Compliance and Corrective Action. (1) The Company and its affiliates shall comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose. (2) In addition to paragraph (1), the Company and its affiliates shall comply with FCIC procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(o). (3) The Company shall fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement. (4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a written demand. The Company shall provide FCIC with satisfactory documentary evidence of the corrective action taken to address the act of non-compliance. (5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(i) and (j), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance. (6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures. (7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, replant payment, or premium for an eligible crop insurance contract (including, but not limited to, incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being planted, insurable shares, insurable causes of loss, or unit division) and FCIC is: (A) Able to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium, FCIC, except as provided in paragraph (8)(A), will deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company: (i) To report to FCIC through PASS the correct amount of indemnity, prevented planting payment, replant payment, and premium; (ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, or overpaid premium; and (iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive. (B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium that should have been paid, FCIC shall deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, or premium. (8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAE. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred: (A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAE, as applicable, on all crop insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and (B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A). (9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)). (10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program. (11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement. (12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(i) and (j). (13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 17 contracts
Samples: Reinsurance Agreement, Reinsurance Agreement, Reinsurance Agreement
Compliance and Corrective Action. (1) The Company and its affiliates shall comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall comply with FCIC procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(oIV.(n).
(3) The Company shall fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a written demand. The Company shall provide FCIC with satisfactory documentary evidence of the corrective action taken to address the act of non-compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV(h) and (ji), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop livestock price insurance contracts for which such non- non-compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, replant payment, indemnity or premium for an eligible crop livestock price insurance contract (including, but not limited to, incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedlivestock production, insurable shares, insurable causes of loss, or unit division) and FCIC is:
(A) Able to determine the correct amount of indemnity, prevented planting payment, replant payment, indemnity or premium, FCIC, except as provided in paragraph (8)(A), will deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop livestock price insurance contract based on the severity of the failure, and require the Company:
(i) To report to FCIC through PASS e-DAS the correct amount of indemnity, prevented planting payment, replant payment, indemnity and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, indemnity or overpaid premium; and
(iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, indemnity or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, indemnity or premium that should have been paid, FCIC shall deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, indemnity or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAEsubsidy. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAEsubsidy, as applicable, on all crop livestock insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(iIV.(h) and (ji).
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 12 contracts
Samples: Livestock Price Reinsurance Agreement, Livestock Price Reinsurance Agreement, Livestock Price Reinsurance Agreement
Compliance and Corrective Action. (1) . The Company and its affiliates shall must comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC the procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement Agreement, or applicable FCIC the procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) . In addition to paragraph (1)., the Company and its affiliates shall must comply with FCIC the procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(o).IV.N.
(3) . The Company shall must fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) . In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) . If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will may take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(i) subsections H. and (j)I., denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) . In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC the procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy reinsurance for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) . Whenever a failure to substantially comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, replant payment, indemnity or premium for an eligible crop livestock price insurance contract (including, but not limited to, incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being planted, livestock production insurable shares, insurable causes of loss, or unit division) and FCIC is:
(A) a. Able to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium, FCIC, except as provided in paragraph (8)(A)8.d, will may deny A&O subsidy, CAT LAE, subsidy and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop livestock price insurance contract based on the severity of the failure, and require the Company:
(i) i. To report to FCIC through PASS e-DAS the correct amount of indemnity, prevented planting payment, replant payment, indemnity and premium;; and
(ii) . To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, or overpaid premium; andor
(iii) . To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) b. Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium that should have been paid, FCIC shall will deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, or reduce the A&O subsidy based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, or premium.
(8) 8. The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAEsubsidy. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) a. During the sales and serviceclaims process (such as loss adjustment, claimsquality control reviews, or operations processverification of applicable information, etc.), the Company agrees to pay FCIC an amount up to 5 percent of the entire A&O subsidy or CAT LAE, as applicable, net book premium on all crop livestock price insurance contracts affected by the failure based on the materiality or severity of the failure;
b. During the sales and service of the livestock price insurance contract, as determined excluding the claims process contained in subparagraph a., the Company agrees to pay FCIC an amount up to 15 percent of the net book premium on all livestock price insurance contracts affected by FCICthe failure based on the materiality or severity of the failure; and
c. FCIC may impose the remedies in both subparagraphs a. and b., if applicable (B) However, both remedies may not be imposed for the same conduct by the same person).
d. If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A)7.a., any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A)7.a.
