Occurrence of an insured event under health insurance. How do I get a life insurance payout? You caused damage to property yourself
Event Insurance is an insurance policy that can help protect your investment in a specific event, such as a wedding. Although sometimes confusing, event insurance is a necessary guarantee for planners who want to keep themselves and their clients - out of court.
Event planners are often puzzled as to whether or not to purchase event insurance for an insured event, and if they do, exactly what they need to insure. Whether it's an intimate cocktail or black tie party, an indoor or outdoor event, a passive or interactive experience, some things always get out of hand.
What is event insurance? Event-related insurance covers and protects planners in several specific areas. Event insurance provides general liability for specific events. General liability insurance protects the company and all participants involved - planner, venue, catering, etc. - for losses caused by bodily injury or material damage caused by employees or agents of the insured.
Cancellation insurance will protect you in the event of unforeseen situations such as inclement weather, including a hurricane, if the venue is deemed unsuitable, or anything else requiring the event to be cancelled. This will help cover out the costs and deposits already paid. Third party insurance covers damages at the location while it is under control, which protects you from having to pay for repairs. Hired/Unused Auto Liability provides liability coverage for cars rented specifically for the event, as well as third party vehicle-related injuries or damage to their property. The automatic physical damage inflicted covers the damage you rent. Workers' compensation provides medical benefits and wages to your employees for injuries in your employment.
The choice of the optimal policy is important. With so many terms in the world of insurance - "personal liability", "general liability", "additional insured" - it's hard to know what suits you for an insured event. Most companies acquire liability, which provides for cases where people slip and fall, or a defective product is dropped into a gift bag. Some planners require that the client for whom they are planning an event add them to their company policy as additionally insured. But this may not be enough. If they join company policy, it only protects them if the company itself is involved in the accident.
What is an insured event?
For example, insurance companies typically cover include:
- Accidental Damage - You are covered for loss or damage caused by an accident at your insured address.
- Accidental Glass Breakage - You are insured for accidental breakage or breakage across the entire thickness of an object such as a window or glass panel.
- Animal Damage - You are covered for damaging anything caused by an animal that enters any part of your building that is normally completely enclosed.
- Motor Burn and Power Boost - You cover the cost of repairing or replacing the motor of any electrical appliance that burns out or any electrical appliance that is damaged by a power surge from an identifiable and verifiable source.
- Earthquake - you are insured for damage caused by an earthquake and/or tsunami, landslide and/or subsidence that occurs within 72 hours and as a result of an earthquake.
- Fluid Loss - You are insured for damage caused by unexpected fluid leakage from, for example, water, fixed plumbing, washing machine or dishwasher, sink, pool, bathtub, toilet and stationary heating or cooling system.
- Explosion - you are insured for damage caused by an explosion and/or landslide and/or subsidence that occurs within 72 hours and as a result of an explosion.
- Fire - you are insured for damage caused by fire and or heat, smoke and/or soot resulting from a fire (the state of combustion that produces a flame).
- Flooding - you are insured for damage caused by covering normally dry land with water that has escaped or been released from the normal limits of any lake or river, stream or other natural watercourse, whether or not altered, or any reservoir, canal or dam.
- Legal Liability - You cover up to $20 million for damages, legal fees and charges, costs and expenses that you legally pay to another person as a result of an incident that occurs at your insurance address.
- Lightning - you are insured for damage caused by a direct lightning strike and/or a power surge at your insurance address caused by a lightning strike.
- Loss of Additional Rent - You are covered for up to 16 weeks of loss of rent if your tenant hasn't paid rent for at least 4 weeks in a row.
- Malicious act, including vandalism - you are insured for damage caused by malicious act, including vandalism, which you report to the police.
- Malicious damage or theft by tenants - you are insured for damage caused by a malicious act or theft that you report to the police.
- Portable Content Cover - You are covered for theft/or accidental loss or damage of portable content items that are normally carried or taken from the home.
