Banking Board of Ecuador

RESOLUTION No. JB-2015-3445

THE BANKING BOARD

CONSIDERING:

THAT the second paragraph of the Third Transitory Provision of the Organic Code of Monetary and Financial matters determines that the Banking Board will continue to act until it resolves all claims, appeals, and other administrative procedures it was handling as of the effective date of this Code, within a period of one hundred and eighty days, extendable at the discretion of the Monetary and Financial Policy and Regulation Board; consequently, said collegiate body is competent to resolve the present appeal;

THAT on October 16, 2013, Dr. Giovanni Gaón, Manager of the Vicente Corral Moscoso Hospital, filed an administrative claim with this regulatory body against Coopseguros del Ecuador S.A., Insurance and Reinsurance Company, currently in liquidation, asserting the existence of delays in the payment of indemnities for accidents corresponding to the Mandatory Traffic Accident Insurance (SOAT), in the amount of US$ 93,680.14, corresponding to the period 2008–2011 for patients treated at said health facility;

THAT by letter No. IRC-2014-0826 of January 4, 2014, the Regional Intendence of Cuenca requested from Mrs. Gabriela Calderón Rosas, in her capacity as Manager of the Cuenca Branch of Coopseguros del Ecuador S.A., currently in liquidation, information related to the aforementioned administrative claim, a request that was attended to via letters Nos. DJ-2014-047 and DJ-2014-069, of January 28 and February 18, 2014, respectively;

THAT by administrative act contained in letter No. IRC-2014-3138, of May 12, 2014, the Acting Regional Intendant of Cuenca ordered:

"(...) In attention to the mandate of the cited norms, this Office orders Coopseguros del Ecuador Insurance and Reinsurance Company S.A. to cancel the amount of US$ 8,894.15 to the Vicente Corral Moscoso Hospital, corresponding to the surcharge established in the Regulation for the Mandatory Traffic Accident Insurance (SOAT), granting a term of eight (8) days, counted from the receipt of this letter, to submit proof of compliance with the instruction given. (...)" (sic);

THAT by communication entered into this Superintendence of Banks on May 23, 2014, Engineer Francisco Prieto Sánchez, in his capacity as General Manager of Coopseguros del Ecuador S.A., currently in liquidation, with the professional sponsorship of lawyer María Belén Checa Altamirano, filed an appeal before the Banking Board against letter No. IRC-2014-3138, of May 12, 2014, under the provisions of article 70 of the

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General Insurance Law;

THAT by resolution No. SBS-IRC-2014-781, of September 19, 2014, the Regional Intendant of Cuenca, granted the appeal filed by the General Manager of Coopseguros del Ecuador S.A., in liquidation, and ordered the sending of the respective file;

THAT the appellant based his appeal on the following arguments:

"(...) In letter No. IRC-2014-3138 of May 12, 2014, the Regional Intendence of Cuenca, in attention to the claim presented by the Vicente Corral Moscoso Hospital on October 16, 2013, orders my represented party to cancel the value of US$ 8,894.15 to the Vicente Corral Moscoso Hospital, corresponding to the surcharge established in the Regulation for the Mandatory Traffic Accident Insurance SOAT, according to the breakdown contained in a table in the aforementioned letter.

As observed from the aforementioned table, these values originate from invoices issued by the Vicente Corral Moscoso Hospital in 2009, 2010, and May and June 2011.

Article 27 of Executive Decree No. 1767 of June 6, 2009, which contains the Regulation of the Mandatory Traffic Accident Insurance SOAT, provides that 'actions derived from the SOAT insurance contract, against insurers and FONSAT, prescribe in two years, counted from the date of the event that gave rise to them'.

