They seek insurance claims because of the policies of insurance companies that do not want to pay money or do not pay them in full. The volume of regulatory material regulating the sphere is considerable and full of numerous nuances.
Normative regulation
- Law on compulsory liability insurance of the vehicle owner - 12.
- Compulsory insurance rules, on their basis a standard contract is concluded with customers.
In addition, there are explanations of plenums, as well as reviews created by the courts of the subjects and the Armed Forces of the Russian Federation. The clarifications relate to the application of insurance rules and the procedure for hearing cases (procedural law).
A distinctive feature is the fact that courts ignore the practice of higher courts. In a similar institution, opposing decisions are made. And lawyers have to carefully study the practices prevailing in their region.
Collecting insurance compensation becomes a complex, lengthy procedure.
Scheme for receiving money
The collection of insurance compensation is not limited to judicial procedures. Initially, an application with a list of documents is required. The company, having examined the papers, makes a decision on them. And then the client acts according to circumstances, going to court or refusing it because of the insignificance of the potential gain.
Citizens make a mistake by translating communication with organizations on an oral plane. All appeals, arguments, submission of documents must be recorded, otherwise then in court the plaintiff will lose the case due to insufficient evidence.
Writing a statement
It is served as soon as possible. The law does not set deadlines. The applicant describes the types of compensation (repair, restoration of the commodity value, payment of the cost of treatment, etc.).
The sending of documents by mail is recorded using a notice and inventory. No more than 20 days are given for a decision. In practice, it is taken for longer periods.
Which company should I contact
The law gives the right to contact the company that insured the liability of the perpetrator of the incident, if the matter concerns harm to life and health of people and property.
The victim has the right to demand recovery from the company that insured his liability, subject to several conditions:
- the damage is property;
- the accident occurred with the participation of two or more vehicles;
- the accident occurred after September 26, 2017;
- liability of the participants in the incident is insured.
The collection of insurance compensation from the company that insured the applicant’s liability is called direct in the legislation and, therefore, affects only property losses.
Citizens almost do not use this method because of its limited capabilities.
The address of the company or its representatives is indicated in the client's policy. They turn to the local office of the company, which transfers the papers to the main office or central office, where the decision is made on the merits.
At the same time, insurance rules oblige all participants in the accident to report it to their company.
Compensation papers
When collecting insurance compensation under OSAGO, the following list of documents is required:
- application drawn up on a form issued by the company;
- a certificate of an accident, performed on a special form, if a policeman participated in its preparation;
- copy of the protocol on an administrative offense or refusal to initiate proceedings.
Desiring to receive compensation for damage to property, the applicant must provide damaged and destroyed property for inspection. The insurer organizes an independent examination. With its help, they determine the amount of damage and identify the circumstances of damage and destruction of the object.
The consent of the insurance company and the victim about the amount of payment gives the right to refuse to conduct an appraisal examination.
Compensation papers for harm to life and health
When collecting insurance compensation under compulsory motor third-party liability insurance it will be required to present:
- conclusion from the hospital about the nature and types of injuries, the diagnosis;
- conclusion of the forensic bureau on the degree of disability;
- certificate of income that the victim had at the time of the injury.
In order to receive payment, heirs must provide the following list of documents:
- a statement indicating family members living with him;
- death certificate of a person;
- birth certificates of the children of the deceased at the time of death;
- a certificate from an educational institution about the education of a deceased dependent there;
- a conclusion on the need for additional care for the person previously looked after by the deceased;
- a certificate from the social security authorities that the spouse did not work at the time of the death of the deceased or looked after one of the relatives.
Documentation Processing
The procedure for collecting insurance compensation as a result of an accident provides for several nuances:
- it is forbidden to demand from applicants documents that are not stipulated in the legislation, in particular, by the procedure of compulsory insurance;
- representatives of the insurance company are obliged upon receipt of the application to report: what are the shortcomings of the submitted papers and what is missing.
The law does not prohibit the use of Internet resources for communication with companies. In this case, the applicant is still obliged to take measures to send documents in writing.
Payout Sizes
The Insurance Law establishes fixed benefits. From April 1, 2015, the amount of compensation may not exceed 500 thousand rubles. Of these, 25 thousand, the maximum amount allocated for burial.
In Art. 7 of the law spelled out the maximum material damage covered by insurance companies - 400 thousand rubles.
A statement of claim for insurance compensation may also be filed in large amounts, when it is described below.
Calculation of amounts paid
The law shares compensation for loss of health and damage to property. After an accident, the recovery of insurance compensation is provided in two forms.
In case of damage to health, money is paid at the request of a citizen or his representatives or heirs. Amounts are transferred at a time or gradually.
The statement is accompanied by the invoices and conclusions of the doctors about the need for additional assistance made during the research.
The applicant is entitled to receive payments both for the car and for other property damaged or destroyed in the accident (for example, cargo or other valuables).