- Riots and Public Disorders - You are covered by loss or damage caused by riots or public disturbances that you have reported to the police.
- Storm - You are insured for damage caused by strong winds, including a tornado or named cyclone, or rain, hail or snow of unusual volume, strength or duration. This is not constant bad weather, but heavy or constant rain.
Planners can purchase additional coverage that protects them from things like liquidity liability and event cancellations.
What do you need to do to receive insurance coverage?
The first step is to call your insurance agent and find out the details. Under certain business conditions, event coverage is automatic.
Depending on their role in the event, the client may be required to cover liability for liquor or forfeit liability for the host. To ensure that the insured receives a copy of the policy in advance to ensure that all coverage is taken care of before the event occurs. Many companies also choose to have a separate event policy that is different from the one that covers their day-to-day operations. Then you only need to tell your agent whenever you have an event instead of compiling a new policy on a per-by-one basis.
It's the little things that cause the most problems if you're not properly covered. So even the most basic coverage policy can be a big help in the long run.
What to do in case of an insured event?
Depending on the selected insurance cover, the insured event is the death or incapacity of the policyholder. In the event of the death of the policyholder, the following documents must be submitted:
- Claim for compensation.
- Death certificate or copy.
- Physician (medical institution) or certificate of the relevant authority on the circumstances related to the cause of death.
- Excerpt from health file.
- Other documents that the insurer has requested for a good reason and / or by law.
If the policyholder is unable to work, please submit the following documents:
- Claim for compensation.
- Identity document of the owner.
- Issuance of the policyholder's insurance card and/or health file.
- Evaluation of the decision to work capacity.
- A transcript of the decision of the court, police or other investigating authority, if the cause of disability is related to a misdemeanor or crime.
- Other documents related to the insured event.
Special events insurance
Event Cancellation Insurance can reimburse you for lost deposits and other fees if something unexpected causes you to delay or cancel your feature. For example, if your photographer suddenly closes the store, you will be covered by the lost deposit and potentially unexpected fees associated with having to book another photographer at the last minute. If your organizer breaks his leg the day before the wedding and you are forced to procrastinate, this coverage can help cover any fees associated with redevelopment of the venue, caterer and other vendors.
Be sure to check your insurance policy to find out what types of situations may or may not be covered.
Event liability insurance can help protect you if you are held liable for property damage or injury caused during your event, and many places require you to get it. For example, if a group you hire damages a wall with their gear, this coverage can help pay for repairs. Some policies also cover incidents caused by your guests. So if someone ends up on the dance floor for a bit and goes to the waiter when they pass, event liability coverage can help pay for medical expenses as a result of an injury. Again, be sure to read your policy to find out what situations it does and does not cover.
Eligible events are usually private and may include features such as:
- weddings.
- Anniversary events
- Children's activities.
- Birthday.
- Religious holidays.
Public events, including dance concerts, sporting events and exhibitions, generally cannot be covered under this coverage. Certain business functions or private corporate parties may be eligible. Your agent can tell you which specific events qualify for coverage.
Keep in mind that it is recommended that you purchase dedicated event insurance once you start making deposits or purchases for your event. There may also be restrictions on when you can purchase coverage - often no later than two weeks before your event, but no earlier than two years before. The Insurance Information Institute also offers these helpful tips when you're looking at insurance for your special event:
- Find out what coverage you already have at home, auto or liability insurance, and credit cards.
- Ask if your place and providers have liability insurance.
- Know what is and is not covered by the policy, such as honeymoon fees, special attire, and gifts.
- Choose an insurer.
Claims and claims for payment for an insured event
If you're lucky, you may never have to sue your insurance. However, when things go wrong and you are involved in an insured event in the form of an unforeseen accident, catastrophe or other loss that is covered by your insurance policy, you can file a claim with your insurer.
