FACTS:

Marcelino Gabriel, an employee of Emerald Construction & Development Corporation (ECDC) in Iraq, had a personal accident insurance coverage of P100,000.00 under a group policy purchased from Fortune Insurance & Surety Company, Inc. (private respondent). When Gabriel died in Iraq on May 22, 1982, ECDC reported his death to private respondent on July 12, 1983. However, private respondent denied ECDC's insurance claim citing prescription on September 22, 1983. In response, Jacqueline Jimenez vda. de Gabriel (petitioner), the surviving spouse, filed a complaint against ECDC and private respondent to recover P100,000.00 for insurance indemnification and damages. Private respondent admitted the authenticity of the insurance policy but denied liability due to the failure to disclose the cause of Gabriel's death. The trial court dismissed the case against ECDC but proceeded against private respondent, ruling in favor of the petitioner's claim on the grounds of waiver by private respondent and timely filing of the complaint. Both petitioner and private respondent appealed to the Court of Appeals, which reversed the trial court's decision, finding the petitioner's claim unsubstantiated and the evidence presented hearsay. The petitioner's motion for reconsideration was subsequently denied.

ISSUES:

1. Whether the cause of Marcelino Gabriel's death was due to an insured peril under the terms of the accident insurance policy, namely "violent accidental external and visible means."

2. Whether the notice of claim was submitted within the required time frame as per Section 384 of the Insurance Code, thereby affecting the prescription of the claim.

RULING:

1. The Court ruled that the petitioner, Jacqueline Jimenez vda. de Gabriel, failed to substantiate that her husband’s death was caused by an insured peril, as required under the accident insurance policy. The evidence provided, including an affidavit and a letter from a co-worker, were deemed hearsay and insufficient to establish the cause of death per the stipulations of the insurance policy covering "violent accidental external and visible means."

2. On the issue of prescription, the Court affirmed that the notice of the claim was not submitted within the six-month period required by Section 384 of the Insurance Code. The notice of death was given to the insurer more than a year after Gabriel's death, which is beyond the stipulated window for submitting a written notice of claim. The Court upheld the finding that the claim was rightfully denied based on prescription as the initial notice requirement was not met, dismissing implications of waiver by the respondent due to technical deficiencies in responses to requests for admission.

PRINCIPLES:

1. Burden of Proof in Accident Insurance In accident insurance, the beneficiary of the insured must demonstrate that the cause of death falls under the risks covered by the policy. Once established, the burden then shifts to the insurer to prove any exceptions.

2. Prescription of Insurance Claims As per Section 384 of the Insurance Code, a written notice of claim must be filed within six months from the date of the accident, and actions for recovering damages must be brought within one year from the denial of the claim.

3. Verification Requirements in Litigation Verification of pleadings is a formal and not a jurisdictional requirement, primarily intended to ensure the authenticity and good faith of the allegations. Courts may allow corrections or waivers of unverified pleadings if justice requires.

4. Hearsay Evidence Hearsay evidence, which lacks proper verification or corroboration, is generally inadmissible in court to establish facts, particularly in proving the occurrence of insured events in insurance claims.

5. Role of Insurance Policy Terms The specific terms of an insurance policy determine the coverage and exclusions, guiding the adjudication of claims based on the documented risks and exceptions agreed upon by the insured and the insurer.