Fronting and Administration Agreement



 EXHIBIT 10.12 

 

			
		  	 [*]    Certain confidential information contained in this document, marked by brackets, has been omitted and
filed separately with the Securities and Exchange Commission pursuant to Rule 406 of the Securities Act of 1933, as amended.


 THIS FRONTING AND ADMINISTRATION AGREEMENT is made this 18th day of 

November, 2009 

Between: 

AMERICAN PET INSURANCE COMPANY (“APIC”) 
 a New York State regulated Insurance Company 
 and 

OMEGA GENERAL INSURANCE COMPANY (“Omega”) 
 A Canadian regulated Insurance Company 
 WHEREAS: 

(A) APIC provides pet insurance for eligible policyholders in the United States and wishes to underwrite a Canadian pet insurance program (the
“Program”) for eligible policyholders in Canada but is not currently a licensed insurance company in Canada; 
 (B) Omega is an
insurance company duly licensed to carry out business in each province and territory of Canada has agreed to act as a participating fronting company for the Program and has entered into a Stop Loss reinsurance agreement in the form attached hereto
as Schedule “A” (the “Reinsurance Agreement”) with APIC; 
 (C) A Broker as defined herein has been appointed by APIC and
Omega to act as the broker of record for the Program and has entered into an Agency Agreement with Omega in the form attached hereto as Schedule “B” (the “Agency Agreement”); 

(D) The parties wish to confirm the basis on which the Program will be underwritten, administered and managed. 

Now in consideration of the premises and the covenants and agreements herein contained, the parties hereby agreed as follows: 

  
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 Definitions 
 In this Agreement and in the schedules attached hereto, the following terms and expressions will have the following meanings. 
 Agreement means this Agreement as amended from time to time by written agreement of the parties; 
 Broker means a brokerage company or a managing general agent approved by APIC and Omega that has entered into a Representation Agreement in the form attached as Schedule “B” and that has
agreed to comply with the terms hereof as it applies to the Broker. 
 Business means the business of writing insurance policies
as part of the Program for Omega in its capacity as fronting insurer for APIC; 
 Business Day means a day (other than a Saturday,
Sunday or statutory holiday) on which banks are open for the transaction of general banking business in Toronto; 
 Confidential
Information means all information obtained by a party as a result of negotiating and entering into this Agreement; and all financial or other information received by a party pursuant to this Agreement in respect of the Program.

 Claim means, in relation to the Business, the notification by the insured of an actual or potential claim. 

Regulatory Action means any order of a court of competent jurisdiction; or any order made, decision given or final view expressed by a competent
national, governmental or regulatory authority or agency; or any enactment of a legislative body which prohibits or restricts to a material extent the carrying on of the Business or the arrangements contemplated by this Agreement; or in consequence
of which any of the parties would incur fines or a liability in damages were this Agreement to be performed in accordance with its terms. 
 Superintendent means the Superintendent of Financial Institutions Canada. 

Taxation means all forms of taxation and statutory, governmental, federal, provincial, local or municipal governmental impositions, duties,
contribution and levies and all penalties, charges, costs and interest relating thereto. 
 References to Recitals, Clauses, Schedules
and parties are, except where otherwise provided, to Recitals, Clauses, Schedules or parties to this Agreement. 
 The Schedules form part of
this Agreement and have the same force and effect as if set out in the body of this Agreement. 
 The sections and headings hereto are inserted
for convenience only and shall not affect the construction of this Agreement. 
 References to APIC, Omega, or the Broker or any of them mean
and include their respective successors in title and permitted assigns. 

  
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 Where the context so admits, references to the singular shall be deemed to include the plural and vice
versa. 
 Section 1—Appointment of Omega to write Fronting Insurance: 
 APIC hereby appoints Omega: 
 To underwrite and/or bind and/or effect policies in the name of Omega
with respect to the Business pursuant to the Program in accordance with the terms of this Agreement provided that all Underwriting Guidelines and/or decisions are acknowledged to remain under the control of APIC; and to administer the Business as
provided herein. 
 Section 2—Appointment of Broker of Record: 
 Omega and the Broker shall enter into an Agency Agreement in the form attached hereto as Schedule “B” with respect to the Program. The Broker shall act as broker of record with respect to the
Program and shall be paid commissions with respect to the Business as agreed to pursuant to the Agency Agreement. The Broker shall receive each premium payment as the agent of Omega and shall hold all premiums in a trust account. 

Section 3—Underwriting: 
 Omega
shall issue policies using forms and rates approved by APIC as provided in the Underwriting Guidelines provided in Schedule “C” (“Underwriting Guidelines”) attached hereto. 

Omega shall at all times follow the Underwriting Guidelines and decisions of APIC with respect to the Program. 

Section 4—Claims: 
 Omega shall
manage and perform the administration of the Business and the negotiation and settlement of Claims hereunder, and in doing so, shall act as agent of APIC. Omega shall at all times follow the claims handling procedures of APIC as provided in Schedule
“D” attached hereto. Omega shall immediately notify APIC of all claims and provide for a full right of consultation regarding the handing of them. 
 APIC shall ensure that, at all times, sufficient funds are provided to Omega to enable all obligations under or in relation to the Business to be met as and when they fall due pursuant to the terms of the
Reinsurance Agreement. 
 In the event of the termination of this Agreement, APIC shall have the right to assume responsibility for the handling
of all claims with respect to the Program. Omega agrees to follow all decisions made by APIC with respect to all claims made under the Program under such circumstances. 

  
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 Any and all funds provided by APIC pursuant to the Reinsurance Agreement shall, until physically disbursed
to or on behalf of the relevant insured, be held by Omega as agent for APIC. 
 Section 5—Accounts and Information: 

Omega and the Broker agree to provide accounting and other information to APIC in the form and in the manner that may be reasonably required by APIC from
time to time. 
 Omega and the Broker shall keep, in such forms as may be agreed from time to time with APIC, books, records, underwriting
statistics and accounts of all transactions under this Agreement. 
 APIC may, subject to any confidentiality obligations, at any reasonable
time and on reasonable notice appoint its officers, employees, agents, or auditors to inspect, examine and verify at the offices of Omega and the Broker (and to take copies of such books and records) all such accounts, records, books, vouchers,
correspondence and papers relating to any of the functions performed by the relevant party under this Agreement insofar as they relate to the Program and the affairs of APIC, including the application of any money belonging to APIC paid or received
by the relevant party pursuant to this Agreement; and Omega and the Broker shall whenever reasonably required at any time during normal business hours give such officers, employees, servants or agents of APIC access to its offices for such purposes.

 APIC undertakes to agree to supply, to the extent permissible under any applicable law or regulatory requirements, such information as Omega
or the Broker shall reasonably request from time to time in order to facilitate the management of the Business. 

Section 6—Relationship between the Parties: 
 Nothing in this Agreement shall create or constitute a partnership between the parties hereto or any of them nor, save as expressly provided herein, constitute any one the agent of another and no party
shall do or suffer anything to be done whereby it shall or may be represented that it is the partner or agent of any other party hereto (save as aforesaid) unless such party is appointed partner or agent of another party subject to the written
consent of every other party to this Agreement. 
 Section 7—Term: 

Unless earlier terminated in accordance with the provisions of Sections 8 or 9 hereof, the initial term of this Agreement shall be
for a period of sixty (60) months, commencing on January 1st, 2010 (the “Effective Date”) and ending on
December 31st, 2014 (the “Initial Term”).

 During the Initial Term either APIC or Omega may terminate this Agreement by providing one hundred and eighty (180) days prior written
notice to the other parties, to take effect at any calendar month end. 

  
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 At the completion of the Initial Term, this Agreement shall be automatically renewed for a minimum of one
year terms provided that any party may terminate this Agreement at any time after the end of the Initial Term by providing ninety (90) days prior written notice to the other parties, to take effect at any calendar year end. 

Section 8—Termination: 
 For
the purposes of this Clause 8, a Trigger Event shall be deemed to have occurred with respect to Omega or APIC if: 
 (a) It ceases to be duly
authorized, or licensed as an insurance company (or has any suspension, restriction or other limitation imposed in respect of its authority, licence, approval or permission), in the case of Omega in each province and territory of Canada and in the
case of APIC in the jurisdiction in which it is incorporated or has its principal place of business (home jurisdiction); 
 (b) It goes into
liquidation whether compulsorily or voluntarily (other than a voluntary and solvent liquidation for the purpose of reconstruction or amalgamation pursuant to a scheme previously agreed between the parties); 

(c) It enters into any composition with its creditors generally or suffers any similar action in consequence of default by it in its obligations in
respect of any indebtedness for borrowed moneys; or an administration order shall be made in respect of such party; 
 (d) It stops or threatens
to stop payment or ceases or threatens to cease to carry on its business (otherwise than in connection with or in pursuance of a winding-up for the purpose of a reconstruction or amalgamation pursuant to a scheme previously agreed between the
parties) or is deemed to be unable to pay its debts; 
 (e) It has an administrative receiver or other receiver or other similar official
appointed over all (or substantially all) of its undertaking and assets; 
 In the event that a Trigger Event occurs in relation to either Omega
or APIC, the other party may suspend entirely with immediate effect the operation of the Program. 
 If this Section 8 applies, neither
Omega, nor the Broker shall (nor shall they have any authority to): 
 (a) Accept new policies with respect to the Business; 

(b) Provide quotations or enter into (or continue) any negotiations relating to the possible acceptance of new policies with respect to the Business;

 (c) Agree to any amendments to the terms of or otherwise agree to any endorsements to any policy with respect to the Business which would, or
be reasonably likely to, increase materially the gross exposure of Omega and APIC under the policy in question. 

  
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 Each party shall notify the other parties upon becoming aware of a Trigger Event in relation to Omega or
APIC at any time. 
 Suspension and/or termination of the authority granted pursuant to this Agreement in whatever manner shall in no way affect
or limit any accrued rights which any party to this Agreement may have against the others pursuant to this Agreement or any rights expressly stated to survive termination of this Agreement. 
 Notwithstanding anything in this Agreement to the contrary if one party is in default of this Agreement and if such default is capable of being cured the non defaulting party shall give written notice of
the default in reasonable detail to the non defaulting party who shall be given a reasonable amount of time to cure such default prior to the non defaulting party terminating this Agreement for such default. 

Section 9—Transfer of Business: 

In the event that APIC becomes a licensed insurance company in Canada, Omega and APIC shall each have the right to require a transfer of the run-off of
the Business from Omega to APIC pursuant to a Transfer and Assumption Agreement, subject to any applicable regulatory approval. A transfer of the Business shall be conditional upon Omega and APIC reaching agreement with respect to the amount of
reserves to be transferred regarding it. In the event that APIC becomes a licensed insurance company in Canada, APIC may terminate this agreement upon 3 months written notice. 
 Section 10—Confidentiality: 
 Each party hereto shall hold in confidence and shall
not divulge to any other party or any third party any Confidential Information nor make any public or press announcement regarding this Agreement or matters connected therewith. 
 Notwithstanding the provisions of this Section 10, any party may disclose Confidential Information: 
 (a) In respect of any party to any other party with the prior written consent of the first party (such consent not to be unreasonably withheld or delayed); 

(b) If and to the extent required by law or for the purpose of any judicial proceedings; 
 (c) If and to the extent required by any securities exchange or regulatory or governmental body or tax authority to which that party is subject, wherever situated; 

(d) To its professional advisers, auditors and bankers. 
 Notwithstanding this Section 10 each party shall be entitled to provide extracts of this Agreement to such banks, reinsurers, brokers and insurance regulators as it reasonably deems necessary for the
purpose of carrying out the Business. 

  
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 Each party shall comply with all applicable federal and provincial privacy laws. 

The provisions of this Section 10 shall remain in full force and effect notwithstanding the termination of this Agreement and each party shall
remain bound by the provisions of this Section 10 for a period of five years following the termination of this Agreement. 

