Allowed people to protect themselves from sudden expenses associated with treatment and life after an accident.

Personal injuries occur frequently in varying degrees of severity, but winter is a busy period for falls and injuries.

Each insurance company has different conditions, but the main points simply vary in terms of the amount of payments and periods for providing documents.

Types of injury insurance

Bodily injuries covered by insurance are considered an accident because they do not depend on the wishes and capabilities of the victim. If the event led to death, then this applies to another type of protection -.

Such an event occurs suddenly and entails a violation of the integrity of the human body, a malfunction in its work or limited functionality.

Common injuries that are considered an insured event include:

• bone fractures;
• hematomas, soft tissue bruises, ruptures of nerve connections, violation of the integrity of tendons, dislocations;
• damage to internal organs as a result of a blow or fall, including eyes, hearing organs, partial or complete loss of them;
• burns and frostbite;
• any surgical interventions that were performed as a result of injury.

A list of more detailed types of injuries that are covered by insurance is in the general table. A similar list is compiled by each individual insurance company, but only indicating the percentage of payments from the total amount of the contract.

№№	Damage related to the insured event
1	Bruise, rupture of the spinal cord.
2	Damage to the skull, including hemorrhage and surgery.
3	Rupture of any type of nerve.
4	Rupture of the sacral, lumbar, brachial, cervical plexuses.
5	Mechanical damage to the eyes, including complete loss of vision, due to an insured event.
6	Deafness due to injury
7	Any damage to the lungs, heart, large or peripheral vessels, or pericardium.
8	Fracture or loss of the jaw and loss of part or all of the tongue.
9	Intestinal adhesions, damage to the esophagus.
10	Removal of the stomach, spleen, liver, pancreas completely or only part.
11	Burns of skin and other soft tissues starting from the 2nd degree and more than 20% of the body area. Sunburn is not an insured event.
12	Fractures of bones (pelvis, hip, knee joints, legs) and loss of phalanges of the fingers.
13	Traumatic loss of teeth, more than three.
14	Fracture of more than three ribs.
15	Rupture of the liver, genital organ, abdominal cavity.
16	Minor fractures (fingers, wrist, heel bone), dislocations and bruises.
17	Loss of a small area of ​​small organs (earlobe, soft tissues)

Personal injury insurance contract

If an insured event occurs, the company that provides insurance services pays compensation in monetary terms depending on the severity of the injuries received, according to a mutually signed agreement.

To sign an agreement between an individual and an insurance company, the former needs to provide: his civil passport, tax identification number (TIN) and fill out a form.

This questionnaire indicates the health status of the individual and all family members living with him in the same house, as well as genetic diseases of the immediate generation of ancestors (if known).

By signing the contract, the insured person consents to the verification of this data in the event of an insured event.

After submitting the above documents, the policyholder provides a contract with the details specified in it. A memo is also issued with information about the events that the insurance will cover and the ratio of the percentage of payments for each individual case.

Payment for a personal injury insurance contract can be one-time or monthly, with different validity periods. The most common and inexpensive is accident insurance with a monthly payment and a period of one year.

After the end of the validity period, the contract is considered fulfilled and completed.
If an accident does not occur, the money is not returned to the insured, but otherwise, the contract is closed on the day the insurance is paid, if it was paid in full.

If the compensation was issued in part, depending on the severity of the traumatic injuries, then the contract continues until the specified date, but the amount of the general insurance will be reduced by the amount already issued.

Payment of injury insurance

If an insured event occurs, it must be documented. It all depends on the case itself, the fact of compensation of which will still need to be documented.

Basic documents to be submitted to the insurance company:

• identification document (passport, military ID);
• statement about the occurrence of an insured event;
• original (or copy) of the contract (in case of individual or);
• medical confirmation of injuries received and their specific diagnosis (certificate from the emergency room, sick leave, extract from the medical record).

The remaining documents are provided based on the actual event, that is, if the damage was caused as a result of a traffic accident, then you should provide copies of the administrative violation report, driver’s license, resolution on the involvement of participants in the accident, and other certificates from the traffic police.

If the injury occurred at the workplace, then an additional report is provided.

