连锁超市保险索赔手册P34（34页）.pdf

1、Insurance Claims Manual Carrefour China/Finance/Insurance Page 1 of 34 Carrefour INSURANCE CLAIMS MANUAL 保险索赔手册保险索赔手册 Organizations Affected : Head Office, Joint Ventures and all Stores Periodic Compliance Checking : China Finance Division Procedure Organized By: Finance Department / Marsh / Aon-COF

2、CO Approved By: Financial Director Version: FA/V1.0 Effective Date: January 01, 2005 Date Validated: January 01 , 2005 Insurance Claims Manual Carrefour China/Finance/Insurance Page 2 of 34 Carrefour CONTENTS 1. Introduction Page 4 序言序言 第 4页 2. Involved Parties and Responsibilities Page 4 保险相关方及其职责保

3、险相关方及其职责 第 4页 3. Insurance Program Summary Page 6 保险计划综述保险计划综述 第 6页 Property all risks (extended to Cover Machinery Breakdown) 财产一切险（扩展机器损坏险） Business Interruption 利润损失险 Money Insurance 现金保险 Fidelity Guarantee 雇员忠诚险 Products Liabilities Insurance 产品责任险 Public Liability Insurance 公众责任险 Employers Liab

4、ility Insurance 雇主责任险 4. Claim Process Page 15 索赔流程索赔流程 第 15页 5. Claim Advice Page 18 索赔要点索赔要点 第 18页 6. Claim Procedures Page 19 各险种项下的索赔程序各险种项下的索赔程序 第 19页 Property all risks (extended to Cover Machinery Breakdown) 财产一切险（扩展机器损坏险） Business Interruption 利润损失险 Money Insurance 现金保险 Fidelity Guarantee 雇员

5、忠诚险 Public and Products Liabilities Insurance Insurance Claims Manual Carrefour China/Finance/Insurance Page 3 of 34 Carrefour 公众及产品责任险 Employers Liability Insurance 雇主责任险 Insurance Claims Manual Carrefour China/Finance/Insurance Page 4 of 34 Carrefour 7. List of Claim Documents Page 25 索赔单证一览表索赔单证一

6、览表 第 25页 8. Contact Information Page 25 联络资料联络资料 第 25页 9. Appendix Page 27 附件附件 第 27页 Loss Notification Form 出险通知书 Loss Notice (for Carrefour Internal Purpose) 损失通知单（供家乐福内部使用） Claim Report 索赔报告 Claim List 损失清单 Subrogation Form 权益转让书 Declaration Form 声明书 Discharge Form 接受书/ 接触责任书 Claim Receipt 赔款收据 C

7、laim Cancellation Form 撤销赔案通知书 Monthly Claim Status Report 月度赔案报表 10. Chart of Communication Channel Page 33 沟通渠道图沟通渠道图 第 33页 Insurance Claims Manual Carrefour China/Finance/Insurance Page 5 of 34 Carrefour 1. Introduction This manual is prepared for the reference of Carrefour China in handling clai

8、ms under all the insurance types effected by Carrefour China. Please comprehensively understand these claim procedures in order to proceed with the claims smoothly and efficiently. This manual is not designed to cover each and every situation. However, it will give guidance for Carrefour China to ca

9、rry out preliminary actions to file a claim. If any questions arise, please seek assistance from Marsh Insurance Date of site incorporation for the other stores/operations as per attached table 10 Excess 所有已注册的家乐福代表处办公室和/或在中华人 民共和国境内已成立的或今后可能成为家乐福管 理控制或合资的附属公司和关联公司，但以各自的 可保利益为限。 2 业务性质 主要但不限于大型超级市场、

10、超级市场及相关业 务。 3 保险期限 2005年 1月 1日 0:00至 2005年 12月 31日 24:00 4 保险地址 主要但不限于在附表中列明的保险地址以及其它 被保险人在中华人民共和国境内拥有财产、营业、 财产仓储或处理地，包括供应商或客户所在地，财 产寄放处或仓库、商品展览地等等。 5 地域限制 中华人民共和国（不包括港、澳、台） 6 司法管辖 适用中华人民共和国司法管辖 7 保险标的 所有被保险人业务范围内的商品及提供的服务 8 保单格式 索赔发生制 9 追溯期 自 1999年 1月 1日起开张的门店， 具体日期见附件 10 免赔额 每次事故 RMB20,000 11 赔偿限额