Section 11—Undertakings: 

APIC, Omega, and the Broker shall use all reasonable care and skill in the performance of their respective obligations under this Agreement and shall
comply with all applicable laws relating thereto. 
 Each party agrees, warrants and undertakes to the others that it has and will have all
necessary consents, powers and authorities to enter into this Agreement in accordance with its terms. 
 Omega represents and warrants to APIC
and the Broker that it is duly authorized and licensed to write the Business it Canada and Omega undertakes to take all reasonable steps to maintain such authorizations and licenses during the duration of this Agreement. 

Omega undertakes to notify APIC and the Broker in writing as soon as reasonably practicable of any changes as to the authorizations and licenses which it
has, or expects to obtain, from time to time. 
 Section 12—Regulatory Matters: 

The parties shall co-operate with each other to ensure that all information necessary or desirable for making any regulatory notification or filing in
respect of this Agreement, or any agreement, arrangement or concerted practice of which it forms part (or responding to any requests for further information following any such notification or filing), is supplied to the party dealing with such
notification or filing and that any such notification or filing is properly, accurately and promptly made. 
 The parties will each ensure that
any other registrations, filings and/or submissions required under the laws or regulations of any jurisdiction in respect of the Agreement or the Business are made. 
 Section 13—Waiver of Obligations: 
 Waiver by any party of any default by any
other party in the performance of any obligation of such other party hereunder shall not affect such party’s rights in respect of any other default nor any subsequent default of the same or of a different kind nor shall any delay or omission of
any party to exercise any right arising from any default affect or prejudice that party’s rights as to the same or any future default. Waiver by one party of any default by any other party shall not constitute a waiver of such default on the
part of or on behalf of any other party. 

  
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 Section 14—Amendments and Representations: 

Any amendment to any term of this Agreement shall be in writing and signed by the authorized representatives of the parties hereto. 

This Agreement together with the Reinsurance Agreement and the Agency Agreement sets out the entire agreement and understanding between the parties in
relation to the Business. It is agreed that no party has entered into this Agreement in reliance upon, or been induced to enter into this Agreement by, any representation, warranty or undertaking of any other party hereto (whether express or implied
and whether pursuant to statute or otherwise) which is not set out in this Agreement or the Reinsurance Agreement or the Agency Agreement and to the extent that it may have done so, it hereby waives all rights, remedies and claims it may have in
respect thereto. 
 A party may claim in contract for breach of warranty under this Agreement or the Reinsurance Agreement or the Agency
Agreement but shall otherwise have no claim or remedy in respect of misrepresentation (whether negligent or otherwise, and whether made prior to, and/or in, this Agreement) or untrue statement made by any other party, provided that this
Section 14 shall not exclude any liability for, or remedy in respect of any fraud including, without limitation, fraudulent misrepresentation by any party. 
 Section 15—Assignment: 
 No party shall sell, transfer or encumber all or any of
its rights or obligations under this Agreement without the prior written consent of all the other parties. 
 Section 16—Notices
and Communications: 
 Notices under this Agreement shall be sent to a party at its address and for the attention of the individual set out
in Section 17 provided that a party may change its notice details on giving written notice to the other parties of the change. That notice shall only be effective on the date falling five clear Business Days after the notification has been
received or such later date as may be specified in the notice. 
 All notices or other communications required for the purposes of this
Agreement shall be in English and shall be given or sent by hand, facsimile, registered mail or courier to the parties and shall be deemed to be received: (i) if given by hand, at the time of delivery; or (ii) if sent by facsimile; at the
time when the sender receives from the recipient facsimile machine or from the addressee of the notice confirmation of receipt of the whole of the facsimile; or (iii) if sent by registered mail, 24 hours after confirmation of delivery; or
(iv) if sent by courier , 24 hours after the date of delivery by the courier company. 

  
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 Section 17—Addresses: 
 Notices under this Agreement shall be sent to the following addresses or facsimile numbers for the attention of the person indicated: 

 

			
	 a) if to APIC:
	  	 1148 NW Leary Way,
 Seattle,
Washington
 U.S.A.

		
		  	Facsimile: 425-776-4295
		
	 b) if to Omega:
	  	 36 King Street East, Suite 500
 Toronto, Ontario, M5C 1E5
 Canada.

 
 Facsimile: 416-361-6113


 Different persons may be authorized to give or receive instructions for different purposes, and such persons may include
officers of corporations other than the parties hereto, authorized in that regard by the board of the relevant party. 
 A certified copy of a
resolution of the board of Omega or APIC or the Broker may be received and accepted by either party as conclusive evidence of the authority of any person to act and may be considered in full force and effect until receipt of written notice to the
contrary. 
 Section 18—Governing Law: 
 This Agreement and the relationship between the parties shall be governed by and interpreted in accordance with the law of the Province of Ontario, Canada. 

Section 19—Enforceability: 
 If
any provision of this Agreement or any part thereof: 
 (a) Purports to exclude, restrict or limit any liability and such exclusion, restriction
or limitation is prohibited, rendered void or unenforceable by any legislation to which it is subject; 
 (b) Is itself prohibited, rendered
void or unenforceable by any legislation to which it is subject, then the exclusion, restriction or limitation or the provision or part thereof in question shall be so prohibited or rendered void or unenforceable to the extent to which it is thus
prohibited or rendered void or unenforceable and the validity or enforceability of any other part of this Agreement shall not thereby be affected. 

  
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 Section 20—Arbitration: 
 1. In the event that any dispute arises between the parties signatory to this agreement, whether such dispute arises during or after the term of this agreement, and as a precedent to any right of action
hereunder a meeting will be held between representatives of each of the parties with decision making authority to settle the dispute. At the meeting the parties will attempt in good faith to negotiate an informal resolution of the dispute. If the
dispute is not resolved through negotiation within 10 Business Days the parties hereby agree to submit their dispute to Arbitration. Upon the written request of either party to the dispute the parties shall select an arbitrator from among persons
with not less than 10 years experience in the insurance or reinsurance business, as persons engaged in the industry itself or as lawyers or other professional advisors, or as otherwise agreed by the parties. If the parties are unable to agree on an
arbitrator within 30 days after receipt of written notice from the other party requesting it to do so then either party may proceed pursuant to the Arbitration Act, 1991 (Ontario) to have an arbitrator appointed. 

2. The arbitrator shall interpret this agreement as an honourable engagement and not as a legal obligation; they are relieved of all judicial formalities
and may abstain from following the strict rules of law, and they shall make their award with a view to effecting the general purpose of this agreement in a reasonable manner rather than in accordance with a literal interpretation of the language.
Each party shall submit its case to the arbitrator within 30 days of the appointment of the arbitrator. 
 3. The arbitrator, so far as is
permissible under the law and practice of the place of arbitration, shall have power to fix all procedural rules for the holding of the arbitration including discretionary power to make orders as to any matters which it may consider proper in the
circumstances of the case with regard to pleadings, discovery, inspection of the documents, examination of witnesses and any other matter whatsoever relating to the conduct of the arbitration and may receive and act upon such evidence whether oral
or written strictly admissible or not as it shall in its discretion think fit. 
 4. The decision in writing of the arbitrator shall be final
and binding on both parties. Judgement may be entered upon the final decision of the arbitrator in any court in Canada having jurisdiction. The arbitrator shall determine who pays the expense of the arbitration. The arbitration will take place in
Toronto, Ontario, Canada, or such other venue in Ontario, Canada as determined by the arbitrator. 

  
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 Section 21—Counterparts: 
 This Agreement may be executed in any number of counterparts and by the parties to it on separate counterparts and by facsimile transmission, each of which is an original but all of which together
constitute one and the same instrument. 
 IN WITNESS WHEREOF this Agreement has been signed by and on behalf of the parties.

  

			
	AMERICAN PET INSURANCE COMPANY
		
		 	/s/ Darryl Rawlings
		 	By:
	
	OMEGA GENERAL INSURANCE COMPANY
		
		 	/s/ Philip H. Cook
	By:     Philip H. Cook, C.E.O.


  
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 SCHEDULE “A” 

REINSURANCE AGREEMENT 
 (see attached) 







 AGREEMENT NUMBER: 200903 

STOP LOSS REINSURANCE AGREEMENT 
 made between 
 OMEGA GENERAL INSURANCE COMPANY 

A company organized and existing under the laws of Canada 
 (hereinafter referred to as the “Reinsured”) 
 and

 AMERICAN PET INSURANCE COMPANY 
 A company organized and existing under the laws of New York, 

(hereinafter referred to as the “Reinsurer”) 
 WHEREAS: The parties to this Agreement having entered into a separate Fronting and Administration Agreement (herein referred to as the “FAA”) wherein the Reinsured is willing to cede, and the
Reinsurer is willing to accept, certain risks underwritten by the Reinsured as contemplated under the FAA. 
 and 

WHEREAS: The Reinsured has also entered into a Representation Agreement with the Broker as defined in the FAA. 

and 
 WHEREAS: For and in consideration of the
Premium specified in this Agreement being paid by the Reinsured to the Reinsurer and subject always to the terms and conditions of this Agreement, the Reinsurer agrees to indemnify the Reinsured as follows: 

ARTICLE 1 INTEREST CLAUSE 
 This
Agreement is to indemnify the Reinsured in respect of liability, which may accrue to them under any and all policies and/or contracts of insurance in respect of the business produced by the Broker and underwritten pursuant to the FAA, and in
accordance with underwriting and claims handling guidelines set out therein. At no time shall the Reinsured accept or underwrite business not provided for in the FAA for this reinsurance. 

  
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 ARTICLE 2 PERIOD CLAUSE 
 This Agreement is in respect of losses as herein defined pertaining to risks attaching during the period specified in the FAA. 
 ARTICLE 3 EXCLUSIONS 
 This Agreement follows the underlying coverage issued to the
policyholders of the Reinsured in accordance with the FAA. For further clarity, this Agreement does not contain any exclusions or limitations, which are not present in the underlying policies. 

ARTICLE 4 REINSURING CLAUSE 
  

	A.	The Reinsurer hereby agrees to pay the Reinsured 100% of the annual Net Underwriting Loss incurred on the subject portfolio underwritten by the Reinsured as business
under the FAA (“Business”), in excess of the Net Premium Retained by the Reinsured. 

  

	B.	The term “Net Underwriting Loss” shall mean the total sum incurred by the Reinsured for all losses or liability in respect of the Business covered hereunder,
including paid claims plus outstanding claims plus incurred but not reported claims as determined by the Reinsured’s Actuary. 

 Calculation of the Net Underwriting Loss hereunder, shall include all costs and adjustment expenses arising from the handling of claims, other than the salaries of employees and the office expenses of the
Reinsured. 
 For purposes of the Net Underwriting Loss calculation, prior to any calendar year end, the Reinsured will estimate
the Net Underwriting Loss as [*]. 
  

	C.	The term “Net Premium Retained” shall mean the gross premium charged to the policyholder, less broker acquisition costs (including profit commission where
applicable), less premium tax incurred by the Reinsured, less the premium paid under Article 8 of this Agreement, less [*]. 

 For purposes of the Net Premium Retained calculation, prior to any calendar year end, the Reinsured will estimate the premium tax incurred to be 3% of the gross premiums charged to the policyholders.

  

	D.	The Reinsurer hereby agrees to pay the Reinsured, in cash, the amount identified in the above Article 4A, upon presentation of supporting documentation by the
Reinsured. The Reinsured undertakes to provide up-dated loss information including paid and outstanding claims on a quarterly basis, no later than 30 days after the end of each calendar quarter. The Reinsurer will have the option of authorising the
Reinsured to deduct such amounts due hereunder from premium funds due to the Reinsurer, but in any event, the Reinsurer agrees to fund the subject losses either by “offset” or direct payment as soon as supporting documentation is received.


 * Confidential Treatment Requested. 

