The insurance company does not pay out money under OSAGO. What to do if the insurance does not pay
Unfortunately, in our time, situations of the following type are often encountered: the client pays for insurance with the maximum list of insured events, thereby hoping to completely protect himself. However, in reality it turns out completely differently: the client was injured or damaged property, turned to the insurance company with a request to pay him for the damage caused by someone, however Insurance Company refused to pay. What to do in this situation? Accept and no longer use the services of insurance companies or seek payment in judicial order?
To begin with, it is worth understanding the reasons for the refusal (they are the ones that allow the insurer not to pay customers cash). All bases must be consistent with Civil Code. In it you can find "non-insurable" cases.
The following reasons are considered the main ones:
- the culprit does not have an insurance policy;
- the keys were left in the stolen vehicle;
- the insurance company did not receive funds from the insurance agent;
- the maximum possible limitation period for the case has expired;
- documents submitted to the insurance company have errors in execution.
Don't rejoice, though: you should always remember that insurance companies are very resourceful in choosing reasons for rejection (which cannot be included in one list).
What to do if the insurance company refuses to pay for an insured event
When an insured event occurs, the owner vehicle goes to the insurer with a statement indicating a request for the return of funds as compensation for OSAGO for the harm caused. But the client does not always receive these funds: the insurance company does not pay for OSAGO quite often.
Important! Making a refusal is also important: it is made in writing using the official bank of the company. In addition, the presence of arguments that influenced the adoption of this decision is mandatory.
If the client doubts the legitimacy of the company's decision, then he needs to carefully double-check the arguments and conditions of the case (in practice, there are often cases of inconsistencies between the company's internal rules and legal norms). If the conditions are found to be illegal, then the client will definitely win the case.
Often the company refuses to pay due to errors in the documentation. This inaccuracy is the easiest to correct: you just need to come to the insurer and correct every mistake in the documents, or bring the missing papers.
If the company recognizes the incident as a non-insurable event, then the client has the right to resolve the case in court, or apply to the PCA and the Central Bank of the Russian Federation.
If the insurer does not give an answer within 20 days (this period is necessarily prescribed in the contract), then the car owner must independently conduct an independent examination, indicating the presence of damage to the vehicle (the invoice for the examination is also included in the documents when applying to the courts). If there is a need, then you need to contact a medical institution, where specialists will assess the harm caused to life or health.
- clearly stated facts that testify to the incident;
- the amount of damage caused;
- instructions to apply to the RSA, the Central Bank of the Russian Federation and the courts in case of no response within 7-10 days.
Is it worth going to court? If you still have not received an acceptable response from the firm, then feel free to resort to creating a lawsuit. In it, the client will be the plaintiff, and the company will be the defendant.
The plaintiff is obliged to write a statement of claim, to which I will be attached.
- A certified copy of each document provided to the company.
- Conclusion independent experts indicating the presence of moral and material damage.
- A copy of the claim filed with the insurance company and the company's response to it.
If the court decides that the plaintiff is right, then the insurer will be obliged to pay him not only full compensation for OSAGO, but also a 50% fine, to which all costs of the trial will be added.
How to avoid an insurance company rejection
To reduce the chance of being denied a payment, the following list of actions must be followed.
- The company must find out about the insured event. It is best to tell your insurer all the information immediately: this will not only help you not to miss the deadlines, but also help the company to independently understand the incident.
It should be remembered! All terms are specified in the contracts (usually they range from 30 to 90 days). After this period, the insurance company must send a written notice of its decision.
- Collection of documentation. According to the law, it is necessary to prove all the circumstances of the case by submitting documentation. Always give documents in person, making a stamp on the remaining copies indicating acceptance of the documentation - this will not allow insurers to “lose” your documents. If circumstances do not allow you to transfer the papers from hand to hand, then send them using the post office or a transport company (be sure to keep the receipts and the receipt for sending).
