“Following notification of a claim, C&S shall: • Check that all claim documents are correctly completed; • Ensure that the claim falls within the terms of the Enterprise policy; • Investigate liability; • Process the claim in a timely fashion; • Liaise, as necessary, with the Enterprise Customer; • Agree the validity and/or quantum of the claim; • Defend claims where the Enterprise customer is not considered liable; • Negotiate settlement; • Arrange for settlement to be made with prior authorisation of Enterprise; • Ensure and maintain a full and correct record of the claims details and amounts paid.” • Check that all claim documents are correctly completed; • Ensure that the claim falls within the terms of the Enterprise policy; • Investigate liability; • Process the claim in a timely fashion; • Liaise, as necessary, with the Enterprise Customer; • Agree the validity and/or quantum of the claim; • Defend claims where the Enterprise customer is not considered liable; • Negotiate settlement; • Arrange for settlement to be made with prior authorisation of Enterprise; • Ensure and maintain a full and correct record of the claims details and amounts paid.”
“The claim reserve rationale will be documented in the file and supported by adequate information. There will be appropriate scope of loss details. Reserves will be set at notification based on the information known at that time. Accurate reserves recommended will be set as soon as practical for each feature but no later than 30 days from initial claims notification. Reserve changes will be promptly made and rationale documented if circumstances are identified to support the change.”
“Reserving: C&S will reserve all claims on a realistic basis and review the reserve when any new information comes to hand. Enterprise will be separately notified of any new claim where the overall reserve is£15,000 or more and of any claim where the existing total cost of the claim is increased by£10,000 or more. In the absence of information on which to base an accurate reserve, the following ‘day one’ reserves will be created until such time as further information becomes available: - Third Party Property Damage -£1,002 - Third Part Credit Hire -£1,502 - Third Party Personal Injury -£2,500 - Third Party Legal Costs -£2,500 ” - Third Party Property Damage -£1,002 - Third Part Credit Hire -£1,502 - Third Party Personal Injury -£2,500 - Third Party Legal Costs -£2,500 ”
“7.1 C&S warrants that it shall provide the Services using all reasonable skill and care as is consistent with C&S being specialists in this field. 7.2 C&S warrants that it shall use competent, appropriately qualified skilled and experienced personnel in the provision of the Services. … 7.6 Enterprise is regulated by the FSC in Gibraltar and as such is required to observe and comply with the standards issued by the FSC and in so far as and to the extent that C&S is providing the Services described in this Agreement it shall observe and comply with the FSC Standards as if it were regulated by the FSC itself. In the event of any conflicts or inconsistency between (i) the FSC (ii) the provisions of this Agreement, the provisions of the FSC Standards shall prevail. 7.7 C&S will observe and comply with the Association of British Insurers Insurance Claims Code (the “ABI Code”) unless the standards set out in this Agreement are greater than those set out in the ABI Code, in which case the provisions of the Agreement shall prevail.”
“… we have discussed at strategic level [our] reserving policy and specifically our closure criteria going forwards on TP claims. We have agreed as a Board the following: • On a TPPI where there has been [no] communications for a period of 9 months then clear the reserve and close the file • On a TPPD where there has been no communications for a period of 6 months then clear the reserve and close the file • Where there is a combination of TPPI and TPPD and there has been no communication on either aspect for 6 months then remove the TDDP reserve but leave the TPPI reserve on and keep file open until such time as the 9 month period has elapsed.” • On a TPPI where there has been [no] communications for a period of 9 months then clear the reserve and close the file • On a TPPD where there has been no communications for a period of 6 months then clear the reserve and close the file • Where there is a combination of TPPI and TPPD and there has been no communication on either aspect for 6 months then remove the TDDP reserve but leave the TPPI reserve on and keep file open until such time as the 9 month period has elapsed.”
