Law on Obligations and Contracts. A Case Digest about G.R. No. 133803, September 16, 2005. A group work during our first semester for the third year in college. BIENVENIDO M. CASIÑO, JR., P…Full description
covers cases of Part 2 of Syllabus of Election law
case digest
case digest format for polirev.Full description
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contains landmark judgment on fire insuranceFull description
Parties to an Insurance policy. Cancellation.
Covers: Proximate Cause, Loss
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MITS MITSUB UBIS ISHI HI MOTO MOTORS RS PHIL PHILIP IPPI PINE NES S SALA SALARI RIED ED vs. MITSUBISHI MOTORS PHILIPPINES CORPORATION
EMPL EMPLOY OYEE EES S
UNIO UNION N
(MMP (MMP
G.R. No. 175773 June 17 !"13
DEL CASTILLO
J.:
#ACTS$
The Collec Collectiv tive e Barga Bargaini ining ng Agree Agreeme ment nt (CBA) (CBA) of the the parti parties es in this this case case provid provides es th company company shoulde shoulderr the hospita hospitalizat lization ion expense expenses s of the depende dependents nts of covered covered empl subject to certain limitations and restrictions. Accordingly covered employees pay part of hospitalization insurance premium through monthly salary deduction !hile the company u hospitalization of the covered employees" dependents shall pay the hospitalization expen incurred for the same.
#ach employee shall pay one hundred pesos ($%&&.&&) per month through salary deductio his share in the payment of the insurance premium for the above coverage !ith the balanc the premium to be paid by the C'$A*. +f the C'$A* is self,insured the one hun Read Free Foron 30this Days Sign up to vote title pesos ($%&&.&&) per employee monthly contribution shall be given to the C'$A* !hich Useful Not useful shoulder the expenses expenses subject to the above level of benefits and subject Cancel anytime. to the same limita Special offer forand students: Only $4.99/month. restrictions provided for in Annex -B- hereof.
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$C paid only a portion of their hospitalization insurance claims not the full amount. +n case of Calida his !ife 7anie !as confined at 3to. Tomas 4niversity 5ospital from 3eptem 8 to 9 %99: due to Thyroidectomy. The medical expenses incurred totalled $;99<2.%&. 'f amount $9&&&.&& representing professional fees !as paid by #=+Card $hilippines !hich provides health maintenance to 7anie. $C only paid $%;%8:.<1. +t did not pay $9&&&.&& already paid by #=+Card and the $<;2:.82 not covered by official receip refused to give to Calida the difference bet!een the amount of medical expenses of $;28; !hich he claimed to be entitled to under the CBA and the $%;%8:.<1 !hich $C directly to the hospital.
+n the case of artin his father 6ose !as admitted at The edical City from arch ;< to ;&&& due to Acid $eptic =isease and incurred medical expenses amounting to $9 #=+Card paid $:89<.&&. Conse>uently $C only paid $;::.8& after deducting from total medical expenses the amount paid by #=+Card and the $1%<.9& discount given by hospital.
Claiming that under the CBA they are entitled to hospital benefits amounting to $;28; $<2<9.10 and $:%;1.:& respectively !hich should not be reduced by the amounts pai #=+Card and by $rosper Calida 'abel and artin as?ed for reimbursement from $C.
5o!ever $C denied the claims contending that double insurance !ould result if the employees !ould receive from the company the fulla amount You're Reading Previewof hospitalization expenses des having already received payment of portions thereof from other health insurance providers. Unlock full access with a free trial.
This prompted the $3#4 $resident to !rite the $C $resident demanding full payme the hospitalization benefits. Download With Free Trial
$C clarified that the claims of the said $3#4 members have already been paid on basis of official receipts submitted.
$3#4 referred the dispute to the ational Conciliation and ediation Board and Master your semester with Scribd re>ue Read Free Foron 30this Days Sign up to vote title for preventive mediation. & The New York Times Useful Not useful Cancel anytime.
alleged that there is nothing in the CBA !hich prohibits an employee from obtai Special offer for$3#4 students: Only $4.99/month.
other insurance or declares that medical expenses can be reimbursed only upon presentatio
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Code. oreover a contract of insurance is a contract of indemnity and the employees canno allo!ed to profit from their dependents loss.
