Insured events in health insurance. Insurance case

Unlike car insurance, life and health insurance is relatively unpopular in our country - it is often provided by certain companies or required for employment in dangerous jobs. However, voluntary life and health insurance is a guarantee that in the event of an accident a person will not be left without finances for existence.

What are the types of life and health insurance?

Chapter 48 of the Civil Code of the Russian Federation provides for the main features of insurance, including life and health insurance. It refers to voluntary personal insurance.

The Civil Code of the Russian Federation indicates that this insurance may be based on the fact of insurance:

• survival
• life
• health

In case of survival insurance, the insured event is the occurrence certain age citizen specified in the contract with the insurer.

Life insurance means that the moment of payment occurs only in the event of the death of the insured person.

Important fact

The life insurance contract can be term. That is, if the death of the insured person occurs during a certain period established by this contract.

Health insurance is the most common type of personal insurance. Often it is referred to as life and health insurance, since the insured event according to the contract is a certain loss of health or the onset of death as a result of an accident, serious illness or any other reason directly established by the contract.

In addition to personal life and health insurance, a corporate (group) insurance contract can be concluded. In this case, the insured is a certain organization that makes contributions to the account of the insurance company for its employees.

With group insurance, insurance is quite popular not around the clock, but operating exclusively during the performance of work duties by the employee.

If, with such insurance, a citizen receives a domestic injury, for example, gets into an accident on his day off, insurance payments in this case will not be paid.

Parties to the insurance contract

The following persons may participate in this agreement:

• Insured – a person who has entered into an agreement with an insurance company and who undertakes to pay the corresponding sums insured.
• An insurer is an insurance company acting exclusively as a legal entity.
• The insured person is a citizen in whose favor the insurance contract is concluded.
• Beneficiary - a person entitled to receive insurance payments in the event of insured event.

Often, a personal insurance contract is concluded between two parties - an insurance company and a citizen acting simultaneously as an insured, an insured person and a beneficiary. Less commonly, another person may be appointed as the beneficiary. For example, such a case is popular when concluding a life insurance contract.

Important fact

In practice, the policyholder and the insured person are often separate parties to the contract when concluding a group insurance contract or an individual insurance contract concluded by the employer in favor of its employee.

Who can receive a life and health insurance payout?

According to the general rules, the insured person is entitled to receive payments (compensation) in the event of an insured event. However, Article 934 of the Civil Code of the Russian Federation establishes that in addition to the insured person himself, a third person (beneficiary) can receive payment if he is indicated as such in the contract.

note

Even if the contract does not specify a third party as a beneficiary, in the event of the death of the insured person, when the cause and occurrence of death is an insured event, insurance payments are received by the heirs in the form of an inheritance inherited by law.

How to get compensation for life and health insurance, sample

In the event of an insured event established by the contract, in order to receive the appropriate payments, it is necessary to perform a number of specific actions.

The first thing is to prepare an application to the insurance company to receive an insurance payment. Often, when concluding a contract, the insurance company provides an appropriate form. If there is no such form, then you should draw up a document yourself or fill out a standard sample.

• Passport or other identity document of the insured person
• Copy or original of the contract
• If there is a beneficiary, documents confirming given right. In case of death in the absence of the beneficiary, it is necessary to provide a document confirming the right to the inheritance of his heirs applying for payment.
• Document confirming the moment of occurrence of the insured event

The last document is the most important and may vary depending on the type of event that has occurred and the type of personal insurance contract. The most popular documents in the case of health insurance in practice include:

• Conclusion or certificate of the attending physician;
• Certificate of disability
• Conclusion of the commission on an accident at work
• Protocol of the traffic police about the occurrence of an accident.
• If a citizen died as a result of an insured event established by the contract, it is necessary to provide a death certificate to the documents indicated above.

Important fact

Often, in addition to the application form, insurance companies at the conclusion of the contract issue appropriate instructions on what needs to be done in the event of an insured event.

