Source: http://lawlibrary.chanrobles.com/index.php?option=com_content&view=article&id=81813:175773&catid=1571&Itemid=566
Timestamp: 2019-04-23 10:45:33+00:00

Document:
G.R. NO. 175773, June 17, 2013 - MITSUBISHI MOTORS PHILIPPINES SALARIED EMPLOYEES UNION (MMPSEU), Petitioner, v. MITSUBISHI MOTORS PHILIPPINES CORPORATION, Respondent.
MITSUBISHI MOTORS PHILIPPINES SALARIED EMPLOYEES UNION (MMPSEU), Petitioner, v. MITSUBISHI MOTORS PHILIPPINES CORPORATION, Respondent.
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 restrictions. Accordingly, covered employees pay part of the hospitalization insurance premium through monthly salary deduction while the company, upon hospitalization of the covered employees’ dependents, shall pay the hospitalization expenses incurred for the same. The conflict arose when a portion of the hospitalization expenses of the covered employees’ dependents were paid/shouldered by the dependent’s own health insurance. While the company refused to pay the portion of the hospital expenses already shouldered by the dependents’ own health insurance, the union insists that the covered employees are entitled to the whole and undiminished amount of said hospital expenses.
By this Petition for Review on Certiorari,1 petitioner Mitsubishi Motors Philippines Salaried Employees Union (MMPSEU) assails the March 31, 2006 Decision2 and December 5, 2006 Resolution3 of the Court of Appeals (CA) in CA-G.R. SP No. 75630, which reversed and set aside the Voluntary Arbitrator’s December 3, 2002 Decision4 and declared respondent Mitsubishi Motors Philippines Corporation (MMPC) to be under no legal obligation to pay its covered employees’ dependents’ hospitalization expenses which were already shouldered by other health insurance companies.
The room and board must not exceed three hundred pesos (P300.00) per day up to a maximum of thirty-one (31) days. Similarly, Doctor’s Call fees must not exceed three hundred pesos (P300.00) per day for a maximum of thirty-one (31) days. Any excess of this amount shall be borne by the employee.
Confinement must be in a hospital designated by the COMPANY. For this purpose, the COMPANY shall designate hospitals in different convenient places to be availed of by the dependents of employees. In cases of emergency where the dependent is confined without the recommendation of the company doctor or in a hospital not designated by the COMPANY, the COMPANY shall look into the circumstances of such confinement and arrange for the payment of the amount to the extent of the hospitalization benefit.
The limitations and restrictions listed in Annex "B" must be observed.
Payment shall be direct to the hospital and doctor and must be covered by actual billings.
Each employee shall pay one hundred pesos (P100.00) per month through salary deduction as his share in the payment of the insurance premium for the above coverage with the balance of the premium to be paid by the COMPANY. If the COMPANY is self-insured the one hundred pesos (P100.00) per employee monthly contribution shall be given to the COMPANY which shall shoulder the expenses subject to the above level of benefits and subject to the same limitations and restrictions provided for in Annex "B" hereof.
The hospitalization expenses must be covered by actual hospital and doctor’s bills and any amount in excess of the above mentioned level of benefits will be for the account of the employee.
For purposes of this provision, eligible dependents are the covered employees’ natural parents, legal spouse and legitimate or legally adopted or step children who are unmarried, unemployed who have not attained twenty-one (21) years of age and wholly dependent upon the employee for support.
This provision applies only in cases of actual confinement in the hospital for at least six (6) hours.
When the CBA expired on July 31, 1999, the parties executed another CBA7 effective August 1, 1999 to July 31, 2002 incorporating the same provisions on dependents’ hospitalization insurance benefits but in the increased amount of P50,000.00. The room and board expenses, as well as the doctor’s call fees, were also increased to P375.00.
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. In the case of Calida, his wife, Lanie, was confined at Sto. Tomas University Hospital from September 4 to 9, 1998 due to Thyroidectomy. The medical expenses incurred totalled P29,967.10. Of this amount, P9,000.00 representing professional fees was paid by MEDICard Philippines, Inc. (MEDICard) which provides health maintenance to Lanie.8 MMPC only paid P12,148.63.9 It did not pay the P9,000.00 already paid by MEDICard and the P6,278.47 not covered by official receipts. It refused to give to Calida the difference between the amount of medical expenses of P27,427.1010 which he claimed to be entitled to under the CBA and the P12,148.63 which MMPC directly paid to the hospital.
