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-第七章-合同措辞E3-E7）
Key points（要点回顾）
Main features of facultative and treaty wordings
• The parties to the contract are the insurer(s) and the reinsurer(s).
• The subject matter of the reinsurance contract is the reinsured’s interest in a particular insurance contract in the case of facultative reinsurance or, a particular account or book of insurance business in the case of treaty reinsurance.
• The reinsurance contract is a separate and distinct contract from the underlying insurance contract. This reinsurance relationship is mutually exclusive from the relationship between the reinsured and the insured.
临时和条约措辞的主要特征
• 合同双方是保险公司和再保险公司。
• 再保险合同的标的物是分保人在临时再保险情况下的特定保险合同中的权益，或者在条约再保险情况下是保险业务的特定账户或账簿。
• 再保险合同是与基础保险合同不同的独立合同。这种再保险关系与分保人和（原）被保险人之间的关系是相互排斥的。
Clauses common to proportional and non-proportional wordings
• A proportional treaty is usually a continuous contract, that is, it continues until terminated on notice, by agreement or otherwise. A fixed period is usual for a non-proportional treaty.
• The territorial scope clause defines the territorial or geographical scope of the reinsurance contract.
• The cancellation clause provides that one or both parties may terminate (or cancel) the agreement immediately if there is a significant change during the currency of the agreement in the character of that other party, or in the commercial and/or political background, from that at placement.
• Currency clauses set out the relationship between the currency of the original premium and/or claim transactions, and the corresponding reinsurance (premium and/or claim) transactions.
• Late payments clause requires the defaulting (or debtor) party to pay interest on any amounts past due under the contract.
• Law and jurisdiction clauses record the law governing the treaty and the courts having power and authority to administer justice between the parties to the treaty.
• Dispute resolution clauses set out how the parties go about resolving any disputes between them, for example, arbitration and/or mediation failing which litigation.
• The underwriting policy clause requires a reinsured to seek a reinsurer’s approval to significant change in its underwriting policy.
• The errors and omissions clause seeks to ensure that any inadvertent errors, omissions or delay in complying with the terms and conditions of the treaty are remedied immediately upon discovery and without any impact to the treaty beyond that of ordinary rectification.
• An ECO clause extends the scope of the treaty to damages, arising from the reinsured’s bad faith or negligence in handling claims under policies subject to the treaty. In this case, the court has made an award against the insurer/reinsured outside of the insurance relationship.
• An XPL clause extends the scope of the treaty to original loss in excess of the original policy limit, arising from the reinsured’s bad faith or negligence in handling claims under policies subject to the treaty. In this case, the court has set aside the original policy limit, awarding a claim amount in excess of that limit.
• The insolvency clause sets out the impact of the reinsured’s insolvency on the reinsurance contract.
• The offset clause allows the parties to offset any balance or amount due from one party to the other under a particular reinsurance contract or any others between the parties, whether acting as reinsurer or reinsured.
• The co-reinsurance clause states the proportion that the reinsured agrees to retain ‘net and unreinsured’.
• ‘Boilerplate’ clauses are standard clauses with little reinsurance content and include the following clauses: notice, intermediary, termination of intermediary, confidentiality, amendments and alterations, severability, entire agreement, non-waiver and several liability.
