G.R. No. 103883 - Vda. de Gabriel vs. Court of Appeals

The insured, Marcelino Gabriel, was employed by Emerald Construction & Development Corporation (ECDC) for its construction project in Iraq.
Gabriel was covered by a group accident insurance policy issued by Fortune Insurance & Surety Company, Inc., procured by ECDC.
The policy provided coverage in the amount of P100,000.00, specifically for injuries or death caused by "violent accidental external and visible means," defined as bodily injury caused solely and independently of any other cause.

On May 22, 1982, during the policy period, Marcelino Gabriel died in Iraq.
ECDC reported Gabriel’s death by telephone on July 12, 1983, which was notably delayed relative to the insured event.
Documents supporting the claim included a death certificate from the Ministry of Health of the Republic of Iraq stating “REASON OF DEATH: UNDER EXAMINATION NOW – NOT YET KNOWN” and an autopsy report by the National Bureau of Investigation (NBI) indicating that the cause of death could not be determined due to an advanced state of postmortem decomposition.

Petitioner Jacqueline Jimenez vda. de Gabriel, as the surviving spouse and beneficiary, initiated a claim seeking P100,000.00 plus legal interest and other damages, alleging that Gabriel died of electrocution while performing his work.
Fortune Insurance & Surety Company, Inc. (private respondent) denied the claim on two grounds:

The absence of evidence to support that the cause of death was due to the insured peril (violent accidental external and visible means).
Prescription, arguing that the notice of death and corresponding claim were not submitted in a timely manner as prescribed by the Insurance Code.

The Regional Trial Court of Manila, Branch 55, initially ordered Fortune Insurance to pay the claim, holding that the insurer had waived its defense by failing to substantiate its contention regarding the cause of death.
The trial court ruled that the defense of prescription was inapplicable since the complaint was filed within the period allowed post-denial of the claim.
The case against ECDC was dismissed without prejudice due to procedural deficiencies, notably the improper service of the fourth alias summons.
On appeal, both petitioner and private respondent contested the trial court’s decision before the Court of Appeals, which eventually reversed the decision. The appellate court found that:

The petitioner failed to produce competent evidence substantiating that the husband's death resulted from an event insured against.
The key documents (the death certificate and autopsy report) and other evidence (an affidavit and a letter from a co-worker) were either inconclusive or affected by hearsay defects.
The insurer’s invocation of the prescription defense, based on the late submission of the notice of claim (exceeding the six-month period), was proper.

Whether the petitioner sufficiently proved that Marcelino Gabriel’s death was caused by “violent accidental external and visible means” as required by the insurance policy.

The core issue centers on the causal link between the insured event and the beneficiary’s claim.
The inadequacy and hearsay nature of the petitioner’s evidence (affidavit and co-worker’s letter) contrasted with the neutral official documents (death certificate and autopsy report).

Whether the insurer’s defense of prescription is valid under the provisions of the Insurance Code.

Specifically, whether the written notice of claim, not filed within the prescribed six-month period from the date of the accident, bars recovery.
The discussion also involves the applicability of the one-year period for filing an action post-denial of claim.

Whether the insurer’s failure to verify its answers to the Request for Admission constitutes a waiver of its defense.

The issue examines if the formal procedural lapse should lead to an implied admission of the petitioner's version of facts.
The court’s approach to balancing procedural formalities against the substantive proof required to establish coverage under the policy.