Depending on the type of contract signed, payments may be made as a percentage of the severity of the damage caused and the validity period of the certificate of incapacity for work.
Each agreement specifies the deadline for submitting an application and the time for collecting all necessary documents.

Some companies practice notification of the occurrence of an insured event by telephone. That is, the insured person can call the company within two to three days after receiving injuries, and provide a written statement and other documents within another period allotted in the contract (average value 5-20 days).

In the process of submitting documents for payment of an insurance policy, the insurer may request additional documents that were not agreed upon before signing the contract. This is necessary for the insurer to verify the authenticity of the documentation, the reality of the injuries and the reasons for their occurrence, that is, whether payment is legally required.

The sooner all requested documents are collected, the sooner the insurer will issue insurance compensation.

How to get payment from personal injury insurance

There are many nuances due to which insurance payments are not issued or are paid partially. Here are some of them.

The declared cost of treatment and rehabilitation cannot exceed the total amount of insurance under the contract. If an insured event occurs that falls under several payment headings, then the cost is summed up.

But their amount should not exceed the total size of the contract. In this case, the insured person receives money only for one, the most expensive, injury or receives the maximum payment (depending on the type of contract).

Damage, no matter how serious, will not be paid if it was received during: the commission of a crime, the insured person being under the influence of alcohol or drugs, or intentional self-injury. And also, in the event of an accident, when the insured person is recognized as the culprit of the accident, unless otherwise specified in the insurance contract.

Repeated injuries are also not covered, that is: repeated bone fractures, the initial occurrence of which did not fall within the period of validity of the insurance policy, dislocations (recurrences) of previously received injuries.

If the authenticity of the documents provided is in doubt and the contrary is not proven in court, then the insured person has no right to receive insurance payment. This also applies to clarifying the circumstances why the insured event occurred.

After receiving and considering all documents and circumstances of the case, the insurance company makes a decision on payment. In any case, she is obliged to notify the insured person of her decision in writing.

Among injuries to internal organs and limbs, the most common case is bruise. It can be the cause of some damage, or it can be an independent injury. You can bruise not only your arm or knee, but also various soft organs. At first glance, this is a fairly harmless case; it does not seem as scary as a fracture. But in fact, the consequences of such damage can be negative and lead to protracted illnesses if the severity of the injury is not detected in time. Cases are different, but each requires diagnosis and attention from doctors. This is why it is worth taking out an insurance policy to protect against injuries and accidents. Cases of bruises are considered individually in the insurance contract.

What is a bruise

You can bruise any part of the body, including internal organs. This means damaging tissues and small vessels without destroying the integrity of the skin and the tissues themselves. Bruises are often combined with sprains, abrasions, etc. The first sign of such damage is a bruise, hematoma and then a slight swelling of the bruised area. In medicine, bruises are assigned different degrees, depending on how badly the victim damaged a particular part of the body. There are four degrees of bruises.

The most severe is the fourth, when changes in the affected organ interfere with the normal functioning of other organs and systems of the human body. Do not think that such an injury is trivial and does not require treatment. If you damage the knee or other hard place on the body, then in addition to a hematoma or as a consequence of it, necrosis and tissue rejection may occur. An injured joint becomes non-functional for a long time, taking a person out of the usual rhythm of life. It is difficult to say immediately whether treatment will be required and how complex it will be. Therefore, an insurance policy can be useful in any case. If you hit your head, it is worth checking to see if you have suffered a concussion. And this is a serious injury.

Compensation for injuries

In accordance with the payment table, if you bruise an organ or limb, you will be compensated from 3 to 10%, depending on the area that was damaged by the victim.

In order to receive compensation for an insured event, you must first write an application for payment to the insurance company. There is a clear deadline for filing an application in the contract itself. It is also necessary to submit documents such as certificates from a medical institution where you recorded the fact of injury and received treatment. The insurance company may request other documents if necessary. The payment is made not to the applicant, but as payment for treatment to a medical institution. Don't delay contacting your insurance company.

The policy will not directly protect against injury, but it will allow you to avoid unnecessary expenses when dealing with the consequences. The insurance guarantees payment to the victim of compensation for material costs during treatment. Protecting life and health from accidents allows you to select individual conditions for each person and include the necessary risks for each case. Depending on the number, type of damage, and their severity, the amount of payments under the policy is calculated. For ease of calculation, a single table of payments for injuries has been developed.

