Casualty insurance notes
Content
CASUALTY INSURANCE
Sec. 176. Casualty insurance is insurance
covering loss or liability arising from accident or
mishap, excluding certain types of loss which by
law or custom are considered as falling
exclusively within the scope of other types of
insurance such as fire and marine. It includes,
but is not limited to, employer’s liability insurance,
motor vehicle liability insurance, burglary and
theft insurance, personal accident and health
insurance as written by non-life insurance
companies, and other substantially similar kinds
of insurance.
Casualty Insurance defined.
Casualty Insurance includes all forms of
insurance covering LOSS or LIABILITY arising
from ACCIDENT or MISHAP, excluding those
falling under other types of insurance such as fire
or marine.
Coverage of Casualty Insurance
employer’s liability insurance
workmen’s compensation insurance
motor vehicle liability insurance
Claimants/victims may be a “passenger” or a “3 rd
party”
It applies to all vehicles whether public and
private vehicles.
Passenger – Any fare-paying person being
transported and conveyed in and by a motor
vehicle for transportation of passengers for
compensation, including persons expressly
authorized by law or by the vehicle’s operator or
his agents to ride without fare. (Sec. 373[b])
Third Party – Any person other than the
passenger, excluding a member of the household
or a member of the family within the second
degree of consanguinity or affinity, of a motor
vehicle owner or land transportation operator, or
his employee in respect of death or bodily injury
arising out of and in the course of employment.
(Sec. 373[c])
“No-Fault” Clause
A clause that allows the victim (injured person or
heirs of the deceased) to an option to file a claim
for death or injury without the necessity of
proving fault or negligence of any kind.
Purpose: To guarantee compensation or indemnity to
injured persons in motor vehicle accidents.
burglary and theft insurance
personal accident and health insurance
as written by non-life insurance
companies
plate glass insurance
The essence of the no-fault indemnity insurance
is to provide victims of vehicular accidents or
their heirs immediate compensation although in
limited amount, pending final determination of
who is responsible for the accident and liable for
the victims injuries or death. (Ibid.)
public liability insurance
Compulsory Motor Vehicle Liability INSURANCE
(CMVLI)
Note: It is the only compulsory insurance coverage under
the Insurance Code.
A species of compulsory insurance that provides
for protection coverage that will answer for legal
liability for losses and damages for bodily injuries
or property damage that may be sustained by
another arising from the use and operation of
motor vehicle by its owner.
Purpose of CMVLI
To give immediate financial assistance to victims
of motor vehicle accidents and/or their
dependents, especially if they are poor
regardless of the financial capability of motor
vehicle owners or operators responsible for the
accident sustained (Shafer v. Judge, RTC, 167
SCRA 386).
What shall govern the others?
The general provisions applicable to all types of
insurance, and outside of such statutory provisions, the
rights and obligations of the parties must be determined
by their contract, taking into consideration its purpose and
always in accordance with the general principles of
insurance law.
General divisions of Casualty Insurance
1. Insurance against specified perils which may
affect the person and/or property of the insured.
2. Insurance against specified perils which may
give rise to liability on the part of the insured for
claims for injuries to or damage to property of
others.
Person or
property of the
insured
Two divisions distinguished.
1. Insurable The insured has
Interest
interest
in his
A third
party
life (Sec.
10)
has no cause
and of
onaction
his
property
(Sec.
against
the
13) insurer.
2. When
payable?
Third party
liability
The insured has
interest
in the
A third
party
safety
of
persons
can directly sue
whothe
may
insurer.
maintain, or in the
freedom from
damage of
property which
may become the
basis of suits
against him in
case of their injury
or destruction
Action against
the insurer lie
only when there
is an actual loss
sustained by the
insured
Attaches when the
liability of the
insured to the
injured third party
attaches,
regardless of
actual loss at that
time.
