Substitute insurer: an insurance company gimmick or a boon for the policyholder? Insurance coverage What is a securing insurer.
Insurer
Insurer- this is entity (Insurance Company), having a license to carry out insurance activities, taking upon itself under an insurance contract for a certain remuneration (insurance premium) the obligation to reimburse the policyholder or another person in favor of whom the insurance was concluded for losses incurred as a result of the occurrence of insured events stipulated in the contract.
The insured
The insured- a legal entity or capable individual concluded with
Insurance contract by the insurer.
The policyholder under the contract may be:
- owner of the vehicle (DO);
- or a person who has a power of attorney of the established form from the owner of the vehicle (DO);
- or a person using the vehicle (DO) on the basis of a civil law contract.
the owner of the vehicle (DO), has the right to conclude an insurance contract in his favor only for a period
actions of the mentioned power of attorney or contract.
Insured
Insured- an individual who is covered by the insurance coverage under the insurance contract.
Beneficiary
Beneficiary- the person in whose favor the insurance contract has been concluded.
- The beneficiary in property insurance is the owner of the insured property or another person specified in the insurance contract, who has, based on the law, otherwise legal act or a contract of interest in the preservation of the property.
- Beneficiaries in insurance civil liability the owner of the vehicle is a third party (hereinafter referred to as the “Victims”), whose life, health and / or property was damaged as a result of the operation of the vehicle by the Insured or the Admitted Person;
- The beneficiaries in the insurance of the driver and / or passengers against accidents are the Insured, and in the event of the death of the Insured, their heirs.
Third person
Third person- a person who is not a party to the insurance contract.
Driver
Driver - the person who drove the vehicle at the moment insured event and belonging to the group of admitted persons
Road user
Road user - a person who is directly involved in the process of movement as a driver, pedestrian, passenger vehicle.
Sum insured
Sum insured- the amount of money determined by the insurance contract or established by law, within which the insurer, upon the occurrence of an insured event, undertakes to pay insurance compensation under the property insurance contract, or which he undertakes to pay under the personal insurance contract.
The sum insured corresponds maximum size the obligations of the insurer for the insurance payment to the policyholder or to a third party entitled to receive it. Based on the sum insured, the sizes are set insurance premium and insurance payments, if by agreement or legislative acts not provided otherwise. The sum insured is an essential condition of the insurance contract.
Insurance payment
Insurance payment(insurance indemnity) - the amount of money calculated in the manner prescribed by the insurance contract and these Insurance Rules and paid by the Insurer to the Policyholder, the Insured person, the Beneficiary upon the occurrence of an insured event.
Insurance premium
Insurance premium(also gross premium) (insurance premium, insurance premium) - insurance payment that the policyholder is obliged to pay to the insurer in accordance with the insurance contract or the law. The insurance premium depends on the sum insured and the gross rate insurance rate, sometimes calculated as the product of the latter, taking into account the correction factors.
The amount of the insurance premium is reflected in the insurance policy. The insurance premium is paid by the insured as a lump sum in advance or in parts during the entire insurance period.
KBM or Bonus Malus
Bonus Malus Coefficient (BMR) is a coefficient corresponding to the class assigned to the driver or vehicle owner, which affects the cost of the OSAGO contract.
When concluding an OSAGO contract, the insurance company is obliged to use information about previous periods of insurance contained in the automated information system Russian Union of Auto Insurers (AIS RSA).
The coefficient has been put into effect and has been used in calculating the cost of OSAGO since 2003.
MSC can be increasing - in the presence of accidents and lowering - during trouble-free driving. Bonus-malus is retained both when the policy is renewed in "own" insurance company, and when moving to another insurance company.
To date, 15 classes of drivers have been established, providing for the application of the appropriate coefficients:
Insurance case
Insurance case- an event that has taken place, provided for by the insurance contract and these Insurance Rules, upon the occurrence of which the Insurer becomes obliged to make insurance payments to the Policyholder, the Insured person, the Beneficiary or other third parties.
Addendum
Addendum- a written addendum (additional agreement) to the previously concluded insurance contract (policy), which contains the changes to the previously agreed conditions agreed between the parties.
