Compensation payments. Sequence of actions to receive insurance payment under MTPL after an accident Receive payment under insurance

Receiving insurance payments in the event of an accident may take an indefinite period. Companies acting as insurers, in some cases, deliberately delay this process in order to delay payment or completely avoid providing a certain amount of money to their client. In this situation, the direct participation of the judiciary is a vital necessity.

It may take quite some time before you receive insurance after an accident. In order to speed up this process, it is very important to be legally savvy.

Features of obtaining insurance

It should be noted right away that when it comes to compensation for damage, the case rarely goes to court. In order to file a claim for payment, you must provide an insurance certificate from the traffic police. Here are the main points regarding the accident. In particular, the main causes of the traffic accident are noted, whether the client of the insurance company was drunk and whether he violated traffic rules. Some insurers require an extended certificate.

Standard certificate from the traffic police

In the body of such a document the fact of the accident is confirmed. Such a certificate must include the person who was driving the car at the time of the accident. The number and make of the car are also indicated here, as well as a description of all visible damage to the car.

Extended certificate from the traffic police

Such a certificate includes more extensive information about all participants in the traffic accident. The following points are noted:

• residential addresses;
• driver's license series;
• license numbers

In addition, the sobriety and sanity of drivers during a traffic accident is determined. Obtaining an extended certificate from the traffic police requires more time, but at the same time provides more detailed information about the incident.

Contacting your insurance company after an accident can be challenging. This trend is due to the fact that the insurer may require a court decision on the fact of the accident as an additional document during an internal investigation. This need arises if the company suspects that the client is cheating.

Important! Direct participation of the courts may be required if the parties cannot independently agree on the amount of payments.

The CASCO insurance program allows for an accelerated settlement of the issue in the event of damage to the most fragile elements of the vehicle. These car elements include:

• headlights;
• spoilers;
• glass;
• bumpers.

It is very important to note that such a resolution of the problem is possible if the amount of damages received varies within 2-5% of the total cost of the car. A significant advantage of this method is that registering an accident and providing a certificate from the traffic police is not necessary.

Procedure for receiving payments

Obtaining insurance after an accident requires clear and decisive action from the client of the insurance company. To achieve a positive result, you should be very careful and follow the points specified in the contract.

Use of the Europrotocol

Provided that no one was injured in the accident and all participants in the incident fully agree with the current picture, then you can use the drafting of the so-called Europrotocol. Neither party to the conflict should make any claims. In this case, all issues are resolved directly at the scene of the accident.

It should also be noted here that the CASCO insurance program implies the mandatory presence of an insurance commissioner, who must personally inspect and evaluate the scene of the accident. After this, the protocol is filled out and the parties' insurance companies are notified.

In a different situation, there is a need for the presence of traffic police officers. They are the ones who draw up a diagram of the accident and, if necessary, can provide this information to insurance companies. One of the participants in the accident will be fined for violating traffic rules.

Alternative option

To obtain compulsory motor liability insurance after an accident, you must perform a number of actions in a certain sequence. The resolution of this issue must be approached with full responsibility.

Step #1. Notification of the insurance company and the traffic police

If the situation cannot be resolved through the European Protocol, then you must immediately report the incident to the traffic police and the insurance company. At this stage, you should also exchange contacts with other participants in the accident. The following points should be noted:

• passport details;
• insurance policy number;
• series of insurance;
• special sign number.

The special sign is mainly attached to the windshield. After this, you should wait for the arrival of a traffic police officer and a representative of the insurance company.

Step #2. Obtaining a certificate from the traffic police

After this, you should visit the traffic police department and request a certificate of the traffic accident. The body of the document should indicate as many details as possible regarding the nature of the damage to the vehicle.

Step #3. Submitting documents to receive insurance payments

Being the culprit of a traffic accident, you must submit a package of documents to the insurance company within three days. Otherwise, the insurer has the legal right to demand compensation for damage with recourse. If you are applying for insurance benefits, you must write an application and submit papers to the insurance company. As of 2019, the required list of documents is as follows:

• passport;
• driver's license;
• vehicle registration certificate;
• certificate from the traffic police;
• insurance policy;
• certificate from the hospital.

If necessary, you must also add a power of attorney for the car and documents confirming expenses after an accident. This refers to payment for tow truck services.

Step #4. Obtaining a court decision

The court makes a decision after a ten-day period. Sometimes this period may change up or down. In order for the insurance to be paid out as soon as possible after an accident, it is recommended to independently collect the court decision and take it to the insurance company. In this case, you should keep a copy for yourself, and deliver the original with a wet stamp to your insurer.

