There must be a positive proof of fraud the burden of proving it is on the

There must be a positive proof of fraud the burden of

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There must be a positive proof of fraud, the burden of proving it is on the insurer. FRAUDULENT CLAIM OF LOSS
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No insurance company doing business in the Philippines shall refuse, without just cause, to pay or settle claims arising under coverages provided by its policies, nor shall any such company engage in unfair claim settlement practices. Insurance companies are enjoined from: Refusing without just cause, to pay or settle claims arising under their policies; or Engaging in unfair claim settlement practices. RULE ON CLAIMS SETTLEMENT SEC 247 (A), IC
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1. Knowingly misrepresenting to claimants pertinent facts or policy provisions relating to coverage ender its policies; 2. Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies; 3. Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under its policies; UNFAIR CLAIMS SETTLEMENT PRACTICES SEC 247 (A), IC
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4. Not attempting in good faith to effectuate prompt, fair and equitable settlement of claims submitted in which liability has become reasonably clear; 5. Compelling policyholders to institute suits to recover amounts due under its policies by offering without justifiable reason substantially less than the amount ultimately recovered in suits brought by them. UNFAIR CLAIMS SETTLEMENT PRACTICES SEC 247 (A), IC
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The proceeds in life insurance shall be paid immediately upon maturity unless such shall be paid in installments or annuities. In case of policy maturing by death of the insured, the proceeds shall be paid within 60 days after presentation of claim and filing of proof of death . After said date, the beneficiary shall be entitled to interests unless the refusal to pay is based on the ground that the claim is fraudulent. (Fernandez v. National Life Ins. Co. 105 Phil 59) PAYMENT OF PROCEEDS OF LIFE INSURANCE SEC 248, IC
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The payment of proceeds shall be paid within 30 days after proof of loss is received by the insurer and after ascertainment of the loss or damage is made either by agreement between the insured and insurer or by arbitration. (Bay View Hotel Inc v. Ker & Co. Ltd. 116 SCRA 327) If such ascertainment is not had or made within sixty (60) days after such receipt by the insurer of the proof of loss, then the loss or damage shall be paid within ninety (90) days after such receipt. (Sec 249, ICP) PAYMENT OF PROCEEDS IN NON-LIFE INSURANCE SEC 249, IC
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Refusal or failure to pay the loss or damage within the time prescribed herein will entitle the insured to collect interest on the proceeds of the policy for the duration of the delay at the rate of twice the ceiling prescribed by the Monetary Board. EXCEPTION: failure or refusal to pay is based on the ground that the claim is fraudulent EFFECT OF REFUSAL TO PAY PROCEEDS SEC 248 & 249, IC
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It shall be the duty of the Commissioner or the Court, as the case may be, to make a finding as to whether the payment of the claim of the insured has been unreasonably denied or withheld.
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