Europrotocol
European Protocol or Europrotocol- simplified registration of documents on road accidents, which is carried out without the participation of police officers. The ability to independently record the fact of an accident for further contacting the insurance company for compensation and promptly leave the scene of the accident, without creating congestion on the road.
Road traffic accident (RTA)
Road traffic accident - an event that occurred during the movement of the insured vehicle on the road and with its participation, in which people were killed or injured, the vehicle, structures, goods were damaged, or other material damage was caused.
Non-aggregate sum insured
Does not reduce the amount of the insured amount after the payments made.
Aggregate sum insured
The aggregate sum insured provides that after each insurance payment of a part of the sum insured, the remaining sum insured is reduced by the amount of the payment made.
Unconditional deductible
Unconditional deductible is a deductible in which, if the amount of loss does not exceed the amount of the deductible, the Insurer is exempt from its compensation, and in case of excess, the amount of insurance payment is determined as the difference between the amount of the loss and the amount of the deductible. The insurance contract may establish the following types of unconditional deductibles:
- Deductible for the 1st insured event - an unconditional deductible, applies to the 1st by the date of occurrence of the event recognized as an insured event in accordance with these Insurance Rules;
- Deductible from the 2nd insured event - an unconditional deductible, applied to the 2nd and subsequent (by the date of occurrence) events recognized as insured events in accordance with these Insurance Rules;
Franchise
Franchise- part of the losses determined by the insurance contract, not subject to compensation by the insurer to the policyholder or another person whose interest is insured in accordance with the terms of the insurance contract, established as a certain percentage of the insured amount or in a fixed amount. The deductible can be established for each or a certain insured event, for all risks or a separate risk, in relation to all or certain types of damage (loss), as well as in a different order, determined by the insurance contract.
Unconditional deductible- deductible, in which, if the amount of loss does not exceed the amount of the deductible, the Insurer is exempted from its compensation, and in case of excess, the amount of insurance payment is determined as the difference between the amount of the loss and the amount of the deductible. The insurance contract may establish the following types of unconditional deductibles:
- Deductible for the 1st insured event- unconditional deductible, applied to the 1st by the date of occurrence of the event recognized as an insured event in accordance with these Insurance Rules;
- Franchise from the 2nd insured event- unconditional deductible, applied to the 2nd and subsequent (by the date of occurrence) events recognized as insured events in accordance with these Insurance Rules;
Abandon- agreement on the transfer of ownership (possession, use, disposal) to the insured property to the Insurer.
Drivers trying to issue an electronic OSAGO (whether it be Rosgosstrakh or any other company), often after filling out and checking all the fields, receive this error and the offer “Go to the site of the substitute insurer”:
Due to the presence of a threat of the onset of risks of violation ...
The wording may be different, but the essence is the same - you are informed about the presence of a certain “threat of the onset of risks to the uninterrupted operation of the site” and are offered to go to the site of the “substitute insurer”. What it is? Why? And what to do?
What is a replacement insurer?
All members of the Russian Union of Auto Insurers (RSA, this organization includes all companies licensed for compulsory motor third party liability insurance in Russia) divided the cars among themselves. Simply by the TCP number, that is, a certain company is assigned to each car, depending on the last digits of the TCP.
The geographical feature is not taken into account, i.e. Your number may be assigned an insurer from another region, however, all insurance companies must have a representative in each region of the Russian Federation - their own branch or a partner from among other insurance companies. The distribution takes into account market share - this means that most of the cars are attributed to Rosgosstrakh (), and small companies receive fewer cars.
This system was invented for use in sales of a “single agent” in toxic regions in 2016, but by 2017 it had migrated to the area of electronic OSAGO.
Why and how does this happen?
Because insurance companies do not want to insure some regions, some drivers, some cars. Therefore, such a principle of solidarity was introduced - everyone gets a little bit of “bad” clients.
