An insurance company, including Rosgosstrakh, formalizes a refusal to pay under compulsory motor liability insurance in writing with a mandatory indication of the reasons. A written refusal to provide MTPL insurance, however, does not mean that the actions of the insurance company are lawful. What to do if the insurance company refuses to pay?

Compensation for compulsory motor liability insurance in Rosgosstrakh

Rosgosstrakh is the largest insurer on the Russian insurance market. It has not been state-owned for more than 15 years, and for 9 years it has been operating without any state participation, being an ordinary private public joint-stock company. Therefore, the company pays compensation for motor vehicle insurance in the same manner and amounts as other insurers - within the limits of the insurance compensation fixed by Art. 7 Federal Law No. 40 “On OSAGO”:

• 500 thousand rubles in respect of personal damage;
• 400 thousand rubles in respect of property damage;
• 100 thousand rubles in respect of damage in an accident registered without the participation of the traffic police.

Pay attention!

These are the maximum amounts. The specific amount of compensation is determined separately based on the results of a visual inspection of the damaged property and an independent expert opinion.

According to clause 4.15 of the OSAGO Rules, approved. Central Bank Regulation No. 431-P, the amount of compensation for damage to property is determined by:

• in the form of the cost of damaged property at the time of the collision, if repairs are impossible or cost more than the cost of the vehicle;
• in the form of the cost of restoration of the vehicle to restore it to its condition at the time of the accident.

Pay attention!

Compensation is calculated based on average prices in the victim’s region of residence. In this case, the wear of parts/assemblies/assemblies can be taken into account, reducing their base cost to a maximum of 50%. All this may lower the cost of compensation compared to the expectations of the policyholder.

As for the amount of compensation for personal injury, it is determined in the form of the cost of treatment expenses incurred. In case of loss of ability to work, additional compensation may be paid as a percentage of average monthly earnings corresponding to the degree of loss of ability to work.

In what case is insurance payment due?

Payment of compensation under the civil liability insurance program for drivers in Rosgosstrakh is due to the injured party only in the event of the occurrence of a special event - an insured event, if as a result of the occurrence of such an event harm is caused to the injured party. Under an insured event, according to Art. 1 Federal Law No. 40, the fact of civil liability of the vehicle owner for damage to life/health/property due to the use of such a vehicle is understood. This is an accident that results in property or personal damage to the injured party.

Pay attention!

According to clause 15.1 of Art. 12 Federal Law No. 40, if the car damaged in an accident is owned by a citizen of the Russian Federation and registered on Russian territory, the priority form of insurance compensation is restoration of the vehicle at the expense of the insurance company.

Reimbursement in the form of payment in this case is possible in exceptional cases specified in clause 16.1 of Art. 12, namely when:

• complete destruction of the vehicle;
• death of the injured driver;
• causing serious or moderate damage to health;
• disability of the victim;
• the cost of restoration repairs exceeds the maximum amount of compensation;
• reaching an agreement between the parties.

In case of personal injury, it is compensated exclusively in monetary form.

How to receive payments under compulsory motor liability insurance in Rosgosstrakh in case of an accident

In the event of an insured event, in order to receive compensation, the injured driver must contact his insurer for direct compensation, if only property was damaged in the accident, referring to clause 1 of Art. 14.1 Federal Law No. 40, or to the insurer of the culprit of the accident, if personal damage was also caused.

The appeal is made in the form of an application in the form approved. Appendix No. 6 to Central Bank Regulation No. 431-P, and a package of documents including:

• copy of passport;
• notification of an accident;
• copies of the protocol/resolution on an administrative offense or a ruling on not initiating a case on an administrative offense, if the accident was registered by the police;
• bank details for transferring compensation;
• other documents specified in clauses 4.1, 4.2, 4.4 - 4.7, 4.13 Rules.

After the driver submits an application, a representative of Rosgosstrakh has the right, within 5 days, to demand the presentation of the car for inspection and examination. From the moment the application is received, the insurer has 20 days to carry out all necessary measures and make a decision on insurance compensation or refusal of it - clause 21 of Art. 12 Federal Law No. 40.

