The International Confederation of Consumer Societies (ConfOP) shared interesting cases of refusals that ConfOP encountered while studying the transparency of insurance conditions from large insurers, and Sravni.ru prepared tips on how to avoid becoming the heroes of such stories.

I bought a refrigerator - it’s my own fault

The client insured his apartment and property (household appliances, decoration, structural elements), the contract contained a corresponding inventory. Then he bought a refrigerator. At some point, the refrigerator caught fire and a fire broke out. But the client was denied payment because, according to the contract, he was required to notify the insurer of any change in the degree of risk and the list of insured property, including the purchase of a refrigerator.

You can't insure - we insure

The apartment in the Khrushchev building was insured. But according to the terms of the contract, apartments in buildings built after 1980 are accepted for insurance, and the client did not read all the conditions when purchasing the policy. He found out about them later - when, when an insured event occurred, he was not paid anything.

This is not an isolated case. “Sometimes insurance companies, for example, sell an insurance policy to a disabled person, although the insurance rules say that people with disabilities cannot be insured,” says Dmitry Yanin, chairman of the board of ConfOP.

Fracture is not an insured event

A pensioner purchased a health insurance policy for the period of his stay abroad. While walking, the man fell and broke his hip. At the hospital he underwent endoprosthetic surgery. All formalities related to notifying the insurance company were complied with. When the victim applied for payments, he was reimbursed only for ambulance services, expenses for his stay in the hospital and transportation home. Compensation for the costs of the operation was denied. The insurer referred to a clause in the contract that stated that seeking medical help in connection with endoprosthetics is not an insured event.

Not healthy - not insured

During this time, the woman required medical attention due to abdominal pain. After the examination, a diagnosis of gastritis was made, and the cost of medical services was about 3.5 thousand dollars. The insurance company refused to pay the costs, citing the fact that the woman had previously consulted a doctor with complaints of abdominal pain, as follows from her medical record. The insurance contract stipulates that diseases that the policyholder had at the time of purchasing the policy - regardless of whether the client himself knew about the presence of these diseases or not - are not covered by insurance.

For one large Russian insurer, non-insurance events recognize health complications that occur as a result of pregnancy and childbirth.

The salvation of the insured is the work of the insured themselves

The owner of the car registered it. During another trip, a fire broke out due to an electrical problem. The driver got out of the car and walked away from it - obviously, the instinct of self-preservation worked. As a result, he was denied payment, since the owner, according to the agreement, must take reasonable measures to save his property.

How to avoid tricks

No matter how trite it sounds, you need to read the contract very carefully - all the loopholes for the insurer are contained in its text. Of course, it is really difficult to understand the meaning of wording like “... unless it is proven that the Insurer promptly learned about the occurrence of an insured event or that the Insurer’s lack of information about this could not affect its obligation to make an insurance payment.” But this is the expectation - that the client will not read to the end and will sign what is there. Alas, there is no other option but to re-read the vague wording several times.

According to the ConfOP study, only 1 company out of the 25 largest has available insurance rules and only for one type of insurance - property insurance.

Particular attention should be paid to the key points of the contract.

For home insurance:

The period within which the owner must notify the insurer of the occurrence of an insured event;

The presence of reservations about the time of construction of the object or the level of its wear;

Cases excluded from insurance coverage - for example, does the insurance cover flood damage if the apartment is on the top floor, or if the incident occurred as a result of a washing machine breakdown.

When purchasing insurance for traveling abroad:

List of insured events (when traveling to an exotic country, the insurance must include treatment for poisonous insect bites);

Cases not covered by insurance;

Reasons for refusal to reimburse expenses;

The procedure for notifying the insurance company about the occurrence of an insured event (for example, most often you should not call an ambulance before calling the insurance company);

Is insurance covered in all countries?

For life and health insurance:

A list of what is excluded from the insurance coverage area (for example, you can be left without payments as a result of playing sports at the time of injury;

The insurer may refuse compensation if the policyholder drank wine before the incident, etc.);

Does the duration of treatment affect the decision on payment (there are cases when it is impossible to obtain insurance if the treatment required less than 21 days);

Restrictions on the territory of coverage (for example, only in Russia, but not abroad).

You shouldn't be shy. Sue

If the advice above is not relevant, since payment has already been refused, then you should go to court. Thus, the pensioner from story number three stated in court that he sought help due to an accident, and not for the purpose of endoprosthetics. But the magistrate sided with the insurance company. But the appellate court satisfied the plaintiff’s demands. The decision stated that ambiguity in the wording of the contract should be interpreted in favor of the consumer.

Insurance activity refers to the types of services regulated by the consumer protection law. The policyholder can file a claim in court at the place of residence and not pay a state fee when going to court. In addition, he has the right to demand compensation for moral damage, and in types of insurance for which the amount of the penalty for delay is not determined by a special law, also payment of the penalty. Its amount is 3% of the price of the service for each day of delay.

CASCO is an additional insurance that can provide a guarantee of receiving compensation payment in the event of an insured event. But if the insurance company refuses to pay under the CASCO policy, what should you do?

Let's consider when there is a refusal to transfer funds, where you have the right to turn, and what measures to take.

The reasons for refusal to pay under CASCO may be justified or unjustified. In the first case, the company will not violate the law.

That is, the refusal in this case is legal and starting a war with the insurance company is pointless. But when there is an unreasonable reason for refusal, the policy owner files a lawsuit.

But such denials are often sent to policyholders who have no experience in such proceedings. Insurers hope that the citizen will simply remain silent and accept the fact that he is allegedly not entitled to compensation.

In order not to join the ranks of defrauded clients, it is worth remembering when the insurance company has the right to refuse insurance payment, as well as what the policy owner should do next.