  
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 ARTICLE 5 ULTIMATE NET UNDERWRITING LOSS SETTLEMENT CLAUSE 

The Reinsured will continue to update the calculations in the above Article 4A until the third calendar year following the year in which the premium is
received by the Reinsured, when the calculation made at that time will be considered “final” unless an extension is agreed between the parties. 
 ARTICLE 6 NET RETAINED LINES CLAUSE 
 This Agreement shall only protect that portion of any
Business the subject matter of this Agreement which is above the Reinsured’s net retention as agreed in advance with the Reinsurer. The Reinsurers’ liability hereunder shall not be increased due to an error or omission which results in an
increase in the Reinsured’s net retention nor by the inability of the Reinsured to collect from any other reinsurer any amounts which may have become due from them whether such inability arises from the insolvency of such other reinsurer or
otherwise. 
 ARTICLE 7 TERRITORIAL LIMITATIONS 
 This Agreement is in respect of Business in Canada. 
 ARTICLE 8 PREMIUM CLAUSE 

The Reinsured hereby agrees to pay the Reinsurer a premium equal to [*]. This premium shall be paid to the Reinsurer on a monthly basis, fifteen
(15) days following the end of the month in which the premium is received by the Reinsured. 
 ARTICLE 9 CURRENCY CLAUSE 

For the purpose of this Agreement all currencies are expressed in Canadian dollars. Any losses involving other than Canadian currency shall be converted
into Canadian currency at the rates of exchange used in the Reinsured’s books, or where there is a specific remittance for a loss settlement, at the rates of exchange used in making such remittance. 

ARTICLE 10 UNDERWRITING POLICY CLAUSE 

It is a condition precedent to the Reinsurer’s liability hereunder that the Reinsured shall not introduce at any time after the Reinsured enters into
this Agreement any change in the FAA without the prior written approval of the Reinsurer. 
 * Confidential Treatment
Requested. 

  
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 ARTICLE 11 INSPECTION OF RECORDS CLAUSE 
 For as long as either party retains any liability hereunder the Reinsured shall, upon request by the Reinsurer, make available at the Reinsured’s head office for inspection at any reasonable time by
such representatives as may be authorised by the Reinsurer for that purpose, all information relating to business reinsured hereunder (including actuarial reviews and evaluations) in the Reinsured’s possession or under its control and the said
representatives may arrange for copies to be made of any of the records containing such information as they may require. 
 ARTICLE 12
AMENDMENTS AND ALTERATIONS CLAUSE 
 Any amendments and/or alterations to this Agreement that are agreed either by correspondence and/or
Broker’s Slip endorsements, shall be automatically binding on the parties and unless otherwise agreed by the parties hereto shall be formally documented by an exchange of correspondence signed by the parties or by the issue of a contract
addendum which shall be considered to form an integral part hereof. 
 ARTICLE 13 ERRORS OR OMISSIONS CLAUSE 

Any inadvertent errors or omissions on the part of either the Reinsured or the Reinsurer shall not relieve the other party from any liability which would
have attached hereunder, provided that such errors or omissions shall be rectified as soon as possible after discovery. Nevertheless, nothing contained in this Article shall be held to override any of the terms and conditions of this Agreement and
no liability shall be imposed on the other party greater than would have attached hereunder had such errors or omissions not occurred. 

ARTICLE 14 CLAIMS NOTIFICATION AND SETTLEMENTS CLAUSE 
 The Reinsured undertakes to advise the Reinsurer as soon as possible in the event of a loss being likely to arise hereunder together with an estimate of the Reinsurer’s liability and thereafter keep
the Reinsurer fully informed of any developments regarding the original claims. In addition, the Reinsured shall provide to the Reinsurer with monthly information on all claims made under the subject agreement, even if the aggregate total of such
claims (including incurred but not reported) does not exceed the Reinsured’s retention. 
 All losses under the program will be adjusted on
behalf of the Reinsured by claim handlers selected by mutual agreement between the Reinsured and the Reinsurer. 
 All loss settlements made by
the Reinsured shall be binding upon the Reinsurer, provided such settlements are within the terms and conditions of the original policies and/or contracts and within the terms and conditions of this Agreement, and amounts falling to the share of the
Reinsurer shall be payable by them upon reasonable evidence being given by the Reinsured. 
 ARTICLE 15 INSOLVENCY CLAUSE 

Where an Insolvency Event (as defined below) occurs in relation to the Reinsured the following terms shall apply (and, in the event of any inconsistency
between these terms and any other terms of this Agreement, these terms shall prevail): 

  
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	A.	Notwithstanding any requirement in this Agreement to the contrary: 

  

	 	(i)	the Reinsurer shall be liable to pay the Reinsured even though the Reinsured is unable actually to pay, or discharge its liability to, its policyholder; but


  

	 	(ii)	nothing in this clause shall operate to accelerate the date for payment by the Reinsurer of any sum which may be payable to the Reinsured but for it being the subject
of any Insolvency Event. 

  

	B.	The existence, quantum, valuation and date for payment of any sum which the Reinsurer is liable to pay the Reinsured under this Agreement shall be those and only those
for which the Reinsurer would be liable to the Reinsured if the liability of the Reinsured to its policyholders had been determined without reference to any term in any composition or scheme of arrangement or any similar such arrangement, entered
into between the Reinsured and all or any part of its policyholders, unless and until the Reinsurer serves written notice to the contrary on the Reinsured in relation to any composition or scheme of arrangement. 


 

	C.	The Reinsurer shall be entitled (but not obliged) to set-off, against any sum which it may be liable to pay the Reinsured, any sum for which the Reinsured is liable to
pay the Reinsurer. 

  

	D.	The Reinsurer shall be entitled (but not obliged) to assume direct control of any losses under this program by giving notice to the policyholder, the Reinsured or its
representative. The Reinsurer will then assume total responsibility for such losses as though they had issued the underlying policy. 

 An Insolvency Event shall occur if 
  

	 	(i) (a)	(for the purposes of and in relation to A, B, C and D above) a winding up petition is presented in respect of the Reinsured or a provisional liquidator is appointed
over it or if the Reinsured goes into administration, administrative receivership or receivership or if the Reinsured has a scheme of arrangement or voluntary arrangement proposed in relation to all or any part of its affairs; or


  

	 	(b)	(for the purposes of and in relation to A above) the Reinsured goes into compulsory or voluntary liquidation; 


 

	 	(c)	(for the purposes of and in relation to D above) the Reinsured becomes subject to any regulatory intervention. 


or, in each case, if the Reinsured becomes subject to any other similar insolvency process; and 

 

	 	(ii)  	the Reinsured is unable to pay its debts as and when they fall due within the meaning of relevant Canadian law or statute. 


  
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 ARTICLE 16 TERMINATION CLAUSE 
 Either party shall have the right to terminate this Agreement immediately by giving the other party written notice:- 
  

	A.	If the performance of the whole or any part of this Agreement is prohibited or rendered impossible de jure or de facto in particular and without prejudice to the
generality of the preceding words in consequence of any law or regulation which is or shall be in force in any country or territory or if any law or regulation shall prevent directly or indirectly the remittance of any or all or any part of the
balance of payments due to or from either party. 

  

	B.	If the other party has become insolvent or unable to pay its debts or has lost the whole or any part of it’s paid up capital. 


 

	C.	If there is any material change in the ownership or control of the other party. 


 

	D.	If the country or territory in which the other party resides or has its head office or is incorporated shall be involved in armed hostilities with any other country
whether war be declared or not or is partly or wholly occupied by another power. 

  

	E.	If the other party shall have failed to comply with any of the terms and conditions of this Agreement. 


After the date of any such termination the liability of the Reinsurers hereunder shall cease outright other than in respect of losses which have occurred
prior thereto. 
 All notices of termination in accordance with any of the provisions of this paragraph shall be by Telex, Facsimile, Telegram
or any other permanent means of instantaneous communication, and shall be deemed to be served upon despatch or where communications between the parties are interrupted upon attempted despatch. 

All notices of termination served in accordance with any of the provisions of this Article shall be addressed to the party concerned at its head office
or at any other address previously designated by that party. 
 Notwithstanding anything in this Agreement to the contrary if one party is in
default of this Agreement and if such default is capable of being cured the non defaulting party shall give written notice of the default in reasonable detail to the non defaulting party who shall be given 60 days or such additional time as the non
defaulting party may consider reasonable to cure such default prior to the non defaulting party terminating this Agreement for such default. 

ARTICLE 17 ARBITRATION CLAUSE 
 1. In the
event that any dispute arises between the parties signatory to this agreement, whether such dispute arises during or after the term of this agreement, and as a precedent to any right of action hereunder a meeting will be held between representatives
of each of the parties with 

  
 6 








 
decision making authority to settle the dispute. At the meeting the parties will attempt in good faith to negotiate an informal resolution of the dispute. If the dispute is not resolved through
negotiation within 10 Business Days the parties hereby agree to submit their dispute to Arbitration. Upon the written request of either party to the dispute the parties shall select an arbitrator from among persons with not less than 10 years
experience in the insurance or reinsurance business, as persons engaged in the industry itself or as lawyers or other professional advisors, or as otherwise agreed by the parties. If the parties are unable to agree on an arbitrator within 30 days
after receipt of written notice from the other party requesting it to do so then either party may proceed pursuant to the Arbitration Act, 1991 (Ontario) to have an arbitrator appointed. 
 2. The arbitrator shall interpret this agreement as an honourable engagement and not as a legal obligation; they are relieved of all judicial formalities and may abstain from following the strict rules of
law, and they shall make their award with a view to effecting the general purpose of this agreement in a reasonable manner rather than in accordance with a literal interpretation of the language. Each party shall submit its case to the arbitrator
within 30 days of the appointment of the arbitrator. 
 3. The arbitrator, so far as is permissible under the law and practice of the place of
arbitration, shall have power to fix all procedural rules for the holding of the arbitration including discretionary power to make orders as to any matters which it may consider proper in the circumstances of the case with regard to pleadings,
discovery, inspection of the documents, examination of witnesses and any other matter whatsoever relating to the conduct of the arbitration and may receive and act upon such evidence whether oral or written strictly admissible or not as it shall in
its discretion think fit. 
 4. The decision in writing of the arbitrator shall be final and binding on both parties. Judgement may be entered
upon the final decision of the arbitrator in any court in Canada having jurisdiction. The arbitrator shall determine who pays the expense of the arbitration. The arbitration will take place in Toronto, Ontario, Canada, or such other venue in
Ontario, Canada as determined by the arbitrator. 
 ARTICLE 18 JURISDICTION CLAUSE 

This Agreement shall be governed by the laws of Ontario, Canada. 
 ARTICLE 19 INTERMEDIARY CLAUSE 
 The parties to this agreement recognize and accept that
there is no intermediary involved in the placement or handling of this Agreement and that the relationship is direct between the Reinsured and the Reinsurer. 

  
 7 








 ARTICLE 20 WARRANTIES AND/OR SPECIAL CONDITIONS CLAUSE 

The parties to this agreement hereby warrant and confirm that they are licensed in good standing in their respective regulatory jurisdictions and that
they are authorized to carry on the business of Insurance or Reinsurance for the line of business contemplated by this Agreement. The parties also warrant and confirm that they have the necessary authority to enter in to and execute this Agreement,
and that both have accepted the terms and conditions of the FAA. 
 ARTICLE 21 COUNTERPARTS 

This Agreement may be executed in any number of counterparts and by the parties to it on separate counterparts and by facsimile transmission, each of
which is an original but all of which together constitute one and the same instrument. 
 SIGNED this 18th day of November, 2009 

For the Reinsured, OMEGA GENERAL INSURANCE COMPANY 
  

			
	/s/ Philip H. Cook C.E.O.
	SIGNED this 18th day of November, 2009

 For the Reinsurer, AMERICAN PET INSURANCE COMPANY 

 

	
	/s/ Darryl Rawlings
	


  
 8 








 SCHEDULE “B” 

AGENCY AGREEMENT 
 (see attached) 







 Agency Agreement 
 Between 
 Omega General Insurance Company 

36 King Street East, Suite 500 
 Toronto, Ontario M5C 1E5 
 hereinafter called “The Company” 

And 
 Vetinsurance
Brokers Canada Inc. 
 PO Box 34538, 1268 Marine Drive 
 North Vancouver, British Columbia V7P 1T2 
 hereinafter called “The
Broker” 
 ARTICLE I 
 Appointment 
 Whereas The Company and American Pet Insurance Co. have entered into a
separate Fronting and Administration Agreement (“FAA”), The Company hereby appoints the Broker, subject to all the terms and conditions herein, all of the insurance laws and other laws applicable to insurance companies and insurance
brokers of each province and territory of Canada (“Provincial Insurance Laws”) and to any limitations, underwriting rules and procedural instructions issued by The Company. It is understood and agreed that this appointment is solely for
the purpose of selling policies of insurance as contemplated under the FAA and other related insurance as may be mutually agreed by the parties to this agreement. The Broker shall not hold itself out as having the power to bind or obligate The
Company in any manner whatsoever except for the purpose set out herein. 
 The Broker has read and fully understands the contents, terms,
conditions and covenants of the FAA and agrees to be bound by FAA as it relates to the Broker and the business of the Broker. 

