1、Insurance Claims Manual Carrefour China/Finance/Insurance Page 1 of 34 Carrefour INSURANCE CLAIMS MANUAL 保險索賠手冊保險索賠手冊 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頁 2. Involved Parties and Responsibilities Page 4 保險相關(guān)方及其職責保

3、險相關(guān)方及其職責 第 4頁 3. Insurance Program Summary Page 6 保險計劃綜述保險計劃綜述 第 6頁 Property all risks (extended to Cover Machinery Breakdown) 財產(chǎn)一切險（擴展機器損壞險） Business Interruption 利潤損失險 Money Insurance 現(xiàn)金保險 Fidelity Guarantee 雇員忠誠險 Products Liabilities Insurance 產(chǎn)品責任險 Public Liability Insurance 公眾責任險 Employers Liab

4、ility Insurance 雇主責任險 4. Claim Process Page 15 索賠流程索賠流程 第 15頁 5. Claim Advice Page 18 索賠要點索賠要點 第 18頁 6. Claim Procedures Page 19 各險種項下的索賠程序各險種項下的索賠程序 第 19頁 Property all risks (extended to Cover Machinery Breakdown) 財產(chǎn)一切險（擴展機器損壞險） Business Interruption 利潤損失險 Money Insurance 現(xiàn)金保險 Fidelity Guarantee 雇員

5、忠誠險 Public and Products Liabilities Insurance Insurance Claims Manual Carrefour China/Finance/Insurance Page 3 of 34 Carrefour 公眾及產(chǎn)品責任險 Employers Liability Insurance 雇主責任險 Insurance Claims Manual Carrefour China/Finance/Insurance Page 4 of 34 Carrefour 7. List of Claim Documents Page 25 索賠單證一覽表索賠單證一

6、覽表 第 25頁 8. Contact Information Page 25 聯(lián)絡(luò)資料聯(lián)絡(luò)資料 第 25頁 9. Appendix Page 27 附件附件 第 27頁 Loss Notification Form 出險通知書 Loss Notice (for Carrefour Internal Purpose) 損失通知單（供家樂福內(nèi)部使用） Claim Report 索賠報告 Claim List 損失清單 Subrogation Form 權(quán)益轉(zhuǎn)讓書 Declaration Form 聲明書 Discharge Form 接受書/ 接觸責任書 Claim Receipt 賠款收據(jù) C

7、laim Cancellation Form 撤銷賠案通知書 Monthly Claim Status Report 月度賠案報表 10. Chart of Communication Channel Page 33 溝通渠道圖溝通渠道圖 第 33頁 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 所有已注冊的家樂福代表處辦公室和/或在中華人 民共和國境內(nèi)已成立的或今后可能成為家樂福管 理控制或合資的附屬公司和關(guān)聯(lián)公司，但以各自的 可保利益為限。 2 業(yè)務(wù)性質(zhì) 主要但不限于大型超級市場、

10、超級市場及相關(guān)業(yè) 務(wù)。 3 保險期限 2005年 1月 1日 0:00至 2005年 12月 31日 24:00 4 保險地址 主要但不限于在附表中列明的保險地址以及其它 被保險人在中華人民共和國境內(nèi)擁有財產(chǎn)、營業(yè)、 財產(chǎn)倉儲或處理地，包括供應(yīng)商或客戶所在地，財 產(chǎn)寄放處或倉庫、商品展覽地等等。 5 地域限制 中華人民共和國（不包括港、澳、臺） 6 司法管轄 適用中華人民共和國司法管轄 7 保險標的 所有被保險人業(yè)務(wù)范圍內(nèi)的商品及提供的服務(wù) 8 保單格式 索賠發(fā)生制 9 追溯期 自 1999年 1月 1日起開張的門店， 具體日期見附件 10 免賠額 每次事故 RMB20,000 11 賠償限額

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 暫時性喪失工作能力： 雇員暫時性喪失工作能力超過 5天的，在此期 間，經(jīng)醫(yī)生證明，按照雇員工資給予賠償。 3) 保險公司對本保單項下承擔由于一次事故導(dǎo) 致一個或多個雇員產(chǎn)生的損失，以每人 RMB1,500,000為限 4) 雇主責任 茲經(jīng)雙方同意，本保單在被保險人完全遵守本 保單條件的情況下同意擴展，在中華人民共和 國境內(nèi)經(jīng)法庭審判被保險人被判定有義務(wù)對雇 員進行賠償。 限額：每次事故 RMB1,000,000 5) 住院現(xiàn)金標準：每人每天 RMB20 9