“We have not had the opportunity to meet, but I am the CEO and major Shareholder of Enterprise Insurance Company. I understand that you are principally responsible for the team that manages all of the Enterprise open claims. I tried to call you a little earlier today but understand you are in a meeting. I wished to alert you to the contents of this email and to talk you through it to allay any concerns that may arise, and which would be unfounded. We are going through an exercise with external advisors, which is placing some scrutiny on the value of our UK motor reserves, and in turn the number of outstanding cases we have currently both with you and other claims handlers. Whilst I am unable to go into the confidential nature of this exercise, we have decided that the best way of providing the comfort and certainty required is to undertake an entire file review of every single UK motor claim we currently have open. It so happens that you are the largest provider of services to us in this respect however, you will be aware that we have other providers also, and we will be writing to them in the same regard. We are utilising a firm of solicitors with whom you maybe familiar, Ozon Law in Manchester, and we need to commence the exercise on Monday of next week. We have discussed internally how to best deal with the logistics and have decided we would like to courier all the file that you are currently holding on our behalf to Manchester for review and return. As one of our trusted partners, we don’t wish you to be inconvenienced however we do need your active participation in order that we can complete the exercise within the timescales that are essential to the business, and we are wanting to complete the review by31st December 2013 . I have attached a spreadsheet, which hopefully is a comprehensive list of files that you hold for each underwriting year; we would like to request that you release to us the files listed for 2010, 2011 and the first half of the files for 2012 by Friday afternoon this week in order that they may be couriered to Manchester for review and return. We will in due course request the outstanding files of 2012 and 2013 to date once the review well underway. I appreciate the timescale is fairly short however I understand that the nature of your filing system should facilitate this. …”
“… We will of course endeavour to support your requirements. There’s no doubt the undertaking is challenging and will be hugely disruptive to the day to day operational activity but that aside, we will do everything we can to support your objectives. Perhaps we can speak first thing in the morning to talk thru’ logistics etc. [For] example, might it be possible for ozon staff to come to the files rather than shift circa 5-6000 files to them. I only say this given the enormous volumes of post/email and telephone traffic that occurs day to day. Either way, we’ll accommodate …”
“… I reiterate the intention is to prioritise the 2011/10 files and urgent matters save that it is necessary for C&S to identify such urgent matters. The urgent files will be audited and returned by DX.”
“The draconian action that I was forced to take several weeks ago in demanding a full file review was as a result of spiralling reserves on the case load handled by C&S. As matters presently stand, I simply fail to understand the reasons for which case reserves remain outstanding at significant levels particularly on claims arising in 2010/11 and 12. As you are aware, Ozon is now in possession of around 2,000 files and have a team of 10 people consisting in part of qualified solicitors undertaking audits. The results thus far have left me with major concerns as to the historical claims handling by C&S and have proved beyond doubt my rational for undertaking this exercise. I do not propose to go into detail vis á vis the findings of the audit thus far, I will, however, say at this stage that substantial savings have been made in respect of the files audited. You will gather from the tone of this note that I have some very real initial concerns. I will in due course be proposing a meeting with you.”
“It is too early to currently form a view as to how we will be dealing with claims going forward. I have no desire to enter into a conflict situation with C&S and in that respect we will continue to liaise with you, returning some files and requesting further files for audit over the next few weeks. We are discussing internally the ongoing findings and once a sensible conclusion has been reached, we will arrange a meeting with you. In this respect, we will of course continue to expect you to work the files you have in your possession and in turn we will clearly be paying for those services as agreed. … In summary, given that C&S should have less files in its possession, I would hope the result in handling those files should improve. EIC does not expect C&S to provide service for no consideration and will continue to meet C&S’s fees in accordance with the agreement between the parties. I must, however, reserve EIC’s position as to any loss or spillage caused as a result of inadequate handling of claims. I hope this short note brings you up to speed. I reiterate I will arrange a visit with Andrew Stone in due course. I suspect this will occur in the New Year. It goes without saying that EIC too has its reputation on the line hence the drastic action I took. I have no doubt C&S will take all necessary steps to assist EIC and comply with its instructions.”
