In road traffic accidents there is always an injured party, and so she has the right to receive compensation based on the MTPL insurance policy. This type of insurance is related to the civil liability of car owners. Rosgosstrakh carries out the amount of payment under compulsory motor liability insurance taking into account its maximum value, it is prescribed in the Law “On Compulsory Motor Liability Insurance”.

Interesting! According to Article 12 of the Insurance Bill, victims of an accident have the right to receive monetary compensation from the funds specified in a pre-drafted agreement between the insurance company and the owner of the vehicle. Anything more than the established limit is paid from the personal funds of the participant in the accident.

Basic information about the amounts and timing of payments

Those who are interested in the topic of payments by Rosgosstrakh in case of an accident should know that the provision of financial assistance is not possible in all situations. Typical ones are:

• exceeding the maximum amount of compensation amounting to 160 thousand rubles;
• the maximum payment amount was more than 400 thousand rubles.

According to the law, if the victim died, then monetary compensation cannot exceed 135 thousand and 25 thousand rubles to cover funeral expenses.

How is the amount of compensation calculated for damage to property?

1. In the event of its complete destruction, the actual value at the time of the insured event is taken into account.
2. If we are talking about damage, then the costs that must be incurred in order to restore the car are taken into account, namely, bringing it to its pre-accident condition.
3. All other damages are assessed at an amount equivalent to expenses.

Attention! Previously, a person faced with an emergency situation considered an insured event had to immediately contact the insurance company serving the person responsible for the accident. Now things are different. If the damage caused is estimated at no more than 50 thousand rubles, a claim for compensation for damage in an accident under Rosgosstrakh OSAGO can be submitted directly to your insurer.

Compensation is not always in monetary form; sometimes the company simply repairs the damaged vehicle. The basis for calculating the final amount of compensation is the results of an independent examination. During the calculation process, all costs and losses are added up, and the degree of wear of parts is taken into account.

Behavior of someone involved in a traffic accident

To receive payments from Rosgosstrakh, the deadlines for compulsory motor liability insurance must be taken into account. The first step is to notify government authorities about the accident. An examination is scheduled, which allows you to obtain accurate information necessary to calculate the possibilities for receiving compensation. If the result exceeds 120 thousand rubles, then you should not count on payments under the compulsory civil liability insurance policy. If the insurer does not agree with the amount of compensation, it is necessary to take care of the opinion of an independent expert.

When the insurance company receives a signal about the occurrence of an insured event, it sends an employee authorized to give an objective assessment of the incident to the scene of the incident as soon as possible. As a result, it determines whether the damage caused is subject to compensation under the policy or not. All necessary information is set out in a special act.

Package of documents that need to be collected

If an insured event occurs during an accident under compulsory motor liability insurance, Rosgosstrakh will pay them, but before contacting the company you need to collect a number of documents:

• identification of the victim;
• indicating that the citizen has the right to receive payments. This could be a policy, agreement, certificate or power of attorney;
• confirming ownership of damaged property in a collision;
• identification code.

If the insured person dies, then there must be a death certificate and documents reflecting funeral expenses. It is mandatory to provide bank details for which payments will be made, as well as information confirming the loss of a breadwinner.

How to get insurance after an accident in Rosgosstrakh, it is now known that when contacting an insurance company you need to have the originals of the policy, certificates from law enforcement agencies about the road accident, a driver’s license, and a certificate of registration of the land vehicle.

Attention! The package of documents must be collected in full. It is provided to the insurer no later than three working days from the date of the incident.

Compensation payments will not be made if...

1. The insurance company has been declared bankrupt.
2. The license to carry out insurance activities was revoked by higher authorities.
3. The culprit turned out to be dishonest and fled the scene of the accident, which makes it impossible to establish his identity.
4. There is no contract concluded with the company on civil liability insurance.

In all the situations described above, compensation is provided by the Union of Auto Insurers, but this is very rare.
A refusal to pay under compulsory motor liability insurance from Rosgosstrakh can be obtained if the provocation of a traffic accident was intentional or the driver of the car was drunk and did not have a license. The same applies to situations where damage to human health or the environment was caused by uninsured and dangerous cargo; the damage is a consequence of educational, experimental and other activities. If Rosgosstrakh has refused to pay under compulsory motor liability insurance, which may happen due to the need to compensate for moral damage or exceeding the established limit, it makes sense to seek help from a lawyer.
In order not to face a refusal due to exceeding the payment limit, you can enter into a DSAGO agreement. Its cost is insignificant, but its coverage area is much greater. The law on compulsory motor liability insurance is interpreted by the judge at his discretion.