- Call insurers more often. If you doubt the productivity of insurers, then be sure to call them, thereby controlling the progress of the case. However, do not just ask general issues but ask for detailed and clear explanations.
- Do not be afraid to meet with leaders. It is the bosses who will force negligent employees to immediately get to work. This is directly related to the position of jobs in the company: above each director of the branch there are a number of high-ranking persons who will easily dismiss any of the lower ones in the ranks due to reasons such as: lost image of the company;
non-compliance with the interests of the organization. - Submit complaints. At the slightest infringement of your rights, write complaints (filing a complaint must be documented in accordance with all the rules) so that the insurer responds to them in writing.
- Write to other instances. If you think that the insurance company does not fulfill its obligations well, then do not hesitate to submit written complaints to: the prosecutor's office;
consumer rights protection service;
market regulation commission financial services;
interregional unions that protect the rights of the insured;
federal service insurance supervision If you manage to explain any of the above services to the current situation, they will come to the insurance company with checks, thereby forcing insurers not only to fulfill their direct duties, but also to present a huge number of documents. - Express your opinion. Do not be shy and post a question from the series “the insurance company does not pay what to do” in one of the blogs of your city. With due luck, you can find several people with similar problems and give a joint interview to one of the local TV channels or one of the most popular newspapers: usually insurers do not like the appearance of negative information about their own company, preferring to agree to virtually any conditions of the client.
- Don't be afraid of lawsuits.
It should be remembered! For the most successful performance in court, it is required to collect a large number of documents: certificates, papers, testimonials, letters, and so on. Every word in the trial must be supported by evidence.
In addition, the best solution is to use the help of a professional lawyer who specializes in such cases (do not forget to attach invoices for legal fees to the application).
The insurance company does not pay for CASCO: assistance from a car lawyer without prepayment
As you know, each problem requires an individual approach. Is no exception, and the problem called "the insurance company does not pay for CASCO." What to do? Use the services of a lawyer.
An experienced specialist will offer a comprehensive solution, using several types of documents for this:
- claim against the insurer;
- a statement of claim to the court;
- a complaint to the FSF;
- a complaint to the RCC;
- other documents.
In addition, an experienced specialist will help you build the most correct line of prosecution and behavior during the entire trial.
What to do if the insurer refuses to pay the insurance premium?
These days, there are different types of car insurance. The OSAGO insurance policy is obligatory for each owner. And such type of insurance as Casco is not obligatory. Its owners buy it for their peace of mind on the road. Having an accident, the owners, of course, expect to restore their transport at the expense of payments from the insurance company. But it happens that she refuses to pay or pays significantly less than expected. Every driver can get into this undoubtedly unpleasant situation. Therefore, you need to know what to do if such a disaster occurs to you.
After you have got into an accident and have issued all the papers required by law, you must begin to act in the following cases:
- The deadline for the payment of funds has approached, but you have not received them. However, there was no explanation from the insurance company in this regard. This kind of thing happens very often. Although the insurance company knows perfectly well that a delay in payment is punishable by law. At compulsory insurance OSAGO payment period is 30 days. And in the case of registration of Casco, you must carefully study the contract. It is there that the payment period and the possibility of its extension for a certain period are prescribed.
- You have been sent an unreasonable refusal, which is against the law. There can be many reasons. For example, the most common are: the absence of an insured event or driving a car that is not subject to operation.
- You received an amount significantly less than what you were entitled to. For current insurance companies, this case is normal. In any case, you will be given an evaluation report with which you will not agree at all.
In this situation, there is no need to wait for a miracle. The insurance company will not bring you changes and you will definitely not have the payment due to you. It all depends on your actions. The only thing that can help you is the court The sooner you collect everything Required documents the better for you. The process is not pleasant, but you have no other way out of the situation.
First you need to write a written claim to the insurance company. In it, write about the insured event that happened, that you asked for payment in accordance with applicable law, but were refused. Be sure not to forget to indicate that in case of refusal you intend to go to court and at the same time all legal costs will be collected from them.