4. Basis of
Insurer’s
liability
Based on
contract
Based on contract
5. Extent of
Insurer’s
Liability
Extent of Policy
Extent of Policy
3. Right of a
third party
injured to sue
the insurer
Effect of “no action” clause
It is requirement in a policy of liability insurance
which provides that suit and final judgment be
first obtained against the insured; that only
“thereafter” can the person injured recover on the
policy. (Guingon vs. Del Monte, 20 SCRA 1043)
Which procedure to follow
The “no action” clause is in conflict with Sec. 5
Rule 2 of the Rules of Court on “Joinder of
causes of actions” and Sec. 5 of Rule 3 on
“permissive joinder of causes of parties.
It cannot prevail over the Rules of Court
provisions aimed at avoiding multiplicity of suits.
Accident and Health Insurance
ACCIDENT INSURANCE
Reimburses the insured for pecuniary
loss suffered as a result of injuries
sustained in an accident.
HEALTH INSURANCE
Reimburses the insured for pecuniary
loss out of disease-related illness.
“INTENTIONAL” vs. “ACCIDENTAL” AS USED
IN INSURANCE POLICIES
1. Intentional – Implies the exercise of the
reasoning faculties, consciousness and
volition. Where a provision of the policy
excludes intentional injury, it is the intention
of the person inflicting the injury that is
controlling. If the injuries suffered by the
insured clearly resulted from the intentional
act of the third person, the insurer is relieve
from liability as stipulated. (Biagtan v. the
Insular Life Assurance Co. Ltd., 44 SCRA 58,
1972)
2. Accidental – That which happens by chance or
fortuitously, without intention or design, which is
unexpected, unusual and unforeseen.
Rule as to Death or Injury resulting from Accident
General Rule:
Death or injury does not result from accident if it is the
natural result of the insured’s voluntary act,
unaccompanied by anything unforeseen except the death
or injury.
Exception:
Where the death or injury is not the natural result
of the insured’s voluntary act, or if something
unforeseen occurs in the doing of the act which
produces the injury, the resulting death is within
the protection of the insurance policy.
Sec. 176. Casualty insurance is insurance
covering loss or liability arising from accident or
mishap, excluding certain types of loss which by
law or custom are considered as falling
exclusively within the scope of other types of
insurance such as fire and marine. It includes,
but is not limited to, employer’s liability insurance,
motor vehicle liability insurance, burglary and
theft insurance, personal accident and health
insurance as written by non-life insurance
companies, and other substantially similar kinds
of insurance.
Casualty Insurance defined.
Casualty Insurance includes all forms of
insurance covering LOSS or LIABILITY arising
from ACCIDENT or MISHAP, excluding those
falling under other types of insurance such as fire
or marine.
Coverage of Casualty Insurance
employer’s liability insurance
workmen’s compensation insurance
motor vehicle liability insurance
Claimants/victims may be a “passenger” or a “3 rd
party”
It applies to all vehicles whether public and
private vehicles.
Passenger – Any fare-paying person being
transported and conveyed in and by a motor
vehicle for transportation of passengers for
compensation, including persons expressly
authorized by law or by the vehicle’s operator or
his agents to ride without fare. (Sec. 373[b])
Third Party – Any person other than the
passenger, excluding a member of the household
or a member of the family within the second
degree of consanguinity or affinity, of a motor
vehicle owner or land transportation operator, or
his employee in respect of death or bodily injury
arising out of and in the course of employment.
(Sec. 373[c])
“No-Fault” Clause
A clause that allows the victim (injured person or
heirs of the deceased) to an option to file a claim
for death or injury without the necessity of
proving fault or negligence of any kind.
Purpose: To guarantee compensation or indemnity to
injured persons in motor vehicle accidents.
burglary and theft insurance
personal accident and health insurance
as written by non-life insurance
companies
plate glass insurance
The essence of the no-fault indemnity insurance
is to provide victims of vehicular accidents or
their heirs immediate compensation although in
limited amount, pending final determination of
who is responsible for the accident and liable for
the victims injuries or death. (Ibid.)
public liability insurance
Compulsory Motor Vehicle Liability INSURANCE
(CMVLI)
Note: It is the only compulsory insurance coverage under
the Insurance Code.
