Biagtan vs. Insular Life Assurance Company, Ltd.

Where the insured's death results from injuries inflicted by a third party through deliberate, volitional acts — such as multiple stab wounds inflicted at close range by robbers — the injuries are "intentionally inflicted" within the meaning of an accidental death benefit clause's exception, even if the third party's ultimate purpose was robbery rather than killing. The exception speaks to the intentionality of the act of infliction, not the specific homicidal purpose behind it.

Juan S. Biagtan held a life insurance policy with The Insular Life Assurance Company, Ltd. under Policy No. 398075, with a face value of ₱5,000.00, supplemented by an "Accidental Death Benefit Clause" providing for an additional ₱5,000.00 payable if death resulted "directly from bodily injury effected solely through external and violent means sustained in an accident … and independently of all other causes." The clause expressly excluded coverage where death resulted from injury "intentionally inflicted by another party." The plaintiffs-appellees were the insured's beneficiaries. The insured was also separately covered by the Lincoln National Life Insurance Co. and Sun Life Assurance Co. of Canada under similar accidental death benefit provisions, both of which paid the claimed benefits to the beneficiaries.

Juan S. Biagtan was insured with The Insular Life Assurance Company, Ltd. under Policy No. 398075 for ₱5,000.00, supplemented by an "Accidental Death Benefit Clause" providing for an additional ₱5,000.00 if death resulted "directly from bodily injury effected solely through external and violent means sustained in an accident … and independently of all other causes." The clause, however, expressly provided that it would not apply where death resulted from injury "intentionally inflicted by another party."

On the night of May 20, 1964, or during the first hours of the following day, a band of robbers entered the insured's house. Upon reaching the staircase landing on the second floor, they rushed toward the doors of the second-floor rooms, where they suddenly met a person near the door of one of the rooms who turned out to be Juan S. Biagtan. The robbers inflicted thrusts with sharp-pointed instruments upon him, causing nine wounds — five mortal and four non-mortal — from which the insured died at about 7:00 a.m. on May 21, 1964. The robbers were subsequently charged with and convicted by the Court of First Instance of Pangasinan for the crime of robbery with homicide.

The plaintiffs, as beneficiaries of the insured, filed a claim under the policy. The insurance company paid the basic amount of ₱5,000.00 but refused to pay the additional sum of ₱5,000.00 under the accidental death benefit clause, on the ground that the insured's death resulted from injuries intentionally inflicted by third parties and therefore fell within the stipulated exception. The parties submitted the case for decision upon a stipulation of facts, presenting no additional evidence. The stipulation also established that two other insurance companies — the Lincoln National Life Insurance Co. and Sun Life Assurance Co. of Canada — which had covered the insured for larger sums under similar accidental death benefit provisions, had promptly paid the benefits thereunder to the plaintiffs-beneficiaries.

The trial court rendered judgment in favor of the plaintiffs, reasoning that since no evidence had been presented on the robbers' intent, it could not be concluded that the thrusts were intended to inflict injury rather than merely to scare away persons who might offer resistance. The insurer appealed, limiting its appeal to questions of law.

• Intentionality of Injuries: Whether the nine stab wounds inflicted upon the insured by robbers at close range constituted injuries "intentionally inflicted" by another party within the meaning of the exception in the accidental death benefit clause, thereby excluding coverage.

• Intentionality of Injuries: Yes. The nine wounds inflicted with sharp-pointed instruments at close range by robbers were intentionally inflicted, bringing the insured's death within the policy's express exception and relieving the insurer of liability for the additional sum.

• Intentionality of Injuries: The exception in the accidental death benefit clause speaks only of the fact that injuries have been "intentionally" inflicted — to distinguish them from injuries which, though received at the hands of a third party, are purely accidental. It does not require proof of homicidal intent; it requires only that the act of inflicting the injury was intentional. Nine wounds inflicted by thrusts with sharp-pointed instruments wielded by robbers is a physical fact beyond dispute, and whether the robbers intended to kill or merely to scare the victim or ward off defense, the act itself of inflicting the injuries was intentional. The Court distinguished this case from Calanoc vs. Court of Appeals, 98 Phil. 79, where a single shot was fired from a distance by a person not even seen aiming at the victim, making it possible that the shot was fired merely to scare. In the present case, nine wounds inflicted with bladed weapons at close range permitted no conclusion other than that the injuries were intentionally inflicted. The manner of execution of the crime — multiple stab wounds at close quarters — ruled out the possibility of accidental infliction. American jurisprudence was cited in support: "intentional" as used in an accident policy exception implies the exercise of reasoning faculties, consciousness, and volition; where the injuries clearly resulted from the intentional act of a third person, the insurer is relieved from liability. In Hutchcraft's Ex'r vs. Travelers' Ins. Co., the insured was waylaid and assassinated for robbery, and the court held that while the assassination was accidental as to the insured, the proviso excluding liability for death intentionally inflicted by another applied. In Butero vs. Travelers' Acc. Ins. Co., the insured was shot three times by a known assailant, and the court found no recovery under a policy excepting death from intentional injuries.

• Intentional Infliction Exception in Accidental Death Benefit Clauses — The exception for injuries "intentionally inflicted by another party" in an accidental death benefit clause refers to the intentionality of the act of infliction, not to the specific purpose (e.g., homicidal intent) of the third party. The critical inquiry is whether the act causing the injury was volitional and deliberate, not whether the third party specifically intended to kill. Where multiple wounds are inflicted with bladed weapons at close range, the act is intentional as a matter of physical fact and logical inference, regardless of the perpetrator's ultimate motive. This distinguishes cases involving a single shot fired from an unseen assailant at a distance, where the possibility remains that the shot was fired merely to scare.

