of a fraudulent lease contract, he forfeited all benefits therein by virtue of Section 13 of the policy in the absence of proof that Fidelity waived such provision.
Basically a contract of indemnity, an insurance contract is the law between the parties. Its terms and conditions constitute the measure of the insurer’s liability and compliance therewith is a condition precedent to the insured’s right to recovery from the insurer
PHILAMCARE HEALTH SYSTEMS INC. v CA
the health care agreement was an insurance contract. More particularly, it was one in the nature of a non-life insurance, which is primarily a contract of indemnity. An insurance contract exists when the following elements concur: (1) the insured has an insurable interest; (2) the insured is subject to a risk of loss by the happening of the designated peril; (3) the insurer assumes the risk; (4) such assumption of risk is part of a general scheme to distribute actual losses among a large group of persons bearing a similar risk; and (5) in consideration of the insurer’s promise, the insured pays a premium.
Insurable interest of the husband was his own health
FORTUNE INSURANCE AND SURETY CO., INC. v CA
has been aptly observed that in burglary, robbery, and theft insurance, “the opportunity to defraud the insurer — the moral hazard — is so great that insurers have found it necessary to fill up their policies with countless restrictions, many designed to reduce this hazard. Seldom does the insurer assume the risk of all losses due to the hazards insured against.”
An insurance contract is a contract of indemnity upon the terms and conditions specified therein. It is settled that the terms of the policy constitute the measure of the insurer’s liability.
GULF RESORTS v PHILIPPINE CHARTER INSURANCE CORPORATION
In the subject policy, no premium payments were made with regard to earthquake shock coverage, except on the two swimming pools.
In sum, there is no ambiguity in the terms of the contract and its riders. Petitioner cannot rely on the general rule that insurance contracts are contracts of adhesion which should be liberally construed in favor of the insured and strictly against the insurer company which usually prepares it.
MANILA MAHOGANY v CA
Should the insured, after receiving payment from the insurer, release the wrongdoer who caused the loss, the insurer loses his rights against the latter. In such a case, the insurer will be entitled to recover from the insured whatever it has paid to the latter, unless the release was made with the consent of the insurer.
However, when petitioner released San Miguel Corporation from any liability (by virtue of the Release of Claim made when San Miguel likewise paid petitioner for the said incident which discharges it from “all actions, claims, demands and rights of action”), petitioner’s right to retain the sum of P5,000.00 no longer existed, thereby entitling private respondent to recover the same.
FEDERAL EXPRESS CORP v AMERICAN HOME ASSURANCE COMPANY & PHIL-AM INSURANCE CO
Upon payment of an indemnity for the loss of or damage to the insured goods, the insurers entitlement to subrogation pro tanto – being of the highest equity – equips it with a cause of action in case of a contractual breach or negligence.
ETERNAL GARDENS MEMORIAL PARK v PHIL AMERICAN
the seemingly conflicting provisions must be harmonized to mean that upon a party’s purchase of a memorial lot on installment from Eternal, an insurance contract covering the lot purchaser is created and the same is effective, valid, and binding until terminated by Philamlife by disapproving the insurance application.
the mere inaction of the insurer on the insurance application must not work to prejudice the insured; it cannot be interpreted as a termination of the insurance contract. The termination of the insurance contract by the insurer must be explicit and unambiguous.
JAIME T. GAISANO v DEVELOPMENT INSURANCE AND SURETY CORPORATION
The premium is the source of life of the insurance business. Art 77. No policy or contract of insurance issued by an insurance company is valid or biding unless and until the premium thereof has been paid. Exceptions: (1) In case of life or industrial life policy, whenever the grace period provision applies (Art 77) (2) Where the insurer acknowledged in the policy or contract of insurance itself the receipt of premium, even if premium has not been actually paid (Art 78) (3) where the parties agreed that premium payment shall be in installments and partial payment has been made at the time of loss (Makati Tuscany Condominium Corp. v. Court of Appeals) (4) where the insurer granted the insured a credit term for the payment of the premium, and loss occurs before the expiration of the term (Makati Tuscany Condominium Corp. v. Court of Appeals) (5) where the insurer is in estoppel as when it has consistently granted a 60 to 90-day credit term for the payment of premiums
The premium, therefore, is the elixir vitae or the source of life of the insurance business. In the case, no premium was paid yet at the time of the loss. Notice of the availability of the check, in itself, does not produce the effect of payment of premium
PHILIPPINE HEALTH CARE PROVIDERS, INC. v CIR
even if a contract contains all the elements of an insurance contract, if its primary purpose is the rendering of service, it is not a contract of insurance. The primary purpose o f the parties in making the contract may negate the existence of an insurance contract.
NEW WORLD INTERNATIO NYKNAL DEVELOPMENT (PHI LS.), INC., FILJAPAN SHIPPING CO R
The marine open policy that Seaboard issued to New World was an all risk policy. Such a policy insured against all causes of conceivable loss or damage except when otherwise excluded or when the loss or damage was due to fraud or intentional misconduct committed by the insured. The policy covered all losses during the voyage whether or not arising from a marine peril. The policy enumerated certain exceptions like unsuitable packaging, inherent vice, delay in voyage, or vessels unseaworthiness, among others. But Seaboard had been unable to show that New Worlds loss or damage fell within some or one of the enumerated exceptions.
TRAVELLERS INSURANCE & SURETY CORPORATION v CA
The persons suing under an insurance contract must comply with the indispensable requirement of filing the written notice of claim within six (6) months from the date of the accident mandated by Section 384 of the Insurance Code. Absent such written claim filed by the person suing under an insurance contract, no cause of action accrues under such insurance contract.
The right of the person injured to sue the insurer of the party at fault (insured), depends on whether the contract of insurance is intended to benefit third persons also or on the insured.
And the test applied has been this: Where the contract provides for indemnity against liability to third persons, then third persons to whom the insured is liable can sue the insurer. Where the contract is for indemnity against actual loss or payment, then third persons cannot proceed against the insurer, the contract being solely to reimburse the insured for liability actually discharged by him thru payment to third persons, said third persons recourse being thus limited to the insured alone.
