Protocol of the "procedure to follow in case of loss" pro forma (Text THB Mx 09/10 "A")

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1 Protocol of the "procedure to follow in case of loss" pro forma (Text THB Mx 09/10 "A") Assured: Type of Business: Policy: Period: The present Protocol, establishing the procedure to be followed upon becoming aware of the occurrence of an event that may affect the risk to which it applies, is hereby agreed in order to comply with the Claims Control or Cooperation Clause (Annex 1). The Parties The Insurance Company: and the Leading Reinsurer(s): 1) 2) 3) 4) Jointly appoint through (Reinsurance broker): Adjuster: for minor losses Adjuster: for major losses Adjuster for all losses: As the designated adjuster(s) to adjust each and every loss affecting the above mentioned policy, the tasks of the adjuster(s) will include, but not be limited to, the following: 1) to asses the damage 2) to determine and document its causes 3) to quantify the loss 4) to recommend the payment of advances 5) to calculate the recommended indemnity according to the policy s terms and conditions (adjustment) 6) to produce an adjustment report in Spanish and English, if required, accompanied by all the relevant supporting documents including a photographic report. Based on Article 18 of the Insurance Contract Law, which establishes that Even if the Insurer obtains reinsurance against the risks that it has insured, it will remain the only liable party in respect of the Insured, the Adjuster will be obliged to provide the Insurance Company, as required by it, all the information related to the loss, including, but not limited to: 1. updated information, in writing or electronically, 1

2 2. copies or originals of the documents received from the Insured, affected third party, experts or any other party involved in the adjustment, 3. anything else provided to the Adjuster in this capacity. The Adjuster will provide the adjustment report in the shortest possible time but always within 15 days from having received all the information required from the Insurance Company and the Insured and/or any other party designated by the latter to provide it The Adjuster will provide the Insurance Company and the Leading Reinsurer(s) the necessary elements and will recommend whether the claim should be indemnified or not. The Insurance Company will hold a meeting with the Adjuster in order to notify them of their appointment in the policy and if this is not possible it will notify them in writing. The parties signing this Protocol undertake to carry out all the actions established in it, having agreed that this is the most convenient way to obtain an accurate indemnity in benefit of all parties and, therefore, they agree the following procedure: Procedure in Case of Loss 1) The Insured will notify the Insurance Company of the occurrence of a loss through the individuals, telephone numbers and electronic mail addresses that appear in the Insurance Policy. In this first notification, the Insured will provide the Insurance Company with all the available information that might allow them to make a first assessment of the events and to identify the policy that may be affected. The information provided in this notification will include, but not be limited to, the list below. It constitutes the minimum required and it is only intended to be the means of reporting the occurrence of the loss to the Insurance Company for the first time: 1. policy number; 2. brief description of the circumstances of the loss; 3. preliminary estimation of the quantum of the loss; this will not have effects on the final amount of indemnity (as far as possible); 4. description of the damaged objects or assets; 5. location/address of the damaged object or injured person; 6. persons to be contacted to initiate the claims handling procedure and to carry out the first inspection of the damages, informing their positions, telephone numbers and electronic mail addresses. 2) Immediately after receiving this notice from the Insured, the Insurance Company will send the Adjuster a notice of occurrence of a loss with the details available in order to instruct him to contact the Insured and commence the adjustment process. 3) The Adjuster will issue and sent a preliminary loss notice within 7 days after having received the notification of occurrence and/or having inspected the damage and send it to the Insurance Company, Reinsurer(s) and reinsurance broker, with the information available so far. All subsequent reports produced by the Adjuster will be sent immediately and simultaneously to the Insurance Company, Reinsurer(s) and the Reinsurance Broker. 4) The Adjuster, jointly appointed by the Insurance Company and Reinsurer(s), will carry out the adjustment process requesting all the necessary information from the Insured in order to determine 2