The policy you are buying is a promise of help when things go wrong, as long as you fit the terms of the policy. You need to apply to activate the insurer's response. If your claim is accepted, the insurer will honor the promise made in the policy. This is usually by repairing or replacing damaged property or items, covering legal costs or by payment.
When you apply for an insurance policy, you formally notify the insurance company that you have suffered a loss or damage that you believe is covered by the policy, and you request action. The insurer will review your claim and determine if the events or circumstances are covered by the policy. You will need to provide evidence that this is a genuine claim and the insurer will need to verify that the claim satisfies the terms of your insurance policy. If your claim is accepted, the replacement or repair of your property or any payment by the insurer is called a benefit or payment. The insurer will work out the cost of the claim and provide the corresponding benefit specified in your insurance contract.
Claims Process
Insurance companies try to make the claims process as smooth as possible, but the policyholder must go through several steps in the claims process.
If you are well prepared and organized and have all the information the insurance company needs to see, filing a claim is usually quick and easy. The first thing you should do is contact your insurance company as soon as possible after this happens, especially if the loss is due to theft or a major accident. You may want to consider a Product Disclosure Statement for your insurance policy to see if you have a valid claim and if the event is not listed as an exception for your policy. Your insurer will do this anyway once you apply. You can make your application much smoother if you take an organized, step-by-step approach.
If you are ever subjected to a crime such as theft, vandalism, malicious acts, or any serious accident (such as one in which a person is injured or a tow truck is required), you should call the police as soon as possible and save the incident number they they give you. Follow any directions the police give you and give them as much information as possible about what happened. In the event of any serious incident, a police report will be made. Ask the police officer you are dealing with for a police report number. You will need to include this in your insurance claim.
You can review the Claim Disclosure Report and your policy schedule for your insurance policy to see if you have a valid claim and if the event is not listed as an exception for your policy. Your insurer will do this anyway once you apply. At this time, you can check the excess amount that you may have to pay.
Insurance companies are expected to promptly evaluate all claims that are made and pay out all claims that are covered by the wording in their policies. Under the General Insurance Code, insurance companies promise to respond to your claims within 10 business days and tell you whether they will accept or reject your claim based on the information you provide. When you make a claim, you will need to provide sufficient proof of your financial loss under the policy. This may include proof of ownership of claimed items, police or medical reports, and receipts or invoices. If the insurance company needs more information before making a decision, it will tell you what information you need within 10 business days of receiving your claim.
The insurance company may decide to appoint a loss adjuster, loss adjuster or investigator to obtain additional information. If so, the insurance company will give you an estimate of how long it will take to resolve your claim. He will also notify you within five business days of that person's appointment, and he will update you every 20 business days on the progress of your claim. If your claim is complex, the insurance company will negotiate with you to agree on a different time frame to resolve the claim. You may have access to any information about you that was used by the insurance company to evaluate your claim if the company does not investigate your claim. Insurance companies are not allowed to be unreasonable in refusing your request for information and reporting on your claim. If the error is related to your claim, the insurance company promises to correct this information immediately. If the insurance claim is denied, the company must provide written reasons for the decision to deny the claim and information about the procedures for handling complaints. If you ask them, the insurance company will also provide you with copies of any provider reports that were used to evaluate your claim.
The General Insurance Code states that an insurance company reacts to an event like a disaster because companies may not meet tight deadlines when many people make property claims at the same time. If you have a property claim caused by a catastrophe and insurers completed your claim within a month of the catastrophe event that caused your loss, you may request a review of your claim if you believe your loss estimate was not complete or accurate, even though you may have signed the release. Insurers will give you 12 months from the date you filed your claim to ask you to review your claim.
If you are suffering financial hardship due to the event that triggered the claim, the companies promise to expedite the assessment as well as pre-pay for any urgent financial need.
By filing a claim and receiving a claim number, your insurer receives information about your loss and can begin to evaluate your claim. You can provide relevant information later. If you delay reporting your claim, your insurer cannot pay for additional loss or damage caused by your delay. Some types of policies may also have time limits for filing a claim, so check your policy.