In the field of e-CMTPL it happens as follows. According to the law, if the insurance company does not want to be unable to insure the client due to technical problems (but who will check - these are technical problems, or the site has automatically determined that you are an unwanted client), then it is obliged to redirect the client to the replacement insurance company, identified by the number PTS. Hence such a strange wording about “the risk of disruption of continuity,” this is a quote from the law.
And now this replacement insurance company must insure you. There are penalties for her for not doing it.
What to do?
At first, if you are still eager to insure with the company whose website you originally visited, then you need to try to change some data. For example, remove drivers with bad Kbm, put “unlimited number of drivers” (multidrive). Perhaps, in this way, you get out of the filter and the system will let you through to the purchase.
But it is still better to try to issue an e-CTP policy through the website of the substitute insurer. I repeat, the chances are higher there, since fines from the Central Bank have already been imposed for this. But no one will give guarantees either, of course. However, the replacement insurer will no longer be able to kick you off on the basis of technical problems, so it makes sense to try. Moreover, in many insurance companies you can upload scans of documents, if some data does not coincide with the AIS RSA base, these scans will be manually checked by an insurance employee and will make changes to the base.
Many are afraid to insure themselves, since they are assigned a little-known company from another region, without offices in their city, as a substitute insurer. This is not pleasant, but the law on OSAGO provides for this. I repeat, every insurance company must have a representative for compulsory motor third party liability insurance in all constituent entities of the federation. In the case of small regional companies, this role is mainly played by large insurers like Rosgosstrakh, Ingosstrakh, AlfaStrakhovanie, etc. That is, in case of an insured event, you will have to contact their branch.
You can find out in more detail who is the representative in your city by hotline substitute insurer or on the website. For example, here is a list of representatives of the insurance company Muscovy in each region: http://www.skmoskovia.ru/files/images/Representative_on_01.07.2016.pdf Although Muscovy itself has offices only in the central part of Russia.
P. S. Substitute insurer on the PCA website
To guarantee the purchase of e-OSAGO from a replacement company, it was planned from July 2017 to redirect the client not to its website, but to the PCA website. And there the client would have already drawn up a policy issued on behalf of the replacement company. However, in practice, in July 2017, this does not work yet.
Also, in most cases (there are exceptions) the “Go with data transfer” function does not work. This means that most likely you will have to re-enter all the numbers of passports, PTS, rights, etc. on the new site.
In one way or another, we all come across insurance activities all the time. But not everyone can operate or even explain the basic concepts used in and accurately name their status in legal language. In the article we will tell you about what the concepts of "insurance", "insurer", "insured" and others mean, what rights and obligations the parties have and other important points.
Policyholder concept
The policyholder is a legal entity (company or individual entrepreneur) or an individual who has entered into with the Policyholder can insure anything: health, real estate, car, dog, smile, etc.
What is the code of the policyholder
People rarely hear this concept, and even more so many do not know what it means. The insurer's code is a sequence of numbers that characterizes the payer of contributions and is indicated in the title section of the 4-FSS form (the form of a quarterly report to the Fund social insurance). The code allows the Fund to obtain information about who the policyholder is and about the rates that should be guided by when collecting payments from the policyholder. You can determine your own cipher yourself by referring to the policyholder cipher reference book, which are in Appendices No. 1, 2 and 3 to the Procedure for filling out the 4-FSS form, respectively. Each cipher includes three parts: 000/00/00. Let's figure out what each of them means.
- The first 3 digits identify the type of activity.
- The second part of 2 digits designates a code that characterizes tax regime.
- The third part of the code characterizes the source of the payer's capital.
If something changes in the payer's data (source of capital, type of activity, tax regime), then the code of the insured also changes.
Insurer concept
Just like the question "Who is the insured?", Most people often do not have an answer to a similar question about the insurer. So, the insurer is the second side of the insurance transaction, the company that conducts financial activities to insure something, has a license to do so and assumes obligations to compensate for losses arising from the occurrence of insured events specified in the insurance contract. The insured is the one to whom the losses are reimbursed.
Rights and obligations of the parties
The policyholder must know the rights and obligations of each of the parties. Otherwise, you can miss a detail and in the future get big problems with the insurer.