The calculation is based on the materials of the appraisal examination. The victim provides an object for assessment. If he violates the conditions for their provision, the results of the examination carried out on his order are not accepted.
If the evasion or refusal to assess the damage occurred on the part of the insurer, then the applicant has the right to order an independent examination and refer to its results.
How the company operates
The result of consideration of the application is the preparation of an insurance act with a description of:
- the causes and circumstances of the accident;
- nature and extent of damage;
- the amount of payments assigned by the company.
The act is the result of work on studying documents, conducting an inspection, therefore, insurers do not fit into the required time frame.
As stated above, the lack of an answer entitles the applicant to proceed further.In particular, send a claim to the insurer.
Pre-trial Order
The collection of insurance compensation in court begins with the sending of the claim. It describes why the applicant does not agree with the decision of the company. It is a refusal to pay money or an understated amount. When it comes to medical treatment and disability benefits, the company may consider that the claimed costs are not really needed. Claim - a statement of calculations, the justification of all the requirements that are planned to be set. You can not treat her as an unnecessary formality.
In the explanations, the Supreme Court obliges the applicant to take measures to identify all his applications to the insurance company (indicate the numbers and dates of previously submitted applications).
The right to recover insurance compensation in court arises after receipt of the refusal or 10 days after the insurer receives the package of documents.
Without proof of sending the claim before the lawsuit is filed, the court will leave the lawsuit motionless, and then return it if no confirmation is given to it.
Jurisdiction
Disputes regarding insurance claims are settled by civil and arbitration courts. The former receive the bulk of cases; ordinary citizens participate in them. Disputes where parties are organizations and entrepreneurs are settled by arbitration courts.
Claims up to 50 thousand rubles. considered by world courts. District courts hear cases where either the price of the claim is high or the application includes jurisdiction to the district court.
Increasing the price of a lawsuit and introducing new requirements of the jurisdiction to the district court means referring the case to the district court.
The collection of the amount of insurance compensation is made at the option of the plaintiff. In a number of cases, in particular, in case of damage to property or health, the plaintiff has the right to turn to a judge at his place of residence.
In a dispute that does not fall under the rules on the choice of court, a lawsuit is filed at the location of the defendant or his representative office.
Parties to the process
Participants as defendants are:
- insurance companies to which claims are made;
- the person who caused the harm;
- Russian Union of Automobile Insurers.
Who is entitled to go to court:
- anyone who was harmed (vehicle owner, driver, passengers, other citizens, etc.);
- heirs or assigns to which the right of claim passes.
Payment of money to third parties is regulated directly by insurance, and not by inheritance law.
If the amount of compensation required exceeds the limit laid down in the law, the culprit of the incident and the SAR are also involved as a defendant.
Claim to the insurer
The insurance company pays compensation from its own funds, taking into account the established limits. Citizens are suing them about:
- refusal to make payments;
- regarding the recovery of unpaid insurance compensation;
- evasion of timely consideration of the application and submitted documents and failure to take other measures on its part to resolve the issue.
Disputes arise between companies.
The lawsuit against the culprit
According to the law, the culprit becomes the defendant in the following cases. Recovery of the difference in insurance compensation from the culprit of an accident. For example, the damage caused to the victim is 600 thousand, and the defendant will be required to pay the balance of 200 thousand rubles. The same rule applies to property damage and harm to life and health.
The culprit did not have an insurance policy or he terminated or is invalid. The absence of a policy is a separate administrative violation.
Several victims whose damage was not fully covered. The insurance amount is distributed evenly between them, and everyone needs to go to court.
CTP does not compensate for non-pecuniary damage and loss of lost profits.The insurance company does not compensate for damage that was not caused while the vehicle was moving (for example, a car was damaged on a parking lot).
PCA
RSA is a professional association of insurance companies. His involvement is permitted on a number of grounds, all of which affect harm to life and health and property. The first list includes the following cases:
- a bankruptcy procedure has been introduced in respect of a company obligated to make payments;
- the insurance company has lost the license to conduct business;
- the guilty person who caused the harm was never identified;
- the culprit of the accident did not have a valid insurance policy.
Payments for property claims are provided by the SAR if:
- the company has its license revoked;
- insurance company came under bankruptcy proceedings.
Statutes of limitations
After an accident, the recovery of insurance compensation is limited to the limitation period. Their pass gives the court the right, when the defendant claims, to refuse the claim without examining it on the merits.
The plaintiff who missed the time to appeal due to good circumstances, has the right to ask the court to restore the term. It is advisable to make a statement at the stage of filing a claim so that the statement is not subsequently refused without the request of the defendant. This practice is illegal, but is taking place.
Duration - 3 years. Its countdown starts from the moment the company refuses to pay compensation. Its countdown starts from the moment the time allotted for making a decision on the application expires if the company has not made a formal decision on the application.
The rule of limitation does not apply to harm to life and health. The same rules apply in respect of non-pecuniary damage. In case of property damage - the collection period is 3 years, in case of harm to life and health - the statute of limitations also does not apply.
