Why is the accident not an insured event? OSAGO - what is an insured event, what is not it and what is considered controversial? Basic and mandatory details
Many insurers are faced with a situation where applying for a insurance compensation the company protecting the interests of the guilty party refuses to pay compensation. Such situations are not rare, even when the fact of the occurrence of a traffic accident has been officially registered.
Of course, it is unprofitable for insurers to cover the damage and they try to come up with excuses not to make payments. In order not to fall for the illegal tricks of the insurance company, it is important for car owners to know what can be mistaken for an OSAGO insured event, and what really is not.
These cases are governed by the provisions of the SDA and the Federal Law, therefore, in the event of a dispute, it is necessary to resort to these documents.
Car owners who buy a compulsory auto insurance policy hope that, thanks to it, the victim will be able to receive compensation for the restoration of a vehicle damaged in a car accident without any delay.
But insurance organizations they do not always recognize insured events (CC), even if the insured car has damage of a different nature.
That is, it is important for the insurance company that, when accepting a statement from the insured of the victim in the accident, the presence of the guilty and injured parties, the scene of the accident, suitable for the SS and other circumstances, be confirmed. Otherwise, such an OSAGO event is not recognized as insurance.
A compulsory car insurance policy protects the car owner from financial penalties that may be imposed on him if he is found guilty of a car accident. Auto insurance in this case covers the damage to the injured person as if on behalf of the culprit.
Consequently, it is not the initiator of the accident who pays for the fact of harm, but his insurance company. But in order for insurers to pay compensation, you need to know what is included in the insured event under OSAGO, so as not to waste time filing an application and know in advance in which case a refusal will follow.
In 2018, according to the current Federal Law "On OSAGO", there are only a few situations that are included in the list of insured events, namely:
- An event that occurred on the roads and adjacent territories, as a result of which people and their lives suffered. A sign of SS in this situation is the harm to health and life that innocent car owners, their passengers or pedestrians received.
- An event that occurred as a result of the vehicle moving on the road, in which the property of an innocent car owner was damaged. Here, only the vehicle of the victim falls under the SS.
It is these two situations that are an insured event under OSAGO, but each of them has certain subtleties in determining. To understand in more detail, let's look at examples.
Insured event under OSAGO in case of an accident
So, we know that insurers are in no hurry to recognize all accidents on roads as an insured event for which they are obliged to pay compensation.
Therefore, the occurrence of an insured event under OSAGO is recognized only if the following conditions are met:
- Damage to property (motor vehicle) was recorded as a result of an accident.
- Damage was caused to the health of other persons as a result of the movement of the vehicle.
- The guilty party was insured at the time of the accident.
- When compiling the Europrotocol, both the guilty and the injured parties were identified by traffic police officers or participants on their own.
- A car accident or a minor accident occurred on the territory suitable for the category of the road and the objects adjacent to it (parking lots, parking lots, lanes, roadsides).
That is, if an accident (accident) occurred, but there was no victim in it, an application was not sent to the insurance company, then the SS will not be like this, since there will be no one to pay compensation. If the accident occurs on the territory of a special racing track, then this also does not fit under the insured event in case of an accident, even if the perpetrators are identified.
The law and the insurer decide in which cases under OSAGO in case of an accident the compensation is paid. The presence of damage is not yet a guarantee that the company will recognize this CC and pay compensation to the injured party.
No accident
When we talk about the cases in which it is paid, you need to remember what exactly this type of auto insurance protects. So, this insurance paid by the company representing the interests of the car owner who initiated the accident.
That is, the OSAGO policy implies the payment of compensation to the party injured in a car accident instead of its initiator. Consequently, the "avtocitizen" protects the responsibility of the car owner to third parties. The protection applies to accidents on the road involving only two or more vehicles.
This means that if the vehicle was damaged not by another car, but by a fallen tree or an intruder, then such insured events under OSAGO without an accident are not recognized. To receive compensation in such accidents, those that did not occur on the road will have to be bought additional insurance Casco, covering damage in such situations.
