Article 13 of the Regulation of the Insurance of Civil Liability for Use and Circulation of Motor Vehicles, of compulsory subscription, approved by Royal Decree 2641/1986, of December 30, establishes full coverage of the costs of medical and hospital care to the victims provided that it is provided in Centers recognized by the Insurance Compensation Consortium.

For this purpose the Insurance Compensation Consortium and the Spanish Union of Insurance and Reinsurance Entities (UNESPA), has signed agreements with the Catalan Health Service, Andalusian Health Service, Valencian Service Health Service, Basque Health Service, Health Service, Health Service, Galician Health Service and the National Institute of Health (INHEALTH), in identical terms, establishing the rates applicable during 1993, to the assistance provided in the Centers dependent on them.

As the first provision of the Civil Liability Insurance Regulation for the Use and Circulation of Motor Vehicles is required, the Framework Convention must be made public. cited above, as well as the relationship of the Centers which, under the same, have the consideration of recognized by the Consortium of Insurance Compensation for the purposes of Article 13 of the said Regulation and of insurance entities attached to that. In its virtue, this Body has resolved the following:

First.-The Framework Convention on Health Care for Traffic Accidents for 1993 is published in the framework of public health.

Second. -Public Assistance Centers recognized by the Insurance Compensation Consortium is published for purposes as provided for in Article 13 of the Civil Liability Insurance Regulation. Movement of Motor Vehicles, of compulsory subscription, approved by Royal Decree 2641/1986, of December 30.

Third. -The relationship of insurance entities adhered to the Convention is published.

Fourth. -Insurance Entities that are not in the previous relationship wish to avail themselves of the Convention or who are not willing to, will report to the Insurance Compensation Consortium prior to the course of a month, which will be computed at from the day of its publication.

Madrid, March 17, 1993. -Director General of Insurance, Eduardo Aguilar Fernández-Hontoria.

HEALTH ASSISTANCE AGREEMENT RESULTING FROM ROAD ACCIDENTS FOR 1993 IN THE FIELD OF PUBLIC HEALTH

The Insurance Compensation Consortium, the Spanish Union of Insurers and Reinsurers, the National Institute of Health, the Catalan Health Service, the Andalusian Health Service, the Valencian Health Service, the The Basque Health Service, the Navarro Health Service and the Galician Health Service, agree on the rules governing the provision for health care and the rates of compulsory observance for the interveners and represented, according to the following

Stipulations

First.-The rates of care expenses that are incorporated as Annex I to this Convention, which in accordance with its entry into force, will be applicable to the assistance provided from 1 January 1993, are approved.

Second.-The aforementioned tariffs will apply to the care costs provided to the injured by facts of the circulation produced by the use and circulation of vehicles obliged to arrange the Insurance of Liability Civil derivative of Use and Circulation of Motor Vehicles, of compulsory subscription, according to the regulation established in the Royal Legislative Decree 1301/1986, of 28 June, for which the recast text of the Law of Use and Circulation of Motor vehicles in the Community legal order and Royal Decree 2641/1986 of 30 December 1986 approving the Regulation of the Insurance of Civil Liability arising from the use and circulation of motor vehicles, of compulsory subscription, and especially in its articles 12 and 13, and will be applied considering the limits of coverage to referring to the abovementioned articles, ensuring the total health care necessary for the victims of road accidents, taking into account the following specific cases:

(a) Claims in which a single vehicle is involved. -In this type of claims, the insurance institution is obliged to pay the costs incurred by the victims of the accident, with the sole exception of the costs incurred by the health care provided to the taker, owner of the vehicle identified in the policy or to the insured or driver.

In the case of non-existence of compulsory subscription Civil Liability Insurance or in others where the intervention in the casualty of an unknown vehicle is credited, as well as when the vehicle has been stolen or stolen, unless the damage had been caused to persons who voluntarily occupied the vehicle and the Consortium proved that they were aware of such circumstances, the expenses of the victim of the accident, Exception of the taker, owner of the vehicle identified in the policy, the insured or the driver of the insured vehicle, shall be on behalf of the Insurance Compensation Consortium.

