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    Philamcare Health Systems, Inc. v. Court of Appeals

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    wuplawschool
    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions. The Supreme Court ruled that (1) Ernani's health coverage agreement was a non-life insurance contract covered by insurance law, and (2) there was no concealment by Ernani in completing his application in good faith as a non-medical professional. The Court also noted that (3) Philamcare did not take steps to void the agreement before the suit was filed. Philamcare was ordered to reimburse Julita Trinos for the hospital expenses she paid.

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    Philamcare Health Systems, Inc. v. Court of Appeals

    Uploaded by

    wuplawschool
    73 views1 page
    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions. The Supreme Court ruled that (1) Ernani's health coverage agreement was a non-life insurance contract covered by insurance law, and (2) there was no concealment by Ernani in completing his application in good faith as a non-medical professional. The Court also noted that (3) Philamcare did not take steps to void the agreement before the suit was filed. Philamcare was ordered to reimburse Julita Trinos for the hospital expenses she paid.

    Original Title

    140. Philamcare Health Systems, Inc. v. Court of Appeals

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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. The Supreme Court ruled that (1) Ernani's health coverage agreement was a non-life insurance contract covered by insurance law, and (2) there was no concealment by Ernani in completing his application in good faith as a non-medical professional. The Court also noted that (3) Philamcare did not take steps to void the agreement before the suit was filed. Philamcare was ordered to reimburse Julita Trinos for the hospital expenses she paid.

    Copyright:

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

    Philamcare Health Systems, Inc. v. Court of Appeals

    Uploaded by

    wuplawschool
    Philamcare refused to pay Ernani Trinos' hospitalization costs after he suffered a heart attack, claiming he failed to disclose pre-existing medical conditions. The Supreme Court ruled that (1) Ernani's health coverage agreement was a non-life insurance contract covered by insurance law, and (2) there was no concealment by Ernani in completing his application in good faith as a non-medical professional. The Court also noted that (3) Philamcare did not take steps to void the agreement before the suit was filed. Philamcare was ordered to reimburse Julita Trinos for the hospital expenses she paid.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Philamcare Health Systems, Inc. v.

    Court of Appeals
    G.R. No. 125678, 18 March 2002, 379 SCRA 356
    YNARES-SANTIAGO, J
    FACTS:
    In 1988, Ernani Trinos applied for a health care insurance under the Philamcare
    Health Systems, Inc. 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 the latter 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 (health care 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.

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