Step #5. Carrying out an examination

The examination has a direct impact on the amount of insurance payments that will be provided to the company's client. Until inspection, it is prohibited to carry out repair work. With a high degree of probability, the appraiser will minimize costs, so it is most advisable to use the services of an independent expert.

Step #6. Receiving payments

The insurance company is given 90 calendar days to make payments. Provided that if the agreed amount has not been paid after such a time period, then the client has every right to demand payment of a penalty.

Video: How to get paid with the help of a free public consumer rights organization

How to speed up the insurance payment process after an accident?

To somewhat speed up the process of paying out insurance, the injured party can get involved in clarifying the relationship between the culprit of the accident and the insurer. To do this, you can go to the traffic police and find out the date of consideration of the case.

After that you can write a petition to speed up the consideration of the case. At the end of the court hearing, you can take a copy of the decision and personally bring it to the insurance company.

It is important to remember that refusal of payments by the insurance company is not yet a reason for disappointment. In this case, you can go to court with a claim for compensation for losses by the person who caused the accident. The timing of receiving compensation depends on the speed of consideration of the case.

Total car loss

The described procedure for insurance payments is relevant only if if the vehicle is subject to restoration. However, sometimes situations arise in which car repairs are inappropriate. In this case, the insurance company may raise the issue of constructive destruction of the vehicle. In this case, the client remains without payments and loses the car.

When assessing the condition of a car, everything depends on the initial cost of the car. Most often, total loss is announced if restoration requires from 60 to 80% of the cost of the car. Much depends on the results of the examination, which determines the final cost of repair work.

If the machine is structurally destroyed, then the question arises regarding the assessment of the value of the remains. It is also very important to determine who will own them. If the situation is resolved in favor of the owner, the latter receives compensation. If the company insists that the car should remain with the owner, then another examination is appointed, which is aimed at assessing the value of the remains.

To avoid conflict situations, it is strongly recommended to clarify all controversial issues at the stage of concluding an agreement with the insurance company. In particular, it is necessary to clarify how the total loss of a vehicle will be assessed and who will deal with the sale of the remains.

Not everyone wants to have their car repaired under the MTPL policy at the insurance company’s service station. Many people are concerned about how they can refuse mandatory repairs and receive monetary compensation, and today we will talk about how this can be achieved legally.

It is well known that monetary compensation is paid when:

• Total vehicle destruction
• The service station is located at a significant distance from the victim’s place of residence
• The cost of repairs exceeds the payment limit for compulsory motor liability insurance
• Receipt of serious and moderate harm to health by the victim
• Mutual fault in an accident
• Whether the victim has a disability.

In addition to these conditions listed directly in the law “On Compulsory Motor Liability Insurance”, there are those that follow from it indirectly and also make it possible to obtain compensation in monetary form.

Agreement between the insurer and the victim

The insurer and the victim, by mutual agreement, can resolve the issue of compensation in favor of monetary compensation. The first disadvantage of this method is that the insurer must also be interested in monetary compensation. The second disadvantage is that insurance companies in 2018 do not give monetary compensation for nothing and almost always try to impose a waiver of claims in the future.

Service station failure

It often turns out that, due to circumstances, the service station itself refuses to carry out repairs in the direction of the insurance company, and sometimes all service stations that had an agreement with the insurance company refuse. It doesn’t matter for what reasons the refusal occurred, it is important to understand that the refusal of all suitable service stations is a concrete reason to receive compensation in money.

Additional payment for repairs

Sometimes you may be required to pay extra for repairs under MTPL. A possible surcharge can be indicated both on the referral to the service station and announced directly at the service station. Regardless of the basis on which an additional payment is required from you, you have every right to refuse the additional payment and demand compensation in money.

Delayed renovation

According to the law “On OSAGO”, 30 working days are allotted for repairs from the moment the car is presented to the service station. However, the repair shop is not always able to meet this deadline. By law, in such cases, the service station must notify the insurer, and the insurer must try to conclude an agreement to extend the repair period. You may not agree to an agreement and demand compensation in money.

The insurance company does not have a contract with the official dealer

If the car is under a manufacturer's warranty, it must be repaired by an authorized dealer, but the insurance company does not always have an agreement with the authorized dealer or the dealer does not have a repair center in the area. In this case, compensation occurs through the payment of money.

Ask your questions in the comments and join the discussion!

Reading time: 8 minutes

Motorist liability insurance is a mandatory requirement for all drivers. Read on to find out exactly what payments are due in case of an accident under compulsory motor liability insurance in 2019, as well as the intricacies of obtaining funds and the principles of behavior of the insured driver after an accident.

OSAGO - what is its purpose?

The policy gives its owner financial protection in the event of a traffic accident that occurs through his fault. Insurance is mandatory for every driver and is issued on a paid basis.

