G.R. No. 100970 - Finman General Assurance Corp. vs. Court of Appeals

Petitioner: Finman General Assurance Corporation (insurer) under the Finman General Teachers Protection Plan, Master Policy No. 2005 and Individual Policy No. 08924.
Private Respondent: Julia Surposa, mother and one of the designated beneficiaries of the insured, along with her husband Carlos and sons Christopher, Charles, Chester, and Clifton, all surnamed Surposa.
Insured: Carlie Surposa, covered under a personal accident insurance policy issued on October 22, 1986.

On October 18, 1988, while the policy was in full force and effect, the insured was stabbed by one of three unidentified men without provocation or warning while he and his cousin, Winston Surposa, were waiting for a ride home at the corner of Rizal-Locsin Streets, Bacolod City, after attending the Maskarra Annual Festival.
The insured sustained a single stab wound and died as a result of said injury.

The beneficiaries submitted a written notice of claim to Finman seeking the policy proceeds.
Finman denied the claim, arguing that death resulting from murder or assault was not within the policy coverage and that the cause of death was an intentional act (not accidental) given the nature and location of the stab wound.

On February 24, 1989, private respondent filed a complaint before the Insurance Commission.
Decision dated March 20, 1990: Finman was ordered to pay P15,000.00 representing the policy proceeds, with legal interest from the filing of the complaint until fully satisfied, and costs; claim for P1,000.00 mortuary aid was denied for lack of evidence.

On July 11, 1991, the Court of Appeals affirmed the Insurance Commission’s ruling.
The CA held that the insured’s death was accidental from the standpoint of the victim and that murder or assault was not among the policy’s enumerated exclusions; therefore, coverage applied.

Finman filed a petition for certiorari alleging grave abuse of discretion by the CA, reiterating that murder/assault were impliedly excluded and that the insured’s death was the product of a deliberate, intentional act incompatible with “accident” coverage.
Reliefs sought included annulment of the CA decision and injunctive relief.

Whether the insured’s death by stabbing inflicted by unidentified assailants constituted “accidental” death within the meaning of the personal accident insurance policy.

Whether death resulting from murder and/or assault is excluded from coverage when such causes are not expressly listed among the policy’s specific exclusions.

Whether the Court of Appeals committed grave abuse of discretion in affirming the Insurance Commission’s decision based on the application of expressio unius est exclusio alterius and principles of construction of insurance contracts.

Whether the award of legal interest from the filing of the complaint and the denial of the mortuary aid claim for lack of proof were proper.