When can an insurance company refuse to pay out? The insurance company refuses to pay for OSAGO - only the court will help? Grounds for refusing to pay for OSAGO

Or were additional services imposed during its registration? Did you set a date for submitting a package of documents and issuing a policy in a month or two after the expiration of the current insurance policy? These actions of the insurer are illegal, and it is possible and necessary to call him to order.

Why don't insurers sell OSAGO policies?

Insurance companies have arranged an artificial shortage of autocitizenship forms for exactly one reason. OSAGO insurance has become unprofitable, or even simply unprofitable. Thus, for the first quarter of 2014 in three regions of Russia: Amur, Ulyanovsk and Murmansk regions - payments reached 90% of fees, and in the Kamchatka Territory the amount of payments exceeded the amount of collected insurance premiums and amounted to 107%.

At the beginning of the year, insurers everywhere began to close their representative offices in anticipation of an increase in tariffs due to summer changes in legislation.

The law on OSAGO has been updated, the schedule for changing tariffs for the year has been approved, and the procedure for establishing base tariffs and adjustment factors has been given to the Central Bank of the Russian Federation. However, the situation remains critical in many respects.

What does the legislation of the Russian Federation say?

During the first half of 2014, the Federal Antimonopoly Service registered 1,500 complaints from car owners against insurers in 66 regions of Russia. Insurance organizations everywhere refuse to issue an OSAGO policy and impose additional services. 47 insurers received warnings, 34 cases were initiated, and the court has already ruled on 27 violations. And the verdict is always the same: the insurer is wrong.

The list of unscrupulous companies included: Ingosstrakh, VTB Insurance, Yugoriya, ASKO, Renaissance Insurance, Rosgosstrakh, AlfaStrakhovanie, VSK, ZHASO, SOGAZ, Alliance, BASK, Guta -insurance", MAKS, SG MSK, "RESO-guarantee", "Consent", "Zurich", "UralSib". The Ministry of Finance on its website published an unambiguous position on this issue and offered the car owner a sequence of actions in case of an unlawful refusal.

So let's look at the laws:

Federal Law No. 40-F3 "On Compulsory Insurance of Civil Liability of Vehicle Owners" dated April 25, 2002 states that the owner of the vehicle is required to have an OSAGO policy.
In Art. 426 of the Civil Code of the Russian Federation and art. 1 of Law No. 40-F3 emphasizes that the OSAGO agreement is public. I.e the insurer is obliged to conclude a contract with everyone who applies to him. Refusal is not allowed.
In paragraph 2 of Art. 16 of the Law of the Russian Federation No. 2300-1 "On Protection of Consumer Rights" (dated February 7, 1992) states that the conditionality of the acquisition of some goods by the obligatory purchase of others(in other words, the imposition of additional goods and services) forbidden.
Clause 14 of the OSAGO Rules says that the car owner has the right to freely choose an insurance company. The latter, upon receipt of a package of documents and a written application, does not have the right to refuse to provide this service.

According to Federal Law No. 223-FZ of July 21, 2014, unjustified refusal of the insurer to conclude public contracts and the imposition of additional services not stipulated by federal law, entails administrative responsibility. Corresponding changes have been made to Art. 15.34.1 of the Code of the Russian Federation on Administrative Violations.

Punishment: a fine of 50,000 rubles imposed on the official who committed the offense.

The competent authority is the Central Bank of the Russian Federation, the mega-regulator of the insurance market. The heads of territorial subdivisions are authorized to resolve issues of control and supervision in the field of financial markets, incl. insurance.

We summarize.

The car owner can apply to any insurance company.
The insurer is not entitled to refuse to sell the OSAGO policy.
It is also illegal to force you to buy additional options (for example, the life insurance policy of the insured or drivers included in the policy).

If this happens, then, according to paragraph 4 of Art. 445 of the Civil Code of the Russian Federation, an insurance organization is forced to conclude an agreement in court and compensate for losses caused to the car owner by its refusal.

Remark RSA

At the end of September 2014, the RAMI published the "Procedure for notifying insurance companies of the refusal to conclude an OSAGO agreement for RAMI vehicle owners." It is based on paragraph 7 of Art. 15 of the law on OSAGO, which states the obligation of the insurer to issue a written refusal and notify the higher authorities - the Central Bank and the RSA. From the entire document, we are interested in the list of acceptable grounds for refusing to issue a car citizen. Among them:

lack of communication with AIS RSA;
failure to present the vehicle for inspection (can be carried out both at the location of the insurer and at the place of residence of the insured);
failure to submit a complete set of documents required by law;
lack of a power of attorney to conclude an insurance contract on behalf of an individual entrepreneur or legal entity.