As regards Oabel’s claim, his wife Jovita Nemia (Jovita) was confined at The Medical City from March 8 to 11, 1999 due to Tonsillopharyngitis, incurring medical expenses totalling P8,489.35.11 Of this amount, P7,811.00 was paid by Jovita’s personal health insurance, Prosper Insurance Company (Prosper).12 MMPC paid the hospital the amount of P630.87,13 after deducting from the total medical expenses the amount paid by Prosper and the P47.48 discount given by the hospital.
In the case of Martin, his father, Jose, was admitted at The Medical City from March 26 to 27, 2000 due to Acid Peptic Disease and incurred medical expenses amounting to P9,101.30.14 MEDICard paid P8,496.00.15 Consequently, MMPC only paid P288.40,16 after deducting from the total medical expenses the amount paid by MEDICard and the P316.90 discount given by the hospital.
Claiming that under the CBA, they are entitled to hospital benefits amounting to P27,427.10, P6,769.35 and P8,123.80, respectively, which should not be reduced by the amounts paid by MEDICard and by Prosper, Calida, Oabel and Martin asked for reimbursement from MMPC. However, 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.
This prompted the MMPSEU President to write the MMPC President17 demanding full payment of the hospitalization benefits. Alleging discrimination against MMPSEU union members, she pointed out that full reimbursement was given in a similar claim filed by Luisito Cruz (Cruz), a member of the Hourly Union. In a letter-reply,18 MMPC, through its Vice-President for Industrial Relations Division, clarified that the claims of the said MMPSEU members have already been paid on the basis of official receipts submitted. It also denied the charge of discrimination and explained that the case of Cruz involved an entirely different matter since it concerned the admissibility of certified true copies of documents for reimbursement purposes, which case had been settled through voluntary arbitration.
We acknowledge receipt of your letter which, to our impression, basically poses the question of whether or not recovery of medical expenses from a Health Maintenance Organization bars recovery of the same reimbursable amount of medical expenses under a contract of health or medical insurance.
We wish to opine that in cases of claims for reimbursement of medical expenses where there are two contracts providing benefits to that effect, recovery may be had on both simultaneously. In the absence of an Other Insurance provision in these coverages, the courts have uniformly held that an insured is entitled to receive the insurance benefits without regard to the amount of total benefits provided by other insurance. (INSURANCE LAW, A Guide to Fundamental Principles, Legal Doctrines, and Commercial Practices; Robert E. Keeton, Alau I. Widiss, p. 261). The result is consistent with the public policy underlying the collateral source rule – that is, x x x the courts have usually concluded that the liability of a health or accident insurer is not reduced by other possible sources of indemnification or compensation. (ibid).
On December 3, 2002, the Voluntary Arbitrator rendered a Decision27 finding MMPC liable to pay or reimburse the amount of hospitalization expenses already paid by other health insurance companies. The Voluntary Arbitrator held that the employees may demand simultaneous payment from both the CBA and their dependents’ separate health insurance without resulting to double insurance, since separate premiums were paid for each contract. He also noted that the CBA does not prohibit reimbursement in case there are other health insurers.
MMPC filed a Petition for Review with Prayer for the Issuance of a Temporary Restraining Order and/or Writ of Preliminary Injunction28 before the CA. It claimed that the Voluntary Arbitrator committed grave abuse of discretion in not finding that recovery under both insurance policies constitutes double insurance as both had the same subject matter, interest insured and risk or peril insured against; in relying solely on the unauthorized legal opinion of Atty. Funk; and in not finding that the employees will be benefitted twice for the same loss. In its Comment,29 MMPSEU countered that MMPC will unjustly enrich itself and profit from the monthly premiums paid if full reimbursement is not made.