14、 免配額 暫時性喪失工作能力：5天 10 費率 國內(nèi)雇員：0.21% 外國雇員：0.41% 11 特別條款 1) 提前三十天通知注銷保險條款 2) 被保險人隨時通知取消保單 3) 擴展承保雇員上下班途中 4) 海外出差條款 5) 社交、娛樂活動責任條款 6) 自動承保新雇員條款 7) 指定公估理算師條款 8) 責任險 2000年問題除外責任條款 9) 非職業(yè)病醫(yī)療費用除外責任條款 12 特別約定 1) 家樂福中國店雇員內(nèi)部流動不影響本保單效力 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) 簽發(fā)一個總保單但分別對每個單獨的商店/營業(yè) 場所開出發(fā)票 3) 新的門店或辦公室按季度申報， 保險公司開具 批單收費 4. 索賠流程索賠流程 1 損失通知 一旦發(fā)生可能導(dǎo)致保單項下索賠的事故時，家樂福 應(yīng)立即通知平量行（必須是第一時間）。 財產(chǎn)保險

20、平量行在接到出險通知后，視賠案大小，根據(jù) 以往經(jīng)驗以及是否在保險責任范圍內(nèi)，自行確 定是否立即到達現(xiàn)場查勘， 并在1個工作日內(nèi)書 面通知深圳人保。如果賠案金額較大或情況較 為復(fù)雜，平量行應(yīng)將損失情況告知達信。 責任保險 平量行在接到出險通知后，視賠案大小，聽候 上海人保的意見，確定是否到達現(xiàn)場查勘。 1) 平量行在接到報案后于1個工作日內(nèi)書面 通知上海人保。 2) 上海人保在1個工作日內(nèi)答復(fù)是否進行現(xiàn) 場勘察。 同時，各門店或辦公室的營運監(jiān)控主管必須于1個工 作日內(nèi)以電子郵件方式提供 “損失通知單 （家樂福內(nèi) 部用） ” 給家樂福中國區(qū)總部財務(wù)部段志奇先生。 表 格見第31頁附表3 2 現(xiàn)場查

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. 平量行根據(jù)賠案的具體情況安排人員進行現(xiàn)場查 勘，了解事故原因，根據(jù)標的損失數(shù)量及程度核定 損失金額。家樂福應(yīng)全力與平量行合作。如家樂福 對平量行的建議或方法有任何異議，請及時與達信 或中怡聯(lián)系。 財產(chǎn)保險 1) 對于保險責任明確的賠案，由平量行自行 指導(dǎo)家樂福進行及時的搶修工作，并于1 個工作日內(nèi)書面通知深圳人保。 2) 對于保險責任不明確的賠案，平量行應(yīng)及 時通知深圳人保和達信，深圳人保在與達 信溝通后于1個工作日內(nèi)作出處理指示。 平 量行在收到深圳人保的指示后應(yīng)

27、及時指導(dǎo) 家樂福進行修復(fù)工作。 3) 針對以上兩種情況， 平量行需在3個工作日 內(nèi)出具即時報告，書面遞送至深圳人保。 責任保險 1) 對于不需現(xiàn)場勘察的賠案， 平量行在3個工 作日內(nèi)出具即時報告，書面遞送至上海人 保。 2) 對于需要現(xiàn)場勘察的賠案，平量行在收到 上海人保指示后的1個工作日內(nèi)， 與家樂福 相關(guān)門店聯(lián)系勘察。 在勘察定損后3個工作 日內(nèi)出具即時報告， 書面遞送至上海人保。 3) 上海人保審核報告， 并在3個工作日內(nèi)就賠 案作出書面答復(fù)， 列明所需索賠文件清單， 遞至平量行。 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 單證提交 家樂福應(yīng)提供相關(guān)的資料、憑證、單據(jù)作為索賠依 據(jù)，并盡快寄給平量行。延誤提交會導(dǎo)致記憶模糊 或單證遺失，造成理賠困難。 財產(chǎn)保險 1) 平量行根據(jù)以往慣例

