The settlement of insurance cases under compulsory motor liability insurance often raises many questions, especially when controversial situations arise with insurance companies that refuse to recognize certain cases as insured. In this article we will try to analyze in detail in what situations the driver has the right to count on compensation for damage under the MTPL policy, which cases are insurable and which are not, and what legislative norms govern this.

What law governs compulsory motor liability insurance?

Due to the fact that compulsory MTPL insurance is regulated by the relevant Federal Law No. 40 of April 25, 2002, all basic principles and concepts are recorded and documented in it. This also applies to information about the conditions for the occurrence of an insured event and its recognition as such. Therefore, if any controversial situations arise, you should refer to this document.

Summarizing the main provisions of this law, we can draw the following conclusion:

Insured events are all events in which a citizen, having a valid MTPL policy in hand, while driving a vehicle, caused harm to the life or health of other persons or the property of these persons. If such an event occurs, the company is obliged to compensate for the damage caused.

At the same time, the law also specifies an extensive list of events that are not insured events and the occurrence of which is not covered by the policy.

The version of the law dated July 3, 2016 provides for a maximum amount of compensation of 400 thousand rubles for compensation for damage to property, and 500 thousand rubles for damage to life and health.

Criteria for recognizing an event as insured

According to the above-mentioned law, an insured event under compulsory motor liability insurance occurs when two main conditions are met:

1. The presence of the culprit of the accident, in respect of whom such a concept as civil liability will apply. Accordingly, there must be at least two participants in the accident: the culprit and the victim (who will be compensated for the damage by paying him compensation from the insurance company). Here are examples of relevant insurance and non-insurance events for this situation:

   Insured event: The driver was distracted and did not have time to brake in front of a pedestrian crossing, which is why he crashed into a car in front.

   Non-insurance event: A citizen, leaving a shopping center, discovered a dent in the trunk of his car. There were no witnesses to the incident, as a result of which the culprit of the incident was not identified.

2. The damage must have occurred when the culprit used an insured vehicle (VV). According to the law, such use is recognized as driving a vehicle associated with its movement on roads and adjacent territories on which the vehicle is intended to move. Here are examples of relevant insurance and non-insurance events for this situation:

   Insured event: A dump truck drove past a car parked in a parking lot and accidentally crashed into it.

   Non-insurance event: Poorly secured construction material fell out of a parked truck and damaged a neighboring car. The fact that the truck was moving was not recorded, and, therefore, it is pointless to expect that the insurance company will cover the damage.

What cases are not covered by insurance?

According to Article 6 of the above-mentioned Law “On Compulsory Motor Liability Insurance”, the following events are not recognized as insurance:

• causing damage while driving a vehicle other than that specified in the MTPL policy. Insurance is issued exclusively for the vehicle, and not for its owner;
• causing harm by cargo, the transportation of which is associated with risk. Such cargo must be insured separately by the owner;
• moral damages and lost profits incurred by the victim in an accident (estimated income that could have been received if the accident had not occurred);
• causing harm by a vehicle at competitions, during training driving and in other circumstances of this kind, occurring in places specially designed for these actions;
• causing damage to the life or health of citizens who are in the performance of their work duties in the case where such damage is compensated by a separate type of insurance (social, individual);
• the occurrence of other situations in which damage to the vehicle or property of the victim was caused directly by the driver of the vehicle;
• damage caused during loading and unloading operations;
• causing losses to the employing organization if an employee of this organization was injured on a vehicle (for which the policy was issued);
• Damage caused to historical and cultural values ​​(architecture, antiques, etc.), cash, jewelry is compensated not by the insurance company, but directly by the culprit of the accident, usually in court.

Is it possible to have an insured event without an accident?

From the content of the Law “On Compulsory Motor Liability Insurance” it follows that if the fact of an accident has not been documented, then you should not expect that the insurance company will pay anything. As noted above, the case must be traffic related. If there is a need to insure a vehicle against all kinds of risks not related to accidents on the road (natural disasters, theft, fire, spontaneous combustion and other troubles), you must also take out a CASCO policy.

However, there is one exception to this situation. Many companies like to impose additional services on the client, one of which is damage insurance and theft insurance programs. Therefore, if the client decides to additionally include one of these programs in the policy, then, of course, upon the occurrence of the stipulated insured event, he will be paid monetary compensation.

