Gabriel vs. Court of Appeals

In accident insurance covering a specified peril, the beneficiary has the burden of proving that the insured's death was caused by the covered risk; the insurer's failure to verify its written answer to a request for admission does not constitute implied admission or waiver of defenses, verification being a formal, non-jurisdictional requirement.

Marcelino Gabriel was employed by Emerald Construction & Development Corporation ("ECDC") at a construction project in Iraq. ECDC procured from Fortune Insurance & Surety Company, Inc. a group personal accident insurance policy covering its overseas workers, including Gabriel, in the amount of P100,000.00. The insured risk was bodily injury caused by "violent accidental external and visible means" resulting in death or disability. Jacqueline Jimenez vda. de Gabriel was Gabriel's surviving spouse and the beneficiary under the policy.

Marcelino Gabriel was employed by Emerald Construction & Development Corporation ("ECDC") at its construction project in Iraq and was covered by a personal accident insurance policy in the amount of P100,000.00 under a group policy procured from Fortune Insurance & Surety Company, Inc. by ECDC for its overseas workers. The insured risk was bodily injury caused by "violent accidental external and visible means" which injury would solely and independently of any other cause result in death or disability.

On 22 May 1982, within the life of the policy, Gabriel died in Iraq. A year later, on 12 July 1983, ECDC reported Gabriel's death to the insurer by telephone. Among the documents thereafter submitted were a death certificate issued by the Ministry of Health of the Republic of Iraq, which stated "REASON OF DEATH: UNDER EXAMINATION NOW — NOT YET KNOWN," and an NBI autopsy report stating that due to the advanced state of postmortem decomposition, the cause of death could not be determined. The insurer referred the insurance claim to Mission Adjustment Service, Inc. Following a series of communications between petitioner and the insurer, the latter, on 22 September 1983, ultimately denied the claim on the ground of prescription.

Petitioner filed a complaint with the Regional Trial Court of Manila against ECDC and the insurer, averring that her husband died of electrocution while in the performance of his work and praying for recovery of P100,000.00 for insurance indemnification plus actual, moral, and exemplary damages, attorney's fees, and costs of suit. The insurer filed an unverified answer admitting the genuineness and due execution of the insurance policy but denying liability on the ground that both the Iraqi death certificate and the NBI autopsy report failed to disclose the cause of death. It also raised the defense of prescription under Section 384 of the Insurance Code. The insurer later filed an amended answer, still unverified, reiterating its original defenses and adding a counterclaim and a crossclaim.

The case against ECDC was dismissed without prejudice for petitioner's failure to cause service of the fourth alias summons. The case proceeded against the insurer alone. On 28 May 1987, the trial court rendered a decision partly in favor of petitioner, holding that the insurer was deemed to have waived the defense that the cause of death was not covered by the policy when it failed to impugn by evidence petitioner's averment on the matter, and that the complaint was timely filed within one year from denial of the claim. Both parties appealed to the Court of Appeals—petitioner contending that the lower court should have awarded all her claims, and the insurer asserting that the lower court erred in ruling that it had waived the defense on cause of death and that the cause of action had not prescribed.

The Court of Appeals, on 18 September 1991, reversed the trial court. It held that petitioner had failed to substantiate her allegation that her husband's death was caused by a risk insured against, observing that the only evidence she presented—a letter allegedly written by a co-worker of the deceased in Iraq and her own affidavit—were both hearsay, neither having been identified or testified to in court by their authors. The appellate court also found no basis for the trial court's ruling that the insurer had waived its defense, noting that the death certificate and autopsy report more than controverted petitioner's allegation as to the cause of death. The motion for reconsideration was denied.

• Waiver by Unverified Answer: Petitioner argued that the insurer must be deemed to have waived its right to controvert the claim—that is, to show that the cause of death was an excepted peril—by failing to have its answers to the Request for Admission duly verified, such that the matters requested were deemed impliedly admitted.
• Full Award of Damages: Petitioner contended that the lower court should have awarded all the claims she had asked for, not merely the insurance indemnification.