(...)" (sic);

THAT the Vicente Corral Moscoso Hospital bases its claim against the insurer on the fact that, having submitted the clinical, administrative documentation, and invoices corresponding to each of the patients who suffered traffic accidents covered under the mandatory traffic accident insurance (SOAT), Coopseguros del Ecuador S.A., in liquidation, has not paid the respective indemnities within the maximum period of thirty (30) days provided for in article 33 of the Regulation of the Mandatory Traffic Accident Insurance, SOAT, (current article 364 of the General Regulation for the Application of the Organic Law of Land Transport, Transit and Road Safety); therefore, according to article 34 of the Regulation of the Mandatory Traffic Accident Insurance, SOAT, (current article 365 of the General Regulation for the Application of the Organic Law of Land Transport, Transit and Road Safety), it corresponds to the insurance company to make the payment of said indemnities with a 15% surcharge per month or fraction of a month;

THAT from the review of the file, and particularly from the analysis of the information by the Insurance Unit of the Regional Intendence of Cuenca, the following observations arise:

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• Part of the information sent and held in the file of 11 boxes is illegible;
• Of the 446 patients, 421 of them have settlement acts and discharges stamped and signed by the Hospital, where the beneficiary accepts the payment made to them and rejects any subsequent claim;
• From the list, 25 patients did not submit the justifications, so these must be indemnified to the claimant;

THAT in line with the above, the process contains the table "DETAIL OF VALUES TO PAY COOPSEGUROS DEL ECUADOR S.A. SOAT VICENTE CORRAL MOSCOSO HOSPITAL", where it is determined the 25 patients that must be indemnified by Coopseguros del Ecuador Insurance and Reinsurance Company S.A., in liquidation, for the value of US$ 8,894.15, including the corresponding legal surcharge, as provided by article 17 of Executive Decree No. 809, which provides:

"When indemnities are not settled within the time established in this article, they may be claimed before the Superintendence of Banks and Insurance or through the judicial route, increased in both cases with the interest and fines provided for in the General Insurance Law";

THAT in concordance, it is worth mentioning article 34, title XIV, of Executive Decree 1767, which states:

"When indemnities are not paid by insurance companies within the period established in this regulation, it will give rise to insurers paying claims with a surcharge of 15% per month for fraction of a month of delay, and may be claimed before the Superintendence of Banks and Insurance which, after gathering explanations from the insurer, will order, if appropriate, the payment of the indemnity."

THAT regarding the prescription alleged by the insurer in its appeal, it is not applicable, since the insured requested the payment of the corresponding indemnities directly and within the periods provided for in the aforementioned Regulation, and only in the absence of payment by the insurance company, filed the administrative claim;

THAT the National Legal Intendence, through memorandum INJ-DNJ-SAL-2015-0231 of March 18, 2015, recommended to the Banking Board to reject the claim contained in the appeal filed;

IN exercise of its legal powers,

RESOLVES:

ARTICLE 1.- REJECT the claim contained in the appeal filed by Engineer Francisco Prieto Sánchez, General Manager of

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Coopseguros del Ecuador S.A. Insurance and Reinsurance Company, currently in liquidation; and, consequently, CONFIRM letter No. IRC-2014-3138 of May 12, 2014, with which the Regional Intendence of Cuenca ordered Coopseguros del Ecuador S.A. Insurance and Reinsurance Company, currently in liquidation, to cancel the value of US$ 8,894.15 to the Vicente Corral Moscoso Hospital.

ARTICLE 2.- ORDER that the insurance company comply with what is established in the previous article within a period of fifteen days, counted from the date on which it is notified with this resolution, under legal warnings.

ARTICLE 3.- PROVIDE that this resolution and the complete file formed around the appeal filed by Coopseguros del Ecuador S.A. Insurance and Reinsurance Company, currently in liquidation, against the administrative act contained in letter IRC-2014-3138 of May 12, 2014, be sent to the Comptroller General of the State, for the purposes that, according to its competence, correspond to it.

NOTIFY.- Given at the Superintendence of Banks, in Quito, Metropolitan District, on the twenty-seventh of May of two thousand fifteen.

Signature Econ. Rodrigo Landeta Parra GENERAL INTENDENT, S PRESIDENT OF THE BANKING BOARD, E

I CERTIFY.- Quito, Metropolitan District, on the twenty-seventh of May of two thousand fifteen.

Signature Lcdo. Pablo Cobo Luna SECRETARY OF THE BANKING BOARD