Does OSAGO apply in courtyards and parking lots?

Many car owners are interested in the question: will the policy be valid if an accident occurs not while driving on the road, but in the parking lot or yard where the car was left? According to the content of the law, courtyards and parking lots are areas adjacent to the road, which means that exactly the same rules apply regarding incidents that occur there.

It should be remembered that for these territories there are standard requirements for documents submitted to the insurance company to receive payment. Getting into a serious accident in a parking lot is difficult and is mostly limited to minor accidents with minor damage. Given this fact, drivers often do not want to spend too much time on paperwork, make many mistakes in the documents, and ultimately the injured party is left without monetary payment.

In addition, accidents often occur in parking lots due to inattention, even when the cars of both the victim and the culprit are not in motion at all. A typical situation of this kind is careless opening of car doors, leading to damage to a nearby car. This incident is not an accident, which means the Law “On Compulsory Motor Liability Insurance” will not apply to it.

Is it possible to repair a bumper under OSAGO or replace it?

After an accident has occurred and the victim has contacted the insurer with documents for damage compensation, the company must assess the condition of the car after the accident. Based on the examination, a conclusion is made on the recommended course of action - in this context, repairing the bumper or replacing it. Of course, the amount of payment will depend entirely on the expert’s conclusion. Repairing the bumper will obviously cost insurers less, so there are often cases when the assessment of the car’s condition is biased. In such a situation, you need to apply for an examination to another organization, and transfer the resulting conclusion with the cost of repairs to the insurance company. If the organization does not want to pay the specified amount, then there is only one way out - to go to court.

It should be remembered that the modernization and tuning of the car must be officially registered, otherwise there is a possibility that compulsory motor liability insurance will not cover losses. For example, if a car crashes into the back of another car and causes an accident. At first glance, the case is clearly an insurance case. But when registering an accident, it turns out that the stylish bumper on the car is not original, and this modernization has not been registered in any way. As a result, driving such a car may be considered illegal, and the incident may be considered uninsurable. Accordingly, no compensation can be expected in such a situation. And this regulation applies to all parts and components of the machine that are not included in the basic configuration.

Conclusion

Insurance and non-insurance cases under compulsory motor liability insurance are enshrined in law and compensation for damage is carried out only in accordance with the norms of legal acts. Under compulsory motor liability insurance, the insurance company provides compensation only in the event of an accident, while minor accidents in parking lots or in the courtyards of houses also qualify as insured events.

1. Immediately stop the vehicle (hereinafter referred to as the vehicle) and turn on the hazard warning lights.
2. Place a warning triangle (at least 15 m from the vehicle in a populated area and at least 30 m outside a populated area).
3. Contact emergency services: 112 - emergency or 102 – Police (free from mobile even in roaming) and act according to the instructions of the traffic police officer.
4. Record the circumstances of the accident using a mobile application developed by RSA and ensuring the transfer of data to the AIS OSAGO, which is entered through the Unified Identification of Information and Logistics (registration on the State Services portal), for example, “Road accident. Europrotocol", and (or) with the help of technical control means (if they provide data transfer to the AIS OSAGO) no more than 10 minutes from the moment of registration of an accident using technical control means. You can download the application in the Play Market or App Store application stores. Using photos and videos, record in relation to each other and road infrastructure objects, traces and objects related to the incident, damage to the vehicle, reg. vehicle numbers and VIN numbers.
   To settle an accident under the European Protocol (without calling the traffic police), registration using a mobile application until 10/01/2019 is mandatory only in case of disagreements or the need for settlement in the amount of 100 to 400 thousand rubles in Moscow, Moscow region, St. Petersburg, Leningrad region.
   From 10/01/2019, recording using a mobile application and (or) technical means of control (if they transmit information to the AIS OSAGO) is mandatory for all accidents without calling the traffic police. If it is impossible to fix it, it is necessary to call the traffic police.
5. Clear the roadway if an obstacle is created to the movement of other vehicles (only if there is no harm to life or health, if any, vehicles cannot be moved without the instructions of the traffic police officers).
6. Fill out the Notification form together with the other participant(s) in the accident - instructions.
   
7. Call the Ingosstrakh contact center at:
   +7 (495) 956-55-55 (Moscow), 8 (800) 100-77-55 (other regions of the Russian Federation) for advice.

