J. Malcolm
Facts:
Bernardo Argente signed an application for joint insurance with his wife in the sum of P2,000. The wife, Vicenta de Ocampo, signed for the same. All the information contained in the applications was furnished the agent by Bernardo Argente.
Argente was examined by Dr. Sta. Ana, a medical examiner for the West Coast. The result was recorded in the Medical Examiner's Report, and with the exception of the signature of Bernardo Argente, was in the hand-writing of Doctor Sta. Ana. But the information or answers to the questions contained on the face of the Medical Examiner's Report were furnished the doctor by Argente.
Vicenta de Ocampo, wife of the plaintiff, was examined at her residence by the same doctor.
The spouses submitted to West Coast Life an amended application, increasing the amount to P15,000, and asked that the policy be dated May 15, 1925. The amended application was accompanied by the documents entitled "Short Form Medical Report." In both of these documents appear certain questions and answers.
A temporary policy for P15,000 was issued to Bernardo Argente and his wife as of May 15, but it was not delivered until the first quarterly premium on the policy was paid. More than thirty days had elapsed since the applicants were examined. Each of them was required to file a certificate of health before the policy was delivered.
Vicenta de Ocampo died of cerebral apoplexy. Argente presented a claim in due form to the West Coast Life Insurance Co. for the payment of the sum of P15,000. It was apparently disclosed that the answers given by the insured in their medical examinations with regard to their health were untrue. West Coastrefused to pay the claim and wrote Argente to the effect that the claim was rejected due to fraud.
The trial court held the policy null and void, hence this appeal.
Issue: WON Argente and Ocampo were guilty of concealment and thereby misled the insurer into accepting the risk?
Held: Yes. Petition dismissed.
Ratio:
Vicenta de Ocampo, in response to the question asked by the medical examiner, answered no to "Have you ever consulted a physician for or have you ever suffered from any ailment or disease of the brain or nervous system?" She also answered “none” as to the question whether she consumed alcohol of not.
To the question, "What physician or physicians, if any, not named above, have you consulted or been treated by, within the last five years and for what illness or ailment?" she answered "None."
But the facts show that she was taken to San Lazaro Hospital, her case was diagnosed by the admitting physician as "alcoholism”, moreover, she was diagnosed with "phycho-neurosis."
Section 25 of the Insurance Code defined concealment as "a neglect to communicate that which a party knows and ought to communicate."
The court held that the alleged concealment was not immaterial and insufficient to avoid the policy. In an action on a life insurance policy where the evidence conclusively shows that the answers to questions concerning diseases were untrue, the truth of falsity of the answers become the determining factor. If the true facts been disclosed by the assured, the insurance would never have been granted.
Concealment must, in the absence of inquiries, be not only material, but fraudulent, or the fact must have been intentionally withheld. If no inquiries are made and no fraud or design to conceal enters into the concealment the contract is not avoided.
The assurer is entitled to know every material fact of which the assured has exclusive or peculiar knowledge, as well as all material facts which directly tend to increase the hazard or risk which are known by the assured, or which ought to be or are presumed to be known by him. And a concealment of such facts vitiates the policy.
If the assured has exclusive knowledge of material facts, he should fully and fairly disclose the same, whether he believes them material or not. The determination of the point whether there has or has not been a material concealment must rest largely in all cases upon the exact terms of the contract.
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