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-第八章-再保险相关的法律问题D5-E）
F Measures to avoid disputes（避免纠纷的措施）
The consequences of disputes can be very serious for all parties. Disputes can result in claims being repudiated and uncollected, professional indemnity claims for brokers and loss of reputation.
纠纷的后果对各方来说都非常严重。纠纷可能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。
A number of situations that give rise to disputes can be avoided by monitoring and review procedures. In this section we have examples of actual situations that caused disputes, with notes on how the issues could have been prevented or how they were resolved.
通过监控和审查程序可以避免许多引起纠纷的情况。本节中，我们列举了引起纠纷的实际情况，并说明了如何预防或解决这些问题。
F1 Not complying with claims clauses（不遵守索赔条款）
CGX Insurance Company wrote motor and employer’s liability and was protected by a motor and liability excess of loss programme. The reinsurance programme was subject to a claims co-operation clause. This specified that all claims involving death, brain damage or spinal injury should be reported to reinsurers immediately, irrespective of the level of the initial reserve. CGX’s procedure was to only advise reinsurers of claims that were reserved at monetary amounts that exceeded the retention of the first excess of loss layer. CGX also had a procedure to initially enter into their system a reserve of £100 for each bodily injury claim, with the intention of updating the reserve once medical reports and legal opinions had been received.
CGX 保险公司承保了汽车和雇主责任，并受到汽车和责任超额损失计划的保护。再保险计划受索赔合作条款的约束。该条款规定，所有涉及死亡、脑损伤或脊髓损伤的索赔都应立即报告给再保险公司，无论初始准备金的水平如何。CGX 的程序是只通知再保险公司，其保留金额超过第一层超额损失保留的索赔。CGX 还制定了一项程序，最初将每起人身伤害索赔的 100 英镑储备金输入其系统，目的是在收到医疗报告和法律意见后更新储备金。
In practice a number of these claims, which involved spinal injury or brain damage, were reserved at £100 for about two years. On receipt of medical and legal reports, the individual reserves on some of these claims jumped to between £1m and £4m. At that point CGX reported the claims to the reinsurers. Reinsurers repudiated liability on the grounds that these losses were reported two years late.
实际上，许多涉及脊髓损伤或脑损伤的索赔被保留 100 英镑约两年。在收到医疗和法律报告后，其中一些索赔的个人储备金跃升至 100 万至 400 万英镑之间。此时 CGX 向再保险公司报告了索赔。再保险公司以这些损失报告晚了两年为由拒绝承担责任。
Meanwhile, with the assistance of the reinsurance broker, CGX held internal claims seminars and upgraded internal systems and procedures to ensure that all serious bodily injury claims were reported immediately to reinsurers. Ongoing discussions were held involving CGX, the broker and the reinsurers. CGX apologised, explained that the late reporting was a genuine oversight and advised of the new procedures that were now in place. The reinsurers finally agreed to pay the claims.
同时，在再保险经纪人的协助下，CGX 举办了内部索赔研讨会并升级了内部系统和程序，以确保所有严重的人身伤害索赔都立即报告给再保险公司。CGX、经纪人和再保险公司之间进行了持续的讨论。CGX 道歉，解释说延迟报告是真正的疏忽，并告知了现在实施的新程序。再保险公司最终同意支付索赔。
This situation would never have occurred if CGX had the correct internal procedures at the outset. This case was finally resolved amicably, but reinsurers would have been within their rights to repudiate the claims, which totalled several million.
如果 CGX 一开始就采用正确的内部程序，这种情况就不会发生。此案最终得到友好解决，但再保险公司有权拒绝赔偿总额达数百万的索赔。
There have been a number of other cases where reinsurers have categorically repudiated liability where there have been clear cut breaches of the claims reporting and claims co-operation clauses.
还有许多其他案件，再保险公司断然拒绝赔偿责任，这些案件明显违反了索赔报告和索赔合作条款。
F2 Non-disclosure of material information（未披露重大信息）
BLG Insurance Company wrote property insurance through various overseas agencies. This was protected by a surplus treaty with a Cat XL programme for the net retention.