Claiming an insured event

You can file an insurance claim for damage to vehicles and other property as a result of an accident at the offices of independent experts - partners of Ingosstrakh.

You can find a list of independent technical expertise that accepts clients under compulsory motor liability insurance in Moscow and the Moscow region in the section “Settlement Offices”.

Natural form of compensation for harm

Compensation for damage caused to the victim’s vehicle can be carried out by organizing and paying for restoration repairs at a service station (STS), from among those with which Ingosstrakh has concluded relevant agreements, taking into account the criteria for accepting vehicles for repairs for each service station .

In case of damage to vehicles and other property as a result of an accident.

You can file an insured event at the offices of independent experts - partners of Ingosstrakh:

Submitting an application to the office of independent examination will allow you to:

• inspect the damaged vehicle and conduct an independent examination on the day of application;
• significantly speed up the process of considering an insured event and making a decision on making an insurance payment.

You can find a list of independent technical expertise that accepts clients under compulsory motor liability insurance in Moscow and the Moscow region in the “Settlement Offices” section.

A natural form of compensation for harm.

Compensation for damage caused to the victim’s vehicle can be carried out by organizing and paying for restoration repairs at a service station (STS), from among those with which Ingosstrakh has concluded relevant agreements, taking into account the criteria for accepting vehicles for repairs for each service station .

Terms of payment of insurance compensation: The victim's application for insurance payment is considered within 20 calendar days (excluding non-working holidays).

IMPORTANT! To receive insurance compensation up to 400 thousand rubles. for road accidents that occurred in Moscow, Moscow Region, St. Petersburg and Leningrad Region, as well as in order to receive insurance compensation in the event of disagreements, data on the road accident must be recorded by its participants and transferred to the AIS OSAGO through the RSA mobile application “DTP.Europrotocol”. The fact of using the RSA mobile application “DTP.Europrotocol” when registering an accident under the Europrotocol should be indicated in the application for payment of insurance compensation.

A set of documents to be completed when applying to Ingosstrakh:

1. A notification of an accident (original) must be submitted within 5 working days from the date of the accident to the address: Moscow, st. B. Tulskaya, 10 building 9 (for Moscow and the Moscow region); For addresses of branches in the regional network, see the website (see)
2. Application for payment of insurance compensation.
3. A duly certified copy of the identity document of the victim (beneficiary).
4. Documents confirming the victim's ownership of the damaged property: vehicle registration certificate or vehicle passport (PTS). If at the time of the accident the vehicle had transit license plates, the provision of a title is mandatory.
5. Documents confirming the authority of the person who is the representative of the beneficiary.
6. Consent of the guardianship and trusteeship authorities, if the payment of insurance compensation will be made to the representative of the victim (beneficiary) under the age of 18 years.
7. Bank details of the recipient of the insurance compensation (the transfer is made to the account of the owner of the damaged property or to the account of the person entitled to the insurance payment.

A memo on the procedure at the scene of an accident to claim a loss under the Euro Protocol -.

When contacting Ingosstrakh, you must submit.

More detailed information on the Europrotocol can be found on the RSA website.

When contacting Ingosstrakh, you need to provide the following.

Insurance is a way to guarantee financial assistance to yourself or your family in the event of certain events.

An insured event is precisely those events for which compensation is due; they are specified in the insurance contract.

Each insurance company, in the terms of the contract, specifies its own list of such situations, upon the occurrence of which compensation is provided.

For life and health insurance against accidents

Such insurance is relatively inexpensive, since it covers a small list of risks. The main points regarding insured persons due to an accident are:

• death;
• establishment of full working capacity;
• establishing temporary working capacity;

That is, with such insurance, the insured event is a sharp deterioration in health or death of the insured person. Not everything is so simple, insurance companies cannot be easily deceived and enter into an agreement knowing about your health problems.

If such an insured accident occurred as a result of chronic illnesses or other ailments that the client knew about but did not report at the time of concluding the contract, then it will not be recognized due to concealment of facts affecting the amount of insurance payments.

Such insurance is also called social insurance, since the same risks are included in compulsory social insurance.

