Reinsurance - M97（Dip级30学分，选修）-《再保险》
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（前述章节【Dip系列课程】M97-第八章-再保险相关的法律问题F）
Key points（要点回顾）
The law applicable to reinsurance contracts
• A contract of reinsurance is a distinct and separate contract from the underlying contract of (re)insurance.
• A contract of reinsurance is subject to the general rules governing contracts and, therefore, requires for its valid formation offer and acceptance, consideration and legality.
• A contract of reinsurance is subject to the special rules governing insurance contracts, for example, utmost good faith, indemnity and insurable interest. It is also subject to the duty of fair presentation under the Insurance Act 2015.
适用于再保险合同的法律
• 再保险合同是与基础（再）保险合同截然不同的独立合同。
• 再保险合同受合同一般规则的约束，因此，其有效形成需要要约和承诺、对价和合法性。
• 再保险合同受保险合同特殊规则的约束，例如最大诚信、弥偿和保险利益。根据《2015 年保险法》，再保险合同还受公平陈述义务的约束。
Interpreting contractual documents – key issues and case law
• Reinsurance contracts are subject to the ordinary principles of construction (or interpretation): – The court must give effect to the expressed intention of the parties. – Words should be given their ordinary and natural meaning. However, if the meaning of the word has been settled by a court, or if a word has a technical meaning, it is presumed that such meanings were intended. – Context may come from either within, or exceptionally, outside the terms and conditions of the reinsurance contract. – Extrinsic evidence may be sought to elucidate technical meaning, to resolve ambiguity or absurdity or, as envisaged by Lord Hoffmann in ICS v. West Bromwich BS (1998), to ascertain what a reasonable man, having the background knowledge and information of the parties at the time of the contract, would have understood the parties to have meant.
• The courts continue to make use of the long established rules of construction, but now as presumptions or guidelines. These include the Parol Evidence Rule; contra proferentem; standard printed terms which are overridden by those terms specifically agreed by the parties, which may, for example, have been written, typed or stamped; and ejusdem generis.
解释合同文件——关键问题和判例法
• 再保险合同受一般解释（或解释）原则的约束：– 法院必须履行当事人的明确意图。– 应赋予词语其通常和自然的含义。但是，如果法院已经确定了词语的含义，或者词语具有技术含义，则推定这些含义是有意为之。– 上下文可能来自再保险合同条款和条件之内，或者在特殊情况下来自其之外。– 可以寻求外部证据来阐明技术含义，解决歧义或荒谬之处，或者如 Lord Hoffmann 在 ICS v. West Bromwich BS (1998) 案中所设想的那样，确定一个理性的人在拥有合同签订时双方的背景知识和信息的情况下，会理解双方的意思。
• 法院继续使用长期确立的解释规则，但现在将其作为推定或指导方针。这些规则包括口头证据规则；不利解释原则；标准印刷条款，这些条款被双方明确同意的条款所取代，这些条款可能是书面的、打字的或盖章的；以及同类解释原则。
Express terms
• A warranty is a contractual promise made by a reinsured as to past or existing facts (or ‘state of affairs’), or to its own future conduct. A breach causes the reinsurance cover to be suspended until remedied (if it can be).
• A condition precedent is a contractual promise which must be performed to bring a valid contract into force or, once in force, to make the reinsurer liable under that contract. On breach, the reinsurer is discharged from liability to pay a particular claim. The breach has no impact on future claims under the contract.
• A condition is a contractual promise under which the reinsured promises to perform some action. A reinsured’s right to recovery is not dependent on the act being completed. A reinsured is entitled to claim damages for loss caused by the breach.
• An innominate term is another contractual promise where the remedy for breach depends on the seriousness of the breach. Where the breach is serious, a reinsurer may be entitled to repudiate the contract. Where it is minor, the remedy would be in damages only.
• The parties may use incorporation clauses to import the terms of the original insurance contract into the reinsurance contract.
• A common issue for the parties to a reinsurance contract is whether original claims may be aggregated for the purposes of a claim under that contract. The issue may be addressed specifically by aggregation clauses e.g. the hours clause or alternatively, the parties must look to the reinsuring clause and to the basis of the limit and retention.
• The meaning of an event or occurrence is: – A unifying factor allowing a number of individual losses to be aggregated and treated as a single happening. – An ‘event’ is what has happened as opposed to the reason for what has happened. It is something that happens in a particular time, at a particular place and in a particular way. – The individual losses must be sufficiently closely connected to the event by reference to the unities of time, locality, cause and motive. – The individual losses must have a causal connection to and must not be too remote from the aggregating event. – The assessment is objective, to be made from the perspective of the informed observer and is a matter of intuition and common sense.