Rosgosstrakh refused to pay under OSAGO

If a decision is made to refuse insurance compensation, the insurer, within the same 20-day period, is obliged to send the applicant a written notice justifying the reasons for making such a decision. If the deadlines for sending a reasoned refusal are not met, the insurer is charged a penalty amount of 0.05% of the statutory insurance amount for each type of insurance for each day of delay.

The law allows the insurer to lawfully refuse compensation in the following cases:

• the driver did not present the car to the insurer at his request within the specified time frame - para. 4 clause 11 art. 12 Federal Law No. 40;
• restoration repairs were carried out before the inspection/expertise or the presented materials do not allow us to reliably establish the fact of an insured event and the amount of damage - clause 20 of Art. 12 Federal Law No. 40;
• the driver applied to the RGS in violation of the deadlines;
• the driver staged an accident to obtain insurance - Art. 963 Civil Code;
• the driver did not take available measures to reduce the amount of damage - clause 3 of Art. 962 Civil Code;
• the damage was caused by military actions, civil conflict and other circumstances specified in Art. 964 Civil Code.

What to do if the insurance company refuses to pay under MTPL

If the RGS refuses to compensate for damage in an accident, the injured driver is recommended to conduct an independent examination of the damage. It will be required if the Investigative Committee questions the fact and circumstances of the damage or in the event of failure to reach agreement on the value of the damage.

After receiving the results of the examination, the driver sends a written claim to the RGS regarding the insurer’s fulfillment of its obligations under the insurance contract. Its submission is a mandatory stage in the pre-trial settlement of disagreements between the parties. The requirements for its content are defined in clause 5.1 of the OSAGO Rules. In addition to other details, it fully describes the requirements for the insurer with a description of the circumstances that led to the filing of such a claim.

Pay attention!

The claim must be considered within 10 days, after which the applicant’s demands are satisfied or denied.

Where to go if Rosgosstrakh refuses to pay under OSAGO

If the insurance company continues to refuse to pay, we recommend preparing a statement of claim to the court. Through it, the injured party can recover from the RGS the amount of compensation, penalties, moral damages under Art. 15 Federal Law No. 2300-1 “On the Protection of Consumer Rights”, as well as a fine of 50% of the unpaid amount - clause 3 of Art. 16.1.

Pay attention!

Under the agreement with the insurance company, the policyholder is recognized as a consumer, therefore he has the right under Art. 17 Federal Law No. 2300-1 file a claim in court at your residence address, and also avoid paying a fee for filing a claim if the amount of the claim does not exceed 1 million rubles.

• the prosecutor's office;
• Rospotrebnadzor;
• Russian Union of Auto Insurers;
• Central Bank.

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 quickly 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 payment 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.

Every vehicle owner must purchase compulsory motor insurance. Every driver should know not only how to correctly record an insured event, but what to do if, after an accident, a refusal to pay under compulsory motor liability insurance is received. In this article, we will consider what are the legitimate reasons for refusing to pay insurance compensation and what to do if the insurance company has refused to pay under compulsory motor liability insurance step by step.

Legitimate reasons for refusal

There are various legal grounds for refusing payment under compulsory motor liability insurance. Each victim should study them carefully. As a rule, all the nuances listed below are specified in the rules that are issued to each client when applying for insurance.

Legitimate reasons:

Expired policy	Very often, motorists remember about extending their MTPL agreement only when they are stopped by traffic police officers or an emergency occurs. If the contract has expired, the insurance company may legally refuse to transfer money to the victim. In this case, the injured party can receive money for repair work only from the culprit.
The driver is not included in the insurance	Since the driver’s liability is insured under the contract, the financial institution will not send money to the victim if the culprit of the accident is an uninsured driver. Unfortunately, some drivers entrust their car to third parties, in the hope that nothing will happen.
Incorrectly recorded case	Some drivers have heard about the European protocol, but do not know at all how to correctly record an insured event. Very often, drivers are refused because they do not call the traffic police and contact the insurer’s office 5 days later.