However, the lack of communication with the base will still need to be proved, and after its restoration, invite the client (in writing!) To conclude an agreement. The issue of not presenting the car for inspection is also controversial, since there is a diagnostic card that serves as the basis for selling the policy. In general, it is possible to discuss whether the grounds for refusal given by the PCA do not contradict the Law of the Russian Federation. And the fact that the courts, when considering cases, will appeal only to officially approved norms, does not raise any doubts.

The procedure for purchasing an OSAGO policy

Since the OSAGO agreement is recognized as public, the desire of one of the parties is sufficient to conclude it. There are several options for purchasing a policy.

When contacting the insurance company in person, ask for a written refusal. Oral you will not be able to present anywhere.
When sending an offer-offer by the Russian Post (an application in the appropriate form approved by the Ministry of Finance of the Russian Federation on July 1, 2009) with a package of necessary documents attached, a notification of delivery is given. In case of refusal, it will serve as proof that the insurer has received the offer.

14 working days are allowed for its consideration, as well as execution and sending of a response to the insurer. The response might be:

about acceptance (acceptance),
about the refusal
acceptance on other terms.

What to do if denied?

If you do not agree with the insurer's response, you have the right to appeal against its actions. To do this, you need to apply in writing, attaching correspondence with the insurance company or a written refusal. A package of documents must be sent to one of the authorities:

territorial subdivision of the Central Bank of the Russian Federation;
court at the place of residence;
prosecutor's office;
department of RSA;
Federal Antimonopoly Service, address: 123995, Moscow, D-242, GSP-5, Sadovaya-Kudrinskaya, 11.

Usually, when you personally contact the insurer and threaten to transfer a written refusal to one of the above organizations, the insurance company finds an opportunity to conclude an OSAGO agreement. And the desire appears, and the forms are found, and the issue is resolved in a pre-trial order.

What documents are needed to challenge a denial?

Firstly, written statement from the insured(proposal-offer) on the conclusion of an OSAGO agreement. The copy that remains with the car owner is stamped, dated and signed by the person who accepted the application.
Secondly, insurer's written waiver. Needed to contact the competent authorities.

What to do if there is no time to argue?

Russian judicial system pretty inflexible. It takes several months, or even six months, to consider even the simplest case. It is clear that not everyone is ready to endure lengthy judicial debates, and certainly no one has the opportunity to live without insurance, waiting for the insurer to be forced to conclude an OSAGO agreement. If you are required to buy an OSAGO policy along with an additional insurance product, the procedure is quite simple.

Invite a witness and, in his presence, ask a representative of the insurance company to draw up a written disagreement in the design of a "car citizen" without a load.
On the basis of this paper, write a claim to the insurer demanding the termination of the imposed additional insurance contract and the return of the full amount of the premium paid.
If denied, submit statement of claim to court.

If you are not being sold a policy, then there is a very dubious path. The desperate can follow it.

Since, by law, an OSAGO insurance contract is public, the very fact of a written request from a potential insured can be considered as a fact of concluding a contract. To do this, the application-offer should be sent to the insurer by mail.
If the car gets into an accident, then on the basis of this application and a notice of delivery, damages should be collected from the insurance company.

Obvious disadvantages of such "amateur activity".

According to the Rules of Insurance, the contract comes into force after the payment of premiums by the insured (the full amount or a certain part of it). So the insurer has the opportunity to legally evade payment insurance compensation unless the Supreme Court awards otherwise.
The traffic police inspector, having stopped the car, will not be satisfied with a copy of the application-offer and confirmation of its receipt by the insurer. Firstly, this, whatever one may say, is not an OSAGO policy. Secondly, a logical question arises about the serviceability of the vehicle and the possibility of its operation.
Even if the self-made "policy" indicates that this is a duplicate, valid until the issuance of the original, it will take a lot of time and nerves to communicate with the inspector. Possible options development: a fine, removal of numbers, a ban on participation in road traffic.

Perhaps a few dozen precedents will create a reliable basis for a quick resolution of such issues, but so far the development of events according to this scenario has not been recorded.

This does not mean that car repairs will have to be done at your own expense. It is necessary to find out the reasons for such a decision and, accordingly, take actions to resolve the situation.

Which party's insurer should pay out

The insurance organization is obliged to compensate the received damage to its client in the event of:

The presence of two sides of the accident;
When no damage has been done to human health and life;
The culprit has been identified and his guilt is not protested.

In other situations, the obligation to pay insurance falls on the company - the holder of the insurance contract of the guilty party.

If the organization with which the OSAGO is concluded refuses to make a payment, then it will not be possible to apply to another.

In most cases, payments are made by the insurer of the guilty party. If you still manage to get a refund from your own insurer, he will later collect this amount from the organization that issued the policy to the culprit of the accident.

