Insurance company refused to pay ... Reasons for refusal, lawsuit

By concluding a contract with an insurance company, a person hopes that in case of trouble, the insurers will fully or at least partially compensate for the damage. But sometimes there are situations when compensation is refused. What if the insurance company does not pay money? Where to turn in this case? We will discuss these and other issues in our article.

Why insurance may refuse to pay damages

All conditions regarding the payment term, their size and conditions for receiving money are clearly stated in the contract. But if happens insurance case, this does not mean that you need to sit and quietly watch everything that happens from the side. It is not only the insurer that has responsibilities. The insured himself requires not less, and sometimes even more, participation in the process.

If the insurance company refused to pay, then there are reasons for this, most often quite justified. For example, the payment of funds is possible not earlier than the insurer will be presented with all the necessary documents, on the basis of which the decision is made. The collection of such documents is most often the responsibility of the insured.

Just come to the insurance company and inform that you had an accident and on this basis you want to get 100 thousand, it will not work. You will need to document all your costs and losses. Based on what kind of evidence you can provide, and the amount of compensation will be established.

What reasons for refusal can be considered legal, and which are not?

Often there are situations when the payment of funds is completely refused. The reasons for this may be different. For example, an accident cannot be recognized as an insured event for any reason.

If the insurance company refused to pay, you need to carefully understand why this happened. All causes of failure can be divided into three groups:

• reasonable;
• unreasonable;
• conditionally substantiated.

In the first case, the insurance company acts in accordance with the law and does not violate anything. Simply put, all incident scenarios that are not included in the contract are justified grounds for refusal. For example, when the clause on damage to the car by animals is not included in the contract, you will not receive compensation if it is proved that you had an accident because a deer or a stray dog ​​suddenly ran out onto the road.

In the second option, SK employees flagrantly violate the current insurance law. If this happens, the only way to get paid is to go to court. In fairness, it is worth saying that most often the lawsuit will be won and you still get the money. True, this may not happen as fast as you would like. Unreasonable refusals are most often designed for young and inexperienced people. Here the stake is placed on the fact that no one will prove anything, the client simply swears and leaves with nothing.

Conditional reasons for refusal are a very confusing thing. These include situations for which the law does not have a clearly defined definition. An example is damage incurred through negligence. Suppose, if your car was stolen along with documents and an insurance policy, insurers may require you to restore documents first.At the same time, getting duplicates and meeting the deadline for submitting an application for payment of compensation is physically impossible. The only solution to this problem is to go to court.

Legal reasons for refusal of insurance

In some cases, OSAGO rules clearly define the grounds for legitimate refusals to pay cash. For example, such:

• the policyholder did not inform the UK about the occurrence of the insured event;
• damage to the car is associated with a training drive or the holding / organization of competitions if the action took place in a specially designated area;
• the car with which the damage was caused was not included in the insurance policy;
• damage / harm was associated with the carriage cargo insurance which was to be carried out separately;
• the owner / driver of a car or other vehicle has independently damaged in order to obtain undue benefits;
• the damage was not related to driving, but to loading and unloading.

In these and some other cases, the CMTPL rules provide for a legitimate opportunity to refuse monetary compensation.

List of illegal reasons

There are also unsubstantiated denials of damages. Very often unscrupulous SKs use such tricks:

• driving in a state of drug or alcohol intoxication;
• the absence of the person responsible for the accident in the list of persons allowed to drive a vehicle;
• leaving a place of an accident;
• the person guilty of the accident does not have the category necessary to drive the relevant vehicle or a driver’s license as such;
• use of the car during the period not covered by the terms of the policy (this item is especially typical for seasonal insurance).

If the insurance company refused to pay for one of these reasons, its actions are clearly illegal. In such cases, the UK must first make a payment, and then contact the perpetrator for recourse payments. If the insurers still refuse compensation, you must necessarily demand a written refusal indicating the articles of the law to which they refer.

Several reasons for the legal refusal of payment under CASCO

If you have a CASCO policy, then you can also compile a list of reasons for it - both legitimate and far-fetched. There are at least 5 reasons why insurance companies do not pay on hull insurance quite legitimately:

