On 4 May 2016 the Enterprise Bill receivedRoyal Assent and became the Enterprise Act 2016. Part 5 of the Enterprise Actcontains provisions which will amend the Insurance Act 2015 to provide that(re)insurers must pay sums due within a reasonable time. Policyholders willhave the opportunity to claim damages if a (re)insurer’s unreasonable delaycauses additional loss.
2016年5月4日，英国《企业法草案》得到王室御准而正式成为了《2016年企业法》。根据《企业法》第5章的规定，对《2015年保险法》作出修改，要求（再）保险人必须在合理时间内给付保险赔偿金。因此，如果（再）保险人不合理迟延给付保险赔偿金对保单持有人造成了的额外的损失，则该保单持有人将有权提出索赔。
The provisions will come into force on 4May 2017 and will apply to all insurance and reinsurance contracts entered intoon or after that date.
这些修定将于2017年5月4日生效，并适用于所有于2017年5月4日或之后达成的保险合同与再保险合同。
The changes to be introduced will raise newand challenging issues for (re)insurers and particularly for claims handlers.We discuss the implications below.
上述修定所带来的变化将会为（再）保险人，特别是理赔人员，带来新的问题与挑战。我们将在下文中讨论这些可能的影响。
The key points
要点
It will be an implied term in all“insurance contracts” that claims must be paid “within a reasonable time”.“Insurance contracts” in this context will include reinsurance contracts.
在新法下所有“保险合同”中将被视为包含一个默示条款，即保险赔偿金必须“在合理时间内予以给付”。此处，“保险合同”的含义包含了再保险合同。
The remedies for breach of this impliedterm will be the usual remedies for breach of contract, including damages. Thatmeans, of course, that the usual tests of causation will have to be satisfiedand the insured will have to prove on the balance of probabilities that anyloss for which it claims damages was caused by the insurer’s breach of theimplied term.
违反该默示条款的救济与一般违约救济相同，其中包括损害赔偿。也就是说，因果关系必须得以确立，被保险人必须证明其主张的损失是由于保险人违反了该默示条款而造成的。
The right to claim interest for latepayment will remain and any damages will be in addition to that interest and inaddition to the amount payable under the insurance in respect of the originalclaim.
被保险人依旧可以主张因迟延给付而产生的利息。在新法下，被保险人除了该利息以及在原保险赔付请求下应予支付的金额之外，还可额外获得损害赔偿。
These terms will take effect through theinclusion of a new s.13A in the Insurance Act 2015.
新法以新增《2015年保险法》第13A条体现。
The limitation period in which an insuredcan bring a claim for damages for late payment will be one year from the dateof the last payment by the insurer in respect of the relevant loss. This willbe reflected in an amendment to the Limitation Act 1980.
被保险人因迟延给付而主张损害赔偿的时效为一年，自保险人就相应损失支付保险赔偿金之日起算。这一规定将透过对《1980年时效法》的修订中与以落实。
Contracting out
协议排除
In certain circumstances the parties to anon-consumer contract will be able to contract out of this implied term,subject to the transparency provisions in the Insurance Act 2015.
