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Sunlife v CA G.R. No. 105135 June 22, 1995

J. Quiason

Facts:

Roe!t Jo"n #. #acani $!ocu!e% a life insu!ance cont!act fo! "i&self f!o& Sunlife. 'e(as issue% a $olic) fo! *100,000.00, (it" %oule in%e&nit) in case of acci%ental

%eat". +"e %esinate% ene-cia!) (as "is &ot"e!, #e!na!%a #acani.

+"e insu!e% %ie% in a $lane c!as". Res$on%ent #e!na!%a #acani -le% a clai& (it"

$etitione!, seein t"e ene-ts of t"e insu!ance $olic) taen ) "e! son. *etitione!

con%ucte% an investiation an% its -n%ins $!o&$te% it to !e/ect t"e clai&.

Sunlife info!&e% #acani t"at t"e insu!e% %i% not %isclose &ate!ial facts !elevant to

t"e issuance of t"e $olic), t"us !en%e!in t"e cont!act of insu!ance voi%ale. A

c"ec !e$!esentin t"e total $!e&iu&s $ai% in t"e a&ount of *10,12.00 (as

attac"e% to sai% lette!.

*etitione! clai&e% t"at t"e insu!e% ave false state&ents in "is a$$lication. +"e

%ecease% ans(e!e% clai&e% t"at "e consulte% a !. Ra)&un%o of t"e C"inese

Gene!al 'os$ital fo! cou" an% u co&$lications. +"e ot"e! uestions (e!e

ans(e!e% in t"e neative.

*etitione! %iscove!e% t"at t(o (ees $!io! to "is a$$lication fo! insu!ance, t"e

insu!e% (as e4a&ine% an% con-ne% at t"e un Cente! of t"e *"ili$$ines, ("e!e "e

(as %ianose% fo! !enal failu!e. u!in "is con-ne&ent, t"e %ecease% (as

su/ecte% to u!inal)sis tests.

#e!na!%a #acani an% "e! "usan% -le% an action fo! s$eci-c $e!fo!&ance aainst

$etitione! (it" t"e R+C. +"e cou!t !ule% in favo! of t"e s$ouses an% o!%e!e% Sunlife

to $a) *100,000.00.

6n !ulin fo! $!ivate !es$on%ents, t"e t!ial cou!t conclu%e% t"at t"e facts conceale%

) t"e insu!e% (e!e &a%e in oo% fait" an% un%e! a elief t"at t"e) nee% not e

%isclose%. +"e cou!t also "el% t"at t"e &e%ial "isto!) (as i!!elevant ecause it

(asn7t &e%ical insu!ance.

+"e Cou!t of A$$eals a8!&e% t"e %ecision of t"e t!ial cou!t. +"e a$$ellate cou!t

!ule% t"at $etitione! cannot avoi% its oliation ) clai&in conceal&ent ecause

t"e cause of %eat" (as un!elate% to t"e facts conceale% ) t"e insu!e%. *etitione!s

&otion fo! !econsi%e!ation (as %enie%. 'ence, t"is $etition.

6ssue: ;N t"e insu!e% (as uilt) of &is!e$!esentation ("ic" &a%e t"e cont!act

voi%.

'el%:

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Ratio:

Section 2= of +"e 6nsu!ance Co%e !eui!e% a $a!t) to a cont!act of insu!ance to

co&&unicate to t"e ot"e!, in oo% fait", all facts (it"in "is no(le%e ("ic" a!e

&ate!ial to t"e cont!act an% as to ("ic" "e &aes no (a!!ant), an% ("ic" t"e ot"e!

"as no &eans of asce!tainin.

>A nelect to co&&unicate t"at ("ic" a $a!t) no(s an% ou"t to co&&unicate, is

calle% conceal&ent.?

>@ate!ialit) is to e %ete!&ine% not ) t"e event, ut solel) ) t"e $!oale an%

!easonale inuence of t"e facts u$on t"e $a!t) to ("o& co&&unication is %ue, in

fo!&in "is esti&ate of t"e %isa%vantaes of t"e $!o$ose% cont!act o! in &ain "is

inui!ies.?

+"e te!&s of t"e cont!act a!e clea!. +"e insu!e% is s$eci-call) !eui!e% to %isclose to

t"e insu!e! &atte!s !elatin to "is "ealt".

+"e info!&ation ("ic" t"e insu!e% faile% to %isclose (e!e &ate!ial an% !elevant to

t"e a$$!oval an% issuance of t"e insu!ance $olic). +"e &atte!s conceale% (oul%

"ave %e-nitel) aecte% $etitione!s action on "is a$$lication, eit"e! ) a$$!ovin it

(it" t"e co!!es$on%in a%/ust&ent fo! a "i"e! $!e&iu& o! !e/ectin t"e sa&e.

@o!eove!, a %isclosu!e &a) "ave (a!!ante% a &e%ical e4a&ination of t"e insu!e%

) $etitione! in o!%e! fo! it to !easonal) assess t"e !is involve% in acce$tin t"e

a$$lication.

B%a. %e Canilan v. Cou!t of A$$eals &ate!ialit) of t"e info!&ation (it""el% %oes

not %e$en% on t"e state of &in% of t"e insu!e%. Neit"e! %oes it %e$en% on t"e actual

o! $")sical events ("ic" ensue.

>Goo% fait"D is no %efense in conceal&ent. +"e insu!e%s failu!e to %isclose t"e fact

t"at "e (as "os$italiEe% !aises !ave %outs aout "is eliiilit). Suc" conceal&ent

(as %elie!ate on "is $a!t.

+"e a!u&ent, t"at $etitione!s (aive! of t"e &e%ical e4a&ination of t"e insu!e%

%euns t"e &ate!ialit) of t"e facts conceale%, is untenale.

Satu!nino v. *"ili$$ine A&e!ican ife 6nsu!ance D . . . t"e (aive! of a &e%ical

e4a&ination in a non&e%ical insu!ance cont!act !en%e!s even &o!e &ate!ial t"e

info!&ation !eui!e% of t"e a$$licant conce!nin $!evious con%ition of "ealt" an%%iseases sue!e%, fo! suc" info!&ation necessa!il) constitutes an i&$o!tant facto!

("ic" t"e insu!e! taes into consi%e!ation in %eci%in ("et"e! to issue t"e $olic) o!

not . . . D

Anent t"e -n%in t"at t"e facts conceale% "a% no ea!in to t"e cause of %eat" of

t"e insu!e%, it is (ell settle% t"at t"e insu!e% nee% not %ie of t"e %isease "e "a%

faile% to %isclose to t"e insu!e!. 6t is su8cient t"at "is non%isclosu!e &isle% t"e

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insu!e! in fo!&in "is esti&ates of t"e !iss of t"e $!o$ose% insu!ance $olic) o! in

&ain inui!ies as "el% in 'enson.