Insurer's rights
- Obtaining complete information about who the policyholder is, what he wants to insure.
- Preliminary assessment of the degree of risk for a particular property, life and health of a potential policyholder. An expert examination is possible to assess the risks. Refusal in the event of a decision on the inexpediency of insurance.
- Receiving payment for the provided insurance service.
- Request for documents confirming the occurrence of the insured event and the fact that it is such.
- Refusal to pay insurance sums, if found false information in the data of the policyholder or has expired, given by law to notify the insurer about the occurrence of an insured event.
- Investigation of the circumstances under which the insured event occurred, if the insurance company suspects the policyholder of fraud.
- if the policyholder does not pay the premiums on time (if the insurance payment is paid in installments).
Obligations of the insurer
- Providing the policyholder with information about the type of insurance that interests him.
- Conclusion of a contract for the type of insurance that is necessary for the policyholder to justify the expediency.
- Payment of the sum insured, compensation for losses if an insured event occurs.
- Maintaining the secrecy of insurance and the personal data of the policyholder.
- Direction independent expert to assess property in a situation of occurrence of an insured event and drawing up an insurance act within a specified period.
Policyholder's rights
Who is the policyholder? This is a person / company that must comply with its rights and obligations, otherwise the insurer has legal right refuse to provide the service.
- Obtaining complete information about the service provided about the company, the license.
- Receipt of insurance payment subject to the conditions of the notification of the insured event and all further actions.
- Termination of the insurance contract early, if necessary, and refund of the unused insurance premium.
- Replacement of the insurer at your own request.
- The right to challenge the decision of the insurance company to refuse payments in court.
Obligations of the policyholder
- Providing reliable and complete information about the subject, the subject of insurance in the application and the subsequent contract, as well as the degree of risk and the possibility of checking the information by the insurer.
- Payment of a lump sum or in installments, if the terms of the contract permit, of the insurance premium.
- Notification of the occurrence of an insured event within the time limit established by law (or the rules of the contract) or the subsequent provision of a document that may justify a delay in notification ( sick leave, business trip, etc.).
- Notification of the insurer within the period specified in the contract in the event of compensation for damage by the person guilty of the insured event.
The concept of an insured event
An insured event is a situation that is provided for in the insurance contract or by law, upon the occurrence of which the insurance company is obliged to pay the insured the financial amount assigned in the contract, in full or as a percentage.
What are insurance payments
Insurance payment (amount) is the amount of money that the policyholder receives from the insurance company in the event of an insured event. Payments are made, if it is prescribed in the contract, the amount is also stipulated in the insurance contract.
Customers are unhappy that they cannot purchase an OSAGO policy on the website of the selected company. Insurers can thus cover up the reluctance to sell e-policies in regions with high unprofitable payments, experts say.
Photo: Dmitry Serebryakov / TASS
The Bank of Russia recorded the first sales calls electronic policies OSAGO. As a representative of the Central Bank's press service told RBC, consumers, in particular, complain about the inability to buy a policy on the website of the insurance company they have chosen. Instead, they are redirected to the site of another insurer. Market participants do not exclude that insurers can use this tool to cover up their unwillingness to sell electronic policies in the so-called toxic regions, where there is a high loss ratio in payments. The Russian Union of Auto Insurers (PCA) is now discussing the issue of introducing fines for the refusal of some companies to sell e-policies.
“Electronic OSAGO is a new service for most consumers, car owners are just getting used to the ability to communicate with the insurer via the Internet. That is why some of the complaints received by the Bank of Russia concern communication with the insurance company, difficulties with filling out an application for insurance in in electronic format", - said an employee of the press service of the Central Bank to RBC. At the same time, he noted that some of the complaints are related to the inability to buy a policy on the website of the insurance company chosen by the consumer, since there is a redirection to the website of another insurer.
The mechanism of a substitute insurer, developed by the Russian Union of Auto Insurers (PCA), makes it possible to ensure uninterrupted sales of electronic policies by connecting the websites of other members of the union. If the client, due to existing technical problems, cannot issue a policy, he is redirected to the website of another insurer. In this case, the insurer is selected at random from the total OSAGO insurers.