(9) . Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) . Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the programrepayment.
(11) . Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall may subject the Company to the remedies available under this Agreement.
(12) . Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(i) and (j)subsections H. or I.
13. Any A&O subsidies collected under this subsection will be placed in the Contingency Fund.
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 5 contracts
Samples: Livestock Price Reinsurance Agreement, Livestock Price Reinsurance Agreement, Livestock Price Reinsurance Agreement
Compliance and Corrective Action. (1) . The Company and its affiliates shall must comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC the procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC the procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) . In addition to paragraph (1)., the Company and its affiliates shall must comply with FCIC the procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(o).IV.P.
(3) . The Company shall must fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) . In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) . If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will may take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(i) subsections I. and (j)J., denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) . In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC the procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy reinsurance for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) . Whenever a failure to substantially comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, payment or replant payment, payment or premium for an eligible crop insurance contract (including, including but not limited to, to incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedplanting, insurable shares, insurable causes of loss, loss or unit division) and FCIC is:
(A) a. Able to determine the correct amount of indemnity, prevented planting payment, payment or replant payment, payment or premium, FCIC, except as provided in paragraph (8)(A)8.d, will may deny A&O subsidy, CAT LAE, subsidy and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) i. To report to FCIC through PASS DAS the correct amount of indemnity, prevented planting payment, replant payment, payment and premium;
(ii) . To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, payment or overpaid premium; and
(iii) . To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, payment or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) b. Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, payment or premium that should have been paid, FCIC shall will deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, payment or premium.
(8) 8. The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAEsubsidy. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) a. During the sales and serviceclaims process (such as loss adjustment, claimsquality control reviews, or operations processverification of applicable information, etc.), the Company agrees to pay FCIC an amount up to 5 percent of the entire A&O subsidy or CAT LAE, as applicable, net book premium on all crop insurance contracts affected by the failure based on the materiality or severity of the failure;
b. During the sales and service of the crop insurance contract, as determined excluding the claims process contained in subparagraph a., the Company agrees to pay FCIC an amount up to 15 percent of the net book premium on all crop insurance contracts affected by FCICthe failure based on the materiality or severity of the failure;
c. FCIC may impose the remedies in both subparagraphs a. and b., if applicable (However, both remedies may not be imposed for the same conduct by the same person); and
(B) d. If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A)7.a., any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A)7.a.
(9) . Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) . Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the programrepayment.
(11) . Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall may subject the Company to the remedies available under this Agreement.
(12) . Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(i) and (j)subsections I. or J.
13. Any A&O subsidies collected under this subsection will be placed in the Contingency Fund.
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 3 contracts
Samples: Standard Reinsurance Agreement, Reinsurance Agreement, Reinsurance Agreement
Compliance and Corrective Action. (1) . The Company and its affiliates shall comply must be in compliance with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct laws and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC procedures, is the sole responsibility regulations of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1)United States, the Company laws and its affiliates shall comply with FCIC procedures, and the applicable laws regulations of the States and locales in which the Company is conducting business under this Agreement, unless preempted such State and local laws and regulations are in accordance conflict with section IV(o)this Agreement, and all bulletins, handbooks, instructions, and procedures of FCIC.
(3) 2. The Company shall fully must cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreementoperations.
