Reinsurance - M97（Dip级30学分，选修）-《再保险》
往期精选：
（前述章节【Dip系列课程】M97-第七章-合同措辞D11-D11B）
D11C Claims series clause（连带索赔条款）
This clause extends the cover provided by a casualty treaty to a ‘claims series event’, enabling all claims from a specific common cause that involve one original insured to be aggregated for the purposes of recovery. In this way, the clause modifies the ‘event’ (or similar) to cater for public and/or products liability and professional indemnity policies.
该条款将意外伤害保险条款的承保范围扩展至 “索赔系列事件”，使涉及一个原始被保险人的、由特定共同原因引起的所有索赔都可以汇总在一起进行索赔。通过这种方式，该条款修改了 “事件”（或类似事件），以满足公共和/或产品责任以及专业赔偿保单的要求。
The standard clauses are known as TPX 1986 and TPX 1988 and the main elements of the latter are as follows:
• ‘Claims series event’ definition – for example, a series of claims arising from one specific common cause which is attributable to one design and/or specification and/or formula in products and/or services supplied by one and only one original insured.
• The statement that a ‘claims series event’ is deemed, for the purposes of the reinsurance contract, to be an event with a date of loss (as determined).
• ‘Date of loss’ definition applicable to ‘claims made’ and ‘losses occurring’ policies: – in relation to ‘claims made’ policies, the date of loss is the date the original insured is first advised, in writing, of the first claim of the ‘claim series event’; – in relation to ‘losses occurring’ policies, or a combination of ‘claims made’ and ‘losses occurring’ policies, the date of loss is the date on which the first loss of such a ‘claims series event’ occurred. Be aware that the corresponding provision in the TPX 1986 is very different, namely, the date of written notification by the reinsured to reinsurers of the possibility of a ‘claims series event’.
• There are special reporting provisions requiring notification to reinsurers within 90 days of the reinsured having knowledge of any claims series event involving five or more claimants, or the reinsured establishing a reserve for a claims series event in excess of 25% of the retention.
• A list of exclusions including all losses occurring before 1986, and claims part of a claims series event that arise from any policy issued or renewed after notification of such an event.
标准条款称为 TPX 1986 和 TPX 1988，后者的主要内容如下：
• 索赔系列事件 “的定义——例如，由一个特定的共同原因引起的一系列索赔，这些原因可归因于一个且仅有一个原始被保险人提供的产品和/或服务中的一个设计和/或规格和/或配方。
• 就再保险合同而言，”索赔系列事件 “被视为具有损失日期（已确定）的事件。
• “损失日期”的定义适用于 “索赔发生 “和 “损失发生 “保单：–就 “索赔发生 “保单而言，损失日期是原始被保险人首次被书面告知 “理赔系列事件 “中第一笔索赔的日期；–就 “损失发生 “保单或 “索赔发生 “和 “损失发生 “保单的组合而言，损失日期是此类 “理赔系列事件 “中第一笔损失发生的日期。要注意的是，1986 年 TPX 中的相应条款有很大不同，即分保人书面通知再保险人可能发生 “索赔系列事件 “的日期。
• 其中有特殊的报告规定，要求分保人在了解到任何涉及五个或五个以上索赔人的索赔系列事件，或分保人为索赔系列事件建立的准备金超过自留额的 25%后 90 天内通知再保险人。
• 除外责任清单，包括 1986 年前发生的所有损失，以及在接到此类事件通知后签发或续保的任何保单所产生的索赔系列事件中的部分索赔。
D11D Commutation clause（折算条款）
In the commutation clause, the parties agree to close off (or commute) all claims under the reinsurance contract, extinguishing a reinsurer’s known and unknown liabilities. In return for a single payment, the reinsured grants the reinsurer a full and final release from all past, present and future obligations under the contract.
在折算条款中，双方同意关闭（或折算）再保险合同下的所有索赔，消除再保险人已知和未知的责任。作为一次性付款的回报，分保人授予再保险人对合同项下所有过去、现在和未来义务的完全和最终免除。
Commutation may be optional or mandatory. If mandatory, the parties must come to an agreement on the terms and the amount of the payment necessary to discharge the reinsurer of its liability. Such a clause typically details the mechanism for valuing that liability and, if the parties cannot agree, for settling the dispute (usually with the assistance of one or more actuaries).
折算可以是选择性的，也可以是强制性的。如果是强制性的，双方必须就解除再保险人责任所需的付款条件和金额达成协议。此类条款通常详细规定了对该责任进行估价的机制，如果双方无法达成一致，则规定了解决争议的机制（通常在一名或多名精算师的协助下）。
D11E Sunset clause（日落条款）
The sunset clause requires the reinsured to notify claims within a certain period, beyond which the contract ceases to respond. In other words, the sun sets on claims not reported to reinsurers within, for example, five years of expiry of the reinsurance treaty. This type of clause is usually found on old US non-proportional casualty treaties.
日落条款要求分保人在一定期限内通知理赔，超过此期限，合同不再生效。换句话说，在再保险条款到期后的五年内未向再保险人报告的索赔不再有效。这类条款通常出现在旧的美国非比例意外险条约中。
The clause requires the reinsured to notify reinsurers, within the requisite period, of all outstanding occurrences that have not been settled and may give rise to a claim under the reinsurance contract. If not listed (or reported), no liability attaches under the reinsurance contract and they are lost to the contract.
该条款要求分保人在规定期限内通知再保险人所有尚未解决且可能引起再保险合同项下索赔的未决事故。如果没有列出（或报告），则不承担再保险合同项下的任何责任，这些事故也就失去了合同的效力。
D11F Extended claims reporting clause（扩展索赔报告条款）
The extended claims reporting clause is an extended version of the previously discussed claims notification and handling clauses. The clause serves to require the reporting of three types of claims:
• claims valued in excess of a specified percentage of the retention irrespective of liability;
• certain types of serious bodily injuries irrespective of value or liability; and
• claims involving periodical payments under the Damages Act 1986 (as amended).
扩展索赔报告条款是之前讨论过的索赔通知和处理条款的扩展版本。该条款要求报告三类索赔：
• 无论责任大小，价值超过自留额特定百分比的索赔；
• 某些类型的严重人身伤害，不论价值或责任；以及
• 根据《1986 年损害赔偿法》（经修订）涉及定期付款的索赔。
感谢阅读，欢迎打赏。
记得分享朋友圈打卡哦！
关注本sir，向更优秀的自己前进！
