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SUN INSURANCE OFFICE, LTD., vs. COURT OF APPEALS and EMILIO TANG.R. No. 89741 March 13, 1991

Facts:Private respondent Emilio Tan took from petitioner a P300,000.00 property insurance policy to cover his interestin the electrical supply store of his brother housed in a building in Iloilo City. Four days after the issuance of thepolicy, the building was burned including the insured store. Tan filed his claim for fire loss with petitioner, but onFebruary 29, 1984, petitioner wrote Tan denying the latter's claim. On April 3, 1984, Tan wrote petitioner,seeking reconsideration of the denial of his claim. Tan filed a case but petitioner filed a motion to dismiss on thealleged ground that the action had already prescribed and said motion was denied; and petitioner's motion forreconsideration was also denied.

Issue:1. WON the court the filing of a motion for reconsideration interrupts the 12 months prescription period to

contest the denial of the insurance claim2. WON the rejection of the claim shall be deemed final only if it contains words to the effect that the denial

is final

Held:1. NO. The SC held that Condition 27 of the Insurance policy is very clear and free from any doubt or ambiguity.

It has to be taken in its plain, ordinary, and popular sense. The rejection letter of February 29, 1984 wasclear and plain. The Court noted that the one year period is likewise in accord with Section 23 of theInsurance Code which states that any condition which limits the time for commencing an action to a periodof less than one year when the cause of action accrues is void. The right of action, according to the SC,accrues at the time that the claim is rejected at the first instance. A request for reconsideration of the denialcannot suspend the running of the prescriptive period. The Court noted that the rationale for the one yearperiod is to ensure that the evidence as to the origin and cause of the destruction have not yet disappeared.

2. NO. The Court clarified its ruling in Eagle Star Insurance Co. vs Chia Yu where it ruled that the cause of action in an insurance contract does not accrue until the Insureds claim is finally rejected by the Insurer bystating the use of the word finally cannot be construed to mean the rejection of a petition forreconsideration. What the court referred to in effect is the rejection in the first instance as claimed by SunInsurance

Disposition: The decision of the CA is reversed and set aside. The case is dismissed.

JACQUELINE JIMENEZ VDA. DE GABRIELvs. CA and FORTUNE INSURANCE & SURETY COMPANY, INC.G.R. No. 103883 November 14, 1996

Facts:Marcelino Gabriel was employed by Emerald Construction & Development Corporation (Emerald Construction forbrevity) at its construction project in Iraq. He was covered by a personal accident insurance in the amount of P100,000.00 under a group policy procured from Fortune Insurance & Surety Company (Fortune Insurance forbrevity) by Emerald Construction for its overseas workers. The insured risk was for bodily injury caused byviolent accidental external and visible means which injury would solely and independently of any other causeresult in death or disability.

On 22 May 1982, within the life of the policy, Gabriel died in Iraq. On 12 July 1983, Emerald Constructionreported Gabriels death to Fortune Insurance by telephone. Among the documents thereafter submitted toFortune Insurance were a copy of the death certificate issued by the Ministry of Health of the Republic of Iraqwhich stated that an autopsy report by the National Bureau of Investigation was conducted to the effect that dueto advanced state of post mortem decomposition, the cause of death of Gabriel could not be determined

Because of this development Fortune Insurance ultimately denied the claim of Emerald Construction on theground of prescription. Gabriels widow, Jacqueline Jimenez, went to the lower court. In her complaint againstEmerald Construction and Fortune Insurance, she averred that her husband died of electrocution while in theperformance of his work.

Fortune Insurance alleged that since both the death certificate issued by the Iraqi Ministry of Health and theautopsy report of the NBI failed to disclose the cause of Gabriels death, it denied liability under the policy. In

addition, private respondent raised the defense of prescription, invoking Section 384 of the Insurance Code.

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Issue:WON Jacqueline Jimenez Vda. De Gabriels claim against Fortune Insurance should be denied on the ground of prescription

Held:Yes. Section 384 of the Insurance Code provides:Sec. 384. Any person having any claim upon the policy issued pursuant to this chapter shall, without any unnecessary delay, present to the insurance company concerned a written notice of claim setting forth thenature, extent and duration of the injuries sustained as certified by a duly licensed physician. Notice of claimmust be filed within six months from date of the accident, otherwise, the claim shall be deemed waived. Actionor suit for recovery of damage due to loss or injury must be brought, in proper cases, with the Commissioner or the Courts within one year from denial of the claim, otherwise, the claimants right of action shall prescribe.

The notice of death was given to Fortune Insurance, concededly, more than a year after the death of Vda. DeGabriels husband. Fortune Insurance, in invoking prescription, was not referring to the one-year period from thedenial of the claim within which to file an action against an insurer but obviously to the written notice of claimthat had to be submitted within six months from the time of the accident.

Vda. De Gabriel argues that Fortune Insurance must be deemed to have waived its right to show that the causeof death is an excepted peril, by failing to have its answers duly verified. It is true that a matter of which awritten request for admission is made shall be deemed impliedly admitted unless, within a period designated inthe request, which shall not be less than 10 days after service thereof, or within such further time as the courtmay allow on motion and notice, the party to whom the request is directed serves upon the party requesting theadmission a sworn statement either denying specifically the matters of which an admission is requested orsetting forth in detail the reasons why he cannot truthfully either admit or deny those matters; however, theverification, like in most cases required by the rules of procedure, is a formal, not jurisdictional, requirement,and mainly intended to secure an assurance that matters which are alleged are done in good faith or are trueand correct and not of mere speculation. When circumstances warrant, the court may simply order thecorrection of unverified pleadings or act on it and waive strict compliance with the rules in order that the ends of ustice may thereby be served. In the case of answers to written requests for admission particularly, the courtcan allow the party making the admission, whether made expressly or deemed to have been made impliedly, towithdraw or amend it upon such terms as may be just.

The insurance policy expressly provided that to be compensable, the injury or death should be caused by violentaccidental external and visible means. In attempting to prove the cause of her husbands death, all that Vda. DeGabriel could submit were a letter sent to her by her husbands co-worker, stating that Gabriel died when he

tried to haul water out of a tank while its submerged motor was still functioning, and Vda. De Gabriels swornaffidavit. The said affidavit, however, suffers from procedural infirmity as it was not even testified to or identifiedby Vda. De Gabriel herself. This affidavit therefore is a mere hearsay under the law.

In like manner, the letter allegedly written by the deceaseds co-worker which was never identified to in court bythe supposed author, suffers from the same defect as the affidavit of Vda. De Gabriel. Not one of the otherdocuments submitted, to wit, the POEA decision, the death certificate issued by the Ministry of Health of Iraqand the NBI autopsy report, could give any probative value to Vda. De Gabriels claim. The POEA decision did notmake any categorical holding on the specific cause of Gabriels death.

In summary, evidence is utterly wanting to establish that the insured suffered from an accidental death, the riskcovered by the policy.