For property insurance of high-level cardholders

Typically, such insurance is available to holders of MasterCard Standard and higher plastic cards. The list of covered risks includes:

• loss/theft of plastic cards;
• loss/theft of wallet;
• loss/theft of goods purchased using this card;
• loss/theft of documents.

Often the occurrence of an insured event under these points is limited in time - about 2-4 hours from the moment of the incident. This means that if you have not reported it missing within this time, you will not be paid. In addition, you must report the theft to the police.

For medical insurance of persons traveling abroad

This insurance can be purchased separately or as an addition to other banking products. For example, plastic cards of the Gold, Platinum, and Premium classes often include this option in the cost of settlement and cash services and cover the following risks:

• severe toothache, dental services abroad;
• treatment of inflammatory processes;
• repatriation of the body.

That is, with this type of contract, the insured event is various health problems that may occur to the cardholder.

Moreover, all such insured events are confirmed by a specific document that must be properly executed. Also, the attending physician must recognize that the insured had to be treated urgently, so postponing treatment until he arrived home would be unacceptable.

In health insurance

Such insurance is not common in the Russian Federation. It is relevant in those countries where it is mandatory, for example, in the United States of America. Basically, all injuries, temporary loss of ability to work or its complete loss, disability, death - this is an insured event. Insurance implies payment if it occurs as a result of the following events:

• natural Disasters;
• burns;
• explosions;
• drowning;
• frostbite;
• lightning strike;
• action of electric current;
• illegal actions of third parties or animals;
• sunstroke;
• falling objects;
• the insured person falls from a height;
• foreign objects entering the respiratory tract;
• strangulation due to unforeseen events;
• use of automotive, household appliances, etc.

Gradually and very slowly, this type of insurance is developing in the Russian Federation.

IN OSAGO

In this type of service, the insured event is the infliction of losses to third parties in the process of participation in road traffic:

• property;
• health (including passengers).

However, these situations will not be such cases if they occurred in the case of a gross violation of traffic rules and (or) in a state of drug and (or) alcohol intoxication, and (or) driving through a prohibitory traffic light sign.

Car insurance CASCO

Unlike the above types of insurance, each insurance case in CASCO is individual for each insurer, but the most popular are the following:

• illegal actions of third parties (hijacking or theft of car components);
• accidents;
• natural disasters (large hail, wind, falling trees);
• other events (for example, flooding of a car in a parking lot due to a sewerage problem).

That is, an insured event is various damage to a car that occurred due to circumstances beyond the control of the insured.

However, in cases of alcohol or drug intoxication, gross violations of traffic rules and driving through a red light, insurance compensation is not provided.

When insuring commercial or non-commercial real estate

This is a rather unpopular type of insurance, especially in relation to residential real estate, although insurance companies often offer a wide range of covered risks:

• damage to the interior decoration of the apartment/house due to flooding by neighbors;
• similar damage due to weather conditions (for example, earthquakes);
• breakdown of household appliances and electrical appliances due to power surges or other factors.

To compensate for damage to household appliances, a mandatory condition will be the presence of a receipt and documents for such products, which could damage ownership rights.

Some insurers also add to the list the life and health of one family member living in the insured apartment/house if he is physically damaged as a result of property destruction.

Insured event when insuring goods

Such insurance is often offered when taking out a consumer loan at retail outlets. This type of insurance allows you to cover the following insured events:

• manufacturing defects;
• breakdown of electronic mechanisms;
• mechanical damage to the goods associated with the delivery of goods to the client.

Such damage is quite difficult to prove, so it is worth testing the product when purchasing it in a store, as well as immediately after it is delivered to its destination (home).

What are the nuances that can affect the amount of insurance compensation?

Simply the occurrence of an insured event is not enough to provide guaranteed compensation for damage - it is necessary to report the incident to the insurer, who will send an emergency commissioner to record the event.

In addition, the insurance company will calculate the damage incurred by the other party to the contract in order to pay the insurance compensation.

At this point, many people come across who want to get a large list of covered insurance events for pennies. After all, this list will not guarantee complete protection, but may only be a trick.

It is always necessary to look at the following points of the insurance contract:

1. Franchise size. The following example can be given:

Very often, car owners insure their cars under the CASCO program in the hope that the slightest scratch will be compensated. To save money, the insurance company may offer a high deductible.

