Finman General Assurance Corporation vs. Court of Appeals

Death resulting from murder or assault by a third party is covered under a personal accident insurance policy where the victim's death was unforeseen, unexpected, and not the natural result of his own voluntary act, and where the policy's enumerated exclusions do not expressly include murder or assault. The principle of expressio unius exclusio alterius — the mention of one thing implies the exclusion of another — applies to the policy's exclusion clause, such that the failure to list murder or assault among the excluded risks precludes the insurer from disclaiming liability by implication.

Finman General Assurance Corporation issued a personal accident insurance policy — the Finman General Teachers Protection Plan Master Policy No. 2005 and Individual Policy No. 08924 — covering Carlie Surposa, with his parents (spouses Julia and Carlos Surposa) and brothers (Christopher, Charles, Chester, and Clifton) as beneficiaries. The policy was in full force and effect at the time of the insured's death. The dispute centered on whether death caused by an intentional criminal act of a third party — specifically, a stabbing by unidentified assailants — falls within the coverage of a personal accident insurance policy, which insures against death or injury from accident or accidental means.

On October 22, 1986, Carlie Surposa was insured with Finman General Assurance Corporation under the Finman General Teachers Protection Plan Master Policy No. 2005 and Individual Policy No. 08924. The named beneficiaries were his parents, spouses Julia and Carlos Surposa, and his brothers Christopher, Charles, Chester, and Clifton, all surnamed Surposa.

While the insurance policy was in full force and effect, Carlie Surposa died on October 18, 1988 from a stab wound inflicted by one of three unidentified men. The attack occurred without provocation or warning as Carlie and his cousin, Winston Surposa, were waiting for a ride on their way home along Rizal-Locsin Streets, Bacolod City, after attending the celebration of the "Maskarra Annual Festival." The record contained no circumstance showing how the stab wound was inflicted, nor any indication that the assailant specifically targeted Carlie to take his life.

Thereafter, private respondent Julia Surposa and the other beneficiaries filed a written notice of claim with petitioner. The insurance company denied the claim, contending that murder and assault are not within the scope of the coverage of the insurance policy. On February 24, 1989, private respondent filed a complaint with the Insurance Commission, which rendered a decision on March 20, 1990 ordering petitioner to pay P15,000.00 representing the proceeds of the policy with legal interest from the date of filing of the complaint until fully satisfied, with costs. The claim for mortuary aid in the sum of P1,000.00 was denied for lack of evidence. On July 11, 1991, the Court of Appeals affirmed the Insurance Commission's decision.

• Abuse of Discretion: Petitioner alleged grave abuse of discretion on the part of the Court of Appeals in applying the principle of expressio unius exclusio alterius in a personal accident insurance policy.
• Death Not Accidental: Petitioner contended that death resulting from murder and/or assault is impliedly excluded from the insurance policy because the cause of death was not accidental but rather a deliberate and intentional act of the assailant, as indicated by the location of the lone stab wound on the insured.
• Deliberate Intent: Petitioner argued that the death was committed with deliberate intent which, by the very nature of a personal accident insurance policy, cannot be indemnified.

• Coverage of Personal Accident Insurance: Whether death resulting from murder or assault by a third party is covered under a personal accident insurance policy.
• Application of Expressio Unius Exclusio Alterius: Whether the principle of expressio unius exclusio alterius applies to preclude the insurer from implying an exclusion for murder and assault not expressly listed among the policy's enumerated exclusions.

• Coverage of Personal Accident Insurance: Yes. The insured's death was accidental from the victim's perspective, as it was an event that took place without his foresight or expectation, proceeding from an unusual effect of a known cause, and not the natural result of his own voluntary act.
• Application of Expressio Unius Exclusio Alterius: Yes. The principle applies because the policy expressly enumerated only ten circumstances excluding liability, and murder and assault were not among them; the failure to include them leads to the conclusion that the insurer did not intend to limit or exempt itself from liability for such death.

• Coverage of Personal Accident Insurance: The terms "accident" and "accidental" in insurance contracts have not acquired any technical meaning and are construed in their ordinary and common acceptation — that which happens by chance or fortuitously, without intention and design, and which is unexpected, unusual, and unforeseen. The generally accepted rule is that death or injury does not result from accident if it is the natural result of the insured's voluntary act, unaccompanied by anything unforeseen except the death or injury. However, where the death is not the natural or probable result of the insured's voluntary act, or where 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. In this case, the insured and his companion were simply on their way home from a festival when confronted by unidentified persons. The record was barren of any circumstance showing how the stab wound was inflicted, nor could it be said that the killer specifically intended to take the insured's life. The insured died from an event that took place without his foresight or expectation — a pure accident from the victim's perspective. There was no capricious desire on the part of the insured to expose his life to danger.

