De la Cruz vs. Capital Insurance and Surety Co., Inc.

Death or injury sustained during voluntary participation in a sport is caused by "accidental means" within the coverage of an accident insurance policy when an unforeseen, independent event—such as unintentionally slipping—occurs during the activity and produces the injury, provided the sport is not among the risks expressly excluded by the policy.

Eduardo de la Cruz was employed as a mucker at Itogon-Suyoc Mines, Inc. in Baguio and held accident insurance policy No. ITO-BFE-170, underwritten by Capital Insurance & Surety Co., Inc., covering the period from November 13, 1956 to November 12, 1957. His father, Simon de la Cruz, was named as beneficiary under the policy. The policy insured against "death or disability caused by accidental means" and contained a clause specifically excluding death or disablement consequent upon the insured engaging in certain enumerated sports and activities.

Eduardo de la Cruz was employed as a mucker at Itogon-Suyoc Mines, Inc. in Baguio and held accident insurance policy No. ITO-BFE-170, underwritten by Capital Insurance & Surety Co., Inc., covering the period from November 13, 1956 to November 12, 1957. His father, Simon de la Cruz, was named as beneficiary under the policy, which insured against "death or disability caused by accidental means."

On January 1, 1957, in connection with the New Year celebration, Itogon-Suyoc Mines, Inc. sponsored a boxing contest for general entertainment. Eduardo, a non-professional boxer, participated in a bout against another non-professional of the same height, weight, and size. In the course of the fight, Eduardo slipped unintentionally, and at that moment his opponent landed a blow on the left part of the back of his head, sending him into the ropes of the ring. He was brought to the Baguio General Hospital the following day. The cause of death was reported as hemorrhage, intracranial, left.

Simon de la Cruz thereupon filed a claim with the insurance company for payment of indemnity under the policy. As the claim was denied, Simon instituted an action for specific performance in the Court of First Instance of Pangasinan. The defendant insurer raised the defense that the death of the insured, caused by his participation in a boxing contest, was not accidental and therefore not covered by the policy. After due hearing, the trial court rendered judgment in favor of the plaintiff, ordering the insurer to indemnify Simon for the death of his son, to pay burial expenses, and to pay attorney's fees. The insurer appealed, contending that while the death was due to head injury, the injury was sustained because of the insured's voluntary participation in the contest, which constituted the "means" that produced the injury, and thus the death was not caused by "accidental means."

• Voluntary Act as Non-Accidental Means: The insurer argued that the insured's death, while caused by head injury, was sustained because of his voluntary participation in the boxing contest, which was the "means" that produced the injury causing death. Since his inclusion in the boxing card was voluntary, the insurer contended he could not be considered to have met his death by "accidental means."
• Distinction Between "Accidental" and "Accidental Means": The insurer sought to draw a distinction between the terms "accident or accidental" and "accidental means" as used in the policy, arguing that what must be accidental is the means that caused or brought about the death, not the death itself.

• Accidental Means: Whether the death of the insured resulting from injuries sustained during voluntary participation in a boxing contest was caused by "accidental means" within the coverage of the accident insurance policy.
• Policy Exclusions: Whether the insurer is liable for death resulting from a boxing contest, given that boxing was not among the activities expressly excluded from coverage under the policy.

• Accidental Means: Yes. The death was caused by accidental means because the insured's unintentional slipping during the bout was an unforeseen, independent event that produced the fatal injury, notwithstanding his voluntary participation in the boxing contest.
• Policy Exclusions: The insurer is liable. Boxing was not among the enumerated excluded activities in the policy, and the insurer's failure to include it among the prohibitive risks indicates it did not intend to exempt itself from liability for such death.

• Accidental Means: The terms "accident" and "accidental," as used in insurance contracts, have not acquired any technical meaning and are construed in their ordinary and common acceptation—something that happens by chance or fortuitously, without intention and design, and which is unexpected, unusual, and unforeseen. While the insurer sought to distinguish "accidental means" from "accidental," the Court noted the tendency of U.S. decisions to eliminate this fine distinction and treat the terms as legally synonymous. Even accepting the insurer's theory, the generally accepted rule is that death or injury does not result from accident or accidental means if it is the natural result of the insured's voluntary act, unaccompanied by anything unforeseen except the death or injury itself. However, where something unforeseen occurs in the doing of the act which produces the injury, the resulting death is within the protection of the policy. In the present case, while Eduardo's participation in the boxing contest was voluntary, the injury was sustained when he slipped unintentionally, giving occasion for the opponent's blow that threw him to the ropes. Without this unintentional slipping, he likely would not have received the fatal blow to the head. The Court further reasoned that in boxing, as in other physically rigorous sports such as basketball or baseball, death is not ordinarily anticipated to result; if it does, the injury or death can only be accidental or produced by some unforeseen happening, as occurred here.
• Policy Exclusions: The policy specifically excluded death or disablement consequent upon the insured engaging in football, hunting, pigsticking, steeplechasing, polo-playing, racing of any kind, mountaineering, or motorcycling. Death or disablement resulting from engagement in boxing contests was not declared outside the protection of the insurance contract. The insurer's failure to include boxing or other sports among the prohibitive risks leads inevitably to the conclusion that it did not intend to limit or exempt itself from liability for such death.