“If the mechanism of the substitute insurer is connected, a message appears on the computer screen with a proposal to follow the link to the site of the substitute insurer,” the PCA press service officer explained, noting that the relevant norms are enshrined in the rules of the association's professional activities, agreed with the Bank of Russia.
The RSA reported that they also record citizens' complaints about difficulties in registering an electronic compulsory motor third party liability insurance. “Applicants are worried that the client is being redirected from the site of one insurer to the site of another insurer; it is impossible to conclude an e-policy due to errors that occur; [there is] general issues according to the procedure for concluding a CMTPL agreement in electronic form, ”said an employee of the press service of the association. At the same time, he notes that since the beginning of 2017 and as of 15:00 Moscow time on January 24, the RSA received 104 such written requests.
Market participants do not officially explain the reasons for frequent redirects. At the same time, a market participant who wished to remain anonymous told RBC that this is the right way for those who do not want to sell electronic OSAGO, especially if it comes about the so-called toxic regions, where there is a high loss ratio. “Some companies are doing this now. For example, after entering all customer data, an error occurs, and you need to enter everything again. “I don’t know how companies do it technically, but some are now actively using them,” said another source in the market.
As previously stated by the president of RSA Igor Yurgens, in certain regions, in certain companies, there is low level sales of electronic policies. According to RSA statistics, from January 1 to January 19, less than 500 electronic policies were sold in 32 regions, less than 100 policies in seven regions (Chukotka, Nenets, Tyva, Magadan and Jewish regions, Altai and Yakutia). At the same time, the Krasnodar Territory, Volgograd, Rostov Regions became the leading regions in the sale of electronic OSAGOs, Stavropol region, in each of which more than 4.5 thousand e-policies were sold during this period. In total, in the first 20 days of January, about 100 thousand policies were sold on the territory of the Russian Federation.
“Accordingly, sanctions are needed. The PCA Board made a decision to instruct the Union's specialized committees to develop a system of such sanctions and asked representatives of the Bank of Russia to take part in this work, ”Yurgens said. According to him, the proposals of the PCA committees will be considered at the PCA board meeting on February 2. It is planned that on February 9 they will be approved by the presidium of the association.
According to the amendments to the law on OSAGO, which came into force in the summer of last year, from January 1, 2017, all insurance companies licensed for the relevant type of activity are required to conclude contracts in electronic form throughout the Russian Federation. At the same time, insurers entering into such contracts online must ensure the continuous and uninterrupted operation of their sites. According to current legislation, the total duration of an interruption in the work of the insurer's website per day should not exceed 30 minutes. When carrying out scheduled technical work, the company is obliged to notify at least one day before they start. home page site, indicating the date and time of their end. If you have any questions about the purchase of e-policies, policyholders can send applications both to the service for the protection of the rights of consumers of financial services and minority shareholders of the Bank of Russia, and to the PCA.
Currently, it is important for every person to have certain guarantees that can not only provide financial protection property, but also to provide citizens themselves with confidence in the future and that even with full or partial disability, they will receive support from the employer or the state. This can be achieved thanks to the insurance system, which exists at the expense of contributions from interested parties.
Description
It is important for every person who decides to conclude an insurance agreement or has already signed it, what insurance coverage is. it insurance payment, which is sometimes called insurance indemnity in property insurance. It indicates the extent to which the property is valued in the agreement (sum insured) in relation to its actual value.
In other words, it is the value expression of a certain amount in a certain currency, for which the insurance agreement is concluded. The concept of insurance coverage is used to establish the general obligations of the insurer in the entire set of types of insurance carried out.
If the policyholder incurs losses, he can receive compensation both in cash and in kind. For example, in car insurance, the company may, instead of paying compensation, repair the car or replace parts of it.
To receive compensation payments the occurrence of an insured event is necessary - an event prescribed in the contract. After the occurrence of this event and its recognition as an insurance policyholder is entitled to compensation for losses from the insurer.