(4) In addition to any other remedies available under this Agreement, if 3. If FCIC finds that the Company has not complied with a any provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-non- compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) If a State makes a determination that . Failure to timely take the Company corrective action directed by FCIC is grounds for termination or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under suspension of this Agreement, and all appeals have been exhausted, FCIC will take remedial actions, which may include suspension
4. Whenever an act or termination of this Agreement in accordance with section IV(i) and (j), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures omission by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, replant payment, indemnity or premium for an eligible crop insurance contract paid (including, but not limited to, incorrect APH calculationslivestock production data; improper adjustment of lossesloss; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being planted, insurable sharesinterest, insurable causes of loss, or unit division) and FCIC is:
(A) Able a. able to determine the correct amount of indemnity, prevented planting payment, replant payment, indemnity or premium, FCIC, except as provided in paragraph (8)(A), will deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and premium that should have been paid;
i. FCIC shall require the Company:
(i) To Company to report to FCIC through PASS the e-DAS system the correct amount of indemnity, prevented planting payment, replant payment, and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, indemnity or overpaid premiumpremiums; and
(iii) To pay ii. FCIC will require the Company to FCIC refund any overpaid indemnity, prevented planting payment, replant payment, or underpaid premium and any A&O subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable b. unable to determine the correct amount of indemnity, prevented planting payment, replant payment, indemnity or premium that should have been be paid, FCIC ;
i. reinsurance shall deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based be denied on the severity of the failureall such policies, unless the Company can provide documentary provides satisfactory evidence satisfactory of what such losses or premium should have been; and
ii. FCIC will require the Company to FCIC refund any A&O subsidy that shows exceeds the correct amount of the indemnity, prevented planting payment, replant payment, or premiumCompany was entitled to receive.
(8) 5. The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAEsubsidy. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, requirements and procedures and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service services or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the exact value of such each service, the amounts stated below are reasonable estimates of the value. value of such services.
a. If the Company's loss adjustment performance and practices are not carried out in accordance with this Agreement and FCIC assumes the Company's loss adjustment obligations, the Company shall pay FCIC an amount equal to 10 percent of the net book premium on all eligible livestock price insurance contracts adjusted or readjusted by FCIC.
b. If this Agreement should be terminated for cause, the Company shall pay FCIC the equivalent of 10 percent of the net book premium for all eligible livestock price insurance contracts.
c. In the event there is a pattern or practice of failing the following failures to comply with the Agreement or FCIC procedures terms and FCIC has determined the Company or its service providers, agents, and loss adjusters have failed to provide services or to comply with a provision conditions of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations processAgreement, the Company agrees to shall pay FCIC an amount up as follows:
i. For failure to follow approved sales agent training requirements contained in Manual 14, 1 percent of the entire A&O subsidy or CAT LAE, as applicable, on all crop net book premium for eligible livestock price insurance contracts affected written by sales agents not trained in accordance with Manual 14 if, for the purposes of this subparagraph only, the number of such sales agents exceeds 5 percent of all sales agents requiring training;
ii. For failure based on the materiality or severity to follow approved loss adjuster training requirements contained in Manual 14, 1 percent of the failurenet book premium for eligible livestock price insurance contracts adjusted by loss adjusters not trained in accordance with Manual 14 if, as determined by FCICfor the purposes of this subparagraph only, the number of loss adjusters exceeds 5 percent of the loss adjusters requiring training; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may iii. For failure to follow approved quality control review requirements in Manual 14, 1 percent of the net book premium for eligible livestock price insurance contracts not reviewed in accordance with Manual 14, but which were required to be collected under paragraph (7)(A)reviewed, any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, if the number of reviews not paragraph (7)(A)performed exceeds 5 percent of the number required.
(9) Failure d. For failure to follow FCIC approved procedure that materially impacts the existence or amount of the Company or its affiliates to cease or desist any activity or to take a specific actionloss, as required by FCIC in writing, will subject the Company or its affiliates shall pay to the sanctions in section 515(h) FCIC 3 percent of the Act (7 U.S.C. § 1515(h))net book premium of all eligible livestock price insurance contracts for which each failure occurred.
(10) e. The total amount payable under sections IV.H.5.c. and d. may not exceed 4.5 percent of the net book premium on each eligible livestock price insurance contract for which any payment is due FCIC under sections IV.H.5.c. or d.
6. Any payment due from, from or paid by, by the Company under this subsection section shall be in addition, addition to and without prejudice, prejudice to any other rights of FCIC, or the United States, if the deficiency in compliance with terms and conditions of this Agreement result from the Company's violation of criminal or civil false claims statutes.
7. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the programrepayment.
(11) Failure of 8. Any amounts due from or paid by the Company under this section shall be paid by the Company to make FCIC on the next monthly summary report after a final determination by FCIC. Any payment not timely paid will be subject to provisions of section IV.C.
9. If FCIC collects any amount in accordance with the provisions of this Agreementsection IV.H.4. or IV.H.5.a. or b., or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject then FCIC will not require the Company to pay any amount under section IV.H.5.d. on the remedies available under this Agreementsame eligible livestock price insurance contracts.
(12) 10. Nothing in this subsection prevents FCIC from collecting any amounts due under this subsection from the Company and suspending or terminating this Agreement in accordance with section IV(i) and (j)Agreement.
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 2 contracts
Samples: Livestock Price Reinsurance Agreement, Livestock Price Reinsurance Agreement
Compliance and Corrective Action. (1) The Company and its affiliates shall must comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC the procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC the procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall must comply with FCIC the procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(oIV.(o).
(3) The Company shall must fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will may take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV.(i) and (j), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC the procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy reinsurance for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to substantially comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, payment or replant payment, payment or premium for an eligible crop insurance contract (including, including but not limited to, to incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedplanting, insurable shares, insurable causes of loss, loss or unit division) and FCIC is:
(A) Able to determine the correct amount of indemnity, prevented planting payment, payment or replant payment, payment or premium, FCIC, except as provided in paragraph (8)(A8)(D), will may deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) To report to FCIC through PASS DAS the correct amount of indemnity, prevented planting payment, replant payment, payment and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, payment or overpaid premium; and
(iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, payment or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, payment or premium that should have been paid, FCIC shall will deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, payment or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAE. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAE, as applicable, on all crop insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the programrepayment.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall may subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(iIV.(i) and (j).
(13) Nothing Any A&O subsidies and CAT LAE collected under this subsection will be placed in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuseContingency Fund.
Appears in 2 contracts
Samples: Reinsurance Agreement, Reinsurance Agreement
Compliance and Corrective Action.
(1) The Company and its affiliates shall comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall comply with FCIC procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(o).IV(n).
(3) The Company shall fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a written demand. The Company shall provide FCIC with satisfactory documentary evidence of the corrective action taken to address the act of non-compliance.compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV(h) and (ji), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop livestock price insurance contracts for which such non- non-compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, replant payment, or premium for an eligible crop insurance contract (including, but not limited to, incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being planted, insurable shares, insurable causes of loss, or unit division) and FCIC is:
(A) Able to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium, FCIC, except as provided in paragraph (8)(A), will deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) To report to FCIC through PASS the correct amount of indemnity, prevented planting payment, replant payment, and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, or overpaid premium; and
(iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium that should have been paid, FCIC shall deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAE. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAE, as applicable, on all crop insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(i) and (j).
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.compliance.
Appears in 1 contract
Compliance and Corrective Action. (1) The Company and its affiliates shall must comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC the procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC the procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall must comply with FCIC the procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(oIV.(o).
(3) The Company shall must fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will may shall take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV.(i) and (j), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC the procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy reinsurance for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to substantially comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, payment or replant payment, payment or premium for an eligible crop insurance contract (including, including but not limited to, to incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedplanting, insurable shares, insurable causes of loss, loss or unit division) and FCIC is:
(A) Able to determine the correct amount of indemnity, prevented planting payment, payment or replant payment, payment or premium, FCIC, except as provided in paragraph (8)(A8)(AD), will may shall deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) To report to FCIC through PASS PASSDAS the correct amount of indemnity, prevented planting payment, replant payment, payment and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, payment or overpaid premium; and
(iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, payment or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, payment or premium that should have been paid, FCIC shall will deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, payment or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAE. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAE, as applicable, on all crop insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment repayment. if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, may shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(iIV.(i) and (j).