In accordance with the Rules of Compulsory Insurance, situations are established when compensation for damage is not made. This applies to cases that have occurred:

With the intent of the injured party;
Due to force majeure circumstances;
From the reaction to a nuclear explosion;
Due to hostilities, civil unrest.

The reasons may be simpler situations that are not recognized as insurance. Damage will not be compensated in cases where:

The damaged car is not insured under OSAGO;
The owner of the car has performed any actions with it, due to which it is impossible to assess the damage;
Notifying the insurer in a timely manner;
Submission of an incomplete list of documents;
Infliction of exclusively moral damage or loss of profit;
The insured situation occurred while learning to drive or during the competitive process;
The damage is done environment;
Harmful consequences have been caused due to the cargo being moved, if the probability of its occurrence should be insured with a separate option;
Damage is caused to an employee when such consequences should be provided for by another agreement;
The driver caused damage to the vehicle and the transported cargo;
The employee caused damage to the employer;
Carrying out loading operations caused damage;
Antiques and antiquities affected, including immovable objects, precious items, works of art and religious beliefs;
The damage was sustained by passengers who had to be insured separately.

It should be noted that there are not so many reasons for refusal, and many of them are specific.

What reasons cannot serve as grounds for refusing to pay compensation

There are situations when the company that issued the policy cannot refuse to pay compensation. These are the cases:

Intentional harm to human life and health by the culprit of the incident;
Finding the guilty participant under the influence of alcoholic, psychotropic and other substances;
Lack of a driver's license from the guilty party;
Departure from the scene of an accident by the person who caused harm;
The citizen who drove the car, due to whose actions the damage was received, is not indicated in the policy;
The occurrence of the incident at a time not stipulated by the contract;
Failure to timely submit a notice of an accident to the insurer;
Failure to present the car for examination by the culprit of the accident;
The person who caused the accident restored or performed other similar actions with the transport before the expiration of a period of 15 days from the date of the accident;
Lack of a valid diagnostic card;
Submission of false data of the electronic policy by the culprit of the accident;
Submission of an incomplete package of documentation established for each specific situation;
Committing an accident due to a malfunction of the car, not installed in the diagnostic card during the technical inspection;
Revocation of a license from an insurance company.

When the insurer refused to pay: what to do

So the claim for damages was denied. It must be understood that in the absence legal grounds for this, the company acts in violation of the law, relying on the inaction of the owner of the car, who does not have the necessary knowledge. If the driver is sure that he did not commit any violations, it is worth protecting your rights. This will require:

Get a refusal in writing, which will become the basis for applying to the judicial authorities. It should be noted that sometimes the requirement to issue it helps the insurance company to make a decision on compensation for damage.
It is worth analyzing the reasons for such a verdict. Their awareness will help develop a further course of action. If the motives for such a resolution are logical and entirely legitimate, it is necessary to try to eliminate them. If the arguments are controversial, it is necessary to start preparing for their appeal.
Make a complaint to the body controlling the activities of insurance companies. They are the Russian Union of Motor Insurers (RSA) and the Central Bank of Russia. The appeal can be filed in person, by mail or by mail - online. It may take up to 30 days to process it.
Pre-trial procedure for solving the problem. If the appeal to the controlling organizations did not bring the desired effect, it is necessary to prepare a claim to the insurance agent who refused to compensate for the damage. It must contain the following information:

Company name;
Personal data of the owner of the car, including full name, address of residence, his contact information;
The required requirements based on the rules of law. In addition to the insurance payment, the owner of the vehicle has the right to demand a penalty for late payment in the amount of 1% of the amount;
Bank account details.

The application must be accompanied by copies of the following documents:

Passport of a citizen of the Russian Federation;
Power of attorney of the representative;
Documentation certifying the ownership of the object;
Certificates and protocols from the traffic police about the incident or notification of an accident;

Papers can be sent by mail or submitted in person with confirmation of the acceptance of the claim in the form of a receipt signed by an authorized person and a seal of the organization or a receipt from the Russian post.

Without compliance with the pre-trial procedure for resolving the issue, the appeal to the court may be rejected.

Preparing and filing a lawsuit. If at the end of 10 days the claim is refused or the letter is not received at all, you need to draw up a claim. Its form and content must comply with the requirements of the Code of Civil Procedure of the Russian Federation, in particular Article 131. it should set out:

The essence of the violation of rights;
Requirements for the defendant;
The grounds for their exposure;
Evidence of a court settlement;
The price of the claim;
List of attached documentation.

The claim is submitted to the justice of the peace if the value of the claims does not exceed 50 thousand rubles, to the district judge - when such an amount is higher.