• Material losses, most often damage to the car.
• Harm caused to the life or health of those involved in the accident.

The size of payments is limited by the rates approved by the Central Bank of the Russian Federation. , and the policy does not compensate for lost profits, so these costs will be fully borne by .

In order to prevent road accidents, it has been developed that affect the cost of compulsory motor liability insurance after an accident. The more insurance cases a driver has, the more expensive a new policy will cost him. And vice versa.

You can read about the types and sizes of coefficients in the article “”.

Payment amounts

The amount of payments that the insurance company is obliged to make to the injured party increases periodically. The latest changes were made by Law No. 49-FZ of March 28, 2017 and came into force on September 25, 2017, as well as last year to Article 11 1 of the Law “On Compulsory Civil Liability Insurance of Vehicle Owners,” which came into effect on June 1 and are still in effect today.

The maximum payment under compulsory motor liability insurance in 2019 for an accident is 500 thousand rubles for accidents where harm was caused to health or. For compensation for material damage, the amount of compensation can reach 400 thousand rubles.

The fact how much the insurance company pays in case of an accident under compulsory motor liability insurance will depend on: medical, automotive, road, traceability and others. And also on the scale of the harm caused and the number of victims. The make, model and year of manufacture of the car, its actual wear and tear at the time of the accident, the driver’s place of residence, and other nuances will be important.

To control the calculations of the insurance company, it is useful to pay the cost of compulsory motor liability insurance after an accident. The most reliable and informative way is to organize an independent examination. But in the simplest cases, basic programs that are easy to find on the Internet are also suitable.

Insurance cases

The legislation specifies all situations in which the injured party will be entitled to payments under the policy. Let us note one general rule - insurance cases under compulsory motor liability insurance in case of an accident involve any road accidents that occurred through the fault of the policy owner while driving a car and caused harm to the life, health and/or property of other road users.

Legislation regarding the principles of driver behavior after an accident also. The last of them, as mentioned above, came into force on September 25, 2017. Thanks to him, the procedure for dealing with an accident under compulsory motor liability insurance in 2019 has now become simpler.

When can you do without traffic police?

Please take the sociological survey!

Now you don’t have to contact traffic police officers at all if:

• there are no injured or dead people;
• only two vehicles collided;
• the amount of damage will not exceed 100 thousand rubles;
• Drivers can independently draw a diagram of the accident.

How to act in case of an accident for compulsory motor liability insurance if all the above requirements are met:

• Take photographs of the accident scene from all angles with all details. Photos will be enough.
• Only then remove the car from the roadway.
• Fill out the notices.

Drivers who issued a policy before July 1, 2018 can use the old-style European Protocol forms, and those who issued compulsory motor vehicle liability insurance after this date must already use the new forms.

What should a victim with a compulsory motor liability insurance policy do after an accident? Take the notice to the insurance company. Next, all that remains is to wait for the time given by the insurance company to consider the issue.

When you need help from the traffic police

It is necessary to call the inspection staff if:

• There are people injured and killed in the accident.
• The vehicles received significant damage.
• It is necessary to officially record the actions of the culprit of the accident under compulsory motor liability insurance with the traffic police. This is required precisely when the parties do not have the opportunity to amicably draw up a European protocol and have to call the traffic police.
• Drivers cannot draw a diagram of an accident.
• One of the parties without good reason.
• More than two cars were involved in an accident.
• For one reason or another, vehicles were displaced.
• If one or all parties have a conflict.

What to do in case of an accident under compulsory motor liability insurance in this situation:

The actions after an accident to receive payment under compulsory motor liability insurance will be identical to the first situation: submit a notice, wait for the results.

You will find more information on the issue in the article “”.

How to get compensation

Not everyone knows how to get MTPL insurance after an accident. Because of this, numerous minor disputes and serious conflicts arise between car owners and insurers. In fact, the procedure is quite simple.

The procedure for receiving payment under compulsory motor liability insurance in case of an accident in 2019 still includes the need to notify the insurance company within the established time frame that an accident has occurred. Insurers, in turn, have the opportunity, over a certain period, to study the case materials and conduct an automobile examination to determine the exact amount of compensation.

Also, the procedure for registering an accident under compulsory motor liability insurance involves mandatory pre-trial settlement of disputes with insurance companies. This means that if for some reason you do not agree with the actions of the company serving you, then before going to court, you will have to formalize and submit. This also applies to situations when you are not happy with the way payments are made under compulsory motor liability insurance in case of an accident. For example, if the insurance company underestimates the amount due to the culprit of the accident.