Applicant: Lebedev Ivan Alekseevich
Payment case number: 0016723280
On August 16, 2018, an accident occurred in St. Petersburg. On the same day, the traffic police issued a resolution, which stated that I was the injured party. On the same day, documents were submitted to the loss settlement center.
On 08/22/18, an expert appraiser from the insurance company arrived at the car’s parking lot, because... the car is not running. After inspecting the car, I was given a document indicating that the inspection had been completed.
08.23.18 (attention!) TELEGRAM arrived! It contained a requirement to bring the car to the claims settlement center. Call support. According to the call center operator, a system failure occurred, as a result of which this telegram was sent to me by mistake and that a decision on my payment case will be made on 08/28/18.
08/30/18 Call to the contact center. A certain Roman said with a grin that I need to wait 20 days from (again, attention!) the moment of the examination, which is contrary to Federal Law No. 40-FZ. He foolishly decided to attribute the employee’s incompetence to his illiteracy and, possibly, his short tenure in the company.
On 09/04/18 I checked the status of the case on the RGS website (I checked consistently every 2-3 days). The website contains the following information: “In your case, a refusal to pay insurance compensation has been approved. Information about the reasons for the refusal is indicated in the written notice sent to you by mail.”
Attention, questions: 1) why the contact center employees cannot provide detailed information about the reasons for the refusal, but cannot even give the track number of the letter they sent (and they also sent it to an unknown location, since registration and place of residence do not currently match) .
2) In general, are there legal grounds for refusing payment under compulsory motor liability insurance if traffic police officers checked all the documents at the scene of the accident (including the insurance of both participants in the accident)?
Of course, I don’t want to go through the courts, but, apparently, I’ll have to... I don’t recommend insuring your car with this company, even if you don’t have much of a choice.

SOLUTION

In the name of the Russian Federation

<данные изъяты>2010 Lyubertsy

Lyubertsy City Court of the Moscow Region, composed of: presiding judge T.V. Sorokina, with secretary V.M. Potylitsina, having considered the case in open court<данные изъяты>to Rosgosstrakh LLC for the collection of insurance compensation, the collection of interest for the use of other people's funds, the collection of legal expenses,

U S T A N O V I L:

