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C3）
C4 Follow clauses（跟随条款）
The follow clause (also known as loss settlement clause) in a reinsurance contract binds reinsurers to pay in accordance with the payments of the reinsured under the original insurance contract. Without it the reinsured ‘must prove the loss in the same manner as the original assured must have proved it against them, and the reinsurers can raise all defences which were open to the reassured against the original assured’ (Re London County Commercial Reinsurance Office (1922)).
再保险合同中的跟随条款（也称损失理赔条款）要求再保险人按照原保险合同中分保人的赔付金额进行赔付。如果没有该条款，则分保人 “必须以原被保险人必须对其提出的同样方式证明损失，并且再保险人可以对原被保险人提出分保人可以提出的所有抗辩”（Re London County Commercial Reinsurance Office (1922)）。
This latter approach is far from practical, hence the parties invariably agree – in facultative as well as treaty reinsurances – some sort of loss settlement provision. In this section, we look at three types: ‘follow the settlements’ clauses, ‘loss settlements binding’ clauses and, briefly, ‘follow the fortunes’ clauses.
后一种方法远非实际可行，因此，在临分再保险和条约再保险中，双方总是商定某种损失结算条款。在本节中，我们将探讨三种类型的条款：“遵循理赔 ”条款、“损失理赔约束 ”条款以及简而言之的 “遵循命运 ”条款。
It is important when interpreting such provisions to understand the inherent tension or conflict in this clause. This was articulated by Lord Mustill in Hill & Others v. Mercantile and General Reinsurance Co. (1996). On the one hand, a reinsured wishes to avoid having to investigate and agree 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. On the other hand, a reinsurer does not want to be bound to respond to all of the reinsured’s original claim payments, of whatever nature. So, while payments relating to a judgment or award are unlikely to be contentious, the same cannot necessarily be said of settlements reached between an insured and its insurer. A loss settlement provision must find a balance between these competing requirements of the parties.
在解释此类条款时，重要的是理解该条款中固有的矛盾或冲突。Mustill 勋爵在 Hill & Others 诉 Mercantile and General Reinsurance Co.（1996 年）一案中阐明了这一点。一方面，再保险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处理索赔时，第二次是为了根据再保险合同索赔。另一方面，再保险人也不希望自己必须对再保险人的所有原始索赔付款（无论其性质如何）做出回应。因此，虽然与判决或裁决有关的付款不太可能引起争议，但被保险人与其保险人之间达成的理赔却未必如此。损失理赔条款必须在双方这些相互冲突的要求之间找到平衡。
Follow the settlements clause（“遵循理赔 ”条款）
A typical example of a follow the settlements clause is as follows: ‘Being a reinsurance of and warranted same gross terms and conditions as and to follow the settlements of [the reinsured].’
遵循理赔条款的典型示例如下： ‘作为[分保人]的再保险，保证条款和条件与[分保人]的理赔相同，并遵循[分保人]的理赔。
In Insurance Company of Africa v. SCOR (1985), a facultative reinsurance contract contained both a ‘follow the settlements’ clause and a claims cooperation clause. Warehouse premises in Monrovia, Liberia were insured against fire by the Insurance Company of Africa (ICA) and, in turn, the ICA was reinsured facultatively by SCOR and other London Market reinsurers. The warehouse caught fire. The adjusters – a local unqualified adjuster and a second qualified adjuster from the head office – appointed by ICA found no suspicious circumstances and, in due course, a claim was made against reinsurers. Reinsurers, however, received anonymous letters claiming arson and fraud, and SCOR, after having instructed its own adjusters, denied the claim. Later, it emerged that the anonymous letters had been sent by business rivals of ICA. ICA was sued by the insured in Liberia and lost, and brought proceedings against SCOR in London.
在非洲保险公司诉 SCOR 案（1985 年）中，一份分保再保险合同既包含 “遵循理赔 ”条款，也包含索赔合作条款。非洲保险公司（ICA）为利比里亚蒙罗维亚的仓库房舍投保了火灾险，而 SCOR 和伦敦市场的其他再保险人则为 ICA 提供了分保。仓库着火了。ICA 指派的理算师–一名当地的不合格理算师和来自总公司的第二名合格理算师–没有发现任何可疑情况，并在适当的时候向再保险人提出了索赔。然而，再保险公司收到了匿名信，信中声称有纵火和欺诈行为，SCOR 在指示自己的理算师后拒绝了索赔。后来发现匿名信是由 ICA 的商业竞争对手发出的。被保险人在利比里亚起诉 ICA，但 ICA 败诉，并在伦敦对 SCOR 提起诉讼。
Both the court at first instance and of appeal, held that ICA was entitled to indemnity. Importantly, Robert Goff, LJ, set out the effect of such a ‘follow the settlement’ clause, namely that reinsurers agree to indemnify insurers if the:
• claim as recognised by the reinsured falls within the risks covered by the reinsurance contract as a matter of law; and
• reinsured acted honestly and has taken all proper and businesslike steps in settling the claim (the implied obligation).
一审法院和上诉法院均裁定 ICA 有权获得赔偿。重要的是，Robert Goff 法官阐述了这种“遵循理赔”条款的效果，即再保险公司同意在以下情况下赔偿保险公司：
• 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范围；并且
• 分保人诚实行事，并已采取所有适当和务实的步骤来解决索赔（默示义务）。
So, in cases of absent dishonesty or breach of the implied obligation, reinsurers have no basis to reinvestigate the original claim, and must rely on the honesty and professionalism of the reinsured. The businesslike obligation will extend to include the appointment of the adjuster, the adjuster adjusting the claim and the reinsured settling the claim. Further, it is not relevant how the original claim was presented to the reinsured, only that it was settled.
因此，在不诚实或违反默示义务的情况下，再保险人没有重新调查原索赔的依据，必须依靠分保人的诚实和专业精神。业务上的义务将延伸至包括理算师的任命、理算师对索赔的理算以及分保人对索赔的理赔。此外，如何向分保人提出原始索赔并不重要，重要的是索赔是否得到解决。
Reinsurers may, however, argue that the claim falls outside the risks covered by the reinsurance contract. On this point, it has been held in the Court of Appeal that a reinsured does not have to show that the claim it settled, in fact, falls within the risks covered by the reinsurance, but that the claim which [it] recognised ‘did or arguably did’ (Tuckey LJ in Assicurazioni Generali v. CGU International Insurance (2004)).
但是，再保险人可以辩称，索赔不属于再保险合同承保的风险范围。关于这一点，上诉法院认为，分保人不必证明其理赔的索赔事实上属于再保险承保的风险范围，但[其]承认的索赔’确实或可以说确实属于’（Tuckey LJ 在 Assicurazioni Generali 诉 CGU International Insurance (2004) 案中）。
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