When insurance claims are not recognized
As you already understood, only the injured party is entitled to receive compensation from the insurance company under the compulsory auto insurance policy. Therefore, if the initiator of the accident wants to receive compensation, then he needs to have a voluntary Casco car insurance policy, since the “car citizen” protects his liability, and does not cover the damage to the culprit.
In order not to lose time collecting documents, it is advisable to know in which cases insurance is not paid in an accident:
- If a motor vehicle not specified in the "autocitizenship" was damaged in a car accident. That is, the culprit does not have a valid auto insurance policy.
- The victim wants to receive compensation citing lost profits. What is not an OSAGO insured event cannot be obtained, because with such an appeal you can go to court and collect compensation from the culprit directly.
- The injured party became so because of the cargo carried in the vehicle of the culprit. If dangerous goods of the vehicle are transported, they must be insured separately.
- The accident occurred on the training track, competitions or other types of training driving.
- Moral compensation is non-insurable OSAGO cases, but it can be demanded through the court.
- Damage to green spaces, architectural monuments or structures are also cases where insurance is not paid.
Registration of an insured event under OSAGO
We have said before that in order to receive compensation and recognize the incident, the SS needs the presence of the injured party. That is, the settlement of insured events under OSAGO occurs only if there is a culprit and a victim.
The latter must set time submit an application to the company so that it considers it and inspects the damage and makes a payment. The most important thing to do after an accident is to report insured event to an insurance company.
Notifying the insurer of an accident involves submitting an application for reimbursement, as well as providing required documents and references. If the victim is not insured, then he turns to the company of the insured culprit, but if the innocent party also has a “car citizen” policy, then you can contact your insurance company.
What documents are needed
If the OSAGO contract of the culprit of the accident is concluded in the same company where the innocent car owner is insured, then the procedure for issuing an insurance certificate takes place, as a rule, according to a simplified scheme. But even in the case of filing an application with other insurance companies, the procedure for registering an insured event will be the same.
To accept an application from the injured insured, he will need the following papers:
- An application written in free form (or on a special form) with a request for compensation.
- Civil passport or other identification document.
- Certificate issued by the traffic police inspector.
- Notice (protocol) of an incident on the road.
- Accident information.
Terms of application and consideration
In order not to be denied payment, the injured party in a car accident must submit an application to the insurance company within a certain time. The term for notifying the insurance company about the incident is also limited for the initiators of the accident.
It is advisable to contact the insurer as soon as the fact of an accident has been recorded, but both parties have a few days. So, the “autocitizen” will be able to compensate for the damage only if the insured contacts the company in the fact of an accident no later than 5 days from the moment of the accident.
After submitting an application, you must take a certificate from the insurer, which will indicate the date of receipt of the application. It is from this moment that the time allotted for the insurer to consider the application, inspect the car, and also pay compensation will go. 15 days are allotted for this SC.
Payouts
They pay OSAGO by providing repair work in specialized service stations. Previously, policyholders had a choice between receiving monetary compensation or being sent for repairs. Now, all cases, with the exception of the total loss of a car, are subject to repair work, which is paid for by the insurance company.
A similar situation occurs with respect to compensation for harm to health. That is, the insurance company will pay for the treatment, medicines and other expenses necessary to restore the health of the injured car owner.
In the case of compulsory auto insurance, the amount of payments is strictly limited. If the damage in amount exceeds the established limit, then the culprit must pay the missing amount.
So, according to the “auto-citizenship”, insurers can count on compensation of the following size:
- In case of damage to a vehicle - a maximum of 400,000 rubles.
- In case of harm to life or health - 500,000 rubles.
If the SC refuses to pay
We have already said earlier in which cases insurance is not paid in case of an accident, but the refusal of the insurance company is not always justified. Thus, unscrupulous insurers may refuse to pay the insured car owner due to the absence of a compulsory insurance policy from the perpetrator of the accident.
Of course, if the initiator of the accident is not insured anywhere, then from whom to claim compensation. But in this situation, the insurance company of the victim should deal with this issue. Therefore, if the car owner injured in an accident applied to the company with a request for compensation, the insurer is obliged to judicial order collect a refund from the culprit, and not refuse your client.