ARTICLE II 
 Accounts

 1. The Broker agrees to submit to The Company monthly statements in the required format, reporting all policies in numerical order; a
record of all premiums due; and such other reports as The Company may reasonably request pertaining to its business in force or expired. The Broker shall forward statements due to The Company no later than 15 calendar days following the end of each
month in which the business is recorded at its offices. If no sale is made during the month, a “Nil” report must be submitted. Commissions and other remuneration shall be determined by agreement and may be subject to change from time to
time. The initial commission is set out in the attached Exhibit 1. 

  
 1 








 2. All monies received or collected by the Broker on behalf of The Company, less The Broker’s
commissions, and any other amounts agreed to herein shall be the property of The Company, and shall be held by The Broker in trust for The Company. The Broker shall not use the funds or apply them for other purposes, except as contained in this
agreement, unless otherwise approved by The Company in writing. 
 ARTICLE III 

Records 
  

	1.	All records of The Broker pertaining to the business of The Company shall be open to inspection by The Company at any reasonable time for the purpose of determining any
fact related to money due The Company, or the status of business placed with The Company by The Broker. Except for forms, manuals, advertising and other materials that may be supplied to The Broker by The Company at its option and in the ordinary
course of business, The Broker shall bear all the cost and expense of operating its business. 

  

	2.	Ownership, use and control of all customer lists and records shall remain the property of The Broker and shall not be used by The Company without the express written
permission of The Broker, except to the extent required by law. 

 ARTICLE IV 

Sub Agents 
 The Broker shall have the
sole responsibility of appointing or removing other agencies, brokers and producers with respect to the business contemplated under the FAA. The Company reserves the right to require that any such appointments be cancelled with or without cause on
30 days notice and The Company shall be relieved of all liability hereunder. Any sub agents or affiliated agents will be expected to confirm their agreement to the terms and conditions of this Agreement. 

ARTICLE V 
 Termination

 1. It is expressly understood and agreed that The Company and The Broker have mutually agreed to the premiums and coverages assigned to
the business contemplated under the FAA and that neither party has the authority to change the premium or coverage terms. 
 2. This Appointment
may be terminated by giving 60 days prior written notice, or in accordance with the termination provisions of the FAA. Upon termination by either party The Broker shall return to The Company all documents and supplies in their possession, if any,
along with any monies due to The Company. 

  
 2 








 ARTICLE VI 
 Administration 
 1. The Broker, after deducting The Broker’s agreed commission as
compensation, will remit all premiums to The Company by the 30th day of the month following the month in which the transactions are recorded at its offices. 
 2. The Company located at Suite 500, 36 King Street East, Toronto, Ontario MSC 1E5 will receive all premiums from The Broker, and will validate and process all entries of premium as required herein.

 ARTICLE VII 

Service of Suit 
 The Broker may not
accept service of legal process issued against The Company in respect of any of the business hereunder. 
 ARTICLE VIII

 Indemnity 
 1. It is expressly
understood and agreed that in order to comply with the Provincial Insurance Laws, The Broker, and any sub agents or brokers representing the business under this agreement when required by law or regulation, shall be in possession of a valid
Insurance License appointment in each Province or Territory of Canada where it solicits business as the case may be. Also, the Broker shall indemnify and hold The Company harmless against liability to policy or certificate holders caused solely by
acts or omissions of negligence or fraud by The Broker in processing authorized business for The Company. 
 2. The Company shall hold The
Broker harmless from any civil liability resulting from The Company’s acts or omissions in services performed under this Agreement. Such indemnification shall include reasonable legal fees incurred in connection with the investigation or
defense against any claim. Upon receiving notice of any claim that could be covered by this section, The Broker shall notify The Company within 5 working days. 
 ARTICLE IX 
 Arbitration 
 1. In the event that any dispute arises between the parties signatory to this agreement, whether such dispute arises during or after the term of this agreement, and as a precedent to any right of action
hereunder a meeting will be held between representatives of each of the parties with decision making authority to settle the dispute. At the meeting the parties will attempt in good faith to negotiate an informal resolution of the dispute. If the
dispute is not resolved through negotiation within 10 Business Days the parties hereby agree to submit their dispute to 

  
 3 








 
Arbitration. Upon the written request of either party to the dispute the parties shall select an arbitrator from among persons with not less than 10 years experience in the insurance or
reinsurance business, as persons engaged in the industry itself or as lawyers or other professional advisors, or as otherwise agreed by the parties. If the parties are unable to agree on an arbitrator within 30 days after receipt of written notice
from the other party requesting it to do so then either party may proceed pursuant to the Arbitration Act, 1991 (Ontario) to have an arbitrator appointed. 
 2. The arbitrator shall interpret this agreement as an honourable engagement and not as a legal obligation; they are relieved of all judicial formalities and may abstain from following the strict rules of
law, and they shall make their award with a view to effecting the general purpose of this agreement in a reasonable manner rather than in accordance with a literal interpretation of the language. Each party shall submit its case to the arbitrator
within 30 days of the appointment of the arbitrator. 
 3. The arbitrator, so far as is permissible under the law and practice of the place of
arbitration, shall have power to fix all procedural rules for the holding of the arbitration including discretionary power to make orders as to any matters which it may consider proper in the circumstances of the case with regard to pleadings,
discovery, inspection of the documents, examination of witnesses and any other matter whatsoever relating to the conduct of the arbitration and may receive and act upon such evidence whether oral or written strictly admissible or not as it shall in
its discretion think fit. 
 4. The decision in writing of the arbitrator shall be final and binding on both parties. Judgement may be entered
upon the final decision of the arbitrator in any court in Canada having jurisdiction. The arbitrator shall determine who pays the expense of the arbitration. The arbitration will take place in Toronto, Ontario, Canada, or such other venue in
Ontario, Canada as determined by the arbitrator. 
 Signed and accepted by the parties to this agreement. 

Dated this 18th day of November, 2009, in Toronto, Ontario. 
 For – Omega General Insurance Company  

      By: Philip H. Cook, CEO 

 

			
	/s/ Philip H. Cook

 For – Vetinsurance Brokers Canada Inc.  

      By: 
  

			
	/s/ Darryl Rawlings


  
 4 








 EXHIBIT 1 – Commissions 
 Regular Commission: [*]. 
 Profit Commission: to be paid to The Broker annually by
The Company based on the performance of the business for each calendar year, such payment to be made no later than 90 days following the end of the year in which the profit commission is earned. 

The profit commission shall be equal to 100% of the net profit generated by the business. Net profit for the purpose of this calculation is defined as
follows—the gross premium charged to the policyholder, minus the regular commission paid to The Broker, minus premium tax incurred by The Company, minus the stop loss reinsurance premium paid to American Pet Insurance Co, minus claims incurred
by The Company (including paid claims plus outstanding claims) minus [*]. 
 Where the net profit for any given year is negative, The Broker
will not be eligible for a profit commission for that year. 
 Each calendar year calculation of the profit commission will be updated annually
thereafter (and adjusted accordingly) until its third anniversary, when the calculation made at that time will be considered “final” unless an extension is agreed between the parties. 

* Confidential Treatment Requested. 

  
 5 








 SCHEDULE “C” 

UNDERWRITING GUIDELINES 
 (see attached) 







 AMERICAN PET INSURANCE COMPANY 

PET INSURANCE PROGRAM 
 Underwriting and Rate Guidelines 
 AMERICAN PET INSURANCE COMPANY 

1148 NW Leary Way 

Seattle, Washington 98107-5133 
 888-738-7478 
 www.trupanion.com 

EFFECTIVE: 

January 1, 2008 







 COMPANY DIRECTORY 
 UNDERWRITING 
  

					
		  	ADDRESS:	  	 1148 NW Leary Way
 Seattle,
Washington 98107-5133

			
		  	PHONE:	  	888-738-7478
			
	CLAIMS	  		  	
		  	ADDRESS:	  	 1148 NW Leary Way
 Seattle,
Washington 98107-5133

			
		  	PHONE:	  	888-738-7478
			
	BILLING	  		  	
		  	ADDRESS:	  	 1148 NW Leary Way
 Seattle,
Washington 98107-5133

			
		  	PHONE:	  	888-738-7478


  

			
	APIC January 2008	  	1









 PET INSURANCE PROGRAM 
 Effective January 1, 2008 
 UNDERWRITING RULES & GUIDELINES

 Since it is not possible to make rules to cover every situation, final decisions with respect to acceptance of risk, underwriting, rates,
etc., are reserved by the Company. 
 MONTHLY PREMIUM 

 

	1.	Your monthly premium will not increase as your pet’s age increases. 

  

	2.	Your monthly premium will not increase regardless of the number of claims you make. 

 ELIGIBLE PETS 
  

	 	1.	All dogs and cats under age 14 are eligible for enrollment, 

 POLICY TERM 
  

	 	1.	All policies are on a monthly basis. 


OPTIONAL COVERAGES 
  

	 	1.	Coverage for hip dysplasia may be purchased. An additional surcharge will be applied if this coverage is elected. 


 

	 	2.	Coverage for veterinarian exam fees may be purchased. An additional surcharge will be applied if this coverage is elected. 


 

	 	3.	Coverage is provided with 90% co-insurance. You may select optional co-insurance amounts ranging from 50% to 90%. Your premium will be adjusted accordingly.


  

	 	4.	Coverage is provided with no deductible. You may select optional deductible amounts ranging from $50.00 to $1,000.00. Your premium will be adjusted accordingly.


  

	 	5.	Coverage for Additional Benefits may be purchased. These benefits include Third Party Property Damage Liability, Advertising and Reward, Boarding Fees, Holiday
Cancellation Costs, and Pet Cremation or Burial. An additional charge will be applied if this coverage is elected. 

 POLICY
PLANS 
  

	 	1.	Plan 1 is for pets under one year old. This plan features a 90% co-insurance, no deductible, no hip dysplasia coverage, no exam fee coverage, and no additional benefits
coverage. 

  

	 	2.	Plan 2 is for pets under one year old. This plan allows you to choose all optional coverages. 


 

	 	3.	Plan 3 is for all pets under 14 years old. This plan features a 90% co-insurance, no deductible, no hip dysplasia coverage, no exam fee coverage, and no additional
benefits coverage. 

  

	 	4.	Plan 4 is for all pets under 14 years old. This plan allows you to choose all optional coverages. 


Please refer to your policy for various exclusions and limitations, which restrict coverage. Please read it carefully. 