Contacting the insurance company

According to the new rules, the period for contacting an insurance company after an accident under compulsory motor liability insurance in 2019 is 5 days (previously it was 15 days). However, it must be borne in mind that this requirement is rather advisory in nature. Thus, if for some reason you are unable to meet the deadline for filing an application for compulsory motor liability insurance for an accident, you may well do so when such an opportunity arises. Moreover, delay cannot be grounds for refusing to pay you monetary compensation. But the sooner, the better, of course.

For convenience, you can submit an application for payment not only during a personal visit, but also by fax or through your legal representative.

Many drivers doubt whether the person at fault for the accident should contact the insurance company under compulsory motor liability insurance, or whether this is the task of the injured party. According to the established procedure, the one who intends to receive it applies for compensation. If the injured party is seriously injured or killed in an accident, the next of kin or their trusted legal representatives may speak on their behalf.

Where to go after an accident under compulsory motor liability insurance for a victim in 2019 depends on the circumstances of the incident.

Documents required for insurance

You will be able to receive funds under the policy only if you submit a complete package of papers drawn up in accordance with all the rules. Depending on the situation, their list may differ slightly. But at least the following documents are always required:

• Identity card of the victim.
• Protocol (copy) and resolution on an administrative offense/ruling on refusal to initiate an administrative violation from the traffic police, if the traffic accident was registered with the participation of police officers.
• Notification of an accident.
• A package of documents for the car.
• Papers with bank details to which insurers can transfer money.

Notification to insurance about an accident

This document must be completed both when traffic police officers are called to the scene of an accident, and when drivers decide to fill out the documents themselves.

The notification contains detailed information about the participants in the accident and the accident itself. Completed in accordance with the instructions and bearing the personal signature of the originator, it is submitted to the insurance company by the injured party.

When there are both OSAGO and CASCO policies

The rules for payments under compulsory motor liability insurance in case of an accident in 2019, as before, do not limit the ability of drivers to insure themselves and receive financial insurance.

Many people are interested in how insurance is paid in case of an accident? That is, is it possible to receive payment under both policies, and in what amount? Here it is important to remind car owners that the purpose of insurance is not to enrich the insured person in the event of an insured event, but to compensate him for the damage caused.

The question of how to receive payment under compulsory motor liability insurance after an accident along with payment under CASCO hints at a desire to carry out some kind of fraudulent operation, which is, of course, illegal. A logical rule follows from this: you can receive 100 percent compensation for damage received using only one insurance policy. Which one is up to the victim to decide.

If there are victims

Payments to the culprit

Another popular question concerns whether the person at fault for an accident can obtain insurance under compulsory motor liability insurance. The answer here is no, since this insurance policy provides for the payment of monetary compensation only to the injured party.

Moreover, in some cases, payment under compulsory motor liability insurance in case of an accident requires the filing of a counterclaim by the insurance company against the person responsible for the accident. For example, if the culprit drove a car while intoxicated or intentionally caused harm to the property, health or lives of other road users.

As for whether MTPL insurance is paid to the culprit of an accident if, as a result of the trial, he was cleared of responsibility for the incident, then the answer is yes.

If none of the traffic participants is at fault, for example, the cause of the accident was an incorrectly placed sign or poor road surface, compensation will be due to all victims. In such cases, MTPL insurance is also paid in case of an accident.

Reimbursement of funds specifically to the guilty party is allowed only under a CASCO agreement. To do this, the insurance agreement must contain a corresponding clause.

How to get the full payment from the insurance company for an accident: Video

Payments expected under insurance contracts that were signed before 1992 were classified by the state as internal debt to the population. The registration and collection of documentation necessary for the calculation and subsequent payment of compensation is handled by the insurance company Rosgosstrakh. She was appointed the full legal successor of the insurer Gosstrakh of the USSR.

To process requests that come from the population, a special unit was created, called the Settlement Center for Compensation Payments. This department is located in the city of Ryazan, and it is the department that is assigned the corresponding responsibilities.

This article will discuss compensation payments from Rosgosstrakh.

Official data

Rosgosstrakh does not make compensation payments on its own and is only an intermediary (operator) between the insured person and the state. Thus, the main responsibility of the center is to collect and process requests received from the public. Direct payments are made by an organization such as the Federal Treasury.

In order to apply to the RCCV, you need to prepare a package of certain documents and then send it via Russian Post by registered letter. In this case, it will not be superfluous to request a notification of delivery. The letter with the request should be sent to the official address of the organization: 390046, Ryazan, Vvedenskaya street, building 110. The recipient must indicate the RKVTs. This center is unified for residents of the entire country; it accepts applications regardless of the region in which the insurance contract was concluded.

How are compensation payments made by Rosgosstrakh?