If the situation is reversed, i.e. the victim is not insured, then the refusal is also illegal. In any case, the injured party was paid accident insurance to cover the cost of restoring the car or health.
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An insured event is an unpleasant incident not only for motorists, but especially for car insurers.
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The first party considers losses and losses for its own property to be an extremely undesirable event, while the insurer, as the other party, must pay compensation, thereby losing its own income.
Often there are cases when insurance companies try in every possible way to avoid paying out insured events. It is worth noting that due to the legal illiteracy of motorists, they succeed quite well.
In order not to become a victim of an unscrupulous insurance company, and to be able to unforeseen situation, which entails losses for the motorist, you need to be competent in the issue of insurance, to know what an insured event is, what documents are needed to request a CMTPL payment, how to properly carry out this process.
What is included
An insured event is called an offensive civil liability motorist as a result of causing damage to life, health or vehicles of the victim or victims using his vehicle.
The result of the accident is the obligation of the culprit to pay the insurance payment.
This issue is much easier to resolve if the injured and the guilty motorists have the same insurer, because this allows you to quickly investigate and deal with the bureaucratic nuance.
There are two types of insured events:
- as a result of a traffic accident;
- without an accident.
Let us analyze all cases of these types of insured events, which will allow us to correctly classify our own case and choose the correct algorithm of actions.
In an insured event under OSAGO in case of an accident
The current one, namely, according to which the auto-citizen policies were drawn up, regulates the issue of insured events. It also indicates the payments under OSAGO if the insured has become the culprit of an accident on the road.
This legislation provides:
The legislation provides that cases of road accidents were considered by insurers within 20 days. Wherein maximum amount in some cases, it can be a limit of 400 thousand rubles.
And the UK should be notified of the accident on the road no later than 15 days after the accident.
No accident
There is another category of insured events, the cause of which is not an accident while driving. Such incidents are also regarded as losses to the property of car owners, because it is not always possible to find or restore a vehicle.
Insured events without an accident are:
- theft;
- intentional arson or spontaneous combustion of a vehicle;
- disaster;
- intentional harm of third parties.
In order to receive timely payment in any of these cases, you should investigate and collect information as quickly as possible. required documents, which will help explain the circumstances of the incident to insurers.
What to do first
It provides coverage of damage to property or health not to the guilty insured, but to the victims of his actions.
Therefore, in the interests of the victims of the insured event, contact the insurer in a timely manner and report the occurrence of the incident. This is what should be done first.
Insured events under OSAGO in case of an accident if the culprit is not identified is not new in practice, therefore, all evidence from the incident, the necessary documents should be collected and reported to law enforcement agencies for investigation.
The investigation will be much easier if the guilty motorist escapes without a vehicle. So, as license plates will help to immediately find out the data about this driver.
If you make a request to the insurer of the guilty motorist as quickly as possible, you will be allowed to choose among three main damage compensation schemes:
- direct payment (“direct settlement”);
- standard loss recovery procedure.
The first two payment schemes are considered simple and practically not time-consuming, but they require an application to be made immediately after the occurrence of an insured event.
Statement
With this document, to which a whole package of official papers is attached, the victim during the insured event must apply to the UK.
The application for the occurrence of an insured event with the participation of the Insured has its main clear structure, which should be taken into account when writing the document.
Basic and required details:
- Contact and passport details of the injured motorist.
- Information about the person insured in this company.
- Structured description of the insured event.
- Statement of consequences.
- Data about insurance policy.
- Signatures and date of the document.
It should be borne in mind that the application does not have strict regulations regarding the structure and content, so it can be drawn up at the scene of the incident and contact the insurance company.
But at the same time, keep in mind that the presence of the details listed above will allow the insurer to obtain the most accurate information for making a decision.
What documents are needed
The application is submitted with a full package of necessary documentation. Such a condition is provided so that the insurer can verify the accuracy of the received facts about the incident.
Therefore, if the victim applies for damages under the OSAGO policy, then he should provide:
- herself;
- legally certified copy of completed passport pages;
- power of attorney to represent the interests of the beneficiary (if necessary);
- bank details if a non-cash payment is made;
- if he cannot apply to the insurance service on his own;
- certificate of an accident on the road;
It should be remembered that the notice of an accident is filled in by both the victim and the perpetrator of the accident, so you should think about filling it out earlier.