If you are unable to pay premiums due to financial hardship, contact your insurance company to discuss this. Given the circumstances, you can take steps to ensure that your policy remains up to date. Some insurers, particularly for recent annual payments, may renew coverage from the date the payment is received. If so, you will not have coverage from the date you pay until the date you make the payment. If you do not pay the premium, your cover may be cancelled. Generally, if a payment is late, your insurer may refuse to pay a claim if 14 days (or more) of payment is late and may automatically cancel your insurance without notifying you if a month (or more) payment is late. It is provided that you were informed about this by your insurer before you entered into an insurance contract. If you are paying the premium in installments, make sure your designated account has sufficient funds to meet each payment at each due date.
Talk to your insurer before spending money on temporary repairs after an incident. Some repairs may be urgent and necessary - such as preventing water from entering through a damaged roof - but not overspending. Many insurers prefer repairers and suppliers and can arrange the appropriate emergency repairs for you. Be sure to leave receipts for any expenses you incur.
When an insured event occurs, the policyholders have a reasonable question - how to receive payment from the insurer in full. According to the standard terms of the insurance contract, in order to receive a payment, it is required to prepare a package of documents and prove that the event falls under the conditions for payment of compensation. And if everything is done correctly, the company will pay the insured.
But in practice it is not always easy to get reimbursement. Insurance companies often impose a number of stringent requirements and often refuse compensation for one reason or another, as a result of which the insured has no choice but to receive compensation from the company in court. In this article, we will highlight the question - what forms of compensation under a life insurance contract exist, how and in what order can they be obtained?
Forms of payment of insurance compensation
In accordance with the standard conditions of a life insurance contract, the payment of compensation can be made in several ways:
- in the form of monetary compensation for expenses incurred upon the occurrence of an insured event that led to disability or death of a person;
- in the form of an accumulated amount previously deposited by the insured into a savings account - usually operates within the framework of pension programs, as well as survival insurance programs.
Within the framework of accumulative insurance, the payment can be made at once in the entire amount, or distributed over several years. In case of sudden death of the insured person, the indemnity will be paid to the beneficiary specified in the contract.
Standard conditions for payment of compensation
Specific conditions for making payments are usually detailed in the insurance contract, and can vary greatly depending on the type and conditions of the program. At the same time, the general requirement for payment of compensation is the occurrence of an event provided for by the contract. In life insurance, these include:
- reaching the age specified in the policy;
- death of a person due to reasons beyond his control;
- obtaining any disability group after an injury or illness;
- diagnosing a deadly disease;
- receiving serious injuries as a result of an accident or illegal actions of third parties;
- the need for emergency surgical treatment;
- receiving temporary disability.
Common reasons for denied payments
There are several reasons for the refusal of the insurance company to make payments, which are the legitimate demand of the insurer, and even going to court will not be able to change the situation. In particular, these include:
- Notification of the insurer about the occurrence of an event later than the terms established by the contract. However, there are exceptions, for example, if the reason for the delay was a long business trip, hospital treatment or other obstacles that objectively prevented the insured from reporting an accident. In this case, the applicant through the court will be able to restore the legal rights to receive payments.
- Lack of documents confirming the occurrence of an insured event. Insurers usually clearly prescribe in the contract a list of documents that must be presented to the applicant in order to receive compensation. Lack of necessary certificates may result in a legal refusal of compensation by the insurance company.
- Providing false information - for the purpose of material gain, many try to provide false information or even fake documents. These actions will not only lead to a refusal to pay, but can also serve as a reason for initiating a criminal case.
- The insured event is not subject to the terms of the contract. Usually, in the insurance contract, all insured and non-insured events are indicated as a separate clause. If the death of a person occurred as a result of an accident, then such a case can be recognized as insured, and if, for example, the death occurred from suicide, then such a case will be non-insurable. Also, the UK can find other excuses, just not to pay a refund - in this case, it is better to consult a lawyer and then go to court.