Possible reasons for refusal

The most common reason for an insurance company's refusal to pay compensation is violations in the field of insurance, as well as cases where insurance situations are not included in the list of risks reflected in CASCO contracts.

That is, you do not need to count on payment if the risk is excluded from insurance coverage.

We list the reasons for refusal:

1. The insurance company from which the policy was purchased was declared insolvent.
2. The CASCO insurance number is listed in the database of policies that are stolen or lost.
3. The insurance has expired or is invalid.
4. The deadlines for submitting an application for compensation to the insurance company have been violated.
5. The applicant submitted false documents regarding the insurance claim.
6. The driver was driving while intoxicated.
7. The insured event occurred due to special negligence, committed to extract a benefit.
8. The identity of the person who was driving does not match the identity specified in the insurance contract.
9. The insured person drove a vehicle that was not inspected by specialists (there is no inspection certificate).
10. The insurer will not be liable for property that was in the car and was stolen.
11. If the accident occurred at the moment of stopping the railway crossing under closed barriers.
12. Traffic rules were violated, resulting in an accident.
13. The driver exceeded the speed limit, resulting in a traffic accident.
14. The insured person was moving in the oncoming lane, where the prohibitory marking sign was located.
15. When the accident occurred, the car was faulty.
16. A car located next to the policyholder's car exploded or caught fire, resulting in damage to the insured person's vehicle.
17. The car was damaged during special work (loading, installation).
18. The vehicle owner has not taken safety measures.
19. The driver provided false information about the traffic accident. It is worth clarifying exactly what data is considered incorrect.
20. In case of theft of a car, the Investigative Committee may indicate the right to suspend proceedings in a criminal case for the theft of a vehicle.
21. The driver may refuse to claim compensation for losses. Then the insurance organization does not consider the reported cases to be insured.

A complete list of reasons for which the insurance company has the right to refuse payment is prescribed when drawing up the contract (clause 1, clause 3, article 3).

What to do if the insurance company does not pay for CASCO insurance

In the event that the insurance company does not pay for CASCO, the policyholder will have to defend his case. Let's figure out how to act.

Where to contact

First of all, try to resolve the issue with the insurer. If your efforts do not bring results, you have the right to file a complaint against the actions of the insurance company with the insurance supervisory authority.

But it is worth remembering that RSA will only resolve issues related to compulsory motor liability insurance. In the case of CASCO, you need to go to the Central Bank of Russia.

A representative of such a body will require documents and explanations. If a violation is detected, the authorized structures will oblige the Investigative Committee to reconsider its initial decision.

As an option, write negative reviews on the Internet or go to the union with a complaint. Maybe at this stage the insurer will decide to reconsider the decision.

If even after such actions it is not possible to resolve the dispute peacefully, then there is only one way left - to go to court.

Procedure

The insurance procedure is approved by the insurance organization in accordance with the provisions of the Civil Code.

And if the insurer does not fulfill its obligations to pay compensation, proceed as follows:

1. Determine why the insurer refuses to pay the due amount. To do this, it is worth getting a refusal in writing, which will contain references to legal provisions and insurance procedures.
2. Determine how justified the refusal is. The grounds must correspond to the approved list in -. If a discrepancy is identified, a written claim must be submitted to the insurance company.
3. The next step is to write and submit a claim.
4. Write and submit a claim to the court if the insurance company does not respond to the claim. The application must contain information about events in chronological order, the actions of the policyholder, and the insurance company.

Requirements should be justified based on legal provisions. Attach all necessary documents that are relevant to the incident. If damage occurs, it is worth using the services of an independent appraiser.

If a trusted person will act on your behalf, you need to prepare the appropriate permission - a power of attorney certified by a notary office (,).

In the event that the insurance company underestimates the amount of payment, the insured person must:

1. Organize an independent examination to determine the damage.
2. Submit a request to the Investigative Committee to review the amount of the transfer. Attach reports on the results of the examination.
3. If the insurer's representatives refuse this, file a claim with a judicial authority.

If the insurance company does not pay CASCO on time:

1. A claim is submitted indicating the terms for compensation specified in the contract.
2. If you refuse, file a claim.

When applying to the court, you must submit the following documents:

• a payment receipt that confirms the fact of payment of the state duty;
• and a payment document that confirms payment for the policy;
• samples of certificates that were submitted to the Investigative Committee at the first application;
• a photocopy of the document refusing to make payments;
• and the answer to it;
• documents that confirm the owner’s right to the vehicle;
• identification;
• power of attorney.

The claim must contain the following information:

• name of the court;
• name of the plaintiff (or his full name, if the applicant is a citizen), contacts;
• defendant (name, address where he is located);
• circumstances;
• requirements (amount of damage, amount of penalty, amount of legal costs, etc.).

One set of certificates must be sent to the defendant.

How to make a claim

Usually the claim is made voluntarily. That is, if the contract does not provide for pre-trial settlement of the issue in the event of a controversial situation, you may not submit a claim. Instead, you have the right to go straight to court.

The claim is drawn up arbitrarily (the unified form has not been approved by the government), but taking into account the general norms of the law. But there is a standard template on the Internet that you can rely on when drawing up.

Keep in mind that not in all cases the presented form is suitable to reflect a specific situation.

That is why, before writing a claim, you should carefully re-read the terms of the CASCO agreement, and in the document make references not to the general insurance rules, but to the relevant clauses of your contract.