In extreme cases, you can fill out the form with one side if one of the participants refuses to complete the documentation.
An application for insurance payment is written by the injured independently in a free form, but with an exhaustive description of the insured event.
If the policyholder provides a special application form, then it must be completed.
After cases with a fatal outcome of the victim from an insured event, family members of the deceased apply to the insurer of the guilty motorist with a death certificate.
Terms of application and consideration
The offending driver is obliged to provide his insurance company with a notice of an accident in which he became a participant. The deadline is the same - no more than 5 working days.
Documents can be delivered in several convenient ways:
- during a personal visit;
- by registered mail.
The victim as a result of the insured event may notify the insurance company in one of the following two ways:
- file a claim with the insurance company;
- file a claim for direct damage compensation to your insurer.
But for this, the following circumstances should be taken into account:
- Only two vehicles, the owners of which have issued OSAGO policies, were involved in the accident.
- Only vehicles suffered losses.
In turn, the insurer undertakes to put forward its verdict and pay compensation within twenty days, according to current legislation, but practice shows that such a time frame stretches up to thirty working days.
Notification of an OSAGO insured event must have fixed dates so that the insurer does not have the right to delay the payment deadlines.
Act
This document is provided by the insurance company after it has carried out investigative actions and issues its verdict.
This act will help in the future to monitor compliance with the insurer's obligations, calculating all kinds of underpayments.
Each motorist who will be paid for an insured event may require such an act in writing.
Practice shows that insurers often refuse drivers to obtain such a document, which is an illegal act.
This is due to the fact that during a possible pre-trial proceedings, such a document may affect a disappointing result for the insurer.
In such cases, contact the motorist and demand that you exercise your rights to receive accurate and reliable information.
Neglecting such nuances can affect not only the amount of compensation, but also cause it to not be paid at all.
Such an act has its own strict structure:
- information about the victim and the perpetrator of the insured event;
- an accurate description of the damage and calculation of the total amount;
- time and date of the incident;
- time and date of filing an application for the occurrence of an insured event under the OSAGO policy;
- examination results;
- the time and date of the decision on payments;
- details of the insurance company.
Note that each insurer can draw up an act according to its own rules, but it must be taken into account that it records all the necessary data that we have listed above.
Registration procedure
The insurance payment is drawn up and made in accordance with strict order actions. They are performed after considering the application for the occurrence of an insured event.
The order is presented as follows:
- Establish grounds for compensation by the insurance company.
- Measure the amount of the payment to cover the damage (depends on the conditions).
- Preparation of the required documentation indicating all the required details.
Within up to 15 working days after the occurrence of an accident, the insurer is given filled-in information about the accident (or sent in any way, especially by registered mail, which fixes the time of sending and receiving in hand).
settlement agreement
Draft law on OSAGO, which was certified by the Presidium Supreme Court Russian Federation last June states that as soon as the insurer fulfills its obligations in terms of insurance payments in the required amount, without additional independent examinations, the insured and the victim cannot demand additional compensation.
A document that records the fact that the parties are satisfied with the amount and conditions of the compensation, indicates an agreement on the settlement of an insured event under OSAGO.
Practice shows that insurers by cunning require their clients to sign such an official paper in order to remove obligations from the insurance company.
This document contains all the basic data of the insured event and the payments made to the victim.
An important point is "The parties have come to an agreement", which is signed by the participants and indicates the absence of claims against the insurance company.
Payouts
The type of damage after the occurrence of an insured event directly affects the amount of payment that will be made to the victim. The amount of compensation is regulated by the OSAGO Law (clause 49).
SC undertakes to pay:
If the damage affected the health and ability to work of the victim, then the costs for his treatment are calculated, as well as the possible salaries that he lost during rehabilitation.
statute of limitations
The statute of limitations for a motor vehicle citizen is a period that provides for a motorist the opportunity to apply to the court for legal assistance to protect their legitimate interests.