The plaintiff filed a claim in court for the recovery of insurance compensation, the recovery of interest for the use of other people's funds, and the recovery of legal costs against Rosgosstrakh LLC, citing the fact that DD.MM.GG between her and the defendant a land transport insurance agreement was concluded . The subject of the insurance contract was a car of the brand that belonged to her<данные изъяты>.
She indicated that the car was insured for the risk of theft (theft) + damage.
The insured amount was determined in the amount<данные изъяты>.
The plaintiff indicated that for concluding an insurance contract she had to pay in installments an insurance premium in the amount of<данные изъяты>first payment in the amount<данные изъяты>rub. was paid no later than DD.MM.YY DD.MM.YY, during the period from 00 o'clock to 11 o'clock, an unidentified person, with the intent to secretly steal someone else's property, stole a brand car through free access<данные изъяты>., cost<данные изъяты>., parked near the house<адрес>on the street<адрес>, belonging to her. After which she fled the scene of the crime, causing her large material damage in the amount of the indicated value of the car.
She indicated that upon the fact of the theft of the car, she filed a corresponding statement with law enforcement agencies, and on the basis of this statement a criminal case was initiated.
Upon the occurrence of an insured event, she submitted an application for payment of insurance compensation to the insurance company Rosgosstrakh LLC, which was refused payment.
Rosgosstrakh LLC motivated its refusal to pay by the fact that the policyholder violated the terms of voluntary insurance “A” of vehicles developed in accordance with rules No. 102 of voluntary insurance of vehicles dated March 25, 2003.
She indicated that the car was stolen along with the registration document left in it - a vehicle registration certificate.
Considers that the condition of the insurance rules that the secret theft of a vehicle along with its registration documents and (or) a set of original keys is not an insured event is void as contrary to Art. 963, 964 of the Civil Code of the Russian Federation, which provide for cases of exemption of the insurer from payment of the insured amount.
She asked to recover from Rosgosstrakh LLC in its favor the amount of insurance compensation in the amount<данные изъяты>.; recover the cost of paying state duty in the amount of<данные изъяты>.; recover expenses for the provision of legal services in the amount of<данные изъяты>.; collect interest on the use of someone else's money in the amount<данные изъяты>.
The plaintiff did not appear at the court hearing. Duly notified of the hearing.
Representative of the plaintiff Druzhinin S.G. At the court hearing, he supported the claims in full and asked to satisfy them.
The representative of Rosgosstrakh LLC did not recognize the claims at the court hearing and asked to dismiss the claim.
Having studied the case materials and listened to the explanations of the parties, the court comes to the conclusion that the claims are subject to partial satisfaction.
From the case materials, it appears that DD.MM.GG between the plaintiff and the defendant an insurance agreement for ground transport was concluded.
The subject of the insurance contract was a car of the brand that belonged to her<данные изъяты>The car was insured for the risk of theft (theft) + damage. The insured amount was determined in the amount<данные изъяты>.
The court found that DD.MM.GG in the period from 00 o'clock to 11 o'clock, an unidentified person, with the intent to secretly steal someone else's property, stole a brand car through free access<данные изъяты>., cost<данные изъяты>parked near the house<адрес>on the street<адрес>belonging to the plaintiff, after which he fled from the scene of the crime, causing the plaintiff large material damage in the amount of the specified value of the car. A criminal case was opened on this fact.
The car was stolen along with the registration document left in it - a vehicle registration certificate.
Rosgosstrakh LLC refused to pay the insurance compensation to the plaintiff, citing the refusal by the fact that the policyholder violated the terms of voluntary insurance “A” of vehicles developed in accordance with rules No. 102 of voluntary insurance of vehicles dated March 25, 2003.
The parties do not deny the occurrence of the insured event DD.MM.YY, namely the fact that the plaintiff’s car was stolen during the period of the voluntary insurance agreement concluded by the parties for the period from DD.MM.YY to DD.MM.YY for the total amount<данные изъяты>.
The first insurance premium in the amount<данные изъяты>was paid by the plaintiff until DD.MM.YY
The defendant's representative further did not deny that the plaintiff submitted to the insurance company all the necessary documents, except for the vehicle registration certificate, driver's license and genuine insurance policy, technical service coupon (case number).
In accordance with clause 1 of Article 963 of the Civil Code of the Russian Federation, the insurer is exempt from paying insurance compensation or the insured amount if the insured event occurred due to the intent of the policyholder, beneficiary or insured person, except for the cases provided for in clauses 2 and 3 of this article. The law may provide for cases of exemption of the insurer from payment of insurance compensation under property insurance contracts upon the occurrence of an insured event due to the gross negligence of the insured or beneficiary.
By virtue of Art. 964 of the Civil Code of the Russian Federation, unless otherwise provided by law or the insurance contract, the insurer is exempt from paying insurance compensation and the insured amount when the insured event occurred as a result of the impact of a nuclear explosion, radiation or radioactive contamination; military operations, as well as maneuvers or other military events; civil war, civil unrest of all kinds or strikes. Unless otherwise provided by the property insurance contract, the insurer is exempt from paying insurance compensation for losses arising as a result of seizure, confiscation, requisition, seizure or destruction of insured property by order of government agencies.
Thus, from the above provisions of the Civil Code of the Russian Federation it follows that the possibility of exempting the insurer from paying insurance compensation upon the occurrence of an insured event can be provided exclusively by law, including when there was gross negligence of the insured or beneficiary.
Taking into account the judicial practice of the Supreme Court of the Russian Federation on this issue, set out in particular in the ruling of the Supreme Court of the Russian Federation dated July 29, 2008. for No. 51-B08-7, which states that since such grounds for exemption from payment of insurance compensation as a result of the theft of a car are the abandonment of registration documents (vehicle registration certificate and/or vehicle passport) and/or ignition keys (which, in essence, is gross negligence of the insured) is not provided for either by the norms of the Civil Code of the Russian Federation or by any other law, then the inclusion of such a condition in the insurance contract is void, contrary to the Civil Code of the Russian Federation and, accordingly, should not be applied (case file no. ), the court concluded that the insurer did not have any grounds provided for by law to refuse to pay the insurance compensation to the policyholder.
According to clause 67 of the Rules for the risk “Theft”, the amount of insurance compensation is determined based on the insured amount specified in the insurance policy, minus (in the specified sequence):
a) depreciation wear and tear of the vehicle during the period of validity of the insurance contract. The insurer applies the following depreciation rates as a percentage of the insured amount: 1st year of operation - 20% (1.67% per month for each month). In this case, an incomplete month of validity of the insurance contract is considered as full.
b) an unconditional franchise established by the insurance contract;
c) previously made payments to the “Damage” risk (for aggregate insurance).
Thus, the amount of insurance compensation for this insured event will be<данные изъяты>(20% at the time of the insured event the contract was valid for 12 months)<данные изъяты>.
Interest under art. 395 of the Civil Code of the Russian Federation will be for the period from DD.MM.YY to DD.MM.YY for<данные изъяты>days will be:<данные изъяты>however, the plaintiff asked to recover interest in the amount<данные изъяты>. and this claim is subject to satisfaction to this extent.
The costs of providing legal assistance are subject to partial satisfaction in accordance with Art. 100 Code of Civil Procedure of the Russian Federation in the amount of 20,000 rubles, state duty costs in the amount<данные изъяты>.
The rest of the claims for recovery of costs for legal assistance should be provided.