• Follow clauses attempt to find a balance between, on the one hand, a reinsured wishing to avoid investigating and agreeing a loss a second time, the first time when responding to a claim under an insurance contract and the second time for the purpose of claiming under a reinsurance contract and, on the other hand, a reinsurer not wanting to be bound to respond to all of the reinsured’s original claim payments, of whatever nature.
• Follow the settlement clauses bind reinsurers where the claim as recognised by the reinsured falls within the risks covered by the reinsurance contract as a matter of law, and the reinsured acted honestly and has taken all proper and businesslike steps in settling the claim.
• Loss settlement binding clauses bind reinsurers provided the settlements are within the terms and conditions of the original and reinsurance policies.
明示条款
• 保证是分保人就过去或现有事实（或“事态”）或其自身未来行为作出的合同承诺。违约会导致再保险被暂停，直至补救（如果可以补救）。
• 先决条件是必须履行的合同承诺，以使有效合同生效，或一旦生效，使再保险人根据该合同承担责任。违约时，再保险人将免除支付特定索赔的责任。违约不会影响合同项下的未来索赔。
• 条件是分保人承诺执行某些行动的合同承诺。分保人的追偿权并不取决于行为是否完成。分保人有权要求赔偿违约造成的损失。
• 匿名条款是另一种合同承诺，违约补救取决于违约的严重程度。如果违约严重，再保险人可能有权拒绝履行合同。如果损失较小，则只能通过损害赔偿来获得救济。
• 双方可使用合并条款将原保险合同的条款纳入再保险合同。
• 再保险合同双方常见的一个问题是，是否可以将原索赔汇总以用于该合同项下的索赔。该问题可以通过汇总条款（例如工时条款）专门解决，或者，双方必须考虑再保险条款以及限额和保留的依据。
• 事件或发生的含义是：– 允许将多个个人损失汇总并视为单一事件的统一因素。– “事件”是发生的事情，而不是发生原因。它是在特定时间、特定地点以特定方式发生的事情。– 个人损失必须与事件有足够紧密的联系，参考时间、地点、原因和动机的统一性。– 个人损失必须与汇总事件有因果关系，并且不能离汇总事件太远。– 评估是客观的，是从知情观察者的角度进行的，是直觉和常识的问题。
• 后续条款试图在以下两方面找到平衡：一方面，分保人希望避免第二次调查和同意损失，第一次是在根据保险合同回应索赔时，第二次是在根据再保险合同提出索赔时；另一方面，再保险人不想被约束对分保人的所有原始索赔付款做出回应，无论其性质如何。
• 如果分保人确认的索赔在法律上属于再保险合同所涵盖的风险，并且分保人诚实行事并在解决索赔时采取了所有适当和有条理的步骤，则后续结算条款对再保险人具有约束力。
• 损失结算约束条款对再保险公司具有约束力，前提是结算符合原始和再保险单的条款和条件。
Implied terms
• Contract terms may be implied by common law, by statute law, by previous dealings between the parties, or by trade custom or usage.
• Arbitration agreements are self-contained and ancillary to the commercial contracts to which they relate. An express provision is required. Similarly, it is not possible to use general words of incorporation to incorporate the arbitration agreement in an underlying contract into the overlying contract.
• The Insurance Act 2015 prohibits reinsurers from relying on a breach of a term which is entirely unconnected to the actual loss to exclude, limit or otherwise avoid liability for that loss. Terms affected by this provision are those which seek to reduce the risk of loss of a particular kind or at a particular location or time.
• The Insurance Act 2015 also imposes an obligation on reinsurers to pay any sums due under the contract within a reasonable time. On breach, the reinsured is entitled to recover contractual damages.
默示条款
• 合同条款可能由普通法、成文法、双方先前的交易或贸易习惯或惯例暗示。
• 仲裁协议是独立的，并且是与其相关的商业合同的附属品。需要有明示规定。同样，不可能使用一般的纳入措辞将基础合同中的仲裁协议纳入上级合同。
• 2015 年《保险法》禁止再保险公司依赖与实际损失完全无关的条款的违反来排除、限制或以其他方式避免对该损失承担责任。受此规定影响的条款是那些旨在降低特定类型或在特定地点或时间发生损失的风险的条款。
• 2015 年《保险法》还规定再保险人有义务在合理的时间内支付合同规定的任何到期款项。一旦违约，分保人有权追回合同损害赔偿金。
Limitation
• Under English statute law, the limitation period relating to reinsurance contracts is six years. This allows a reinsurer to reject claims made more than six years after the date on which the original right to make a claim came into existence (or accrued).