After collecting all required documents you need to contact directly insurance company and notify of the occurrence of an insured event. By general rule, the notice period is not more than 30 calendar days.

note

The specified period is not final. Often, the insurance contract indicates the possibility of its extension, for example, if the applicant is unable to submit documents due to a serious illness or other force majeure. However, in order to avoid possible disagreements, it is better to notify the representative of the insurance company in advance about the extension of the period.

The procedure for consideration and payment of insurance

However, the review process may be delayed if the insurance company suspects, for example, that the submitted documents are not fake or if a criminal case has been initiated on the fact of the insured event and a final decision has not yet been made on it.

Payments are usually made within a period of not more than 15 days from the moment the insurer recognizes the occurrence of an insured event.

All existing system insurance is built on the order of insurance premiums, cases and subsequent payments. People try to protect themselves financially 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 insured 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 specific danger, but also against their accidental occurrence, as well as causing harm to the object insured under the relevant contract.

The case under consideration is a 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. Randomness is of an exclusively objective nature, due to the lack of complete information regarding the possibility of an unfavorable event.

An insured event is a three-dimensional structure, in connection with which an event that has occurred is classified as an event only if there are three elements: the occurrence of danger, causing harm, and a causal relationship between them. And the legal consequence of the occurrence of such an event (change of subject in relation to the obligation 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 eligibility of the insurer's obligations, fixed in the relevant insurance contract.

According to the specified obligations, after the occurrence of a certain insured event, this insurer is obliged to compensate for material damage that was caused to the insured or to the insured - a third party accompanying liability insurance.

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

The frequently used legal term "insurable event" in Latin is interpreted as "death, event, fall, case, occasion, circumstance." In Russian legislation, it is interpreted as an event that has already taken place, which is provided for by law or an insurance contract and upon the occurrence of which the insurer is obliged to make the appropriate insurance payment to the specified insured person, or to another third party, or to the insured himself.

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

Additional conditions may be specified in the relevant agreement. For example, DOSAGO (additional voluntary insurance to OSAGO, expanding the powers compulsory insurance in relation to civil liability) becomes eligible at the moment when the damage caused by this insured to third parties exceeds the amount specified in the OSAGO agreement.

As for such a category as personal insurance, an insured event (PL 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.

Here it is worth mentioning one more definition: an accident at work is considered insured if it happened to any insured or other person who is subject to compulsory insurance against the cases in question during production activities as well as occupational diseases.

In a situation where, during the procedure for investigating an accident with any insured person, his own gross negligence was established, which later led to the occurrence or increase in harm to his health, the degree of guilt of this participant is necessarily determined in percent.

Types of insured events

It is customary to distinguish two main types of insurance: voluntary and mandatory. All known wealth, which are within the framework of civil circulation (a set of transactions concluded by counterparties, the basis of which is always obligations). But there are definitely no safeguards against illegal activities.

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

1. Property (protection material assets eg damage to a vehicle or buildings, lean year, etc.).
2. Liability insurance (this includes the most extensive list of insured events, which are most often issued by state of emergency and legal entities, for example, compensation if the insured did not fulfill his obligations under the product supply agreement or did not repay 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 length of service or disability, as well as a social insured event - loss of a breadwinner, etc.).
5. Entrepreneurs' risk insurance (their protection in case of loss of income, non-receipt of profit, losses, 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 a contract for all types of insured events, the insured is obliged to compensate for losses that have arisen due to unforeseen circumstances in the activities of the entrepreneur.

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

Compulsory insurance: conditions of occurrence, types

It occurs when at least one of three conditions is present:

1. Voluntary insurance of the same risks as in compulsory insurance is not commercially feasible from the point of view of insurers.
2. It is also significantly more expensive than the one under consideration.
3. The policyholder underestimates the significance of such risks.

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

In Russia today, insurance is mandatory in the following areas:

1. OSAGO, the 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 would be useful to know that the application (insured event - accident) for the required insurance payment differs based on who fills it out (the victim is not a CTP client, the insured, the victim is a CTP client).