You will need to submit with your application:

Refusal to compensate for damages;
Papers certifying the direction of the claim;
Act on the insurance situation, containing information about the incident and the damage caused;
Other documents evidencing the legitimacy of the claims, including the legal costs incurred.

Claims may include:

The cost of repairing damage;
Moral injury;
Penalty for late payment;
Penalty for non-fulfillment of duties, including the lack of response to the claim or its delay;
The amount of the state duty;
The cost of legal services;
Expenses for conducting an examination and others;
Penalty for refusal to pay compensation.

All expenses incurred must be confirmed by payment documentation (checks, certificates, receipts, payment orders, etc.).

Litigation. The claim may be submitted to the court personally, through a representative or by means of postal communication. A copy of it with attached documentation must be sent to the defendant. After the application is accepted for proceedings, consideration of the case is scheduled and summons are sent to the parties indicating the place and time of the hearing. It is better for a plaintiff who does not have practical experience in such cases to seek the help of qualified specialists who will undertake the implementation of the necessary procedural actions, on which the outcome of the case may depend. Upon receipt of a refusal to satisfy the claims, it is necessary to apply to a higher authority with an appeal against such a decision.
Recovery of the amount under the writ of execution. Having received a positive court decision, you must contact the FSSP service or the bank to receive the required compensation.

Failure to notify the insurance agent

In accordance with the provisions of the OSAGO agreement, the victim is obliged to notify his agent within five days of the occurrence of an insured situation. But, even if this did not happen, the refusal to pay the due amounts cannot be unconditional. At the same time, if it is possible to prove that the insurance company was notified or the delay in sending the notification did not in any way affect the obligation to compensate for damage to the transport, the payment must be made on the basis of Article 961 of the Civil Code of the Russian Federation.

In addition, the position of the insurer that such a delay may prevent claims for damages from the guilty party is also unfounded, which can be proved in court.

When the perpetrator left the scene

Such justification cannot be a reason for refusing damages, provided that he can be found and his car is insured.

In the absence of the culprit, the insurer cannot make a payment, but the PCA must pay for compensation for harm to health.

When the offending driver was drunk

Article 14 of the Federal Law-40 establishes the obligation of the insurance company to pay compensation. In addition, such a case cannot be a basis for non-compensation of harm to the victim. In the future, this amount will be recovered from the culprit.

When the culprit has no insurance

The insurer cannot indemnify for a person who has not insured liability under OSAGO with him. The essence of insurance is to compensate for harm caused by another citizen using a vehicle, his agent is financially responsible for him.

Even when the victim has not purchased the policy, the insurance organization must compensate for the damage caused, since under the terms of the contract it is obliged to do so. The driver, having purchased insurance, sold his liability.

Therefore, if the guilty party does not have OSAGO, then payment can only be received by agreement with the other party or through proceedings in court.

If the culprit has a fake policy

This situation is close to total absence insurance and it is not so easy to get compensation. If you suspect that the document is a fake, you should check its authenticity through the PCA portal or simply by calling the organization.

If suspicions are confirmed and:

The policy form belongs to the insurer - this becomes a problem for such a company, even if it is not involved in fraud with the document. A claim for compensation will be brought against her;
The organization does not own the number of the form, then compensation can only be demanded from the person responsible for the incident.

How to be in this case?

Submit an application to the Association of Motor Insurers to verify the validity of insurance.
Get a conclusion. There are two scenarios for the development of the situation:

When the form belongs to the insurance company, you need to apply for damages. If denied, submit a refund claim. If there is no response, apply to the court, attaching a certificate of policy status from the PCA. The court decision establishes the obligation to pay, which is imposed either on the organization or on the guilty party.
These checks did not establish a link between the policy form and the insurance company. In this case, it will be necessary to hand the instigator of the incident a claim for compensation for harm. In a situation where he evades compliance with the requirements, he will apply to the judicial authority, attaching the conclusion of the supervisory authority. The court will determine the person liable to compensate for the damage.

In all these situations, a statement about a case of fraud is sent to the Ministry of Internal Affairs with an opinion from the RSA attached.

Arbitrage practice

Judges, as a rule, take the side of the injured party, because the presence of a policy confirms the conclusion of an OSAGO agreement until the opposite is proven. When establishing the fact that the form belongs to the insurance agent, he is obliged to make the due payments. If it is established that the form is falsified, then it will not be possible to demand compensation from the organization.

In addition, the obligation to prove the forgery of the policy falls on the organization that concluded the OSAGO agreement and issued the form.

It should be noted that insurers in most cases refuse without reason. When such a situation occurs, it is necessary to take specific actions to resolve the problem outlined in the article.