A species of compulsory insurance that provides
for protection coverage that will answer for legal
liability for losses and damages for bodily injuries
or property damage that may be sustained by
another arising from the use and operation of
motor vehicle by its owner.
Purpose of CMVLI
To give immediate financial assistance to victims
of motor vehicle accidents and/or their
dependents, especially if they are poor
regardless of the financial capability of motor
vehicle owners or operators responsible for the
accident sustained (Shafer v. Judge, RTC, 167
SCRA 386).
What shall govern the others?
The general provisions applicable to all types of
insurance, and outside of such statutory provisions, the
rights and obligations of the parties must be determined
by their contract, taking into consideration its purpose and
always in accordance with the general principles of
insurance law.
General divisions of Casualty Insurance
1. Insurance against specified perils which may
affect the person and/or property of the insured.
2. Insurance against specified perils which may
give rise to liability on the part of the insured for
claims for injuries to or damage to property of
others.
Person or
property of the
insured
Two divisions distinguished.
1. Insurable The insured has
Interest
interest
in his
A third
party
life (Sec.
10)
has no cause
and of
onaction
his
property
(Sec.
against
the
13) insurer.
2. When
payable?
Third party
liability
The insured has
interest
in the
A third
party
safety
of
persons
can directly sue
whothe
may
insurer.
maintain, or in the
freedom from
damage of
property which
may become the
basis of suits
against him in
case of their injury
or destruction
Action against
the insurer lie
only when there
is an actual loss
sustained by the
insured
Attaches when the
liability of the
insured to the
injured third party
attaches,
regardless of
actual loss at that
time.
4. Basis of
Insurer’s
liability
Based on
contract
Based on contract
5. Extent of
Insurer’s
Liability
Extent of Policy
Extent of Policy
3. Right of a
third party
injured to sue
the insurer
Effect of “no action” clause
It is requirement in a policy of liability insurance
which provides that suit and final judgment be
first obtained against the insured; that only
“thereafter” can the person injured recover on the
policy. (Guingon vs. Del Monte, 20 SCRA 1043)
Which procedure to follow
The “no action” clause is in conflict with Sec. 5
Rule 2 of the Rules of Court on “Joinder of
causes of actions” and Sec. 5 of Rule 3 on
“permissive joinder of causes of parties.
It cannot prevail over the Rules of Court
provisions aimed at avoiding multiplicity of suits.
Accident and Health Insurance
ACCIDENT INSURANCE
Reimburses the insured for pecuniary
loss suffered as a result of injuries
sustained in an accident.
HEALTH INSURANCE
Reimburses the insured for pecuniary
loss out of disease-related illness.
“INTENTIONAL” vs. “ACCIDENTAL” AS USED
IN INSURANCE POLICIES
1. Intentional – Implies the exercise of the
reasoning faculties, consciousness and
volition. Where a provision of the policy
excludes intentional injury, it is the intention
of the person inflicting the injury that is
controlling. If the injuries suffered by the
insured clearly resulted from the intentional
act of the third person, the insurer is relieve
from liability as stipulated. (Biagtan v. the
Insular Life Assurance Co. Ltd., 44 SCRA 58,
1972)
2. Accidental – That which happens by chance or
fortuitously, without intention or design, which is
unexpected, unusual and unforeseen.
Rule as to Death or Injury resulting from Accident
General Rule:
Death or injury does not result from accident if it is the
natural result of the insured’s voluntary act,
unaccompanied by anything unforeseen except the death
or injury.
Exception:
Where the death or injury is not the natural result
of the insured’s voluntary act, or if something
unforeseen occurs in the doing of the act which
produces the injury, the resulting death is within
the protection of the insurance policy.