  

			
	APIC January 2008	  	2









 RATING ORDER OF CALCULATIONS 
 DOG RATING FORMULA 
  

	 	1)	Dog Base Rate $25.06 

  

	 	2)	x AGE OF DOG FACTOR 

  

	 	3)	x BREED OF DOG FACTOR 

  

	 	4)	x HIP DYSPLASIA FACTOR 

  

	 	5)	x EXAM FEE FACTOR 

  

	 	6)	x ZIP CODE FACTOR 

  

	 	7)	x CO-INSURANCE FACTOR 

  

	 	8)	x DEDUCTIBLE FACTOR 

  

	 	9)	x WEB LINK PARTNER CREDIT FACTOR 

  

	 	10)	x AFFINITY GROUP CREDIT FACTOR 

  

	 	11)	+ ADDITIONAL BENEFITS COVERAGE (if elected) $4.95 

  

	 	12)	+ EXPENSE FACTOR $9.00 

 CAT RATING FORMULA

  

	 	1)	Cat Base Rate $14.58 

  

	 	2)	x AGE OF CAT FACTOR 

  

	 	3)	x HIP DYSPLASIA FACTOR 

  

	 	4)	x ZIP CODE FACTOR 

  

	 	5)	x EXAM FEE FACTOR 

  

	 	6)	x CO-INSURANCE FACTOR 

  

	 	7)	x DEDUCTIBLE FACTOR 

  

	 	8)	x WEB LINK PARTNER CREDIT FACTOR 

  

	 	9)	x AFFINITY GROUP CREDIT FACTOR 

  

	 	10)	+ ADDITIONAL BENEFITS COVERAGE (if elected) $4.95 

  

	 	11)	+ EXPENSE FACTOR $6.00 


  

			
	APIC January 2008	  	3










									
	 	  	PET AGE RELATIVITIES	  	 
					
		  	Age of Dog	  	Factor	  	Age of Cat	  	Factor
					
		  	less than 1 year old	  	0.90	  	less than 1 year old	  	0.90
		  	1 year old	  	1.00	  	1 year old	  	1.00
		  	2 years old	  	1.10	  	2 years old	  	1.10
		  	3 years old	  	1.20	  	3 years old	  	1.20
		  	4 years old	  	1.30	  	4 years old	  	1.30
		  	5 years old	  	1.40	  	5 years old	  	1.40
		  	6 years old	  	1.50	  	6 years old	  	1.50
		  	7 years old	  	1.55	  	7 years old	  	1.55
		  	8 years old	  	1.65	  	8 years old	  	1.65
		  	9 years old	  	1.75	  	9 years old	  	1.75
		  	10 years old	  	1.85	  	10 years old	  	1.85
		  	11 years old	  	1.95	  	11 years old	  	1.95
		  	12 years old	  	2.05	  	12 years old	  	2.05
		  	13 years old	  	2.10	  	13 years old	  	2.10
	
	 BREED OF DOG FACTOR—Apply a factor of 1.40 for pure breeds or a factor of 1.20 for cross breeds to the
following:

				
		  	American Bandogge Mastiff	  	Coonhound-Blue Tick	  	Newfoundland
		  	American Black and Tan Coonhound	  	Coonhound-Redbone	  	Old English Mastiff
		  	American. Blue Gascon Hound	  	Dachshund	  	Old English Sheepdog
		  	American Bulldog	  	Doberman Pinscher	  	Olde Boston Buildogge
		  	American Cocker Spaniel	  	English Bulldog	  	Olde English Sheepdog
		  	American Mastiff	  	French Bulldog	  	Olde Victorian Bulldogge
		  	American Mastiff (Panja)	  	French Mastiff	  	Perro De Presa Canario
		  	Belgian Mastiff	  	Great Dane	  	Pyrenean Mastiff
		  	Berger Des Pyrenees	  	Great Pyrenees	  	Pyrenean Mountain Dog
		  	Bernese Mountain Dog	  	Greater Swiss Mountain	  	Saint Bernard
		  	Bull Boxer	  	Irish Wolfhound	  	Scottish Deerhound
		  	Bulldog	  	Italian Buildogge	  	Shar Pei
		  	Bullmastiff	  	Labradoodle	  	Spanish Bulldog
		  	Canary Dog	  	Mastiff	  	Spanish Mastiff
		  	Chow Chow	  	Nebolish Mastiff	  	Snoodle
		  	Coonhound-Black and Tan	  	Neopolitan Mastiff	  	Tibetan Mastiff
		  		  		  		  	 Treeing Walker Coon Hound

			
		  	HIP DYSPLASIA RELATIVITIES – DOG	  	HIP DYSPLASIA RELATIVITIES - CAT
					
		  	Coverage	  	Factor	  	Coverage	  	Factor
					
		  	Yes	  	1.24	  	Yes	  	1.24
		  	No	  	1.00	  	No	  	1.00
					
		  	 EXAM FEE

 RELATIVITIES—DOG
	  		  	 EXAM FEE

 RELATIVITIES—CAT
	  	
					
		  	Coverage	  	Factor	  	Coverage	  	Factor
					
		  	Yes	  	1.20	  	Yes	  	1.20
		  	No	  	1.00	  	No	  	1.00


  

			
	APIC January 2008	  	4










									
					
		  	CO-INSURANCE RELATIVITIES—DOG	  	CO-INSURANCE RELATIVITIES—CAT	  		  	
					
		  	Co-insurance Formula	  	Co-insurance Formula	  		  	
					
		  	 1.05 - [1.05 x (0.9-
selected co-insurance)].

Co-insurance selections range from 50% to 90%.
	  	 1.05 - [1.05 x (0.9-
selected co-insurance)].

Co-insurance selections range from 50% to 90%.
	  		  	
					
		  	 DEDUCTIBLE RELATIVITIES -

 DOG
	  	 DEDUCTIBLE RELATIVITIES –

 CAT
	  		  	
					
		  	Deductible Formula	  	Deductible Formula	  		  	
					
		  	1.00 – (selected deductible raised to the power of 0.81) divided by 407.2806.
Deductible selections are $0 or range from 50 to $1,000.	  	1.00 – (selected
deductible raised to the
power of 0.81) divided by 407.2806. Deductible selections are $0 or range from 50 to $1,000.	  		  	
					
		  	WEB LINK PARTNER CREDIT—CATS & DOGS	  		  		  	
		  	Web Link Partner	  	Factor	  		  	
					
		  	Yes	  	0.94	  		  	
		  	No	  	1.00	  		  	
					
		  	 AFFINITY GROUP
 CREDIT – CATS & DOGS
	  		  		  	
		  	Affinity/Strategic Educational/Promotion
al Providers Group	  	Factor	  		  	
					
		  	Yes	  	0.89	  		  	
		  	No	  	1.00	  		  	
					
	ZIP CODE RELATIVITIES—CATS AND DOGS	  	See attached. If your zip code is not included in the list, please contact your agent.	  		  		  	


  

			
	APIC January 2008	  	5









 SCHEDULE “D” 

CLAIMS HANDLING PROCEDURES 
 (see attached) 







 Vetinsurance Claims Wizard 

and 
 SOAP Manual









			
	Claims Wizard : Other For	  	Page 1 of 1

  

							
	



	  	ILLNESS	  	 Owner: [*]
 Pet Name: [*]
 Date Of Birth: [*]

Gender: Female
 Claim
Number: [*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: Paid Policy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
		 	 
	   Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>>	  		  	
	   Claim Status>> Claim Conclusions>> Summary	  	

  

																									
	Clinics & Additional Forms	  		  		 		 		 		 		  	Patient History	  	 
	  Add Clinics	  		  		 		 		 		 		  	Date of Loss: 6/15/2009	  	 
		 		 		 		 		  		  		 		 		 		 		  	 Current Claim status	  	 
	  Clinics:	  		  		 		 		 		 		  	 Is Claim Form Complete:	  	Yes
		  		  		 		 		  	 Claim Express:	  	No
	  Vet Clinic:	  		  		 		 		 		 		  	 Certificate Claim:	  	No
	   Select	 		 		 		 		  	Other: 	  	 	 	Add	 		 		 		  	 Pre Approval:	  	No
		 		 		  		  		 		 		 		 		  	 Suspicious Claim:	  	No
	  Add Additional Forms	 		 		  		  		 		 		 		 		  	 90 Day Claim:	  	No
	Form Name	 	Form Type	  	Clinic	  	Description	 	Data Attache	 	Remove	 		  	 Claim From QC, NB, PEI,  NFL:	  	No
	180408946.pdf	 	Others	  		  	Information from Owner	 	Jul 06 2009	 	



	 		  	 Claim Over $2500:	  	No
	176340582.pdf	 	Update History	  		  	Leduc	 	Jul 16 2009	 	



	 		  		  	 
		 		 		 		 		  		  		 		 		 		 		  	Current records	  	 
	Upload Additional Forms:  	 		 		  		  		 		 		 		 		  	Others	  	 
		 	  Browse...  	 		  		  		 		 		  	UpdateHistory	  	 
		 		 		 		 		  		  		 		 		 		 		  	ClaimForm	  	 
	Form Type:	 		 		 		  		  		 		 		 		 		  		  	 
	Select	 		 		 		 		  		  		 		 		  	Pre-Existing Records	  	 
		 		 		 		 		  		  		 		 		 		 		  	Claim [*] ClaimForm.pdf-
	Description:	 		 		  		  		 		 		 		 		  		  	 
		 		 	 	 	 	 	 	  	 	  		 		 		 		 		  	Past Claims	  	 
	Clinic:	 		 		  		  		 		 		 		 		  	Added Date  Type   No     Status
	Select	 		  		  		 		 		 		 		  	7/20/2009     -Ill   -[*]   -paid
		 		 		  		  		 		 		 		 		  	Conjunctivitis-bilateral suspect
	Add Form	 		 		 		  		  		 		 		 		 		  	hypersensitivity
		 		 		 		 		  		  		 		 		 		 		  	 
	Back  	 		 		 		 		  		  		 	Continue  	 		 		 		  	 

  

			
	http://www.petorganizer.com/ClaimsWizard/ClaimRecords.aspx?claimID=[*]	  	7/20/2009

 *Confidential Treatment Requested. 








			
	Claims Wizard : Claim Form	  	Page 1 of 1

  

							
	



	  	ILLNESS    	  	 Owner: [*]
 Pet Name: [*]
 Date Of Birth: [*]

Gender: Female
 Claim Number:
[*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: Paid Policy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
		 	 
	   Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>>	  		  	
	   Claim Status>> Claim Conclusions>> Summary	  	

  

															
	ClaimForm Details:        Edit	  		  		 		 		  	Patient History	  	 
		  		  		 		 		  	Date of Loss: 6/15/2009	  	 
	 	  	 	  	 	 	 	 		  	Current Claim status	  	 
	  
 Is Condition Initial, Novel, or Repeat? :
Initial
	  		 		 		  	Is Claim Form Complete:	  	Yes
		  		  		 		 		  	Claims Express:	  	No
	Claims Form: ClaimForm From Fax 176241401.pdf	  		 		 		  	Certificate Claim:	  	No
	 	  	 	  	 	 	 	 		  	Pre Approval:	  	No
	Is Claim Form Complete :	  	Yes	  		 		 		  	Suspicious Claim:	  	No
	Claims Express:	  	No	  		 		 		  	90 Day Claim:	  	No
	Certificate Claim:	  	No	  		 		 		  	Claim From QC, NB, PEI,	  	No
	Pre Approval:	  	No	  		 		 		  	NFL:	  	 
	Suspicious Claim:	  	No	  		 		 		  	Claim Over $2500:	  	No
	90 Day Claim:	  	No	  		 		 		  		  	 
	Claim From QC, NB, PEI, NFL:	  	No	  		 		 		  	Current records	  	 
	Claim Over $2500:	  	No	  		 		 		  	Others	  	 
	 	  	 	  	 	 	 	 		  	UpdateHistory	  	 
	Assign To: [*]	  		  		 		 		  	ClaimForm	  	 
		 		  		  		 		 		  		  	 
	Back  	 		  		  	  Continue  	 		 		  	Pre-Existing Records	  	 
		 		  		  		 		 		  	Claim [*] ClaimForm.pdf -
		 		  		  		 		 		  		  	 
		 		  		  		 		 		  	 Past Claims
  
	  	 
		 		  		  		 		 		  	Added Date  Type   No     Status
		 		  		  		 		 		  	7/20/2009     -Ill   -[*]   -Paid
		 		  		  		 		 		  	 Conjunctivitis-bilateral
suspect
 hypersensitivity

		 		  		  		 		 		  	 
		 		  		  		 		 		  	 

  

					
	 http://www.petorganizer.com/ClaimsWizard/ClaimForm.aspx?claimID=[*]
	  	 	7/20/2009	  

 *Confidential Treatment Requested. 