The Insurance Compensation Consortium will also meet these expenses when they are the result of a disaster caused by a vehicle insured in the same.

(b) Claims involving two or more vehicles. -In these claims, the insurance entities shall contribute to the fulfilment of the obligations arising out of the facts in the form set out below:

b) 1. In the case of the participation of two vehicles, each insurer shall pay the costs of assistance to the occupants of the vehicle which is secured, with the exception of the taker, the owner of the vehicle identified in the policy or the insured person or driver of the same, who are in charge of the compulsory subscription Civil Liability Insurance, on the contrary.

(b) 2. In the case of the participation of three or more vehicles by each insurance institution, the care costs of the occupants of each vehicle and those of the taker, owner of the vehicle identified on the policy, the insured and/or the driver of the policy.

In the previous two cases, the health care costs of other persons whose injuries materially cause each vehicle, will be paid by the insurer of the vehicle causing injury material. Accordingly, the parties to the assistance of the victims of an accident involving two or more vehicles must be sent for information to all the insurance companies, without prejudice to the amount of the assistance (a) in accordance with the above paragraphs, it is satisfied by the insurance institutions in accordance with the above paragraphs.

In cases involving vehicles secured by the Insurance Compensation Consortium, these same rules apply.

When a vehicle is involved in the accident, the liability of which is to be assumed by the Insurance Compensation Consortium in a subsidiary manner (without insurance, unknown or stolen) the Insurance Compensation Consortium assumes the costs which it is legally required to pay by virtue of the subsidiary liability and the exception made of the driver, the owner of the vehicle identified in the policy, the taker or the insured of the vehicle from which he/she assumes responsibility, the cost of which will be borne by the driver himself, owner or insured.

(c) Claims involving vehicles insured in entities declared bankrupt, suspension of payments or that, being insolvent, their liquidation is brought or entrusted to the Liquidator Commission of the Insurance Entities (CLEA). -In accordance with the provisions of Article 17.2 (c) of the Civil Liability Insurance Regulation derived from the Use and Circulation of Motor Vehicles, the Insurance Compensation Consortium, will assume on the same terms as made the insurer, the outstanding obligations of those who will find themselves in the assumptions defined above, in accordance with the following rules:

c) 1. The Insurance Compensation Consortium shall be sent copies of the items of assistance corresponding to the outstanding invoices for each insurance undertaking referred to above, with the justification that, within the time limit laid down in this Convention, they shall be referred to the insurers.

(c) 2. The Insurance Compensation Consortium shall not assume the payment of invoices issued for assistance provided within a period of more than one year, before filing for bankruptcy, suspension of payment or settlement to the CLEA, pursuant to Article 5. of the Royal Legislative Decree 1301/1986 of 28 June, regulator of the Insurance of Civil Liability for Use and Circulation of Motor Vehicles, except that the interruption of the prescription is justified.

c) 3. Declared bankruptcy, suspension of payments, or settlement to the Liquidator of Insurance Entities (CLEA) of an insurer, the Insurance Compensation Consortium will pay out the outstanding payments from the insurance company. This entity would have been legally claimed, provided that the corresponding withdrawal of the initiated proceedings is established.

c) 4. The Insurance Compensation Consortium undertakes to inform the National Institute of Health and Health Services of the Convention, all the cases of the Assured Entities that are in the described situations.

Third. -All the Health Centers of the National Institute of Health, the Catalan Health Service, the Andalusian Health Service, the Valencian Health Service, the Basque Health Service, the Navarro Health Service and the Galician Service. -Health shall have the consideration of centres recognised by the Insurance Compensation Consortium within the meaning of Article 13 (c) of Royal Decree 2641/1986 of 30 December 1986. Without prejudice to the foregoing, the relationship of Hospital Centres is published as Annex IV to this Convention.