- Violation of the terms of the agreement - in practice, there may be cases in which the policyholder violated the terms of the contract (for example, did not pay the premiums on time), which deprives him of the right to receive compensation.
For example, a citizen who insured his life received a disability by ignoring the safety rules at work. It may seem that such an event is an insured event, but since it occurred through the fault of the insured himself, such an event will be recognized as non-insurable and the company has the right to refuse compensation.
Terms of payment of compensation
Upon the occurrence of an insured event, the applicant must notify the insurer of the event as soon as possible, but no later than 30 days later. This condition must be additionally spelled out in the contract, as well as a list of good reasons why this period can be extended.
According to the insurance contract, the documents for compensation are usually considered within 5-20 days. In practice, the period for consideration of the application can be extended to several weeks if the company has doubts about the authenticity of the documents and the reliability of the information provided by the applicant. The terms may also be extended in cases where law enforcement agencies were involved in the investigation of the insured event to determine the cause.
If the insurer delays the time without sufficient grounds, you can go to court. However, before going to court, it is recommended to write a letter addressed to the General Director of the Insurance Company with a complaint about the lengthy examination of the insured event. If this does not help, you can contact the prosecutor's office, consumer protection authorities and Rospotrebnadzor.
Reimbursement procedure
In life insurance, the general rules for registration of an insured event apply. So, if an insured event occurs, the applicant must contact the representative of the insurer using the contacts specified in the policy or insurance contract, or directly contact the office of the insurance company.
After that, he will need to prepare an application and provide supporting documents in the amount stipulated by the contract. When making an application, it is mandatory to indicate:
- applicant's data;
- contract or policy number;
- date and time of occurrence of the insured event;
- a detailed description of the incident.
Next, you need to submit documents to the insurance company - at this stage, an employee of the company must check the correctness of the application, and confirm the availability of all required documents. If the appeal was drawn up correctly and the accompanying documents were collected in sufficient volume, the insured event will be registered, and the documents will be submitted for consideration.
Based on the results of the check, the policyholder will receive a notification by phone or e-mail, and in case of a positive decision, he will be required to contact the insurance company again to receive payment.
Already today, many insurance companies offer to notify about the occurrence of an insured event on their website. In practice, this system does not always work smoothly, but it allows you to remotely notify the insurer of the occurrence of an insured event.
Required documents
The list of documents required to consider an insured event is specified in the contract and often depends on the event. Here is a list of the main documents required for submission to the company:
- a statement from the beneficiary (if it is specified in the contract), or from the legal heir;
- a document confirming the right to inherit the property of the deceased;
- applicant's passport;
- insurance policy or contract;
- death certificate of the insured person;
- a certificate from a medical institution indicating the cause of death;
- bank account details.
If the insured person has received serious bodily injury or disability, then it may also be necessary to provide appropriate certificates confirming the diagnosis and indicating the reason for the disability. Medical workers have no right to refuse to issue a document.
Arbitrage practice
Life insurance is a complex process from a legal point of view. In recent years, companies have begun to increasingly refuse to pay, and in about a third of cases, insurers manage to get the amount due only through the courts.
Example: Citizen Ivanov insured life in the amount of 1 million rubles. Crossing the road in the wrong place, he was hit by a car, and as a result of severe injuries, he died. The direct heir - Ivanov's son - turned to the company to receive compensation. But the applicant was denied payment and was motivated by the fact that the death occurred due to the negligence of the insured person. The court ruled that the company has no right to refuse to pay out under a life insurance contract, since the case falls under the insurance. The company was ordered to pay the full amount provided for the risk of "Death".
Sometimes it is not possible to establish the cause of death, and in this case it becomes problematic to receive the compensation specified in the contract. In this case, an independent examination can help to clarify the cause of death of the insured person and subsequent litigation with the insurance company.