比例和非比例措辞的共同条款
• 比例条约通常是连续性合同，即，其持续有效直至因通知、协议或其他方式终止。非比例条约通常有固定期限。
• 地域范围条款定义了再保险合同的地域或地理范围。
• 取消条款规定，如果在协议有效期内，另一方的性质或商业和/或政治背景与协议签订时发生重大变化，则一方或双方可立即终止（或取消）协议。
• 货币条款规定了原始保费和/或索赔交易的货币与相应的再保险（保费和/或索赔）交易之间的关系。
• 逾期付款条款要求违约方（或债务人）支付合同项下任何逾期金额的利息。
• 法律和管辖权条款记录了管辖条约的法律以及有权在条约缔约方之间执行司法的法院。
• 争议解决条款规定了双方如何解决双方之间的任何争议，例如，诉讼失败时进行仲裁和/或调解。
• 承保保单条款要求再保险人对其承保保单进行重大变更时必须寻求再保险公司的批准。
• 错误和遗漏条款旨在确保在遵守条约条款和条件方面出现的任何无意错误、遗漏或延误在发现后立即得到纠正，并且不会对条约造成超出普通纠正的任何影响。
• ECO 条款将条约的范围扩大到因分保人在处理受条约约束的保单下的索赔时的恶意或疏忽而造成的损害。在本案中，法院对保险关系之外的保险人/分保人作出了裁决。
• XPL 条款将条约的范围扩大到超出原保单限额的原始损失，这些损失是由于分保人在处理受条约约束的保单项下的索赔时的恶意或疏忽而造成的。在本案中，法院取消了原来的保单限额，判给超过该限额的索赔金额。
• 破产条款规定了分保人破产对再保险合同的影响。
• 抵销条款允许双方抵销根据特定再保险合同或双方之间的任何其他合同，一方向另一方应付的任何余额或金额，无论是作为再保险人还是分保人。
• 共同再保险条款规定了分保人同意保留“净额和未再保险”的比例。
• “模板”条款是涉及再保险内容很少的标准条款，包括以下条款：通知、中介、中介终止、保密、修订和变更、可分割性、完整协议、非弃权和连带责任。
Clauses used in proportional wordings
• The cession clause sets out the nature and the main terms of the proportional reinsurance, and imposes a cession limit and a cession retention, which may or may not be protected by other reinsurance.
• The accounting clause requires the reinsured to prepare and dispatch periodic accounts to the reinsurer. It states when accounts have to be presented to the reinsurer, what details have to be included in the accounts and when money should be rendered to the reinsured in respect of those accounts, or vice versa.
• The premium clause provides that the reinsured will pay the reinsurer its proportionate share of the original gross (or net) premiums received by the reinsured on business covered by the reinsurance agreement.
• The commission clause sets out how much commission is to be paid by the reinsurer to the reinsured and when it is to be paid. There are two basic types of commission: ceding commission and profit commission.
• The claims clause deals with the notification and settlement of all losses to the treaty; claims are paid either individually as cash losses, or collectively as part of the periodic rendering and settlement of accounts.
• The portfolio transfer clause is concerned with the transfer of liability for pre-existing business, a portfolio, from one set of reinsurers to another.
• The parties may agree to the retention by the reinsured of premium and/or loss reserves (or deposits). The premium reserves (or deposits) clause allows a reinsured to retain additional premium by requiring the reinsurer to deposit a fixed proportion of prior written premium. The loss reserves (or deposits) clause allows the reinsured to establish reserves for the reinsurer’s proportion of amounts outstanding to the treaty.
比例再保险措辞中使用的条款
• 分保条款规定了比例再保险的性质和主要条款，并规定了分保限额和分保保留，这些条款可能受到也可能不受其他再保险的保护。
• 会计条款要求分保人准备并向再保险公司发送定期账目。它规定了何时必须向再保险公司提供账户、账户中必须包含哪些详细信息以及何时应将这些账户的资金提供给再保险人，反之亦然。
• 保费条款规定，分保人将按照分保人就再保险协议所涵盖的业务所收到的原始毛（或净）保费的比例，向再保险人支付其相应份额的保费。
• 佣金条款规定了再保险人向分保人支付多少佣金以及何时支付。佣金有两种基本类型：分保佣金和利润佣金。
• 索赔条款涉及条约所有损失的通知和解决；索赔要么作为现金损失单独支付，要么作为定期提交和结算账目的一部分共同支付。
• 投资组合转让条款涉及将现有业务（投资组合）的责任从一组再保险公司转移到另一组再保险公司。
• 双方可同意分保人保留保费和/或损失准备金（或押金）。保费准备金（或押金）条款允许分保人通过要求再保险人存入先前承保保费的固定比例来保留额外保费。损失准备金（或存款）条款允许分保人根据再保险人未偿付条约金额的比例建立准备金。
Clauses used in non-proportional wordings
• The basis of the reinsurance contract: – on an RAD basis, reinsurers agree to assume liability for claims on risks or original policies attaching during the reinsurance period; – on an LOD basis, reinsurers agree to assume liability for claims occurring during the reinsurance period, irrespective of the inception dates of the original policies giving rise to the claims; – on a losses discovered or claims made basis, reinsurers agree to assume liability for losses that were discovered by, or claims that were notified to, the insurer during the reinsurance period.