Based on the above and guided by Art. Art. 927-929, 963, 395 Civil Code of the Russian Federation, Art. Art. 194 - 198, 12, 56 Code of Civil Procedure of the Russian Federation, court

Claims<данные изъяты>partially satisfy.
To recover from Rosgosstrakh LLC in favor of<данные изъяты>insurance compensation in the amount<данные изъяты>, interest on the use of other people's funds in the amount<данные изъяты>. for the period from DD.MM.YY to DD.MM.YY, expenses for paying state duty in the amount<данные изъяты>and expenses for the provision of legal services partially in the amount<данные изъяты>, total<данные изъяты>. <данные изъяты>
The rest of the claims for recovery of expenses for legal assistance shall be rejected.

The decision can be appealed to the Moscow Regional Court through the Lyubertsy City Court within 10 days.

Judge: Sorokina T.V.

If you have any questions or need professional assistance,insurance disputes , disputes regarding compensation for damage caused orother , You can always call us or write your question to

Reasons (grounds) for non-payment - in what cases (legal and illegal) does the insurance company not pay insurance?

So, let's first look at possible pretexts for refusal under MTPL. There are actually few of these prepositions. First, let's figure out what OSAGO is. This is primarily car owner liability insurance.

Thus, you need to understand that when purchasing an MTPL policy, You do not insure the car against damage, but your civil liability to third parties.

Simply put, this means that if you damage someone else’s property (this could be not only a car, but also, for example, a bicycle, a lamppost, a fence, etc.), the insurance company will pay for the damage to the owner of this property for you (in within the sum insured).

If you are innocent, your policy will not be used at all, and the premium will be paid according to the policy of the culprit.

Grounds for exemption of the insurer from payment under compulsory motor liability insurance

• the at-fault party’s insurance was not valid on the date of the accident;
• the culprit insured a vehicle different from the one involved in the accident;
• the victim restored his property before the damage was recorded by an independent expert organization;
• The accident occurred while the culprit was using the insured car in competitions, testing or for learning to drive on areas prepared for this purpose.

These reasons are legal and quite logical. In addition, in accordance with Art. 6 of the MTPL Law, the insurer will refuse to pay for:

• lost income that the victim would have received under normal conditions;
• moral damage;
• environmental pollution;
• antiques, precious metals, cultural heritage, etc.;
• damage caused by the transported cargo (in the event that the risk of transportation had to be insured separately);
• harm received by passengers or employees (if this harm must be paid for under the appropriate type of insurance);
• damage incurred during loading or unloading a vehicle.