The bottom line is that the minimum threshold that must be overcome depends on its level in order for you to start paying something. If a car costs 200,000 rubles, and the deductible is set at 2 percent, then if the car is damaged in the amount of up to 4,000 rubles. no payments will be made, and you need to rely only on your finances.

2. Level of sum insured. Suppose a person wanted to insure the apartment in which he lives. Often, insurance companies prefer not to go to the site to assess the possible amount of property and offer clients to evaluate it themselves.

If a person wants to “save” and insure for a smaller amount, then in the end he will receive a proportional compensation, that is, the amount of damage will be adjusted by a reducing factor. In the case of insuring an apartment for a larger amount than it actually is, a similar situation does not occur, and the client will receive exactly the amount of actual damage.

3. Possibility of changing the sum insured by the amount of compensation paid. There are situations when insured events occur during the validity of one insurance contract.

There may be two scenarios: the insured amount does not decrease or its level decreases by the amount of compensation paid. In the second option, the payment under the contract will be noticeably less, but the compensation, naturally, will be lower.

If an insured event occurs, you must immediately notify the insurer

The most important thing is to notify the insurance company. And this needs to be done as quickly as possible. Only in this case can you be guaranteed to receive a refund. Otherwise, the insurer will be able to refuse you, based on various clauses of the contract that indicate the need for immediate notification.

The result of a road traffic incident is the emergence of obligations towards the person injured in the accident. Insured events under compulsory motor liability insurance are specified in the relevant Federal Law. But despite this, insurers go to various lengths to avoid compensating the victim for damage. Therefore, you need to know exactly what is included in an insured event, and when insurers absolutely legally refuse to pay compensation.

An insured event under MTPL is any circumstance as a result of which the car owner driving the insured car caused damage to property and/or harm to the health of other persons in another vehicle. Under these circumstances, the insurer is obliged to compensate the damage to the injured person.

The list of circumstances recognized as uninsurable is contained in the same Law. Moreover, it is more specific than the list of those that are insurance. But more about everything.

Signs of insurance cases

So, how do you know whether the insurance company (IC) is obliged to pay compensation or not? Events are insured if:

1. The damage was caused using an insured vehicle. Use means driving a vehicle on roads and adjacent areas intended for driving.
2. There is someone who caused the accident. There must be at least two participants: the culprit, to whom civil liability applies, and the victim (he is paid compensation by the culprit's insurer).

Insured event in case of an accident - examples:

• The driver did not have time to slow down before the traffic light and crashed into the car standing in front.
• The truck drove past a parked car and hit it.

Uninsured cases:

1. Returning to the parked car, the owner discovered a dent on its hood. There were no witnesses to the incident. Therefore, the culprit has not been identified and there will be no payment.
2. The car was damaged by a load that was poorly secured 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;
• a vehicle was damaged in an accident;
• the people in the car were injured;
• property was damaged in the accident (for example, a fence).

Kinds

Current legislation provides for two types of insurance cases:

In the situations listed in the second case, it is not worth counting on a payment under compulsory motor liability insurance that insures not the car, but the driver’s liability. If you want to be calm about your “iron horse” in all unpredictable circumstances, you need to take out voluntary CASCO motor third party liability insurance.

Uninsured events

So, what is not an insured event? The following events fall into this category:

1. Causing harm to property or a person by cargo, the movement of which is associated with an increased risk. This type of cargo is insured separately.
2. Causing damage by driving a car that is not specified in the insurance.
3. Causing harm to the life and/or health of persons performing their official duties. In this case, compensation will be paid through the types of insurance required for employees (personal, social).
4. Compensation for moral damage and lost profits.
5. Damage to property or person was caused not by the vehicle, but directly by its driver.
6. Causing harm in specially designated areas for automobile competitions, training driving, etc.
7. Damage caused during loading and unloading operations.
8. Causing damage to architectural objects, antiques, luxury goods, cash, jewelry, etc. Compensation is made at the expense of the guilty person through the court.
9. Damage to a legal entity if damage was caused to an employee of the same organization on a vehicle owned by it.

Any of these events will be considered by the insurer as a non-insured event, and, therefore, no compensation will be paid.

OSAGO in parking lots and courtyards

According to Federal Law, these territories are considered adjacent to public roads. This means that the same requirements apply to incidents that occur on them as on the roads. For example, if cars in the courtyard of a house were unable to move away, and one of them was damaged, then its owner may receive an insurance payment.