11、 Insurance Claims Manual Carrefour China/Finance/Insurance Page 10 of 34 Carrefour RMB20, 000 any one accident 11 Limit of Liability RMB50,000,000 (Equivalent to EURO5,000,000) any one accident 9 Deductible Five days for temporary disablement 10 Premium Rate For local employees: 0.21% For expatriate

12、 employees: 0.41% 11 Special Provisions 1) 30 Days Notice of Cancellation by Insurer 2) Immediate Notice of Cancellation by Insured 3) Journeys between Employees Home and Place of Work 4) Business Trip Abroad 5) Social & Recreational Activities 6) Automatic Cover for New Employees 7) Nominated Loss

13、Adjuster 8) Y2K Clause 9) Non-professional disease expenses exclusion 暂时性丧失工作能力： 雇员暂时性丧失工作能力超过 5天的，在此期 间，经医生证明，按照雇员工资给予赔偿。 3) 保险公司对本保单项下承担由于一次事故导 致一个或多个雇员产生的损失，以每人 RMB1,500,000为限 4) 雇主责任 兹经双方同意，本保单在被保险人完全遵守本 保单条件的情况下同意扩展，在中华人民共和 国境内经法庭审判被保险人被判定有义务对雇 员进行赔偿。 限额：每次事故 RMB1,000,000 5) 住院现金标准：每人每天 RMB20 9

14、 免配额 暂时性丧失工作能力：5天 10 费率 国内雇员：0.21% 外国雇员：0.41% 11 特别条款 1) 提前三十天通知注销保险条款 2) 被保险人随时通知取消保单 3) 扩展承保雇员上下班途中 4) 海外出差条款 5) 社交、娱乐活动责任条款 6) 自动承保新雇员条款 7) 指定公估理算师条款 8) 责任险 2000年问题除外责任条款 9) 非职业病医疗费用除外责任条款 12 特别约定 1) 家乐福中国店雇员内部流动不影响本保单效力 Insurance Claims Manual Carrefour China/Finance/Insurance Page 16 of 34 Carr

15、efour 12 Remarks 1) The internal transfer of employees among Carrefour China stores / operations shall not prejudice the right of Carrefour China to claim under this policy. 2) One master policy is issued with separate declaration and debit note for individual store / operation. 3) New stores and of

16、fices will be reported on quarterly basis, endorsement issued and premium paid accordingly. 4. Claim Process 1 Loss Notification On the occurrence of any incident likely to give rise to a claim, an immediate notification should be given to Pierre Leong Adjusters (Shanghai) Co., Ltd. at first time. P

17、roperty Insurance Upon receipt of claims, Pierre Leong will see if a site survey should be arranged in case of the claim amount is vast or the circumstances are complicated, and report the loss to PICC Shenzhen within one working day as well as to Marsh. Liability Insurance Upon receipt of claims, P

18、ierre Leong will refer to PICC Shanghai to see if a site survey should be arranged. 1) Upon receipt of claims, Pierre Leong will report to PICC Shanghai in one working day. 2) PICC Shanghai will reply if a site survey should be arranged in one working day. Meanwhile, Business Controllers of the stor

19、es or offices must send “LOSS NOTICE (for Carrefour Internal Purpose)” by email to Mr. Ruben Duan, Finance Division of Carrefour China Head Office, within one working day. 2) 签发一个总保单但分别对每个单独的商店/营业 场所开出发票 3) 新的门店或办公室按季度申报， 保险公司开具 批单收费 4. 索赔流程索赔流程 1 损失通知 一旦发生可能导致保单项下索赔的事故时，家乐福 应立即通知平量行（必须是第一时间）。 财产保险

