After reading about life insurance you may also read: Matters Involving Enforceability of Insurance Policies
-
Generally, a contract may be invalidated if the consent by one party was obtained by mistake or fraud
-
The incontestability clause in the Insurance Code is an exception
-
A life insurance policy is incontestable after two (2) years from the date of issuance
May an insurer deny your claim on the insurance proceeds?
Life insurance is a contract between an insured and an insurer. The insurer agrees to pay the insured’s designated beneficiary upon the occurrence of the insured individual’s death or other event, covered by the policy such as terminal or critical illness. In return, the insured agrees to pay a stipulated amount called premium, at regular intervals or in lump sums.
For a better understanding and to answer the question above, let us take the case of Manila Bankers Life Insurance Corporation vs. Cresencia P. Aban, G.R. No. 175666, July 29, 2013.
On July 3, 1993, Delia (insured) took out a life insurance policy from Manila Bankers Life Insurance Corporation (Bankers Life/insurer), designating Cresencia, her niece, as her beneficiary. The insurer then issued the written instrument in which a contract of insurance is set forth (Policy) with a face value of P100,000.00, in Delia’s favor after the requisite medical examination and payment of the insurance premium.
When the insurance policy had been in force for more than two (2) years and seven (7) months, Delia died. Her niece eventually filed a claim on the insurance proceeds. The insurer conducted an investigation into the claim, and came out with the following findings:
- Delia did not personally apply for insurance coverage, as she was illiterate;
- Delia was sickly since 1990;
- Delia did not have the financial capability to pay the insurance premiums;
- Delia did not sign the July 3, 1993 application for insurance; and
- Cresencia was the one who filed the insurance application, and designated herself as the beneficiary.
For the above reasons, the insurer denied Cresencia’s claim and refunded the premiums paid on the policy. The insurer filed a civil case for the rescission and/or annulment of the policy on the ground that the policy was obtained by fraud, concealment and/or misrepresentation under the Insurance Code.
For her defense as the beneficiary, Cresencia reasoned out that the insurer can no longer question the validity of the insurance policy on the ground of prescription.
Can the Bankers Life deny the claim of the Cresencia on the insurance proceeds?
The law says:
No.
The insurer is given two (2) years – from the effectivity of a life insurance contract and while the insured is alive – to discover or prove that the policy is void from the beginning or is rescindable by reason of fraud, concealment or misrepresentation of the insured or his agent. After the two-year period lapses, the insurer must make good on the policy. This means that the beneficiary is entitled to the claim on the insurance proceeds. The insurer cannot deny the claim except by reason of non-payment of premiums.
What if the insurance policy was obtained by fraud, concealment, or misrepresentation of the insured or his agent?
The Supreme court says:
The insurer, still, must make good on the policy even though the policy was obtained by fraud, concealment, or misrepresentation. This is the so-called “incontestability clause” which precludes the insurer from raising the defenses of false representations or concealment of material facts insofar as health and previous diseases are concerned if the insurance has been in force for at least two (2) years during the insured’s lifetime.
Take note that the insurance policy was in force for a period of more than two (2) years. Considering that Delia, the insured, died after the two-year period, Bankers Life is barred from proving that the policy is void from the beginning by reason of the Delia’s fraudulent concealment or misrepresentation. Thus, to reiterate, Bankers Life cannot deny the claim of the beneficiary.
Alburo Alburo and Associates Law Offices specializes in business law and labor law consulting. For inquiries, you may reach us at info@alburolaw.com, or dial us at (02)7745-4391/0917-5772207.
All rights reserved.
SUBSCRIBE NOW FOR MORE LEGAL UPDATES!
[email-subscribers-form id=”4″]