QuestionsQuestions (IC INSURANCE MEMORANDUM CIRCULAR NO. 2-91)
“Commission” refers to the Insurance Commission, while “Commissioner” refers to the Insurance Commissioner.
They must be liberally construed to promote the principal objective of adjudicating/settling claims and complaints and to assist parties in obtaining a just, speedy, and inexpensive determination.
The rules govern hearings when the amount of loss, damage, or liability claimed or sued upon (excluding interest, costs, and attorney’s fees) does not exceed PHP 100,000 in a single claim.
Every action must be prosecuted in the name of the real party in interest; the person seeking relief is called the complainant.
The claimant/seeking relief is the “Complainant,” and the insurer/mutual benefit association against whom relief is sought is the “Respondent.”
The complainant must file with the Commission a verified complaint stating that the allegations are true of his own knowledge.
It must state: (1) names and addresses of parties; (2) the substance of the claim; (3) date when the loss occurred; (4) the amount of the claim; (5) grounds of action; and (6) the relief sought.
All pleadings must be legibly written/printed on legal-size paper, and the original plus three (3) signed copies must be accepted if they conform to the formal requirements.
The Commission forwards the complaint and requires the respondent to file an answer within fifteen (15) days from receipt.
The respondent must admit or deny specifically the material allegations, or allege any lawful defense.
(a) The Commission has no jurisdiction over the subject matter/nature of the action; (b) pendency of another action between the same parties for the same cause; (c) the complaint does not allege facts involving a claim/complaint where the respondent may be liable under an insurance/bond/reinsurance/suretyship/membership certificate.
The respondent must file within a non-extendible period of fifteen (15) days from service of summons.
It is to consider amicable settlement, simplify issues, amend pleadings if needed, obtain stipulations/admissions, exchange/accept exhibits, limit witnesses, evaluate admissibility/relevance of evidence, and address other matters for just, speedy, inexpensive disposition.
It limits formal-hearing issues to those not disposed of by admissions/agreements, and it guides the subsequent course of action unless modified before formal hearing to prevent manifest injustice.
After the lapse of fifteen (15) days from the date of receipt of a copy by the parties, unless a motion for reconsideration is filed within the prescribed period.
An aggrieved party may file it within fifteen (15) days from receipt of the decision/order; if denied, the movant may appeal during the remaining period for appeal reckoned from notice of denial.
Within fifteen (15) days from notice, the party must file a verified petition for review in six (6) legible copies with the Court of Appeals, serving copies on the Commission and adverse party, and attaching proof of service.