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The result of a road traffic incident is the emergence of obligations to the person injured in the accident. Insured events under OSAGO are prescribed in the relevant Federal Law. But despite this, insurers go to various tricks so as not to compensate for the damage to the victim. Therefore, you need to know exactly what is included in the insured event, and when insurers absolutely legally refuse to pay compensation.
General concepts
OSAGO insured event - any circumstance as a result of which the car owner driving the insured car caused damage to property and / or caused damage to the health of other persons who are in another vehicle. Under these circumstances, the insurer is obliged to compensate the damage to the injured person.
The list of circumstances recognized as non-insurance is contained in the same Law. At the same time, it is more specific than the list of those that are insurance. But more about everything.
Signs of insured events
So, how do you know if an insurance company (IC) is obligated to pay compensation or not? Events are insured if:
- The damage was caused using the insured vehicle. Use means driving a car on roads and adjacent areas intended for driving.
- There is an accident. There must be at least two participants: the perpetrator, to whom civil liability applies, and the victim (he is paid compensation by the insurer of the perpetrator).
Insured event in case of an accident - examples:
- The driver did not have time to slow down in front of a traffic light sign and crashed into a car standing in front.
- The truck drove past a parked car and “hooked” it.
Non-insured events:
- Returning to the parked car, the owner found a dent in her hood. There were no witnesses to what happened. Therefore, the culprit has not been identified, and no payment will be made.
- The car was damaged by a load that was poorly fixed in a truck parked in the parking lot.
There is a list of situations when the victim 100% can and should receive an insurance payment:
- the driver hit a pedestrian;
- the vehicle was damaged in an accident;
- the people in the car were injured;
- property was damaged in the accident (for example, a fence).
Kinds
The current legislation provides for two types of insured events:
It is not worth counting on the payment under OSAGO that insures not the car, but the responsibility of the driver, in the situations listed in the second case. If you want to be calm for your "iron horse" in all unpredictable circumstances, you need to take out voluntary CASCO third party liability insurance.
Non-insured events
So, what is not an insured event? The following events fall into this category:
- Causing harm to property or a person by cargo, the movement of which is associated with an increased risk. This kind of cargo is insured separately.
- Injury while driving a car that is not covered by the insurance.
- Causing harm to the life and / or health of persons performing their official duties. In this case, the payment of compensation will be made at the expense of the types of insurance mandatory for employees (personal, social).
- Compensation for moral damage and lost profits.
- Damage to property or a person was not caused by a vehicle, but directly by its driver.
- Causing harm on specially designated areas for automobile competitions, training driving, etc.
- Causing damage during loading and unloading operations.
- Causing damage to architectural objects, antiques, luxury goods, cash, jewelry, etc. Compensation is made at the expense of the guilty person through the court.
- Causing damage to a legal entity, if an employee of the same organization was harmed on a vehicle belonging to him.
Any of these events will be considered by the insurer as not an insured event, and, therefore, compensation will not be paid.
OSAGO in parking lots and courtyards
These territories, according to the Federal Law, are considered adjacent to public roads. This means that the same requirements are imposed on the incidents occurring on them as on the roads. For example, if the cars could not pass in the courtyard of the house, and one of them was damaged, then its owner can receive an insurance payment.
The only but: regardless of the scale of the incident, in order to receive payment, you must submit a full package of documents. As a rule, minor damage is caused to cars in courtyards and parking areas, so not all car owners want to mess with documents. So it turns out that the situation itself is insurance, but in order to receive compensation, the victim must make a lot of efforts. And for the sake of several thousand rubles, it is burdensome to do this.
It is a completely different matter when damage to cars is caused during parking. The most typical situation is inaccurate opening of the car door. Since none of the cars is in motion, the insurer has the right to refuse payment to the victim.
Instructions for the car owner after the accident
Here are the actions that the insured must follow in the event of an insured event under the OSAGO policy in order to receive 100% of the due remuneration:
- Appointment of the date of the examination. Up to this point, car repairs are strictly prohibited. Based on the results of the technical inspection, an act is drawn up reflecting the amount of insurance compensation.