Do not forget to print the claim in two copies. At the same time, one of them must have a mark of receipt. It must be mandatory, so in case of refusal, be sure to be persistent. Claims can also be sent by registered mail. At the same time, be sure to save the receipt of sending and the notification that the letter was delivered.
A car enthusiast can write a complaint to the union of motor insurers in parallel with the claim. This act will show the insurer your determination to go all the way. Typically, popular companies react to such complaints because they fear for their reputation. If, after the expiration of the period indicated in the claim, no reaction was received and, accordingly, the money was not paid, then you still cannot do without a court.
Sample claims and complaints are available in large numbers on our website. However, for the greatest enlightenment, it is still worth seeking advice from lawyers. It is they who will be able to most competently draw up a statement of claim. In court, it is quite possible to manage on your own, because the process of collecting insurance payments is not difficult. Why would you waste your money on paying a lawyer.
The statement of claim must be in triplicate. The first one stays in court with a mark of receipt, the second one stays with you, and the third goes to the insurance company. You don't need to pay any duty.
A copy of all documents relating to this case must be attached to the claim. Including a response from the insurer, if, of course, there was one. You also have the option to make your own damage assessment.
What can you get from an insurance company?
Through the court, you can safely demand money from the insurance company for:
- Independent expertise;
- The work of a lawyer who will represent you in court;
- Moral damage;
- Forfeit.
You definitely won’t be able to get a lot of money for compensation for moral damage. The maximum that you can get is 5,000 rubles.
After the court approved your claim, and, as a rule, the court always takes the side of the consumer, you will need to carry performance list to a bank that has an insurer's current account Within three days after the court decision, the money must be paid to you.
The main thing is not to be afraid of anything and to know that money is in case of an accident you are legally entitled to. And insurers only save money on people who do not want to seek justice.
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The problem when the insurance company does not pay for OSAGO is familiar to many car owners firsthand. That is why in such a case there is a certain procedure of recommended actions, following which, depending on the "stubbornness" of the insurer, you can get what you want with more or less time: compensation for damage after an accident.
The insurance company issued a refusal on OSAGO
When an accident has occurred, in accordance with the Law "On OSAGO", as well as following the letter of the insurance contract, the insured must submit an application to the office of the insurer for material compensation for the damage received. And although under the insurance contract the answer should be a payment, in practice, clients often receive a refusal in one form or another. The following rules are required for this document:
- The waiver is issued only writing on company letterhead;
- The insurer is obliged to list the reasons for the refusal.
If the actions of the insurer are in doubt, it is necessary to carefully check the compliance of the reasons indicated in the refusal with the law. Contradictions are more common than is commonly believed. However, when the clauses of the contract are contrary to the law, the primacy belongs to the law, and not to the insurance company. The client can point to the contract as much as they like, but any contradictions in it current legislation automatically on all disputable issues, the parties refer to the articles of the Law "On OSAGO". The law specifies a limited number of reasons why an insurer can still refuse a client in payments under OSAGO:
- The absence of any documents from among those that the insured must transfer to the insurer after an accident along with the application (the list includes about 15 documents);
- Errors in the data provided;
- Non-recognition of the incident as an insured event.
The first two reasons are fixable, the car owner can bring the missing papers and correct the identified errors. If the insurer points to the third reason, then the dispute can be resolved by the court, in the PCA, as well as through the Central Bank of the Russian Federation.
Procedure
The insurer does not respond to the application
When, 20 days after filing a claim with the insurer about the occurrence of an insured event, the client does not receive any response, it is time for the next steps.
Independent damage assessment
You can get an expert opinion by concluding an agreement for the provision of such a service in a specialized company. You will have to pay for such an examination yourself. As a result, the conclusion will indicate: what damage was caused to the car. For any instance, including the court, the document will have the force of evidence. If not only the car, but also the passengers suffered as a result of an accident, then an additional assessment of the damage to the health of the victims will be required.