Scheme of work

RCCV "Rosgosstrakh" first accepts documents from the citizen and then registers them. After this, a search is carried out and entered into a single database, and the amount of compensation payment is calculated, which is due in accordance with the documents provided. The next step is to submit a special application for payment of compensation.

Documents are reviewed for no more than two months.

RCCV prepares an application and then sends it to the Regional Department of the Federal Treasury for the city of Ryazan. This department makes direct compensation payments from the state budget. The transfer of funds is carried out to the bank account indicated by the applicant.

It should be noted that before submitting documents for payment, a citizen should check with his bank whether the service agreement involves the transfer of additional amounts or whether such an action is prohibited.

Who has the right to claim compensation for insurance from Rosgosstrakh?

In accordance with the fifteenth article No. 415 of December 19, 2016, the state guarantees the continuation of payment of compensation benefits under accumulative insurance contracts that were concluded by citizens before 1992. Only one condition must be met: the insurance amount (redemption) should not have been paid before 1992.

Thus, persons who executed insurance contracts before the beginning of 1992 have the right to submit documents for registration of compensation payments. Citizens who entered into contracts with the insurer Gosstrakh and their successors can also receive compensation. However, the citizen must have all the necessary documents.

RCCV works exclusively with citizens of the Russian Federation.

What documents are needed to receive compensation from Rosgosstrakh?

Drawing up an application

Specialists working at the RCCV strongly advise checking the date of conclusion of the contract: whether it was actually made before 1992. In addition, clarification of the insurance group is required. It can be for children, pensioners, weddings or mixed. Rosgosstrakh processes payments only for these insurance groups.

First of all, in order to process a compensation payment through Rosgosstrakh, you must write a corresponding application. The insured person directly has the right to draw it up, as well as a person who has a notarized power of attorney.

When writing an application, a citizen must describe the situation in as much detail as possible and list all the documents he is attaching. If the corresponding entry is not found in the database, the insurer has the right to request additional documents. In this case, you will have to attach to the copy of the insurance certificate an extract from your place of work about the insurance contributions made every month. The application form can be downloaded from the intermediary’s official website.

Package of necessary documents

The list of necessary documents to receive insurance compensation from Rosgosstrakh is quite extensive. The citizen will need to attach to the application:

Where should I send the papers?

The papers must be sent via registered mail to the address we indicated a little higher. An alternative option is to personally take the package of documents to any Rosgosstrakh branch.

After the Center considers the citizen’s application, it will notify him of the possibility of receiving compensation from Rosgosstrakh (insurance was issued before 1992) and the time frame during which payment will be made. If upon review it turns out that the applicant has not provided all the necessary papers, he will receive a letter containing a request to submit the documents that are missing. Judging by consumer reviews of compensation payments, you should first send only the application itself to the organization. And after receiving a response, send a package of required papers.

Volumes of compensation payments

When calculating compensation before 1992, Rosgosstrakh relies on certain rules. First, if the applicant was born before 1945, then he will receive the amount that remained in his account before 1992, tripled. The only thing is that payments that were received earlier will be deducted from the amount. If the applicant was born from 1946 to 1991, then the account balance, doubled, is subject to payment. This is how Rosgosstrakh considers the amount of compensation.

If the application is submitted by the successor, he can count on receiving compensation for funds spent on funeral services. This rule applies if the investor died from 2001 to 2016. The total amount of such financial assistance will be no more than six thousand rubles. If the contribution of the deceased insurer exceeded 400 thousand rubles, then the successor may receive compensation for the entire amount spent on the funeral. An alternative option is for the policyholder to offer the applicant the amount of the account balance increased by 15 times. Compensation for Soviet insurance is easy to obtain from Rosgosstrakh.

When calculating compensation payments, the value of money in 1991 is taken into account.

The amount of compensation may also depend on the date when the insurance contract with Gosstrakh was terminated. RCCV considers each case individually. The applicant will be informed only of the amount of funds to be paid and the deadline for its implementation.

If the applicant requires more detailed information, he can contact the special RCCV hotline. Before making a call, you will need to prepare all documents that can confirm verbal information.

What are the nuances of calculating compensation for Soviet insurance at Rosgosstrakh?

Reduction factors

Everything, along with the amount of compensation, is regulated by law. They depend on such factors as the validity period of the insurance contract. The coefficient can be from 1 to 0.6; more detailed information can be obtained by calling the hotline.

For example, if the agreement was valid until 1995, and payment was made in the same year, then a reduction factor of 0.9 will be applied. If the contract was terminated in 1992 and payment was received in the same year, then a different reduction factor will be used - 0.6.

Where can I write an application for compensation from Rosgosstrakh? We will talk about this further.

