Insurance case. Insurance claims payments. Types of Insured Events

The entire existing insurance system is built on the order of insurance premiums, cases and subsequent payments. People are trying to financially protect themselves by insuring their financial security by concluding an appropriate contract with the relevant companies, and they thereby expect to receive compensation in the event of an insurance event.

Interpretation of the concept under consideration

An insured event is a complex of legal factors, which means not only insurance against the consequences of a particular danger, but also against their accidental occurrence, as well as their harm to the insured object under the relevant contract.

The case under consideration is the so-called potentially dangerous phenomenon (event), which may not occur at all. It is this kind of random nature of this phenomenon that determines the nature of insurance relations. Accident is purely objective in view of the lack of complete information regarding the possibility of an unfavorable event.

An insured event is a three-dimensional structure, in connection with which the event that has occurred is classified as it only if there are three elements: the appearance of danger, harm, the causal relationship between them. And the legal consequence of the occurrence of such an event (change of subject with respect to the obligations of the insurer) is also associated with the above elements.

We can say that an insured event is a special event, the occurrence of which leads to the legitimacy of the insurer's obligations fixed in the relevant insurance contract.

According to these obligations, after the occurrence of a certain insured event, this insurer is obliged to compensate for material damage that has been caused to the insured or to the policyholders - third parties accompanying liability insurance.

The list of insured events is specified in detail in the relevant contract. It is usually closed.

The often used legal term “insured event” is translated from Latin as “death, event, fall, accident, occasion, circumstance”. In Russian law, it is interpreted as an event that has already taken place, which is provided for by law or by an insurance contract and upon the occurrence of which the insurer becomes obligated to make the appropriate insurance payment to the specified insured, or to another third party, or to the policyholder.

If we consider property insurance, here the insured event is one of the circumstances listed in the relevant contract that led to the depreciation or damage, loss, loss of property that is the subject of insurance.

The relevant contract may specify additional conditions. For example, DOSAGO (supplementary voluntary insurance for compulsory motor third-party liability insurance, expanding the powers of compulsory insurance in respect of motor third-party liability) becomes competent at the time when the damage caused by this policyholder to third parties exceeds the amount specified in the mandatory liability insurance contract.

Regarding a category like personal insurance then an insured event (FL insurance, more precisely) is an event that caused disability, or loss of health, or death.

An example of an atypical case considered in this situation can be admission to a university or the birth of a child.

One more definition is worth mentioning here: an industrial accident is considered to be insured if it happened to any insured or other person who is subject to compulsory insurance against the cases under consideration during production activities, as well as occupational diseases.

In a situation when during the investigation procedure of an accident with any insured person his own gross negligence was established, which subsequently entailed the occurrence or increase of harm to his health, the degree of guilt of this participant in percent must be determined.

Types of Insured Events

It is customary to distinguish two main types of insurance: voluntary and compulsory. This process is subject to all known material goods that are in the framework of civil turnover (the totality of transactions concluded by contractors, the basis of which is always the obligation relationship). But there is definitely no safeguard regarding illegal actions.

Insured events can be differentiated relative to the insurance industry, namely:

1. Property (protection of material assets, for example, damage to a vehicle or buildings, a lean year, etc.).
2. Liability insurance (this includes the most extensive list of insured events, which are most often filled out by state of emergency and legal entities, for example, compensation if the policyholder has not fulfilled his obligations under the product supply agreement or has not repaid the loan on time, etc.).
3. Personal (protection against disability, accidents, harm to health, life, for example, insurance of children with an additional pension).
4. Social (protection of the population in a situation of deterioration in their financial condition, for example, retirement due to seniority or disability, as well as a social insurance event - loss of a breadwinner, etc.).
5. Insurance of the risks of entrepreneurs (their protection in case of loss of income, non-profit, loss, etc.).

The last of the above is the only chance for entrepreneurs not to lose their business, especially in the current economic situation in the country (extremely unstable, in particular with respect to consumer demand).

When concluding an agreement for all types of insurance events, the policyholder is obligated to compensate for losses incurred due to unforeseen circumstances in the entrepreneur's activities.

An example of an insured event may be the bankruptcy of a counterparty (most often entrepreneurs are afraid of this case). In the agricultural sector, as a rule, they insure against possible drought or unpredictable floods. And when traveling abroad, insurance helps to easily cover all the costs that are associated with the costs of treating mainly exotic diseases.