• The UNL clause describes the loss to which the treaty limits (and deductibles) are applied. The UNL is the sum actually paid by the reinsured in settlement of losses or liability after agreed deductions. Those agreed deductions may or may not include recoveries from other reinsurances.
• The hours clause limits the individual losses arising from one event (or catastrophe) that may be aggregated by reference to peril, time and, on occasion, geography.
• The reinstatement clause limits the amount of cover by specifying the number of times the limit may be reinstated. Absent such a condition, there is no limit.
• The claims clauses address: – the notification (or reporting or advice) of losses and the provision of related information to reinsurers; – reinsurers’ obligations in relation to the reinsured’s loss settlements (that is, original loss payments), and what the reinsured must demonstrate to reinsurers in relation to its settlements to trigger those obligations (loss settlements clauses); and – reinsurers’ rights of involvement in the management and/or determination of the original claim.
• The salvage and subrogation clause sets out how recoveries from third parties are to be distributed between the reinsured and the reinsurer.
• The currency fluctuation clause enables the parties to share any fluctuation in the value of the currency of the original loss between the contract’s inception date and the loss settlement date.
• The index clause adjusts the limit and deductible by reference to an index to take into account inflation over a period of time.
• The aggregate extension clause allows a reinsured to present as one loss, separate and unrelated losses which it covered on an aggregate basis under the terms of the original policy.
• The claims series clause extends the cover provided by a casualty treaty to a ‘claims series event’, enabling all claims from a specific common cause which involve one original insured to be aggregated for the purposes of recovery.
• The sunset clause requires the reinsured to notify claims within a certain period beyond which the contract ceases to respond.
非比例再保险措辞中使用的条款
• 再保险合同的基础：– 在RAD基础（损失发生制）上，再保险公司同意对再保险期间所附的风险或原始保单的索赔承担责任；– 在LOD基础（索赔发生制）上，再保险公司同意对再保险期间发生的索赔承担责任，无论引起索赔的原始保单的生效日期如何；– 在发现损失或提出索赔的基础上，再保险公司同意对再保险期间保险公司发现的损失或通知的索赔承担责任。
• UNL 条款描述了适用条约限额（和免赔额）的损失。UNL是再保险人在约定的扣除额后为解决损失或责任而实际支付的金额。这些商定的扣除额可能包括也可能不包括其他再保险的赔付。
• 时间条款限制了因某一事件（或灾难）而造成的个人损失，这些损失可以根据危险、时间以及（有时）地理因素进行汇总。
• 复效条款通过指定可恢复限额的次数来限制承保金额。如果没有这样的条件，则默认没有限制。
• 索赔条款涉及：– 损失通知（或报告或建议）以及向再保险公司提供相关信息；– 再保险公司与分保人的损失理赔（即原始损失赔付）相关的义务，以及分保人必须向再保险公司证明与其理赔相关的内容以触发这些义务（损失理赔条款）；– 再保险公司参与管理和/或确定原始索赔的权利。
• 挽回残值和代位求偿条款规定了如何在分保人和再保险公司之间分配来自第三方的赔偿。
• 货币波动条款使双方能够分担合同开始日至损失结算日之间原始损失货币价值的波动。
• 指数条款参考指数调整限额和免赔额，以考虑一段时间内的通货膨胀。
• 合计扩展条款允许再保险人将其根据原保单条款以合计方式承保的单独且不相关的损失作为一项损失列报。
• 系列索赔条款将伤亡条约提供的承保范围扩展至“系列索赔事件”，使涉及一名原始被保险人的特定共同原因产生的所有索赔能够汇总起来以实现赔偿目的。
• 日落条款要求再保险人在一定期限内通知索赔，超过该期限合同将停止响应。
Treaty exclusions
• An exclusion is an express term of a contract that limits or reduces the extent of cover provided by that contract. Typically, they exclude un(re)insurable risks or risks reinsured elsewhere.