The only thing is: regardless of the scale of the incident, in order to receive payment, you must submit a complete package of documents. As a rule, minor damage is caused to cars in courtyards and parking areas, so not all car owners want to bother with documents. So it turns out that the situation itself is insured, but in order to receive compensation, the victim must make a lot of effort. And for the sake of several thousand rubles, doing this is burdensome.

It’s a completely different matter when damage to cars is caused while parked. The most typical situation is careless opening of the car door. Since none of the cars is in motion, the insurer has the right to refuse to pay the victim.

Instructions for car owners after an accident

Here are the actions that should be taken by the policyholder in the event of an insured event under a compulsory motor liability insurance policy in order to receive 100% of the due remuneration:

1. Setting a date for the examination. Until this point, it is strictly prohibited to carry out car repairs. Based on the results of the technical inspection, a report is drawn up reflecting the amount of insurance compensation.
2. Direct compensation for losses in cash (to the policyholder’s bank account or through a cash register) or in kind (repairs).

So you have learned what to do after an accident in order to receive an insurance payment. After reviewing the documents submitted by the applicant, the Investigative Committee will decide whether the road incident is insurable or not. In any case, the insurer is obliged to respond no later than 20 days from the date of the client’s request. If the insurance company refuses to compensate for the damage, but you are sure that the damage received is subject to compensation, you can contact the RSA or the court.

If an insured event occurs on a loan, but the insurance company does not pay, you can always appeal this decision in court.

Almost all loans today are accompanied by an offer from the bank to enter into an insurance agreement. The insurer is usually a partner company or a company that is part of a single holding structure along with the bank. Recently, classic insurance has begun to be replaced by financial protection programs, although, if you don’t go into legal details, these products do not have any special differences. In the consumer lending system, insurance is voluntary, and even if the bank managed to impose insurance, it can be refused. For mortgages and car loans, insurance is required, but this only applies to collateral.

In general, credit insurance is generally accepted practice, either on a voluntary or mandatory basis. And if the borrower takes out insurance, then, of course, he expects that if the insured event specified in the conditions occurs, he or the bank will be able to receive monetary compensation. But those who have already encountered issues with insurance payments note that even the most extended insurance does not provide a 100% guarantee of receiving money.

There is nothing special in the credit insurance system in terms of refusal to pay insurance that would not be encountered in other legal relations. The same reasons, the same arguments on the part of insurance companies. Only the consequences are somewhat different: you not only do not get what you expected and paid for, but you also remain in debt, and insurance thereby turns into a useless tool.

Unfortunately, the occurrence of an insured event in itself is not the only condition for payment of compensation. You also need to follow the procedure for contacting the insurance company and a number of other formalities. But you may encounter another situation in which the insurer will try in every possible way either to avoid fulfilling its obligations or to reduce the amount of payment to a minimum. Knowing your rights and skillfully using available tools to protect them is the main condition for effectively combating unscrupulous insurance companies.

How to interact with the insurance company in the event of an insured event

Whatever insured event occurs, first of all you need to make sure that it is indicated in the terms of the insurance contract. It just so happens that many borrowers do not read the agreement carefully when signing: at best, they will glance at it, and at worst, they will take the manager’s word for it. As a result, it may turn out that the event that happened to you is not specified in the contract at all. Or the wording is so vague that what happened can be viewed in the context of the terms of the contract in different ways. Unfortunately, if the case is not listed as insurable, you will not be able to claim compensation. If everything looks controversial and incomprehensible, be sure to contact a lawyer specializing in credit insurance. If there is an ambiguous interpretation, you are unlikely to figure out on your own who is right and who is wrong - you or the insurance company. In such a situation, judicial practice will also be of great importance, and here a specialist, in any case, is more competent than a legally unskilled person.

So, you have determined that the event is an insured event. How to proceed next:

1. We carefully study the contract (policy), the memo of the insured person regarding the procedure (procedure) for contacting the insurance company (or bank) in connection with the occurrence of an insured event. The main task is to find out how, where and within what time frame it is necessary to submit the initial notification.
2. We are preparing a notification. Usually, a fairly short period of time is allotted for the initial notification of the insurance company (or bank) - within a couple of days, sometimes a little more, depending on the event (insured event). It is important to meet the allotted deadline, and even better - apply immediately. Under no circumstances should you delay your application, and it is advisable to do this personally or through a proxy.