2. CHI, according to which every citizen of our country is recognized as insured.

3. OSGOP (Compulsory civil liability insurance of carriers) until 2013 was a pure formality (2 rubles 30 kopecks in the cost of a railway ticket). These funds were definitely not enough even for partial treatment. Further, in January 2013, the current law came into force, according to which the minimum payment in the event of the death of a passenger is 2 million rubles, as well as another 25 thousand rubles. - his funeral. The shortcoming was the moment regarding 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). Direct duty to carry out this insurance it is not provided for firms, and it is permissible to acquire a license from Rostekhnadzor for the relevant types of activity only if there is a special policy. As a rule, this is sufficient sum insured in the amount of 100 thousand rubles. It is by no means possible to call this kind of protection serious. V this moment this law is under revision.

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

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

• housing (a similar bill is being promoted by Gosstroy);
• FL and LE, providing medical services on 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 stage of discussion.

Summing up, we can say that in Russia, motor vehicle insurance (OSAGO) is “most mandatory”. The rest of the areas are either underdeveloped or in the stage of stagnation.

Registration of insurance cases

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

• establishing the basis for the payment of certain insurance indemnities;
• the regulations of the aforementioned grounds and the rationale for the methodology for calculating the specific amount of the due insurance indemnity.

List of documents confirming the fact of the occurrence of insured events and their identification under the terms of insurance

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

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

The last document from the above must be drawn up in accordance with the rules of insurance. It confirms the fact, circumstances and causes of the insured event. It is solely on its basis that the amount of damage caused to the property of the insured can be calculated, the amount of the due insurance compensation can be calculated, and the right of the insured to receive it can be established.

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

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

• provided in the application by the insured;
• reflected and established by the insurer in a special insurance act;
• provided by the competent authorities (in the situation of referring to them).

What is the value of damage in the case under consideration?

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

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

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

Death of a borrower as an insured event on a loan

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

Secondly, total amount debt, passed to several heirs, according to the law is divided in proportion to the received shares of the relevant inheritance.

Thirdly, in the case of securing a debt with a pledge (for example, in a situation with a car loan or a mortgage), the subject of the pledge passes to the heirs, in addition to the debt itself. The bank most often easily approves the decision to sell it, provided that the amount necessary to repay the loan is immediately sent to the bank. After the loan is repaid, the heirs receive the remaining amount (if any).

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

Features of the circumstance under consideration

The considered insured event on the loan has several nuances:

1. If the inheritance is not legally accepted by anyone, and loan agreement was not secured by a guarantee, the bank is authorized to judicial order demand the immediate sale of this property at 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 at the same time, then they formally do not inherit debts. However, if this housing is foreclosed by the relevant bank, 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 legislation, in special cases they cannot be evicted. An example is the 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 are liable for the loan even before the legal registration of the proper right to the due inheritance.

The considered insured event on the loan is good example that Russian law within the framework of this issue is harsh and practically indisputable.

"Forfeit Reduction"

This article Civil Code(333rd). 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 halfway (reduce or cancel fines) by concluding a settlement agreement if the heir does not try to dispute the debt and is ready to pay it off in full.

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 (the death of the original borrower). The heir may not have been informed of this moment. Thirdly, he has the right to notarize the waiver of the due inheritance.

Accident insurance premiums

nuance legal aspect regulation of this compulsory social insurance is that significant elements Tariffs have been established in various regulations.

Insurance premiums (an accident in this case is the subject of compulsory insurance) according to its legal nature- it tax payments, since they meet all their characteristics without exception. Given this fact, we can say that the norms of the Russian Federation apply to the relations related to their payment. tax legislation(calculation of penalties on existing debts for the required transfers to the FSS body, financial sanctions against non-payers of these contributions, as well as against banks that violated the procedure for their transfer to the Fund, etc.).

Are employees considered insured persons?