(13) Nothing Any A&O subsidies and CAT LAE collected under this subsection will be placed in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuseContingency Fund.
Appears in 1 contract
Samples: Reinsurance Agreement
Compliance and Corrective Action. (1) . The Company and its affiliates shall must comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC the procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement Agreement, or applicable FCIC the procedures, is the sole responsibility of the Company. The assumption of liability responsibility under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) . In addition to paragraph (1)., the Company and its affiliates shall must comply with FCIC the procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(o).IV.P.
(3) . The Company shall must fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) . In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) . If the a State makes a final determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s its obligations under this Agreement, and all appeals have been exhausted, FCIC will may take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(i) subsections I. and (j)J., denial of reinsurance, and denial of A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, subsidies or a reduction of the A&O subsidy in whole or in partaccordance with paragraph 8., depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC procedures, . FCIC reserves the right not to provide deny reinsurance, A&O subsidy, CAT LAE, and or risk subsidy for any eligible crop insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) . Whenever a failure to substantially comply with a provision of this Agreement or FCIC procedures by the Company or its affiliates service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, payment or replant payment, payment or premium for an eligible crop insurance contract (including, including but not limited to, to incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedplanting, insurable shares, insurable causes of loss, loss or unit division) and FCIC is:
(A) a. Able to determine the correct amount of indemnity, prevented planting payment, payment or replant payment, payment or premium, FCIC, except as provided in paragraph (8)(A)8.d, will may deny A&O subsidy, CAT LAE, subsidy and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) i. To report to FCIC through PASS DAS the correct amount of indemnity, prevented planting payment, replant payment, payment and premium;; and
(ii) . To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, payment or overpaid premium; andor
(iii) . To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, payment or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) b. Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, payment or premium that should have been paid, FCIC shall will deny reinsurance, reinsurance and deny A&O subsidy, CAT LAE subsidy and risk subsidy, in whole subsidy or in part, reduce the A&O subsidy based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, or premium.the
(8) 8. The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAEsubsidy. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its affiliates service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its affiliates service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) a. During the sales and serviceclaims process (such as loss adjustment, claimsquality control reviews, or operations processverification of applicable information, etc.), the Company agrees to pay FCIC an amount up to 5 percent of the entire A&O subsidy or CAT LAE, as applicable, net book premium on all crop insurance contracts affected by the failure based on the materiality or severity of the failure;
b. During the sales and service of the crop insurance contract, as determined excluding the claims process contained in subparagraph a., the Company agrees to pay FCIC an amount up to 15 percent of the net book premium on all crop insurance contracts affected by FCICthe failure based on the materiality or severity of the failure; and
c. FCIC may impose the remedies in both subparagraphs a. and b., if applicable (B) If a pattern or practice under this paragraph also involves overpaid indemnities that However, both remedies may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will not be imposed under this paragraphfor the same conduct by the same person). Formatted: Indent: Left: 0.75", not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific actionHanging: 0.38", as required by FCIC in writingNumbered + Level: 1 + Numbering Style: a, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due fromb, or paid byc, the Company under this subsection shall be in addition… + Start at: 2 + Alignment: Left + Aligned at: 0.75" + Tab after: 1" + Indent at: 1", and without prejudiceTabs: 1.13", to any other rights of FCIC, or the United States. FCIC may, List tab + Not at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(i) and (j).
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.1"
Appears in 1 contract
Samples: Standard Reinsurance Agreement
Compliance and Corrective Action. (1) The Company and its affiliates shall comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall comply with FCIC procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(oIV.(n).