BLG 保险公司通过各种海外代理机构签发财产保险。这受到与 Cat XL 计划签订的溢额再保险条约的保护，以获得净留存。
Several years after the surplus treaty was first placed, BLG decided to cede a number of smaller risks to the surplus treaty that were previously 100% retained. BLG wrote letters to reinsurers to advise of this change. There were however several reinsurers who BLG inadvertently omitted from the circulation list and which were never advised. There was no endorsement to the placing slip or to the treaty wording, and no formal update to the information presentation.
在溢额合约首次签订几年后，BLG 决定将一些之前 100% 自留的较小风险转让给溢额合约。BLG 致信再保险公司告知这一变化。然而，BLG 无意中将几家再保险公司从流通名单中遗漏，并且从未通知过他们。没有对再保险配售单（即承保凭证）或合约措辞进行背书，也没有对信息呈现进行正式更新。
A hurricane caused a huge loss to BLG’s Caribbean account. Virtually all the risks damaged by the hurricane were the smaller risks that BLG had previously retained 100%, but which at the date of the hurricane had been ceded to the Treaty. BLG submitted a claim to the surplus treaty reinsurers.
一场飓风给 BLG 的加勒比账户造成了巨大损失。几乎所有受飓风损害的风险都是 BLG 之前 100% 自留的较小风险，但在飓风发生之日，这些风险已转让给合约。BLG 向溢额合约再保险公司提交了索赔。
All the reinsurers initially disputed the claim on the grounds that ceding the smaller risks was never specified in the placing information. BLG produced the letters that were sent advising reinsurers of the change and the reinsurers that received the letters eventually agreed to settle their share of the claim. The reinsurers that did not receive the letters, however, repudiated liability on the ground of non-disclosure and that left BLG with a sizeable amount that was uncollected.
所有再保险公司最初都对索赔提出异议，理由是配售信息中从未指定转让较小风险。BLG 出具了通知再保险公司变更的信件，收到信件的再保险公司最终同意解决其应承担的索赔份额。然而，未收到信件的再保险公司以未披露为由拒绝承担责任，导致 BLG 有相当一部分金额未收回。
The proportion of the risks ceded to the surplus treaty could not be added to the ultimate net loss for purposes of recovery from the Cat XLs. Excess of loss treaties specifically exclude claims amounts that cannot be recovered from other treaty arrangements.
转让给溢额条约的风险比例不能加到最终净损失中，以便从 Cat XL 中收回。超额损失条约明确排除了无法从其他合同安排中收回的索赔金额。
Key measures that can be taken to avoid inadvertent non-disclosure include:
• A thorough review of the information and slip wording before each renewal to ensure all information and coverage is correct and adequate for the forthcoming year.
• Quarterly or half yearly review meetings to cover the reinsured’s activities and developments and to ascertain if any changes should be made to the treaty documents that would need to be agreed and signed by all reinsurers. The reviews could also include a cross check of the information. Significant changes could be advised to reinsurers by way of an ‘information endorsement’ to be signed by all reinsurers.
为避免无意间不披露信息，可以采取的关键措施包括：
• 每次续保前彻底审查信息和单据措辞，以确保所有信息和保险范围在来年都是正确且充分的。
• 每季度或每半年召开一次审查会议，以涵盖分保人的活动和发展情况，并确定是否应对条约文件进行任何需要所有再保险公司同意和签署的变更。审查还可以包括对信息的交叉核对。可以通过由所有再保险公司签署的“信息背书”向再保险公司通报重大变更。
All reinsurance treaty contracts contain an inspection of records clause. This allows reinsurers to visit the reinsured’s offices and look through all manual and electronic files relevant to the business reinsured. Reinsured’s that are deliberately, or inadvertently, guilty of non-disclosure run the risk of being caught out.
所有再保险条约合同都包含记录检查条款。这允许再保险人访问分保人的办公室并查看与再保险业务相关的所有纸质和电子文件。故意或无意地不披露信息的分保人有被发现的风险。
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