It is important to understand that the insurance organization is obliged to provide a refusal in writing. It must indicate:

• full name of the company;
• manager's name;
• case number;
• vehicle characteristics;
• reason.

Unlawful grounds for refusal

Unfortunately, many drivers are faced with a situation where an insurance company has illegally refused to pay under compulsory motor liability insurance. In this case, you should not give up and pay for repair work using your own savings. You should always try to get the insurer to transfer the money. Our consultants on the website can help you receive a payment and will tell you what needs to be done.

In practice, an unlawful refusal of insurance payment under compulsory motor liability insurance is received if:

The driver is drunk	Very often, insurance companies do not want to transfer funds due to the fact that the driver was under the influence of alcohol or drugs. In fact, according to the rules, the insurance company is required to transfer funds to the injured party.
The guilty party disappeared	If the guilty party was identified, but fled the scene of the accident, then the insurer is also obliged to pay funds to the victim. In practice, organizations often do not transfer funds voluntarily.
The company's MTPL insurance license has been revoked	It is important to know that an organization whose license for compulsory motor liability insurance has been revoked is obliged to make payments under all concluded contracts and bear responsibility for several years. Of course, there are exceptions when the insurer completely withdraws from the financial services market. In this case, a legal successor is appointed to whom all contracts for which she will be liable are transferred as a result of the occurrence of an insured event.

These are the most common unlawful reasons for refusal of payment under compulsory motor insurance to injured motorists.

What to do step by step if the insurance company refuses to pay

If the insurance company does not want to make a payment under compulsory motor liability insurance, then every victim should know what needs to be done. We offer a step-by-step procedure for those who illegally received a negative decision on compensation.

Step by step guide:

Receiving a refusal	The insurance organization must provide a written refusal, which clearly states the reason. It would be good if the insurer not only indicated the reason in writing, but also wrote down a clause in the rules according to which it would not transfer money for restoration repairs.
Learning the rules	You must make sure that the insurance company actually denied it illegally. To do this, you should carefully study the rules and law. If necessary, you can get advice from an experienced expert on our website, who works around the clock.
Drawing up a pre-trial claim	If, after studying the rights, it is clear that the financial organization is refusing payment under compulsory motor liability insurance illegally, then a pre-trial claim should be filed. The document must indicate the amount of damage received, the clause of the rules according to which it is necessary to transfer money and personal account details. It is also necessary to indicate the time frame within which the insurer is obliged to either pay the funds or provide a second refusal.
Going to court	Only after receiving a second refusal can you file a claim and go to court. You can go to court either yourself or entrust this to an experienced lawyer. If you win, the insurance company will pay for the lawyer's services. In practice, the court always takes the side of the victim if the refusal is granted illegally.
Receiving compensation	After the court decision is made, you will be given a writ of execution, with which you need to contact the bank where the insurer has an account and write an application to receive funds to repair the car. You can also contact the bailiffs with a writ of execution, but this is used extremely rarely.

The entire procedure for obtaining compensation, as a rule, lasts no more than 14 working days. If necessary, you can always get advice from a specialist on our website, who will tell you your rights and how to correctly file a claim in court. Sign up for a free consultation in a special form.

The insurer was not notified on time

The rules clearly state that the guilty party must notify the insurer of the occurrence of an insured event within 5 working days (according to the European protocol). If the accident was recorded by the traffic police, then you can apply on any day convenient for you, since the statute of limitations in this case is 3 years.

The company is not always obliged to refuse the victim if he applied for payment 5 days later, and there is no official confirmation from the traffic police officers. In such a situation, the insurer is obliged:

• request a compulsory motor liability insurance agreement form;
• Europrotocol;
• a statement stating the reason why the guilty party failed to apply in a timely manner.

Only after accepting the application should the insurance company announce its decision. If the case is recognized as an insurance case, refer the victim to an independent expert to assess the damage. If you refuse, you should prepare an official document and send it to the client by registered mail or hand it in person against signature.

