Edillon vs. Manila Bankers Life, 717 SCRA 187 (1982)

FACTS:

Carmen O, Lapuz applied with Manila Bankers for insurance coverage against accidents and injuries. She gave the date of her birth as July 11, 1904. She paid the sum of P20.00 representing the premium for which she was issued the corresponding receipt. The policy was to be effective for 90 days.

During the effectivity, Carmen O. Lapuz died in a vehicular accident in the North Diversion Road. Petitioner Regina L. Edillon, a sister of the insured and the beneficiary in the policy, filed her claim for the proceeds of the insurance. Her claim having been denied, Regina L. Edillon instituted this action in the trial court.

The insurance corporation relies on a provision contained in the contract excluding its liability to pay claims under the policy in behalf of “persons who are under the age of sixteen (16) years of age or over the age of sixty (60) years” They pointed out that the insured was over sixty (60) years of age when she applied for the insurance coverage, hence the policy became void.

The trial court dismissed the complaint and ordered Edillon to pay P1000. The reason was that a policy of insurance being a contract of adhesion, it was the duty of the insured to know the terms of the contract he or she is entering into. The insured could not have been qualified under the conditions stated in said contract and should have asked for a refund of the premium.

ISSUE/S:

(a) WON Manila Bankers may correctly refuse the claim of Edillon.

NO. The age of the insured Carmen O. Lapuz was not concealed to the insurance company. Her application for insurance coverage which was on a printed form furnished by private respondent and which contained very few items of information clearly indicated her age at the time of filing the same to be almost 65 years of age. Despite such information which could hardly be overlooked in the application form, considering its prominence thereon and its materiality to the coverage applied for, the respondent insurance corporation received her payment of premium and issued the corresponding certificate of insurance without question. The accident which resulted in the death of the insured, a risk covered by the policy, occurred on May 31, 1969 or FORTY-FIVE (45) DAYS after the insurance coverage was applied for. There was sufficient time for the private respondent to process the application and to notice that the application was over 60 years of age and thereby cancel the policy on that ground if it was minded to do so. If the private respondent failed to act, it is either because it was willing to waive such disqualification; or, through the negligence or incompetence of its employees for which it has only itself to blame, it simply overlooked such fact. Under the circumstances, the insurance corporation is already deemed in estoppel. Its inaction to revoke the policy despite a departure from the exclusionary condition contained in the said policy constituted a waiver of such condition.

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