Petitioner Vs Vs Respondent: Second Division
Petitioner Vs Vs Respondent: Second Division
Petitioner Vs Vs Respondent: Second Division
DECISION
DEL CASTILLO , J : p
The Collective Bargaining Agreement (CBA) of the parties in this case provides that the
company shoulder the hospitalization expenses of the dependents of covered employees
subject to certain limitations and restrictions. Accordingly, covered employees pay part of
the hospitalization insurance premium through monthly salary deduction while the
company, upon hospitalization of the covered employees' dependents, shall pay the
hospitalization expenses incurred for the same. The conflict arose when a portion of the
hospitalization expenses of the covered employees' dependents were paid/shouldered by
the dependent's own health insurance. While the company refused to pay the portion of the
hospital expenses already shouldered by the dependents' own health insurance, the union
insists that the covered employees are entitled to the whole and undiminished amount of
said hospital expenses.
By this Petition for Review on Certiorari, 1 petitioner Mitsubishi Motors Philippines Salaried
Employees Union (MMPSEU) assails the March 31, 2006 Decision 2 and December 5, 2006
Resolution 3 of the Court of Appeals (CA) in CA-G.R. SP No. 75630, which reversed and set
aside the Voluntary Arbitrator's December 3, 2002 Decision 4 and declared respondent
Mitsubishi Motors Philippines Corporation (MMPC) to be under no legal obligation to pay
its covered employees' dependents' hospitalization expenses which were already
shouldered by other health insurance companies.
Factual Antecedents
The parties' CBA 5 covering the period August 1, 1996 to July 31, 1999 provides for the
hospitalization insurance benefits for the covered dependents, thus:
SECTION 4.DEPENDENTS' GROUP HOSPITALIZATION INSURANCE . — The
COMPANY shall obtain group hospitalization insurance coverage or assume
under a self-insurance basis hospitalization for the dependents of regular
employees up to a maximum amount of forty thousand pesos (P40,000.00) per
confinement subject to the following: DEICTS
a. The room and board must not exceed three hundred pesos
(P300.00) per day up to a maximum of thirty-one (31) days.
Similarly, Doctor's Call fees must not exceed three hundred pesos
(P300.00) per day for a maximum of thirty-one (31) days. Any
excess of this amount shall be borne by the employee.
For purposes of this provision, eligible dependents are the covered employees'
natural parents, legal spouse and legitimate or legally adopted or step children
who are unmarried, unemployed who have not attained twenty-one (21) years of
age and wholly dependent upon the employee for support. CcSEIH
This provision applies only in cases of actual confinement in the hospital for at
least six (6) hours.
Maternity cases are not covered by this section but will be under the next
succeeding section on maternity benefits. 6
When the CBA expired on July 31, 1999, the parties executed another CBA 7 effective
August 1, 1999 to July 31, 2002 incorporating the same provisions on dependents'
hospitalization insurance benefits but in the increased amount of P50,000.00. The room
and board expenses, as well as the doctor's call fees, were also increased to P375.00.
On separate occasions, three members of MMPSEU, namely, Ernesto Calida (Calida),
Hermie Juan Oabel (Oabel) and Jocelyn Martin (Martin), filed claims for reimbursement of
hospitalization expenses of their dependents.
MMPC paid only a portion of their hospitalization insurance claims, not the full amount. In
the case of Calida, his wife, Lanie, was con ned at Sto. Tomas University Hospital from
September 4 to 9, 1998 due to Thyroidectomy. The medical expenses incurred totalled
P29,967.10. Of this amount, P9,000.00 representing professional fees was paid by
MEDICard Philippines, Inc. (MEDICard) which provides health maintenance to Lanie. 8
MMPC only paid P12,148.63. 9 It did not pay the P9,000.00 already paid by MEDICard and
the P6,278.47 not covered by of cial receipts. It refused to give to Calida the difference
between the amount of medical expenses of P27,427.10 1 0 which he claimed to be
entitled to under the CBA and the P12,148.63 which MMPC directly paid to the hospital.
As regards Oabel's claim, his wife Jovita Nemia (Jovita) was con ned at The Medical City
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from March 8 to 11, 1999 due to Tonsillopharyngitis, incurring medical expenses totalling
P8,489.35. 1 1 Of this amount, P7,811.00 was paid by Jovita's personal health insurance,
Prosper Insurance Company (Prosper). 1 2 MMPC paid the hospital the amount of P630.87,
1 3 after deducting from the total medical expenses the amount paid by Prosper and the
P47.48 discount given by the hospital.