• Accidental Means in Insurance — An accident is an event that takes place without one's foresight or expectation, proceeding from an unknown cause or producing an unusual effect of a known cause, and therefore not expected. Death or injury does not result from accident or accidental means if it is the natural result of the insured's voluntary act, unaccompanied by anything unforeseen except the death or injury itself. However, where the death or injury is not the natural or probable result of the insured's voluntary act, or if something unforeseen occurs in the doing of the act which produces the injury, the resulting death is within the protection of policies insuring against death or injury from accident. The Court applied this doctrine by finding that the insured's unintentional slipping during the boxing bout was the unforeseen event that produced the fatal injury, bringing the death within the policy's coverage.
• Expressio Unius Est Exclusio Alterius in Insurance Exclusions — The specific enumeration of excluded activities in an insurance policy implies the exclusion of all others not mentioned. The Court applied this principle by noting that the policy excluded football, hunting, pigsticking, steeplechasing, polo-playing, racing of any kind, mountaineering, and motorcycling, but not boxing. The insurer's failure to include boxing among the prohibitive risks indicated it did not intend to exempt itself from liability for death resulting from such activity.

• "There is no accident when a deliberate act is performed unless some additional, unexpected, independent, and unforeseen happening occurs which produces or brings about the result of injury or death." — This passage states the controlling test for determining whether death results from accidental means, distinguishing a voluntary act's natural consequences from those produced by an unforeseen intervening event.
• "Where the death or injury is not the natural or probable result of the insured's voluntary act, or if something unforeseen occurs in the doing of the act which produces the injury, the resulting death is within the protection of policies insuring against death or injury from accident." — This articulates the ratio decidendi: when an unforeseen event during a voluntary activity produces injury, the death is covered by an accident insurance policy.
• "Failure of the defendant insurance company to include death resulting from a boxing match or other sports among the prohibitive risks leads inevitably to the conclusion that it did not intend to limit or exempt itself from liability for such death." — This applies the principle of expressio unius est exclusio alterius to insurance policy exclusions, establishing that risks not enumerated as excluded remain covered.

• Traveler's Protective Association vs. Stephens, 185 Ark. 660, 49 S.W. (2d) 364 — Cited for the proposition that the distinction between "accidental" and "accidental means" is being eliminated in recent U.S. court decisions, the terms being considered legally synonymous.
• Landress vs. Phoenix Mut. Life Ins. Co., 291 U.S. 291 — Cited as authority for the general rule that death or injury does not result from accident or accidental means if it is the natural result of the insured's voluntary act, unaccompanied by anything unforeseen except the death or injury itself.
• Evans vs. Metropolitan Life Ins. Co., 26 Wash. (2d) 594, 174 P. (2d) 961 — Cited for the rule that there is no accident when a deliberate act is performed unless some additional, unexpected, independent, and unforeseen happening occurs which produces or brings about the result of injury or death.
• Brams vs. New York Life Ins., 299 Pa. 11, 148 Atl. 855 — Cited for the rule that an insurer's failure to include a particular risk among the excluded risks in the policy leads to the conclusion that it did not intend to limit or exempt itself from liability for such risk.

• Policy Exclusion Clause (e), Accident Insurance Policy No. ITO-BFE-170 — The policy expressly excluded death or disablement consequent upon the insured engaging in football, hunting, pigsticking, steeplechasing, polo-playing, racing of any kind, mountaineering, or motorcycling. The Court applied this provision by noting that boxing was not among the enumerated excluded activities, and therefore death resulting from a boxing contest remained within the policy's coverage.

Concepcion, C.J., Reyes, J.B.L., Dizon, Regala, Makalintal, Bengzon, J.P., Zaldivar, and Sanchez, JJ., concur.