Compulsory insurance: conditions of occurrence, types

It arises in the presence of at least one of three conditions:

1. Voluntary insurance is the same as in compulsory insurance, risks are not commercially feasible, from the point of view of insurers.
2. It is also much more expensive than considered.
3. The policyholder underestimates the significance of such risks.

However, there is an objective social need for protection from such risks. In this regard, the state adopts the relevant law regarding compulsory insurance.

In Russia today insurance is mandatory in the following areas:

1. CTP, Law on which was adopted in 2003, had a beneficial effect both on today's situations on the roads and on the rapid development of all insurance in our country as a whole.

It will not be out of place to know that the application (insured event - accident) about the required insurance payment varies based on who is filling it out (the injured party is not a CTP insurance client, the policyholder, the injured one is a CTP insurance client).

2. MHI, according to which each citizen of our country is recognized as insured.

3. OSGOP (Mandatory liability insurance carriers) until 2013 was a pure formality (2 rubles 30 kopecks in the cost of a train ticket). These funds were definitely not enough even for partial treatment. Further, in January 2013, a law has been enacted to this day, according to which the minimum payment in the situation of the death of a passenger is 2 million rubles, as well as another 25 thousand rubles. - his funeral. The drawback was the fact that the law came into force in early January, and licenses for this compulsory insurance began to be issued only at the end of the month. Until that moment, carriers either voluntarily insured themselves or made payments to victims on their own.

4. OPO (Compulsory liability insurance for the operation of hazardous production facilities). There is no direct obligation to provide this insurance for companies, and acquiring a license from Rostekhnadzor for the relevant types of activities is permissible only if there is a special policy. As a rule, an insurance amount of 100 thousand rubles is sufficient for this. Such protection cannot be called serious. This law is currently under revision.

5. Compulsory insurance of military personnel, which (in the constitutional and legal aspect) is guaranteed by the state as a member of the Armed Forces of the Russian Federation, in addition to other kinds of payments, the amount of compensation for harm caused to compensate for the consequences of the insured event, including moral and material damage .

At the moment, it is being discussed that insurance must be carried out in the following categories:

• housing (a similar bill is being promoted by Gosstroy);
• FL and YL providing medical services in the Russian territory;
• responsibility of manufacturers of products and services (most often these are branches of Western firms that need reports to their Board of Shareholders).

These are very correct directions for the development of this industry. It is a pity that they are only at the discussion stage.

Summing up, we can say that in Russia "the most necessary" motor vehicle insurance (CTP). The remaining directions are either underdeveloped or are in a stagnation stage.

Registration of insurance cases

According to Russian law, the contracts and rules of the property type of insurance provide for the appropriate procedures for determining the conditions and procedure for paying the required insurance compensation, namely:

• establishing the basis for the payment of certain insurance claims;
• the regulation of the above grounds and the justification of the methodology for calculating the specific amount of the insurance insurance indemnity

The list of documents confirming the occurrence of insured events and their identification with the insurance conditions

The basis for the payment of the required insurance indemnity is the occurrence of insured events in accordance with the insurance contract. Their occurrence, as well as identification of insurance conditions, is further confirmed by the following documents:

• a statement by the insured regarding the occurrence of an insured event;
• a list of destroyed or stolen or damaged property;
• special insurance act on the destruction (damage or theft) of property.

The last document of the above must be executed in accordance with the insurance rules. It confirms the fact, circumstances and causes of the insured event.Exclusively on its basis, the amount of damage caused to the property of the insured can be calculated, the amount of the insurance indemnity calculated, and the right of the insured to receive it can be established.

What data can serve as a basis for calculating the insurance indemnity due?

The basis for calculating the amount of insurance indemnity due (directly to the insurer) is the following information:

• provided in the application by the policyholder;
• reflected and established by the insurer in a special insurance act;
• provided by the competent authorities (in a situation of appeal to those).

What is the cost expression of the damage in the case under consideration?

This is the value of the impaired or lost property (part thereof), which is determined by means of an insurance valuation. The amount of insurance compensation is established on the basis of previously calculated damage, as well as subject to the terms of the insurance contract, and represents either part or the full amount of damage that is intended to be issued to the insured, according to its conditions.