The claim to the insurance company must contain the following information:

• the name of the insurance company to which the claim is being submitted (do not make mistakes, as the document will be considered one that will not reach the addressee), full name of the manager;
• identification data of the sender, his contacts;
• information about the insured event - about the participants in the accident, the policy number, a certificate of the incident, a protocol of violation of administrative legislation, a resolution on an administrative offense;
• actions of the insured person upon the occurrence of an insured event;
• requirements;
• the circumstances on which the claim is based;
• legal grounds, references to legislation;
• the period during which the claim must be considered (usually 10 days);
• what will you do if your demands are refused (go to court);
• date and signature.

The claim must be submitted to the addressee in person. 2 copies are made, one of which you will keep for yourself. This sample must bear the signature of the insurance company employee who accepted the document. The date and registration number are indicated.

If you are unable to file a claim yourself, send certified mail.

CASCO for theft

Since 2012, insurance organizations have been required to pay compensation in the event of theft in all cases. That is, insurers cannot refuse compensation if they do not provide keys and documents (which were left in the car).

The insurance company does not have the right to refuse payment even when the car is stolen due to the driver’s negligence.

Although in practice there are cases when the insurance company refuses to fulfill its direct obligation upon the occurrence of an insured event.

For example, insurers often refer to such provisions as “intentional actions of the policyholder and gross negligence,” on the basis of which a refusal to pay may be made.

But then the insurance company is obliged to provide evidence of such actions. And then time drags on indefinitely. An investigation is allegedly underway. How to proceed? The same as in other cases. File a claim, complaint, statement of claim.

Your task is simple - adhere to the traffic rules, undergo a technical inspection in a timely manner, and study the insurance rules specified in the contract.

Then the risk of receiving a justified refusal will be minimized. In other cases, there is nothing to fear - the court will be on your side. If you are insured by a company that values ​​its reputation, your claim will not be wrongfully denied.

Video: Why doesn’t the insurance company pay for CASCO insurance?

According to current legislation, drivers who have taken out a compulsory motor liability insurance policy and are found not guilty of a traffic accident have the right to claim an insurance payment in the established amount.

However, in 7 out of 10 applications the insurer refuses to pay compensation. We are ready to tell you when the decision of the insurance company will be illegal, and how to competently challenge it.

Reasons for refusal

Any insurance company is a commercial organization, and each payment becomes a significant loss for it. Therefore, all insurers are interested in not paying, and to achieve their goal they use not only justified, but also unjustified reasons for refusal.

Among the most common reasons why insurers do not pay compensation under compulsory motor liability insurance are:

• Incomplete package of documents. Typically, insurance companies require an impressive set of documentation - up to 12-15 items. If they are not fully prepared or the application requesting payment is filled out incorrectly, the insurer refuses to compensate for the damage. Keep in mind that even a minor mistake made when preparing documents can serve as grounds for refusal;
• Expired policy. If at the time of the traffic accident the driver has not renewed his MTPL policy, compensation will be denied. Some insurers indicate that the diagnostic card for the car must be valid, however, this basis is not provided for by law and a refusal for this reason will be unfounded;
• Missing deadlines (30 days). If you do not submit documents or notification of the insured event in a timely manner, then you will be denied compensation, and quite legally. An exception is the presence of a valid reason for absence (for example, a long business trip, serious illness or other insurmountable obstacle);
• Claims against the culprit of the incident. In practice, there are 2 reasons - the at-fault driver is not included in the MTPL policy or he was under the influence of alcohol (drugs) at the time of the accident. None of these reasons are justified, they do not exempt the insurance company from paying;
• Hitting a stationary car. The insurer indicates that in such a situation there is no corpus delicti, since specific traffic rules were not violated. This is an illegal decision! In accordance with the law, any damage to a vehicle, regardless of the crime, is subject to insurance compensation.

Note! Insurance compensation cannot be recovered if the accident occurred as a result of force majeure (for example, a hurricane or flood), a nuclear explosion, radiation or war. All these circumstances are specified in the contract.

There are other, less common reasons for refusal. There are cases when the insurance company refers to the staging of a traffic accident, forgery of documents and certificates from independent experts, the at-fault driver’s lack of an original MTPL policy, etc.

Appealing a refusal

What to do if the insurance company does not pay compensation under compulsory motor liability insurance? There is only one answer - to act. Especially when we are talking not about 5,000-10,000 rubles, but larger amounts. The appeal procedure consists of 5 steps, let's take a closer look at each of them.

Step No. 1 – we receive a refusal from the insurer

Contact your insurance company within 30 days from the date of the accident. Submit an application and a complete list of documents (it is published on the official website of each insurer). Be sure to check the availability of the traffic police resolution and a copy of the protocol drawn up at the scene of the accident!

The first thing you should do if the insurance company does not pay direct compensation under compulsory motor liability insurance is to request a refusal in writing. Some insurers already accept applications and make payments at this stage of appeal, but if your company continues to refuse to fulfill its obligations, then take a written refusal and file a complaint.

Step No. 2 – write a complaint to the RSA

If the reasons with which the insurance company motivated its refusal are unfounded, then the next step is to contact the RSA (Russian Union of Auto Insurers) or the FSSN (Federal Insurance Supervision Service).

RCA does not have the right to fulfill the obligations assigned to the insurer, since it only performs the role of an intermediary. However, the union of auto insurers can make recommendations that are mandatory for the insurer to follow.

The most common and effective form of contacting the RSA is filing a complaint. All application forms are presented on the organization’s official website, so you can download them for free and enter your information.

The following must be attached to the complaint:

• the entire set of documentation that was requested by the insurance company (applicant’s passport, insurance policy, both driver’s licenses, etc.),
• written request to the insurer,
• official response about refusal of payment.

Each of the documents must be scanned and, together with the completed application form, sent to the RSA email (address: [email protected]). Residents of Moscow and the Moscow region have the right to personally contact the union of auto insurers. We recommend checking the organization’s address and reception schedule on its official website.