Forms of insurance coverage
Occurring insurance events are divided into different groups. The most popular classification of forms by insurance object, which includes the following categories:
1. Property insurance. The main purpose of property insurance is the official protection of real estate and compensation for possible damage. Its objects include any property owned by the policyholder:
- transport;
- Residential Properties;
- land;
- harvest;
- animals;
- inventory;
- equipment, etc.
2. Personal insurance. It allows you to insure health and even human life. It includes:
- health and life insurance;
- social insurance;
- pension insurance;
- medical insurance, etc.
This type of insurance allows you to provide protection against possible risks that threaten a person's performance, health and, in some cases, life. Since it is impossible to objectively assess life or death, the sums insured are calculated taking into account financial capacity the insured and his wishes. In this case, the insured individual can only try to prevent financial difficulties that will be likely after loss of working capacity or death.
Insurance systems
The term “insurance coverage system” is used to formulate a way to compensate for incurred losses. Depending on the system, the ratio between the insurance coverage and the actual loss is calculated. For example, if an object valued at 10 million rubles is insured for 5 million, then in this case the level of insurance coverage will be 50%.
There are several systems using different methods of compensation for losses.
Actual cost insurance
This type of insurance is quite widespread. The insurance system begins to apply after the valuation of the property on the same day when the contract was concluded and signed. The amount of compensation in the event of an insured event will be the actual value of the object. Payment will be made in full.
Proportional liability system
When performing incomplete insurance of property of various industries, a proportional liability system is often used. In this case, the compensation payment will be that share of the loss, which will be equal to the ratio of the insurance valuation and the real value of the property. It follows that the ratio of insurance payments to losses incurred will correspond to the ratio of the insured amount to the value of the property.
First risk system
The essence of this system is that damage caused to property within the insured amount specified in the agreement will be paid in full (the so-called first risk), and losses in excess of the agreed amount (the so-called second risk) are not reimbursed. This type of insurance is most often used when concluding contracts for ensuring the safety of personal vehicles and real estate.
Let's say the insured amount at the conclusion of the agreement was 10 million rubles. Then the loss of 5 million rubles will be reimbursed. However, if the amount of damage is 14 million rubles, the insurer will pay the victim 10 million rubles, and the remaining amount (4 million rubles) will remain unpaid.
Initial cost insurance
The system used for insurance at replacement property value is applied when concluding and signing an agreement, which indicates that the amount of insurance compensation is the price of the property, excluding accrued depreciation. It turns out that the amount of compensation payments will be equal to the cost of a new object of the corresponding type.
The ultimate responsibility system
This insurance system is used quite rarely. The method developed historically and was used in the USSR until 1934 when registering insurance for vegetable and horticultural crops in agriculture... The essence of the method lies in the definition in the contract of the minimum and maximum amount of compensation for damage.
Double (triple) insurance system
Sometimes there are situations when the policyholder enters into contracts with different insurers for the same object. As a result, the total sum of compensation payments from all insurance companies added together could theoretically exceed the real value of the object. In such a situation, if the insured event did occur, insurance compensation distributed proportionally between the insurers according to the amounts of payments that appear in the contracts, thereby reducing the amount of insurance liability of each of them.
Let's say the real value of the property is 10 million rubles. An individual entered into an agreement with one insurance company for 9 million rubles, and with another - for 6 million.Then, in the event of complete destruction of the insured property total amount insurance coverage from both insurers will be equal to 10 million rubles. The first company will pay 6 million rubles, and the second - 4 million rubles.
Some of the above insurance systems can also be used when concluding personal insurance agreements (and not only in property insurance).
Execution of the contract
The form of the agreement is always approved by the regulations in force in the insurance company, and is a pre-established document of a certain type, proving the very fact of insurance.
V mandatory a property insurance contract or personal safety agreement must contain information about:
- temporary insurance terms;
- parties involved in the registration of insurance;
- property for which the agreement is being drawn up;
- the amount and procedure for payment of insurance compensation;
- current bank accounts;
- insurance events;
- the amount and frequency of payment of contributions.
The agreement is certified by the signatures of all parties and the seal of the insurer.