对于非消费者合同，双方可以在符合《2015年保险法》透明性条件前提下，通过协议排除上述默示条款的适用。
Implications of the new provisions forclaims handling
新的规定对于理赔所带来的影响
A ‘reasonable time’
“合理的时间”
One of the key issues will be whatconstitutes a “reasonable time” in which to pay a claim. This will be anobjective judgement and the Act makes clear that it includes time toinvestigate and assess the claim. What else is included will depend on all the circumstancesbut relevant issues are likely to include:
其中的一个关键问题是，什么是保险赔偿金给付的“合理时间”。这将是一个客观判断，《企业法》中明确规定其中应包含调查与评估索赔申请的时间。其他可能计算在内的时间将取决于案件的具体情况，但可能包括如下因素：
The type of insurance (one can imagine, forexample, that some third party claims or business interruption losses may welltake longer to investigate than first party property losses);
保险合同的种类（可以想像，对于例如第三方索赔或业务中断损失的调查较第一方财产险损失索赔需要更长时间处理)；
The size and complexity of the claim. Thatseems clear, although readers will know that there may be large straightforwardlosses which can be resolved more quickly than smaller but more complex claims;
索赔案件的规模与复杂程度。这点无需多言，但是读者需要知道，有时规模巨大但事实清楚明确的案件比起规模虽小但更加复杂的案件处理起来可能会更加快捷。
Compliance with regulatory rules andguidelines. These might include, for example, compliance with sanctionsregimes; and
为遵守监管制度方面的规定而需耗费一定时间。其中可能的情形包括要符合制裁规则的时间；和
Factors outside the insurer’s control. Thisis largely self-explanatory and might include, for example, the failure of theinsured or a third party to provide information or difficulties in gainingaccess to loss sites, for example for reasons of safety. It is unlikely toinclude things like the loss adjuster’s workload, however, because one wouldexpect the insurer to be responsible for that in any event.
保险人控制范围外的因素。这一点在很大程度上是不言自明的，其中可能包括的情形有，举例来说，被保险人或第三方未能提供相关信息，或由于因为安全等原因而无法抵达事故现场。但是，保险人控制范围外的因素应当不包括损失理算员的工作量，因为这在任何情况下都理应是由保险人负责协调的。
Reasonable grounds for disputing theoriginal claim
拒绝赔付的合理依据
At a minimum, it seems likely thatreasonable grounds for disputing the claim may well equate to “…real prospectsof successfully defending the claim…”, namely the same test as would berequired to defend a claim for summary judgment. That is not a high standard,however, and it is certainly possible that more will be required.
从最低限度来看，拒绝赔付的合理依据应等同于“…对成功抗辩具实际可能性…”，也即与主张赔案不适用简易判决的要求相一致。这并非一个很高的要求，然而，法院在司法实践中可能有进一步的要求。
Failure to pay while a dispute iscontinuing will not be unreasonable but the conduct of the insurer in handlinga claim may be a relevant factor in deciding whether there has been ‘unreasonabledelay’. For example, an insurer may still be in breach of the implied term ifit fails to respond promptly to developments in the case or if it moves forwardonly slowly in the conduct of its investigations. Other issues that may berelevant are how the insurer treats the insured in pre-action correspondence,refusal of offers of ADR (or failure to propose same), failure to make oraccept reasonable offers of settlement, failure to make interim payments,unsuccessfully contesting interlocutory and summary judgment applications,appealing unfavourable judgments unsuccessfully and breaches of the CivilProcedure Rules which cause delays.
当应否赔付的纠纷尚未得到解决时，保险人不予赔付的行为一般不会被视为不合理的。但是，保险人在处理理赔时的具体行为可能被纳入是否存在“不合理延迟”的考量。例如，如果保险人未能就案情进展及时给予答复或保险人只是缓慢的推进案情调查，那么保险人仍可能被视为违反默示条款。其他可能的相关因素有，保险人在前期沟通中对待被保险人的态度与方式、未有提议/拒绝接受替代性争议解决方案如调解、未有提出或拒绝接受合理的和解、拒绝支付中期预付款、未能成功抗辩简易判决的申请、对于不利判决的上诉未能成功或及违反《民事诉讼规则》而对纠纷的解决造成迟延。
At least in the short term, the consequenceof the introduction of these new rules is likely to be that pressure to settledifficult claims or to make interim payments is increased and that may welllead to higher reserves and more capital commitment.
至少从短期来看，新规则的引入可能会导致在处理复杂案件或中期预付款方面的压力增加，并很可能导致保险人要准备更高的储备金与资本。
Issues for the London Market
伦敦市场所面临的问题
The nature of theLondon market also gives rise to some particular uncertainties about theoperation of this proposed implied term. For example:
伦敦市场的独特性也为该默示条款的操作带来不确定性。例如：
What will be the position where a reinsurerexercises its right under a claims control clause to take control of the claimbut unreasonably delays settlement? Would there be a claim by the insuredagainst the reinsurer if the contracts were back to back? If the insuredclaimed against the insurer would the insurer have a right of recovery againstthe reinsurer?
