Case Digest (G.R. No. 197528) Core Legal Reasoning Model
Core Legal Reasoning Model
Facts:
In The Insular Life Assurance Company, Ltd. (“Insular Life”) versus Paz Y. Khu, Felipe Y. Khu, Jr., and Frederick Y. Khu (collectively, the beneficiaries), the insured, Felipe N. Khu, Sr., applied on March 6, 1997 in Cagayan de Oro City for a life insurance policy under Insular Life’s Diamond Jubilee plan. Policy No. A000015683 with a P1,000,000 face value took effect on June 22, 1997. Due to non‐payment, the policy lapsed on June 23, 1999. On September 7, 1999, Felipe filed for reinstatement and paid P25,020.00. Insular Life conditioned approval on an additional premium and the removal of accidental death and premium waiver riders; Felipe agreed and on December 27, 1999 paid the P3,054.50 extra premium. By Endorsement No. PN‐A000015683 dated January 7, 2000, Insular Life stated that “the reinstatement of this policy has been approved … effective June 22, 1999.” Felipe continued premium payments through July 2, 2001, but died on September 22, 2001. His beneficiaries filed a deat Case Digest (G.R. No. 197528) Expanded Legal Reasoning Model
Expanded Legal Reasoning Model
Facts:
- Initial Policy Application and Issuance
- March 6, 1997: Felipe N. Khu, Sr. applied for a life insurance policy under Insular Life’s Diamond Jubilee Plan and declared no adverse medical condition in the medical questionnaire.
- Insular Life issued Policy No. A000015683, effective June 22, 1997, with a face value of ₱1,000,000.00.
- Policy Lapse and Reinstatement Application
- June 23, 1999: The policy lapsed for non-payment of the premium due for June 22, 1999–June 23, 2000.
- September 7, 1999: Felipe applied for reinstatement and paid ₱25,020.00; only his occupation changed (now Municipal Mayor), all other declarations remained the same.
- Conditions Imposed and Approval of Reinstatement
- October 12, 1999: Insular Life conditioned reconsideration upon payment of additional premium and cancellation of the Accidental Death Benefit (ADB) and Waiver of Premium Disability (WPD) riders; Felipe agreed.
- December 27, 1999: Felipe paid the additional premium of ₱3,054.50.
- January 7, 2000: Insular Life issued Endorsement No. PN-A000015683 “approving reinstatement … effective June 22, 1999,” imposing the extra premium, deleting the ADB and WPD riders, and adjusting premium rates.
- Premium Payments and Insured’s Death
- June 23, 2000 and July 2, 2001: Felipe paid the annual premiums (₱28,000.00 each) covering June 22, 2000–June 22, 2001 and June 22, 2001–June 21, 2002.
- September 22, 2001: Felipe died; death certificate cited end-stage renal failure, hepatic failure, congestive heart failure, myocardial ischemia, diabetes neuropathy, alcoholism, and pneumonia.
- Claim Filing and Insurer’s Rescission
- October 5, 2001: Beneficiaries filed a death benefit claim; Insular Life denied the claim and rescinded the reinstated policy for alleged concealment and misrepresentation of pre-existing ailments.
- Beneficiaries sued for specific performance, seeking declaration of validity and payment of the policy proceeds; Insular Life countered that the policy was still within the two-year contestability period.
- Proceedings Below
- RTC (Dec. 12, 2003): Found for beneficiaries, held policy reinstated June 22, 1999, therefore incontestable at death; awarded ₱1,000,000.00 plus moral damages (₱20,000.00), attorney’s fees (₱30,000.00), and litigation expenses (₱10,000.00).
- CA Decision (June 24, 2010): Affirmed RTC’s finding on incontestability and reinstatement date; deleted awards of moral damages, attorney’s fees, and litigation expenses.
- CA Resolution (Dec. 13, 2010): Denied Insular Life’s motion for partial reconsideration.
- Petition for Review on Certiorari
- Insular Life petitioned before the Supreme Court, arguing (a) effective date of reinstatement was December 27, 1999 (date of extra premium payment), (b) two-year contestability period had not expired at death, and (c) misrepresentation justified rescission.
- Respondents maintained reinstatement effective June 22, 1999 and two-year period had lapsed by September 22, 2001.
Issues:
- Whether Felipe’s reinstated life insurance policy had become incontestable at the time of his death on September 22, 2001.
- Whether the “date of last reinstatement” under Insurance Code Section 48 is June 22, 1999 (as per insurer’s documents) or December 27, 1999 (date of extra premium payment), in light of ambiguities in the Letter of Acceptance and Endorsement.
Ruling:
- (Subscriber-Only)
Ratio:
- (Subscriber-Only)
Doctrine:
- (Subscriber-Only)