To complete the agreement, the policyholder must write a statement indicating all the conditions of insurance. The agreement becomes effective after the insured person pays the prescribed insurance premiums and affixes the signatures of the parties involved. After that, the policyholder receives an insurance policy - a document that confirms the fact of signing an insurance agreement. It contains all the information specified in the insurance contract.
Procedure for payment of insurance coverage
The main duty of the insurer is to carry out compensation payments in those situations when an insured event occurs.
Insurance payment is a certain documented amount (can be expressed both in cash and in kind) specified in the agreement or approved by the Federal Law "On the organization of insurance business in the Russian Federation". It is paid by the insurer to the person who signed a property insurance contract with him (in some cases, an individual insurance contract).
The limit value of the insured amount paid by the company due to damage to the insurance object is prescribed in the contract, which also indicates the term of the agreement. In order to receive compensation security, the insured must collect all documents approved by law and prove the occurrence of the insured event, as well as present a personal identification document and an insurance policy.
The sum insured agreed upon by the agreement can be paid in Russian currency- rubles, if another currency is not indicated in the agreement. In the event of a delay in mandatory payments, the insurer must, in accordance with Article 395 of the Civil Code of the Russian Federation, pay a penalty, sometimes presented as a percentage of the amount unpaid on time (if this is provided for by the rules of the agreement).
Property insurance payments
Insurance coverage is what is most often referred to as “indemnity insurance” when taking out property insurance. This name is closer to the essence, since here the losses incurred in case of damage to the property belonging to the insured are reimbursed.
After the insured event has occurred, the policyholder is obliged to notify the specialist of the insurance company about its occurrence for the time period specified in the agreement. This can be done in different ways: by phone call, letter, or during a personal visit. After that, an application form for the payment of insurance coverage is presented, the original insurance policy and independent opinions of the authorized bodies on the causes and circumstances of the incident.
After receiving the application, the representative of the insurer draws up an insurance act, to which he attaches various evidentiary documents: acts of real estate depreciation, acts on the destruction of property objects, acts of independent examination, calculations of losses and insurance amounts.
Then, within a week (unless other terms are specified in the agreement), funds are allocated for the payment of insurance coverage either in cash or in non-cash form.
The damage is paid up to the sum insured specified in the agreement. This may also include expenses incurred by the insurer while attempting to rescue property, even if these measures did not give a positive result. Insurance compensation as Money can be replaced by property similar to the lost one.
Payments in individual insurance
The designation "sum insured", like the concept of "insurance coverage", is a synonym for the phrase "payments made under an individual insurance agreement." In this case, the insurance company undertakes to pay once or with a certain frequency as stipulated by the agreement sum of money depending on the terms of the concluded contract, in cases where the specified age has been reached, damage to the health of the insured person has occurred, as well as in the event of another insured event. Pensions, annuities can be paid - fixed amounts that are paid at regular intervals, annuities are consecutive periodic payments.
Withdrawal of payments from the insurer
The insurance company has every right not to pay out insurance coverage. This is permissible in the following cases provided by law:
1) if the policyholder has not warned about the occurrence of the insured event within the agreed time frame;
2) if the insured event occurred due to intent on the part of the policyholder;
3) due to gross negligence of the policyholder (insufficient reason for refusing to pay compensation in individual insurance);
4) when the force majeure action occurred:
- military maneuvers,
- nuclear explosion,
- Civil War;
5) if the property was confiscated or destroyed by authorized state bodies.
In other situations, the insurer is obliged to compensate in full all losses incurred by the insured person, beneficiary or policyholder.
Conclusion
Insurance coverage is a concept that has several meanings. In some cases, it is used to indicate the amounts paid in personal insurance, in others - indicates the ratio of the insurance valuation to the total value of the insured property in property insurance. Payment for insurance coverage can be carried out both in cash and non-cash monetary terms, and in kind, and the total amount of compensation depends on the category of the insured event and the provisions specified in the agreement.
In some cases, the insurance company has the authority not to reimburse property or health damage. Most often this is due to the reasons for the occurrence of which the policyholder himself is to blame.
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