WHEREFORE, the instant petition is GRANTED. The decision of the voluntary arbitrator dated December 3, 2002 is REVERSED and SET ASIDE and judgment is rendered declaring that under Art. XI, Sec. 4 of the Collective Bargaining Agreement between petitioner and respondent effective August 1, 1999 to July 31, 2002, the former’s obligation to reimburse the Union members for the hospitalization expenses incurred by their dependents is exclusive of those paid by the Union members to the hospital.
In its Motion for Reconsideration,33 MMPSEU pointed out that the alleged oppression that may be committed by abusive employees is a mere possibility whereas the resulting losses to the employees are real. MMPSEU cited Samsel v. Allstate Insurance Co.,34 wherein the Arizona Supreme Court explicitly ruled that an insured may recover from separate health insurance providers, regardless of whether one of them has already paid the medical expenses incurred. On the other hand, MMPC argued in its Comment35 that the cited foreign case involves a different set of facts. The CA, in its Resolution36 dated December 5, 2006, denied MMPSEU’s motion.
The Voluntary Arbitrator based his ruling on the opinion of Atty. Funk that the employees may recover benefits from different insurance providers without regard to the amount of benefits paid by each. According to him, this view is consistent with the theory of the collateral source rule.
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. A plaintiff who receives a double recovery for a single tort enjoys a windfall; a defendant who escapes, in whole or in part, liability for his wrong enjoys a windfall. Because the law must sanction one windfall and deny the other, it favors the victim of the wrong rather than the wrongdoer.
As seen, the collateral source rule applies in order to place the responsibility for losses on the party causing them.43 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."44 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.45 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.
The Voluntary Arbitrator therefore erred in adopting Atty. Funk’s view that the covered employees are entitled to full payment of the hospital expenses incurred by their dependents, including the amounts already paid by other health insurance companies based on the theory of collateral source rule.
by dependents’ other health insurance providers.
The Voluntary Arbitrator ruled that the CBA has no express provision barring claims for hospitalization expenses already paid by other insurers. Hence, the covered employees can recover from both. The CA did not agree, saying that the conditions set forth in the CBA implied an intention of the parties to limit MMPC’s liability only to the extent of the expenses actually incurred by their dependents which excludes the amounts shouldered by other health insurance companies.
We agree with the CA. The condition that payment should be direct to the hospital and doctor implies that MMPC is only liable to pay medical expenses actually shouldered by the employees’ dependents. It follows that MMPC’s liability is limited, that is, it does not include the amounts paid by other health insurance providers. This condition is obviously intended to thwart not only fraudulent claims but also double claims for the same loss of the dependents of covered employees.
It is well to note at this point that the CBA constitutes a contract between the parties and as such, it should be strictly construed for the purpose of limiting the amount of the employer’s liability.46 The terms of the subject provision are clear and provide no room for any other interpretation. As there is no ambiguity, the terms must be taken in their plain, ordinary and popular sense.47 Consequently, MMPSEU cannot rely on the rule that a contract of insurance is to be liberally construed in favor of the insured. Neither can it rely on the theory that any doubt must be resolved in favor of labor.
on all fours with the case at bar.
MMPSEU cannot rely on Samsel v. Allstate Insurance Co. where the Supreme Court of Arizona allowed the insured to enjoy medical benefits under an automobile policy insurance despite being able to also recover from a separate health insurer. In that case, the Allstate automobile policy does not contain any clause restricting medical payment coverage to expenses actually paid by the insured nor does it specifically provide for reduction of medical payments benefits by a coordination of benefits.48 However, in the case before us, the dependents’ group hospitalization insurance provision in the CBA specifically contains a condition which limits MMPC’s liability only up to the extent of the expenses that should be paid by the covered employee’s dependent to the hospital and doctor. This is evident from the portion which states that "payment [by MMPC] shall be direct to the hospital and doctor."49 In contrast, the Allstate automobile policy expressly gives Allstate the authority to pay directly to the insured person or on the latter’s behalf all reasonable expenses actually incurred. Therefore, reliance on [Samsel] is unavailing because the facts therein are different and not decisive of the issues in the present case.
double recovery which is not sanctioned by law.
MMPSEU insists that MMPC is also liable for the amounts covered under other insurance policies; otherwise, MMPC will unjustly profit from the premiums the employees contribute through monthly salary deductions.