Unespa, will forward to the Insurance Compensation Consortium, relationship of insurance entities that individually manifest their express desire not to adhere to this Convention, as well as the high and low that occur. Those insurance entities that are not members of Unespa and wish to accede to the Convention, will apply directly to the Insurance Compensation Consortium, who will inform the signatory parties.

The relationship of the attached Entities is attached as Annex V to this Convention.

Fourth. -Each health center represented in this Convention is fully responsible for the correct provision of service and application of the same rates, according to the prices and types of service established in the Present Convention.

Fifth. -The rates referred to in Annex I to this Convention relate to all the care costs incurred by the injured party.

Sixth. -The contracting parties to this Convention undertake to give the necessary publicity and dissemination for their general compliance and knowledge.

Surveillance and Arbitration Commission

Seventh. -This is a Surveillance and Arbitration Commission, which will ensure the best compliance with the Convention. The Commission will be composed of two representatives of the National Institute of Health, the Catalan Health Service, the Andalusian Health Service, the Valencian Health Service, the Basque Health Service, the Navarro de Salud Health Service, the Service Gallego de Salud, Unespa and the Insurance Compensation Consortium. Subcommittees of a territorial nature of tripartite composition are constituted.

The Commission shall meet at least once a quarter and, in any case, at the request of either party with a 15-day notice.

It will be functions of the Monitoring and Arbitration Commission:

1. To interpret the Convention in matters which are subject to it by the parties, including those relating to the inclusion of new or wholly unknown techniques at the time of the conclusion of the Convention, provided that they are susceptible to Assimilation to existing ones.

2. To settle the disagreements between the insurance institutions and the health centers, in order to the contents and amounts of the invoices.

3. To address the differences between the different Territorial Subcommittees.

4. To establish charging for new techniques and treatments that appear during the Convention and until its next revision or renewal.

5. To report to the Insurance Compensation Consortium, for transfer to the Directorate General of Insurance, the actions of the insurance companies that unjustifiably delay the payment of the bills adjusted to the provisions of the present Convention.

6. To report, in addition, to the Insurance Compensation Consortium, to the Health Centers that do not comply with this Convention or the agreements that for its application are taken by the Commission or the Territorial Subcommittees for the purposes of refusal of the recognition referred to in Article 13 (c) of the Regulation adopted by Royal Decree 2641/1986 of 30 December 1986.

7. To issue certifications attesting to any breach of the Convention in order to facilitate the exercise of the appropriate legal actions.

The second and seventh functions attributed to the Supervisory and Arbitration Commission are delegated to the Territorial Subcommittees, and the Commission shall immediately communicate to the Commission the agreements adopted. These Subcommittees will meet monthly at the Central Services of each Health Service, or when any of the parties believe it is necessary.

If the agreements of the Commission take the form of a general criterion to be applied in the framework of the Convention, the Commission of Surveillance and Arbitration shall be obliged to disseminate them by means of a circular, which shall be communicated to the Instituto Nacional de la Salud, to the Catalan, Andalusian, Valencian, Basque, Navarro and Gallego Health Services, to Unespa and to the Insurance Compensation Consortium, and the Institute and Services are required to do so These circulars are available to all health centres, and Unespa to the insurance companies, respectively. For the purposes of communications, the address of the Commission shall be that of the Insurance Compensation Consortium, Calle Serrano, 69, 28006 Madrid.

Eighth. -Both the National Health Institute, the Catalan Health Service, the Andalusian Health Service, the Valencian Health Service, the Basque Health Service, the Navarro Health Service, the Galician Health Service, as the Entities (a) insurance companies operating in the Ramo of Civil Liability, derived from the use and circulation of motor vehicles, of compulsory subscription, are obliged to submit the differences, which in the field of application of the same may arise, to the Commission or Oversight and Arbitration Subcommittees, prior to any judicial contest for their resolution.