• A reinsurer has the burden of proving that a particular loss falls within an exclusion.
• Nuclear, pollution, war and terrorism exclusions are common to all forms of proportional and non-proportional reinsurances.
条约除外责任
• 除外责任是合同的明确条款，限制或减少该合同提供的承保范围。通常，它们排除不可（再）保险的风险或在其他地方再保险的风险。
• 再保险公司有责任证明特定损失属于除外责任。
• 核、污染、战争和恐怖主义除外责任是所有形式的比例和非比例再保险的常见除外。
Self-test questions（自测题）
1.What are the bases of cover under a non-proportional wording?
1.非比例措辞的保障基础是什么？
2.What is included and excluded from the UNL?
2.UNL 包括什么和不包括什么？
3.Which provision distinguishes a claims control clause from a claims cooperation clause?
3.索赔控制条款与索赔合作条款有何区别？
4.When would an interlocking clause apply?
4.联锁条款何时适用？
5.What are the provisions of the loss settlements clause in an excess of loss treaty?
5.超额损失条约中的损失赔偿条款有哪些规定？
6.What should be specified in an index clause?
6.指数条款中应该指定什么？
Answer（答案）
1 Non-proportional reinsurers may assume liability for losses on risks attaching during a specified period, for losses occurring during a specified period, irrespective of the inception dates of the original risk or policies, or for losses discovered or claims made during a specified period.
1 非比例再保险公司可以对特定期间内附加的风险损失、特定期间内发生的损失（无论原始风险或保单的起始日期如何）、或特定期间内发现的损失或提出的索赔承担责任。
2 According to the usual definition of ultimate net loss (UNL):
• The sum actually paid by the reinsured in settlement of the claim, with the exception of ex gratia claims, is included.
• Unless specifically excluded, expenses attributable to the claim – such as legal and loss adjustment expenses – are included.
• Usual office expenses and salaries payable by the reinsured are excluded.
• All recoveries, salvages, subrogations and recoveries under reinsurances which are to the benefit of this reinsurance are deducted.
2 根据最终净损失（UNL）的通常定义：
• 包括再保险人在理赔时实际支付的金额（通融赔付除外）。
• 除非明确排除，否则索赔所产生的费用（例如法律费用和损失调整费用）均包括在内。
• 通常的办公费用和分保人应付的工资不包括在内。
• 扣除再保险项下有利于本再保险的所有追偿、挽回残值、代位求偿和追回款。
3 A claims control clause allows a reinsurer to appoint adjusters to act on its behalf to control the investigation, adjustments and settlements in connection with the claim notified by the insured.
3 索赔控制条款允许再保险公司指定理算员代表其行事，以控制与被保险人通知的索赔有关的调查、理赔和和解。
4 When a reinsured has incurred losses under more than one policy but arising from the same occurrence or event, and the policies attach to different excess of loss treaty periods.
4 当再保险人因同一事件或事件而在多份保单下遭受损失，且这些保单附加不同的超额损失条约期限时。
5 Loss settlements made by the reinsured are binding upon the reinsurer provided they are within the terms and conditions of the original policies and within the terms and conditions of the reinsurance contract. The reinsurer undertakes to pay its share of losses upon reasonable evidence of the amount paid by the reinsured being given to the reinsurer.
5 分保人作出的损失赔偿，只要符合原保单的条款和条件以及再保险合同的条款和条件，对再保险公司具有约束力。再保险公司承诺根据分保人向再保险公司支付的合理证据支付其损失份额。
6 The index clause should specify:
• The index to be applied and its value at the base date.
• Whether indexation applies to all claims or to bodily injury claims only.
• Whether an excess or franchise is to apply and, if so, at what percentage.
6 指数条款应指定：
• 要应用的指数及其在基准日的值。
• 指数是否适用于所有索赔或仅适用于人身伤害索赔。
• 是否适用绝对或相对免赔额，如果适用，比例是多少。
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