• Distinguishing Accidental from Intentional Injury in Insurance Law — An accidental death benefit clause covers death from bodily injury effected solely through external and violent means sustained in an accident. Injuries are "accidental" in the coverage sense where the infliction is unintentional — e.g., a gun discharging while being cleaned, a hunter shooting at prey and hitting a bystander, or a fatal collision during a competitive game. Where a gang of robbers enters a house and, coming face to face with the owner, stabs him repeatedly, the injuries are not accidental even if the encounter was unexpected.

• "Whether the robbers had the intent to kill or merely to scare the victim or to ward off any defense he might offer, it cannot be denied that the act itself of inflicting the injuries was intentional." — This passage articulates the ratio decidendi: the exception turns on the intentionality of the act of infliction, not on the perpetrator's ultimate homicidal purpose.

• "It should be noted that the exception in the accidental benefit clause invoked by the appellant does not speak of the purpose — whether homicidal or not — of a third party in causing the injuries, but only of the fact that such injuries have been 'intentionally' inflicted — this obviously to distinguish them from injuries which, although received at the hands of a third party, are purely accidental." — This defines the scope of the exception clause and its purpose within the structure of accidental death benefit coverage.

• "But where a gang of robbers enter a house and coming face to face with the owner, even if unexpectedly, stab him repeatedly, it is contrary to all reason and logic to say that his injuries are not intentionally inflicted, regardless of whether they prove fatal or not." — This establishes the factual threshold: multiple stab wounds at close range are per se intentional infliction, distinguishing the case from Calanoc.

• Calanoc vs. Court of Appeals, 98 Phil. 79 — Distinguished. In Calanoc, a single shot was fired from a distance by an unseen assailant during a robbery, and the Court held the killing could not be deemed intentional since the shot may have been fired merely to scare. The present case was distinguished on the basis that nine wounds inflicted with bladed weapons at close range permitted no such possibility.

• Hutchcraft's Ex'r vs. Travelers' Ins. Co., 87 Ky. 300, 8 S.W. 570 — Followed. The insured was waylaid and assassinated for robbery; the court held that while the assassination was accidental as to the insured, the proviso excluding liability for death intentionally inflicted by another applied.

• Butero vs. Travelers' Acc. Ins. Co., 96 Wis. 536, 71 S.W. 811 — Followed. The insured was shot three times by a known assailant; the court found no recovery under a policy excepting death from intentional injuries inflicted by any person.

• Landicho vs. GSIS, L-28866, March 17, 1972 — Cited in the dissent for the doctrine that ambiguous terms in insurance contracts are construed against the insurer.

• Accidental Death Benefit Clause, Policy No. 398075 — Provided for an additional ₱5,000.00 if death resulted "directly from bodily injury effected solely through external and violent means sustained in an accident … and independently of all other causes." The clause expressly excluded coverage where death resulted from injury "intentionally inflicted by another party." The Court construed the exception as referring to the intentionality of the act of infliction, not the perpetrator's homicidal purpose, and applied it to the facts of nine stab wounds at close range.

• Article 1377, Civil Code of the Philippines — Cited in the dissent (drawing from Calanoc) for the rule that the interpretation of obscure words or stipulations in a contract shall not favor the party who caused the obscurity. The majority did not rely on this provision.

• Barredo, J. (concurring opinion) — Initially entertained doubts but upon further reflection concurred with the majority. He reasoned that while every non-suicidal death might logically be considered accidental in a general sense, the unequivocal language of the policy exception — accepted by the insured without objection — supported the view that death caused by criminal assault is not covered, particularly where the assault could have been anticipated. He had no doubt the killing was "as intentional as any intentional act can be."

• Zaldivar, J. — Concurred.

• Castro, J. — Concurred.
• Fernando, J. — Concurred.
• Villamor, J. — Concurred.
• Makasiar, J. — Reserved his vote.

• Teehankee, J. (joined by Concepcion, C.J. and Reyes, J.B.L., J.) — The dissent argued for affirmance of the trial court on five grounds: (1) Calanoc vs. Court of Appeals is controlling, as it held that fatal injuries inflicted by a malefactor during the commission of a crime are deemed accidental on the part of the victim, and the burden of proving intentional infliction rests on the insurer; (2) the insurer failed to discharge that burden, as the stipulation of facts was silent on the robbers' intent, and the thrusts appeared to be a reflex action upon the robbers being surprised by the insured; (3) the insurer's appeal was limited to pure questions of law under Rule 42, Section 2, thereby waiving all questions of fact and conceding the trial court's factual findings; (4) insurance contracts are contracts of adhesion, and ambiguous exception clauses must be construed strictly against the insurer and liberally in favor of the insured, pursuant to Article 1377 of the Civil Code; and (5) the exception in paragraph 5(e) is ambiguous and conflicts with the other exceptions in the same paragraph, particularly 5(d), which already excepts injuries received in violation of law by the insured or assault provoked by the insured — construed as the insurer claimed, 5(e) would except all injuries intentionally inflicted by a third party regardless of the insured's conduct, defeating the dominant purpose of double indemnity for accidental death by "external and violent means." The dissent also noted that two other insurance companies had paid under similar clauses, underscoring the insurer's claim's untenability.