			
	Claims Wizard : Claim Form	  	Page 1 of 1

  

							
	



	  	ILLNESS	  	 Owner: [*]

Pet Name: [*]
 Date Of Birth:
[*]
 Gender: Female
 Claim
Number: [*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: Paid Policy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
	   Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>>	  	 	  	 
	   Claim Status>> Claim Conclusions>> Summary	  	

  

																			
	Accident/Illness:	 		 		  		 		 		  		  	Patient History	  	 
	



 Accident 



 Illness	 		 		  		 		 		  		  	Date of Loss: 6/15/2009	  	 
	Date of Loss (Service):	 		 	Total Customer Claimed($):	 		  		  	Current Claim Status	  	 
	15-Jun-2009	 	



	 	90	  		 		 		  		  	Is Claim Form Complete:	  	Yes
		 		 		 		  		 		 		  		  	Claims Express:	  	No
	Diagnosis or Clinical Symptoms of the Illness as noted on claim Form:	 		 		  		  	Certificate Claim:	  	No
		 		 		 		  		 		 		  		  	Pre Approval:	  	No
	Persistent Bilateral conjunctivitis	 		 		  		  	Suspicious Claim:	  	No
		 		 		 		  		 		 		  		  	90 Day Claim:	  	No
		 		 		 		  		 		 		  		  	Claim From QC, NB, PEI, NFL:	  	No
	Is Condition Initial, Novel, or Repeat?	 		 		  		  	Claim Over $2500:	  	No
	Initial	 		 		 		  		 		 		  		  		  	 
	 	 	 	 	 	 	 	  	 	 	 	 	 	  		  	Current records	  	 
	Check All that Apply:	 		  		 		 		  		  	Others	  	 
	 ̈ 90 Day Claim	 	 ̈ Suspicious Claim	 		 		  		  	UpdateHistory	  	 
	 ̈ Claim Over $2500	 	 ̈ Claim From QC, NB, PEI, NFL	 		 		  		  	ClaimForm	  	 
	 ̈ Certificate Claim	 		 		  		 		 		  		  		  	 
		 		 		 		  		 		 		  		  	Pre-Existing Records	  	 
		 		 		 		  		 		 		  		  	Claim [*] ClaimForm.pdf -	  	 
	Note: Old ClaimForm file may not be shown here. If it is not shown please browse the file again.	 		  		  		  	 
	Claims Form: ClaimForm From Fax 176241401.pdf        Delete	 		 		  		  	Past Claims	  	 
		 		 		 		  		 		 		  		  	Added Date  Type   No     Status
	Type Of Claim:	 		 		  		 		 		  		  	7/20/2009     
-Ill   -[*]   -Paid
	



 Claim Form



 Claims Express



 Pre Approval	 		  		  	Conjunctivitis-bilateral suspect hypersensitivity
	Form complete and legible:	 		 		  		 		 		  		  	 
	



 Yes



 No	 		 		  		 		 		  		  	 
	 	 	 	 	 	  	 	 	 	 	 	  		  	 
	Assign To: [*]	 		 		  		 		 		  		  	 
		 		 		  		 		 		  		  	 
	Cancel  	 		 		 	  Save and Exit  	  		 	  Save And Continue  	 		  		  	 
		 		 		 		  		 		 		  		  	 

 http://www.petorganizer.com/ClaimsWizard/ClaimForm.aspx?claimID=[*]&EditView...    7/20/2009

 * Confidential Treatment Requested. 








			
	Claims Wizard : Summary	  	Page 1 of 2

  

							
	



	  	ILLNESS	  	 Owner: [*]
 Pet Name: [*]
 Date Of Birth: [*]

Gender: Female
 Claim
Number: [*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: Paid Policy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
	   Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>>	  	 	  	 
	   Claim Status>> Claim Conclusions>> Summary	  	

  

																							
	Summary	  		  		  	Patient History	  	 
	Claim Number: [*]	  		  		  		  		  		  	Date of Loss: 6/15/2009	  	 
	    Claim Status	  		  		  		  		  		  	Current Claim status	  	 
	    Status: Paid	  		  		  		  		  		  	Is Claim Form Complete:	  	Yes
		  		  		  		  		  	Claim Express:	  	No
		 		 	 	 	 	  	 	  	 	  	Not Covered	  	Covered	  		  	Certificate Claim:	  	No
		 		 	  1  	 	Consultation/Examination	  	$44.9	  	 	  		  	Pre Approval:	  	No
		 		 	  2  	 	Recheck/s	  	$0	  	 	  		  	Suspicious Claim:	  	No
		 		 	  3  	 	Kennel Fee(hospitalization)	  	$0	  	 	  		  	90 Day Claim:	  	No
		 		 	  4  	 	Unrelated charges that are included on the receipt:	  	$0	  	 	  		  	Claim From QC, NB, PEI,	  	 
		 		 	  5  	 	All other Veterinary costs related to this case/claim	  	 	  	$41.05	  		  	NFL:	  	No
		 		 	 	 	GST of section 5	  	 	  	$2.05	  		  	Claim Over $2500:	  	No
		 		 	 	 	Deductible Applied	  	 	  	$0	  		  		  	 
		 		 	 	 	Total Claim	  	 	  	$43.1	  		  	Current records	  	 
		 		 	 	 	Total Claim amount paid to owner at 90% coinsurance	  	 	  	$38.79	  		  	 Others
 Update
History
	  	 
		 		 		 	             Cheque issued by
[*]            on 7/7/2009
	  		  	ClaimForm	  	 
		 		 		 		  		  		  	 
		 		 		 		 		  		  		  		  		  	Pre-Existing Records	  	 
	Date Closed: 7/7/2009	  		  		  		  	Claim [*] ClaimForm.pdf-
	Invoice Number: 120107	  		  		  		  		  	 
	Claim Form Values	  		  		  		  	Past Claims	  	 
	Diagnosis or Clinical Symptoms of the Illness as noted on claim Form: Persistent Bilateral conjunctivitis	  		  	Added Date  Type   No     Status
	Date of loss (Service): 6/15/2009	  		  		  	7/20/2009     -Ill   -[*]   -paid
	Is condition Initial, Novel, or Repeat? : Initial	  	 	  		  	Conjunctivitis-bilateral suspect hypersensitivity
		 		 		 		 		  		  		  		  		  		  	 
	Is Claim Form Complete:	 		 	Yes	 		  	Claims Express:	  	No	  		  		  		  	 
	Certificate Claim:	 	No	 		  	Per Approval:	  	No	  		  		  		  	 
	Suspicious Claim	 		 	No	 		  	90 Day Claim:	  	No	  		  		  		  	 
	Claim form QC, NB, PEI, NFL:	 		 	No	 		  	Claim Over $ 2500:	  	No	  		  		  		  	 
		 		 		 		 		  		  		  		  		  		  	 
	ClaimForm: ClaimForm From Fax 176241401.pdf	  		  		  		  		  	 
		 		 		 		 		  		  		  		  		  		  	 
	Forms:	 		 		 		 		  		  		  		  		  		  	 
	Form Name	 	Date Attached	  		  		  		  		  		  	 
	1.    Others.pdf	 	7/6/2009	 		 		 		  		  		  		  		  		  	 
	2.    UpadateHistory.pdf	 	6/16/2009	 		 		 		  		  		  		  		  		  	 
	 	 	 	 	 	 	 	 	 	  	 	  	 	  	 	  	 	  		  		  	 
	Observation	 		 		 		 		  		  		  		  		  		  		  	 
	Date Observed	 	Observation	 	 	 	Type	 	Occurance	  	Significance	  	Relationship	  	ClaimID	  	 Added
 By
	  	 Added
 Date
	  	 	  	  
	4/8/2009	 	Spay: at less than 1 yr. (Boosters done and Initial eye Issue noted)	 		 	Objective	 	Single	  	Low	  	Single	  	 [*]
	  	[*]	  	07/07/2009  	  		  	 
	2/22/2009	 	Misc: dog adopted Early 2009, Vaccine up to date from previous owner, No access to those records.	 		 		 		  		  		  	 [*]
	  	[*]	  	07/07/2009  	  		  	 
	2/22/2009	 	First Exam: Vomiting- ER visit. Abd-no pain on palon.	 		 	Objective	 	Single	  	Low	  	Single	  	 [*]
	  	[*]	  	07/07/2009  	  	 	  	 


http://www.petorganizer.com/ClaimsWizard/Summary.aspx?claimID=[*]              
                      7/20/2009 
 *Confidential Treatment Requested. 








					
	Claims Wizard: Summary	  		  	Page 2 of 2
	 Increased gut

sounds
 bilaterally,
 abnormal

contents
 palpable-
 liquidy, Try

NPO at
 home.
	  		  	
		  		  	
	Letter sent/Other Attachments	  		  	
			
	       Date
     Created
	  	Regarding	  	Attachment
	 7/20/2009 Paid Letter
	  		  	Claim [*] Att 126501 AutoCheqLetter.html
	 7/20/2009 Paid Letter
	  		  	Claim [*] Att 126500 AutoCheqLetter.html
	 7/20/2009 Paid Letter
	  		  	Claim [*] Att 126499 AutoCheqLetter.html
	 7/20/2009 Paid Letter
	  		  	Claim [*] Att 126498 AutoCheqLetter.html
	 7/7/2009 Paid Letter
	  		  	Claim [*] Att 123930 AutoCheqLetter.html
	 7/7/2009 Paid Letter
	  		  	Claim [*] Att 123929 AutoCheqLetter.html

 Paid/Denied Letter/Envelope 
 Paid Letter 
 VI Cheque Letter 

Envelope 
 RePrint the Cheque
# [*] 
  

			
	Relssue  	  	 the cheque for this claim.


 Cheques list for this Claim 

 

																													
	 	    	Date
Requested	    	Check
Number	 	    	Amount	 	    	 Date
 Issued
	 	    	Issued By	 	    	 Check
 Status
	 	    	 Requested
 By
	    	Reason	  	Comments
	  ̈
	    	01/01/01	    	 	[*]	  	    	 	38.79	  	    	 	07/07/09	  	    	 	[	*] 	    	 	Issued	  	    		    		  	

 Reason: 
  

			
	  Stop Selected Cheques  	  	

 Adjuster Comments 
 Awaiting record...061609. Awaiting info from O...061709...062609. No pp symptoms consistent with coughing nor eye infections (Bordatella Vx not recc in April previous Hx not know) Paid. 

									
		  		  	Close  	  		  	


http://www.petorganizer.com/ClaimsWizard/Summary.aspx?claimID=[*]              
                              7/20/2009 

*Confidential Treatment Requested. 








			
	Claims Wizard : Observation Diagnosis	  	Page 1 of 1

  

							
	



	  	ILLNESS	  	 Owner: [*]
 Pet Name:: [*]
 Date Of Birth: [*]

Gender: Female
 Claim
Number: [*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: PaidPolicy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
		 	 
	   Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>> Claim Status>>	  		  	
	   Claim Conclusions>> Summary	  	

  

																									
	Pre Existing Observation	  		  		 		 		 		 		 		 		 		  	Patient History	  	 
	  Observations	  		  		 		 		 		 		 		 		 		  	Date of Loss: 6/15/2009	  	 
		  		  		 		 		 		 	Added	 	Added	 		 		  		  	 
	Date	 	Observations	  	Type	  	Occurance	 	Significance	 	Relationship	 	ClaimID	 	By	 	Date	 	Edit	 		  	Current Claim status	  	 
	04/08/09	 	Spay: at less than 1 yr. (Boosters	  	Objective	  	Single	 	Low	 	Single	 	 [*]
	 	[*]	 	07/07/2009	 	Edit	 		  	Is Claim Form Complete:	  	Yes
		 	done and initial eye issue noted)	  		  		 		 		 		 		 		 		 		  	Claims Express:	  	No
	02/22/09	 	Misc: dog adopted Early 2009.	  		  		 		 		 	 [*]
	 	[*]	 	07/07/2009	 	Edit	 		  	Certificate Claim:	  	No
		 	Vaccine up todate from previous	  		  		 		 		 		 		 		 		 		  	Pre Approval:	  	No
		 	owner. No access to those records.	  		  		 		 		 		 		 		 		 		  	Suspicious Claim:	  	No
	02/22/09	 	First Exam: Vomiting- ER visit.	  	Objective	  	Single	 	Low	 	Single	 	 [*]
	 	[*]	 	07/07/2009	 	Edit	 		  	90 Day Claim:	  	No
		 	Abd-no pain on palpn. Increased	  		  		 		 		 		 		 		 		 		  	Claim From QC, NB, PEI,	  	 
		 	gut sounds bilaterally, abnormal	  		  		 		 		 		 		 		 		 		  	NFL:	  	No
		 	contents palpable-liquidy. Try	  		  		 		 		 		 		 		 		 		  	Claim Over $2500:	  	No
		 	NPO at home.	  		  		 		 		 		 		 		 		 		  		  	 
		 		  		  		 		 		 		 		 		 		 		  	Current records	  	 
		 		  		  		 		 		 		 		 		 		 		  	Others	  	 
		 		  		  		 		 		 		 		 		 		 		  	UpdateHistory	  	 
		 		  		  		 		 		 		 		 		 		 		  	ClaimForm	  	 
		 		  		  		 		 		 		 		 		 		 		  		  	 
		 		  		  		 		 		 		 		 		 		 		  	Pre-Existing Records	  	 
		 		  		  		 		 		 		 		 		 		 		  	Claim [*] ClaimForm.pdf-
	Add Observations	  		  		 		 		 		 		 		 		 		  		  	 
		 		  		  		 		 		 		 		 		 		 		  	Past Claims	  	 
	Diagnosis	  		  		 		 		 		 		 		 		 		  	Added Date  Type   No     Status
	Add Diagnoses	  		  		 		 		 		 		 		 		 		  	7/20/2009     -Ill   -[*]   -paid
		 		  		  		 		 		 		 		 		 		 		  	Conjunctivitis-bilateral suspect hypersensitivity
	Back	 		  		  		 		 		 		 		 	Continue	 		 		  	 
		 		  		  		 		 		 		 		 		 		 		  	 


http://www.petorganizer.com/ClaimWizard/Observations.aspx?claimID=[*]              
                      7/20/2009 
 *Confidential Treatment Requested. 