All appeals from citizens are subject to consideration within 10-15 days from the date of their receipt. Please note that complaints containing profanity or threats, or those sent by an anonymous complainant, will not be considered.

Step No. 3 – draw up a pre-trial claim

A subsequent appeal against the insurance company's refusal to compensate for damage is carried out if the RSA has not taken any action to resolve the current situation or the organization's decision does not suit you (for example, the amount of payment is greatly underestimated).

It is necessary to prepare a pre-trial claim and send it to the insurer that refused payment. If you skip this step, the claim procedure will not be followed and the judge will subsequently refuse to satisfy the claims.

So, the pre-trial claim is drawn up in free form. You can download a sample online and fill in your details on the form. The main thing is that the document contains the following information:

• details of the insurer and the name of its director,
• Full name of the applicant and his contact information,
• title (in this case, a pre-trial claim for refusal to pay insurance compensation),
• appeal – a brief description of the problem,
• list of requirements,
• signature/date.

Note! The main thing is to indicate at the end of the claim that if it is not satisfied, you reserve the right to go to court and recover not only payment, but also the costs of the services of a representative (lawyer), as well as penalties and interest.

We recommend that you adhere to a business style in your description and provide references to current legislation, and not just to the law, but to a specific clause and article. Please attach a valid insurance contract, passport, vehicle documentation, accident documents and a certificate received from an independent expert company (if available) to your claim.

The insurance company has 10 days after receiving your pre-trial claim to fulfill the requirements specified in it or respond to you with a written refusal. If no response has been received or you have received a refusal that you consider unfounded, then the last step remains - appealing the decision in court.

Step No. 4 – go to court

According to Federal Law No. 40, you have the right to go to court only after filing a pre-trial claim. In principle, you can start writing a statement of claim even earlier - insurance companies do not respond to claims at all, and will most likely refuse you. Their actions are not entirely clear, since judicial practice shows that courts more often side with the plaintiff.

So, if the insurance company refuses to pay, you file a claim. Guided by Art. 131 of the Civil Code of the Russian Federation, it must indicate:

• name of the judicial authority,
• Full name of the plaintiff/defendant and their personal data,
• description of the dispute,
• basis for appeal,
• requirements against the defendant,
• appendix (list of attached documentation),
• signature/date.

Note! In the requirements, you indicate a specific amount, including direct compensation, as well as other costs incurred.

The claim is sent to the court located at the insurance company's address. If the total amount of your claims is more than 50,000 rubles, then contact the district court, if less than 50,000 rubles, then contact the magistrate.

Immediately write a statement in 2 copies - to the court and to the defendant. Attach a set of documents to it, including a written refusal from the insurer (on your claim), a valid insurance contract, a compulsory motor liability insurance policy, the results of an independent examination, as well as documents from the scene of the accident.

Step No. 5 – we receive insurance payment

Typically, insurance companies do not even send their representatives to the court hearing, since its outcome is known - satisfaction of the claims in full or in part. The exception is when the insurer legally refuses.

In accordance with the court decision that has entered into legal force, the insurance company must make a payment and also pay your expenses:

• for an independent examination,
• representative services,
• payment of state duty,
• penalty.

The longer the process in court continues, the higher the costs for the policyholder. By the way, you can also request compensation provided that you prove to the judge that it was caused.

TOP 3 tricks of insurance companies

Insurance companies use a whole arsenal of means to refuse payment of compensation or significantly underestimate its size. Let's figure out what tricks the insurer uses and how to wisely avoid them.

Situation No. 1 – the proposal to “solve everything on the spot”

After a traffic accident, the driver contacts the insurance company, having prepared a complete package of documents. In response, he receives a tempting offer to “figure it out on the spot,” i.e. receive a certain amount of money in a couple of minutes, but at the same time completely abandon your claims.

What should I do? Do not agree to such illegal actions. The driver who made a deal with his conscience and the insurer will receive a payment that is not enough to even eliminate the minimal damage caused by the accident.

Situation No. 2 – underestimation of the amount of compensation

Experts note that the amount of compensation paid and the final costs of repairs may differ by 8-10 times! For example, a technician intentionally leaves out information about certain damages on a report, reducing the cost on paper.

What should I do? Participate in the inspection of the vehicle and insist that all damage be included in the report! Additionally, you can contact an independent appraisal company, and then attach the certificates received from it to your claims and complaints.

Situation No. 3 – banal delay of payment

Suppose the car owner collected all the documents, submitted them to the insurer, passed and even agreed with the results. He did not receive a refusal, but the insurance company simply does not pay compensation, delaying the deadline.

What should I do? Demand a penalty. Everything is transparent here: there is a law on compulsory motor liability insurance that sets payment deadlines; if the insurer violates them, then he is at great risk. You can collect a penalty or interest from him for delay in payment.

NAFI regularly surveys Russian car owners, assessing their level of trust in insurance companies. In 2016, this figure was only 40%, and the main reason for such a low level was the unjustified refusals of insurers to pay compensation.

The best advice for every driver is to exercise extreme caution and avoid getting caught. If such a situation occurs, do not panic, but carefully check your every step with the current law on compulsory motor liability insurance!

We hear this question most often in applications received on the site and in telephone conversations.

To begin with, we should accept as a fact that the insurance market in our country is still in the 90s, in other words, it is wild. Insurance companies unreasonably and for far-fetched reasons refuse to pay, underpay, and sometimes go bankrupt, simply bursting like soap bubbles.

Be prepared for the fact that when you apply for an insured event, the smile on the face of the insurance company employee will no longer be as wide as when concluding an insurance contract, when you gave them your hard-earned money.

Why is this happening?

The main reason is the low insurance culture of both insurance companies and their clients.