(3) The Company shall fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a written demand. The Company shall provide FCIC with satisfactory 2024 LPRA 07-01-23 documentary evidence of the corrective action taken to address the act of non-compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV(h) and (ji), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop livestock price insurance contracts for which such non- non-compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, replant payment, indemnity or premium for an eligible crop livestock price insurance contract (including, but not limited to, incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedlivestock production, insurable shares, insurable causes of loss, or unit division) and FCIC is:
: (A) Able to determine the correct amount of indemnity, prevented planting payment, replant payment, indemnity or premium, FCIC, except as provided in paragraph (8)(A), will deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop livestock price insurance contract based on the severity of the failure, and require the Company:
: (i) To report to FCIC through PASS e-DAS the correct amount of indemnity, prevented planting payment, replant payment, indemnity and premium;
; (ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, indemnity or overpaid premium; and
and (iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, indemnity or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
. (B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, indemnity or premium that should have been paid, FCIC shall deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary 2024 LPRA 07-01-23 evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, indemnity or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAEsubsidy. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
: (A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAEsubsidy, as applicable, on all crop livestock insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
and (B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(iIV.(h) and (ji).
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 1 contract
Compliance and Corrective Action. (1) The Company and its affiliates shall must comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and FCIC the procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or applicable FCIC the procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall must comply with FCIC the procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(oIV.(o).
(3) The Company shall must fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall must provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will shall take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV.(i) and (j), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or FCIC the procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy reinsurance for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, payment or replant payment, payment or premium for an eligible crop insurance contract (including, including but not limited to, to incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedplanting, insurable shares, insurable causes of loss, loss or unit division) and FCIC is:
(A) Able to determine the correct amount of indemnity, prevented planting payment, payment or replant payment, payment or premium, FCIC, except as provided in paragraph (8)(A), will shall deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) To report to FCIC through PASS the correct amount of indemnity, prevented planting payment, replant payment, payment and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, payment or overpaid premium; and
(iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, payment or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, payment or premium that should have been paid, FCIC shall will deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, payment or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAE. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAE, as applicable, on all crop insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(iIV.(i) and (j).
(13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or abuse.
Appears in 1 contract
Samples: Reinsurance Agreement
Compliance and Corrective Action. (1) The Company and its affiliates shall mustshall comply with the provisions of this Agreement, as applicable. The Company is solely responsible for the conduct and performance of its personnel and affiliates with respect to the obligations imposed by this Agreement and the FCIC procedures. Liability for damages incurred, to the extent it is caused by an error or omission or failure to comply with this Agreement or the applicable FCIC procedures, is the sole responsibility of the Company. The assumption of liability under this section is only for the purpose of this Agreement and may not be relied upon by any person or entity not a part to this Agreement for any purpose.
(2) In addition to paragraph (1), the Company and its affiliates shall mustshall comply with the FCIC procedures, and the applicable laws of the States in which the Company is conducting business under this Agreement, unless preempted in accordance with section IV(oIV.(o).
(3) The Company shall mustshall fully cooperate with FCIC in the review or examination of the Company or its affiliates regarding compliance with the requirements of the Agreement and FCIC procedures. The Company shall will include in its agreements with its affiliates provisions that ensure that such affiliates agree to cooperate and assist FCIC in the reviews and examinations conducted in accordance with this Agreement.
(4) In addition to any other remedies available under this Agreement, if FCIC finds that the Company has not complied with a provision of this Agreement, and the Company has not taken appropriate steps to correct the reported act of non-compliance, FCIC may, at its sole discretion, require that the Company take corrective action within 45 days of the date of making a such written demand. The Company shall mustshall provide FCIC with satisfactory documentary evidence of the corrective action taken to address the reported act of non-compliance.
(5) If a State makes a determination that the Company or its affiliates are not in compliance with state law and FCIC determines such non-compliance is material to the Company’s obligations under this Agreement, and all appeals have been exhausted, FCIC will shallwill take remedial actions, which may include suspension or termination of this Agreement in accordance with section IV(iIV.(i) and (j), denial of reinsurance, A&O subsidy, CAT LAE, and risk subsidy, for all eligible crop insurance contracts for which such non- non-compliance occurred, in whole or in part, depending on the materiality or severity of the non-compliance.
(6) In addition to any other remedies in this Agreement, if FCIC determines that the Company or its affiliate willfully violated the Agreement or the FCIC procedures, FCIC reserves the right to deny reinsurance, A&O subsidy, CAT LAE, and risk subsidy for any insurance contract that is sold or serviced in violation of the terms of this Agreement or FCIC procedures.
