Pag-deny ng insurer sa claim, pwedeng kasuhan ng ‘action for the recovery of sum of money’

ni Atty. Persida Rueda-Acosta @Magtanong Kay Attorney Pebrero 21, 2024

Dear Chief Acosta,

Ako ay nagmamay-ari ng isang sasakyan at ito ay may aktibong comprehensive insurance.  Nakasaad sa nasabing insurance ang obligasyon ng insurance provider ko na babayaran nito ang mga danyos o sira sa sasakyan ko at pinsalang maaaring matamo ng ibang tao kaugnay sa isang aksidente. Ang aking sasakyan ay nasangkot sa isang aksidente. Kaugnay nito ay nag-file ako ng claim sa aking insurer pero ito ay na-deny dahil di-umano ang aking drayber ay lasing nang mangyari ang aksidente. Anong kaso ang pwede kong isampa laban sa aking insurer, at kung kuwestiyonable ang ebidensyang ipapakita ng insurer ko pati ang pagkalap nito, ano ang mangyayari sa aking claim? -- Mikel 

Dear Mikel,

Ang sagot sa iyong katanungan ay matatagpuan sa kasong Stronghold Insurance Company, Incorporated vs. Interpacific Container Services, G.R. No. 194328, 1 July 2015, sa panulat ni Honorable Associate Justice Jose P. Perez.

Sa nasabing kaso ay nagsampa ang insured ng kaso na action for the recovery of sum of money matapos i-deny ng insurer ang kanyang insurance claim. Sa pag-award ng proceeds ng insurance policy pabor sa insured, sinabi ng Korte Suprema na:

The evident tampering of the medico legal certificate necessitated the presentation by the petitioner of additional evidence to buttress his claim. For instance, petitioner could have adduced affidavits of witnesses who were present at the scene of the accident to attest to the fact that the driver was intoxicated. It did not. Upon the other hand, respondents duly established their right to claim the proceeds of a validly subsisting contract of insurance. Such contract was never denied.

Simply put, he who alleges the affirmative (sic) of the issue has the burden of proof, and upon the plaintiff in a civil case rested the burden of proof. Notably, in the course of trial in a civil case, once plaintiff makes out a prima facie case in his favor, the duty or the burden of evidence shifts to defendant to controvert plaintiff’s prima facie case, otherwise, a verdict must be returned in favor of plaintiff. Moreover, in civil cases, the party having the burden of proof must produce a preponderance of evidence thereon, with plaintiff having to rely on the strength of his own evidence and not upon the weakness of the defendant’s. xxx.

This case involves a contract of insurance, the authenticity and validity of which was uncontested. In exempting insurers from liability under the contract, proof thereof must be clear, credible and convincing. Fundamental is the rule that the contract is the law between the parties and, that absent any showing that its provisions are wholly or in part contrary to law, morals, good customs, public order, or public policy, it shall be enforced to the letter by the courts.

Base sa nabanggit sa itaas ay pwede kang mag-file ng action for the recovery of sum of money laban sa iyong insurer. Kung hindi nito mapapatunayan na ligtas o walang pananagutan ito sa ilalim ng inyong insurance contract, at kung kuwestiyonable ang ebidensya o pagkalap nila nito para i-deny ang iyong insurance claim, ay karapat-dapat kang mabayaran sa iyong claim base sa probisyon ng iyong insurance policy. 

Sana ay nasagot namin ang iyong katanungan. Tandaan na ang aming opinyon dito ay nakabatay lamang sa mga naisalaysay sa iyong liham at sa pagkakaintindi namin dito. Maaaring maiba ang aming opinyon kung mayroong karagdagang impormasyong ibibigay. Mas mainam kung personal kang sasangguni sa isang abogado.

Maraming salamat sa iyong patuloy na pagtitiwala.