On their car, they often forget that each company offers its own conditions. To avoid unpleasant surprises in the event of an accident, you should immediately carefully read all the clauses of the contract. You can sign it only if all the conditions meet your requirements. Otherwise, the denial of an insurance payment may come as an unpleasant surprise for you.

What to do to reduce the chance of rejection

We would like to give you a few recommendations that will help you avoid being denied an OSAGO insurance payment. You can only receive a payout if all insurance rules are met. Therefore, it is very important to carefully read not only the contract, but also all attached documents. You can minimize the risk of failure by observing the following rules:

notify the insurance company in time;
make sure that the traffic police officers correctly fill out all the documents at the scene of the accident;
make sure that all your data is correctly indicated in the papers, especially the state numbers of the car;
make copies in advance of all documents that the insurer requires to receive compensation;
require insurance agents to put marks on photocopies of documents on acceptance of originals, then in case of loss you can present copies;
in case of refusal in the CASCO insurance payment, ask the insurers for a written motivation.

On the video - how to reduce the likelihood of failure of the insurance company:

Important nuances

Although insurance organizations are now coming up with increasingly unusual arguments for refusing to pay out, only a few cases can really be legitimate grounds for this. And all of them are fixed in the Civil Code. Strange, but most drivers do not even know about it. At the same time, each legal basis has its own nuances. Therefore, in order not to be deceived, you must arm yourself with some knowledge.

Legal basis 1

Article 961 of the Civil Code states that the company is exempt from payments if the driver, in the event of an insured event specified in the contract, did not notify the insurer in a timely manner.

Nuance: This provision applies only in cases where the lack of notification in one way or another could affect the ability of the insurance company to pay compensation.

Legal basis 2

Another ground for refusals is recorded in article 962. In accordance with it, the company is not obliged, which arose due to the fact that the driver deliberately did not take available measures to reduce possible losses.

Nuance: This ground applies to both CASCO and OSAGO agreements, but in practice it is almost unprovable. Any good lawyer will be able to protect your interests with such a reason for refusal.

Legal basis 3

Article 963 contains provisions according to which the insurer has the right to refuse compensation if due to the willful actions of the driver himself or another person who may benefit from it. This article also provides for the possibility of refusal in the event of an accident as a result of gross negligence of the driver or beneficiary.

Nuance: Again, in practice, it is very difficult to prove the validity of such a refusal.

Legal basis 4

Article 964 states that an insurance organization is exempt from compensation if an accident occurred as a result of a nuclear explosion, civil war, pickets and strikes, radioactive contamination, etc. Also, the insurer is not obliged to compensate for damage caused by confiscation, seizure of property by government agencies.

Nuance: All these cases can be spelled out in the contract itself. Then the company is obliged to pay compensation.

Legal basis 5

The OSAGO insurance law (Article 12) states that the insurer may refuse to compensate the victim for losses (in whole or in part) if the repair or disposal of the car carried out before the examination does not allow to accurately determine the presence of an insured event and the degree of damage.

As you can see, in reality there are not many legal grounds for your insurance to be denied. Most of the refusals are explained by low legal, which draw up OSAGO and CASCO policies for themselves. Do not assume that all the words of an insurance agent are obviously true. Don't be fooled!

"Recipe" for receiving insurance payments after an accident:

Legal educational program - OSAGO: How to get money for repairs:

Make sure you don't get rejected in advance. Follow all of the above guidelines and you will minimize the risk of not being compensated. In case of groundless refusal, file a claim with the judicial authorities. But it is better to play it safe and hire a lawyer who can adequately protect your interests.

Insurance lawyers deal specifically with insurance disputes and have extensive experience in this, so they will be able to competently help. In addition, they have a list of problematic insurance organizations (whose licenses have been revoked). If your insurance company goes bankrupt, you can apply for damages from the Association of Auto Insurers.

When drawing up a contractual relationship with an insurance service provider in relation to the civil liability of vehicle owners, one should not forget that insurers are, first of all, profit-oriented structures. Taking this fact for granted, it becomes obvious that any insurance company is not interested in paying for the damage caused by its customers and will consider the circumstances of the incident extremely meticulously in order to find an opportunity to formulate a denial of payment for.

Grounds for refusal to pay under OSAGO

The justification for denial of insurance payment may be the presence of motivated reasons, by virtue of which it cannot be attributed to insurance, or a purely formal background, when the service provider finds a reason not to fulfill its obligations.

