zarsona medical clinic v phil. health insurance corp

7/25/2019 Zarsona Medical Clinic v Phil. Health Insurance Corp

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G.R. No. 191225 October 13, 2014

ZARSONA MEDICAL CLINIC,Petitioner,vs.PHILIPPINE HEALH INS!RANCE CORPORAION,Respondent.

D E C I S I O N

PEREZ, J.:

Before the Court is a petition for review on certiorari under Ruic 45 of the Rues ofCourt, !uestionin" the #$ %anuar& #''()and * Dece+er #''(#Resoutions of theCourt of -ppeas in C-/.R. SP No. '#4$(0IN.

- co+paint was 1ed a"ainst petitioner 2arsona 0edica Cinic 320C for vioation ofSection )4( of the Revised I+pe+entin" Rues and Re"uations of Repuic -ct No.

*$*5 or the Nationa eath Insurance -ct of )((5. Section )4( penai6es an& heathcare provider that increases the period of actua con1ne+ent of an& patient withrevocation of accreditation.

20C 1ed a cai+ withthe Phiippine eath Insurance Corporation 3Phiheath onthe con1ne+ent of Nationa eath Insurance Pro"ra+ 3NIP +e+er 7orna 0.-estre 3-estre on )')# -u"ust #''8. Said cai+ was denied on the "round of9e:tended con1ne+ent.9 It was stated on the cai+ for+ that -estre was ad+ittedto 20C on ; -u"ust #''8 and was dischar"ed on )# -u"ust #''8. Itwas asoreveaed in her Saa&sa&8dated )# %anuar& #''4 that -estre


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to 20C to attend to her chid and process her dischar"e papers. -t around #A''p.+., she 1na& ca+e ac= to the schoo.

Dr. -rie dea Cru6, attendin" ph&sician of -estre, con1r+ed that he ordered-estre


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Rues of CourtF 38 faiure of the petitioner


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Leri1cation of a peadin" is a for+a, not Gurisdictiona, re!uire+ent intended tosecure the assurance that the +atters ae"ed in a peadin" are true and correct.

hus, the court +a& si+p& order the correction of unveri1ed peadin"s or act onthe+ and waive strict co+piance with the rues. It is dee+ed sustantia&co+pied with when one who has a+pe =nowed"e to swear to the truth of theae"ations in the co+paint or petition si"ns the veri1cation, and when+atters

ae"ed inthe petition have een +ade in "ood faith orare true and correct.))

-s to certi1cation a"ainst foru+ shoppin", nonco+piance therewith or a defecttherein, uni=e in veri1cation, is "enera& not curae & its suse!uent su+issionor correction thereof, uness there is a need to rea: the Rue on the "round of9sustantia co+piance9 or presence of 9specia circu+stances or co+pein"reasons.9)#Rue *, Section 5 of the Rues of the Court, re!uires that the certi1cationshoud e si"ned & the 9petitioner or principa part&9 hi+sef. he rationaeehindthis is 9ecause on& the petitioner hi+sef has actua =nowed"e of whether or nothe has initiated si+iar actions or proceedin"s indiMerent courts or a"encies.9 )8

In 7i+ v. he Court of -ppeas, 0indanao Station,)4we reiterated that there!uire+ents of veri1cation and certi1cation a"ainst foru+ shoppin" are not

Gurisdictiona. Leri1cation is re!uired to secure an assurance that the ae"ations inthe petition have een +ade in "ood faith or are true and correct, and not +ere&specuative. Nonco+piance with the veri1cation re!uire+ent does not necessari&render the peadin" fata& defective, and is sustantia& co+pied with whensi"ned & one who has a+pe =nowed"e of the truth of the ae"ations in theco+paint or petition, and when +atters ae"ed in the petition have een +ade in"ood faith orare true and correct. On the other hand, the certi1cation a"ainst foru+shoppin" is re!uired ased on the principe that a part&iti"antshoud not eaowed to pursue si+utaneous re+edies in diMerent fora. hie the certi1cationre!uire+ent is oi"ator&, nonco+piance or a defect in the certi1cate coud ecured & its suse!uent correction or su+ission under specia circu+stances orco+pein" reasons, or on the "round of 9sustantia co+piance.9 )5

In oth cases, the su+ission of an SP- authori6in" an attorne&infact to si"n theveri1cation and certi1cation a"ainst foru+shoppin" in ehaf of the principa part&is considered as sustantia co+piance with the Rues.

