In this case, the Supreme Court affirmed the principle that an insurer’s right to contest a life insurance policy is limited to two years from the policy’s effective date or until the death of the insured, whichever comes first. Sun Life of Canada (Philippines), Inc. was ordered to pay death benefits to the beneficiaries of the deceased Atty. Jesus Sibya, Jr., because the company failed to prove fraudulent concealment or misrepresentation within the contestability period. This decision reinforces the protection afforded to beneficiaries, ensuring that legitimate claims are honored promptly and fairly.

Sun Life’s Denied Claim: Did Atty. Sibya Conceal His Medical History?

The case arose when Atty. Jesus Sibya, Jr. applied for a life insurance policy with Sun Life in 2001, disclosing a past kidney stone treatment. After Atty. Sibya, Jr.’s death, Sun Life denied the claim, alleging that he had failed to disclose additional medical treatments for a kidney ailment. The insurance company then filed a complaint for rescission of the insurance policy. The respondents, Ma. Daisy S. Sibya, Jesus Manuel S. Sibya III, and Jaime Luis S. Sibya, the beneficiaries of the policy, argued that there was no fraudulent intent or misrepresentation on the part of Atty. Sibya, Jr., and that Sun Life was merely trying to evade its obligations.

The primary legal question before the Court was whether Sun Life could validly deny the claim based on alleged concealment or misrepresentation, or whether the incontestability clause barred such action. The Regional Trial Court (RTC) ruled in favor of the respondents, ordering Sun Life to pay the death benefits and damages. The Court of Appeals (CA) affirmed the RTC’s decision regarding the death benefits and damages but absolved Sun Life from charges of violating Sections 241 and 242 of the Insurance Code.

At the heart of this case is Section 48 of the Insurance Code, which establishes the **incontestability clause**. This provision limits the period during which an insurer can challenge the validity of a life insurance policy based on concealment or misrepresentation. The Supreme Court has consistently upheld the incontestability clause to protect beneficiaries from unwarranted denials of claims, even if the insured may have made misstatements in their application. As the Supreme Court cited the case of Manila Bankers Life Insurance Corporation v. Aban:

Section 48 serves a noble purpose, as it regulates the actions of both the insurer and the insured. Under the provision, an insurer is given two years – from the effectivity of a life insurance contract and while the insured is alive – to discover or prove that the policy is void ab initio or is rescindible by reason of the fraudulent concealment or misrepresentation of the insured or his agent. After the two-year period lapses, or when the insured dies within the period, the insurer must make good on the policy, even though the policy was obtained by fraud, concealment, or misrepresentation.

The Supreme Court emphasized that the two-year period begins from the policy’s effective date and continues while the insured is alive. If the insured dies within this period, the insurer loses the right to rescind the policy, and the incontestability clause becomes effective. In this case, Atty. Jesus Jr. died just three months after the policy was issued, thus preventing Sun Life from rescinding the policy based on alleged misrepresentation.

Even assuming the incontestability period had not yet set in, the Court found that Sun Life failed to prove concealment or misrepresentation on the part of Atty. Jesus Jr. The application for insurance disclosed that he had sought medical treatment for a kidney ailment. Furthermore, Atty. Jesus Jr. signed an authorization allowing Sun Life to investigate his medical history. Given these circumstances, the Court held that Sun Life had the means to ascertain the facts and could not claim concealment.

The Court also addressed the issue of misrepresentation, noting that Atty. Jesus Jr.’s statement of “no recurrence” of his kidney ailment could be construed as an honest opinion, not a deliberate attempt to deceive the insurer. The burden of proving fraudulent intent rests on the insurer, and in this case, Sun Life failed to meet that burden. The Court cited the CA’s observations on the declarations made by Atty. Jesus Jr. in his insurance application.

Records show that in the Application for Insurance, [Atty. Jesus Jr.] admitted that he had sought medical treatment for kidney ailment. When asked to provide details on the said medication, [Atty. Jesus Jr.] indicated the following information: year (“1987“), medical procedure (“undergone lithotripsy due to kidney stone“), length of confinement (“3 days“), attending physician (“Dr. Jesus Benjamin Mendoza“) and the hospital (“National Kidney Institute“).

In insurance law, **concealment** refers to the intentional withholding of information that is material to the risk being insured. For concealment to be a valid defense for the insurer, it must be shown that the insured had knowledge of the facts, that the facts were material to the risk, and that the insured suppressed or failed to disclose those facts. In this case, the court determined that Atty. Jesus Jr. had disclosed having kidney issues and, in addition, gave authority to Sun Life to conduct investigations to his medical records.

The decision underscores the importance of insurers conducting thorough investigations during the contestability period. It also highlights the protection afforded to insured parties who provide honest and reasonable answers in their insurance applications. The Supreme Court’s ruling serves as a reminder that insurers cannot avoid their contractual obligations based on flimsy allegations of concealment or misrepresentation.

Moreover, the Supreme Court is not a trier of facts. As such, factual findings of the lower courts are entitled to great weight and respect on appeal, and in fact accorded finality when supported by substantial evidence on the record.

FAQs

What is the incontestability clause in insurance policies?	The incontestability clause limits the period during which an insurer can contest the validity of a life insurance policy based on concealment or misrepresentation, typically to two years from the policy’s effective date.
When does the incontestability period begin?	The incontestability period begins on the effective date of the insurance policy.
What happens if the insured dies within the contestability period?	If the insured dies within the two-year contestability period, the insurer loses the right to rescind the policy based on concealment or misrepresentation.
What is considered concealment in insurance law?	Concealment is the intentional withholding of information that is material to the risk being insured.
Who has the burden of proving concealment or misrepresentation?	The insurer has the burden of proving concealment or misrepresentation by satisfactory and convincing evidence.
What kind of information must be disclosed in an insurance application?	An applicant must disclose all information that is material to the risk being insured, meaning information that would influence the insurer’s decision to issue the policy or determine the premium rate.
What if an applicant makes an honest mistake in their insurance application?	If an applicant makes an honest mistake or expresses an opinion in good faith, without intent to deceive, it will not necessarily void the policy.
Can an insurer deny a claim based on information they could have discovered themselves?	No, if the insurer had the means to ascertain the facts but failed to do so, they cannot later deny a claim based on those facts.

In conclusion, this case underscores the importance of the incontestability clause in protecting the rights of beneficiaries under life insurance policies. It also serves as a reminder to insurers to conduct thorough investigations within the prescribed period and to avoid denying claims based on unsubstantiated allegations of concealment or misrepresentation.

For inquiries regarding the application of this ruling to specific circumstances, please contact ASG Law through contact or via email at frontdesk@asglawpartners.com.

Disclaimer: This analysis is provided for informational purposes only and does not constitute legal advice. For specific legal guidance tailored to your situation, please consult with a qualified attorney.
Source: Sun Life of Canada (Philippines), Inc. vs. Ma. Daisy’s. Sibya, G.R. No. 211212, June 08, 2016