The insurance company cannot have any other legal grounds for exemption from payment. It is necessary to understand that in no case are circumstances such as:

• the culprit was not included in the MTPL policy;
• was under the influence of alcohol;
• left the scene of the accident.

None of the above grounds exempts the insurer from making payments.

The insurance company does not pay for CASCO: what to do? Here the situation is a little more complicated for the simple reason that a voluntary type of insurance, the conditions of which, unlike compulsory motor liability insurance, are not regulated by the State. Insurers themselves draw up insurance rules and in each company they are different, which means there can be a great many reasons for refusal.

If the insurance company does not pay for CASCO insurance, the procedure should begin by considering the main reasons for the possible refusal. CASCO is voluntary insurance of property, in particular a car. A standard contract contains the following risks:

• damage to the vehicle (in the event of a traffic accident, illegal actions of third parties, fire, exposure to natural phenomena or animals);
• vehicle theft (in other words, theft);
• total or constructive loss of the vehicle (damage to the vehicle after which restoration is impractical).

The vast majority of insurance companies will refuse payment if the following circumstances exist:

• the event occurred at a time when the policy was not in force (has not yet begun or has already ended);
• driving by a person under the influence of alcohol or drugs, who did not have the right to drive a vehicle under the terms of the CASCO agreement, or by a person who does not have (deprived) of a driver’s license;
• the damage was caused by the owner’s malicious intent;
• damage was received as a result of exposure to radiation, a nuclear explosion, military action or during the seizure of the car by government authorities;
• the circumstances under which the car was damaged are unknown (in this case, the insurer simply cannot establish the existence of an insured event);
• damage was caused when loading or unloading a vehicle or when renting it out without the consent of the insurer;
• the insurance company will refuse to repair damage caused to uninsured additional equipment (for example, you insured a car with summer wheels, but the damage was caused by winter ones);
• Damage to parts that required repair before insurance is not paid for (for example, if you insure a car with a dent on the fender, the insurance company will not pay for future repairs of this fender);
• car theft along with registration documents, ignition keys.

Depending on the terms of insurance, there may be other reasons for refusal to pay insurance compensation.

How long does it take for an insurance company to pay out insurance and compulsory motor insurance?

Insurance companies often delay the processing of applications for insurance compensation. How to determine the period within which the insurer must pay?

In terms of compulsory motor liability insurance, this period is clearly regulated by law.- no more than 20 days, excluding official holidays, from the date of submission of the last document and inspection of the car by an independent expert organization.

The terms for voluntary insurance are established by the insurance rules and, as a rule, do not exceed two weeks. When thinking about which insurance companies pay out in cash, there is no doubt that the ones we are considering in this article can and should do so. But we’ll talk further about what to do if the insurance company does not pay the money on time.

The insurance company does not pay: procedure

If you receive a denial of an insurance payment, you need to calmly, putting aside your emotions, examine it for legality. If, from your point of view, the refusal is not legal, then first you should contact the insurance company for negotiations.

To reinforce your intention, you must indicate the insurance policy number, the circumstances of the event and the reasons for your disagreement with the refusal. The claim must be prepared in two copies: one copy is transferred to the insurance company, the second remains with you.

Important obtain confirmation of document acceptance from the insurer, this can be done by asking for an incoming number and stamp on your copy. In case of refusal to accept the claim, you can send the document by valuable letter with notification.

Obtaining confirmation of an attempt at pre-trial settlement is an important point if in the future you intend to go to court to protect your interests (see)

After all, for compulsory motor liability insurance, for example, the Law establishes no alternative, and if you cannot prove to the court that you filed a claim with the insurer, the judge will leave your case without consideration.

What to do if the insurance company repeatedly refuses to pay? There is another option for pre-trial settlement - a complaint against the insurer’s decision to the insurance supervisory authorities.

In the case of compulsory motor liability insurance, it is necessary to file a complaint with the Russian Union of Auto Insurers and the Central Bank of the Russian Federation, in the case of CASCO - only with the Central Bank of the Russian Federation, since RSA deals only with motor vehicle issues.

The supervisory authority will request the necessary documents and explanations from the insurance company. If violations of current legislation or insurance rules are detected, the regulator will oblige the insurer to reconsider its decision to refuse.

If you still cannot resolve the dispute peacefully, and you are confident that you are right, you should definitely go to court to protect your interests.