An injury such as a bruise, along with fractures and injuries, is described in the table of payments for insurance claims in great detail, which gives insurance companies clear instructions when calculating the amount for compensation.

Injuries sometimes occur at work, the state protects injured citizens, and compensation is provided for people who have received work-related injuries. The employer can also compensate the employee for part of the salary or the full monthly salary. Read about the legal basis of such relations in the article.

According to Article 5 of the Federal Law on Social Insurance against Accidents at Work, industrial damage includes accidents that occur to an employee at work. Russian legislation provides for financial compensation for work-related injuries in the form of both a one-time and regulatory payment. To receive money, health damage must be documented in accordance with legal requirements. This means that the victim must contact doctors and take sick leave. An industrial injury and the costs associated with it must be compensated by the employer or the Social Insurance Fund.

Work injury payments and compensation 2018

If an employee receives a work-related injury, he or she has the right to compensation for sick leave and rehabilitation from the employer. If severe or moderate damage has been caused to health, affecting the employee’s ability to work, then the amount of compensation is determined by a medical and social examination. It is the employee’s responsibility to enable doctors to determine what harm was caused to the body at work.

The employer also has the right, after an accident at work, to pay the employee additional compensation, which is issued in a separate order or provided for in the agreement/contract.

Procedure for payment of insurance compensation and terms

If an employee was injured at work, the procedure is as follows: within ten days, in order to receive payment for an industrial injury at the enterprise, the employee must collect documents and go to the Federal Social Insurance Fund of Russia, attention: not to the employer. According to the law, a one-time insurance payment is transferred to the employee immediately.

Depending on the duration of the employee’s incapacity for work, you can count on compensation from the employer for temporary loss of ability to work. It will be 100% of monthly earnings and can be either one-time or monthly. Insurance benefits for work injuries can also be temporary or regular. Finally, the employee is also entitled to compensation for moral damages. However, to receive this type of payment, the employee must go to court. Moral damage is not included in the insurance amount.

How is the insurance amount calculated?

The amount of mandatory payment and compensation to the employee from the employer depends on the type of insurance contract, as well as the severity of the damage. For some professions, the amount of payments is regulated by legislation. For example, employees of the Ministry of Internal Affairs who, as a result of an injury, received a disability of the first group receive 1.5 million rubles, the second group - 1 million rubles, the third group - 5 thousand rubles. The insurance company makes the calculation.

Moderate injury

According to Article 111 of the Criminal Code, the following damages and disorders are considered to be of moderate severity:

• long-term health disorder of the employee (work capacity lost for more than 21 days);
• permanent loss of the employee’s general ability to work by less than one third.

Remember that in order to receive payment for this type of damage, the employee must see a doctor.

Compensation for lost earnings due to a work injury for an employee

According to the labor code, payment for lost earnings for an employee from the employer will occur on sick leave. After the incident, the employee was treated and could not work for some time - he is entitled to 100% compensation for absenteeism. If, at the end of the sick leave, the employee returns to work, then, as a rule, compensation is expressed in the fact that the employee receives from the employer at the end of the month his standard monthly salary without any deductions. Or several months' salary at once, if the work injury was serious. Remember that the employer does not have the right to deduct money for sick leave.

How much is a lump sum payment to an employee in case of injury?

A one-time payment to an employee from an employer means compensation for medical expenses in the event of a work-related injury. If we are talking about a serious injury with long-term disability, for example, an eye injury, then the employee can count on compensation from the employer or the Social Insurance Fund for monthly compensation. And a one-time monetary compensation applies exclusively to measures that are necessary in order to restore the employee’s health to the maximum extent possible. It is easy to calculate from documents. The calculation procedure is very simple, we discussed it above.

Monthly insurance payment in case of accident

Unlike car insurance, life and health insurance is relatively unpopular in our country - it is often provided by certain companies or required when applying for dangerous jobs. However, voluntary life and health insurance is a guarantee that if an accident occurs, a person will not be left without finances for existence.

Table of contents:

What are the types of life and health insurance?

Chapter 48 of the Civil Code of the Russian Federation provides for the main features of insurance, including life and health. It refers to voluntary personal insurance.