The policyholder who comes for payment is perceived as a swindler and freeloader; insurers are perceived as absolute evil, focused on making a profit. Insurance itself is perceived as nothing other than a means for making money, and this perception is the same for both parties.

Policyholders believe that the insurance must “beat back”, that is, the amount of payments received for the year of the policy must be greater than the amount paid for the insurance. Insurers think they should be paid for insurance and have no right to ask for anything in compensation.

You should begin to break such a vicious circle of misconceptions with yourself, no matter who you are reading this article.

Frequent reasons for refusal to pay CASCO insurance

The policyholder untimely notified or failed to notify the insurance company in writing of the occurrence of the insured event

Insurance companies actually have this right by law. However, we should not forget that the insurance company has the right to refuse on this basis only if it was not notified at all or the condition of the car after the accident has changed and it is impossible to determine the amount of damage and its cause. It is not difficult to prove that you called the insurance company by taking a printout of calls and their duration from the telecom operator.

If you did not repair the damaged car and/or did not receive new damage in the same places, then the refusal to pay insurance due to failure to notify can also be easily appealed and you can receive insurance.

The mechanism of damage does not correspond to the circumstances specified in the claim for the insured event

Typically, such refusals are received by lazy or very busy people who do not have the desire or time to go to the insurance company for every scratch. As a result, all scratches and dents collected over the year are reported on one claim. Insurers, of course, don’t like this, but we don’t care about it, since insurers don’t like much other than money in principle.

Therefore, such refusals also have no chance. Now there is no need to do a trace examination to determine the mechanism of mark formation of scratches. It is enough to assess the damage from an independent expert, file a claim, have the claim rejected or ignored, and go to court. The court is now not interested, most often, in the mechanism of trace formation of damage. The fact of causing damage to the insured car is important.

The driver is not included in the CASCO policy or is not allowed to drive

It happens that you need to urgently travel on business, but the only person included in the policy cannot do this for various reasons. It happens that adding a wife or girlfriend with little experience to a CASCO policy is a little expensive and an incredible “toad” attacks your throat. All these “happens” will definitely lead you to have to pay an insurance compensation if a person who is not included in the insurance is driving in an accident. However, it is too early to despair, and it is not right. The Supreme Court of the Russian Federation said its weighty “fie” to such refusals in one of the recent plenums. Now, when filing a claim in court, you don’t have to worry, since a person who is not included in the policy is not a reason for refusal. The property itself is insured, not the people managing it. Now we are half a step closer to global insurance practice.

The driver driving the car and insured under CASCO was drunk

We express our agreement in this position with the insurers and with the Supreme Court, which said that this violation of traffic rules and insurance rules is intentional and should be the basis for refusal to pay insurance compensation.

Another thing is that with our corruption, including in the traffic police, no one is protected from the fact that anyone who has not given a bribe can be made drunk. Remember that you can protect yourself from this chaos. During a medical examination, there must be witnesses present who are obliged to monitor every action that takes place; you have the right to film everything that happens on camera, and the right to attract witnesses. If you are still made drunk by conspiracy by traffic police officers and unscrupulous doctors, then you should immediately apply for a medical examination at another clinic, preferably a state one.

The car was stolen along with keys and/or documents

The Supreme Court also spoke on this issue. In accordance with Articles 961, 963 and 964 of the Civil Code of the Russian Federation, leaving in a vehicle due to negligence the registration documents for it or a set(s) of keys, a diagnostic card, as well as their loss is not grounds for releasing the insurer from paying insurance compensation.

Insurance companies simply do not pay additional insurance compensation

This happens because, based on the results of payments, only three out of ten clients of insurance companies go to court. Good savings due to the unwillingness of the majority of the population to go to court. Insurers can be accused for a long time of being bad, but it is much faster and more effective not to wait for the next handout, but to defend your rights in court. It's not fast, but it's effective.

If the insurance company did not pay extra for the damage or paid little indemnity, you should conduct an independent examination, file a pre-trial claim, indicating your bank details and the deadline for responding to it 7 days, and after 7 days you can safely go to court.

Updated: 06/5/2018 3371

What to do when the insurance company refuses to pay under compulsory motor liability insurance: step-by-step instructions + detailed analysis of individual cases

Has your insurance company refused to pay you under compulsory motor liability insurance? But this does not mean that now you have to repair the car yourself. After reading this article, you will learn when the insurer has no right not to compensate for damage, and what to do if he thinks otherwise.

The insurer must pay compensation to its client if:

• only two participants accidents;
• all people are safe and healthy;
• everyone understands, who is guilty.

In other cases, the insurance company in which the culprit entered into the insurance contract is obligated to pay.

If the insurance company refuses to pay, you still cannot turn to another.

Note. In fact, it is always the at-fault party's insurer who pays. Your insurer, if it pays you, will demand compensation from the insurance company at fault.

In what cases does the insurance company legally refuse to pay?

First of all, the Compulsory Insurance Rules stipulate the following cases when damage is not compensated if insured events occur:

• by intent victim;
• due to the action of force, which could not be overcome (for example, an earthquake or hurricane);
• due to radiation, from a nuclear explosion;
• because of the war, including civil, as well as other public unrest;

Reasons for refusal will also include more ordinary cases, which, however, are not recognized as insurance.

