G.R. No.

195872

FORTUNE MEDICARE, INC, Petitioner,

vs.
DAVID ROBERT U. AMORIN, Respondent

Facts:

Amorin was a cardholder/member of Fortune Medicare, INC, a corporation

engaged in providing health maintenance servive to its members. While on a
vacation in Honolulu, Hawaii, he underwent an emergency surgery,
appendectomy, at the St. Francis Medical Center. As a result, Amorin wanted to
reimburse from Fortune Care for the full amount of his expenses amounting to
US$1,777.79 and US$7,242.35, both for professional and hospitalization
expenses. However, only 12,151.36 PHP was paid to him by Fortune
Medicareprompting him to file this petition.

Issue:

Whether Fortune Medicare is liable under the policy given to Amorin.

Held:

Yes, Fortune Medicare is liable. In the policy, a provision stating that a member
shall be entitles to full coverage benefits whether in the Philippines or abroad.
It also provides that if the emergency confinement occurs in a foreign country,
Fortune Medicare shall be obligated to reimburse or pay 80% of the approved
standard charges which shall cover the hospitalization and professional fees.

Settled is the rule that ambiguities in a contract are interpreted against the
party that caused it. In this case, Fortune Medicare.
G.R. No. 200784

Malayan Insurance Company, Inc., Petitioner,

vs

PAP CO, LTD (Phil Branch), Respondent

Facts:

Malayan Insurance Company issued Fire Insurance policy to PAP Co, LTD for
the latter’s machineries and equipment located at Sanyo Precision Philippines
building in Rosario, Cavite. After one year and before the expiration of the
contract, PAP CO LTD renewed the policy on “as-is” basis. PAP Co, LTD, without
the consent of Malayan Insurance, moved the properties from Cavite to a
different place. Fire then broke out. Malayan denied liability, hence, this
petition.

Issue:

Whether Malayan Insurance is liable to PAP Co, LTD and whether such transfer
increase the risk of loss of the insured properties.

Held:

No. Supreme Court held that the insurance company is not liable for the
reason that the transfer of properties without its consent was a violation of
the contract and that the same increased the risk of loss of the insured
properties.
G.R. No. 175773

MITSUBISHI MOTORS PHILIPPINES SALARIED EMPLOYEES UNION

(MMPSEU),Petitioner,
vs.
MITSUBISHI MOTORS PHILIPPINES CORPORATION, Respondent.

Facts:

The Collective Bargaining Agreement (CBA) of the parties in this case provides
that the company shoulder the hospitalization expenses of the dependents of
covered employees subject to certain limitations and restrictions.

Covered employees pay part of the hospitalization insurance premium

through monthly salary deduction while the company, upon hospitalization of
the covered employees' dependents, shall pay the hospitalization expenses
incurred for the same. Portion of the hospitalization expenses of the covered
employees' dependents were paid/shouldered by the dependent's own health
insurance. Tthe company refused to pay the portion of the hospital expenses
already shouldered by the dependents' own health insurance.

MMPC denied the claims contending that double insurance would result if the
said employees would receive from the company the full amount of
hospitalization expenses despite having already received payment of portions
thereof from other health insurance providers.

MMPSE Union alleged that there is nothing in the CBA which prohibits an
employee from obtaining other insurance or declares that medical expenses
can be reimbursed only upon presentation of original official receipts. And
that the hospitalization benefits should be computed based on the formula
indicated in the CBA without deducting the benefits derived from other
insurance providers.

Voluntary Arbitrator rendered a Decision finding MMPC liable to pay or

reimburse the amount of hospitalization expenses already paid by other
health insurance companies but was reversed by CA. A Motion for
Reconsideration was filed but was still denied. Hence, this petition.

Issue:

Whether or not the Court of Appeals erred in reversing the decision of the
Voluntary Arbitrator ordering MMPC to pay or reimburse the whole amount of
hospitalization expenses incur by the employee

Held:

No. The conditions in the CBA provision indicate an intention to limit MMPC’s
liability only to actual expenses incurred by the employees’ dependents, that
is, excluding the amounts paid by dependents’ other health insurance
providers.

The condition that payment should be direct to the hospital and doctor
implies that MMPC is only liable to pay medical expenses actually shouldered
by the employees’ dependents. It follows that MMPC’s liability is limited, that
is, it does not include the amounts paid by other health insurance providers.

Since the subject CBA provision is an insurance contract, the rights and
obligations of the parties must be determined in accordance with the general
principles of insurance law. Being in the nature of a non-life insurance contract
and essentially a contract of indemnity, the CBA provision obligates MMPC to
indemnify the covered employees’ medical expenses incurred by their
dependents but only up to the extent of the expenses actually incurred.

G.R. No. 173773

PARAMOUNT INSURANCE CORPORATION, Petitioner,

vs.
SPOUSES YVES and MARIA TERESA REMONDEULAZ, Respondents.
Facts:

Respondents insured with petitioner their Toyota Corolla sedan under a

comprehensive motor vehicle insurance policy for one year.