About what reasons for refusing to pay for OSAGO are legal and which are not, the specialist will tell in the video below:

Causes

The legal grounds and reasons for refusing an insurance payment under OSAGO are:

The commission of an accident by a vehicle that is not fixed in the name of the insured.
Forwarding to the insurer the claims of the victim for compensation for moral damage.
Late presentation of claims for compensation payment with the correct execution of documents.
Causing harm to third-party vehicles, people or their property in the process of driving lessons, competitive events or when testing equipment.
Upon receipt of damage from the transported goods.
If the injured person at the time of the accident was in the performance of a labor function subject to individual insurance.
When a building or structure belonging to antique or rare objects was damaged as a result of a collision.

Circumstances

Circumstances disputed under the current legislation, which means that they are illegal on the part of the insurance provider, are:

the absence of the subject who drove the insured vehicle in the insurance policy;
when the issued certificate of the accident does not contain a statement of the fact of violation of the rules traffic, but there is a protocol on, or a resolution is presented confirming the fact of refusal to initiate a criminal case;
when submitting an application not by the owner of the affected vehicle, but by a person who has the right to drive only;
when diagnosing the state of alcoholic intoxication in the perpetrator of the accident;
in the absence of proven guilt on the part of the person who initiated the collision, for example, when hitting a parked vehicle from behind;
when the subject guilty of the incident files an appeal of appeal in order to appeal the decision of the traffic police officer and change the content of the certificate of the accident;
when hiding from the scene of a collision of his perpetrator, but in the presence of his data on insurance and the vehicle, that is, there is no only subjective identification of the person;
upon expiration of the insurance policy of the person responsible for the accident at the time of the occurrence of circumstances related to the list of coverage cases;
upon expiration or termination of the license of the insurer that issued the policy to the person responsible for the traffic accident;
in the absence of a vehicle diagnostic card valid at the time of filing an application for compensation of damage;
if the perpetrator of the collision does not present his vehicle for inspection by the insurance payer.

The next section of this article will tell you what to do if the insurance company refused to pay out under OSAGO.

This video will tell you what to do if the insurance company refuses to pay for OSAGO:

What to do if the SC fails

In any of the above cases, the insurer's refusal to pay compensation coverage is unreasonable and subject to challenge in three successive instances, namely:

In a declarative manner against the insurance company responsible for the accident.
In a claim procedure to the association of insurers, which is the guarantor of the observance of the rights of insured citizens.
In a lawsuit by applying to the judiciary.

Each of the listed stages must be implemented in the specified sequence, since consideration of the applicant's appeals of the next instance, in the absence of feedback from the previous one, will not be carried out.

Action algorithm

The first iteration is an appeal to the insurer with a standard application and a complete package of documents confirming the validity of the claim for damages. Regardless of whether such an appeal will have an effect or not, the insurance service provider is obliged to provide a response, which may consist in satisfying the requirements of the insured or issuing a reasoned refusal to pay.

If there is no feedback after a written request in a declarative manner, then it is necessary to use the claim practice, since any insurance services are subject not only to the Law "On Insurance", but also under the jurisdiction of the Law "On Protection of Consumer Rights". For information on how to make a claim for the refusal of an insurance company to pay insurance under OSAGO, read below.

How to make a claim

A claim filed against the insurer is needed to achieve two goals:

psychological pressure on the provider, who may not want the conflict of interest to escalate into a lawsuit, and satisfy the consumer's demand;
implementation of the procedure of pre-trial attempt to resolve the conflict, without a formalized confirmation of which, not a single instance of the justice system will accept a statement of claim.

The standard procedure for filing a claim implies the presence of the following significant blocks of data in the application:

Details of the addressee (position, full name, name of the organization, TIN, ORGN) and the applicant (name, address of actual residence, telephone number for feedback), located in the upper right corner (1/3 of the page in width).
The name of the document is “CLAIMS” (in the center of the page, indented two lines from the details block).
The main part, including a link to, a description of the circumstances of the traffic incident, the initial application for damage coverage, the results of interaction with the insurer's official and an unambiguously formulated requirement. The requirement should be an indication of the harm to be covered and its expression in monetary terms.
List of attached documents and copies.
Personal signature and date of the claim.

Sample Claim on refusal to pay under OSAGO, you can download.

Sample Claim on refusal to pay under OSAGO

Sample claim for refusal to pay for OSAGO - 1

Sample claim for refusal to pay for OSAGO - 2

Sample claim for refusal to pay for OSAGO - 3

Sample claim for refusal to pay for OSAGO - 4

The claim statement must be drawn up in two copies, on one of which the official of the insurance service provider must put a mark on acceptance for consideration indicating the date, position, full name and signature. From the moment of filing a claim, the insurer has 10 days to satisfy it or send a reasoned refusal to the applicant. After the expiration of the specified period and the absence of feedback or an effect that does not correspond to the expected one, it is necessary to prepare an appeal to the justice authority.