The CBA has provided for MMPC’s limited liability which extends only up to the amount to be paid to the hospital and doctor by the employees’ dependents, excluding those paid by other insurers. 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.52 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.53 This is consistent with the principle of indemnity which proscribes the insured from recovering greater than the loss.54 Indeed, to profit from a loss will lead to unjust enrichment and therefore should not be countenanced. As aptly ruled by the CA, to grant the claims of MMPSEU will permit possible abuse by employees.
WHEREFORE, the Petition is DENIED. The Decision dated March 31, 2006 and Resolution dated December 5, 2006 of the Court of Appeals in CA-G.R. SP No. 75630, are AFFIRMED.
2 CA rollo, pp. 215-223; penned by Associate Justice Edgardo P. Cruz and concurred in by Associate Justices Rosalinda Asuncion-Vicente and Sesinando E. Villon.
4 Id. at 30-38; penned by Voluntary Arbitrator Atty. Rodolfo M. Capocyan.
5 Annex "A" of MMPC’s Position Paper before the Voluntary Arbitrator, id. at 85-87.
7 Annex "B," id. at 88-90.
8 Annexes "C" and "D," id. at 91-94.
9 Annex "E," id. at 95-96.
10 P12,148.63 + P9,000.00 + P6,278.47.
11 Annex "F," CA rollo, pp. 97-100.
13 Annex "G," id. at 101-102.
14 Annex "H," id. at 103-107.
15 Annex "I," id. at 108.
16 Annex "J," id. at 109.
17 Annex "A" of MMPSEU’s Position Paper before the Voluntary Arbitrator, id. at 152.
18 Annex "E," id. at 156.
19 Annex "F," id. at 157.
20 Annex "G," id. at 158.
21 See MMPSEU’s Position Paper and Reply to MMPC’s Position Paper before the Voluntary Arbitrator, id. at 144-151 and 139-142, respectively.
22 See MMPC’s Position Paper and Reply to MMPSEU’s Position Paper before the Voluntary Arbitrator, id. at 74-84 and 110-121, respectively.
23 Annex "L" of MMPC Petition for Review filed before the CA, id. at 64-65.
24 See October 24, 2000 letter of the Insurance Commission, Annex "M", id. at 66.
25 See November 14, 2001 letter of MMPSEU, id. at 182-185.
26 Annex "A" of MMPSEU Reply to MMPC’s Position Paper before the Voluntary Arbitrator, id. at 143.
34 59 P.3d 281 (Ariz. 2002).
35 CA rollo, pp. 264-272.
38 YOUNG, MELISSA. TORT REFORM AND THE COLLATERAL SOURCE RULE , (visited March 1, 2013).
39 BLACK’S LAW DICTIONARY WITH PRONUNCIATIONS, (Sixth ed. 1990/Centennial Edition).
40 Wills v. Foster, Jr., 229 Ill. 2d 393, 399 (Ill. 2008).
42 883 A.2d 32, 37-38 (Del. 2005).
44Wills v. Foster, Jr., supra note 40 at 397.
45 BLACK’S LAW DICTIONARY, (Fifth ed. 273, 1979).
46Asiatic Petroleum Co. v. De Pio, 46 Phil 167, 170 (1924).
47New Life Enterprises v. Court of Appeals, G.R. NO. 94071, March 31, 1992, 207 SCRA 669, 676.
48 Supra note 34 at 290.
49 CA rollo, p. 87.
50 University of the Philippines v. Philab Industries, Inc., 482 Phil. 693, 709 (2004).
51Car Cool Phils., Inc. v. Ushio Realty & Development Corporation, 515 Phil. 376, 384 (2006).
52Fortune Insurance and Surety, Inc. v. Court of Appeals, 314 Phil. 184, 196 (1995).
53 Philamcare Health Systems, Inc. v. Court of Appeals, 429 Phil. 82, 90 (2002).
54 The principle of indemnity in property insurance is based on Section 18 of the Insurance Code which provides that no contract or policy of insurance on property shall be enforceable except for the benefit of some person having an insurable interest in the property insured.

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