G.R. No. 103883 November 14, 1996
JACQUELINE JIMENEZ VDA. DE GABRIEL, petitioner, vs. HON. COURT OF APPEALS and FORTUNE INSURANCE & SURETY COMPANY, INC., respondents.

FACTS

Marcelino Gabriel, an overseas worker in Iraq, was covered by a group personal accident insurance policy issued by Fortune Insurance to his employer. The policy insured against death due to “bodily injury caused by violent accidental external and visible means.” Gabriel died in Iraq on May 22, 1982. His employer reported the death to the insurer over a year later, in July 1983. The submitted death certificate from Iraqi authorities stated the reason for death was “under examination now — not yet known,” and an NBI autopsy report likewise stated the cause of death could not be determined due to advanced decomposition. Fortune Insurance denied the claim filed by the petitioner, Gabriel’s widow and beneficiary, primarily on the ground of prescription.
The petitioner filed a complaint alleging her husband died of electrocution at work. The Regional Trial Court ruled partly in her favor, holding the insurer waived certain defenses and that the action was timely filed. The Court of Appeals reversed this decision, prompting the petitioner’s appeal to the Supreme Court.

ISSUE

The primary issues were: (1) whether the petitioner sufficiently proved that her husband’s death was due to the insured peril; and (2) whether the claim had prescribed under the Insurance Code.

RULING

The Supreme Court denied the petition and affirmed the Court of Appeals. On the substantive issue, the Court held that in an accident insurance policy specifying the covered peril (violent accidental external means), the beneficiary carries the burden of proving the loss was caused by that specific peril. The petitioner failed to discharge this burden. The evidence presented, including an affidavit by the petitioner and an alleged letter from a co-worker, were correctly deemed hearsay by the appellate court. The official documents—the Iraqi death certificate and the NBI report—did not establish an accidental cause. Without proof that the death resulted from the insured risk, no liability under the policy arises.
On the procedural issue of prescription, the Court upheld the insurer’s defense based on Section 384 of the Insurance Code, which requires a written notice of claim to be filed with the insurer within six months from the date of the accident; otherwise, the claim is deemed waived. The notice here was given over a year after the death, thus the claim was waived. The Court clarified that the insurer invoked this six-month period for filing the notice of claim, not the one-year period for filing an action after denial. The defense was properly raised in the insurer’s answer. The Court also found no merit in the petitioner’s argument that the insurer waived defenses through unverified answers to requests for admission, as the matters requested were deemed denied under the Rules of Court.