Although the legislation provides for a three-year limitation period, but in fact for OSAGO it is 2 years.
For a given period of time, you can file claims against the insurer, the main thing is that the period does not expire, and that all dates of the insured event and documentation are documented.
The process of filing an insured event and conducting it compensation payments requires the participants in the insured event to comply with some bureaucratic and organizational aspects that relate to the execution and signing of an application for an accident, an act on an insured event and an agreement between the parties to the process.
The presence of all these components allows you to receive compensation from the insurer in full and in the shortest possible time.
It is important to comply with such measures even with the help of a car lawyer, because insurers are reluctant to make payments, trying in every possible way to reject or reduce them in size, each time coming up with the most diverse and plausible reasons for this.
OSAGO insured event notification is an important document that officially notifies the insurer of the fact that his client caused the insured event, and the consequences of the incident require compensation in a certain amount of money.
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 issue voluntary insurance auto civil liability CASCO.
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.
- Damage 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
The specified territories according to the Federal law are considered adjacent to roads common use. 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 effort. 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.
The car is damaged, and the insurance says that the refund is not due? A common situation, but this should not be believed. After all, an insured event under OSAGO is not only a banal accident, but sometimes confusing situations that insurers always strive to interpret from their bell tower. Do you want to be able to figure this out on your own? The legal article below is waiting for you. The topic is complex, but I tried to explain simply.
The definition of an insured event (SS) is one of the main concepts. However, in the legislative regulations, surprisingly, little attention is paid to it.
Here is a list of documents that indicate what SS is:
- Federal Law No. 40"About compulsory insurance Civil Liability of Vehicle Owners” (dated April 25, 2002, as amended on June 23, 2016) (as amended and supplemented, effective from September 1, 2016), art. 1, paragraph 11;
- FZ№ 306 "About amendments to The federal law No. 40” (dated 01.12.2007, as amended on 21.07.2014), art. 1, p. "b";
- Decree of the Government of the Russian Federation No. 263“On OSAGO Rules” (dated May 7, 2003), section two;
- Regulation of the Central Bank of the Russian Federation No. 431-P"On OSAGO" (dated September 19, 2014).
However, all these documents describe the insured event sparingly and insufficiently for a complete understanding of the subject not only by ordinary motorists, but even by insurers, auto lawyers and the judiciary.
For example, in Law No. 40, namely this normative act is responsible for the terminology and definitions related to OSAGO, one small paragraph of 35 words is given to clarify the essence of the SS (Article 1, paragraph 11).
In Federal Law No. 306, a whole section (second) is allocated for SS, but in it the main volume of the text is occupied by the definition of insurance exclusions, and there is nothing about the concept of SS that could supplement the provision from Federal Law No. 40.
What is an OSAGO insured event?
Well, since we can learn little from the laws, let's try to deal with the concept of SS on our own.
So, for the basic definition of an insured event, two main criteria are used that reflect the essence of both the SS and the auto citizen as a whole.
- Object of insurance is the auto civil liability of the guilty person for the damage caused;
- Subject of insurance is the movement of a vehicle (TC) on certain roads and territories.
Based on this, the insured event is considered to be the fact of causing damage to the vehicle, other property, and (or) the victim (s) as a result of the culprit's vehicle moving along the roads (or territories) provided for this.
That is, to recognize a case as insured, a combination of the following factors is needed:
- The fact of insurance auto civil liability (available valid policy OSAGO);
- Fact of movement vehicle at the time of the incident;
- The fact of damage upon incident.
Based on all of the above, it becomes clear that not every incident associated with the use of vehicles can be recognized as an insured event.
Attention! Remember that OSAGO insures your motor third party liability to victims. CASCO is used to insure the car itself.
What are the difficulties in determining the insured event
We have dealt with the basic concept, but this does not mean that we have a complete understanding of the essence of the insured event. At first glance, it may seem that since the concept of SS is basic, then its legislative interpretation should be as clear and unambiguous as possible.
In fact, the situation here is different.
Often, for a particular accident with a car, its interpretation as an insured event can be problematic. AND Insurance companies, and lawyers representing the insured, if no agreement is reached between the parties, may seek recognition or challenge of the fact of CC.