“Frankly the ‘quality’ of Ozon review team is crap, they’re missing stuff which is on file, recommending closures ahead of even the dormancy protocols of 4 and 6 months, suggesting we close files where payments need to be made or where there’s clear evidence of ongoing TP claims. No doubt Enterprise are paying for the privilege of this rubbish.”
“As you know we are keen to meet to discuss recent events, the relationship between our firms and the implications of the Ozon file review. We feel that we need to have that meeting before we can contemplate delivering a further 1500 files to Ozon and would be very grateful if we could meet as soon as possible. Last year we sent over 2000 files off-site to Ozon Law for review. Despite repeated requests, only a small proportion of these files have been returned to C&S, which has resulted in major operational difficulties and loss of revenue. We have in addition concerns regarding the management of those files and the impact [on] our firm’s reputation in the market. We recognise the importance of the audit and are happy to support it. If Ozon want to review the files here in our office they remain available. We are conscious that you indicated in your email of [7] January, addressed to Lee Roberts, that the delivery of the next batch of documents should not wait until we have met but we feel it is important that we talk these issues through with you as soon as possible. We are available to meet at short notice and look forward to hearing from you.”
“3. The findings thus far give rise to serious concerns as to the manner in which you have been handling and pursuing claims on behalf of Enterprise. Your failure to progress matters has caused to Enterprise considerable loss and disadvantage particularly when dealing with the impact over the reserve levels maintained by Enterprise. It is necessary for Enterprise to conclude its audit before setting out its position as to the discharge of obligations under the Agreement. We confirm Enterprise hereby fully reserves its position accordingly. 4. On7 January 2014 by email timed at 09:39, Ozon requested that a further 1,500 files are delivered for the purpose of its review. The request was met by a holding response which was communicated by your Mr Roberts under cover of an email timed 11:07 on7 January 2014 stating that you have entered into “dialog” with Enterprise regarding the request. The “dialog” culminated in the exchange between Mr Flowers of Enterprise and Mr Chamberlain on your behalf. 5. By his email dated10 January 2014 timed at 19:00, Mr Chamberlain on your behalf reaffirmed your steadfast refusal to release to Ozon the files requested. We consider that this amounts to a repudiatory breach which repudiation Enterprise hereby accepts. Further or in the alternative, insofar as no repudiation has occurred (which is denied), we hereby give notice to terminate on behalf of Enterprise pursuant to Clause 15.1 of the Agreement.”
“12.1 All data held within C&S’s computer systems or on paper on Enterprise claims shall at all time remain the property of Enterprise unless the Parties agree otherwise, and shall be held in trust by C&S. C&S undertakes that it shall not use the data otherwise than for a purpose contemplated by this Agreement. 12.2 C&S hereby agrees to provide unrestricted access by any or all of the following methods: • through its internet site with the ability of Enterprise to download all data fields • by the transfer electronically and/or digitally of a copy of the C&S database of Enterprise claims in a form which can be used by Enterprise to download or replicate the data.” • through its internet site with the ability of Enterprise to download all data fields • by the transfer electronically and/or digitally of a copy of the C&S database of Enterprise claims in a form which can be used by Enterprise to download or replicate the data.”
“13.1 Enterprise and its appointed professional advisers shall have the right to examine C&S’s books and records relating to its handling and servicing of Enterprise claims which are the subject of this Agreement. Such audits may take place at C&S’s premises during business hours, Enterprise having given reasonable prior notice of its intention to conduct an audit either at C&S’s premises or via remote access of C&S’s systems. 13.2 Enterprise and its appointed professional advisers may carry out such audits of C&S’s premises and systems as frequently as they wish on the giving of reasonable notice during normal business hours (being not less than three working days). Enterprise and its professional advisers shall at their own cost have the right to take copies of any data and records relating to Enterprise claims they reasonably require and C&S shall provide all necessary facilities to do so.”