• The limitation period may be extended by agreement between the reinsured and reinsurer.
时效
• 根据英国成文法，再保险合同的诉讼时效期为六年。这允许再保险人拒绝在原始索赔权产生（或产生）之日起六年之后提出的索赔。
• 时效期可由分保人和再保险人协商延长。
Measures to avoid disputes
• The consequences of disputes can be very serious for all parties, leading to claims being repudiated and uncollected, professional indemnity claims for brokers and loss of reputation.
• A number of situations that give rise to disputes can be avoided by monitoring and review procedures.
避免纠纷的措施
• 纠纷的后果可能对所有各方都非常严重，导致索赔被拒绝和无法收回、经纪人的专业赔偿索赔和声誉受损。
• 通过监控和审查程序可以避免许多引起纠纷的情况。
Self-test questions（自测题）
1.What part does a ‘reasonable search’ play in the duty to make a fair presentation of the risk?
1.“合理搜索”在公平陈述风险的义务中起什么作用？
2.What formal requirements are necessary for an ordinary contract?
2.普通合同有哪些正式要求？
3.What is the test for a term to be implied by common law?
3.普通法默示条款的检验标准是什么？
4.What is contra proferentem?
4.什么是不利解释原则？
5.Describe a warranty and the effect of its breach by a reinsured.
5.描述担保以及分保人违反担保的后果。
6.According to Evans, LJ, in Caudle v. Sharp (1995) what three elements are required for an event?
6.根据 Evans, LJ 在 Caudle v. Sharp (1995) 一案中的说法，事件需要哪三个要素？
7.What is a limitation period?
7.什么是诉讼时效期？
8.Describe the inherent tension in follow (or loss settlement) clauses.
8.描述跟随（或损失赔偿）条款中的内在矛盾。
Answer（答案）
1 To make a fair presentation of the risk, the reinsured has a duty to disclose, amongst other things, all that it ought to know. The Insurance Act 2015 defines this by reference to all that should reasonably have been revealed by a reasonable search of information available to the reinsured.
1 为了公平陈述风险，再保险人有义务披露其应该知道的所有信息，其中包括其他信息。2015 年《保险法》对此的定义是，通过合理搜索再保险人可获得的信息，应合理地揭示所有信息。
2 Offer, acceptance, consideration, legality and an intention to create legal terms.
2 要约、承诺、对价、合法性和创建法律条款的意图。
3 A party must show that such a term is necessary to give business efficacy (or effectiveness) to the contract, is consistent with the express terms of the contract, and would have been agreed by the parties.
3 一方必须证明，这样的条款对于使合同具有商业效力（或有效性）是必要的，与合同的明示条款一致，并且双方会同意。
4 It is a doctrine used as an aid to interpretation which provides that ambiguity is construed against the drafting party.
4 这是一项用于解释的原则，规定歧义将对起草方不利。
5 A warranty is a contractual promise as to past or existing fact, or as to future conduct. On breach, reinsurance cover is suspended until remedied (if it can be).
5 保证是对过去或现有事实或未来行为的合同承诺。一旦违约，再保险承保将暂停，直至补救（如果可以补救）。
6 a. A common or unifying factor which can properly be described as an event; b. the event must be causative of the individual losses, satisfying the test of causation; and c. the individual losses must not be too remote from that event.
6 a. 可以恰当地描述为事件的共同或统一因素；b. 该事件必须是导致个人损失的原因，满足因果关系测试；c. 个人损失与该事件的距离不能太远。
7 In relation to contracts, a limitation period is prescribed in s.5 of the Limitation Act 1980 as a six-year period which starts on the date a cause of action accrues, during which proceedings to enforce that cause of action may be commenced, and beyond which a court will not enforce that course of action.
7 关于合同，《1980 年时效法》第 5 条规定，时效期为六年，从诉讼原因产生之日起计算，在此期间可以开始强制执行该诉讼原因的程序，超过该期限，法院将不会强制执行该程序。
8 On the one hand, the reinsured does not want to have to (re-)agree each loss with its reinsurer and, on the other, the reinsurer does not want to be bound to respond to all of the reinsured’s original claim payments.
8 一方面，分保人不希望必须与再保险人（重新）就每笔损失达成一致，另一方面，再保险人也不希望有义务对分保人的所有原始索赔付款作出回应。
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