Any type of insurance is designed to provide compensation for any damage. This also applies to car insurance. Companies that provide such services, by all convenient means, strive to get you as their client, promising maximum and instant damages. But when it comes to insured event and the payment of the promised money, not all of them are in a hurry to keep their promises. It also happens that the client, through his actions or inaction, unconsciously or consciously helps the insurance company to refuse it.
In this article, we will examine what grounds for refusing insurance payments are legal, and we will also talk about what measures should be taken to defend our rights. But first, let's look at some of the legal subtleties.
Refusal and exemption from payment
The insurance obligation implies reimbursement by the insurer of the damage caused or the payment of the amount provided for in the contract upon occurrence of the insured event. But in any such agreement there are grounds for refusing to pay or exemption from it.
These two concepts have different legal implications; in no case should they be confused. In the first case, the insurer quite legitimately does not pay the compensation provided to the insured in connection with his violation of the terms of the contract. In accordance with paragraph 1 of Art. 21 of the Law "On Insurance", the following can serve as the basis for refusing insurance payments:
- the actions of the insured intentionally aimed at the occurrence of the insured event;
- commission by the insured of a crime that is a causal link of the insured event;
- false information about insurance object provided by the client;
- payment of damage to the policyholder by the person involved in causing it.
An insurance company may receive a legal exemption from payment due to:
- nuclear explosion, the effects of its damaging factors;
- military operations;
- civil war, riots, popular unrest;
- confiscation, seizure, destruction of insurance property by state bodies;
- the insurer's refusal of the right of claim in relation to the person who caused the damage.
Do not forget that the refusal of insurance in the payment may be illegal. But we will talk about this a little later. Now let's look at the main reasons why insurers refuse to pay money under CASCO and CTP insurance contracts.
The main causes of failure
It is impossible to list all the grounds for refusal of payment, since it all depends on the conditions stipulated by the insurance contract, but referring to practice, we can say that the main reasons for non-payment are:
- violation of the deadlines for submitting documents on the insured event;
- car repair prior to inspection by an insurance company representative;
- Uninstalled or not activated anti-theft system;
- shelter from the insurance company of spare keys and documents for a car;
- car storage in a place not provided for in the contract;
- the insured’s unwillingness to institute criminal proceedings upon the fact of the insured event;
- non-compliance of the damage claimed by the policyholder with the actual circumstances of the accident;
- driving an insured vehicle during an insured event by a person not included in the insurance policy;
- gross violation of traffic rules by the driver.
Violation of the deadline for submitting documents on the insured event
Absolutely all insurers focus on meeting the deadlines for submitting an application for the occurrence of an insured event, as well as documents confirming it. Violation of the stipulated terms, firstly, causes them to suspect fraud, and secondly, this is the most convenient and legal way to refuse compensation. The refusal of insurance in this case is clearly regulated by paragraph 1 of Art. 961 of the Civil Code of the Russian Federation, which states that the policyholder is obliged to immediately inform the company about the occurrence of a case stipulated by the contract.
If the agreement specifies the time period for appeal, it is better to comply with it, otherwise you risk being left without compensation for damage. Typically, a time violation occurs for the following reasons:
- the policyholder "got caught up" and simply forgot to file the documents on time;
- the insured event occurred when the insured was on a business trip (on vacation), and he applied only upon return;
- the policyholder wrote a statement on time, but could not provide the documents confirming the insured event in a timely manner.
The violation provided by the last paragraph is often the result of the fact that the policyholder has been waiting for the results of the inspection conducted by the traffic police for a long time. The refusal of the insurance company to pay based on exceeding the term specified in the agreement is considered legal only if the insurer is able to prove that the untimely appeal prevented the establishment of the necessary circumstances of the accident. At least, so says paragraph 2 of Art. 961 of the Civil Code of the Russian Federation.
In principle, any decision of the insurer can be challenged in court, but it is better not to violate the deadlines. To avoid misunderstanding, submit documents in duplicate. Ask the person who receives them to sign the copies that you keep for yourself.
Auto repair before being inspected by an insurance company representative
Do not rush to repair your car after a traffic accident. Repair and restoration of a car prior to inspection by a representative of the insurer is a good reason for refusing insurance payment. You have every right to assess the amount of damage caused in any valuation organization. Naturally, she must have a certificate that permits a similar type of activity, as well as a liability insurance policy. You will be required to submit copies of these documents to your insurer along with the certificate of inspection of the car and damage assessment, as well as relevant photographs.
The insurance refusal, based on the fact that the car was not inspected and evaluated by its representative, is illegal.
Uninstalled or inactive anti-theft system
If the insurance contract provides for the installation of an anti-theft system, but at the time of the insured event (theft) it was not installed or activated, the insurer has the right to refuse compensation for the damage caused. Insurance company refusal to pay in this case it will be considered legal, and it is unlikely to be able to prove the opposite in court.
Shelter from the insurance company of spare keys and documents for the car
Most companies, when concluding an agreement, require the provision of a complete set of documents and keys. Left to myself, just in case, a spare key or documentation for a car, which subsequently will be inside the stolen car, are serious reasons for the insurer's refusal to make insurance payments. This immediately raises the suspicion that the car owner could have staged theft in order to obtain compensation.
Such cases are often found in judicial practice, but the owner of the car is far from always able to prove that this is a real hijacking, and not a staging.