• No Waiver of Defense on Cause of Death: Respondent asserted that the lower court erred in ruling that the insurer had waived the defense that Gabriel's death was not caused by the insured peril specified in the policy, pointing to the death certificate and autopsy report that failed to disclose the cause of death.
• Prescription: Respondent raised the defense of prescription, invoking Section 384 of the Insurance Code, arguing that the written notice of claim was not filed within six months from the date of the accident.
• No Prescription of Action: Respondent argued that the lower court erred in ruling that the cause of action had not prescribed.

• Burden of Proof in Accident Insurance: Whether petitioner sufficiently proved that the insured's death was caused by the peril covered by the accident insurance policy.
• Waiver by Unverified Answer to Request for Admission: Whether the insurer's failure to verify its answer to a Request for Admission constituted implied admission or waiver of its defenses.
• Prescription: Whether the claim had prescribed under Section 384 of the Insurance Code.

• Burden of Proof in Accident Insurance: No. In accident insurance with a specified insured risk, the beneficiary bears the burden of proving that the loss was caused by the covered peril; petitioner's evidence was hearsay and the official documents did not establish the cause of death.
• Waiver by Unverified Answer to Request for Admission: No. Verification is a formal, not jurisdictional, requirement; the insurer substantially answered the request in writing, precluding a finding of implied admission or waiver.
• Prescription: Yes, in favor of the insurer. The notice of death was given more than a year after the accident, beyond the six-month period prescribed by Section 384 of the Insurance Code for filing a written notice of claim.

• Burden of Proof in Accident Insurance: The insurance policy expressly provided that to be compensable, the injury or death should be caused by "violent accidental external and visible means." Petitioner's only evidence consisted of a letter from a co-worker stating that Gabriel died when he tried to haul water out of a tank while its submerged motor was still functioning, and petitioner's own sinumpaang salaysay confirming receipt and contents of that letter. Both were hearsay: the affidavit was not testified to or identified by petitioner herself in court, and the letter was never identified by its alleged author. None of the other documents—the POEA decision, the Iraqi death certificate, or the NBI autopsy report—provided any clue on the cause of death. The POEA decision made no categorical holding on the specific cause, and both the death certificate and autopsy report expressly stated the cause could not be determined. In accident insurance where the insured risk is specified, the beneficiary has the burden of initially proving that the loss was caused by the covered peril; only then does the burden shift to the insurer to show any excepted peril. This differs from ordinary life insurance, akin to "all risk" coverage, where the insured's death regardless of cause is normally compensable. Because petitioner failed to establish that the insured suffered an accidental death, the claim must fail.
• Waiver by Unverified Answer to Request for Admission: While a matter of which a written request for admission is made is deemed impliedly admitted unless the party serves a sworn statement denying or explaining within the designated period, verification is a formal, not jurisdictional, requirement intended to secure an assurance that allegations are made in good faith. Courts may order correction of unverified pleadings or waive strict compliance to serve the ends of justice. Here, the insurer did file a written answer to the request for admission, albeit without verification, answering practically every question posed. The situation was thus distinguishable from Motor Service Co., Inc. vs. Yellow Taxicab Co., Inc., where there was absolute failure to answer. The appellate court correctly upheld the trial court's ruling that no waiver or implied admission arose from the lack of verification, the insurer having substantially complied with the request.
• Prescription: Section 384 of the Insurance Code requires that a written notice of claim be filed within six months from the date of the accident, otherwise the claim is deemed waived. The notice of death was given to the insurer more than a year after Gabriel's death, concededly beyond the six-month period. The insurer's invocation of prescription referred not to the one-year period from denial of the claim within which to file an action, but to the six-month notice requirement. The insurer correctly invoked Section 384 on this ground.