So, under compulsory motor liability insurance, damage is not compensated if:

• the car that was damaged is not insured under MTPL;
• the injured policyholder performed some actions with the car, due to which it is impossible to assess the damage;
• failure to notify the insurer in a timely manner(in some cases it is possible to challenge it in court);
• required documents not provided(not everything that the insurance company may require is really necessary)
• only moral damage was caused or loss of profit;
• an insured event occurred while learning to drive, during competitions;
• damage to the environment;
• damage caused due to cargo, if the likelihood of its occurrence must be insured separately;
• harm caused to the employee, if the possibility of its occurrence must be insured by another contract;
• the employee caused damage to your employer;
• the driver caused harm vehicle and cargo;
• damage occurred during loading/unloading;
• antiques and unique items were damaged, including buildings, jewelry, money, works of art, science¸ items related to religion;
• harm caused to passengers if they must be insured separately.

As you noticed, there are not so many situations when there really is a reason to refuse, especially since many of them are specific.

For what reasons does the insurance company not have the right to refuse?

In the following non-standard cases, the insurer still cannot refuse payment, no matter how serious the reasons may seem:

• the guilty party intentionally caused harm life and/or health;
• the culprit was drunk(including on drugs, etc.)
• lack of driving license at the culprit;
• the one who caused the harm disappeared from the scene of the accident (but was later found);
• person not registered in insurance who was driving the car that caused the damage;
• The accident occurred during(second column of the form), not covered by insurance;
• the culprit did not provide his part of the form to his insurer in due time notifications (if the accident was registered without Traffic Inspectorate employees);
• the person who caused the accident did not provide his car for examination;
• the person who caused the accident restored or disposed of his car before the end of 15 days after the accident(when issued according to the European Protocol);
• the culprit does not have a valid diagnostic card;
• the culprit's electronic policy contains incorrect data, indicated by him to save on the insurance premium;
• documents not provided, not required in a particular case;
• the accident occurred due to a malfunction, which is not indicated in the diagnostic card, although it was possible to identify it during a technical inspection
• The insurer's license has been revoked.

What to do if the insurance company refuses to pay: step-by-step instructions

So, if payment under compulsory motor liability insurance is refused, the main thing is not to be afraid and not to be lazy in seeking the truth. There are not so many legal grounds for refusal. Insurers rely on the driver's inaction mainly due to ignorance of the law. Are you sure there were no violations on your part? Feel free to defend your rights.

A very wide judicial practice on such issues can be found both in official documents and in automotive and legal forums, where motorists share their experience in combating the arbitrariness of insurers. I will talk about some court decisions in this article.

Step one - we get a refusal

Already got it, you say. It is important to obtain a written refusal, which, among other things, will be required as a basis for a claim in court. Often, one request to issue it is enough for the insurance company to change its decision and compensate for the damage.

Step two - understand the reason

This is a very important stage. All further actions depend on understanding the rationale for the refusal. If legitimate reasons are given, or it is necessary to eliminate them if possible, or take a lesson from this for the future. The law is strong, but it's law.

If the insurance company provides incorrect or controversial arguments, move on to the next step.

Step three - contact the RSA and the Central Bank

If the reasons for refusal indicated by the insurer clearly contradict the law, it is better to start by filing a complaint with the organizations that control insurance activities, namely the Russian Union of Auto Insurers and the Central Bank. With this decision, the result will be faster than through the court, and no costs will be required.

In case of payment refusals, you should first contact the Central Bank of the Russian Federation. You can submit a complaint:

• by regular mail(preferably by registered mail with notification) to the address 107016, Moscow, st. Neglinnaya, 12, Bank of Russia;
• online in the Internet reception;
• personally at the address: Moscow, Sandunovsky lane, 3, building 1.

The period for consideration of the complaint is 30 days. A sample application can be downloaded.

A complaint is submitted to the RSA by mail or e-mail. The addresses are here. There are also sample forms there.

Step four - pre-trial claim

If the issue is controversial, or for some reason contacting the above-mentioned organizations did not produce any effect, we file a pre-trial claim with the insurance company.

The claim must indicate:

1. name of the insurer to whom the claim is sent;
2. Full name, address and contacts owner;
3. specific requirements, supported by references to laws, if more than 20 days have passed since the application was submitted, you can, in addition to payment, demand a penalty for late payment - 1% of the total compensation for each day;
4. your details, if you want to receive a refund on your card.

The claim must be accompanied by copies certified by a notary or originals :

1. civil passport the owner or his representative;
2. powers of attorney, if a representative submits documents
3. papers evidencing ownership of the car;
4. documents from the Traffic Inspectorate about an accident (certificate, protocol, etc.) or Notification of an accident;
5. insurance policy;

You can apply either in person or by mail. Be sure to receive confirmation that the claim has been accepted; this can be a receipt with the company seal and the signature of the employee who accepted the claim if you delivered the claim in person, or a receipt from the mail if you sent the claim by letter.

Important. Without filing a pre-trial claim, going to court is unlawful.

Step five - trial

If within ten working days the insurer sends a refusal to the claim, or does not respond at all, you can file a claim in court. It is better to use the services of an experienced lawyer, especially since if you win, the defendant will also compensate for this.

If the amount of the claim does not exceed 50 thousand rubles, it should be submitted to the magistrate court, otherwise - to the district court. The court must be at the location of the insurance organization (its branch).

How to file a claim

The statement of claim is written in accordance with Article 131. Civil Procedure Code (Civil Procedure Code) of the Russian Federation. It is necessary to clearly state what your request is, how the violation of your rights is expressed, what you are basing your demands on, evidence of pre-trial treatment, the cost of the claim, and at the end - a list of attached documents.

To the documents you submitted with your claim, add:

• insurance refusal in compensation for damage;
• confirmation of the complaint;
• insurance claim certificate, which is issued by the insurance company, it contains information about the accident and damage;
• other documents, confirming the legality of your claims, incl. confirmation of expenses incurred in connection with the trial.

The amount collected from the insurance company can include:

• insurance compensation;
• moral damage;
• penalty for delay in payment;
• penalty for lack or delay of response for a claim;
• state duty;
• price of lawyer's services;
• examination fees and other expenses related to this case;
• fine for non-payment.