Moreover, there is generally no comprehensive clarity so far, which is why decisions on controversial incidents have to be made by courts, whose decisions, like the opinions of lawyers, are far from complete consensus.
Let's try to figure out what we can on our own.
Why is the legal definition of an insured event not exhaustive?
If we compare the generally accepted practice of OSAGO and what is written in the essence of the insured event in the relevant laws, a clear understatement and even a contradiction will catch your eye.
See: all SCs recognize the fact of the onset of the SS if the moving vehicle caused damage. That is, if the culprit car was not in motion at the time of the damage, then the SS does not occur - and this is a common insurance practice.
What does the law say? According to the definition of Federal Law No. 40, CC (there it is called auto civil liability) occurs after an incident that caused harm (health / life) or damage (property) to the victims when using the vehicle.
Do you get the gist of the controversy? The wording “use of the vehicle” can mean a wider range of incidents than with the clarification “with a moving vehicle”. And as a consequence of this incident, in some courts the SS offensive is interpreted more broadly and makes decisions, which the IC then appeals.
What is the opinion of the courts regarding insured events?
Yes, most of the courts, operating in an ordinary bureaucratic mode, make their decisions without deviating much from the traditional interpretation of the SS. However, there are courts where lawyers read and delve into the essence of existing legislation and their decisions cause a big headache to the UK.
Example? Please.
Take the classic case of damage caused by an opening car door: two cars are parked close together in a parking lot. In one of them, the door opens abruptly, causing damage to the body of a neighboring car. SK flatly refuse to recognize this SS, but there are quite a few motorists who have achieved this recognition in court.
Based on the incident with the movement / use of a car that I mentioned above, some lawyers and judges reasonably attribute the door set in motion to a type of vehicle movement process and its use. After all, a car door is integral part TS and setting it in motion means that it was produced by the whole machine, since it is a mechanism of complex construction.
Some courts do more simply by considering statements of claim disputed cases under OSAGO with damage in case of an accident, without the use of legal casuistry. The decision is made on the basis of the fact that a traffic police inspector issued a certificate of an accident: there is such a document, the SS is confirmed - no, then no.
How do regression and subrogation affect the insured event?
There are such concepts in the insurance business as recourse (reverse requirement) and. I will tell you more about them in a separate article, and here I will touch on their influence on the SS.
The fact is that the payment of compensation to the injured party does not have a direct dependence on the fact of the onset of the SS. Rather, from his recognition of the UK as such. After all, in the OSAGO rules there are such rules according to which, under SS, the right to compensation at the expense of the insurer is lost or does not occur at all (for example, an accident notification has not been filed, the deadline for filing has been missed, an incorrectly completed form, etc.).
Then the payments are still made, but the ultimate material defendant becomes the culprit of the accident, from which the insurance company, through the mechanisms of recourse or subrogation, recover the amount paid to the injured party.
That is, for injured persons, claims for compensation can be satisfied when the IC has refused or canceled liability for the perpetrator. Even the complete absence of an insurance policy by the guilty party is not a basis for refusing to pay if the CC is recognized by the company - the main thing is that the other party has OSAGO.
When do insurers not recognize insured events?
The second section of the OSAGO Rules (clauses 8 and 9, which includes many sub-clauses) lists the types of damage that are not recognized as insured events. Let's see what's in there.
The provisions of paragraph 8 of the OSAGO Rules
According to paragraph 8, in certain situations, insurance companies refuse to compensate for the damage caused, even if it has all the particular signs of an insured event.
That is, this paragraph provides legal waiver from the insurance compensation, regardless of the presence of the fact of the SS, the moments of recourse, subrogation, etc. - they simply refuse and that's it.