In the case of proportional insurance (for partial insured value or underinsurance), the indemnity due shall be paid in the appropriate proportion (in relation to the insured amount to its value). Simply put, this is part of the damage actually caused to the property, for which the policyholder paid the appropriate contributions.

Registration of insurance cases according to the first risk system is most often used in real life, the client is compensated for the damage caused by the amount not exceeding a certain insurance amount, on the basis of which this participant actually paid insurance premiums. If losses are less than fixed insurance amount then the contract continues to be implemented as part of its remainder.

The death of the borrower as a loan insured event

According to Russian civil law (Art. 1175), unpaid debt obligations of the deceased borrower pass to the heirs. In accordance with the above article, firstly, they are responsible for them exclusively within the transferred property. For example, if the amount of debt is 500 thousand rubles, and the heir received only 200 thousand rubles, then his obligations to the bank can not exceed the actually transferred amount.

Secondly, the total amount of debt transferred to several heirs is legally divided in proportion to the shares of the corresponding inheritance received.

Thirdly, if a debt is secured by a pledge (for example, in a situation with a car loan or a mortgage), the heirs pass, in addition to the debt itself, the pledged item. The bank most often easily approves the decision to sell it, provided that the amount necessary to repay the loan will be immediately sent to the bank. After repayment of the loan, the heirs receive the remaining amount (if any).

Fourth, in a situation when a will is formed in favor of minor citizens, the outcome is that they, along with adult heirs, acquire the debts of the deceased, which are paid by their legal representatives (guardians or parents).

Features parsed circumstances

The credit insurance case under consideration has several nuances:

1. If the inheritance was not legally accepted by anyone and the loan agreement was not guaranteed, then the bank is legally entitled to demand the immediate sale of this property from the auction.

2. In a situation where family members of a deceased debtor use his property (for example, they are registered there or live), but do not always act as heirs, then formally they do not inherit debts.However, if the relevant bank is levied on this housing, these family members lose the right to use this property, and are also subject to eviction. But according to the current Russian housing and family law, in special cases they cannot be evicted. An example is a ban on violation of the rights of minor children or the rights of family members who do not have other housing.

3. The heirs of the borrower shall be liable for the loan even before the legal registration of the proper right to the inheritance due.

The credit insurance case under consideration is a clear example of the fact that the Russian law in the framework of this issue is harsh and practically indisputable.

“Reduction of forfeit”

This is an article of the Civil Code (333th). Consideration of an insured event (regarding the transfer of a loan from a deceased borrower to heirs) in this aspect opens up a number of possibilities. Firstly, the bank has the right to meet (reduce or annul the fines) by concluding an amicable agreement if the heir does not try to dispute the debt and is ready to pay it off completely.

Secondly, the heir may appeal by the fact that the delay is not the negligence of the newly minted debtor, but a consequence of unforeseen circumstances (death of the original borrower). The heir might not have been informed about this point. Thirdly, he has the right to notarize a waiver of the inheritance due.

Accident Insurance Premiums

The nuance of the legal aspect of the regulation of this mandatory social insurance it appears that the significant elements of tariffs have been established in various regulations.

Insurance premiums (an accident in this case is the subject of compulsory insurance) by their legal nature are tax payments, since they meet all their attributes without exception. Given this fact, we can say that the rules of the Russian tax legislation also apply to the relations connected with their payment (charging a penalty for existing debts on required transfers to the FSS body, financial sanctions against non-payers of these contributions, as well as to banks that violated the order their transfers to the Fund, etc.).

Are employees considered insured?

According to the federal law regarding compulsory social insurance against all kinds of accidents during production activities, as well as occupational diseases, they are, of course, recognized by insured persons.

Employees are provided with the following payments for an insured event at work:

1. The allowance compensating for temporary incapacity for work due to an accident in the course of production activities (in a situation where it is delayed by the employer for more than a month, the victim has the right after receiving an application to receive it at the Russian regional branch of the Social Insurance Fund).
2. Monthly payments (insurance).
3. Lump sum payment (insurance).
4. Compensation for all additional costs (for social, medical and vocational rehabilitation).

The basis for the issuance of the first type of allowance is a sick leave. The abovementioned payments for industrial insured events must be made by the employer in an appropriate manner (in full and on time).