Concept of Insurance | INSURANCE

Concept of Insurance under Mercantile and Taxation Laws

The concept of insurance in Philippine law is governed primarily by the Insurance Code (Presidential Decree No. 612, as amended). This law is part of mercantile law, as insurance contracts fall under commercial transactions, and it has tax implications since premiums, proceeds, and other aspects are subject to regulatory tax guidelines. This guide will discuss the foundational principles, legal definitions, requirements, classifications, and tax implications of insurance in the Philippines.

1. Definition and Nature of Insurance

Insurance is a contract by which one party (the insurer), for a consideration known as the premium, binds itself to indemnify another (the insured) against loss, damage, or liability arising from a contingent or unknown event. The purpose of insurance is risk transfer, where the insured transfers the financial consequences of certain risks to the insurer in exchange for periodic payments.

2. Legal Basis

The Insurance Code governs insurance contracts in the Philippines. It establishes the rights, obligations, and liabilities of parties involved in insurance contracts, including insurers, insured, and beneficiaries. The Insurance Commission, an agency under the Department of Finance, is responsible for supervising and regulating the insurance industry in the Philippines.

3. Essential Elements of an Insurance Contract

An insurance contract has several essential elements:

  • Insurable Interest: For a contract to be valid, the insured must have an insurable interest in the subject of the insurance. Insurable interest means that the insured stands to suffer financial loss if the insured event occurs. Insurable interest must exist at the time of the contract in life insurance and at the time of loss in property insurance.

  • Risk or Uncertainty: Insurance contracts cover risks, defined as uncertain events that result in loss. Insurers do not cover events that are certain or intentional losses.

  • Consideration (Premium): The premium is the consideration for the insurer’s promise to indemnify the insured. Without the payment of premiums, the contract may become voidable.

  • Contractual Relationship: An insurance contract is consensual and arises from the agreement between the insurer and the insured. It is formalized when the insurer issues a policy detailing the terms of coverage.

4. Classes of Insurance

The Insurance Code categorizes insurance contracts into various classes, primarily:

  • Life Insurance: This covers the life of an individual. It may be temporary (term insurance) or permanent (whole life, endowment policies).

  • Non-Life Insurance: This includes fire insurance, marine insurance, and liability insurance, covering losses other than life.

  • Health Insurance: Covers medical expenses and healthcare needs. Although generally classified under life insurance, health insurance has unique provisions.

  • Annuities: A contract where the insurer agrees to pay the insured a series of payments at regular intervals, typically after retirement.

5. Insurance Policy Provisions

Insurance policies have specific provisions governed by the Insurance Code:

  • Policy: A written instrument that serves as evidence of the insurance contract.

  • Standard Provisions: The Code requires specific provisions, such as the grace period, incontestability clause, suicide clause (for life insurance), and reinstatement period.

  • Exclusions and Limitations: The policy may contain provisions limiting coverage or excluding certain types of risks.

6. Insurable Interest

Insurable interest is a critical aspect of insurance. In life insurance, a person must have an insurable interest in the life insured at the time the policy is taken out, such as in relationships of close kinship or financial dependence. In property insurance, insurable interest must exist both at the time the policy is taken out and at the time of loss.

7. Perils and Coverage

A peril is the specific risk or event insured against, such as fire, death, or accident. Coverage refers to the extent to which an insurance policy will pay out for losses incurred due to these perils. Coverage may be “all-risk” (covering all perils except those specifically excluded) or “named-peril” (covering only those perils specifically listed).

8. Premium Payment and Effects of Non-Payment

The premium is an essential component of the insurance contract. Payment terms are generally stipulated in the policy. Non-payment of the premium usually results in the lapse of coverage, unless a grace period is provided. In life insurance, the grace period for premium payment is usually 30 days. However, once a policy lapses, the insured may have the right to reinstate the policy within a specified period.

9. Doctrine of Indemnity and Subrogation

The doctrine of indemnity applies primarily to non-life insurance, meaning that the insured should not profit from the insurance policy. The indemnity amount should only compensate for the loss incurred.

Subrogation is the insurer's right to "step into the shoes" of the insured to recover from third parties responsible for the loss after compensating the insured. This prevents the insured from collecting twice for the same loss.

10. Incontestability Clause

Life insurance policies in the Philippines contain an incontestability clause, which states that after a period (typically two years), the insurer cannot contest the policy on the grounds of any misrepresentation, concealment, or fraud. This clause promotes stability and trust in life insurance contracts.

11. Cancellation and Termination of Policies

An insurance contract may be canceled by either party, depending on the terms and provisions within the policy and subject to the Insurance Code. Insurers must follow certain notice requirements before canceling a policy, ensuring that the insured is properly informed and given a chance to remedy any cause for cancellation.

12. Taxation on Insurance

Insurance premiums and proceeds are subject to taxation in various forms:

  • Premium Taxes: In the Philippines, premium taxes are imposed on specific types of insurance, including life and non-life insurance.

  • Documentary Stamp Tax (DST): Policies are subject to DST, calculated based on the amount of insurance coverage.

  • Estate Tax: Life insurance proceeds are subject to estate tax if the insured’s estate is designated as the beneficiary.

  • Withholding Tax on Payments to Foreign Insurers: Payments made to foreign insurers are subject to a 2% withholding tax, unless a tax treaty specifies otherwise.

13. Licensing of Insurance Companies

Insurance companies are required to obtain a license from the Insurance Commission to operate in the Philippines. The commission sets minimum capital requirements, solvency standards, and other regulatory measures to ensure the financial stability of insurers. Foreign insurance companies may also operate in the Philippines, but they must meet specific entry requirements and limitations.

14. Responsibilities of the Insurance Commission

The Insurance Commission is tasked with enforcing the provisions of the Insurance Code and safeguarding the interests of policyholders. Its duties include:

  • Monitoring the solvency and financial health of insurance companies
  • Issuing licenses to insurers, brokers, and agents
  • Approving insurance products and premium rates
  • Resolving disputes between policyholders and insurers

15. Jurisprudence and Case Law

Philippine jurisprudence has shaped many aspects of insurance law. Key cases clarify concepts such as insurable interest, the incontestability clause, and the principle of utmost good faith, underscoring the strict compliance expected from both insurer and insured.

16. Fraud Prevention and Regulation

The Insurance Code contains provisions that guard against fraud. Insurers must undertake due diligence to prevent false claims. Any fraudulent activity can void the insurance policy, and criminal penalties may apply.

Conclusion

The concept of insurance in the Philippines combines principles of contract law, commerce, and regulatory compliance. With elements like insurable interest, indemnity, and subrogation, insurance operates as a risk management tool under strict statutory rules. The Insurance Commission and related legal doctrines ensure that the industry operates fairly, protecting both insurers and the public.