Payment of compensation through the bank

Today, it is possible to make all compensation payments through Rosgosstrakh Bank. He has been working in the financial sector for over 20 years and holds leadership positions. If the applicant applies for compensation from Rosgosstrakh to an account opened with this bank, then he should take into account the following nuances:

• A bank account will be opened automatically upon receipt of the application. That is, you will not need to perform any additional actions to open an account.
• The bank notifies you that the compensation payment has been credited via SMS or registered letter. In this case, the applicant will not incur additional expenses.
• Money can be withdrawn from the account at any additional bank branch or at a Russian Post office by presenting only a passport.

It is worth noting that consumers leave entirely positive reviews about compensation payments at Rosgosstrakh Bank. The only desire of clients at the moment is the ability to process documents remotely.

Experts advise not to delay submitting your request to the RCCV. The main reason is the lack of legally established deadlines for the consideration of applications and the procedure for making compensation. Every year the Government determines the amount that will be allocated for compensation payments.

In practice, every year, by the beginning of autumn, many applications remain unconsidered due to a lack of funds. As a result, the RCCV is forced to suspend accepting documents until a new order from the Government of the Russian Federation is received. For example, this year the state has allocated more than eight billion rubles for compensation payments.

So, we examined the compensation payments of Rosgosstrakh.

What is insurance compensation or insurance payment? How to write an application for payment of insurance compensation under CASCO and OSAGO? Where to go if your insurance claim is denied?

Hello everyone who visited our resource! Denis Kuderin, insurance expert, is in touch.

We continue to explore the multifaceted topic of life, health and property insurance. Our article is about insurance compensation, options and conditions for receiving it.

The publication will be of interest to everyone who already has insurance, as well as those who are just planning to take out a policy with an insurance company.

So let's begin!

1. What is insurance compensation?

The main purpose of obtaining a policy from an insurance company is to protect personal interests. By signing the contract, we hope for timely and full payments for the insured event. This, in essence, is the meaning of insurance - to compensate for the damage caused to the policyholder in the event of an unforeseen situation.

– this is compensation that is paid to the policyholder (or his beneficiary) when an insured event occurs.

The source of payments is the insurance fund, which every insurer must have. Compensation is not always expressed in direct payment of damages. These may be medical services or other material benefits that the policyholder receives.

Example

As insurance compensation for an accident under CASCO insurance, the victim receives free repairs at a car repair shop - damaged elements are restored or failed parts are replaced.

The amount of insurance payments may be equal to the insured amount provided for in the contract, but it can also be less than that if the damage is insignificant.

The total amount for property insurance is determined individually and is approximately equal to the real price of the object for which the policy is issued.

The basis for compensation is a recorded and confirmed insured event. Payments are made in strict accordance with the terms of the agreement.

If it is difficult for the insurer to determine the amount of damage within the terms established by the contract, it can increase the assessment time and conduct additional examination. However, in this case, a late payment factor must be added to the payments.

The procedure for assessing the consequences of an insured situation is called settlement of an insured event. Organizations that value their reputation and truly care about the well-being of their clients try to resolve the case as quickly as possible. Unscrupulous insurers are the opposite: they waste time and look for excuses to refuse compensation.

The following persons are entitled to insurance compensation:

• policyholder;
• beneficiaries (persons appointed by the policyholder in the event of their death);
• heirs of the policyholder (children, parents, spouses, as well as dependent persons).

2. In what form is insurance compensation paid - TOP 4 main types

Compensation for losses, no matter in what form it is made, should not exceed the amount of actual damage caused to the insured.

True, in some cases (for example, with health insurance), it is quite difficult to assess the actual damage. Such contracts immediately indicate a certain amount of payments or the volume of services that must be provided to the policyholder.

Let's look at the main types of insurance compensation.

Type 1. Temporary disability benefit

Compensation for the period of disability resulting from injury or illness is provided for by compulsory medical and social insurance, as well as voluntary life and/or health insurance policies.

View 2. Insurance payments

Money is paid according to the agreement - monthly or in a lump sum. The insurer begins to pay the due amount after the policyholder presents all the documents necessary to confirm the insurance situation.

Each company calculates the total amount of insurance payments for the reporting period. This indicator serves as a kind of confirmation of the insurer’s integrity. Data on payments are publicly available either on the organization’s website or on official federal resources.

View 3. Payment of expenses for the restoration of health and rehabilitation of an enterprise employee

Temporary disability benefits are often not enough to cover the costs of improving your health. Therefore, policies provide payment for medical, social or professional rehabilitation of the victim.

Mandatory social and medical insurance cannot always provide full treatment and restoration of the policyholder’s health. But voluntary life insurance policies guarantee the full scope of therapeutic and additional assistance.