Car storage in a place not provided for in the contract
The grounds for refusal to pay insurance compensation may be quite significant if the insurer proves that the car owner has left the insurance subject in places not provided for by the contract. In other words, if the contract stipulates a clause in which you undertake to park the car for a night at a guarded parking lot, but for some reason left it in the courtyard, from where it was stolen, you can not particularly count on compensation.
The insurer's unwillingness to initiate criminal proceedings upon the fact of the insured event
There are cases when the owner of the insured car, having found it damaged, comes to the police to write a statement, and the district police officer refuses him, so as not to spoil his statistics: they say, the case is insignificant, no one will bring anything up anyway. Or, on the contrary, it accepts a statement, but asks to add that you have applied for the purpose of fixing and informing, and the car is insured, therefore you have no complaints to anyone.
From this gross error may depend not only the amount of insurance payments, but also in general the possibility of receiving any funds. The insurance company then in court will provide a copy of such a statement and inform you that you did not contact the authorities in order to reimburse something, but simply to inform them.
Therefore, at all costs seek criminal proceedings, and when submitting an application, be sure to indicate the damage caused, at least approximately. Well, if you still refused to initiate proceedings, then file a refusal order with the insurance copy. Of course, in this case, the amount of insurance payments is unlikely to exceed the minimum amount of damage necessary to initiate a criminal case.
Non-compliance of the damage claimed by the policyholder with the actual circumstances of the accident
Different situations happen in life. For example, you went to the forest for mushrooms, ran into a stump and slightly damaged the bumper. And since the car is insured, then why not get the compensation provided for compulsory motor third-party liability insurance, having blamed someone else for it. You filed a statement to the insurer that another car at a certain intersection drove into your bumper, and then disappeared from the scene. Naturally, the insurer will conduct its own investigation, collect the necessary materials, and if you also take video from outdoor surveillance cameras, the reasons for the refusal of insurance payments under compulsory motor liability insurance may become a charge against you in court.
Driving an insured vehicle during an insured event by a person not included in the insurance policy
Typically, a list of persons to whom it applies is prescribed in the insurance contract. If at the time of the insured event another person is driving, most likely you will not get a penny.
But here everything is decided not only by the insurer. The court will be on your side if the person who was driving was there because of your illness, fatigue, or if he is not guilty of the accident.
Gross violation by the driver of the rules of the road
And, of course, violation of traffic rules will not contribute to your compensation for damage. Significant over speed, provoked an accident, or, God forbid, drunk driving, will bring your hopes to nothing. The court is also unlikely to support you in such cases, so try not to violate, and if to violate, then at least not so rude.
Why insurance delays payments
In accordance with the law, the insurer is obliged to consider the documents submitted by you and decide on payment of insurance or refusal to do so within thirty days. But it so happens that insurers await compensation for several months. Why is there a delay in insurance payments?
There may be several reasons for this. Firstly, the insurer can make a decision only after an independent assessment, obtaining the necessary documentation from the traffic police.The victims themselves provide some documents, but sometimes the insurance company also has to deal with this. Naturally, to do everything quickly does not always work.
Secondly, the delay in insurance payments may be caused by problems with the liquidity of funds. Money simply “hangs” on deposit accounts in troubled banks, and it takes a while, of course, to withdraw it.
Thirdly, experts of insurance companies do not always agree with the official center or a car service station, especially if they think that they are overpricing. Then disputes, independent expert reviews and the search for a compromise solution begin.
The insurance also pulls with payment in the event that it suspects fraud on the part of the client. She has the right to conduct her own investigation, as a result of which she can turn to law enforcement bodies or to a court.
If the insurance delays payment, and everything is legal on your part, and you submitted all the necessary documents in time, there is reason to think that it is not all clean. In this case, you can protect your rights in court.
Insurance claim and lawsuit
What to do if the insurer is dishonest? Only complain to the appropriate authorities, and the sooner the better. To begin, write a claim on the actions of the company. Most often, customers “thrown” by unscrupulous insurers complain if:
- the company refused damages;
- insurance delays the payment;
- the insurance received was significantly less than the amount spent on repairs.
A written claim is submitted to the insurance itself, with which you entered into an agreement, to the Russian Union of Auto Insurers (RSA), as well as to the Federal Insurance Supervision Service of the Russian Federation (FSSN RF). It should indicate all the circumstances of the insured event, referring to the relevant clauses of the contract by which it is provided. In addition, the essence of the violation of the contract by the service provider, supported by relevant documents, should be stated. For example, if the insurance company delays the payment or refused it at all, you must request a written response from the insurer explaining your actions.
According to the results of claims, if your requirements are not satisfied, feel free to contact the court with a lawsuit against the insurance company. However, keep in mind that if you lose in court, you will have to pay not only legal fees, but also the costs of re-examination.
How to reduce the risk of being left without payout
In conclusion, here are a few useful tips that may help you avoid troubles in dealing with an insurance company.
- Enter into an agreement only with trusted companies that have managed to positively establish themselves in the insurance market.
- Read the text of the contract carefully before signing it.
- Do not break the rules stipulated by the insurance contract.
- Keep track of the technical condition of your car.
- Equip the vehicle with anti-theft system.
- Try not to violate the rules of the road.
- Do not allow unauthorized persons not specified in the policy to drive the insured car.
- In the event of an insured event, inform the insurer immediately. At the first opportunity, submit an application and provide him with all the necessary documents.
- If the insurance is delayed with payment or even refuses it, contact the appropriate authority with the claim.
- And do not try to trick the insurer: it will be more expensive for yourself.