• Application of Expressio Unius Exclusio Alterius: The personal accident insurance policy specifically enumerated only ten circumstances wherein no liability attaches to the insurer for any injury, disability, or loss suffered by the insured. The principle of expressio unius exclusio alterius — the mention of one thing implies the exclusion of another — is applicable because murder and assault, not having been expressly included in the enumeration of circumstances that would negate liability, cannot be considered by implication to discharge the insurer from liability. The failure to include death resulting from murder or assault among the prohibited risks leads inevitably to the conclusion that the insurer did not intend to limit or exempt itself from liability for such death. This conclusion is reinforced by Article 1377 of the Civil Code, which provides that the interpretation of obscure words or stipulations in a contract shall not favor the party who caused the obscurity, and by the settled doctrine that contracts of insurance are to be construed liberally in favor of the insured and strictly against the insurer, so that ambiguity should be interpreted in favor of the beneficiary.

• Liberal Construction of Insurance Contracts — Contracts of insurance are to be construed liberally in favor of the insured and strictly against the insurer. Ambiguity in the words of an insurance contract should be interpreted in favor of its beneficiary. The Court applied this doctrine to hold that the insurer could not imply an exclusion for murder or assault that it had failed to expressly enumerate among the policy's excluded risks.

• Expressio Unius Exclusio Alterius — The mention of one thing implies the exclusion of another. Where an insurance policy expressly enumerates specific circumstances that exclude liability, circumstances not so enumerated are not excluded by implication. The Court applied this principle to the policy's ten-item exclusion list, holding that the absence of murder or assault from that list precluded the insurer from disclaiming liability on those grounds.

• Accident in Insurance Law — An accident is an event that takes place without one's foresight or expectation — an event that proceeds from an unknown cause, or is an unusual effect of a known cause and, therefore, not expected. Death or injury does not result from accident if it is the natural result of the insured's voluntary act, unaccompanied by anything unforeseen except the death or injury. Where the death is not the natural or probable result of the insured's voluntary act, or where something unforeseen occurs which produces the injury, the resulting death is within the protection of policies insuring against accident. The Court applied this definition to hold that the insured's stabbing death was accidental from his perspective, as he was merely going home from a festival and was confronted without provocation or warning.

• "The terms 'accident' and 'accidental' as used in insurance contracts have not acquired any technical meaning, and are construed by the courts in their ordinary and common acceptation." — This passage establishes the foundational interpretive rule for accident clauses in insurance contracts, anchoring the Court's analysis of whether the insured's death was accidental.

• "The generally accepted rule is that, death or injury does not result from accident or accidental means within the terms of an accident-policy if it is the natural result of the insured's voluntary act, unaccompanied by anything unforeseen except the death or injury." — This formulation articulates the controlling test for distinguishing accidental from non-accidental death, focusing on whether the insured's own voluntary act naturally produced the result or whether an unforeseen intervening event caused it.

• "the failure of the petitioner insurance company to include death resulting from murder or assault among the prohibited risks leads inevitably to the conclusion that it did not intend to limit or exempt itself from liability for such death." — This sentence captures the ratio decidendi on the exclusion-list issue, applying expressio unius exclusio alterius to defeat the insurer's implied-exclusion argument.

• "it is well settled that contracts of insurance are to be construed liberally in favor of the insured and strictly against the insurer. Thus ambiguity in the words of an insurance contract should be interpreted in favor of its beneficiary." — This is the canonical statement of the liberal-construction doctrine as applied to the facts, reinforcing the conclusion that the insurer bears the consequence of its own failure to enumerate murder and assault as excluded risks.

• De la Cruz vs. Capital Insurance & Surety Co., Inc., 17 SCRA 559 [1966] — Cited as the source of the definition of "accident" and "accidental" in insurance contracts and the rule that death or injury is accidental where it is not the natural result of the insured's voluntary act or where something unforeseen produces the injury. Followed as controlling precedent.

• National Power Corporation vs. Court of Appeals, 145 SCRA 533 [1986] — Cited for the doctrine that contracts of insurance are to be construed liberally in favor of the insured and strictly against the insurer, and that ambiguity in insurance contract words should be interpreted in favor of the beneficiary. Followed as controlling precedent.

• Article 1377, Civil Code of the Philippines — Provides that the interpretation of obscure words or stipulations in a contract shall not favor the party who caused the obscurity. The Court invoked this provision to reinforce the conclusion that the insurer, having drafted the policy and failed to include murder or assault among the enumerated exclusions, could not benefit from an implied exclusion it itself failed to specify.

Narvasa, C.J., Padilla, Regalado, and Melo, JJ., concurred.