In the case of Martin, his father, Jose, was admitted at The Medical City from March 26 to
27, 2000 due to Acid Peptic Disease and incurred medical expenses amounting to
P9,101.30. 1 4 MEDICard paid P8,496.00. 1 5 Consequently, MMPC only paid P288.40, 1 6
after deducting from the total medical expenses the amount paid by MEDICard and the
P316.90 discount given by the hospital.
Claiming that under the CBA, they are entitled to hospital bene ts amounting to
P27,427.10, P6,769.35 and P8,123.80, respectively, which should not be reduced by the
amounts paid by MEDICard and by Prosper, Calida, Oabel and Martin asked for
reimbursement from MMPC. However, MMPC denied the claims contending that double
insurance would result if the said employees would receive from the company the full
amount of hospitalization expenses despite having already received payment of portions
thereof from other health insurance providers.THaDEA
This prompted the MMPSEU President to write the MMPC President 1 7 demanding full
payment of the hospitalization bene ts. Alleging discrimination against MMPSEU union
members, she pointed out that full reimbursement was given in a similar claim led by
Luisito Cruz (Cruz), a member of the Hourly Union. In a letter-reply, 1 8 MMPC, through its
Vice-President for Industrial Relations Division, clari ed that the claims of the said
MMPSEU members have already been paid on the basis of of cial receipts submitted. It
also denied the charge of discrimination and explained that the case of Cruz involved an
entirely different matter since it concerned the admissibility of certi ed true copies of
documents for reimbursement purposes, which case had been settled through voluntary
arbitration.
On August 28, 2000, MMPSEU referred the dispute to the National Conciliation and
Mediation Board and requested for preventive mediation. 1 9
Proceedings before the Voluntary Arbitrator
On October 3, 2000, the case was referred to Voluntary Arbitrator Rolando Capocyan for
resolution of the issue involving the interpretation of the subject CBA provision. 2 0
MMPSEU alleged that there is nothing in the CBA which prohibits an employee from
obtaining other insurance or declares that medical expenses can be reimbursed only upon
presentation of original of cial receipts. It stressed that the hospitalization bene ts
should be computed based on the formula indicated in the CBA without deducting the
bene ts derived from other insurance providers. Besides, if reduction is permitted, MMPC
would be unjustly bene tted from the monthly premium contributed by the employees
through salary deduction. MMPSEU added that its members had legitimate claims under
the CBA and that any doubt as to any of its provisions should be resolved in favor of its
members. Moreover, any ambiguity should be resolved in favor of labor. 2 1
On the other hand, MMPC argued that the reimbursement of the entire amounts being
claimed by the covered employees, including those already paid by other insurance
companies, would constitute double indemnity or double insurance, which is
circumscribed under the Insurance Code. Moreover, a contract of insurance is a contract
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of indemnity and the employees cannot be allowed to pro t from their dependents' loss.
22 SCaEcD
Meanwhile, the parties separately sought for a legal opinion from the Insurance
Commission relative to the issue at hand. In its letter 2 3 to the Insurance Commission,
MMPC requested for confirmation of its position that the covered employees cannot claim
insurance benefits for a loss that had already been covered or paid by another insurance
company. However, the Office of the Insurance Commission opted not to render an
opinion on the matter as the same may become the subject of a formal complaint before
it. 2 4 On the other hand, when queried by MMPSEU, 2 5 the Insurance Commission, through
Atty. Richard David C. Funk II (Atty. Funk) of the Claims Adjudication Division, rendered an
opinion contained in a letter, 2 6 viz.:
January 8, 2002
Ms. Cecilia L. Paras
President
Madam:
We acknowledge receipt of your letter which, to our impression, basically poses
the question of whether or not recovery of medical expenses from a Health
Maintenance Organization bars recovery of the same reimbursable amount of
medical expenses under a contract of health or medical insurance.
On December 3, 2002, the Voluntary Arbitrator rendered a Decision 2 7 nding MMPC liable
to pay or reimburse the amount of hospitalization expenses already paid by other health
insurance companies. The Voluntary Arbitrator held that the employees may demand
simultaneous payment from both the CBA and their dependents' separate health insurance
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without resulting to double insurance, since separate premiums were paid for each
contract. He also noted that the CBA does not prohibit reimbursement in case there are
other health insurers.
Proceedings before the Court of Appeals
MMPC led a Petition for Review with Prayer for the Issuance of a Temporary Restraining
Order and/or Writ of Preliminary Injunction 2 8 before the CA. It claimed that the Voluntary
Arbitrator committed grave abuse of discretion in not nding that recovery under both
insurance policies constitutes double insurance as both had the same subject matter,
interest insured and risk or peril insured against; in relying solely on the unauthorized legal
opinion of Atty. Funk; and in not nding that the employees will be bene tted twice for the
same loss. In its Comment, 2 9 MMPSEU countered that MMPC will unjustly enrich itself
and profit from the monthly premiums paid if full reimbursement is not made.