33、及規(guī)定，在收到出險 通知的3個工作日內(nèi)書面通知家樂福相關(guān) 門店應(yīng)提交的賠案所需單證。 2) 在收到家樂福相關(guān)門店寄送的文件之后， 平量行應(yīng)立即進行審核，如單證齊全，平 量行應(yīng)在收到文件之日起5個工作日內(nèi)出 具終期報告，書面遞至深圳人保；如單證 不全， 平量行應(yīng)在收到文件之日起1個工作 日內(nèi)，以書面形式通知家樂福相關(guān)門店補 充索賠單證。 責任保險 1) 平量行在收到上海人保對賠案的書面答復(fù) 后的3個工作日內(nèi)書面通知家樂福相關(guān)門 店應(yīng)提交的相關(guān)文件清單。 2) 在收到家樂福相關(guān)門店寄送的文件之后， 平量行應(yīng)立即進行審核，如單證齊全，平 量行應(yīng)在收到文件之日起5個工作日內(nèi)出 具終期報告，書面遞至上海

34、人保；如單證 不全， 平量行應(yīng)在收到文件之日起1個工作 日內(nèi)，以書面形式通知家樂福相關(guān)門店補 充索賠單證。 4 理算結(jié)案 保險公司在收到平量行的終期報告后應(yīng)審核單證 是否齊全；如單證齊全并對索賠金額無異議，保險 公司應(yīng)在 10 個工作日內(nèi)將賠款劃至家樂福相關(guān)門 店；如單證不全，保險公司應(yīng)在收到終期報告之日 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個工作日內(nèi)，書面通知平量行補充資料詳情； 如對索賠金額等持有異議，保險公司應(yīng)在收到終期 報告之日起 3個工作日內(nèi)，書面通知平量行異議細 節(jié)，并同時抄送達信或中怡。 保險雙方應(yīng)對理賠結(jié)果達到共識，一旦發(fā)生爭議， 由保險人、損失理算人、保險顧問和被保險人協(xié)商 解決。 5 追償 被保險人在收到賠款后， 如保險事故是由第三方造 成的，被保險人應(yīng)協(xié)助保險公司向第三方進行追 償。 5. 索賠要點索賠要點 1

40、損失通知 當發(fā)生保單項下的索賠事故時，無論預(yù)期的損失金 額是否在保單免賠額以內(nèi)，請立即通知平量行。延 遲通知可能會影響正常的保險索賠，從而損害家樂 福的利益。 同時， 請及時填寫出險通知書 （附件一） 并傳真至平量行。在出險通知書中，應(yīng)詳細填寫以 下內(nèi)容： - 損失時間 - 損失地點 - 損失情況簡述，包括損失發(fā)生的原因 - 損失程度及初步的估損金額 - 目擊人的姓名、地址和聯(lián)絡(luò)方式 - 臨時防損措施 2 即時措施 在事故發(fā)生后，家樂福應(yīng)采取適當?shù)膽?yīng)變措施以防 止損失的進一步擴大，對損壞或傷亡現(xiàn)場及時拍 照，記錄目擊者的陳述和證詞。在清理現(xiàn)場之前， 盡可能提供平量行進行現(xiàn)場查勘的機會，特別是對

41、 于損失金額較大的賠案。 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 指定索賠代表 家樂福應(yīng)委派專人處理索賠相關(guān)事宜，負責損失通 知，收集所需信息，準備索賠資料，協(xié)助平量行進 行現(xiàn)場調(diào)查。 4 索賠記錄 為了提高索賠效率，家樂福應(yīng)記錄并保存與索賠相 關(guān)的所有文件單證。每一索賠個案應(yīng)存放于獨立的 檔案內(nèi)，按不同的險種進行分類編號，便于管理。 5 免賠額 對于所有保單免賠額以內(nèi)的損失，家樂福需自行承 擔。當損失金額高于免賠額時，保險賠款應(yīng)扣除免 賠額，該部分由家樂福承擔。 6. 各險種項下的索賠程序各險種項下的索賠程序 財產(chǎn)一切險（擴展機器損壞險）財產(chǎn)一切險（擴展機

47、器損壞險） 當事故發(fā)生后， 請立即通知理算人， 不論預(yù)計的損失 金額是否在保單免賠額以內(nèi)。 如財產(chǎn)損失涉及盜竊搶劫，請立即向公安部門報案， 提出法律追究，并索要立案憑證作為保險索賠的依 據(jù)。 如財產(chǎn)損失是由于第三方疏忽或過失造成， 請以書面 形式要求其對損失負責，同時將信函副本抄送理算 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