The first step will be the preparation of the necessary documents, the list of which is as follows:

• statement of claim;
• receipt of payment of state duty;
• a copy of the insurance contract and receipt confirming its payment;
• copies of documents submitted to the insurance company during the initial application;
• a copy of the letter of refusal to pay;
• a copy of the pre-trial claim and its response;
• a copy of documents confirming ownership of the damaged car and a civil passport;
• a copy of the representative's power of attorney.

It is worthwhile to dwell in detail on the contents of the statement of claim. It must indicate:

• name of the judicial authority;
• name of the plaintiff (full name, residential address, contact telephone number);
• name of the defendant (name of the insurance company, location address);
• circumstances of the case;
• claims (amount of damage, penalty, legal costs, etc.).

For information on how to file a claim in court against an insurance company under CASCO, read the article.

The above set of documents is prepared in two copies, one of which is sent to the defendant. Where should I go with this?

So, now with a prepared claim you need to go to court at the location of the defendant - the insurance company. Within 5 days, the court will review the submitted documents and, if the package was prepared correctly, will issue a ruling to accept the statement of claim for proceedings. After this, all that remains is to wait for the trial date to be set.

If you have received a refusal to pay insurance compensation from Rosgosstrakh

Rosgosstrakh is one of the largest insurance companies in Russia; a huge number of concluded contracts and the presence of sales offices in all regions of the country encourage the insurer to refuse payment for sometimes far-fetched reasons.

Being a virtual monopolist of the insurance market in many remote corners of the country, the company is not afraid of losing a client.

When preparing documents about an accident for Rosgosstrakh, be extremely careful, because The insurer often refuses on this basis, for example:

• not fully completed European protocol, if the registration of an accident occurs without the participation of police officers. Fill out all available fields, do not forget to indicate that 2 cars were involved in the accident, and no property or health was damaged. Be sure to draw a diagram of the incident and describe all visible damage to the cars, then, together with the second participant, sign your signatures on the front side of the document. Next, each participant in the accident must fill out the back side of the notice, describing the circumstances of the incident there; the culprit admits his guilt in writing.
• errors in traffic police documents. Check the certificate issued to you immediately at the scene of the accident. Rosgosstrakh will find fault with the document if it finds errors in the full name. drivers, the name of the car or its state and identification (VIN) number. In addition, the certificate must indicate the degree of guilt of both participants and the traffic rule violated by the culprit.
• incomplete set of documents. The list of mandatory documents is fixed in clause 3.10 of the OSAGO Rules. If only the car is damaged, this list includes:
  • identification card of the payment recipient;
  • power of attorney to receive funds (if the compensation is not received by the owner of the car);
  • bank details for transferring insurance payments;
  • certificate of accident (form No. 154);
  • notification of an accident;
  • copies of the protocol, resolution, determination, if any of these documents were compiled by traffic police officers.

    This can be clarified in the accident certificate - if there is a checkmark next to the name of the document, it means that the document was drawn up and is required to be submitted to the insurance company.

Do not start repairing your car until it is inspected by a representative of Rosgosstrakh or an independent expert on behalf of the insurer. Also, before the inspection, you should not change the picture of the consequences of the incident (remove the bumper, adjust the fender so that it does not rub against the wheel). These two actions will result in a denial of insurance benefits.

Another typical reason for refusal of payment from Rosgosstrakh- non-contact road accident. An example of such an accident is as follows: while avoiding a collision with another vehicle, the driver makes a maneuver and crashes, for example, into a tree.

In this case, two cars will be involved in the accident, but only the victim’s car will be damaged. Under such circumstances, Rosgosstrakh, unfortunately, will almost completely refuse insurance payment.

If you have received a refusal to pay insurance compensation from Rosgosstrakh, do not worry and first of all carefully read the reason for the refusal and if it does not comply with the law, feel free to defend your rights, and the above instructions will help you with this.

Conclusion

Experience shows that refusal of insurance payment is not always justified. Having refused payment, the insurer is often confident that a legally unsavvy consumer will not argue.

At the same time, it is simply necessary to defend your rights! Having realized that the policyholder is serious, many insurance companies will prefer not to bring the matter to court, but to fulfill their obligations voluntarily.