The collection of insurance compensation in judicial practice is provided for the last 3 3 years.
Drawing up a claim
The claim is filed for the recovery of insurance compensation subject to the general rules of civil proceedings. The document indicates:
- name of court;
- Name of the defendant, place of residence, full name of the organization, location of the office of the unit with the status of a legal entity;
- Name of the plaintiff, place of residence;
- circumstances of the case (the fact of causing harm, applying for payments, receiving a refusal or ignoring the request, other facts);
- references to regulations, judicial practice;
- requirements to the court (to recover funds or to oblige to ensure the implementation of restoration repair);
- inventory of attached documents;
- receipt of payment of state duty;
- signature and filing date.
A statement from the bank is attached with the details of the account to which the bailiffs or company will transfer the money.
The number of sets is fed by the number of participants in the process.
Regarding the requirements of the Armed Forces of the Russian Federation, he gave an explanation: the plaintiff has the right to make a choice between repairing and collecting insurance compensation, damage in cash. True, it is noted that owners of cars registered in Russia do not have it.
Duty Size
Claims for insurance companies based on personal needs are subject to consumer protection laws, so there is no need to pay state fees.
Litigation related to injury to health or life is also not paid from the pockets of citizens. Thus, when collecting insurance compensation, the state duty by citizens is almost never paid. When an appeal, cassation and supervisory appeal is submitted, the benefit ceases to apply.
Part of the cases continues to be paid, and leaving the court without a motion due to lack of information about the payment of state duty is quite justified.
Features of the proceedings
The application for reimbursement of insurance compensation is considered on the basis of the documents attached to it.
The plaintiff's task is to prove that his actions are fully consistent with the law. For example, all necessary papers were attached to the application to the company. A message about the time and place of inspection of the car is sent using the means of recording the fact of departure.
The fact of the violation that caused the harm is recorded either in a criminal case or in administrative materials.
If, for some reason, no substantive decision has been made in the administrative case, the judge finds out the fact of guilt on the basis of the protocol and other materials issued by the police.
The insured parties in the absence of harm to health are entitled to notify the company of the accident by filling out a form to notify the company of the insured event. Police officers are not involved. The maximum amount under the simplified reimbursement procedure is not more than 100 thousand rubles. The study of the circumstances of the case is provided with the help of photographs, shots taken by the accident participants.
The injured party has the right to demand in court to recover additional amounts if the consequences of the accident manifested themselves in the future, and their occurrence could not be predicted immediately after the accident.
In judicial practice, there are rejection decisions on the recovery of insurance compensation due to repairs before the vehicle is inspected by a company representative. The reason is the lack of a chance to restore the full picture of the incident.
The court's decision
In a judicial act, a judge describes the parties' arguments, the evidence presented by them, the assessment that he gave them. The document awards the amount of compensation, the expenses of the winner from the losing side are recovered, or they are divided depending on the volume of satisfaction of the claims.
If more than one person takes part in the case on each of the parties, the individual obligations of the defendants and the amounts due to each of the plaintiffs are distributed in the decision.
The law, as mentioned above, does not exclude the imposition of obligations in kind - to issue a direction for car repair.
An appeal is given a month from the moment you receive the full decision on the grounds for the reasoning.
If the trial took place with the justice of the peace, an application is filed to draw up a full decision within 3 days from the date of its announcement by the persons present at the announcement. Those who were not at the meeting are given 15 days to write and submit an application.
Collection stage
The issuance of a court decision on the recovery of insurance compensation does not mean receiving cash. The seeker has two ways:
- contact the bailiff service;
- apply to the bank or credit organization maintaining the accounts of the insurance company.
For a bailiff or bank, the basis is a writ of execution issued by the court. He is discharged at the request of citizens. You can ask the court to send the sheet directly to the bailiffs.
It should be noted that the action of the writ of execution is limited to a 3-year period.
A more acceptable option for citizens is to contact the bank. On all documents of the company, their websites account details and names of banks are indicated. Finding where to go is easy.
If there is no information about the accounts or they are out of date, the applicant, having in his hands a writ of execution whose validity has not yet expired, has the right to contact the tax service. At her disposal are the accounts of all organizations and individual entrepreneurs conducting activities using accounts.
Appeal to the bank
Those who wish to recover money with the help of a bank provide an application and the original of a writ of execution.
The statement shall indicate:
- information about the bank account of the applicant;
- Full name, citizenship of the claimant;
- passport number, date of issue, authority that issued it;
- details of another identity document;
- place of residence or stay of a person;
- TIN if it was issued.
If the application is submitted by a representative, he shall indicate the same amount of information about himself and about the collector. Attached is a copy of the power of attorney.It is advisable to submit an application directly to the bank, there they will help to adjust it if necessary.
When accepting documents, the general rules apply: on a copy they put a mark on acceptance and a signature of the corresponding employee.