20、平量行在接到出险通知后，视赔案大小，根据 以往经验以及是否在保险责任范围内，自行确 定是否立即到达现场查勘， 并在1个工作日内书 面通知深圳人保。如果赔案金额较大或情况较 为复杂，平量行应将损失情况告知达信。 责任保险 平量行在接到出险通知后，视赔案大小，听候 上海人保的意见，确定是否到达现场查勘。 1) 平量行在接到报案后于1个工作日内书面 通知上海人保。 2) 上海人保在1个工作日内答复是否进行现 场勘察。 同时，各门店或办公室的营运监控主管必须于1个工 作日内以电子邮件方式提供 “损失通知单 （家乐福内 部用） ” 给家乐福中国区总部财务部段志奇先生。 表 格见第31页附表3 2 现场查

21、勘 Insurance Claims Manual Carrefour China/Finance/Insurance Page 17 of 34 Carrefour Please refer to Table 3 on page 31 for the format 2 Site Survey Upon receipt of Immediate Notification, Pierre Leong will arrange loss adjusters to carry out site survey based on the concrete circumstances to find ou

22、t the real cause of the case, and ascertain the policy liability. Meanwhile, the loss sum can be ascertained according to the extent of bodily injury and the loss quantity of the object insured. If Carrefour has any questions about the work of Pierre Leong, contact with Marsh or Aon-COFCO in due cou

23、rse. Property Insurance 1) For the claims of clear policy liability, do carry out repair work immediately under instruction of Pierre Leong, who will report the loss to PICC Shenzhen in one working day. 2) For the complicated cases, Pierre Leong will report to PICC Shenzhen and Marsh firstly. After

24、negotiation between PICC Shenzhen and Marsh, PICC Shenzhen will give direction to Pierre Leong to carry out instruction work for Carrefour. 3) For both captioned circumstances, Pierre Leong should give immediate report to PICC Shenzhen in three working days. Liability Insurance 1) For the claims not

25、 need site survey, Pierre Leong should give immediate report to PICC Shenzhen in three working days. 2) For the claims need site survey, Pierre Leong will contact with Carrefour to arrange site survey within one working day after receiving instruction of PICC Shanghai. After investigation, Pierre Le

26、ong will submit immediate report to PICC Shanghai in three days. 平量行根据赔案的具体情况安排人员进行现场查 勘，了解事故原因，根据标的损失数量及程度核定 损失金额。家乐福应全力与平量行合作。如家乐福 对平量行的建议或方法有任何异议，请及时与达信 或中怡联系。 财产保险 1) 对于保险责任明确的赔案，由平量行自行 指导家乐福进行及时的抢修工作，并于1 个工作日内书面通知深圳人保。 2) 对于保险责任不明确的赔案，平量行应及 时通知深圳人保和达信，深圳人保在与达 信沟通后于1个工作日内作出处理指示。 平 量行在收到深圳人保的指示后应

27、及时指导 家乐福进行修复工作。 3) 针对以上两种情况， 平量行需在3个工作日 内出具即时报告，书面递送至深圳人保。 责任保险 1) 对于不需现场勘察的赔案， 平量行在3个工 作日内出具即时报告，书面递送至上海人 保。 2) 对于需要现场勘察的赔案，平量行在收到 上海人保指示后的1个工作日内， 与家乐福 相关门店联系勘察。 在勘察定损后3个工作 日内出具即时报告， 书面递送至上海人保。 3) 上海人保审核报告， 并在3个工作日内就赔 案作出书面答复， 列明所需索赔文件清单， 递至平量行。 Insurance Claims Manual Carrefour China/Finance/Insur

28、ance Page 18 of 34 Carrefour 3) Within three days, PICC Shanghai will reply for the claims and list out the necessary claim materials to Pierre Leong after checking the report. 3 Claim Materials Providing Do provide any relevant documents, invoices and vouchers involved in the claims to Pierre Leong

29、 as soon as possible. Our loss adjusters will check all the submitted evidences and list out the complementary materials we need in written if it is necessary, so as to ascertain the loss. Property Insurance 1) According to the routine method and regulations, Pierre Leong will inform Store the relev

