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    Philamcare V CA

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    Oscar E Valero
    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions when applying for health insurance. Ernani's wife Julita sued Philamcare for damages. The court ruled that Ernani's health coverage agreement was a non-life insurance contract according to insurance law. The court also found that Ernani answered the medical questions in good faith without intent to conceal, as he was not a medical expert. For a policy to be voided due to concealment, the insurer must notify the insured, which Philamcare failed to do. Therefore, Philamcare was obligated to pay Ernani's hospital expenses

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    Philamcare V CA

    Uploaded by

    Oscar E Valero
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    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions when applying for health insurance. Ernani's wife Julita sued Philamcare for damages. The court ruled that Ernani's health coverage agreement was a non-life insurance contract according to insurance law. The court also found that Ernani answered the medical questions in good faith without intent to conceal, as he was not a medical expert. For a policy to be voided due to concealment, the insurer must notify the insured, which Philamcare failed to do. Therefore, Philamcare was obligated to pay Ernani's hospital expenses

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    case digest

    Original Title

    15. Philamcare v CA

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    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions when applying for health insurance. Ernani's wife Julita sued Philamcare for damages. The court ruled that Ernani's health coverage agreement was a non-life insurance contract according to insurance law. The court also found that Ernani answered the medical questions in good faith without intent to conceal, as he was not a medical expert. For a policy to be voided due to concealment, the insurer must notify the insured, which Philamcare failed to do. Therefore, Philamcare was obligated to pay Ernani's hospital expenses

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    52 views1 page

    Philamcare V CA

    Uploaded by

    Oscar E Valero
    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions when applying for health insurance. Ernani's wife Julita sued Philamcare for damages. The court ruled that Ernani's health coverage agreement was a non-life insurance contract according to insurance law. The court also found that Ernani answered the medical questions in good faith without intent to conceal, as he was not a medical expert. For a policy to be voided due to concealment, the insurer must notify the insured, which Philamcare failed to do. Therefore, Philamcare was obligated to pay Ernani's hospital expenses

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    of 1

    No.

    15 Construction of Insurance Contract by Valero OE



    Philamcare v CA (G.R. No. 125678. March 18, 2002)
    Facts: In 1988, E rnani Trinos applied for a health care insurance under the Philamcare Health
    Systems. He was asked if he was ever treated for high blood, heart trouble, diabetes, cancer, liver
    disease, asthma, or peptic ulcer; he answered no. His application was approved and it was effective for
    one year. His coverage was subsequently renewed twice for one year each. While the coverage was
    still in force in 1990, Ernani suffered a heart attack for which he was hospitalized. The cost of the
    hospitalization amounted to P76,000.00. Julita Trinos, wife of Ernani, filed a claim before Philamcare
    for them to pay the hospitalization cost. Philamcare refused to pay as it alleged that Ernani failed to
    disclose the fact that he was diabetic, hypertensive, and asthmatic. Julita ended up paying the hospital
    expenses. Ernani eventually died. In July 1990, Julita sued Philamcare for damages. Philamcare
    alleged that the health coverage is not an insurance contract; that the concealment made by Ernani
    voided the agreement.
    ISSUE: Whether or not Philamcare can avoid the health coverage agreement.
    HELD: No. The health coverage agreement entered upon by Ernani with Philamcare is a non-life
    insurance contract and is covered by the Insurance Law. It is primarily a contract of indemnity. Once
    the member incurs hospital, medical or any other expense arising from sickness, injury or other
    stipulated contingent, the health care provider must pay for the same to the extent agreed upon under
    the contract. There is no concealment on the part of Ernani. He answered the question with good faith.
    He was not a medical doctor hence his statement in answering the question asked of him when he was
    applying is an opinion rather than a fact. Answers made in good faith will not void the policy.
    Further, Philamcare, in believing there was concealment, should have taken the necessary steps to void
    the health coverage agreement prior to the filing of the suit by Julita. Philamcare never gave notice to
    Julita of the fact that they are voiding the agreement. Therefore, Philamcare should pay the expenses
    paid by Julita.m

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