Costs already incurred must be confirmed, for example by checks.

If you don’t even know the estimated amount of payment, conduct an independent examination to know what to demand from the insurance company.

Trial

You can submit your claim either in person or by registered mail. A copy of the claim must be sent to the defendant. Moreover, copies of documents are also attached. After that, you just have to wait for the summons to appear in court. You may have to wait a long time, sometimes up to two months. That is why it is preferable to file a complaint with the Central Bank of the Russian Federation or the RSA.

Most likely, there will be several court hearings. It may be necessary to provide additional evidence and conduct forensic examinations. Therefore, it is useful to hire a representative lawyer who, firstly, knows his business well and has experience, and secondly, litigation is his main job, from which he will not be distracted.

If the matter is obvious, there will not be a long trial.

If the court denies your request, file an appeal to a higher court. There are very frequent cases when it was the appeal requirement that was satisfied.

Step six – get your refund

After the decision is made in your favor (which I am 99% sure of, if you do everything correctly), you will receive a writ of execution, which must be submitted to the bailiffs or to the bank, and you will receive the money due to you.

The insurer was not notified on time

Although the victim is obliged to notify within the prescribed period (5 days) about the insured event, however, if he does not do this, the refusal cannot be unconditional. If you can prove that the insurance company was notified, or that the delay in notification could not affect the obligation to compensate for damage, payment to you is guaranteed under clause 2 of Article 961 of the Civil Code of the Russian Federation.

The insurance company may also refuse if it considers that due to the delay it cannot demand compensation for damage from the culprit. You will also have to prove the opposite in court.

For example, N. was on a business trip, his car was parked and was dented. The person who caused the damage turned out to be an honest person and left his contact information to the parking lot guard. N., returning a week after the incident, contacted the culprit and went to the insurance company to demand compensation for the damage. The insurer refused him, explaining that the insured event was not reported on time.

N can appeal the refusal in court because the car was parked in the same place for seven days and no additional harm could have been caused to it. If he provides convincing evidence of this, the court will oblige the insurance company to compensate for the damage.

If the culprit fled the scene of the accident

Does the insurer have the right to refuse payment under compulsory motor liability insurance in this case? No, this cannot be the reason for refusal of compensation under the “motor civil law”. But only under one condition: if the culprit is found and his car is insured under MTPL.

The insurer compensates for damage caused by the fault of its client, and if it is not known who is at fault, there will be no compensation from the insurance company.

If the culprit is not found, there is no trial. The only thing is that RSA will pay for damage to health. If they find it, but there is no policy, you need to demand money from him through the court. For health benefits, again at the RSA. If they find it and have a policy, the culprit’s insurance company pays.

If the culprit was drunk

Can the insurance company not pay out in case of a drunk driving accident? No! In subparagraph b of paragraph 1 of Art. 14 of Federal Law No. 40-FZ specifically talks about this case.

And paragraph 25 of the twelfth article of the same law states that this case will not be a justification for refusing to pay the victim. Therefore, the insurance company is obliged to compensate for the damage. Another thing is that later she will demand the amount paid from the culprit, but this is no longer your concern.

When the culprit does not have insurance

An insurance company should not pay for a person for whom it is not responsible. The insurance company pays you not because you are insured, but because the person who caused the damage to you insured his liability for it.

The essence of compulsory motor liability insurance is that a person is not responsible for damage caused to others using a car (in the amount provided for by compulsory motor liability insurance), his insurer is responsible for it.

This is clearly seen from this example. If you do not have an auto insurance policy, but you are the victim, the culprit’s insurance obliged compensate you for the harm caused, since she is responsible for it. The driver, having insured himself, sold her my responsibility at the price of the policy.

Therefore, if there is no policy, compensation can only be obtained from the culprit, by mutual agreement or through legal proceedings.

Note. Driving during a period (second column on the form) not provided for by the policy is not a reason for refusal. The policy is valid for the entire period (first column of the form).

If the culprit has a “fake” OSAGO policy

The situation with a “fake” policy, in fact, is not much different from the option with a complete absence of a policy. You won't be able to recoup your losses just like that.

What options?

If we suspect a fake, we check the authenticity using the policy number through the RSA website.

As a last resort, if you cannot use the Internet, you can find out by calling RSA or any insurance organization.

Are there any discrepancies between the information received and the form? The insurance is fake.

There are two possible options here. If, according to RSA, the policy is related to the insurance company, respond to it. Because it’s her problem that someone took advantage of her policy (strict reporting form!).

Note. If your insurer should have paid (that is, you receive a direct loss payment), the claim is filed against them, even though they were not involved in the fraud with the form.

If the insurance company is not associated with this policy, compensation can only be demanded from the person who caused the damage.

What do we have to do?

The sequence of actions is as follows:

1. submit a written application to the RSA, asking to check the validity of the policy;
2. we get the conclusion from there.

The policy belonged to the insurer:

1. We are contacting him to demand compensation.;
2. if he refuses, we write him a pre-trial claim for payment
3. we go to court by attaching confirmation from the RSA about the status of the policy, if the insurance company has not made payments after the previous step;
4. the court decides who should pay: the insurance company, or the owner of the counterfeit.

If the insurer, according to the verification data, is not associated with the form:

1. We immediately file a pre-trial claim with the culprit for full compensation for damage;
2. no reaction– we file a claim against him in court, also confirming the validity of our claims with the conclusion of the Union of Auto Insurers;
3. the court decides who should compensate for the damage.

A pre-trial claim to the culprit is written according to the same rules as for the insurance company. It must be accompanied by a conclusion from the RSA about the falsity of the insurance. .

