STRONGHOLD INSURANCE COMPANY, INC., PETITIONER, VS. HON. COURT OF APPEALS AND FELICITAS RIVERA, RESPONDENTS.

Stronghold Insurance versus Court of Appeals

The Case

This is a petition for review brought by Stronghold Insurance Company against the Court of Appeals and Felicitas Rivera. The dispute is a claim for death benefits under a personal accident insurance policy. Cesar Rivera, a contract worker deployed to Baghdad, died there, and his widow sought the seventy-five thousand peso benefit for accidental death. The insurer refused to pay, insisting that the cause of death was a heart attack, not an accident. The case matters because it teaches how our courts weigh conflicting evidence on the cause of death, how a death certificate is treated as proof, and how the proximate cause of death is determined for purposes of accident insurance coverage.

Procedural History

Felicitas Rivera filed her complaint against Stronghold with the Insurance Commission. The Commission rendered judgment dismissing her complaint, giving weight to an inconsistency in the dates of the alleged accident. On appeal, the Court of Appeals reversed the Commission. It ordered Stronghold to pay the seventy-five thousand peso benefit plus five thousand pesos in attorney's fees, with costs against the insurer. Stronghold moved for reconsideration, but the Court of Appeals denied it. Stronghold then came to the Supreme Court by petition for review, assigning as errors the appellate court's finding that the death was accidental and within the coverage of the policy, its disturbance of the Commission's findings on the credibility of the witness Rudy Buendia, its holding Stronghold liable, and its award of attorney's fees. The Supreme Court gave due course to the petition and, after the parties submitted their memoranda, deemed the case submitted for decision.

Facts

On July 24, 1981, Cesar Rivera was hired by Erectors, Incorporated as a helper electrician at the International Airport Project in Baghdad, Iraq. In compliance with the rules of the Ministry of Labor and Employment, Erectors secured a group accident insurance from Stronghold for all the contract workers it deployed to Baghdad. Under Personal Accident Insurance Policy Number UPA-100001, Stronghold undertook to pay the covered worker seventy-five thousand pesos in case of a work-connected or accident-connected death.

On March 23, 1982, Cesar Rivera died. His Certificate of Death listed myocardial infarction, commonly known as heart attack, as the disease directly leading to his death. His remains were transported back to the Philippines for burial, and the Ministry of Health of Iraq issued an International Certificate for Transportation of Cadavers for that purpose. His widow, Felicitas Rivera, then filed her claim with Stronghold, which refused to pay.

On April 23, 1982, the body of the deceased was exhumed and autopsied by the National Bureau of Investigation. The Exhumation Report noted that the thoracic and abdominal organs were missing except for a few loops of large intestines, that the second, third, and fourth ribs on the right were completely fractured, and that no cause of death could be given due to the absence of internal organs. At the hearing before the Insurance Commission, Felicitas presented Rudy Buendia, an electrician at the Baghdad airport. He testified that on March 23, 1982, he was walking behind Cesar Rivera as they carried boxes of electrical fittings; that Cesar tripped on the marble flooring and fell violently, his head hitting the concrete floor; that he saw the upper right forehead of Cesar bleeding; and that he and three co-workers rushed him to the hospital, where he died the same day.

Issues

• Whether or not the Court of Appeals erred in holding Stronghold liable to Felicitas Rivera under Policy Number UPA-100001, that is, whether or not the death of Cesar Rivera was accidental and within the coverage of the policy.
• Whether or not the Court of Appeals ruled correctly in awarding attorney's fees to Felicitas Rivera.

Applicable Provisions

Section 1 of Rule 131 of the Revised Rules of Court, on the burden of proof, provides:

Each party must prove his own affirmative allegations.

This fixes the burden on each side: the widow must prove her claim by preponderance of evidence, and the insurer must prove its defense.

Article 410 of the Civil Code, on the register of births, deaths, and marriages, provides:

The books making up the civil register and all documents relating thereto shall be considered public documents and shall be evidence of the facts therein contained.

This bears on the weight of the death certificate, which the Court held is conclusive only as to the fact of death and, if duly registered, enjoys a disputable presumption of correctness.

Section 84 of the Insurance Code, on the proximate cause of loss, provides:

An insurer is liable for a loss of which a peril insured against was the proximate cause, although a peril not contemplated by the contract may have been a remote cause of the loss; but he is not liable for a loss of which the peril insured against was only a remote cause.

This is the rule that makes the accidental fall, as the proximate cause, the basis for liability even if a heart attack was the immediate cause of death.

Ruling

On the first issue, the Court held that the Court of Appeals committed no reversible error. Each party must prove its affirmative allegations, and in civil cases the required degree of evidence is preponderance of evidence, meaning the evidence of one party that is more conclusive and credible than that of the other. The widow clearly showed that an accident immediately preceded the death. Buendia described the violent fall in detail, and the Exhumation Report showing the completely fractured second, third, and fourth ribs confirmed it. The Court held that the accidental fall was the proximate cause, which it defined as follows:

That cause, which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces the injury, and without which the result would not have occurred.

The Court explained that although the immediate cause of death may have been myocardial infarction, the accidental fall remained the proximate cause, so the death was covered by the policy and compensable. On the inconsistency in dates between Buendia's testimony and the letter of Erectors, the Court held it was not material, since the principal issue was the cause of death, and Stronghold had the chance to cross-examine Buendia on it but did not. The Court also held that the death certificate is conclusive only as to the fact of death; here it was not registered with the civil register, so the presumption of correctness did not apply, and even if it did, the presumption is merely disputable and yields to more positive evidence. The International Certificate for Transportation of Cadavers could not establish the cause of death, since it was issued only to secure the transport of the corpse. The NBI Exhumation Report, far from helping Stronghold, listed myocardial infarction only as the alleged cause and its finding of fractured ribs was more compatible with the widow's theory.

On the second issue, the Court held that the award of attorney's fees must be disallowed. The reason for the award must be stated in the text of the decision; if it appears only in the dispositive portion, it must be disallowed on appeal. The Court of Appeals failed to state in the text the justification for the five thousand peso award, so it was deleted.

Doctrine

First, in a claim under an accident insurance policy, the claimant must prove the claim by preponderance of evidence, and the insurer must prove its defense. Second, the insurer is liable where the peril insured against is the proximate cause of the loss, even if a peril not contemplated by the contract is a remote or immediate cause; thus an accidental fall that leads to a heart attack and death is covered. Third, a death certificate is conclusive only as to the fact of death; if duly registered it is a public document whose entries are presumed correct, but the presumption is disputable and yields to more positive evidence. Fourth, an award of attorney's fees must be justified in the text of the decision; if the reason appears only in the dispositive portion, the award must be disallowed on appeal.

Disposition

The petition was denied and the decision of the Court of Appeals was affirmed, with the modification that the five thousand peso award of attorney's fees in favor of Felicitas Rivera was deleted.

Remember This

Memorize the line that the peril insured against need only be the proximate cause of the loss, even if a heart attack is the immediate cause of death. Examiners use this case to test proximate cause in accident insurance, the limited evidentiary weight of a death certificate, and the rule that attorney's fees must be justified in the body of the decision.