Where differences are over a month in which the invoices are not paid, the Health Centre shall report such a fact to the Commission or the Subcommittee on Surveillance and Arbitration. The Commission or the Subcommittee on Surveillance and Arbitration shall issue an agreement which shall inform the complainant and a copy thereof shall be forwarded to the insurance institution and, after 30 days after that notification, without the insurance institution justify the payment of the outstanding invoices, the Health Centre may come to the competent jurisdiction without further formalities, in order to claim the amount of the invoices extended at real cost.

Where the insurance institution, in accordance with the preceding paragraph, has previously been reported, during the duration of this Convention, the Health Centre may come to the competent jurisdiction, in the complaint of its invoices at the cost price, without the need to exhaust the prior processing of the complaint to the Subcommission of Surveillance and the corresponding territorial arbitration.

Procedure rules

Ninth. -The contracting parties to this Convention are subject to the following rules of procedure for action, for the practical development of the Convention:

1. Health Centers of the National Institute of Health, Catalan Health Service, Andalusian Health Service, Valencian Health Service, Basque Health Service, Navarro Health Service and Galician Health Service are required to be cured in the a period of 30 working days from the receipt of an injured person, to the Insurance Entity or Entities of the vehicles involved in the accident, a portion of assistance for each injured person, as set out in Annex II to the Convention, by completing all the data required in that model, which shall be required to be used. The Insurance Entities and the Insurance Compensation Consortium, if any, shall within a maximum of 30 working days reply in writing to the referring health centre of a part of the assistance expressing their acceptance of the expenditure the care provided by the party. In the case of non-completed parts, the time limit set out above shall not apply until the full completion of the health centre has been carried out.

2. In the case of an accident caused by an unknown, stolen or stolen vehicle and without insurance, the health centres shall accompany the party or parts of the assistance declaration responsible for the circumstances of the accident signed and signed by the accidents, witnesses to the accident or those who have assisted them, accompanied by photocopies of the national identity document of the signatory, as set out in Annex III to the Convention. As long as no such declaration is obtained, the Insurance Compensation Consortium shall be released from the acceptance of the costs of assistance referred to in the part, unless the Health Centre has made a declaration, by means of a responsible declaration, of the failure to obtain such a declaration.

3. The health centers will extend a portion for each of the injured, even though several victims of an accident are involved.

4. All communications and notifications referred to in this Convention shall be made in writing and, in any case, by registered post.

5. The dispatch of the part of the assistance in a longer period than the one referred to in the first provision of this stipulation, for justified reasons, shall not affect the acceptance of the insurance institution to take over the claim.

6. The time limit for the dispatch of the part of the assistance, in the cases of injuries from other health centres, is extended to forty-five days. In the case of successive outpatient receipts and assists carried out within the time limit for the total recovery of an injured person, he shall also communicate to the insurance institution, making express reference to the accident data and the cause of the accident. injuries. The insurance institution, if it does not produce an anti-establishment event within thirty days, shall be deemed to accept the costs of assistance.

7. In cases where two or more vehicles are involved, it may never be claimed as a cause not to take care of the costs of the aid, the fact that the guilt of the claim and, therefore, the obligation to compensate is attributable to the driver of the other vehicle.

8. In the case of non-attached insurers, the injured may not, on the basis of that intervention, refuse payment.

9. The refusal of an insurance institution to take care of the costs of assistance shall mean for the health centre the right to send the invoice in question and for the appropriate purposes to the Commission or Subcommittees of Surveillance and Arbitration, observing the provisions of the eighth stipulation.

10. In the case of the sending of the part of the assistance, completed in its entirety, and, where appropriate, the statement responsible, by the Health Centre, no reply shall be made in any sense, within the following 30 working days. part of the insurance institution, this silence shall be understood as acceptance of the claim and the care costs arising from it, with the right of the health centre to forward the invoice in its day to the Entity and, in the event of default, to knowledge of the Commission or Subcommittees of Surveillance and Arbitration for the intended effects on the Eighth stipulation.

