Professional Documents
Culture Documents
Melanie P. Mejia
Held: Yes.
Ratio: It is founded on the principle of subrogation
Payment to the assured works as an equitable
assignment
Subject to exceptions:
The assured releases the wrongdoer or 3rd party
from liability
Insurer pays the assured without notifying the
carrier who has already settled the assureds claim
The insurer pays the assured for a loss which is not
a risk covered by the policy (voluntary payment)
None of the exceptions is applicable in this case
Held: Yes.
Ratio: Elements of an insurance contract (Sec 2 IC)
1. Insured has an insurable interest
2. Insured is subject to a risk of loss by the happening of a
designated peril
3. Insurer assumes the risk
4. Assumption of risk is part of a general scheme to distribute
actual losses among group bearing a similar risk
5. Insured pays a premium (consideration)
CAB: Healthcare agreement is a non-life insurance, a contract
of indemnity. Once member incurs medical expenses arising
from injury or sickness, the health care provider must pay for
the same to the extent agreed in the contract.
Held: Yes.
Ratio: Art 1377 NCC: The interpretation of obscure
words or stipulations in a contract shall not favor the
party who caused the obscurity.
If there is ambiguity in the terms in the policy, it
should be liberally construed in favor of the insured
and strictly against the insurer
Reason: Contract of adhesion; the insured has no
voice in the selection of the words employed and
that the language of the contract is selected with
great care and deliberation by experts and legal
advisers employed by the insurance company