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

Employees are provided following payments in case of an insured accident at work:

1. A benefit compensating for temporary disability 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 submitting an application, to receive it in the Russian regional office FSS).
2. Monthly payments (insurance).
3. One-time payment (insurance).
4. Compensation of all additional costs(for social, medical and professional rehabilitation).

The basis for issuing the first type of benefit - sick leave. The above payments for insured events at work must be executed by the employer properly (in full and on time).

Some insurance companies claim that the business of selling mandatory motor third party liability insurance policies is unprofitable. As a result, car owners often meet either with attempts to refuse payments for OSAGO or, at a minimum, with an attempt to underestimate the amount of damage.

Honest lawyers have been helping clients deal with unfair practices of insurers for many years. We analyzed the practice and invites the driver to figure out what an OSAGO insured event is and in what situation the car owner legal grounds can demand from insurers payments for car repairs.

The concept of an insured event

Legislation

To understand what exactly is included in the insured event under OSAGO, it is worth studying the federal law Federal Law No. 40. It contains all the basic information. Here is a squeeze about insured events:

• The insured event under OSAGO includes events in which a citizen had an accident while driving a vehicle;
• At that moment, he had an unexpired OSAGO policy;
• The accident caused damage to other property or the health of other people.

The same law states maximum size compensation for OSAGO - property 400 thousand rubles, damage to health 500 thousand rubles.

According to the law, in order to recognize an insured event, there is no difference whether the accident was registered by the drivers on their own, through filling out the European protocol, or whether the forces of the police were involved. But it is worth remembering that if the drivers themselves filled out the notice, then the amount of compensation in the regions is limited (according to the latest amendments to the OSAGO law) to 100 thousand rubles. For "capital" cities and regions - 400 thousand rubles.

Insured event criteria

In order for an insurance company to recognize an event as an insured event, it is necessary that the accident has a combination of several criteria at once:

• The presence of a policy. If the culprit of the accident does not have an OSAGO policy, then the injured motorist will have to sue him and recover damages.
• Vehicle movement. If the car was in the parking lot, the driver opened the door and hit another car - this is not an insured event under OSAGO.
• The damage is done in this situation. Oddly enough, the injured party quite often tries to get around this criterion - that is, he tries to receive compensation under OSAGO not only for a scratch received in an accident, but also for other damage to the car.
• The presence of the culprit in the accident. This is one of the key requirements of OSAGO. What is included in the insured event from this point of view, and what is not? It's simple - if your car crashed, then there is a culprit in the accident. If you find a dented car in the parking lot, but the culprit could not be identified, then this is not an insured event under OSAGO.

Not recognized as an insured event

The OSAGO law lists several cases that the insurance company does not recognize under OSAGO. Let's give examples.

No accident status

The concept of an insured event includes the mandatory presence of the fact of an accident. It does not matter how it is issued - with the help of the European protocol or with the involvement of police officers. If the accident is not recorded in any way, then it is quite difficult to recognize the event as an insured event.

If the car owner wants to get insurance after events not related to an accident, you should take care of this in advance and purchase a CASCO policy. Then the driver will be able to count on payments after theft, fire and natural disasters.

Other transport

The driver got into an accident while driving car number 1. He has an OSAGO policy issued for car No. 2. In such a situation, the driver tries to figure out what is included in the OSAGO insured event, but the answer is simple - nothing. If the driver is responsible for the accident, then he will be required to compensate for the damage caused. Police officers in any case must issue a ticket for driving without insurance. The OSAGO policy is issued for a car, not for a person.

Special Risks

If an accident occurs during the transportation of a special cargo associated with a risk, an insured event under OSAGO is not recognized. Special carriages are regulated by separate legislation and are subject to special insurance.

Moral damage

Under OSAGO, the car owner will not be able to recover moral damages or lost profits. Only compensation for damage caused to the car and compensation for damage to health. In this case, it is worth making a reservation - no one will deprive the car owner of the right to sue the culprit of the accident and try to recover funds, including for moral damage. But talking about an insured event under OSAGO has nothing to do with it.