“C&S shall maintain proper files of all information and documents related to each claim. Enterprise may inspect all such information and documents and make whatever further enquiries in connection with the handling of any claim as it may think fit. C&S shall provide all reasonable co-operation and assistance in connection with any such investigation.”
“All claim papers and files shall be made available to Enterprise and/or its appointed agent at any time during normal business hours upon reasonable request. Upon termination of this Agreement C&S shall, at Enterprise’s discretion, deliver to Enterprise all such claim papers and files (except those that C&S is required by law to retain or requires to fulfil any other legal obligations), or retain such claim papers and files for a period of 3 years after the date of termination and then destroy, or if required return the same to Enterprise.”
“….regard must be had to the nature and consequences of the breach in order to determine whether this right has arisen. The question whether a breach of an intermediate term is sufficiently serious to entitle the innocent party to treat himself as discharged is to be determined ‘by evaluating all the relevant circumstances’. In conducting this inquiry, the court is not exercising a discretion, but is engaged in a fact-sensitive inquiry which involves ‘a multi-factorial assessment’ and the use of various ‘open-textured expressions”
“Whatever test one adopts, it seems to me that the starting point must be to consider what benefit the injured party was intended to obtain from performance of the contract. … The next thing to consider is the effect of the breach on the injured party. What financial loss has it caused? How much of the intended benefit under the contract has the injured party already received? Can the injured party be adequately compensated by an award of damages? Is the breach likely to be repeated? Will the guilty party resume compliance with his obligations? Has the breach fundamentally changed the value of future performance of the guilty party's outstanding obligations?”
“This rule is, however, subject to a proviso. If the point not taken is one which if taken could have been put right, the principle will not apply. This has, I think, clear application here. The plaintiff was producing his document before he was under any obligation to do so. If the defendants had accepted it subject to the provision of a Treasury permission it might have been obtained; further, the plaintiff could have said that he was not bound to produce any guarantee until the defendants obtained from the bankers confirmation of the letter of credit. It is doubtful if they could ever have done so, but if they had this might itself have assisted the plaintiff in getting Treasury permission. I think, therefore, assuming the point was a good one, that it fails on the ground that it was not taken and is not one which can now be relied on.”
“15.1 This Agreement may be terminated at any time by either of the Parties giving at least three calendar months’ notice in writing to the other. 15.2 Either party (‘the Aggrieved Party’) may at any time terminate the Agreement forthwith by written notice to the other Party if any of the events referred to below occur in relation to the other Party, namely: * the other Party commits a material breach of any provision of this Agreement and (if such default is capable of remedy) it is not remedied within 30 days (or such longer notice as the Aggrieved Party may specify) after written notice shall have been given by the Aggrieved Party to the other Party requiring such remedy giving full particulars of the breach and the reasonable steps necessary to remedy it …”
“Upon termination of this agreement: 16.1 Enterprise shall forthwith pay to C&S all sums due to C&S (including all sums which would have been payable at some future time, the due date for which shall become the date of termination); 16.2 C&S shall forthwith pay to Enterprise all sums due to Enterprise (including all sums which would have been payable at some future time, the due date for which shall become the date of termination) and all unused amounts in the Claims Fund; 16.3 C&S shall, unless Enterprise expressly does not require it, continue to handle all existing claims until they are concluded, and all of C&S’s obligations and Enterprise’s obligations under this Agreement shall continue insofar as they can apply to such claims. Should C&S handle existing claims, the fee will continue to be paid on settlement of individual cases, on production of the monthly bordereaux and fee invoices. 16.4 If requested by Enterprise, C&S shall deliver all data and material belonging to Enterprise forthwith and C&S’s authorised representative shall certify full compliance with this clause. 16.5 All provisions of this Agreement which are intended to have effect following any expiry or termination of this Agreement shall survive expiry or termination of this Agreement to the extent permissible by law. 16.6 C&S shall not handle any new claims after the termination date unless agreed otherwise by the Parties.”