All these situations (with the exception of one provision) are of an emergency nature. Here is their list:
- force majeure circumstances- these are mainly natural disasters, but some types of accidents may also be included here (subparagraph (paragraph) "a");
- radiation hazard- this includes not only radioactive contamination, but also all damage from possible concomitant causes: damage to the electrical system of a car by an electromagnetic pulse, ignition from primary radiation, mechanical damage from the action of a blast wave. In general, all damage to the car and people in the event of a nuclear attack or a radioactive accident is not paid for by the UK (clause "b");
- War- in case of any type of conflict classified as a military one (patriotic or civil war), damage to cars and people is not paid by the UK (clauses "c", "d");
- popular unrest- this includes all conflicts classified as non-military: counter-terrorist operations, uprisings, revolutions, strikes, strikes, etc. Damage to people and vehicles in these cases is not compensated by the IC (clause "d");
- Intentional or responsible harm- no compensation is paid for the damage on the intent of the victim and the one who is the culprit of the damage (clauses "a" and clause 8.1).
The provisions of paragraph 9 of the OSAGO Rules
The ninth paragraph contains situations in which the incident will not be counted as an insured event. That is, something that is not SS, although for some points a compromise settlement of the issue of payments is possible.
So, here is a list of non-insured events according to the legislative version:
- Vehicles not specified in the OSAGO policy- if the car that caused the damage is not indicated in the insurance policy of the offending driver, then he pays compensation out of his own pocket (clause "a");
- Moral damage– according to OSAGO, moral suffering is not compensated. But what if they are? Go to court - such payments are possible there (clause "b");
- Lost profit- according to OSAGO, lost profits are not reimbursed, but it can be claimed in court if such a fact can be verified and an accurate calculation can be made on it (clause “b”);
- Training ride, trials and competitions– IC does not pay for damages caused in listed cases, since there is a high risk coefficient, which, if desired, can be insured under other insurance programs (paragraphs "c");
- Environmental harm– damage to the environment under OSAGO is not reimbursed. This is an example of a legislative flaw, since damage to green spaces, for example, clearly relates to reimbursable damage (clauses “e”);
- Damage from transported goods- there are special forms of insurance for this, depending on which documents on the level of danger the transported cargo has (paragraphs "e");
- Damage to health/life of official personnel during working hours- in this case, all the costs of compensation are borne by the employer of the victims or payments are made through social / medical insurance (paragraph "e");
- Loss to the employer due to harm to his employees- all this is also compensated by other types of insurance (clause "g");
- Damage caused to the vehicle (as well as to the cargo) by its driver- according to OSAGO, one person cannot be the culprit and the victim (paragraphs “h”);
- Unloading and loading works- damage during loading and unloading of the vehicle under OSAGO is not paid (clauses "and");
- Damage to items of high or intangible value– OSAGO does not pay for damage from damage to movable or immovable items of high value (historical buildings, jewelry, antiques, banknotes, securities, works of art, objects of intellectual property, worship of believers, etc.) (paragraph "l");
- Damage exceeding the limit specified in the contract- all expenses for compensation for harm and damage, in excess of the insurance limit, are paid to the victim by the perpetrator. Limits may be increased (clause "m");
- Damage to the health/life of passengers- in the event that the vehicle was officially used for passenger transportation, for which special insurance is provided (clause "n");
This completes the list of insurance exclusions, although only the main reasons are indicated here, since. complete list, which takes into account the features of all possible situations, cannot be compiled.
In the next article I will talk about what are insured events.
- When the vehicle is stolen payments under OSAGO are not made, because after the theft, the fact of driving a car rightful owner disappears, keep that in mind. You can insure against theft under other programs.
- In case of a disputable insured event if you are insured in a large company (Rosgosstrakh, Ingosstrakh, Renaissance, Reso, etc.) and intend to fight it, be very careful about the collection and execution of all documents, because serious insurers have a special legal staff to challenge claims . Sometimes a minor mistake is enough to slow down the consideration of the case for a long time or lose it.
- Expired diagnostic card may become a reason for the cancellation of the fact of an insured event for freight and passenger vehicles, please take this into account.
Conclusion
So, from the article, you understood that an insured event under OSAGO occurs when damage is caused to a moving vehicle in the places intended for this, if everything is in order with the auto civil contract. Well, remember that even obviously losing controversial SS can be successfully proved in their favor in court.
What can I ask you to tell about the insured event? Uh ... tell us about your unusual insured events)) Please also write questions on the topic in the comments.
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