当再保险人根据理赔控制条款对理赔行使控制权却导致不合理延迟时，这种情况应如何认定？当直保合同与再保合同是”背靠背”时，被保险人是否因这等延误而有权直接向再保险人要求赔偿？如果被保险人向保险人主张了损害赔偿，保险人是否有权转嫁到再保险人？
Subscription markets may raise a similarissue: if the following market has agreed to be bound by the settlementsnegotiated by the leaders, they will presumably still be liable to the insuredfor their share of any damages for the late payment of claims. Whether they canthen make a recovery from the leaders in respect of those damages will dependon the terms of any agreement amongst the market participants.
认购市场中也可能产生类似的问题：如果共保人同意受首席保险人所达成的解决方案的约束，则推定他们需要向被保险人承担由于迟延支付保险赔偿金而造成的损失的相应份额。共保人是否因此向首席保险人进行追偿将取决于这些市场参与者之间订立的合同。
In layered programmes, high level insurersmay not be liable to pay until the primary layer has been exhausted. If theprimary layer insurer is delaying payment unreasonably, will the excessinsurers be exposed to damages? Do they have an obligation to act if theprimary is unreasonable? If not, could the quantum of the damage to which theprimary insurer is exposed be increased as a result of any damage caused by thefailure of the excess layers to pay?
在分层保险中，直至下一层保险被用尽之前，处于上层的保险人无需支付保险赔付金。如果基础保险人不合理地延迟支付保险赔付金，那么其他超额保险人是否需要承担损害赔偿责任？如果基础保险人不合理地延迟支付，那么超额保险人是否有义务马上支付？若不然，那么基础保险人所面临的损害赔偿会否由于超额保险人的不予支付而导致了损失而进一步增加？
Finally, what about the position inrelation to reinsurance recoveries? Willa reinsured be able to recover any damages which it has to pay to the insuredfor breach of this implied term from the reinsurer? There is no reason inprinciple or in statute why such a loss would not be recoverable in the sensethat there is no public policy objection to its recovery – it is not a fine ora criminal penalty for example. In those circumstances, the issue of recoveryis going to come down to the extent of the coverage under the reinsurance andhow it is expressed.
最后，如何认定再保险中追偿的相关问题？再保险中的被保险人由于自己违反默示条款而向被保险人支付损害赔偿，能否向再保险人进行追偿？在法律上没有明确禁止这种追偿——这种追偿性质上难以等同于罚款或刑事处罚。在那些情形下，是否能够追偿将取决于再保险合同的承保范围以及表述方式。
Conclusion
结论
When the requirementto settle claims within a “reasonable time” becomes implied into insurancecontracts, it will be incumbent on insurers to manage claims proactively and toensure that outsourced claims teams are properly trained and aware of thepotential exposure. It is important to note, however, that nothing in theproposed changes should prevent insurers from disputing claims in good faithand it should be remembered that if the insured wishes to claim damages forlate payment it will have to be able to prove, on the balance of probabilities,that it has been caused to suffer a loss as a result of the delay as well asthe quantum of that loss.
当在“合理时间”内进行理赔这一要求成为保险合同中的默示条款时，保险人将负有不可推脱的责任去积极主动地管理理赔案件并确保其外包的理赔团队得到良好的培训并对潜在的风险具有认知。然而，值得注意的是，新法并不意味着保险人将不再能诚实地对理赔请求提出相反意见。同时，需要记住一点，当被保险人主张由于迟延给付保险赔偿金而造成的损害赔偿时，被保险人必须能够证明其遭受的损失确实是由于迟延给付所造成的，并证明损失的金额。
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