• Burden of Proof in Accident Insurance — In accident insurance covering a specified peril, the beneficiary has the burden of proving that the insured's death was caused by the covered peril. Once that fact is established, the burden shifts to the insurer to show any excepted peril stipulated by the parties. This is distinct from ordinary life insurance, where death regardless of cause is normally compensable, akin to "all risk" coverage in property insurance where the insured need only show the condition of the property when the policy attaches and the fact of loss during the policy period.
• Verification as a Formal, Non-Jurisdictional Requirement — Verification is a formal, not jurisdictional, requirement, intended to secure an assurance that matters alleged are done in good faith or are true and correct and not mere speculation. When circumstances warrant, the court may order correction of unverified pleadings or act on them and waive strict compliance to serve the ends of justice.
• Substantial Compliance with Request for Admission — Where a party files a written answer to a request for admission, even without verification, and substantially answers the questions posed, the court may treat it as compliance under the circumstances, precluding a finding of implied admission or waiver. This contrasts with cases of absolute failure to answer, where summary judgment on deemed admissions is justified.

• "In an accident insurance, the insured's beneficiary has the burden of proof in demonstrating that the cause of death is due to the covered peril. Once that fact is established, the burden then shifts to the insurer to show any excepted peril that may have been stipulated by the parties." — This passage states the ratio decidendi on the allocation of burden of proof in accident insurance with a specified insured risk, distinguishing it from ordinary life insurance.
• "An 'accident insurance' is not thus to be likened to an ordinary life insurance where the insured's death, regardless of the cause thereof, would normally be compensable." — This clarifies the doctrinal distinction between accident insurance and ordinary life insurance as to the burden of proof, a point frequently cited in subsequent insurance jurisprudence.
• "the verification, like in most cases required by the rules of procedure, is a formal, not jurisdictional, requirement, and mainly intended to secure an assurance that matters which are alleged are done in good faith or are true and correct and not of mere speculation." — This defines the canonical formulation of the nature of verification as a procedural requirement, relied upon to justify treating the insurer's unverified answer as substantial compliance.

• Motor Service Co., Inc. vs. Yellow Taxicab Co., Inc. — Distinguished. In that case, there was absolute failure on the part of the defendant to answer the request for admission, justifying summary judgment on deemed admissions. In the present case, the insurer answered in writing practically every question posed, albeit without verification, making the precedent inapplicable.
• Quimpo vs. de la Victoria, 46 SCRA 139 — Followed as more controlling on the issue of substantial compliance with a request for admission, cited by the trial court and upheld by the appellate court.
• Sy vs. Habacon-Garayblas, 228 SCRA 644 — Cited for the proposition that verification is a formal, not jurisdictional, requirement and that courts may waive strict compliance to serve the ends of justice, in turn citing Villarica vs. Court of Appeals, G.R. No. 96085, March 16, 1992.

• Section 384, Insurance Code — Requires that any person having a claim upon a policy issued pursuant to the chapter on accident insurance present a written notice of claim within six months from the date of the accident, otherwise the claim is deemed waived, and that an action or suit for recovery be brought within one year from denial of the claim. Applied to hold that the insurer correctly invoked prescription, the notice of death having been given more than a year after the accident, beyond the six-month notice period.
• Section 2, Rule 26, Revised Rules of Court — Provides that a matter of which a written request for admission is made shall be deemed impliedly admitted unless the party serves a sworn statement denying or explaining within the designated period. Cited by petitioner to argue waiver; the Court held that the rule's verification requirement is formal, not jurisdictional, and that substantial written compliance sufficed.
• Section 4, Rule 26, Revised Rules of Court — Allows the court to permit a party to withdraw or amend an admission, whether express or implied, upon such terms as may be just. Cited to support the Court's flexibility in treating the insurer's unverified answer.

Padilla, Bellosillo, Kapunan, and Hermosisima, Jr., JJ., concurred.