There are many types of such assistance:

• additional diagnostic and therapeutic services (physiotherapeutic procedures, studies, massage and other activities recommended by the attending physician);
• medicines – free or at reduced prices;
• special diet during hospital treatment;
• spa therapy + payment of ticket costs;
• additional paid leave;
• prosthetics and provision of medical equipment.

More information on this topic is in the article “”.

View 4. Additional expenses

If the expert commission has determined that the policyholder requires additional types of assistance or special care, the company must provide him with such services in the appropriate amount. Provided, of course, that this is provided for in the contract.

For example, if a patient from the province requires surgery in a metropolitan clinic, the insurer must pay the costs of transportation and treatment.

3. How to receive insurance compensation - 5 simple steps

Compensation is paid within the time frame established by the insurance contract, as soon as company representatives receive all the documents and certificates they need. The basis for starting payments is an insurance certificate (sometimes called an “emergency certificate”). Such paper is drawn up after confirmation of the insured event.

The amount is paid in one lump sum or in the form of an annuity. Some contracts provide for lifetime payments at predetermined intervals (for example, monthly). For late payments, a fine is imposed - usually in the amount of 1% for each day of delay.

And now - instructions for receiving insurance payments.

Step 1. We notify the relevant authorities

Immediately after an incident that potentially falls into the category of insurance situations, it is necessary to notify the competent authorities.

The operating principle is extremely simple:

• in case of fire, call the fire department;
• in case of illegal and hooligan actions - to the police;
• in case of an accident - to the traffic police;
• in case of injuries and accidents - go to an ambulance;
• in case of a plumbing accident - to the emergency housing and communal services service.

If possible, you should try to minimize the damage caused by the incident, without forgetting, of course, about your own safety.

Important nuance

After an incident, you should not try to repair damaged property, move it, or generally take any actions that could make it difficult for experts to assess the damage.

Be sure to wait for representatives of the relevant services to draw up regulations, resolutions and protocols. You will need copies of these documents.

Independent photo or video recording of the incident is encouraged. The more tangible evidence of damage, the better.

Step 2. We draw up a statement describing the incident

Within 1-5 days (each insurer has its own deadlines), you need to report the incident to representatives of the insurance company. You cannot delay notification, otherwise the organization will have legal grounds for refusing compensation.

An application with a detailed description of the insured event is also required. The document indicates the date of the incident and its cause, the nature and extent of the damage. A list of damaged property or a list of breakdowns (in case of a transport accident) is attached.

The company must register your application and assign it a registration number. Write it down or memorize it (if you have an excellent memory for numbers). This will help when you need to find out at what stage the application is being processed.

If, for reasons beyond your control, you are unable to submit your application within the allotted time frame, notify the firm’s staff by telephone, explain your difficulties and directly ask what you should do. Be sure to write down the name of the employee you spoke with so that if anything happens you have someone to refer to.

Step 3. We collect the necessary documents

To obtain a positive conclusion from the company on the issue of insurance payments, in addition to the application, other papers are needed.

Here is a sample list of them:

• documents confirming the fact of the insured event - medical certificates, protocols, fire department reports;
• inventory of damaged property;
• documents confirming the right to own the damaged property;
• identification;
• copy of the insurance contract.

In case of an accident, you will need documents for the car. If you were injured in an accident, you will be required to provide a copy of the administrative violation report. You also need documentary evidence that you were not under the influence of alcohol at the time of the accident.

More information on the topic of car insurance is in the publications “” and “”.

If insurance is received by the heirs or beneficiaries of a deceased person, a death certificate is required (it is obtained from the registry office). You may need medical certificates about the cause of death or a copy of the autopsy report.

Step 4. We are waiting for the insurance company's decision

The terms of consideration are stipulated in advance by the contract. As a rule, this is 5-20 days from the date of application. The company has the right to increase this period if it doubts the authenticity of the documents or finds it difficult to assess the extent of the damage.

The wait will drag on indefinitely if a criminal case has been initiated regarding the insurance situation. You will have to wait until a procedural act is drawn up in the case.

The insurer's representatives will notify you of their decision by phone or by mail.

Step 5. We receive insurance compensation

The logical conclusion of the activities described above is the receipt of insurance payments. Money is transferred to the client's account, sometimes paid in cash.

Payment is made within 5-10 days if we are talking about a one-time refund. The periodic fee is transferred to the account at the specified time (for example, the 1st day of each month).

If you are not satisfied with the amount or are completely denied compensation without clear reasons, you have the right to file a claim directly with the insurer or with the federal supervisory services.