In this case, Phiheath found the SP- defective.

he SP- "ranted & Dr. 2arsona tohis attorne&sinfact, Dr. Bra"at and iia+Bra"at, authori6es the atter to do the foowin"A

- o represent3, process, foow up, transact and faciitate a cai+s,ene1ts and privie"es eon"in" to or owin" to 2arsona 0edica Cinic in thePhiippine eath Insurance Corporation, Depart+ent of eath and in othera"encies, +a& it e private or "overn+entF

B o receive, withdraw, and encash an& chec= or chec=s eon"in" to or inthe na+e of 2arsona 0edica CinicF
http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt11http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt12http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt13http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt14http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt15http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt11http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt12http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt13http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt14http://www.lawphil.net/judjuris/juri2014/oct2014/gr_191225_2014.html#fnt15


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C o +a=e, e:ecute, and si"n an& contract, docu+ents or a other writin"s ofwhatever =ind and nature which are necessar& to the fore"oin" powers.);

Indeed, a readin" of the SP- reveas that the powers conferred & Dr. 2arsona to hisattorne&sinfact pertain to ad+inistrative +atters. he phrase 9cai+s, ene1ts andprivie"es eon"in" to or owin" to 2arsona 0edica Cinic9 cear& does not incude

the 1in" of cases efore the courts or an& !uasiGudicia a"encies. he ter+9cai+s9in particuar refers to those cai+s for pa&+ent of services rendered & the hospitadurin" a Phiheath +e+er


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procedure of re+and in order to prevent further dea&s in the disposition of thecase. Cear&, a re+and of the instant case to the Court of -ppeas woud on&unnecessari& proon" its resoution which had een pendin" for a decade. It isaread& an accepted rue of procedure for us to strive to settethe entire controvers&in a sin"e proceedin", eavin" no root or ranch toear the seeds of futureiti"ation. If, ased on the records, the peadin"s, and other evidence, the dispute

can e resoved & us, we wi do so to serve the ends of Gustice instead ofre+andin" the case to the ower court for further proceedin"s.)(

hus, we 1nd the petition +eritorious.

20C was char"ed with e:tendin" the period of con1ne+ent punishae underSection )4( of the Revised I+pe+entin" Rues and Re"uations of Repuic -ct No.*$*5, which providesA

Section )4(. E:tendin" Period of Con1ne+ent. his is

co++itted & an& heath care provider who, for the purpose of cai+in" pa&+entfro+ the NIP, 1es a cai+ with e:tended period of con1ne+ent &A

a. Increasin" the actua con1ne+ent of an& patientF

. Continuous& chartin" entries in the Doctors Order, Nurses Notes andOservation despite actua dischar"e or asence of the patientsF

c. Jsin" such other +achinations that woud resut in the unnecessar&e:tension of con1ne+ent.

he fore"oin" oMenses sha e penai6ed & revocation of accreditation. In addition,

a reco++endation sha e su+itted to the DO for canceation of its icense,oraccreditation, orcearance to operate, as appropriate.

he Phiheath -riter and the Board did not "ive wei"ht to the -?davit ofE:panation su+itted & the patient hersef recantin" her previous state+ent andcate"orica& statin" that she was dischar"ed on& on )# -u"ust #''8.

It is an oftrepeated rue that 1ndin"s of ad+inistrative a"encies are "enera&accorded not on& respect ut aso 1nait& when the decision and order are nottainted with unfairness or aritrariness that woud a+ount to ause of discretion orac= of Gurisdiction. he 1ndin"s of facts +ust e respected, so on" as the& aresupported & sustantia evidence even if not overwhe+in" or preponderant.#'

-fter an e:haustive review of the records, we 1nd that this case warrants adeparture fro+ said rue.1wphi1

e are incined to "ive +ore credence to -estre


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wor=, -estre hied ac= and forth etween schoo and the hospita. It is di?cuttoeieve that she woud ris= her reputation as a puic schooteacher, as we asprosecution for vioation of civi service rues, to e an aettor of20C. Second,-estre tru& cannot e in two paces at the sa+e ti+e. But her narration cear&accounts for her whereaouts on )# -u"ust #''8. She traveed at east 8 ti+es toand fro+ the hospita and schoo. She ad+itted that the schoo was a +ere ten

+inute drive awa& fro+ the hospita so she can easi& traverse etween the twoocations. hird, 20C had in fact ad+itted to its error in indicatin" the dates of-estre


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zarsona medical clinic v phil. health insurance corp

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