Claim to the insurer
In a written claim, the client of the insurance company sets out all the important facts about the accident, how the damage was calculated, and also indicates that if the insurer refuses to pay the due compensation, then an appeal to the PCA, the Central Bank of the Russian Federation or the court will follow 10 days after the delivery of this claims. The claim should be handed over personally in the office to an authorized person against signature or sent by registered mail with notification and inventory to the address of the insurer.
Complaint to the RSA or the Central Bank of the Russian Federation
Since any court requires considerable time to obtain a decision, you should first try to resolve the dispute with the insurer out of court. You can contact the insurer at:
- the Russian Union of Motor Insurers (RSA), which receives complaints from clients of insurance companies and helps them resolve disputes that have arisen;
- The Insurance Market Department of the Central Bank of the Russian Federation performs the same function.
The form of the application submitted to both bodies is unified, while the insured reports his personal and contact details. To save time on correspondence, it is better to immediately attach to the application copies of documents related to the merits of the dispute with the insurer.
Going to court
In a situation where the insured is not satisfied with the results of appeals to the authorities, the last resort remains - to file a claim with the court. An experienced insurance lawyer will help to formulate claims, correctly state the essence of the insurance dispute, and also support the document with all the necessary evidence. The standard list of applications for claims of this kind includes:
- Copies of all those documents that the plaintiff attached to the claim against the insurer;
- Examination of the damage caused to the car and / or the health of the victims;
- The insurer's response to the claim.
A positive court decision will oblige the insurer to pay the plaintiff the full amount of compensation, as well as a fine of 50% of this amount and compensation for all legal costs. That is why it can be argued: to obtain from the insurer due payments possible, if there is full confidence in the legality of the claim. The insured will have to prove his case on his own, but there are specialized departments to help him and, in extreme cases, the court.
If you have any questions or need professional help, our online lawyer on duty is ready to quickly help you figure out your particular case.
You have a dispute with the insurer, and you do not know what to do if he does not pay money for CASCO or OSAGO? This article will help you familiarize yourself with your basic rights and options.
Documents regulating the features of the payment of money under CASCO or OSAGO
In the event of a dispute with the insurance company, the first thing to do is to determine what regulates the obligation of the insurer to pay money.
The main document that establishes the amount of payment, the features and terms of its transfer, as well as other nuances of insurance in the event of an accident is an insurance contract (policy).
key legislative acts regulating the features of the collection of insurance payments are the Civil and Civil Procedure Code, as well as Law No. 40-FZ on OSAGO and Law No. 4015-1 on the insurance business. When considering insurance disputes, you can also be guided by the law on consumer rights.
In addition, the procedure for resolving conflicts with the insurer is stipulated by the CASCO and OSAGO Rules. OSAGO rules were approved by the Bank of Russia in 2014, and in May 2015 they were amended. CASCO rules are established by each individual insurance company independently.
The procedure for collecting money under CASCO or OSAGO
If you are not a practicing insurance lawyer, it will be extremely difficult for you to understand your rights and opportunities, however, in any case, you should know the following:
1. The money is paid based on your application. In this case, the insurer has the right to conduct an independent examination to determine the exact amount of damage suffered by you. If the insurer does not conduct such an examination for any reason, then you can order it yourself.
2. If the insurance company does not pay money, then you need to submit a written claim to it outlining your specific requirements. The claim must be based on the terms of the contract that established the fixed amount of payment, or on the results of an independent examination that determined the amount of damage suffered by you.
There is no statutory claim form, but there are certain requirements for its form. In particular, the claim must reflect the contact details of the insurer and the policyholder (name, full name, address, bank details), requirements for the insurer, detailed description circumstances of the accident. The claim must be made in simple written form, with the signature of the witness.