The @oluntary Arbitrator rendered a =ecision finding $C liable to pay or reimburse amount of hospitalization expenses already paid by other health insurance companies. @oluntary Arbitrator held that the employees may demand simultaneous payment from both CBA and their dependents separate health insurance !ithout resulting to double insura since separate premiums !ere paid for each contract. 5e also noted that the CBA does prohibit reimbursement in case there are other health insurers.
$C filed a $etition for evie! before the CA. +t claimed that the @oluntary Arbi committed grave abuse of discretion in not finding that recovery under both insurance poli constitutes double insurance as both had the same subject matter interest insured and ris peril insured against in relying solely on the unauthorized legal opinion of Atty. un? and in finding that the employees !ill be benefited t!ice for the same loss.
'n arch 1% ;&&< the CA found merit in $Cs $etition. +t ruled that despite the lac? provision !hich bars recovery in case of payment by other insurers the !ordings of the sub provision of the CBA sho!ed that the parties intended to ma?e $C liable only for expen actually incurred by an employees >ualified dependent. +n particular the provision stipul that payment should be made directly to the hospital and that the claim should be supporte actual hospital and doctors bills. You're Reading a Preview
Unlock full access a free trial. of the hospital expenses incu %UESTION$ Are member,employees entitled to with full payment by their dependents including the amounts already paid by other health insurance compa from +T34B+35+ under their CBADDownload With Free Trial
ANS&ER$ '. The @oluntary Arbitrator based his ruling on the opinion of Atty. un? tha employees may recover benefits from different insurance providers !ithout regard amount of benefits paid by each. Atty. un? erred in applying thecollateral source rule.
Master your semester with Scribd Read Free Foron 30this Days Signfor up to vote title a source ! 4nder this rule if an injured person receives compensation his injuries from & The New YorkofTimes Useful Notthe useful independent the tortfeasor the payment should not bededucted from damages !hic Cancel anytime.
other!ise collect from the tortfeasor. +n a recent =ecision by the +llinois 3upreme Co Special offer for!ould students: Only $4.99/month.
the rule has been described as -an established exception to the general rule that damage
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expenditures made by the injured party or ta?e advantage of contracts or other relations may exist bet!een the injured party and third persons.- Thus it finds no application to c involving no,fault insurances under !hich the insured is indemnified for losses by insura companies regardless of !ho !as at fault in the incident generating the losses.
5ere it is clear that $C is a no,fault insurer. 5ence it cannot be obliged to pay hospitalization expenses of the dependents of its employees !hich had already been paid separate health insurance providers of said dependents. The conditions set forth in the CBA provision indicate an intention to limit $Cs liability to actual expenses incurred by the employees dependents that is excluding the amounts by dependents other health insurance providers.
The condition that payment should be direct to the hospital and doctor implies that $ only liable to pay medical expenses actually shouldered by the employees dependen follo!s that $Cs liability is limited that is it does not include the amounts paid by o health insurance providers. This condition is obviously intended to th!art not only fraudu claims but also double claims for the same loss of the dependents of covered employees.
+t is !ell to note at this point that the CBA constitutes a contract bet!een the parties and such it should be strictly construed for the purpose of limiting the amount of the employ liability. You're Reading a Preview Unlock full access with under a free trial.other To allo! reimbursement of amounts paid constitute double recovery !hich is not sanctioned by la!.
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The CBA has provided for $Cs limited liability !hich extends only up to the amount t paid to the hospital and doctor by the employees dependents excluding those paid by o insurers. Conse>uently the covered employees !ill not receive more than !hat is due th neither is $C under any obligation to give more than !hat is due under the CBA.
Master your semester with Scribd Read Free For 30 Days Sign up to vote on this title oreover since the subject CBA provision is an insurance contract the rights and obligation & The New York Times Useful principles the parties must be determined in accordance !ith the of insurance general Not useful Cancel anytime.
in the of a non,life insurance contract and essentially a contract of indemnity Special offer forBeing students: Onlynature $4.99/month.
CBA provision obligates $C to indemnify the covered employees medical expenses incu
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