The plaintiff filed a claim with multiple insurers to recover benefits under his accident policies for injuries to his left hand sustained in a factory fire. The policies stated that recovery for loss of a hand required amputation through the wrist bones. As the plaintiff's hand injuries were fractures causing temporary disability, and not amputation, the court found the insurers were not liable. While ambiguous terms are interpreted against the insurer, the policy terms here clearly required amputation, so mere fracture or temporary disability was not covered. The court affirmed the lower court's decision in favor of the insurers.
The plaintiff filed a claim with multiple insurers to recover benefits under his accident policies for injuries to his left hand sustained in a factory fire. The policies stated that recovery for loss of a hand required amputation through the wrist bones. As the plaintiff's hand injuries were fractures causing temporary disability, and not amputation, the court found the insurers were not liable. While ambiguous terms are interpreted against the insurer, the policy terms here clearly required amputation, so mere fracture or temporary disability was not covered. The court affirmed the lower court's decision in favor of the insurers.
The plaintiff filed a claim with multiple insurers to recover benefits under his accident policies for injuries to his left hand sustained in a factory fire. The policies stated that recovery for loss of a hand required amputation through the wrist bones. As the plaintiff's hand injuries were fractures causing temporary disability, and not amputation, the court found the insurers were not liable. While ambiguous terms are interpreted against the insurer, the policy terms here clearly required amputation, so mere fracture or temporary disability was not covered. The court affirmed the lower court's decision in favor of the insurers.
The plaintiff filed a claim with multiple insurers to recover benefits under his accident policies for injuries to his left hand sustained in a factory fire. The policies stated that recovery for loss of a hand required amputation through the wrist bones. As the plaintiff's hand injuries were fractures causing temporary disability, and not amputation, the court found the insurers were not liable. While ambiguous terms are interpreted against the insurer, the policy terms here clearly required amputation, so mere fracture or temporary disability was not covered. The court affirmed the lower court's decision in favor of the insurers.
The physical injuries he sustained caused temporary total disability of
plaintiff's left hand. He then filed the corresponding notice of accident and Topic Construction/Interpretation of Insurance Contracts notice of claim with all of the insurers named as defendant in this case to Case No. G.R. No. 16138-45 | 29 April 1961 recover indemnity under Part II of the policy which read that the loss of a Case Name Ty v. First National Surety hand shall mean the loss by amputation through the bones of the wrist.” Full Case DIOSDADO C. TY, plaintiff-appellant, 6. Ty further argues that in order that he may recover on the insurance policies Name vs. issued him for the loss of his left hand, it is not necessary that there should be FIRST NATIONAL SURETY & ASSURANCE CO., INC., an amputation thereof, but that it is sufficient if the injuries prevent him from defendant-appellee. performing his work or labor necessary in the pursuance of his occupation or Ponente Labrador, J business. Doctrine Obscure words or stipulations should be interpreted against the 7. The insurers rejected Ty’s claim on the ground that there being no severance person who caused the obscurity, and the ones which caused the of amputation of the left hand, the disability suffered by him was not covered obscurity in the cases at bar are the defendant insurance by his policy. companies.
RELEVANT FACTS ISSUES & RATIO DECIDENDI
1. Diosdado C. Ty was employed as operator mechanic foreman in the W/N the insurers are liable. Broadway Cotton Factory, in Grace Park, Caloocan, Rizal, at a monthly salary of P185.00. 2. He insured himself in 18 local insurance companies, among which being the 1. No. The clear and express conditions of the insurance policies following eight named defendants, which issued to him personal accident define partial disability as loss of either hand by amputation policies, upon payment of the premium of P8.12 for each policy. through the bones of the wrist." a) FIRST NATIONAL SURETY & ASSURANCE CO., INC. b)ASSOCIATED INSURANCE & SURETY CO., INC. There was no such amputation in the case at bar. All that was found by c) UNITED INSURANCE CO., INC. the trial court, which is not disputed on appeal, was that the physical d)PHILIPPINE SURETY & INSURANCE CO., INC. injuries "caused temporary total disability of plaintiff's left hand." Note e) RELIANCE SURETY & INSURANCE CO., INC. that the disability of plaintiff's hand was merely temporary, having been f) FAR EASTERN SURETY & INSURANCE CO. caused by fracture of the index, the middle and the fourth fingers of the g) CAPITAL INSURANCE & SURETY CO., INC. left hand. h)CAPITAL INSURANCE & SURETY CO., INC. 3. Plaintiff's beneficiary was his employer, Broadway Cotton Factory, which The Court cited authorities to the effect that "total disability" in relation paid the insurance premiums. to one's occupation means that the condition of the insurance is such 4. On December 24, 1953, a fire broke out which totally destroyed the that common prudence requires him to desist from transacting his Broadway Cotton Factory. Ty was injured on the left hand by a heavy object. business or renders him incapable of working. (46 C.J.S., 970). He was brought to the Manila Central University hospital, and after receiving first aid there, he went to the National Orthopedic Hospital for treatment of The Court also held that while obscure words or stipulations should be his injuries. interpreted against the person who caused the obscurity, and the ones which caused the obscurity in the cases at bar are the defendant insurance companies, the terms of the policies are clear, express and specific that only amputation of the left hand should be considered as a loss thereof, an interpretation that would include the mere fracture or other temporary disability not covered by the policies would certainly be unwarranted.
DISPOSITIVE WHEREFORE, the decision appealed from is hereby affirmed, with costs against the plaintiff-appellant.
August 1, 2018, G.R. No. 163959MARCELINO E. LOPEZ, FELIZA LOPEZ, ZOILO LOPEZ, LEONARDO LOPEZ, and SERGIO F. ANGELES, Petitioners Vs - THE HON. COURT OF APPEALS and PRIMEX C