The claim must be accompanied by:
- A copy of the passport (military ID, international passport or other identity document).
- A copy of the document on the right to damaged property.
- A copy of the certificate of the accident, protocol and decision on an administrative offense or a ruling on refusal to initiate proceedings.
- A copy of the notice of the accident, if the police authorities did not participate in the preparation of documents about the incident.
- Copy of OSAGO policy or CASCO insurance contract.
If the employees of the insurance company do not accept your claim and do not put an incoming number on it, then you need to send the document by mail or courier service. In the first case, it is better to send a valuable letter, with acknowledgment of receipt. After receiving the letter by the addressee, you will receive a receipt confirming that the insurer is familiar with the claim. In this case, the insurance company will no longer be able to state that it did not receive your claims.
When preparing a claim, it makes sense to use the help of an experienced lawyer and together with him state your requirements, with references to laws and possible consequences. It is important to understand that insurance companies have legal advisers who specialize in insurance disputes and are called upon to do everything possible to insurance payment you were not paid in principle, or its size was minimal.
It will be difficult to deal with professionals on your own, so the support of an experienced lawyer can be extremely useful and effective. Even if you do not dare to bring the case to court, with a lawyer you will have a chance to resolve the problem out of court, as he knows everything weak sides insurers and can put pressure on them with the help of the law.
3. The insurance company will have to pay the money within five days (not counting holidays and non-working days) or provide a justified written refusal.
4. If the claim does not bring results, you will need to collect evidence of your claims (for example, the results of an examination, letters, statements, etc.) and file a lawsuit with the court to recover the insurance payment from the insurer. At the same time, if you win, you will be able to claim from him all your costs for legal proceedings (the cost of a lawyer, the cost of your travel to court, other expenses).
In addition, in case of a positive court decision, the court may recover from the insurance company a fine in the amount of 50% of the difference between overall size the insurance payment determined by the court, and the amount of the insurance payment voluntarily made by the insurance company.
And finally, in the event that the insurer had to return insurance premium under OSAGO, but did not do it on time, the court will collect from him a penalty in the amount of 1% of the insurance premium under the contract for each day of delay, but not more than the amount of this premium as a whole.
The right to return the insurance premium for OSAGO is reserved for disabled people who own vehicles in accordance with medical indications. Compensation for them is 50% of the insurance premium paid by them.
If you concluded a contract with an insurance agent or an insurance broker, the insurer is still liable.
By the way, state duty You do not need to pay when filing a claim for an insurance dispute.
After the completion of the trial and the entry into force of the decision, you will need to file an application to initiate enforcement proceedings, and the bailiff will begin all the necessary measures to collect money for CASCO or OSAGO from the insurer, as well as transfer them to your account. You don't have to do this on your own.
What is a compensation payment
If the insurer is required to compensate for damage caused to property, health or life of the victim under OSAGO, but for some reason does not do this, then the insured has the right to receive a compensation payment.
Compensation payment is paid if:
- The insurer is in the process of declaring it bankrupt.
- The insurer's license has been revoked.
- The person who caused the harm is unknown.
- The tortfeasor did not insure his liability under OSAGO.
Compensation payments are paid by the professional association of insurers.
To receive this payment, you must submit an application to this association demanding compensation payment. Documents confirming the right to claim must be attached to the application.
The application must be considered within twenty days (excluding holidays) non-working days). During this period, the association must either pay the money or provide a reasoned written refusal.
You can also appeal this refusal through the court by filing a lawsuit demanding the recovery of compensation.
When preparing a claim, it makes sense to familiarize yourself with the Information Letter of the Presidium of the Supreme Arbitration Court No. 75 of 2003 with an overview of the practice of resolving disputes related to the execution of insurance contracts, as well as court decisions on related issues.
However, it must be borne in mind that in Russia the courts are guided not by precedents (previous court decisions), but exclusively by laws and other regulations. Even if it turns out that a similar case was previously resolved positively for the applicant, and the insurer paid out the money under CASCO or OSAGO, this does not mean that in your case the decision will be similar.