When contacting in person or in response to a notice, the insurance company will most likely offer to prepare and submit documents confirming the occurrence of the insured event, if they were not included in the notice. It is not difficult to prepare documents. For example, if you lost your job, it is enough to provide a copy of the order or other document from the employer confirming the fact of dismissal and its basis. In case of illness or accident, medical documents are provided, and in the event of death of the insured borrower, a corresponding certificate is provided.

During the period of time established by the regulations of the insurance company, the circumstances that gave rise to the application for insurance compensation are checked. Deadlines vary. As part of such a check, the insurance company determines the existence of an event, its confirmation (proof) and the possibility of recognizing this event as an insured event with a decision on payment of compensation, its amount or refusal to pay in full or in part. The policyholder is notified in writing of the decision made. In case of complete refusal or limitation of payment, the grounds for making such a decision must be indicated. Study these grounds carefully, preferably with the assistance of a lawyer.

The most common reason for a complete refusal to pay insurance is the non-recognition of the event as an insured event. There are many reasons that can be given, and they vary depending on the situation. As a rule, this is due to the fact that in the terms of the contract, insured events are given without specifics, in the form of general formulations, or the issue of recognition/non-recognition of an event as insured depends on a number of related factors and conditions.

For example, the borrower may consider his dismissal an insured event under any circumstances, while the insurance company will most likely refuse payment, citing the fact that the dismissal occurred at his own request or for a disciplinary offense, and this is considered as a limiting condition specified in the contract . There are also cases when the borrower's disability is not recognized as an insured event, even if it is expressly designated as such in the contract. Here, when refusing, the argument is often made that the policyholder knew about his illness at the time of signing the contract and did not inform the insurance company about it when filling out the questionnaire.

If the insurer refuses to pay insurance, without recognizing the case as insured, it is useless to argue - it is more effective, as practice shows, to immediately transfer the issue to the trial. It is unlikely that the insurance company will change its decision, even if you additionally submit a huge package of supporting documents. And you will only lose time and money in a dispute with the insurer, since the bank will not relieve you of the obligation to repay the loan while you deal with the insurance. To comply with the formalities, it is enough to prepare and send a written claim to the company demanding the fulfillment of obligations under the insurance contract in full.

At the initial stage, a written claim is sent in the following cases:

• failure to receive any response from the insurance company within the prescribed period to the appeal regarding the insurance payment;
• agreement with payment, but its delay or incompleteness;
• refusal to pay compensation in full (partial compensation).

Along with the claim, you can file complaints about the insurance company violating your financial rights. There are two main options here - Rospotrebnadzor (the most popular) and the Bank of Russia (the main insurance supervisory authority). In these cases, achieving insurance payment is a small probability, but such a step can put some kind of pressure on the insurance company, and if a positive decision is made on the complaint, it will become additional evidence that you are right. You can also file a complaint with the Interregional Union for the Protection of Insured Rights, a specialized organization that provides legal assistance, although not free.

If none of the options for pre-trial dispute resolution help, you will have to file a claim in court. In this case, the claim is made by the borrower-insurer, but in favor of the bank, which is the beneficiary in the credit insurance system. In your favor the borrower may require:

• recognize the event as an insured event (mandatory, if this is precisely the reason for the refusal to pay);
• to recover compensation for moral damages, interest for the insurance company’s use of other people’s funds, as well as court costs and expenses for legal assistance.

If an insurance company and a bank are involved as defendants, which is usually done to solve an additional problem - termination of the loan agreement, then the requirements might look like this:

1. recognize the event as an insured event;
2. recognize the refusal to pay insurance as illegal;
3. oblige the insurance company to fulfill its obligations under the contract in full by paying compensation to the bank;
4. oblige the bank to repay the loan debt at the expense of the insured amount;
5. recognize the loan agreement as terminated, and if there is collateral, recognize it as terminated.

Specific requirements depend on the situation, the grounds for refusal to pay insurance, and the goals that the borrower or his heirs plan to achieve. It is important to take into account that you will not only have to prove your case, but also refute the arguments of the insurance company, and often the bank, which may side with the main defendant.