What documents are needed for the court

When applying to the judiciary, you will need full set documents, including:

a certificate of an accident, a decision on violation of the administrative code or other evidence of the consideration of the case by law enforcement agencies;
copies of documents for the vehicle (PTS, registration certificate, policy);
copies of personal certificates (rights, passport);
a copy of the claim with the visa of the representative of the insurer;
claim to the court.

The presence of an expert opinion is not mandatory, since in most cases the assessment of damage and its causes is carried out at the initiative of the judge by a certain independent specialist.

We will talk about cases of refusal to pay under OSAGO below.

Arbitrage practice

In November 2010, the Soviet District Court of the city of Tula issued a positive decision on the claim of a citizen against an insurance service provider who refused to compensate for damage caused to a car under unspecified circumstances, in the form deep scratch on one of the side surfaces. The reason for the refusal was the absence of corpus delicti, as determined by the police, but the court ordered the insurer to reimburse the amount of the restoration repair of this defect.
In the summer of 2012, in the city of Bologoye, Tver Region, the car owner defended his rights, which were infringed by the insurer and the court of first instance, who came to a unanimous decision that the damage from an accident that occurred due to the fact that the culprit was reversing and crashed into a parked car, should not be compensated. The court of the next instance found such a decision unlawful, despite the fact that the perpetrator fled the scene of the accident and was identified only after search activities. As a result, the victim was fully compensated not only for the expert assessment of the damage caused, but also for moral compensation.
In Orenburg, in 2010, an insurer was called to account for ignoring the client's request for compensation without any reason, without justifying its actions. By a court order, he was charged damages in the amount of the expert's assessment and the cost of the latter's services.

Much more useful information This video will tell you how to deal with OSAGO non-payments:

Not all motorists can receive insurance compensation. Often, the owners of vehicles damaged in an accident do not defend their rights.

Let us consider in what cases the refusal is considered lawful, and when it is necessary to seek the payment of the due funds. We will also figure out what to do for the owner of a car who got into an accident and was refused by the insurance company in paying compensation funds under the OSAGO policy.

Grounds for the refusal of the insurance company to pay compensation for OSAGO - all reasons

The reasons for refusal to make payments from the insurance company are not provided by the legislation of the Russian Federation.

But in practice, there are circumstances under which the court may take the side of the organization.

We list the most common reasons for which compensation is not paid:

The applied citizen does not have a formalized OSAGO policy. For example, the situation may be such that the driver took out a policy from scammers - and did not know about it. When I turned to the insurance organization, it turned out that they did not draw up an official policy.
The OSAGO policy is considered invalid. Read also our article: Where to buy and how to check the OSAGO policy
The culprit has not been identified in the accident. Generally, no damages will be awarded unless fault has been established.
The victim was under the influence of alcohol. This must be confirmed by medical documents.
Documentation on the accident was not submitted in full.
6. Damage caused to the participants in the accident or to vehicles was compensated at the scene. This may be evidenced by a receipt from the culprit of the accident.
The car has been repaired on your own before contacting the insurance company. For example, before an insurance company specialist examined the car, before an independent examination was carried out.
The company insisted on the absence of an insured event.
The fact of fraud was noticed after the investigation of the company. For example, the actions of the victim were intentional.
The owner of the car did not notify the insurance company of the accident.
The transport was damaged due to radiation, a nuclear explosion.
The car was involved in hostilities or military activities.
Transport was damaged during the civil war, popular strike, etc.
The perpetrator of the accident fled the scene.
There were grounds for refusal, provided for by regulatory legal acts. They can be specified in the contract that was concluded with the owner of the car.

All situations are debatable. The reason for refusal may be another case.

If you believe that your rights have been violated, you should defend them yourself - or with the help of lawyers.

What is meant by the refusal of insurance to pay for OSAGO - non-payment for OSAGO and partial payments

The owner of the car may be denied compensation for damages received in the event of an accident.

Refusal may be expressed in:

Ignoring citizen's requests. If you do not receive any response, then we can assume that you received a refusal. Deadlines must be met!
Written response from the insurance company with a refusal. As a rule, only those who submit a written application-appeal can receive a written response. It must be issued personally by the owner of the vehicle. In the letter, the representative of the company must indicate the reason why the insurance company will not reimburse compensation for OSAGO.
A written response from the insurance company with a reduced payment. If the requirements were not fully satisfied, this action can also be considered as a refusal.

In any of these cases, a citizen can defend his rights.

What to do if the insurance company does not pay for OSAGO - where to complain and how to file a claim for OSAGO?

If you do not know what to do - just follow this step-by-step instruction:

Step 1. Collect the documentation package. What papers are needed, consider below.