11. The bill of care costs provided by the Health Centre shall detail the concepts and items corresponding to the different requirements, as well as the data identifying the casualty, the victim, the vehicle and the insurance.

The invoices before the insurance companies must make their amount effective, provided it is in conformity, within the next forty-five days, dispensing with the judicial proceedings. In the event of unjustified and in writing non-compliance, the Health Centre may increase its invoice for late payment by 20 per 100 annual interest.

The payment will be independent of the court judgment, and the Health Center will in no case delay the filing of invoices for a period of more than one year. The insurance institution may reject any invoices submitted outside the deadline.

Tenth. -Only the refusal of an insurance entity to take care of the care costs will be derived, in the following cases:

a) When the Entity has no vehicle insured from those involved in the accident.

b) That in accidents involving a single vehicle, the injured person is one of the persons excluded from the coverage of the Civil Liability Insurance derived from the use and circulation of motor vehicles, mandatory, as provided for in Article 3. of Royal Decree No 1301/1986 of 28 June 1986.

(c) Transcourse of the time limits laid down in Article 2 (c).

The refusal of an insurance entity to take over a claim, based on causes other than those mentioned in the preceding paragraphs, even if the refusal is due to a failure to declare a claim, give rise to the right of the health centre to be able to assert its rights as provided for in the seventh and eighth provisions, for which the necessary documentation shall be accompanied by the Commission or the Monitoring Committees and Arbitration, including copies of the part of the assistance relating to the injured invoices are questioned.

Eleventh. -Any service provided by the Health Centers and not specifically rated will be a reason for charging, which will be established by the Commission on Surveillance and Arbitration.

Twelfth. -Extraordinary non-tariff expenses, such as conference calls, coffee shops, etc., will always be on behalf of the injured and the Health Center, if any, will invoice them to be independent of the invoice Assistance expenditure under the insurance institution.

Thirteenth. -Fee-billed healthcare expenses will include all assists and periods of control and surveillance up to the corresponding high.

Fourteenth. -Insurance Entities may request from the Center for assistance the necessary clarifications to the contents of the invoices. The non-compliance with the amount of the same shall be communicated to the Health Centre within a maximum of 30 working days from the date of receipt of the invoice and by registered post.

The lack of agreement on the content or amount of the invoices between a Healthcare Center and an Insurance Entity must be brought to the attention of the Commission or Subcommittees of Surveillance and Arbitration, which will act (a) the following shall apply in accordance with the provisions of this Convention.

In cases of partial disconformity with the contents of an invoice, the payment of the amount according to and only deferred the amount of the concept or concepts on which there is no agreement with the Previous rules.

It shall have no discharge value for an insurance entity, as regards the payment of the invoice, no claim, where it has not indicated its disconformity, in a feisty form, in the notification procedures to which it is refers to the first paragraph of this stipulation.

All Health Centers undertake to provide all kinds of facilities for the checks that in order to the best fulfillment of the same can make the Consortium of Insurance Compensation, or any of the Entities insurers attached to the Convention.

15th. -Any infringement of these stipulations and rules will be denounced to the Commission and Subcommittees of Surveillance and Arbitration, which will exhaust its possibilities of action, as provided for in the stipulations and norms of this Convention, except the case provided for in the last paragraph of the eighth stipulation.

sixteenth. -Health Centers may invoice the expenses fortnightly and partially, when the injured stay in the Center is extended for longer than the indicated, fifteen days.

High and Low Hospital Centers

17th.-The National Institute of Health, Catalan Health Service, Andalusian Health Service, Valencian Health Service, Basque Health Service, Navarro Health Service and Health Service. (a) the other contracting parties to this Convention shall be able to do so by the other health centres which are subject to their jurisdiction and which adhere to this Convention. Such accession shall begin to be effective from the moment that Unespa and the Insurance Compensation Consortium acknowledge receipt of the discharge of the discharge by those persons.