The Civil Code of the Russian Federation indicates that this insurance can be concluded for the fact of insurance:

• survival
• life
• health

When insuring survival, the insured event is the attainment of a certain age by a citizen specified in the contract with the insurer.

Life insurance means that the moment of payment occurs only in the event of the death of the insured person.

Important fact

A life insurance contract can be term. That is, if the death of the insured person occurs during a certain period established by this agreement.

Health insurance is the most common type of personal insurance. It is often referred to as life and health insurance, since the insured event according to the contract is a certain loss of health or death as a result of an accident, serious illness or other cause directly established by the contract.

In addition to personal life and health insurance, a corporate (group) insurance agreement can be concluded. In this case, the policyholder is a certain organization that makes contributions to the insurance company’s account for its employees.

With group insurance, insurance that is quite popular is not 24-hour, but valid exclusively during the period the employee performs his work duties.

If, with such insurance, a citizen receives a domestic injury, for example, gets into an accident on his day off, insurance payments in this case will not be paid.

Parties to the insurance contract

The following persons may participate in this agreement:

• Policyholder is a person who has entered into an agreement with an insurance company and undertakes to pay the appropriate insurance amounts.
• Insurer is an insurance company acting exclusively as a legal entity.
• The insured person is a citizen in whose favor the insurance contract has been concluded.
• Beneficiary is a person who has the right to receive insurance payments in the event of an insured event.

Often, a personal insurance contract is concluded between two parties - the insurance company and the citizen, who simultaneously acts as the policyholder, the insured person and the beneficiary. Less commonly, another person may be appointed as the beneficiary. For example, this case is popular when concluding a life insurance contract.

Important fact

In practice, often the policyholder and the insured person are separate parties to the contract when concluding a group insurance contract or an individual insurance contract concluded by an employer in favor of its employee.

Who can receive payment from life and health insurance?

According to the general rules, the insured person has the right to receive payments (compensation) in the event of an insured event. However, Article 934 of the Civil Code of the Russian Federation establishes that in addition to the insured person himself, a third party (beneficiary) can receive payment if he is indicated as such in the contract.

note

Even if the contract does not indicate a third party as a beneficiary, in the event of the death of the insured person, when the cause and occurrence of death is an insured event, insurance payments are received by the heirs in the form of an inheritance inherited by law.

How to receive compensation for life and health insurance, sample

When an insured event occurs under the contract, in order to receive the appropriate payments, it is necessary to perform a number of specific actions.

First, you need to prepare an application to the insurance company to receive an insurance payment. Often, when concluding a contract, the insurance company provides the appropriate form. If there is no such form, then you should draw up a document yourself or fill out a standard sample.

• Passport or other identification document of the insured person
• Copy or original of the contract
• If there is a beneficiary, documents confirming this right. In the event of death in the absence of a beneficiary, it is necessary to provide a document confirming the right to inheritance of his heirs applying for payment.
• A document confirming the moment of occurrence of the insured event

The last document is the most important and may vary depending on the type of event that occurred and the type of personal insurance contract. The most popular documents in the case of health insurance in practice include:

• Conclusion or certificate from the attending physician;
• Certificate of disability
• Conclusion of the commission on an industrial accident
• Traffic police report on the occurrence of an accident.
• If a citizen died as a result of an insured event established by the contract, a death certificate must be provided in addition to the documents specified above.

Important fact

Often, in addition to the application form, insurance companies, when concluding a contract, issue relevant reminders about what needs to be done in the event of an insured event.

After collecting all the necessary documents, you must contact the insurance company directly and notify about the occurrence of an insured event. As a general rule, the notice period is no more than 30 calendar days.

note

The specified period is not final. Often, the insurance contract specifies the possibility of its extension, for example, if the applicant is unable to submit documents due to serious illness or other force majeure. However, in order to avoid possible disagreements, it is better to notify a representative of the insurance company in advance about the extension of the period.

The procedure for consideration and payment of insurance

However, the review process may be delayed if the insurance company has suspicions, for example, that the submitted documents are not forgeries or if a criminal case has been initiated regarding the insured event and a final decision has not yet been made.

Payments are usually made within no more than 15 days from the moment the insurer recognizes the occurrence of an insured event.