“Hi Mike Yes I was in Gibraltar last week and have had the opportunity to discuss fees in detail with Andrew. • Property Damage agreed at£95 however as you are aware we are looking at utilising Nationwide’s Engineering facilities in relation to TPPD later in the year which will reduce the number of TPPD claims handled by you. • Credit Hire Claims, we would like to agree a fee of£170 • MOJ <£10k agreed at£200 • MOJ >£10k agreed at£295 • Fraud - Agreed at£500 with 50% success fee however no additional fraud fee to be paid for cases simply passed onto Keoghs for handling as I do not want to be paying double fees. • Fees for higher value claims charged on an hourly basis etc. to remain as per current fee structure. I have discussed providing a minimum 2 year agreement, this is something that Andrew would be agreeable to in consideration for a discount on the above fees of say 10%. Andrew has also spoken to our Finance Director who will be working towards putting in place a single claims fund account to ease the administrative burden that you currently undertake. I look forward to your comments. Kind regards Myles Ellis LLB (Hons), FCILEx. Head of Claims UK” • Property Damage agreed at£95 however as you are aware we are looking at utilising Nationwide’s Engineering facilities in relation to TPPD later in the year which will reduce the number of TPPD claims handled by you. • Credit Hire Claims, we would like to agree a fee of£170 • MOJ <£10k agreed at£200 • MOJ >£10k agreed at£295 • Fraud - Agreed at£500 with 50% success fee however no additional fraud fee to be paid for cases simply passed onto Keoghs for handling as I do not want to be paying double fees. • Fees for higher value claims charged on an hourly basis etc. to remain as per current fee structure. Kind regards Head of Claims UK”
“I am pleased to confirm that following further discussion with Keith [Newing, Enterprise’s Finance Director] and Andrew [Stone, its Chief Operating Officer] we are happy to agree the fees outlined in my e-mail of the 23rd September with a 2 year agreement to take effect from1st October 2013 with no discount. We will in due course submit to you a revised Claims Administration Service Agreement to include the agreed terms. Kind regards, Myles Ellis LLB (Hons), FCILex Head of Claims UK Enterprise Insurance Company Plc”
“Many thanks Myles, much appreciated. Mike”
“Any variation of this Agreement shall not be effective unless made in writing and signed by or on behalf of each of the Parties to this Agreement.”
“The objective test is, however, here (as elsewhere) subject to the limitation that it does not apply in favour of a party who knows the truth. … Nor could a party who did not in fact intend to be bound invoke the objective test so as to bind the other party to the contract.”
“The existence of a binding agreement needs to be determined objectively and does not depend on the subjective intent of one, or even both, parties. What the parties thought, or what it can be inferred they thought from their conduct, is, therefore, unlikely to have much, if any, significance to the question of whether, objectively, the documents demonstrate that the parties had reached a binding agreement.”
"[F]or a term to be implied, the following conditions (which may overlap) must be satisfied: (1) it must be reasonable and equitable; (2) it must be necessary to give business efficacy to the contract, so that no term will be implied if the contract is effective without it; (3) it must be so obvious that 'it goes without saying'; (4) it must be capable of clear expression; (5) it must not contradict any express term of the contract."
"The question of whether a term should be implied, and if so what, almost inevitably arises after a crisis has been reached in the performance of the contract. So the court comes to the task of implication with the benefit of hindsight, and it is tempting for the court then to fashion a term which will reflect the merits of the situation as they then appear. Tempting, but wrong. … [I]t is not enough to show that had the parties foreseen the eventuality which in fact occurred they would have wished to make provision for it, unless it can also be shown either that there was only one contractual solution or that one of several possible solutions would without doubt have been preferred ..."