Vda. de Gabriel v. CA
G.R. No. 103883 (November 14, 1996)
Facts:
Marcelino Gabriel, the insured, was employed by Emerald Construction & Development Corporation (ECDC) and was covered by a personal accident insurance policy amounting to P100,000.00, procured from Fortune Insurance & Surety Company, Inc. for its overseas workers. The policy covered bodily injury resulting from "violent accidental external and visible means" that would lead to death or disability. On May 22, 1982, Gabriel died in Iraq. A year later, ECDC reported his death to Fortune Insurance, submitting a death certificate from the Iraqi Ministry of Health, which stated that the cause of death was "under examination now - not yet known," and an autopsy report from the National Bureau of Investigation (NBI) indicating that the cause of death could not be determined due to advanced decomposition.
Fortune Insurance denied the claim on September 22, 1983, citing the ground of prescription. Subsequently, Jacqueline Jimenez, Gabriel's surviving spouse and beneficiary, filed a complaint against both ECDC and Fortune Insurance, claiming that her husband died from electrocution while working and seeking the insurance indemnification along with other damages. Fortune Insurance admitted the genuineness of the policy but denied liability, arguing that the death certificate and autopsy report did not establish the cause of death and raised the defense of prescription under the Insurance Code.
The Regional Trial Court of Manila dismissed the case against ECDC due to lack of service of summons but ruled in favor of Jimenez against Fortune Insurance, concluding that the insurer had waived its defense regarding the cause of death and that the claim was timely filed. Both parties appealed to the Court of Appeals, with Jimenez seeking additional damages and Fortune Insurance contesting the trial court's findings.
Legal Issues:
- Whether Fortune Insurance waived its defense regarding the cause of death by failing to provide evidence against Jimenez's claims.
- Whether the claim was filed within the prescribed period under the Insurance Code.
Arguments:
Petitioner (Jimenez): Argued that Fortune Insurance waived its right to contest the claim by not providing evidence to refute her assertion that her husband died from an insured peril. She contended that the trial court should have awarded all her claims, including moral and exemplary damages.
Respondent (Fortune Insurance): Contended that the trial court erred in ruling that it waived its defense regarding the cause of death and that the claim was not prescribed. It maintained that the death certificate and autopsy report did not support Jimenez's claim that the death was due to an accident covered by the policy.
Court's Decision and Legal Reasoning:
The Court of Appeals reversed the trial court's decision, ruling that Jimenez failed to substantiate her claim that her husband's death was caused by an insured risk. The appellate court noted that the only evidence presented by Jimenez consisted of her own affidavit and a letter from a co-worker, both of which were deemed hearsay and lacked probative value. The court emphasized that the burden of proof rested on Jimenez to demonstrate that the cause of death fell within the coverage of the insurance policy.
On the issue of prescription, the appellate court upheld Fortune Insurance's argument that Jimenez did not provide the required written notice of claim within six months of the accident, as mandated by Section 384 of the Insurance Code. The court clarified that the notice of claim must be filed within six months from the date of the accident, and since the notice was given more than a year after Gabriel's death, the claim was deemed waived.
The appellate court also addressed the procedural aspect of the unverified answer filed by Fortune Insurance, stating that while verification is a formal requirement, it does not affect the jurisdiction of the court. The court concluded that the insurer's written answer, despite being unverified, sufficiently addressed the claims made by Jimenez.
Significant Legal Principles Established:
- The burden of proof in accident insurance claims lies with the beneficiary to establish that the cause of death is due to a covered peril.
- The requirement for a written notice of claim within six months from the date of the accident is mandatory, and failure to comply results in waiver of the claim.
- Verification of pleadings is a formal requirement and does not affect the jurisdiction of the court; courts may allow corrections to unverified pleadings to serve the ends of justice.