			
	Claims Wizard : Analysis	  	Page 1 of 1

  

							
	



	  	ILLNESS	  	 Owner: [*]
 Pet Name: [*]
 Date Of Birth: [*]

Gender: Female
 Claim Number:
[*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: PaidPolicy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
	  Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>>	  	 	  	 
	  Claim Status>> Claim Conclusions>> Summary	  	

  

																									
	Analysis	  		  		  		  		  		 		 		 		  	Patient History	  	 
	Observation	  		  		  		  		  		 		 		 		  	Date Of Loss: 6/15/2009	  	 
		 		 		  		  		  		  		  		 		 		 		  	Current Claim status	  	 
	Date Observed	 	Observation	  	Type	  	Occurance	  	Significance	  	Relationship	  	Claim ID	 	 Added
 By
	 	Added Date	 		  	Is Claim Form Complete:	  	Yes
		 		 	Spay: at less	  		  		  		  		  		 		 		 		  	Claim Express:	  	No
		 		 	than 1 yr.	  		  		  		  		  		 		 		 		  	Certificate Claim:	  	No
		 		 	(Boosters	  		  		  		  		  		 		 		 		  	Pre Approval:	  	No
	4/8/2009	 	done and	  	Objective	  	Single	  	Low	  	Single	  	 [*]
	 	[*]	 	07/07/2009	 		  	Suspicious Claim:	  	No
		 		 	initial eye	  		  		  		  		  		 		 		 		  	90 Day Claim:	  	No
		 		 	issue noted)	  		  		  		  		  		 		 		 		  	Claim From QC, NB, PEI, NFL:	  	No
		 		 	Misc: dog	  		  		  		  		  		 		 		 		  	Claim Over $2500:	  	No
		 		 	adopted Early	  		  		  		  		  		 		 		 		  		  	 
		 		 	2009,	  		  		  		  		  		 		 		 		  	Current records	  	 
		 		 	Vaccine up	  		  		  		  		  		 		 		 		  	Others	  	 
	2/22/2009	 	todate from	  		  		  		  		  	 [*]
	 	[*]	 	07/07/2009	 		  	UpdateHistory	  	 
		 		 	previous	  		  		  		  		  		 		 		 		  	ClaimForm	  	 
		 		 	owner. No	  		  		  		  		  		 		 		 		  		  	 
		 		 	access to	  		  		  		  		  		 		 		 		  	Pre-Existing Records	  	 
		 		 	those records.	  		  		  		  		  		 		 		 		  	Claim [*] ClaimForm.pdf -
		 		 		  		  		  		  		  		 		 		 		  		  	 
		 		 	First Exam:	  		  		  		  		  		 		 		 		  		  	 
		 		 	Vomiting- ER	  		  		  		  		  		 		 		 		  	Past Claims	  	 
		 		 	Visit, Abd-no	  		  		  		  		  		 		 		 		  	AddedDate  Type   No     Status
		 		 	pain on palpn.	  		  		  		  		  		 		 		 		  	7/20/2009     -Ill   -[*]   -paid
		 		 	increased gut	  		  		  		  		  		 		 		 		  	Conjunctivitis-bilateral suspect
	2/22/2009	 	sounds	  	Objective	  	Single	  	Low	  	Single	  	 [*]
	 	[*]	 	07/07/2009	 		  	hypersensitivity
		 		 	bilaterally,	  		  		  		  		  		 		 		 		  	 
		 		 	abnormal	  		  		  		  		  		 		 		 		  	 
		 		 	contents	  		  		  		  		  		 		 		 		  	 
		 		 	palpable-	  		  		  		  		  		 		 		 		  	 
		 		 	liquidy. Try	  		  		  		  		  		 		 		 		  	 
		 		 	NPO at home.	  		  		  		  		  		 		 		 		  	 
		 		 		  		  		  		  		  		 		 		 		  	 
	 	 	 	 	 	  	 	  	 	  	 	  	 	  	 	 	 	 	 	 		  	 
	 Was this pet spayed or neutered prior to 12 months?

 
 



 Yes    



 No
  
 Was the Illness or injury related to
an activity that caused a similar condition within 18 months prior to policy Inception?
  
 



 Yes    



 No
  
 Was the pet pre-disposed to stated
problem prior to full coverage?
  
 



 Yes    



 No
  
 Are preventative measure available for
the stated condition?
  
 



Yes    



 No
  
 Is this an elective
procedure?
  
 



Yes    



 No
  
 Should the problem have been detected
either at birth or during a routine vet exam?
  
 



Yes    



 No
  
	 		  	 
	  Back  	 		 		  		  		  		  	Save And Continue	  		 		 		 		  	 

  

			
	http://www.petorganizer.com/ClaimsWizard/ReviewHistory.aspx?claimID=[*]	  	7/20/2009

 *Confidential Treatment Requested. 







  

			
	Claims Wizard : Claim St	  	Page 1 of 1

  

							
	



	  	ILLNESS	  	 Owner: [*]
 Pet Name: [*]
 Date Of Birth: [*]

Gender: Female
 Claim Number:
[*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: PaidPolicy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
		 	 
	  Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>>	  		  	
	  Claim Status>> Claim Conclusions>> Summary	  	

  

																							
	Observation	 		 		  		  		  		  		  		  		  	Patient History	  	 
		 		 		 		  		  		  		  		  		  		  	Date of Loss: 6/15/2009	  	 
	Date Observed Observation	 	Type	 	Occurance	  	Significance	  	Relationship	  	ClaimID	  	Added	  	Added	  		  	 Current Claim Status	  	 
		 		 		 		  		  		  		  	By	  	Date	  		  	 Is Claim Form Complete:	  	Yes
		 	Spay: at less	 		 		  		  		  		  		  		  		  	 Claim Express:	  	No
		 	than 1 yr.	 		 		  		  		  		  		  		  		  	 Certificate Claim:	  	No
	4/8/2009	 	(Boosters	 	Objective	 	Single	  	Low	  	Single	  	 [*]
	  	[*]	  	07/07/2009	  		  	 Pre Approval:	  	No
		 	done and	 		 		  		  		  		  		  		  		  	 Suspicious Claim:	  	No
		 	initial eye	 		 		  		  		  		  		  		  		  	 90 Day Claim:	  	No
		 	 issue noted)
 Misc:
dog
	 		 		  		  		  		  		  		  		  	 Claim From QC, NB, PEI,  NFL:	  	No
		 	adopted	 		 		  		  		  		  		  		  		  	 Claim Over $2500:	  	No
		 	Early 2009,	 		 		  		  		  		  		  		  		  		  	 
		 	Vaccine up	 		 		  		  		  		  		  		  		  	Current records	  	 
	2/22/2009	 	todate from	 		 		  		  		  	 [*]
	  	[*]	  	07/07/2009	  		  	Others	  	 
		 	Previous	 		 		  		  		  		  		  		  		  	UpdateHistory	  	 
		 	Owner, No	 		 		  		  		  		  		  		  		  	ClaimForm	  	 
		 	access to	 		 		  		  		  		  		  		  		  		  	 
		 	those records.	 		 		  		  		  		  		  		  		  	Pre-Existing Records	  	 
		 	First Exam:	 		 		  		  		  		  		  		  		  	Claim [*] ClaimForm.pdf-
		 	Vomiting-ER	 		 		  		  		  		  		  		  		  		  	 
		 	Visit. Abd-no	 		 		  		  		  		  		  		  		  	past claims	  	 
		 	Pain on paipn,	 		 		  		  		  		  		  		  		  	Added Date  Type   No     Status
		 	Increased gut	 		 		  		  		  		  		  		  		  	7/20/2009     -Ill   -[*]   -paid
	2/22/2009	 	sounds	 	Objective	 	Single	  	Low	  	Single	  	 [*]
	  	[*]	  	07/07/2009	  		  	Conjunctivitis-bilateral suspect
		 	bilaterally,	 		 		  		  		  		  		  		  		  	hypersensitivity
		 	abnormal	 		 		  		  		  		  		  		  		  	 
		 	contents	 		 		  		  		  		  		  		  		  	 
		 	palpable-	 		 		  		  		  		  		  		  		  	 
		 	liquidy, Try	 		 		  		  		  		  		  		  		  	 
		 	NPO at	 		 		  		  		  		  		  		  		  	 
		 	home.	 		 		  		  		  		  		  		  		  	 
		 		 		 		  		  		  		  		  		  		  	 
		 		 		 		  		  		  		  		  		  		  	 
	Analysis	  		  	 
	1. Was this pet spayed or neutered prior to 12 months? No	  		  	 
			 
	 2. Was the illness or injury related to an activity that caused a similar condition within 18 months prior to

Policy Inception? No
	  		  	 
			 
	3. Was the pet pre-disposed to stated problem prior to full coverage? No	  		  	 
			 
	4. Are Preventative measure available for the stated condition? No	  		  	 
			 
	5. Is this an elective procedure? No	  		  	 
			 
	6. Should the problem have been detected either at birth or during a routine Vet exam? No	  		  	 
			 
	Adjuster Comments:	  		  	 
	 Awaiting records...061609.    Awaiting info from

O...061709...062609. No pp symptoms consistent with
	  		  	 
			 
	ING Claim Reference :	  		  	 
	  [*]	 		 		 		  		  		  		  		  		  		  	 
	Paid or Denied:	 		 		  		  		  		  		  		  		  	 
	  Paid	 		 		 		  		  		  		  		  		  		  	 
		 		 		 		  		  		  		  		  		  		  	 
	Cancel  	 		 		 		  		  		  	Save and Continue  	  		  		  		  	 

  

			
	http://www.petorganizer.com/ClaimsWizard/ClaimStatus.aspx?ClaimId=[*]	  	7/20/2009

 *Confidential Treatment Requested. 