In both cases, a fraud report is submitted to the police, accompanied by a document received from the RSA.

Arbitrage practice

There are not many court decisions on this issue, but most of them are positive. The exceptions are those that were submitted incorrectly. The policy is proof that a “car title” agreement was concluded until the contrary is proven.

If it is established that the form belongs to the insurance company indicated on it, the insurer is obliged to pay. If the form itself is fake, you cannot demand compensation from the insurer.

The form belongs to the company

One such case was considered by the court in 2015 in Tatarstan.

The insurance policy belonged to the insurer of the culprit, but, according to RSA, it was issued to another insured. The insurer refused to pay its client (the victim) because, according to information requested from the at-fault party's insurance company, the policy did not belong to the at-fault party. The victim, with the help of a lawyer, went to court.

The claim was denied in the district court, but its decision was appealed to the Supreme Court, which ordered the victim's insurance to pay him. It's up to her to deal with the culprit's insurer.

The insurance company listed on the form must prove that the policy is fake. No such evidence was presented, so the victim won in court.

The form was found to be counterfeit

Another example is given in the Review of judicial practice on compulsory motor liability insurance of the Armed Forces of the Russian Federation, published in 2016.

The insurance company was sued. But the falsity of the policy, as well as the receipt, was established. It was proven that no contract was concluded with the insurer, and, therefore, he is not responsible for the damage caused by the owner of the "linden". Therefore, the claim against the insurance company was denied. In such cases, it is necessary to recover from the culprit himself.

Refusal after trace examination

In any case, you can try to challenge a refusal based on traceology results. Often such examinations are carried out in violation of the rules; the experts are interested persons or do not have the authority to conduct it.

Therefore, in a trial, especially if there is documentary evidence of an accident from the traffic police, etc., such an “independent” examination is often recognized as invalid. A claim must be filed with a request to refuse to accept the traceological examination carried out by the insurer as a justification for the refusal, since it was carried out with violations and, therefore, is invalid.

If the court does not find the conclusions of the examination to be untrue, a petition must be filed to order a forensic trace examination. In most cases, its result refutes the expert opinion of the insurance company, and the court obliges the insurance company to pay you for the damage.

Important. If possible, do not repair the vehicle to obtain an adequate forensic result. As a last resort, keep high-quality photographs of the damage.

Refusal for registration according to the Europrotocol

Refusal to register under the European Protocol is usually explained for two reasons:

1. The form is filled out incorrectly accident notifications;
2. Failure of the culprit to fulfill his obligations.

Filled with errors

This is the most common reason for refusal. The simplest thing that can be done is to find the culprit and rewrite or correct together with him the defects indicated in the insurance refusal.

If, due to some circumstances, it is not possible to meet with the other party, and you think that the errors are insignificant, you can write a pre-trial claim to the insurer, and then a lawsuit. But I am not aware of the judicial practice on this issue.

There must be signatures in all the required places, including in column 18, an admission of guilt by one of the parties, as well as a correct indication of the damage. These are significant reasons for refusal. If there are such violations in filling out, most likely the court will not grant your request.

Therefore, if you have any doubts about how to properly apply for the European Protocol, call the traffic police.

Link to the culprit's actions

Often, payments are denied because the culprit did not inform his insurance company about the accident, did not show his car, or does not have a technical inspection. This is illegal, which is directly enshrined in the law “On Compulsory Motor Liability Insurance”.

If you are denied for these reasons, feel free to file a complaint with the Central Bank or RSA, or write a pre-trial claim. The insurance company does not change its decision - go to court.

Conclusion

Well, now you know well that in many cases the insurance company does not compensate for damage without reason. If this happens to you, insist on payment and go all the way in your claim.

Have you ever received a refusal from an insurer? Maybe you have sued insurers on similar issues? Write in the comments, this information will be useful to everyone!

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Comments to the article: 23

Maksim

07.06.2017 | 15:16

Thanks for the very valuable articles.

Maksim

18.08.2017 | 10:15

Photo of Honda is right on topic of the article)))

Michael

27.11.2017 | 15:43

There is no discussion of the situation when the insurance company did not show up for inspection within 5 working days, the car was not driving.

Alexei

18.12.2017 | 12:19

The insurance company refuses compensation under compulsory motor liability insurance, citing the fact that the part was previously repaired and it was done “poorly.” Therefore, the payout is 0.00. Does it make sense to fight for payment or is this a reason for refusal?

In principle, this is a common situation, everyone’s cars are not new, and they have damage even without an accident...

Sergey

27.02.2018 | 17:27

The insurance company recognized the insured event, did not pay the full amount of the claim, added it but did not pay additionally, after which a claim was filed in court, the court ordered a forensic trace examination, and according to its conclusion, the injuries received could not have been caused by an accident. As a result, the claim was denied. Is it possible to continue to fight this somehow????

Natalie

13.04.2018 | 21:16

I got into an accident again, the damage in both cases was similar - a year ago I was hit in the rear of my car. After the first accident, the car was completely repaired (as the culprit of the accident, she did not contact the insurance company and repaired the car herself). Now, after the second accident, the insurance company is refusing compensation under compulsory motor liability insurance, citing the fact that the claimed damage could not have occurred in this accident, in addition, the damaged parts were previously repaired and it was done “poorly.” There is an additional CASCO policy for repairs at a service station in the direction of the insurance company.

How to get the insurance company to fulfill its obligations to repair the car?

Denis

18.09.2018 | 21:25

Good evening. The situation is this: there was an accident with 3 cars + personal belongings were damaged, the insurance company and the court refused to pay, can I contact the insurance company at fault? more than 3 months have passed. And the car has already been sold(

Alexei