Respondents’ car was unlawfully taken by a certain Ricardo Sales (Sales) who
took possession of the subject vehicle to add accessories and improvements
thereon, however, Sales failed to return the subject vehicle within the agreed
three-day period.

Respondents notified petitioner to claim for the reimbursement of their lost

vehicle but petitioner refused to pay.

A complaint for a sum of money against petitioner before the Regional Trial
Court of Makati City was filed but was denied as loss of respondents’ vehicle is
not a peril covered by the policy.

The appellate court reversed and set aside the Order issued by the trial court
as well as the motion for reconsideration.

Hence this position.

Issue:

Whether or not petitioner is liable under the insurance policy for the loss of
respondents’ vehicle.

Held:

Yes.

The taking of repondents’ vehicle by Sales is without any consent or authority

from the former. Respondents entrusted possession of their vehicle only to the
extent that Sales will introduce repairs and improvements thereon, and not to
permanently deprive them of possession thereof. Since Theft can also be
committed through misappropriation, the fact that Sales failed to return the
subject vehicle to respondents constitutes Qualified Theft.
Sales’ act of depriving respondents of their motor vehicle at, or soon after the
transfer of physical possession of the movable property, constitutes theft
under the insurance policy, which is compensable.

G.R. No. 184300

Malayan Insurance Co. Inc vs. , Petitioner

Philippine First Insurance Co. Inc and Reputable Forwarder Services Inc.,
Respondent

Facts:

This case involves 2 insurance contract entered into between Wyeth

Philippines, Inc. (Wyeth) and respondent Reputable Forwarder Services
(Reputable) whereby a contract of carriage had been entered into for the
latter to transport and deliver the former’s product to its customers, dealers
and salesmen. While Wyeth procured Marine Policy from respondent
Philippines First Insurance Co., Inc (Philippines First) to secure its interest
over its own products which includes nutritional, pharmaceutical and other
products usual or incidental to Wyeths business while the same were being
transported or shipped in the Philippines. On the first insurance policy, such
required Reputable to secure an insurance policy on Wyeths goods. Thus,
Reputable signed a Special Risk Insurance Policy (SR Policy) with petitioner
Malayan or the amount of 1M.

During the effectivity of the Marine Policy and SR Policy, the truck containing
infant formula amounting to 2,357,582.70 which was supposedly be delivered
to Mercury drug was hijacked.

Pursuant to the Marine Policy, Philippine First paid Whyeth for indemnity.
Such demanded reimbursement from Reputable but the latter ignored its
demand. Consequently Philippine First filed an action against Reputable and
impleaded Malayan as third party defendant in an effort to collect the amount
covered in the SR Policy.

Malayan insists that their liability only covers the prorated share of the loss
based on the amount covered by Section 12 or Other Insurance Clause.

Issue:
Whether Malayan is liable for the whole amount of the insurance policy
despite the existence of “other insurance clause” and “over insurance clause”

Held:

Yes. Sec 5 of the policy which pertains to the additional insurance and double
insurance does not apply to this case as there was no double insurance exist.
In order for double insurance to arise, the following requisites must be
present:

1. The person insured must be the same

2. Two or more insurers insuring separately
3. There is identity of subject matter
4. There is identity of interest insured
5. There is identity of the risk of peril insured against

In the present case both Marine and SR policy were both issued over the same
subject matter and both covered the same peril insured against, however said
policies were issued to two different persons or entities. The interest of Wyeth
over the property subject matter of both insurance contracts is also different
and distinct from that of Reputable’s. The policy issued by Philippines First
was in consideration of the legal and/or equitable interest of Wyeth over its
own goods. On the other hand, what was issued by Malayan to Reputable was
over the latter’s insurable interest over the safety of the goods, which may
become the basis of the latter’s liability in case of loss or damage to the
property and falls within the contemplation of Section 15 of the Insurance
Code.

G.R No. 198588

United Merchants Corporation, Petitioner

vs

Country Bankers Insurance Corporation, Respondent

Facts:

Petitioner United Merchants Corp. (UMC) entered into a contract of insurance

with Country Bankers Insurance Corporation to insured its stocks of
Christmas lights against fire. Sometime in 1996 the warehouse of UMC was
gutted by fire. UMC demanded payment but CBIC rejected the formers claim
due to breach on one of its condition particularly No. 15 focusing on the
petitioner’s fraudulent claim.

Issue:

Whether UMC is entitled to claim from CBIC the full coverage of its fire
insurance policy

Held:

No. the court ruled that submission of false invoices establishes a clear case of
fraud and misrepresentation which voids the insurer’s liability as per
conditions policy. The Insurance Code provides that “a policy may declare that
a violation of specified provisions thereof shall avoid it.” Thus, in fire insurance
policies, which contain provisions such as Condition No. 15 of the Insurance
Policy, a fraudulent discrepancy between the actual loss and that claimed in
the proof of loss voids the insurance policy. Mere filing of such a claim will
exonerate the insurer.