MITSUBISHI MOTORS PHILIPPINES SALARIED EMPLOYEES UNION (MMPSEU)

VS. MITSUBISHI MOTORS PHILIPPINES CORPORATION

G.R. No. 175773
JUNE 17, 2013
Facts:
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 restriction.
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
as the other portion has been paid from other health insurances of their dependents.
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.

Issue:
Whether or not the claims of reimbursement of MMPSEU should be granted by the
MMPC?

Held:
The collateral source rule is designed to strike a balance between two competing
principles of tort law: (1) a plaintiff is entitled to compensation sufficient to make him whole, but
no more; and (2) a defendant is liable for all damages that proximately result from his wrong. Its
application is justified so that "'the wrongdoer should not benefit 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." Thus, it finds no application to cases involving no-fault
insurances under which the insured is indemnified for losses by insurance companies, regardless
of who was at fault in the incident generating the losses. 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.
It follows that MMPCs liability is limited, that is, it does not include the amounts paid
by other health insurance providers. To allow reimbursement of amounts paid under other
insurance policies shall constitute double recovery which is not sanctioned by law.
Consequently, the covered employees will not receive more than what is due them; neither is
MMPC under any obligation to give more than what is due under the CBA. Moreover, since the
subject CBA provision is an insurance contract, the rights and obligations of the parties must be
determined in accordance with the general principles of insurance law. Being in the nature of a
non-life insurance contract and essentially a contract of indemnity, the CBA provision obligates
MMPC to indemnify the covered employees medical expenses incurred by their dependents but
only up to the extent of the expenses actually incurred. This is consistent with the principle of
indemnity which proscribes the insured from recovering greater than the loss. Indeed, to profit
from a loss will lead to unjust enrichment and therefore should not be countenanced. To grant
the claims of MMPSEU will permit possible abuse by employees. Petition is DENIED.
MALAYAN INSURANCE COMPANY, INC V. PAP co., Ltd. (Philippine Branch)
G.R. No. 200784
AUGUST 27, 2013

Facts:
On May 13, 1996, Malayan Insurance Company (Malayan) issued Fire Insurance Policy
for the latters machineries and equipment located at Sanyo Precision Phils. Bldg., Phase III, Lot
4, Block 15, PEZA, Rosario, Cavite (Sanyo Building).
The insurance, which was for 15,000,000.00 and effective for a period of one (1) year,
was procured by PAP Co. for Rizal Commercial Banking Corporation (RCBC), the mortgagee
of the insured machineries and equipment.
After the passage of almost a year but prior to the expiration of the insurance coverage,
PAP Co. renewed the policy on an as is basis.
On October 12, 1997 and during the subsistence of the renewal policy, the insured
machineries and equipment were totally lost by fire. Hence, PAP Co. filed a fire insurance claim
with Malayan in the amount insured.
Malayan denied the claim upon the ground that, at the time of the loss, the insured
machineries and equipment were transferred by PAP Co. to a location different from that
indicated in the policy.

Issue:
Whether or not Malayan is liable for the loss of the insured properties of PAP Co. under
the fire insurance policy?

Held:
It can be said that with the transfer of the location of the subject properties, without
notice and without Malayans consent, after the renewal of the policy, PAP clearly committed
concealment, misrepresentation and a breach of a material warranty. Section 26 of the Insurance
Code provides:
Section 26. A neglect to communicate that which a party knows and ought to
communicate, is called a concealment.
Under Section 27 of the Insurance Code, a concealment entitles the injured party to
rescind a contract of insurance.
Accordingly, an insurer can exercise its right to rescind an insurance contract when the
following conditions are present, to wit:
1) The policy limits the use or condition of the thing insured;
2) There is an alteration in said use or condition;
3) The alteration is without the consent of the insurer;
4) The alteration is made by means within the insured's control; and
5) The alteration increases the risk of loss.
In the case at bench, all these circumstances are present. It was clearly established that
the renewal policy stipulated that the insured properties were located at the Sanyo factory; that
PAP removed the properties without the consent of Malayan; and that the alteration of the
location increased the risk of loss. Thus, petitioner Malayan Insurance Company, Inc. is hereby
declared NOT liable for the loss of the insured machineries and equipment suffered by PAP Co.,
Ltd.
FORTUNE MEDICARE, Inc. V. AMORIN
G.R. No. 195872
MARCH 12, 2014

Facts:
David Robert U. Amorin (Amorin) was a cardholder/member of Fortune Medicare, Inc.
(Fortune Care), a corporation engaged in providing health maintenance services to its members.
While on vacation in Honolulu, Hawaii, United States of America (U.S.A.) Amorin
underwent an emergency surgery, specifically appendectomy, causing him to incur professional
and hospitalization expenses of US$7,242.35 and US$1,777.79, respectively.
He attempted to recover from Fortune Care the full amount thereof upon his return to
Manila, but the company merely approved a reimbursement of P12, 151.36, an amount that was
based on the average cost of appendectomy, if the procedure were performed in an accredited
hospital in Metro Manila.
Amorin asked for the total amount of professional fees which he had paid, and eighty
percent (80%) of the approved standard charges based on American standard.
Fortune Care denied Amorins request.

Issue:
Whether or not the American Standard Cost shall be applied in the payment of medical
and hospitalization expenses and professional fees incurred by Amorin?

Held:
In the instant case, the extent of Fortune Cares liability to Amorin under the attendant
circumstances was governed by Section 3(B), Article V of the subject Health Care Contract. The
Court restates the pertinent portions of Section 3(B):
B. EMERGENCY CARE IN NON-ACCREDITED HOSPITAL
1. Whether as an in-patient or out-patient, FortuneCare shall reimburse the total
hospitalization cost including the professional fee (based on the total approved
charges) to a member who receives emergency care in a non-accredited hospital.
The above coverage applies only to Emergency confinement within Philippine
Territory. However, if the emergency confinement occurs in foreign territory,
Fortune Care will be obligated to reimburse or pay eighty (80%) percent of the
approved standard charges which shall cover the hospitalization costs and
professional fees. x x x
The point of dispute now concerns the proper interpretation of the phrase approved
standard charges. This must be interpreted in its literal sense, guided by the rule that any
ambiguity shall be strictly construed against Fortune Care, and liberally in favor of Amorin.
Settled is the rule that ambiguities in a contract are interpreted against the party that caused the
ambiguity. Any ambiguity in a contract whose terms are susceptible of different interpretations
must be read against the party who drafted it.
Fortune Cares liability to Amorin under the subject Health Care Contract should be
based on the expenses for hospital and professional fees which he actually incurred, and should
not be limited by the amount that he would have incurred had his emergency treatment been
performed in an accredited hospital in the Philippines. The petition is DENIED