Eighteenth.-The casualties of the Health Centers under the jurisdiction of the National Institute of Health, Catalan Health Service, Andalusian Health Service, Valencian Health Service, Basque Health Service, Service Navarro de Salud y Servicio Gallego de Salud, if produced, must be notified to Unespa and the Insurance Compensation Consortium, and will be effective three months after the date when both Unespa and the Compensation Consortium I am sure to acknowledge, in a strong manner, the low-lying communication.

Interpretation of the Convention

Nineteenth. -The contracting parties to the present Convention accept in matters affecting the interpretation of this Convention, and in the event of disagreements between each other, the resolution that the question raised provides with the Commission for Surveillance and Arbitration, without prejudice to the specific provisions of the previous provisions.

Effective and revisions

The present Convention will be valid until 31 December 1993, with the possibility of being tacitly extended on 1 January of each year with the increase of the rates according to the appropriate agreement, if not denounced by any of the contracting parties within three months prior to the expiry date.

The scales and rates approved by this Convention shall apply for all the assistance provided from 1 January 1993.

Final Statement

The signatories of this Convention, representing the Insurance Compensation Consortium, the National Institute of Health, the Catalan Health Service, the Andalusian Health Service, the Valencian Health Service, the Basque Country Service, Health, Navarro Health Service, Galician Health Service and the National Association of Automobile Insurance of Unespa, expect all the strict compliance of the stipulations and norms agreed for the benefit of the mutual relations and the harmed, covered by the Civil Liability Insurance derived from the use and movement of motor vehicles for compulsory subscription.

And for the record, the parties sign this Convention, in triplicate and to a single effect, at the place and date indicated above.

ANNEX I

Health care fees for injured persons in traffic accidents with coverage of civil liability arising from the use and circulation of compulsory subscription motor vehicles, applicable in institutions of their own or in Non-members of the public

and direct financing

1. Hospitalization. -For each day of hospital stay, the entire health care costs are included, but there is an express exception of hemodialysis, transfusion and computed axial tomography (CT) and magnetic resonance imaging. will be billed separately:

Price stay: 26.225 pesetas.

UVI or ICU stay: 43,470 pesetas.

2. Outpatient care:

First query: 11,744 pesetas.

Successive consultations: 5,870 pesetas.

First consultation shall be understood as the initial emergency assistance, including all diagnostic and treatment-setting tests carried out within 15 days of this first consultation, unless otherwise specified in the first consultation. those specified in these tariffs.

Each and every one of the assists dispensed from the fifteen days of the initial visit will be understood by successive consultations, as long as the same process is involved.

3. Physical therapy and rehabilitation. -For each day of outpatient therapy for physical therapy and rehabilitation: 945 pesetas.

4. Hemodialysis. -For each session: 15,000 pesetas.

5. Orthosis and prostheses. -The amount of the orthotheses and prostheses that could be specified for adaptation and individualized use by the crashed will be invoiced independently, according to the cost price. The equipment which the various hospital services will provide to the accident and be reusable will not be taken into account.

6. Health transport.-The costs incurred in the transfer of the injured patient will be invoiced in accordance with the rates established in each area by the Health Care Management Entities.

In cases where health transport is used other than the health centre itself or is concluded by the health centre, it shall be the insurance institution which shall take charge of the direct payment of the costs referred to in this Article. represent, subject to compliance by the insurer.

7. Computed Axial Tomography (CT). The computed tomography (CT) scan will be billed in the amount of 26,500 pesetas.

8. Magnetic resonance imaging (magnetic resonance imaging) -magnetic nuclear resonance: 50,000 pesetas.

9. Transfusions and blood products. -Blood and blood products will be invoiced at the cost price or fixed by each Health Service.

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