- Direct compensation for losses in cash (to the account of the insured or through the cash desk in cash) or in kind (repair).
So you learned what to do after an accident in order to receive an insurance payment. After reviewing the documents submitted by the applicant, the IC will decide whether the traffic incident is insured or not. In any case, the insurer is obliged to give an answer no later than 20 days from the date of the client's request. If the UK refuses to compensate for the damage, but you are sure that the damage received is subject to compensation, you can apply to the PCA or to the court.
Some insurance companies claim that the business of selling mandatory motor third party liability insurance policies is unprofitable. As a result, car owners often meet either with attempts to refuse payments for OSAGO or, at a minimum, with an attempt to underestimate the amount of damage.
Honest lawyers have been helping clients deal with unfair practices of insurers for many years. We analyzed the practice and invites the driver to figure out what an OSAGO insured event is and in what situation a car owner can legally demand payments from insurers for car repairs.
The concept of an insured event
Legislation
To understand what exactly is included in the insured event under OSAGO, it is worth studying the federal law FZ No. 40. It contains all the basic information. Here is a squeeze about insured events:
- The insured event under OSAGO includes events in which a citizen had an accident while driving a vehicle;
- At that moment, he had an unexpired OSAGO policy;
- The accident caused damage to other property or the health of other people.
The same law stipulates the maximum amount of compensation for OSAGO - property 400 thousand rubles, damage to health 500 thousand rubles.
According to the law, in order to recognize an insured event, there is no difference whether the accident was registered by the drivers on their own, through filling out the European protocol, or whether the forces of the police were involved. But it is worth remembering that if the drivers themselves filled out the notice, then the amount of compensation in the regions is limited (according to the latest amendments to the OSAGO law) to 100 thousand rubles. For "capital" cities and regions - 400 thousand rubles.
Insured event criteria
In order for an insurance company to recognize an event as an insured event, it is necessary that the accident has a combination of several criteria at once:
- The presence of a policy. If the culprit of the accident does not have an OSAGO policy, then the injured motorist will have to sue him and recover damages.
- Vehicle movement. If the car was in the parking lot, the driver opened the door and hit another car - this is not an insured event under OSAGO.
- The damage is done in this situation. Oddly enough, the injured party quite often tries to get around this criterion - that is, he tries to receive compensation under OSAGO not only for a scratch received in an accident, but also for other damage to the car.
- The presence of the culprit in the accident. This is one of the key requirements of OSAGO. What is included in the insured event from this point of view, and what is not? It's simple - if your car crashed, then there is a culprit in the accident. If you find a dented car in the parking lot, but the culprit could not be identified, then this is not an insured event under OSAGO.
Not recognized as an insured event
The OSAGO law lists several cases that the insurance company does not recognize under OSAGO. Let's give examples.
No accident status
The concept of an insured event includes the mandatory presence of the fact of an accident. It does not matter how it is issued - with the help of the European protocol or with the involvement of police officers. If the accident is not recorded in any way, then it is quite difficult to recognize the event as an insured event.
If the car owner wants to get insurance after events not related to an accident, you should take care of this in advance and purchase a CASCO policy. Then the driver will be able to count on payments after theft, fire and natural disasters.
Other transport
The driver got into an accident while driving car number 1. He has an OSAGO policy issued for car No. 2. In such a situation, the driver tries to figure out what is included in the OSAGO insured event, but the answer is simple - nothing. If the driver is responsible for the accident, then he will be required to compensate for the damage caused. Police officers in any case must issue a ticket for driving without insurance. The OSAGO policy is issued for a car, not for a person.
Special Risks
If an accident occurs during the transportation of a special cargo associated with a risk, an insured event under OSAGO is not recognized. Special carriages are regulated by separate legislation and are subject to special insurance.
