Insular v. Khu

8.) Title: THE INSULAR LIFE ASSURANCE COMPANY, LTD., vs. PAZ Y. KHU, FELIPE Y. KHU, JR., and FREDERICK Y. KHU Citation: G.R. No. 195176, April 18, 2016 Ponente: DEL CASTILLO Doctrine: The date of last reinstatement mentioned in Section 48 of the Insurance Code pertains to the date that the insurer approved· the application for reinstatement. However, in light of the ambiguity in the insurance documents to this case, this Court adopts the interpretation favorable to the insured in determining the date when the reinstatement was approved. Facts: On March 6, 1997, Felipe N. Khu, Sr. applied for a life insurance policy with Insular Life wherein he did not declare any illness or adverse medical condition. Insular Life thereafter issued him a policy with a face value of P1 million which took effect on June 22, 1997. On June 23, 1999, Felipe’s policy lapsed due to non-payment of the premium covering the period from June 22, 1999 to June 23, 2000. On September 7, 1999, Felipe applied for the reinstatement of his policy and paid P25,020.00 as premium. Except for the change in his occupation of being self-employed to being the Municipal Mayor of Binuangan, Misamis Oriental, all the other information submitted by Felipe in his application for reinstatement was virtually identical to those mentioned in his original policy. On October 12, 1999, Insular Life advised Felipe that his application for reinstatement may only be considered if he agreed to certain conditions such as payment of additional premium and the cancellation of the riders pertaining to premium waiver and accidental death benefits. Felipe agreed to these conditions and on December 27, 1999 paid the agreed additional premium of P3,054.50. On September 22, 2001, Felipe died due to renal and hepatic failure due to Diabetes Neuropathy, Alcoholism, and Pneumonia. Felipe’s beneficiaries or respondents filed with Insular Life a claim for benefit under the reinstated policy. This claim was denied. Insular Life advised Felipe’s beneficiaries that it had decided to rescind the reinstated policy on the grounds of concealment and misrepresentation by Felipe. Respondents instituted a complaint for specific performance with damages and prayed that the reinstated life insurance policy be declared valid and enforceable on Insular Life. Insular Life countered that Felipe did not disclose the ailments that he already had prior to his application for reinstatement of his insurance policy; and that it would not have reinstated the insurance policy had Felipe disclosed the material information on his adverse health condition. It contended that when Felipe died, the policy was still contestable. The RTC ruled in favor the respondents stating that any ambiguity in a contract of insurance should be resolved strictly against the insurer upon the principle that an insurance contract is a contract of adhesion and that the reinstated insurance policy had already become incontestable by the time of Felipe’s death on September 22, 2001 since more than two years had already lapsed from the date of the policy’s reinstatement on June 22, 1999. The CA affirmed the RTC’s ruling that there exists a genuine ambiguity or obscurity in the language of the two documents prepared by Insular Life itself, viz., Felipe’s Letter of Acceptance and Insular Life’s Endorsement; that given the obscurity/ambiguity in the language of these two documents, the construction/interpretation that favors the insured’s right to recover should be adopted; and that in keeping with this principle, the insurance policy in dispute must be deemed reinstated as of June 22, 1999. The MR was denied. Insular Life basically argues that respondents should not be allowed to recover on the reinstated insurance policy because the two-year contestability period had not yet lapsed inasmuch as the insurance policy was reinstated only on December 27, 1999, whereas Felipe died on September 22, 2001; that the CA overlooked the fact that Felipe paid the additional extra premium only on December 27, 1999, hence, it is only upon this date that the reinstated policy had become effective; Issue: WON Felipe’s reinstated life insurance policy is already incontestable at the time of his death? Held: Yes. Sec. 48 of the Insurance Code provides, Whenever a right to rescind a contract of insurance is given to the insurer by any provision of this chapter, such right must be exercised previous to the commencement of an action on the contract. After a policy of life insurance made payable on the death of the insured shall have been in force during the lifetime of the insured for a period of two years from the date

of its issue or of its last reinstatement, the insurer cannot prove that the policy is void ab initio or is rescindible by reason of the fraudulent concealment or misrepresentation of the insured or his agent. The rationale for this provision was discussed by the Court in Manila Bankers Life Insurance Corporation v. Aban, Sec. 48 gives insurers enough time to inquire whether the policy was obtained by fraud, concealment, or misrepresentation; on the other hand, it forewarns scheming individuals that their attempts at insurance fraud would be timely uncovered – thus deterring them from venturing into such nefarious enterprise. At the same time, legitimate policy holders are absolutely protected from unwarranted denial of their claims or delay in the collection of insurance proceeds occasioned by allegations of fraud, concealment, or misrepresentation by insurers, claims which may no longer be set up after the two-year period expires as ordained under the law. In this case, the parties differ as to when the reinstatement was actually approved. Insular Life claims that it approved the reinstatement only on December 27, 1999. On the other hand, respondents contend that it was on June 22, 1999 that the reinstatement took effect. The resolution of this issue hinges on the following documents: 1) Letter of Acceptance which showed that it will be effective on June 22, 1999; and 2) In the Endorsement, the first sentence is not entirely clear whether the phrase "effective June 22, 1999" refers to the subject of the sentence, namely "the reinstatement of this policy," or to the subsequent phrase "changes are made on the policy." Given the obscurity of the language, the construction favorable to the insured will be adopted by the courts. Accordingly, the subject policy is deemed reinstated as of June 22, 1999. Thus, the period of contestability has lapsed. It must be remembered that an insurance contract is a contract of adhesion which must be construed liberally in favor of the insured and strictly against the insurer in order to safeguard the latter’s interest. Thus, in Malayan Insurance Corporation v. Court of Appeals, this Court held that: Indeed, more than two years had lapsed from the time the subject insurance policy was reinstated on June 22, 1999 vis-a-vis Felipe’s death on September 22, 2001. As such, the subject insurance policy has already become incontestable at the time of Felipe’s death. Petition is DENIED.