3 the amount that should be indemnified according to the policy s terms and conditions. The costs and expenses incurred by adjusters and experts will be considered in addition to the maximum limit of liability contracted and will be added to the loss amount so that they are absorbed proportionally (according to the reinsurance distribution and placement) by the Insurance Company and the Reinsurer(s) participating in the risk. If no indemnity is payable or if its value is found to be lower than the deductible, the costs and expenses incurred by the Adjuster and experts will be paid in the same proportional manner in which they participate in the risk, avoiding inappropriate payments to the insured and in the best interest of the Reinsurer(s) and the Insurance Company. 5) For losses higher than one million Dollars, the Adjuster will issue a monthly report on the progress of the case describing the actions taken during that period and the status of the loss. In turn, the Reinsurer(s) will reply to the report with their comments if any and in the case of the final report with the recommendation on claim settlement, with their agreement and/or comment s within a maximum period of 7 working days. For losses of lower values the report will be issued quarterly at the most. In turn, the Reinsurer(s) will reply to the report with their comments if any and in the case of the final report with the recommendation on claim settlement, with their agreement and/or comment s within a maximum period of 7 working days. 6) Simultaneously to the notification of occurrence of a loss sent to the Adjuster, the Insurance Company will send the Reinsurance broker a notice of the occurrence of the loss with the information that will allow the Broker to identify the event and the cover note that may result affected. 7) The Reinsurance Broker will notify the Reinsurer(s), either directly or through its conduct, of the notification of occurrence of a loss received from the Insurance Company within 5 working days after having received it and will inform them that the appointed Adjuster is aware and the adjustment process in under way. All reports subsequently produced by the Adjuster will be sent immediately to the Reinsurance Broker by the Insurance Company and the former will inform the Reinsurer(s) either directly or through their conduct. 8) The Reinsurer(s) leader(s) or the reinsurers Lloyd's broker will acknowledge receipt of the notice from the Reinsurance Broker within a period not exceeding 7 working days, specifying whether it requires additional information to the one normally required by an adjuster to carry out its work. If the amount of the loss justifies it and the Reinsurer requires it, a meeting with the Adjuster will be held to allow him to present and explain the case in detail. The time frames determined for each party to comply with the tasks allocated to them by this Protocol must contribute to comply with the obligation established by article 71 of the Law establishing the period within which the beneficiary must be indemnified. It reads as follows: ARTICLE 71 Insurance Contract Law: The credit arising from an insurance contract will become due 30 days after the date in which the Company has received the documents and information that allow it to know the basis of the claim. Any contractual clause establishing that the credit cannot be demanded until it has been recognised by the Company or proven in court will be null The Reinsurer(s) therefore undertake to, upon signature of the indemnity agreement by the Insurance Company and the Assured, pay the part due by them within 20 calendar days after the date of signature of such agreement and after receipt of the payment request and all the information justifying and giving grounds for the claim and the indemnified loss, according to the terms and 3

4 conditions agreed in the Reinsurance contract. The same period will be applicable to advance payments following a recommendation from the Adjuster and agreement from Reinsurers. Reinsurers will not require proof of payment of the direct claim before releasing reinsurance money to the Insurance Company. The Insurance Company will pay the Insured immediately after receiving the money from reinsurers and provide evidence of this via the reinsurance broker or directly to the reinsurers. In the event that payment of an original policy claim is delayed as a direct consequence of delays for which reinsurers are responsible then reinsurers will respond proportionally to any interest payments, fines or sanctions imposed upon the original insurer for such delay. Reinsurers will also follow the settlement (i.e. not commercial) understood as the application of the terms and conditions, limits and covers of the reinsurance contract in relation to the credit arising from rejecting payment of a claim covered in the reinsurance contract and rejected by Reinsurers. Note: Contact details of all the parties involved in the handling of claims are attached as part of this Protocol. signature in accordance Adjuster Reinsurance broker Insurance Company Leading Reinsurers 4

5 Annex 1 Claims Control Clause Notwithstanding anything to the contrary contained in this Reinsurance it is a condition precedent to Reinsurers' liability under this Reinsurance that: (a) The Reinsured shall give to the Reinsurer(s) written notice as soon as reasonably practicable of any claim made against the Reinsured in respect of the business reinsured hereby or of its being notified of any circumstances which could give rise to such a claim. (b) The Reinsured shall furnish the Reinsurer(s) with all information known to the Reinsured in respect of claims or possible claims notified in accordance with (a) above and shall thereafter keep the Reinsurer(s) fully informed as regards all developments relating thereto as soon as reasonably practicable. (c) The Reinsurer(s) shall have the right at any time to appoint adjusters and/or representatives to act on their behalf to control all investigations, adjustments and settlements in connection with any claim notified to the Reinsurer(s) as aforesaid. (d) The Reinsured shall co-operate with the Reinsurer(s) and any other person or persons designated by the Reinsurer(s) in the investigation, adjustment and settlement of such claim. 1/1/97 NMA2738 5

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