1. Incorrect notification of the UK about the occurrence of an insured event. Most often, the insurance contract says that in the event of an accident, you must inform the company as soon as possible, both in writing and orally. Most often drivers forget about this point. Therefore, having arrived in the UK, having written a statement in full form and having provided the car for inspection, they are surprised to learn that they were refused payment on the simple reason that they forgot to call and notify the incident through the call center operator. Sometimes, at the scene of an accident, under the terms of the contract, you need to wait for the emergency commissioner, even if it is decided not to call the traffic police. Failure to comply with this rule may also be sufficient reason.
2. Refusal to pay insurance due to lack of a passport. This reason is most often indicated when documents were stolen with the machine. Sometimes such an item is even explicitly prescribed in the contract.
3. Incorrectly written explanatory note (explanatory). Sometimes the driver does his best to remove the blame for the accident. Most often this happens when the car does not belong to a private person, but to an enterprise. Fearing to get a reprimand or other punishment, the driver indicates the wrong cause of the accident, for example, failure of the brake system.However, he does not think that such a reason is not an insured event and that payment will be refused.
4. There is no vehicle inspection certificate. Before signing the contract, the representative of the insurance company must inspect the vehicle, about which a corresponding act is drawn up. Sometimes this is supposedly forgotten. The absence of such a document is one hundred percent reason for non-payment of hull insurance. The refusal to pay insurance in this case will be fully legitimate.
5. Overdue payment date. If you pay the cost of the policy in installments and allow at least one day of delay, you may be denied cash compensation.

In addition, no one has canceled such classic reasons as drunk driving, lack of a driver’s license and so on. All these items are usually explicitly stated in the contract.

Illegal refusals

An unlawful situation is when the insurance company refused to pay for the following reasons:

• the driver has lost or left keys or a diagnostic card in the car;
• at the wheel of the vehicle was a person not included in the CASCO insurance policy;
• the owner of the vehicle did not appeal against the decision of the traffic police to refuse to initiate criminal proceedings on the fact of causing harm.

Regress lawsuit: when and to whom is threatened

The concept of recourse means that the victim will receive monetary compensation from the UK in any case, and the right to claim money from the perpetrator of the incident passes to the insurance company. The basis for recourse is:

• inadequate condition of the culprit of an accident (alcohol, drug or other intoxication);
• intentional bodily harm or the lives of victims;
• leaving a place of an accident;
• lack of a driver’s license;
• a situation where the perpetrator of the accident is not included in the policy;
• the culprit did not submit his copy of the European protocol to the insurance company within five days;
• the situation where the culprit of the accident did not provide the car for inspection in the UK, but repaired or disposed of it on its own (applies to the European protocol).
• overdue diagnostic card for trucks, buses and taxis.

What if you do not agree with the refusal?

How to make an insurance company pay if you are sure that you have a legal right to claim monetary compensation? There are two ways to do this:

• try to negotiate amicably with insurers;
• act through court.

In both the first and second cases, you need to receive a written refusal from the insurers indicating the reason for such a decision. Having received such an explanation, refer to the management of the UK and write in writing all your complaints and concerns. If you are absolutely sure that you are right, you can try to threaten insurers by contacting the union, posting negative reviews on various thematic forums and in social networks. If you persist, it can work.

When trying to agree, do not forget to prepare for the negative scenario:

• require additional examination of the circumstances of the incident;
• seek from the traffic police evidence of a lack of a driver’s license / intoxication during an accident;
• conduct evidence-based examination confirming that the car has lost its market value;
• make sure that the insurer has notified you of the refusal to pay within a period not exceeding 3 days from the date you wrote the application;
• With the help of a lawyer, or independently prepare a lawsuit against the insurance company and a complaint to MTIBU.

Most often, seeing that you are determined to fight to the end, the insurance company backs off and still pays compensation. The fact is that the court is likely to be on your side, and the presence of claims spoils the business reputation of the UK.

Package of documents for appeal to court

Many car owners prefer not to bring the case to court and repair cars at their own expense.The reasons for this may be different. For example, such:

• no time - usually court hearings drag on for many months, people just don't want to waste time;
• the amount is not worth the effort - having estimated how much effort and money will have to be spent to receive compensation, the client concludes that it is not worth it;
• apparent hopelessness - the vast majority of car owners simply do not know their rights, it seems to them that it is unrealistic to win the case.

In order to win a case, it is not at all necessary to understand how to sue an insurance company. It is enough just to contact an experienced lawyer and clearly implement his recommendations. First you need to prepare the appropriate paper:

• official conclusion / notice of an accident with signatures of two parties;
• all documents drawn up at the scene of the accident: a copy of the protocol, resolution and certificate of the traffic police;
• a copy of the application to the UK with the obligatory indication of the date when it was accepted, the incoming number, signature and seal;
• an independent expert report on the inspection of a car in an accident;
• A photocopy of the insurance certificate indicating the amount of damage.

Statement of claim

And of course, the main document should be a properly drawn up lawsuit against the insurance company. A qualified lawyer will also help write it. The text should contain the rationale for the appeal. To do this, you need to describe in detail all the violations committed by the insurers, indicating the relevant articles of the law, as well as the situation that led to the need for a trial. As for the amount of the claim, it is not necessary to be limited to expert assessments of damage. Additionally, you can demand to reimburse you the cost of all examinations, state fees and any other expenses. In case of victory, the insurance company will not only pay you all the declared amounts, but also add a penalty accrued for each day of delay.