Reserving Clause Samples

Reserving. Each claim should be reviewed and evaluated according to the merits of the claim and based upon the most current and reliable information received, starting with the initial report of claim and continuing through final resolution. Delays result in understated reserves and, possibly, missed opportunities to settle. A. An accurate and appropriate initial indemnity reserve shall be established on all reportable claims based on facts known, upon completion of the initial investigative report or when suit is filed, whichever occurs first. In addition, separate legal and adjusting reserves shall be established. Indemnity reserves shall reflect the most probable outcome plus exposure to plaintiff attorney’s fees and costs. Most probable outcome is the potential total amount a plaintiff could expect to receive, either through settlement or verdict, after factoring in the Member’s percentage of liability. (This approach is neither the best or worst case outcome). Factors to consider for when evaluating the potential total settlement or verdict a plaintiff could expect to receive include but are not limited to: • Extent of injuries and/or damages • Medical expenses • Loss of income • Any other related expenses • Future anticipated expenses • Total of both gross and out-of-pocket expenses • Permanent injury • Disfigurement/scarring • Pain and suffering • Any other intangible factors which may result in a higher or lower claim value such as jurisdiction, credibility of parties/witnesses, etc. Percentage of liability is determined by various factors that are discovered during an investigation. Reserves shall be adjusted accordingly, as facts are developed, to properly reflect the exposure. These factors include but are not limited to: a. Facts of loss b. Applicable laws c. Defense Counsel evaluations d. Jury Verdict evaluation e. The extent of plaintiff's liability (comparative negligence) f. The number of co-defendants and their percentage of liability g. The ability of the co-defendants to respond financially to any settlement or verdict. h. On cases occurring after June 3, 1986, Proposition 51 allows defendants to limit their liability on non-economic damages to their percentage of fault. i. On cases involving uninsured motorist claimants the recovery is limited to economic damages in accordance with California Code of Civil Procedures sections 3333.3 and 3333.4 (Prop 213). j. Any other mitigating factors

Reserving. Each insurance company subsidiary of the Company is set forth on Schedule VI hereto (each, an “Insurance Subsidiary” and collectively, the “Insurance Subsidiaries”). Except as disclosed in each of the General Disclosure Package and the Prospectus, the Company and its Insurance Subsidiaries have made no material change in their insurance reserving practices since December 31, 2007. The reserves reflected on the most recent annual statutory statements of each Insurance Subsidiary, as of the dates specified in such statements, (A) were computed in accordance with presently accepted actuarial standards consistently applied and (B) met the requirements of the applicable insurance laws, rules and regulations of the jurisdiction of domicile of such Insurance Subsidiary.

Reserving. Between the date of this Agreement and the Closing, for purposes of the applicable Statutory Accounting Principles, Sellers shall cause each Insurance Company to fix and determine reserves consistent with the methodologies and other practices as set forth on Schedule 5.9.

Reserving. SFM Risk will establish timely and reasonable reserves for each claim, and will promptly revise such reserves to reflect changes in the case’s status.

Reserving. (i) establish proper reserves as soon as adequate information exists based on the most likely outcome of the claim; (ii) where the reserve to be set is $500,000 net or greater, notify and obtain approval from the Royal Insurer Affiliates; (iii) evaluate reserves using the following criteria and document such in the Computer Systems: 1) facts related to the claim; 2) liability analysis; 3) if relevant, coverage analysis; and 4) damages and defense costs analysis. (iv) provide, on a quarterly basis, actuarial loss reserve reports to the Royal Insurer Affiliates in a form, electronic or otherwise, as reasonably requested by the Royal Insurer Affiliates

Reserving. Items can be reserved by phone, by email, or in person. Please give us adequate time to prepare the equipment that will be checked out. We will need the patron’s contact information, dates they would like the equipment, type of equipment, and purpose. This signed document must be presented when picking up equipment.

Reserving. Between the date of this Agreement and the Closing, for purposes of SAP, Seller shall cause the Company to fix and determine reserves using generally accepted actuarial standards consistently applied and actuarial assumptions that were in accordance with or more conservative than those called for in the relevant practices prescribed or permitted by the Domiciliary Regulator.

Reserving. The initial reserves shall beset within – two (2) business days of claim assignment to an adjuster based on the adjuster’s analysis of exposure given the information known at the time. Reserves for medical only claims should be set at $500 indemnity, and $100 expense. A reserve worksheet, in a form approved by COUNTY, shall be submitted to COUNTY within two (2) business days. Reserves should be reviewed by the adjuster at each Diary Date or upon receipt of any information that could, in the adjuster’s opinion as documented in the claim’s file notes, impact the exposure. Following the adjuster review, appropriate adjustments should be made reflected in the established reserves. “Stair stepping,” or small incremental reserve increases over time, are unacceptable. All claims with indemnity reserves require a Reserve Worksheet in a form approved COUNTY. Medical only claims with a total reserve of $15,000 or more require a Reserve Worksheet. A new Reserve Worksheet is required for each reserve increase in excess of $15,000. Within 30 days of assignment to adjuster, medical information and index reports must be requested for claimants alleging injury. Status reports must be provided at least every 90 days unless other wise directed by COUNTY. S Reports shall follow the Report Criteria set forth herein and must indicate the degree of permanent disability claimed, if any. Regular review ("Diary Date") shall be set for each open claim including claims in litigation. The interval between reviews must not exceed 90 days. If the claim is handled within the 90-day diary period, then a new Diary Date may be set for up to 90 days from that date. Each diary review shall be documented in the claim’s file notes and shall include documentation of any action taken at the time of review. Hospital records and other documentation pertient to the claim may be obtained at adjuster’s discretion; however, all hospital records and other document pertient to the claim shall be be obtained upon the completion of treatment. Independent Medical Exams (IME) and Second Opinions are used to determine the ability of a claimant to return to work, the extent of a permanent injury or the need for additional treatment. The IME doctor shall be provided with all pertinent documentation at the time of assignment. Any litigation related to an Assigned Claim must be reported to COUNTY within 48 hours of notice received by adjuster. COUNTY shall desginate defense counsel and. CONTRACTOR shall make the...

Reserving. For insurance regulatory accounting purposes, (i) the Reinsured shall determine the amount of its reserves and those of its subsidiaries on the Subject Business and may change those reserves from time to time as it, in its sole discretion, deems necessary or appropriate, (ii) the Reinsurer shall determine the amount of its reserves on its liability hereunder and may change those reserves from time to time as it, in its sole discretion, deems necessary or appropriate. Notwithstanding the amount of reserves carried by the Reinsurer, if Reinsurer's Obligations are subject to any special security deposit under which an insurance regulatory authority requires identical assumed and ceded reserves for purpose of computing the amount of the special security deposit, the Reinsurer or Reinsurer's affiliate shall satisfy the special security deposit by reference to the reserve amount required by the insurance regulatory authority.