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    44.sun Life Assurance Vs CA

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    Mariny Del rosario
    The insured procured a life insurance policy but failed to fully disclose his medical history when applying. Specifically, he did not disclose that he had been hospitalized for two weeks prior to applying. When he died in a plane crash, the insurance company denied the claim, citing concealment of relevant medical information. The beneficiaries sued. The courts initially ruled for the beneficiaries, finding the concealment was in good faith and the policy was non-medical. However, the Supreme Court reversed, finding the concealed medical information was material even for a non-medical policy, as it would have influenced the insurance company's risk assessment. The insurance company validly rescinded the policy due to the concealment.

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    44.sun Life Assurance Vs CA

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    Mariny Del rosario
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    The insured procured a life insurance policy but failed to fully disclose his medical history when applying. Specifically, he did not disclose that he had been hospitalized for two weeks prior to applying. When he died in a plane crash, the insurance company denied the claim, citing concealment of relevant medical information. The beneficiaries sued. The courts initially ruled for the beneficiaries, finding the concealment was in good faith and the policy was non-medical. However, the Supreme Court reversed, finding the concealed medical information was material even for a non-medical policy, as it would have influenced the insurance company's risk assessment. The insurance company validly rescinded the policy due to the concealment.

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    The insured procured a life insurance policy but failed to fully disclose his medical history when applying. Specifically, he did not disclose that he had been hospitalized for two weeks prior to applying. When he died in a plane crash, the insurance company denied the claim, citing concealment of relevant medical information. The beneficiaries sued. The courts initially ruled for the beneficiaries, finding the concealment was in good faith and the policy was non-medical. However, the Supreme Court reversed, finding the concealed medical information was material even for a non-medical policy, as it would have influenced the insurance company's risk assessment. The insurance company validly rescinded the policy due to the concealment.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    36 views2 pages

    44.sun Life Assurance Vs CA

    Uploaded by

    Mariny Del rosario
    The insured procured a life insurance policy but failed to fully disclose his medical history when applying. Specifically, he did not disclose that he had been hospitalized for two weeks prior to applying. When he died in a plane crash, the insurance company denied the claim, citing concealment of relevant medical information. The beneficiaries sued. The courts initially ruled for the beneficiaries, finding the concealment was in good faith and the policy was non-medical. However, the Supreme Court reversed, finding the concealed medical information was material even for a non-medical policy, as it would have influenced the insurance company's risk assessment. The insurance company validly rescinded the policy due to the concealment.

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    © All Rights Reserved
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    44.

    Sun Life Assurance vs CA

    Robert John B. Bacani procured a life insurance contract for himself from petitioner. He was issued Policy No. 3-
    903-766-X valued P100,000.00, with double indemnity in case of accidental death. The designated beneficiary was
    his mother, respondent Bernarda Bacani.

    The insured died in a plane crash. Respondent Bernarda Bacani filed a claim with petitioner, seeking the benefits of
    the insurance policy taken by her son. Petitioner conducted an investigation and its findings prompted it to reject the
    claim.

    Petitioner informed respondent Bernarda Bacani, that the insured did not disclosed material facts relevant to the
    issuance of the policy, thus rendering the contract of insurance voidable. A check representing the total premiums
    paid in the amount of P10,172.00 was attached to said letter.

    "5. Within the past 5 years have you:


    a) consulted any doctor or other health practitioner?
    b) submitted to:
    ECG?
    X-rays?
    blood tests?
    other tests?

    The deceased answered question No. 5(a) in the affirmative but limited his answer to a consultation with a certain
    Dr. Reinaldo D. Raymundo of the Chinese General Hospital on February 1986, for cough and fluu complications.

    Respondent Bernarda Bacani and her husband, respondent Rolando Bacani, filed an action for specific performance
    against petitioner with the Regional Trial Court

    RTC favored Bacani’s. It held that facts concealed by the insured were made in good faith and under the belief that
    they need not be disclosed. Moreover, it held that the health history of the insured was immaterial since the
    insurance policy was "non-medical."

    Ca also sustained the finding of the trial court that the matters relating to the health history of the insured were
    irrelevant since the petitioner waived the medical examination prior to the approval and issuance of the insurance
    policy.
    Moreover, the appellate court agreed with the trial court that the policy was "nonmedical”

    Issue: W/n Respondents Bacani can claim the insurance proceeds despite the concealment done by Robert Bacani

    Ruling:
    No.
    In weighing the evidence presented, the trial court concluded that indeed there was concealment and
    misrepresentation, however, the same was made in "good faith" and the facts concealed or misrepresented were
    irrelevant since the policy was "nonmedical.” SC disagrees.

    Section 26 of the Insurance Code is explicit in requiring a party to a contract of insurance to communicate to the
    other, in good faith, all facts within his knowledge which are material to the contract and as to which he makes no
    warranty, and which the other has no means of ascertaining.

    Materiality is to be determined not by the event, but solely by the probable and reasonable influence of the facts
    upon the party to whom communication is due, in forming his estimate of the disadvantages of the proposed contract
    or in making his inquiries (The Insurance Code, Sec 31).

    The terms of the contract are clear. The insured is specifically required to disclose to the insurer matters relating to
    his health. The information which the insured failed to disclose were material and relevant to the approval and the
    issuance of the insurance policy. The matters concealed would have definitely affected petitioner's action on his
    application, either by approving it with the corresponding adjustment for a higher premium or rejecting the same.
    Moreover, a disclosure may have warranted a medical examination of the insured by petitioner in order for it to
    reasonably assess the risk involved in accepting the application.

    In Vda. de Canilang v. Court of Appeals , 223 SCRA 443 (1993), SC held that materiality of the information
    withheld does not depend on the state of mind of the insured. Neither does it depend on the actual or physical events
    which ensue. Thus, "good faith" is no defense in concealment. The insured's failure to disclose the fact that he was
    hospitalized for two weeks prior to filing his application for insurance, raises grave doubts about his bonafides. It
    appear that such concealment was deliberate on his part.

    The waiver of a medical examination [in a non-medical insurance contract] renders even more material the
    information required of the applicant concerning previous condition of health and diseases suffered, for such
    information necessarily constitutes an important factor which the insurer takes into consideration in deciding
    whether to issue.

    Insured need not die of the disease he had failed to disclose to the insurer. It is sufficient that his non-disclosure
    misled the insurer in forming his estimates of the risks of the proposed insurance policy or in making inquiries
    (Henson v. The Philippine American Life Insurance Co., 56 O.G. No. 48 [1960]).

    SC ruled that petitioner properly exercised its right to rescind the contract of insurance by reason of the concealment
    employed by the insured. It must be emphasized that rescission was exercised within the two-year contestability
    period as recognized in Section 48 of The Insurance Code.

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