			
	Claims Wizard : Claim Conclusions	  	Page 1 of 1

  

							
	



	  	ILLNESS	  	 Owner: [*]
 Pet Name: [*]
 Date Of Birth: [*]

Gender: Female
 Claim
Number: [*]
 Total Rem: $19936.21
	  	
Policy #: [*]

Policy Type: PaidPolicy

Effective Date: 2/28/2009

Adjuster: [*]
 Status:
Paid
 Reserve: $81.0
  

		  	 	  	  
		  	Persistent Bilateral conjunctivitis  	  	  
		  	 	  	  
	Add Comment   Show Comments	  	  
		 	 
	Wizard Home>> Claim Form>> Other Forms>> SOAP>> Analysis>> Claim Status>>	  		  	
	Claim Conclusions>> Summary	  	

  

															
	Input Manually	  		  		 		 		  	Patient History	  	 
	Invoice SubTotal($):	  	Invoice Numbers(seperate by ,)	  		 		 		  	Date of Loss: 6/15/2009	  	 
	85.95	 		  	120107	  		 		 		  	Current Claim Status	  	 
		 		  		  		 		 		  	Is Claim Form Complete:	  	Yes
	Exam Fees($):	  	Rechecks($):	  	Boarding Fees($):	 	Deductibel Applied:	  	Claims Express:	  	No
	44.9	 		  	0	  	0	 	0	 		  	Certificate Claim:	  	No
		 		  		  		 		 		  	Pre Approval:	  	No
	Unrelated charges($):	  	Unrelated Charges Description:	  		 		 		  	Suspicious Claim:	  	No
	0	 		  		  		 		 		  	90 Day Claim:	  	No
		 		  		  		 		 		  	Claim From QC, NB, PEI, NFL:	  	No
	Calculate 	 		  		  		 		 		  	Claim Over $2500:	  	No
		 		  		  		 		 		  		  	 
	Calculate	 		  		  		 		 		  	Current records	  	 
		 		  		  		 		 		  	Others	  	 
	Other Vet Cost($):	  	 GST Rate of 5 applied($):
	 	Total claimed($):	  	UpdateHistory	  	 
	41.05	 		  	 2.05
	  		 	43.1	 		  	ClaimForm	  	 
		 		  		  		 		 		  		  	 
		 		  		  		 	Amount Paid Out($):	  	Pre-Existing Records	  	 
		 		  		  		 	38.79	 		  	Claim [*] ClaimForm.pdf-
	Are funds paid to clinic?   ̈	  		  		 		 		  		  	 
		 		  		  		 		 		  	Past Claims	  	 
	Is this a legacy ING Claim?   ̈	  		  		 		 		  	Added Date  Type   No     Status
		 		  		  		 		 		  	7/20/2009     -Ill   -[*]   -paid
	 Cheque issued by
[*]                on
 7/7/2009
	  		  		 		 		  	Conjunctivitis-bilateral suspect hypersensitivity
		 		  		  		 		 		  	 
	Cancel  	 		  		  		 	Save and Continue  	 		  	 

  

			
	http://www.petorganizer.com/ClaimsWizard/ClaimConclusions.aspx?claimID=[*]	  	7/20/2009

 *Confidential Treatment Requested. 







 SOAP Manual 
 Veterinarian’s use the SOAP acronym as a regular guideline for assessing their patients during an exam. 
  

							
	 S – subjective
	  	O – objective	  	A – assessment	  	P – plan

 Vetinsurance Member Specialists (VIMS) have reconfigured this guideline and developed an efficient and effective way to
transcribe the information from veterinary notes into a more legible and summarized report. This report is easily accessible in the Claims Wizard application in PetOrganizer. It is used, by those adjusting a claim, to determine whether or not an
enrolled pet’s claimed clinical symptom(s) is consistent with those noted pre-policy, or prior to enrolment with Vetinsurance. 
 Please
consider the VIMS’s coined use of the SOAP acronym, at Vetinsurance it is commonly used as a noun (ex. Fido’s SOAP is complete.) and also as a verb (ex. Have you SOAPed Fido’s records?). 

How To SOAP... 
 Please see attached medical
records and SOAP sample. 
  

	 	1.)	PET’S FIRST EXAM. Start at the beginning of the pet’s complete medical
records and note the date and any clinical findings specific to that date, or if the pet is healthy, make that notation instead. Be sure to note that it is the pet’s first exam. Note what clinical symptoms the pet showed, and what the
veterinarian assessed. 

  

	 	2.)	SECOND AND OTHER FOLLOWING EXAMS. It is only necessary to make entries
of exams where clinical symptoms are anything but healthy. Note what clinical symptoms the pet showed, and what the veterinarian assessed. 

  

	 	3.)	NEUTER OR SPAY DATES. It is important to include an entry for the pet which notes the
date that the pet was altered, and whether or not the pet was mature (over 1 year of age) or immature (under 1 year of age). This entry can be included in any other entry. 


 

	 	4.)	EXAMS WITHIN THE 5 AND 30 DAY WAITING
PERIODS. Before the entry make note that the date of the exam took place within both the accident and illness waiting periods. Otherwise a regular entry, and is not necessary if the pet has continued from a vet
certificate. 

  

	 	5.)	EXAMS WITHIN THE 30 DAY WAITING PERIOD. Before the entry
make note that the date of the exam took place within the illness waiting period. Otherwise a regular entry, and is not necessary if the pet has continued from a vet certificate. 


 

	 	6.)	EXAMS AFTER THE WAITING PERIODS. If there are any important notes from
exams that occurred after enrolment and waiting periods make note of the date of the exam, that the exam occurred post-policy, and continue with the entry as normal. 


 

	 	7.)	OBSERVATION DROP DOWN OPTIONS. There are 4 different drop downs, each with different
options. 

  

	 	a.	TYPE defines the type of observation you have entered as subjective or objective. 


 

	 	b.	OCCURANCE labels an observation as whether it is the first time it has been noted, an ongoing note of the original observation, or a repeat observation but separate
occurrence. 









	 	c.	SIGNIFICANCE defines the observation as ranging from low (a condition not likely to increase In severity) to high (a condition that is severe and may need to be
flagged). 

  

	 	d.	RELATIONSHIP denotes if the observation is unrelated to other conditions that the pet may suffer from (single), if it has occurred because of the pet’s other
conditions (compounded), or if it could be both. 

  

	8.)	DIAGNOSIS OBSERVATIONS. These entries are reserved for observations found in the pet’s medical records as a
diagnosis (ex. Blood work results). 

  

	9.)	DIAGNOSIS DROP DOWN OPTIONS. There are 4 different drop downs, each with different
options. 

  

	 	a.	TYPE differentiates between the diagnosis being causative, symptomatic, therapeutic, or definitive. 


 

	 	b.	OCCURANCE labels an observation as whether It is the first time it has been noted, an ongoing note of the original observation, or a repeat observation but separate
occurrence. 

  

	 	c.	SIGNIFICANCE defines the observation as ranging from low (a condition not likely to increase In severity) to high (a condition that is severe and may need to be
flagged). 

  

	 	d.	RELATIONSHIP denotes if the observation is unrelated to other conditions that the pet may suffer from (single), if it has occurred because of the pet’s other
conditions (compounded), or if it could be both. 

 SOAP Examples... 

Fido is a male dog born in August of 2006. His owner’s have enrolled him with Vetinsurance at 6 months of age on
February 17th of 2007. The following is an example of
Fido’s SOAPed medical records. 
  

							
	 FIRST EXAM OBSERVATIONS: 10/06/2006 – First
Exam – Wax in ears, otherwise healthy puppy.

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Single.	  	Relationship: Single.
	 OBSERVATIONS: 10/30/2006 – Puppy scratching at ears, possible otitis, swab
taken.

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Ongoing.	  	Relationship: Single.
	 DIAGNOSIS: 10/31/2006 – Results from swab taken 10/30/2007: Yeast otitis
externa.

				
	 Type: Definitive.
	  	Significance: Low.	  	Occurrence: Single.	  	Relationship: Single.
	 OBSERVATIONS: 11/21/2006 – Otitis has resolved, still some wax in
ears.

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Single.	  	Relationship: Single.
	 OBSERVATIONS: 02/15/2007 – Neuter under 1 year of age. Deciduous canine teeth
extracted.

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Single.	  	Relationship: Single.
	 OBSERVATIONS: 02/20/2007 – Within 5- And 30-Day Waiting Periods – Neuter incision
irritated, red and weeping. Infected.

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Single.	  	Relationship: Single.
	 OBSERVATIONS: 02/28/2007 – Within 30-Day Waiting Period – Ears bothering dog again,
repeat of otitis externa. Both eyes slightly red, conjunctivitis. Possible allergies?

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Repeat	  	Relationship: Compounded.
	 OBSERVATIONS: 03/30/2007 – Post-Policy – Dog is limping, cut foot pad. Ears and eyes
inflamed and red, allergies.

				
	 Type: Objective.
	  	Significance: Low.	  	Occurrence: Single.	  	Relationship: Compounded.








 Definitions... 
 SUBJECTIVE – An opinion based on an observation. Ex. Lethargy, not well, shedding. 
 OBJECTIVE – A factual observation. Ex. Non-weight bearing lameness of the right hind leg, temperature, respiration, heart rate. 

CAUSATIVE – A diagnosis based on symptoms consistent with found etiology. Ex. Diarrhea’s causative agent is Giardia.

 SYMPTOMATIC – A diagnosis based on symptoms. Ex. Common symptoms of allergies are otitis, conjunctivitis, itchy
skin, etc. 
 THERAPEUTIC – A diagnosis based on the response to treatment. Ex. Diarrhea is resolved with deworming
medication, diagnosis is worms. 
 DEFINITIVE – A diagnosis based on factual observation(s). Ex, Dog’s femur
broken and protruding through skin, diagnosed broken femur. 







 We have been asked to generate a more uniform SOAP model to align with development targets to
improve claims processing at a future date. 
 Currently the SOAPing we are doing is fine, it now needs to be more uniform In
order for data collection and program developments to occur. 
 New headings to be used for observations as well as separating
unrelated symptoms noted on the same visit into their own observation. 
 From December 1st forward please use the following: 

New headings for Observations are: 
 Misc, First Exam, Vaccines, Neuter/Spay, 5dayWP, WP. 
 Separate entry per Issue:
‘Presenting complaint’- 
 Misc: 
 This is where one will put the information that is not part of the actual exam but is important for context. This usually happens most on the first exam but the label can be used when ever needed; for
example, 
 Misc: O stepped on RF foot 3 days prior was limping now fine. 

First Exam: 
 For the
initial exam of the pet’s medical records one will enter “First Exam:” followed by findings relevant to that exam. 
 First Exam: Otitis externa, (symptoms of otitis if noted) otherwise healthy. 
 Additional findings
that are involved on the first exam but are not pertaining to that exam, will be noted under “Misc:” as a separate observation. 
 Misc: First Exam: Had diarrhea on adoption date, 3 days ago. 
 Misc: First Exam:
Dog was adopted 3 days ago and had vaccines at breeders. Dewormer given. 







 Vaccines: 
 For every exam where vaccines take place a separate entry is to be made. Please note any vaccine separately should you feel it is important to your claims processing. 

Example, 
 Vaccines: Yearly
booster and rabies. 
 Vaccines: 2nd booster, including Bordatella 
 Spay/Neuter: 
 On the spay/neuter date label the entry as such followed by if the pet is
over or under 1 year of age. 
 Example, 

Neuter: > 1 year or Neuter: Over age of 1 year 

Spay: < 1 year or Spay: at less than 1 year 

5 Day WP: 
 For the exams
that occur within the 5-day accident waiting period and ARE regarding an accident. the entry will be labelled as above and followed by relevant findings. 
 Example, 
 5 Day WP: Fell out of truck, broken leg 

If the accident within the 5 days is also the First exam, use the following. 
 5 Day WP: First Exam: fell down stairs, broken leg, otherwise healthy. 
 WP: 

For exams that occur within the 30-day waiting period and are an illness or an accident the entry will be labelled as “WP:” and
followed by relevant findings. 
 Example, 
 WP: Vomiting and diarrhea, (symptoms pertaining) 
 Example if first exam falls with in this time
frame, 
 WP: First Exam: Otitis Externa, otherwise healthy. 







 Separating out Observations from the same exam date: 

For each unrelated condition noted during an exam, a separate entry is required. 
 ‘Presenting Complaint’- 
 On all examinations that do not fall into the categories
above, begin the entry with a word or phrase that illustrates why ‘fluffy’ is at the vet. 
 Examples; 

Scratching ears- Yeast otitis, left ear. 

Diarrhea- notation of symptoms 
 Limping- non wt
bearing left hind for 5 days. 
 Vomiting and Diarrhea- 
 Check eyes