The table will give a visual representation of the necessary steps and actions:

№	Stages	Specific actions
1	Contacting the competent authorities	We call the appropriate services, get an expert opinion
2	Making a statement	We attach photos and video documents to the application form.
3	Collecting documents	We collect certificates, protocols, evidence of ownership
4	We are waiting for a decision	Average waiting period – 2 weeks
5	We receive payment	We receive compensation in cash or by bank transfer

4. In what cases are insurance compensation denied - an overview of the main reasons

Having a policy gives you some confidence in the future. As they say - insure your property (health, life), sleep well. However, contacting the company when an insurance situation arises does not always guarantee compensation.

Let's look at the reasons why agents may refuse payments on legal grounds.

Reason 1. Late notification of the insurance company about the occurrence of an insured event

Those who didn’t have time were, alas, late. To avoid falling into the category of “underachievers,” study in advance the clauses of the contract regarding the timing of contacting the company after the occurrence of an insured event. In some companies this period is 72 hours, others wait 10-20 days.

If the reason for the delay is valid - illness, business trip, absence from the city, or another insurmountable obstacle - the policyholder can restore his right to file an application in court.

Professional lawyers urge clients who are late in recognizing an insured event not to give up. Experts believe that failure to contact a company on time is not a reason to refuse payments.

However, it’s not worth the risk: contact the insurer immediately after the incident and be sure to document your actions.

Reason 2. Errors in specifying passport data when concluding a contract

For this reason, everything is clear: an error in specifying passport or any other official data automatically makes the contract document invalid.

Advice: when filling out the contract, check and double-check the information relating to you personally and your documents several times.

Reason 3. The insured event occurred due to the fault of the insured person

If the insurer itself is to blame for causing damage to its property or health, the company has the right not to pay compensation.

Example

While intoxicated, a person with a voluntary medical insurance policy fell and was injured - a broken arm. At the medical station, the doctor certified the injury, but at the same time recorded a high level of alcohol in the patient’s blood.

According to such a certificate, insurance compensation is not due - at least according to the standard VHI agreement.

When insuring property, payments may be denied if it is proven that the damage was caused to the property due to the negligence or intent of the policyholder himself. Or the client did not take measures to save the property, although he had such an opportunity.

Reason 4. Providing an incomplete package of documents

A common reason for refusal is an incomplete package of documents for the insured event. There are no certificates from medical institutions, no copy of the police report on the accident or paper from the housing and communal services confirming the plumbing accident.

Fortunately, such a refusal is not yet final. A respectable insurance agent often accommodates the client halfway and gives time to complete the missing document. It’s good if you can get the necessary certificate quickly and without problems.

Please note that all photocopies you provide must be notarized.

Reason 5. The case was considered uninsurable

And another reason for refusal is that the case does not fall into the insurance category.

When insuring property (real and movable), non-insurance situations are:

• consequences of a nuclear explosion and radiation contamination;
• damage caused as a result of military operations;
• damage caused as a result of civil unrest, rallies, strikes.

Each client can read the full list of non-insurance events in the insurance contract. It is better to do this before signing the agreement so that there are no unpleasant surprises in the future.

5. Professional assistance in disputes when receiving insurance payments - TOP 5 service companies

Do you want to receive compensation quickly and without problems or challenge the insurance company’s refusal? Then contact professional legal organizations dealing with these issues.

We offer five of the most reliable companies of this profile.

1) Automotive lawyer

Any type of services in the field of automobile law. Professional protection of the interests of vehicle owners. Settlement of disputes with insurers, assistance in obtaining compensation.

The company's employees are experienced lawyers and attorneys who thoroughly understand the laws and know all the weak points of insurers. The narrow specialization of the company is a guarantee of exceptionally high-quality services and positive results.

2) Legal Empire

A legal center that protects the rights of individuals and legal entities. The company's areas of interest include insurance disputes, appealing insurers' decisions, reviewing examination results and many other services.

The center takes on the most complex cases and offers affordable prices for its services. Among the advantages of the company are free consultations, visiting the client within 24 hours, provision of services in advance - against future compensation from the insurer.

Guaranteed results in any legal disputes. 6 years in the legal services market, more than 5 thousand cases won, 328 million rubles, which the company managed to win in favor of clients. Free consultations online and by phone.

The firm's staff includes only professional lawyers with many years of experience. Flexible pricing system for services, attention to detail, confidentiality of client personal data. When resolving insurance issues, the company guarantees not only payment of compensation in full, but also receipt of fines and penalties from the insurer.

Professional assistance in any legal issues, including insurance disputes. Free user consultation. Works within Moscow and the region. The company's in-house professional lawyers (each with 10 or more years of experience) are ready to take on the most complex cases. The company's motto is: “the client’s problem is our problem.” The initial consultation is free.