On March 31, 2006, the CA found merit in MMPC's Petition. It ruled that despite the lack of
a provision which bars recovery in case of payment by other insurers, the wordings of the
subject provision of the CBA showed that the parties intended to make MMPC liable only
for expenses actually incurred by an employee's quali ed dependent. In particular, the
provision stipulates that payment should be made directly to the hospital and that the
claim should be supported by actual hospital and doctor's bills. These mean that the
employees shall only be paid amounts not covered by other health insurance and is more
in keeping with the principle of indemnity in insurance contracts. Besides, a contrary
interpretation would "allow unscrupulous employees to unduly pro t from the . . . bene ts"
and shall "open the floodgates to questionable claims . . . ." 3 0 ICDcEA
In its Motion for Reconsideration, 3 3 MMPSEU pointed out that the alleged oppression that
may be committed by abusive employees is a mere possibility whereas the resulting
losses to the employees are real. MMPSEU cited Samsel v. Allstate Insurance Co. , 3 4
wherein the Arizona Supreme Court explicitly ruled that an insured may recover from
separate health insurance providers, regardless of whether one of them has already paid
the medical expenses incurred. On the other hand, MMPC argued in its Comment 3 5 that
the cited foreign case involves a different set of facts.
The CA, in its Resolution 3 6 dated December 5, 2006, denied MMPSEU's motion.
Hence, this Petition.
Issues
MMPSEU presented the following grounds in support of its Petition:
A.
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THE COURT OF APPEALS SERIOUSLY ERRED WHEN IT REVERSED THE
DECISION DATED 03 [DECEMBER] 2002 OF THE VOLUNTARY ARBITRATOR
BELOW WHEN THE SAME WAS SUPPORTED BY SUBSTANTIAL EVIDENCE,
INCLUDING THE OPINION OF THE INSURANCE COMMISSION THAT RECOVERY
FROM BOTH THE CBA AND SEPARATE HEALTH CARDS IS NOT PROHIBITED IN
THE ABSENCE OF ANY SPECIFIC PROVISION IN THE CBA.IScaAE
B.
THE COURT OF APPEALS COMMITTED REVERSIBLE ERROR IN OVERTURNING
THE DECISION OF THE VOLUNTARY ARBITRATOR WITHOUT EVEN GIVING ANY
LEGAL OR JUSTIFIABLE BASIS FOR SUCH REVERSAL.
C.
THE COURT OF APPEALS COMMITTED GRAVE ERROR IN REFUSING TO
CONSIDER OR EVEN MENTION ANYTHING ABOUT THE AMERICAN
AUTHORITIES CITED IN THE RECORDS THAT DO NOT PROHIBIT, BUT IN FACT
ALLOW, RECOVERY FROM TWO SEPARATE HEALTH PLANS.
D.
THE COURT OF APPEALS GRAVELY ERRED IN GIVING MORE IMPORTANCE TO
A POSSIBLE, HENCE MERELY SPECULATIVE, ABUSE BY EMPLOYEES OF THE
BENEFITS IF DOUBLE RECOVERY WERE ALLOWED INSTEAD OF THE REAL
INJURY TO THE EMPLOYEES WHO ARE PAYING FOR THE CBA
HOSPITALIZATION BENEFITS THROUGH MONTHLY SALARY DEDUCTIONS
BUT WHO MAY NOT BE ABLE TO AVAIL OF THE SAME IF THEY OR THEIR
DEPENDENTS HAVE OTHER HEALTH INSURANCE. 3 7
MMPSEU avers that the Decision of the Voluntary Arbitrator deserves utmost respect and
nality because it is supported by substantial evidence and is in accordance with the
opinion rendered by the Insurance Commission, an agency equipped with vast knowledge
concerning insurance contracts. It maintains that under the CBA, member-employees are
entitled to full reimbursement of medical expenses incurred by their dependents
regardless of any amounts paid by the latter's health insurance provider. Otherwise, non-
recovery will constitute unjust enrichment on the part of MMPC. It avers that recovery from
both the CBA and other insurance companies is allowed under their CBA and not
prohibited by law nor by jurisprudence.
Our Ruling
The Petition has no merit.
Atty. Funk erred in applying the
collateral source rule.