(7) Whenever a failure to comply with a provision of this Agreement or FCIC procedures by the Company or its service providers, agents, and loss adjusters materially affects the existence or amount of the indemnity, prevented planting payment, or replant payment, or premium for an eligible crop insurance contract (including, but not limited to, incorrect APH calculations; improper adjustment of losses; sales agents or sales supervisors involved in the adjustment of losses; failure to verify eligibility for insurance, acreage planted or prevented from being plantedplanteding, insurable shares, insurable causes of loss, or unit division) and FCIC is:
(A) Able to determine the correct amount of indemnity, prevented planting payment, or replant payment, or premium, FCIC, except as provided in paragraph (8)(A), will shallwill deny A&O subsidy, CAT LAE, and risk subsidy or reduce the A&O subsidy or CAT LAE for the eligible crop insurance contract based on the severity of the failure, and require the Company:
(i) To report to FCIC through PASS the correct amount of indemnity, prevented planting payment, replant payment, and premium;
(ii) To pay to the policyholder any amount of underpaid indemnity, prevented planting payment, replant payment, or overpaid premium; and
(iii) To pay to FCIC any overpaid indemnity, prevented planting payment, replant payment, or underpaid premium and any subsidy that exceeds the amount the Company or policyholder was entitled to receive.
(B) Unable to determine the correct amount of indemnity, prevented planting payment, replant payment, or premium that should have been paid, FCIC shall shallwill deny reinsurance, A&O subsidy, CAT LAE and risk subsidy, in whole or in part, based on the severity of the failure, unless the Company can provide documentary evidence satisfactory to FCIC that shows the correct amount of the indemnity, prevented planting payment, replant payment, or premium.
(8) The Company provides valuable program delivery services for which payment is made in the form of A&O subsidy and CAT LAE. FCIC and the Company agree that FCIC is damaged by a failure of the Company or its service providers, agents, and loss adjusters to provide services or to comply with a provision of this Agreement or FCIC procedures, and that the value of such service or failure to comply is difficult to determine because the damages are uncertain and the amount of service or failure to comply is difficult to quantify. FCIC and the Company agree that in view of the difficulty of determining the value of such service, the amounts stated below are reasonable estimates of the value. In the event there is a pattern or practice of failing to comply with the Agreement or FCIC procedures and FCIC has determined the Company or its service providers, agents, and loss adjusters have has failed to provide services or to comply with a provision of this Agreement or FCIC procedures and such failure has occurred:
(A) During the sales and service, claims, or operations process, the Company agrees to pay FCIC an amount up to the entire A&O subsidy or CAT LAE, as applicable, on all crop insurance contracts affected by the failure based on the materiality or severity of the failure, as determined by FCIC; and
(B) If a pattern or practice under this paragraph also involves overpaid indemnities that may be collected under paragraph (7)(A), any reduction in A&O subsidies and CAT LAE will be imposed under this paragraph, not paragraph (7)(A).
(9) Failure of the Company or its affiliates to cease or desist any activity or to take a specific action, as required by FCIC in writing, will subject the Company or its affiliates to the sanctions in section 515(h) of the Act (7 U.S.C. § 1515(h)).
(10) Any payment due from, or paid by, the Company under this subsection shall be in addition, and without prejudice, to any other rights of FCIC, or the United States. FCIC may, at its sole discretion, waive, reduce or delay repayment if such actions are needed for continued delivery of the program.
(11) Failure of the Company to make payment in accordance with the provisions of this Agreement, or with provisions of any separate written agreement to make such payment between the Company and FCIC, shall subject the Company to the remedies available under this Agreement.
(12) Nothing in this subsection prevents FCIC from suspending or terminating this Agreement in accordance with section IV(iIV.(i) and (j).
(13) Any A&O subsidies and CAT LAE collected under this subsection will be placed in the Contingency Fund.
(14) (13) Nothing in this Agreement precludes the government from taking any actions authorized by law relating to fraud, waste, or and abuse.
Appears in 1 contract
Samples: Reinsurance Agreement