Moral damage
Under OSAGO, the car owner will not be able to recover moral damages or lost profits. Only compensation for damage caused to the car and compensation for damage to health. In this case, it is worth making a reservation - no one will deprive the car owner of the right to sue the culprit of the accident and try to recover funds, including for moral damage. But talking about an insured event under OSAGO has nothing to do with it.
No way to assess damage
The car owner may independently lose the opportunity to receive compensation for damage caused in an accident under OSAGO. This happens if, after an accident, the victim repairs his car on his own. In accordance with paragraph 10 of article 12 of the Federal Law-40 “On OSAGO”, the driver is obliged to show the damaged car to the insurance company. Damage repaired prior to demonstration - no way to estimate compensation amount and receive payouts.
Remember, after an accident, you must notify the insurance company about the event - if a European protocol was issued, then your insurance company. If the traffic police were called, then the insurance culprit of the accident. Do not repair your car in advance, the insurance may refuse to pay out.
Driver inactivity
Quite rare, but possible. The insurance company can go to the conflict and try to prove that the driver was inactive, that's why the accident happened. Thus, insurers will try to refuse to recognize the case as insurance and will object to the payment of legal compensation.
Other options
There are several more situations when, before arguing with insurance companies, you should first think about what is included in the OSAGO insured event:
- The accident occurred at a competition or while driving on a training track or in other places specially designed for this. Even if an OSAGO policy is purchased for a car, claiming compensation for it is inappropriate;
- Damage to health in situations where another type of insurance is applied - individual or social insurance at enterprises. We are talking about damage that can be obtained at work;
- Causing damage in an accident to values \u200b\u200bthat have historical or cultural significance - special monument buildings, antiques, etc.;
- The deadline for notifying the insurance company has expired - the car owner must notify the insurers about what happened within five days. If this does not happen, payments may be denied;
- Damage to the car was due to the cargo that was transported while driving - for example, broken glass when transporting furniture;
- Damage occurred due to events of national importance - for example, civil war, strikes or environmental disasters;
- Freight or passenger transport was operated without an up-to-date diagnostic card;
- The employer's car was damaged while the employee was performing work duties.
Disputable insured event
Insurance companies are not always eager to pay full compensation for damages received by a driver in an accident under an OSAGO policy. Most often, payments are underestimated, but you may encounter a situation where the insurance company refuses to pay out at all. On the basis of non-recognition of the event as an insured event. How to act in such a situation?
Call to Honest
Insurance companies, especially large ones, maintain a professional staff of lawyers. Before getting involved in litigation, it is worth assessing the prospects of the case. Call Honest - each of our consultants has been working in the field of client protection for at least five years. Tell me the details, get the details. The consultation is free - we will be able to guide you on your thoughts on the legality of the insurance company's refusal to pay compensation.
Expertise
If you decide to fight the insurance company, then you need to evaluate your case in more detail. It is possible to carry out an assessment of damage or a trace examination. The first will set the exact amount of damage to your car. The second will help clarify all the circumstances of the accident.
pre-trial claim
If a disputable situation arose regarding the assessment of an insured event, then first of all you will have to send a pre-trial claim to the insurance company. The damage assessment carried out will be the basis for your claims. As practice shows, insurance companies most often pay the full amount of damage already at this stage in order to avoid court costs and a fine for refusing to comply with the requirements of the consumer in a pre-trial order.
lawsuit
If the insurance company continues to refuse to pay out OSAGO or offers compensation, but in a much smaller amount than it was found out by the examination, it is worth going to court. If the price of the claim is less than 50 thousand rubles, then we apply to the world court. If more, then to the district.
We can save your time and prepare the claim ourselves. If necessary, we will support at all stages of the trial. Do not forget that the cost of a claim includes the costs of examinations and legal support. If the judge decides that your claims are justified, then such costs are recognized as legal costs and the insurance company will pay for them.
Over the years, Honest's lawyers have been able to solve a lot of the most difficult problems related to conflicts with insurance companies. Contact Honest, we will help.