30、ant documents and materials needed within three working days. 2) Upon receipt of the claim documents, Pierre Leong will check and submit the final report to PICC Shenzhen in five working days incase of the documents are all ready. On the other hand, Pierre Leong will inform Store the complementary m

31、aterials needed in written in one working day. Liability Insurance 1) Upon receipt of claim reply from PICC Shanghai, Pierre Leong will inform Store the relevant documents and materials needed within three working days. 2) Upon receipt of the claim documents from Store, Pierre Leong will check and s

32、ubmit the final report to PICC Shanghai in five working days incase of the documents are all ready. On the other hand, Pierre Leong will inform Store the complementary materials needed in written in one working day. 3 单证提交 家乐福应提供相关的资料、凭证、单据作为索赔依 据，并尽快寄给平量行。延误提交会导致记忆模糊 或单证遗失，造成理赔困难。 财产保险 1) 平量行根据以往惯例

33、及规定，在收到出险 通知的3个工作日内书面通知家乐福相关 门店应提交的赔案所需单证。 2) 在收到家乐福相关门店寄送的文件之后， 平量行应立即进行审核，如单证齐全，平 量行应在收到文件之日起5个工作日内出 具终期报告，书面递至深圳人保；如单证 不全， 平量行应在收到文件之日起1个工作 日内，以书面形式通知家乐福相关门店补 充索赔单证。 责任保险 1) 平量行在收到上海人保对赔案的书面答复 后的3个工作日内书面通知家乐福相关门 店应提交的相关文件清单。 2) 在收到家乐福相关门店寄送的文件之后， 平量行应立即进行审核，如单证齐全，平 量行应在收到文件之日起5个工作日内出 具终期报告，书面递至上海

34、人保；如单证 不全， 平量行应在收到文件之日起1个工作 日内，以书面形式通知家乐福相关门店补 充索赔单证。 4 理算结案 保险公司在收到平量行的终期报告后应审核单证 是否齐全；如单证齐全并对索赔金额无异议，保险 公司应在 10 个工作日内将赔款划至家乐福相关门 店；如单证不全，保险公司应在收到终期报告之日 Insurance Claims Manual Carrefour China/Finance/Insurance Page 19 of 34 Carrefour 4 Loss Adjustment After receiving the final report and check all

35、 the documents, the Insurers will pay the compensation sum to relevant Store in ten working days incase of the evidences are all ready and without any doubts. Otherwise, the Insurers will notify Pierre Leong to submit complementary evidences in written within three working days. For those disputed c

36、laims, the Insurers will notify Pierre Leong with such disputed aspects in written and forward to Marsh or Aon-COFCO. The loss adjustment result should be accepted both by the Insurers and the Insured. In the event of any disputation, negotiation among the Insurers, loss adjusters, insurance brokers

37、 and the Insured is preferred. 5 Subrogation In the event of the incident was caused by third party, the insured should assist the insurers to subrogate from the third party after receiving the compensation sum. 5. Claim Advice 1 Loss Notification On the occurrence of any incident likely to give ris

38、e to a claim, first notification should be given to Pierre Leong in order not to cause delay to the remedial works. The Incident Notification (Affix 1) should be completed as required: - Time of incident - Place - Brief description, including the cause of incident - Damage extent and preliminary los

39、s assessment - Name, address and contact method of witness - Initial measures 2 Initial Measures 起 3个工作日内，书面通知平量行补充资料详情； 如对索赔金额等持有异议，保险公司应在收到终期 报告之日起 3个工作日内，书面通知平量行异议细 节，并同时抄送达信或中怡。 保险双方应对理赔结果达到共识，一旦发生争议， 由保险人、损失理算人、保险顾问和被保险人协商 解决。 5 追偿 被保险人在收到赔款后， 如保险事故是由第三方造 成的，被保险人应协助保险公司向第三方进行追 偿。 5. 索赔要点索赔要点 1

