FACTS
Ernani, applied for health care coverage with petitioner Philamcare Health. In the standard application form he answered no to the following question: Have you or any of your family members ever consulted or been treated for high blood pressure, heart trouble, diabetes, cancer, liver disease, asthma or peptic ulcer?
The application was approved and Health Care Agreement was issued which entitles him to avail of hospitalization benefits, whether ordinary or emergency, “out-patient benefits” and services. During the period of his coverage, Ernani suffered a heart attack. Respondent, Julia, wife of Ernani, tried to claim the benefits under the health care agreement. However, petitioner denied her claim saying that the Health Care Agreement was void. According to the petitioner, there was a concealment regarding Ernani’s medical history. Doctors at the MMC allegedly discovered at the time of Ernani’s confinement that he was hypertensive, diabetic and asthmatic, contrary to his answer in the application form. Thus, the respondent paid the hospitalization expenses herself, amounting to about P76,000.00. Ernani died.