Therefore, when preparing for court, it makes sense to contact a lawyer specializing in insurance disputes and ask him to assess the prospects for a favorable outcome. The specialist will analyze your documents based on his experience and regulations and then give a relatively accurate prediction.
If it turns out that going to court will be justified, then the lawyer can draw up the necessary statements, claims and lawsuits, send them to the addressees, negotiate on your behalf and carry out other necessary actions to recover all money from the insurer.
Does the insurance company pay for OSAGO? This situation is not uncommon in our country. According to statistics, almost every second victim is not paid insurance compensation, or the amount of payment is underestimated, and the fact that insurers do not meet the deadline prescribed by law is not even worth mentioning, this is almost the rule. If the insurance company did not pay for OSAGO, do not be discouraged, but begin to act immediately and decisively. Receipt insurance compensation much better through the courts. In addition to insurance, you will receive a fine of up to 50% of the amounts recovered, a penalty, moral damages, as well as reimbursement for the services of a lawyer and an expert.
So, let's get started. First, you need to carry out independent evaluation from an expert technician. About a week before, send a telegram to the insurer with a notification of the date, place and time of the independent examination. Put questions to the experts: “What damage was received as a result of this accident?”, “The cost of restoring a damaged vehicle, taking into account wear and tear?”. Ask the expert to prepare a conclusion in two copies.
After the examination is ready, you should write a pre-trial claim. Filing a pre-trial claim is a mandatory procedure provided for by the legislation of the Russian Federation. Without this procedure, the court will not accept your statement of claim for proceedings. The claim is written in free form, the only requirement is an indication of your bank details. Attach your expertise to it, you can simply copy the expertise, submit in two copies, on one put a mark on the receipt of the claim by the insurer and wait for payment within 7 days.
Insurers usually do not respond to this document. While you wait, you can already start preparing a statement of claim in court. Now the Internet is simply littered with samples of claims for the recovery of insurance compensation, and you can independently defend your interests in court. But a lot of time is spent on independent representation of interests in court, and, moreover, you will certainly encounter “pitfalls” that are not so easy to get around. ordinary person. The first thing that will surprise you is the huge line in court, sessions never start on time, and sitting at the judge's door for three hours is a common thing for lawyers. Also insurers different ways they try to drag out the case and set various "traps". Therefore, in order to save your nerves and time, it is better to turn to professional lawyers.
Features of the procedure for filing a lawsuit
In fact, the process from filing statement of claim It takes two to four months to receive funds. If the defendant applies for an appointment forensic examination, then this is another plus month. Within 30 days, the court decision comes into force, then, on average, within two weeks, a writ of execution is issued.
After you receive the writ of execution, you can send it to bailiffs or to the bank where the bank account of the insurer is opened. The application for the recovery of the awarded amounts is written in strict accordance with the Federal Law "On enforcement proceedings". The application must be prepared in two copies, one is submitted to the bank, and the second is marked with a receipt. Within three working days you will receive funds to the specified account.
What to do if the insurance company did not pay on time for OSAGO?
The Law on OSAGO dated 01.10.2015 provides for a penalty for non-compliance with the deadline for making an insurance payment, which is determined in the amount of 1 percent for each day of delay from the amount of insurance compensation payable to the victim under a specific insured event, minus the amounts paid by the insurance company on a voluntary basis within the time limits established by Article 12 of the OSAGO Law.
The penalty is calculated from the day following the day set for making a decision on the payment of insurance compensation, and until the day the insurer actually fulfills the obligation under the contract.
For example, the amount of damage, taking into account depreciation, is 100,000 rubles. The delay is 45 days. 1% of 100,000 rubles is 1,000 rubles. Calculation: 45 days * 1,000 rubles = 45,000 rubles penalty.
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