Let's consider an example where the victim was unable to contact the office in a timely manner. For example, Ivan parked his car and went on a business trip for 10 days. At this time, Ilya was parking in the parking lot and hit Ivan’s car. Since Ivan is on a business trip, Ilya left all his coordinates to the guard and additionally took photographs of the accident scene. Upon his return, Ivan received the information, contacted Ilya and immediately contacted the office for payment. In such a situation, the company does not have the right to refuse the client.

The culprit fled the scene of the accident

But what to do if the party responsible for the accident escaped? In this case, there is only one way out - to look for the culprit. If it is found, the insurance company will be required to pay compensation. Until this happens, the insurer cannot transfer funds to the victim for restoration repairs.

The thing is that the liability of a particular driver is insured under a mandatory contract. When making a payment, insurers recover the money spent from the company where the liability of the perpetrator was insured. It turns out that if there is no culprit, then there is no one to ask for money back. In this case, companies do not agree to make payments from their own budget and refuse on legal grounds.

The culprit has no insurance

Very often, drivers forget to purchase or renew a compulsory insurance form. In the event of an accident, all expenses, in this case, will be borne by the culprit himself.

In this case, the guilty party can:

• voluntarily transfer money;
• after the court's decision.

In the first case, the victim must offer the culprit to pay for the assessment of an independent expert and transfer the amount of the loss to his personal account within the agreed period.

In the second case, you should prepare a legal claim, attach an assessment by an independent expert and an official resolution from the traffic police. Since the assessment is done at your own expense, payment receipts should be attached, since all expenses must be compensated by the person responsible for the accident. All documents are submitted to the court, after which a decision is made and a time frame is negotiated within which the guilty party is obliged to transfer money to the injured driver.

In practice, it is through the court that victims seek money to pay for the restoration of their vehicle.

The culprit has a fake policy

Unfortunately, fake MTPL policies are not uncommon. In practice, payments under compulsory motor liability insurance in Rosgosstrakh are reduced, since every fifth driver bought a fake policy. This is the most unpleasant situation for the culprit, since all losses can be assigned to him.

In this case, the perpetrator must:

• write an application to the insurance company and indicate how the contract form was drawn up;
• duplicate the application to the RSA or the Central Bank;
• file a claim in court and wait for the results of the investigation.

Not to say that often, but sometimes the court sides with the culprit and obliges the insurer to make a payment. Typically, this happens if the policy was sold through an official partner, broker or agent. However, many drivers refuse to submit an application because they are absolutely sure that they will receive a negative decision on compulsory motor liability insurance in court.

Refusal after trace examination

First of all, it is worth understanding what a trace examination is under compulsory motor liability insurance. Traceological examination is a procedural action, as a result of which an authorized employee conducts an examination of material elements in order to identify evidence of the occurrence of an insured event.

An insurance company can order such an examination. If you receive a refusal, you must request the results of the examination, write a claim and go to court. Very often, in court it turns out that the examination was carried out with violations. In this case, the injured party receives not only money for repairs, but also payment for moral compensation.

Refusal for registration under the European protocol

It is worth noting that in most cases, insurers refuse precisely because the victim applies under an incorrectly drawn up European protocol. The company can refuse:

• if there are no photographs from the scene of the accident;
• The European protocol form is filled out incorrectly;
• the form contains inaccurate data (errors);
• on the correction form.

The easiest way to fix everything is to ask the culprit to redo the document so that the company can make the transfers. But what to do if payment is refused and the culprit cannot make changes to the document? In this case, all that remains is to defend your rights in court. However, judicial practice in this case does not always side with the victim.

To summarize, it should be noted that any insured event should be recorded correctly. If in doubt, you should always call the traffic police and officially record the accident. Experienced insurers also advise carefully studying the company where you plan to apply for compulsory motor liability insurance. Before applying, you should carefully study the rating of insurance companies for refusal of payments and only then make a decision.

If you have been rejected by an insurance company, we invite you to leave a review and tell other readers about your experience. We will also be grateful if you tell us how you sought justice and defended your rights.

And of course, the services of your consultant will always help you, who is ready to help around the clock on any issue related to insurance.

We also suggest watching a video on the topic, which describes the most popular reasons for refusal under a mandatory contract.

It is also very important to know in order to get justice from the insurance company in court.

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.