40、损失通知 当发生保单项下的索赔事故时，无论预期的损失金 额是否在保单免赔额以内，请立即通知平量行。延 迟通知可能会影响正常的保险索赔，从而损害家乐 福的利益。 同时， 请及时填写出险通知书 （附件一） 并传真至平量行。在出险通知书中，应详细填写以 下内容： - 损失时间 - 损失地点 - 损失情况简述，包括损失发生的原因 - 损失程度及初步的估损金额 - 目击人的姓名、地址和联络方式 - 临时防损措施 2 即时措施 在事故发生后，家乐福应采取适当的应变措施以防 止损失的进一步扩大，对损坏或伤亡现场及时拍 照，记录目击者的陈述和证词。在清理现场之前， 尽可能提供平量行进行现场查勘的机会，特别是对

41、 于损失金额较大的赔案。 Insurance Claims Manual Carrefour China/Finance/Insurance Page 20 of 34 Carrefour After incident, Carrefour should take measures to control the loss and a record of primary scene should be prepared. Do keep record of the names and addresses of all witnesses. Do give the Adjusters the op

42、portunity of inspection before any clearance or removal, especially for the loss with great sum. 3 Appointed Claim Officer The Insured should appoint a Claims Officer to be in charge of handling claims, including timely reporting of claims to the Adjusters, documents collection and preparation, and

43、recording all incidents of loss or damage which are likely to give rise to claims. In addition, the claim officer should assist Pierre Leong to carry out site survey. 4 Claim Record Carrefour should record and keep record of all incidents of loss or damage and the relevant claim evidence, so as to m

44、ake claim procedure more effective. Do number and file each claim independently according to different insurance types for convenient management concerning. 5 Deductible The loss within the Policy excess shall be undertaken by the Insured. In case of the loss is greater than the excess, which should

45、 also be deducted from the total amount of payment. 6. Claim Procedures Property All Risks (Extended to Cover Machinery Breakdown) In the event of any loss, please notify loss adjuster immediately, regardless of whether the estimated loss amount is below the policy deductible or not. If a property l

46、oss is related to theft / robbery, please report 3 指定索赔代表 家乐福应委派专人处理索赔相关事宜，负责损失通 知，收集所需信息，准备索赔资料，协助平量行进 行现场调查。 4 索赔记录 为了提高索赔效率，家乐福应记录并保存与索赔相 关的所有文件单证。每一索赔个案应存放于独立的 档案内，按不同的险种进行分类编号，便于管理。 5 免赔额 对于所有保单免赔额以内的损失，家乐福需自行承 担。当损失金额高于免赔额时，保险赔款应扣除免 赔额，该部分由家乐福承担。 6. 各险种项下的索赔程序各险种项下的索赔程序 财产一切险（扩展机器损坏险）财产一切险（扩展机

47、器损坏险） 当事故发生后， 请立即通知理算人， 不论预计的损失 金额是否在保单免赔额以内。 如财产损失涉及盗窃抢劫，请立即向公安部门报案， 提出法律追究，并索要立案凭证作为保险索赔的依 据。 如财产损失是由于第三方疏忽或过失造成， 请以书面 形式要求其对损失负责，同时将信函副本抄送理算 人。 Insurance Claims Manual Carrefour China/Finance/Insurance Page 21 of 34 Carrefour the case to the Police and ask for police registration report as the cl

48、aim document. If a property loss is caused by negligence of a third party, please submit a claim request to the responsible party in written and copy it to loss adjuster at the same time. Take all reasonable and necessary measures to prevent the aggravation of the loss and minimize the loss extent.

49、If the salvage expenses are relatively large, please seek prior consent from insurer or loss adjuster. Take photographs of the loss site as the proof. Do not clean up the loss site to have loss adjuster conduct the loss survey and understand the loss circumstance. Please fully co-operate with loss a

50、djuster. Separate and catalog damaged and undamaged property. Fill in the Claim List (Appendix 3) to list the loss amount. Set up special accounts to record all expenses related to the loss and keep all the relevant documents. Prepare the repair or replacement plan for damaged property. Obtain the r