The Voluntary Arbitrator based his ruling on the opinion of Atty. Funk that the employees
may recover benefits from different insurance providers without regard to the amount of
benefits paid by each. According to him, this view is consistent with the theory of the
collateral source rule. CAaDSI
As part of American personal injury law, the collateral source rule was originally applied to
tort cases wherein the defendant is prevented from bene tting from the plaintiff's receipt
of money from other sources. 3 8 Under this rule, if an injured person receives
compensation for his injuries from a source wholly independent of the tortfeasor, the
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payment should not be deducted from the damages which he would otherwise collect
from the tortfeasor. 3 9 In a recent Decision 4 0 by the Illinois Supreme Court, the rule has
been described as "an established exception to the general rule that damages in
negligence actions must be compensatory." The Court went on to explain that although the
rule appears to allow a double recovery, the collateral source will have a lien or subrogation
right to prevent such a double recovery. 4 1 In Mitchell v. Haldar, 4 2 the collateral source rule
was rationalized by the Supreme Court of Delaware:
The collateral source rule is 'predicated on the theory that a tortfeasor has no
interest in, and therefore no right to bene t from monies received by the injured
person from sources unconnected with the defendant'. According to the collateral
source rule, 'a tortfeasor has no right to any mitigation of damages because of
payments or compensation received by the injured person from an independent
source.' The rationale for the collateral source rule is based upon the quasi-
punitive nature of tort law liability. It has been explained as follows:
The collateral source rule is designed to strike a balance between
two competing principles of tort law: (1) a plaintiff is entitled to
compensation suf cient to make him whole, but no more; and (2)
a defendant is liable for all damages that proximately result from
his wrong. A plaintiff who receives a double recovery for a single
tort enjoys a windfall; a defendant who escapes, in whole or in
part, liability for his wrong enjoys a windfall. Because the law
must sanction one windfall and deny the other, it favors the victim
of the wrong rather than the wrongdoer.
Thus, the tortfeasor is required to bear the cost for the full value of his or her
negligent conduct even if it results in a windfall for the innocent plaintiff.
(Citations omitted) cSDHEC
As seen, the collateral source rule applies in order to place the responsibility for losses on
the party causing them. 4 3 Its application is justi ed so that "the wrongdoer should not
bene t from the expenditures made by the injured party or take advantage of contracts or
other relations that may exist between the injured party and third persons." 4 4 Thus, it nds
no application to cases involving no-fault insurances under which the insured is
indemni ed for losses by insurance companies, regardless of who was at fault in the
incident generating the losses. 4 5 Here, it is clear that MMPC is a no-fault insurer. Hence, it
cannot be obliged to pay the hospitalization expenses of the dependents of its employees
which had already been paid by separate health insurance providers of said dependents.
The Voluntary Arbitrator therefore erred in adopting Atty. Funk's view that the covered
employees are entitled to full payment of the hospital expenses incurred by their
dependents, including the amounts already paid by other health insurance companies
based on the theory of collateral source rule. TcaAID
SO ORDERED .
Carpio, Brion, Perez and Perlas-Bernabe, JJ., concur.
Footnotes
2.CA rollo, pp. 215-223; penned by Associate Justice Edgardo P. Cruz and concurred in by
Associate Justices Rosalinda Asuncion-Vicente and Sesinando E. Villon.
3.Id. at 274.
4.Id. at 30-38; penned by Voluntary Arbitrator Atty. Rodolfo M. Capocyan.
5.Annex "A" of MMPC's Position Paper before the Voluntary Arbitrator, id. at 85-87.
6.Id. at 86-87.
7.Annex "B," id. at 88-90.
12.Id.
13.Annex "G," id. at 101-102.
14.Annex "H," id. at 103-107.
15.Annex "I," id. at 108.
23.Annex "L" of MMPC Petition for Review filed before the CA, id. at 64-65.
24.See October 24, 2000 letter of the Insurance Commission, Annex "M", id. at 66.
25.See November 14, 2001 letter of MMPSEU, id. at 182-185.
26.Annex "A" of MMPSEU Reply to MMPC's Position Paper before the Voluntary Arbitrator, id. at
143.
27.Id. at 30-38.
28.Id. at 2-29.
29.Id. at 170-181.
30.Id. at 222.
31.Id. at 215-223.
32.Id. at 223.
33.Id. at 229-244.
34.59 P.3d 281 (Ariz. 2002).
35.CA rollo, pp. 264-272.
36.Id. at 274.
37.Rollo, pp. 16-17.
50.University of the Philippines v. Philab Industries, Inc., 482 Phil. 693, 709 (2004).
51.Car Cool Phils., Inc. v. Ushio Realty & Development Corporation, 515 Phil. 376, 384 (2006).
52.Fortune Insurance and Surety, Inc. v. Court of Appeals, 314 Phil. 184, 196 (1995).
53.Philamcare Health Systems, Inc. v. Court of Appeals, 429 Phil. 82, 90 (2002).
54.The principle of indemnity in property insurance is based on Section 18 of the Insurance
Code which provides that no contract or policy of insurance on property shall be
enforceable except for the benefit of some person having an insurable interest in the
property insured.