DEATH INDEMNITY P12,000.00
PERMANENT DISABLEMENT –
DESCRIPTION OF DISABLEMENT Amount
Loss of two limbs P6,000.00
Loss of both hands, or all fingers and
both thumbs 6,000.00
Loss of both feet 6,000.00
Loss of one hand and one foot 6,000.00
Loss of sight of both eyes 6,000.00
Injuries resulting in being permanently
bedridden 6,000.00
Any other injury causing permanent
total disablement 6,000.00
Loss of arm or above elbow 4,200.00
Loss of arm between elbow and wrist 3,000.00
Loss of hand P2,550.00
Loss of four fingers and thumb of one hand 2,550.00
Loss of four fingers 2,100.00
Loss of leg at or above knee 3,600.00
Loss of leg below knee 2,400.00
Loss of one foot 2,400.00
Loss of toes – all of one foot 900.00
Loss of thumb 900.00
Loss of index finger 600.00
Loss of sight of one eye 1,800.00
Loss of hearing – both ears 3,000.00
Loss of hearing – one ear 450.00
Total of Accommodation of Professional Attendance
Extended Services Rendered Fees or Charges
HOSPITAL ROOM Maximum of 45 days/year P 36.00/day
Laboratory fees, drugs
x-rays, etc. 300.00
SURGICAL Major Operation 1,000.00
EXPENSES Medium Operation 500.00
Minor Operation 100.00
ANAESTHESIO- Major Operation 300.00
LOGISTS’ FEES Medium Operation 150.00
Minor Operation 50.00
OPERATING Major Operation 150.00
ROOM Medium Operation 100.00
Minor Operation 40.00
MEDICAL For daily visits of
EXPENSES Practitioner or 20.00
Specialist /day
Total amount of medical
expenses must not exceed
(for single period of
confinement) 400.00" 1
It will be seen that the above quoted Schedule of Indemnities establishes monetary limits which Western may invoke in case of occurrence of the particular kinds of physical injury there listed, e.g.:chanrob1es virtual 1aw library
loss of both feet P6,000.00;
loss of one foot P2,400.00;
loss of sight of one eye P1,800.00;
It must be stressed, however, that the Schedule of Indemnities does not purport to limit, or to enumerate exhaustively, the species of bodily injury occurrence of which generate liability for petitioner Western. A car accident may, for instance, result in injury to internal organs of a passenger or third party, without any accompanying amputation or loss of an external member (e.g., a foot or an arm or an eye). But such internal injuries are surely covered by Section 1 of the Master Policy, since they certainly constitute bodily injuries. chanrobles virtualawlibrary chanrobles.com:chanrobles.com.ph
Petitioner Western in effect contends before this Court, as it did before the Court of Appeals, that because the Schedule of Indemnities limits the amount payable for certain kinds of expenses – "hospital room", "surgical expenses", "an aesthesiologists’ fee", "operating room" and "medical expenses" – that Schedule should be read as excluding liability for any other type of expense or damage or loss even though actually sustained or incurred by the third party victim. We are not persuaded by Western’s contention.
Firstly, the Schedule of Indemnities does not purport to restrict the kinds of damages that may be awarded against Western once liability has arisen. Section 1, quoted above, does refer to certain "Limits of Liability" which in the case of the third party liability section of the Master Policy, is apparently P50,000.00 per person per accident. Within this over-all quantitative limit, all kinds of damages allowable by law – "actual or compensatory damages"; "moral damages"; "nominal damages"; "temperate or moderate damages"; "liquidated damages"; and "exemplary damages" 2 – may be awarded by a competent court against the insurer once liability is shown to have arisen, and the essential requisites or conditions for grant of each species of damages are present. It appears to us self-evident that the Schedule of Indemnities was not intended to be an enumeration, much less a closed enumeration, of the specific kinds of damages which may be awarded under the Master Policy Western has issued. Accordingly we agree with the Court of Appeals that:jgc:chanrobles.com.ph
". . . we cannot agree with the movant that the schedule was meant to be an exclusive enumeration of the nature of the damages for which it would be liable under its policy. As we see it, the schedule was merely meant to set limits to the amounts the movant would be liable for in cases of ‘claims for death, bodily injuries of, professional services and hospital charges, for services rendered to traffic accident victims,’ and not necessarily exclude claims against the insurance policy for other kinds of damages, such as those in question."cralaw virtua1aw library
Secondly, the reading urged by Western of the Schedule of Indemnities comes too close to working fraud upon both the insured and the third party beneficiary of Section 1, quoted above. For Western’s reading would drastically and without warning limit the otherwise unlimited (save for the over-all quantitative limit of liability of P50,000.00 per person per accident) and comprehensive scope of liability assumed by the insurer Western under Section 1: "all sums necessary to discharge liability of the insured in respect of [bodily injury to a third party]." This result – which is not essentially different from taking away with the left hand what had been given with the right hand – we must avoid as obviously repugnant to public policy. If what Western now urges is what Western intended to achieve by its Schedule of Indemnities, it was incumbent upon Western to use language far more specific and precise than that used in fact by Western, so that the insured, and potential purchasers of its Master Policy, and the Office of the Insurance Commissioner, may be properly informed and act accordingly. chanrobles law library : red
Petitioner Western would have us construe the Schedule of Indemnities as comprising contractual limitations of liability which, as already noted, is comprehensively defined in Section 1 – "Liability to the Public" of the Master Policy. It is well-settled, however, that contractual limitations of liability found in insurance contracts should be regarded by courts with a jaundiced eye and extreme care and should be so construed as to preclude the insurer from evading compliance with its just obligations. 3
Finally, an insurance contract is a contract of adhesion. The rule is well entrenched in our jurisprudence that the terms of such contract are to be construed strictly against the party which prepared the contract, which in this case happens to be petitioner Western. 4
ACCORDINGLY, the Court Resolved to DENY the Petition for Review for lack of merit. Costs against petitioner.
Fernan (C.J., Chairman), Gutierrez, Jr., Bidin and Cortes, JJ., concur.
Endnotes:
1. Rollo, pp. 5-6.
2. Article 2197, Civil Code.
3. Taurus Taxi v. Capital Insurance, 24 SCRA 454 (1968); Eagle Star v. Chia Yu, 96 Phils. 696 (1955).
4. Landicho v. Government Service Insurance System, 44 SCRA 7 (1972); Qua Chee Gan v. Law Union and Rock Insurance Co., Ltd., 98 Phil. (1955).