Step 2. Prepare a claim with the insurance company. There is a special form that applicants can use. It is provided by the insurance company. You can contact your insurance company and ask for a claim form. In the appeal, you must indicate what circumstances forced you to file a claim, and the requirements for insurance must also be listed.

Step 3. Get a response from the insurance company. Within 5 days you should be told whether your requirements will be satisfied or whether you will still receive a refusal to pay compensation.

Step 4. Write a statement of claim to the court. If the answer came negative or did not arrive at all within the prescribed period, then you should contact the judicial authorities. In your claim, you must include all important points, as well as attach to it the documentation that was sent to the insurance company and that you received from the company.

Step 5. Participate in the process and get a court decision. If you do not want to participate in the proceedings, then contact a lawyer. He can act as your legal representative in court.

Going to court is the most effective method resolving the issue. But first, we have to try to resolve the issue out of court.

List of documents for a claim for refusal to pay OSAGO

Consider what is included in the documentation package that is submitted to the insurance company along with the claim.

You may be asked to provide other documents, depending on the specific situation.

Complaint about a refusal to pay or incomplete payments for OSAGO to the Russian Union of Motor Insurers - how to complain about an insurance company to the PCA?

Another way to resolve the issue is to file a complaint with the Russian Union of Motor Insurers.

Note that the most frequent complaints are filed with the RSA for the following reasons:

In case of payment of compensation not in full under OSAGO.
With the inaction of employees of the insurance company.
In case of refusal to pay under OSAGO.

Along with the complaint, you must submit the documents that we have listed above.

Do not forget to submit a copy of your driver's license, passport. Without them, the complaint will not be considered.

Complaint can be written in free form. It should have three parts: introductory, main and final.

The document must indicate:

Who is the applicant. All personal information is recorded.
From which insurance company the violation was noticed.
What rights of the owner of the vehicle were violated.
What actions were taken by the owner of the car to resolve the issue.
What requirements does the applicant put forward to the insurance company and to the PCA.

A claim-complaint can be submitted to the RSA in person - or through the official website of the organization. After contacting the PCA, a motorist can submit a statement of claim to the court.

You can wait for the decision of the Union, but you should not delay.

Terms for filing a claim with the insurance company, terms for considering a claim for non-payment of OSAGO and statute of limitations

We note all the important dates that motorists should be aware of.

*Period*	*Why is it needed?*
5 days	Needed to report an accident to an insurance company.
20 days	It is given to the company to consider the issue and determine further actions.
5 days	After 20 days, a citizen can file a claim with the insurance organization. The representative of the organization must consider the application-claim within 5 days.
3 years	During this time, the owner of the vehicle can apply for compensation.
3 years	That is the statute of limitations. After this period, the application or claim will be denied.

Observe the specified periods - and do not rush to file a claim with the PCA or a lawsuit in court. You can call your insurance company and ask how your claim is progressing.

Perhaps the delay in payment was several days, and not through the fault of the insurance company, but through the fault of the bank. It is also worth considering.

Challenging the refusal of insurance to pay for OSAGO in court - procedure and judicial practice

In the event of a refusal from the insurance company, the issue of compensation should be resolved in court.

Consider what the procedure is, and how cases are considered in practice.

What to do when applying to the courts?

If you do not know what to do and where to turn, our instructions will help you.

Prepare documents . Make sure copies do not need to be certified. You can read about the requirements for claims applications in Article 132 of the Code of Civil Procedure of the Russian Federation.
Write a statement of claim to the court. It must comply with the requirements specified in Article 131 of the Code of Civil Procedure of the Russian Federation.
Submit the claim and documents to the secretariat of the district court. As a rule, the magistrates consider the application.
Get a notification receipt on the acceptance of documents in the authority.
Come to court. The claimant must be notified by letter of the appointed date. It is better to indicate not only the address, but also the contact phone number.
During the meeting, the plaintiff may request an independent examination and recalculation of the amount of compensation.
Wait for the decision of the authorities - and get a writ of execution.

As a rule, the writ of execution is sent to the department of bailiffs. They will control the execution of the court decision.

Judicial practice - how is compensation calculated, and what else can be returned through the court?

The algorithm for calculating the final amount of compensation for insurance is as follows:

The amount stipulated by the contract is taken into account.
The penalty is calculated. For each overdue day (after the prescribed 20 days), 1% is withheld.
Determines whether the company should be prosecuted and fined. Usually the penalty is 50% of the total amount of compensation.

Through the court, the applicant, the plaintiff, as the victim, will be able to recover from the insurance company the amounts for:

Paid state fee.
Services of a legal nature.
The work of specialists conducting an independent examination.
Penalty for untimely sending a response to the appeal of the owner of the car. For each day of delay, 0.05% of the total amount of compensation can be claimed.