No way to assess damage

The car owner may independently lose the opportunity to receive compensation for damage caused in an accident under OSAGO. This happens if, after an accident, the victim repairs his car on his own. In accordance with paragraph 10 of article 12 of the Federal Law-40 “On OSAGO”, the driver is obliged to show the damaged car to the insurance company. Damage repaired prior to demonstration - no way to estimate compensation amount and receive payouts.

Remember, after an accident, you must notify the insurance company about the event - if a European protocol was issued, then your insurance company. If the traffic police were called, then the insurance culprit of the accident. Do not repair your car in advance, the insurance may refuse to pay out.

Driver inactivity

Quite rare, but possible. The insurance company can go to the conflict and try to prove that the driver was inactive, that's why the accident happened. Thus, insurers will try to refuse to recognize the case as insurance and will object to the payment of legal compensation.

Other options

There are several more situations when, before arguing with insurance companies, you should first think about what is included in the OSAGO insured event:

• The accident occurred at a competition or while driving on a training track or in other places specially designed for this. Even if an OSAGO policy is purchased for a car, claiming compensation for it is inappropriate;
• Damage to health in situations where another type of insurance is applied - individual or social insurance at enterprises. It's about about injuries that may be received at work;
• Causing damage in an accident to values ​​\u200b\u200bthat have historical or cultural significance - special monument buildings, antiques, etc.;
• The deadline for notifying the insurance company has expired - the car owner must notify the insurers about what happened within five days. If this does not happen, payments may be denied;
• Damage to the car was due to the cargo that was transported while driving - for example, broken glass when transporting furniture;
• Damage occurred due to events national importance– for example, civil war, strikes or environmental disasters;
• Freight or passenger transport was operated without an up-to-date diagnostic card;
• The employer's car was damaged while the employee was performing work duties.

Disputable insured event

Insurance companies are not always eager to pay full compensation for damages received by a driver in an accident under an OSAGO policy. Most often, payments are underestimated, but you may encounter a situation where the insurance company refuses to pay out at all. On the basis of non-recognition of the event as an insured event. How to act in such a situation?

Call to Honest

Insurance companies, especially large ones, maintain a professional staff of lawyers. Before getting involved in litigation, it is worth assessing the prospects of the case. Call Honest - each of our consultants has been working in the field of client protection for at least five years. Tell me the details, get the details. The consultation is free - we will be able to guide you on your thoughts on the legality of the insurance company's refusal to pay compensation.

Expertise

If you decide to fight the insurance company, then you need to evaluate your case in more detail. It is possible to carry out an assessment of damage or a trace examination. The first will install the exact amount damage to your vehicle. The second will help clarify all the circumstances of the accident.

pre-trial claim

If there was controversial situation according to the assessment of the insured event, then first of all you will have to send to insurance organization pre-trial claim. The damage assessment carried out will be the basis for your claims. As practice shows, insurance companies most often pay the full amount of damage already at this stage in order to avoid court costs and a fine for refusing to comply with the requirements of the consumer in a pre-trial order.

lawsuit

If the insurance company continues to refuse to pay out OSAGO or offers compensation, but in a much smaller amount than it was found out by the examination, it is worth going to court. If the price of the claim is less than 50 thousand rubles, then we apply to the world court. If more, then to the district.

We can save your time and prepare the claim ourselves. If necessary, we will support at all stages of the trial. Do not forget that the cost of a claim includes the costs of examinations and legal support. If the judge decides that your claims are justified, then such costs are recognized as legal costs and the insurance company will pay for them.

Over the years, Honest's lawyers have been able to solve a lot of the most difficult problems related to conflicts with insurance companies. Contact Honest, we will help.

An insured car can get into a variety of accidents, but not every vehicle owner knows what insurance claims under OSAGO apply to a particular accident.

In order to understand whether it is worth counting on compensation for insurance policy, you should know the law, and its provisions in this matter are clearly spelled out.

When does the civil liability of the driver not come?

In the case when you are the only participant in the accident, such as when you leave the road or damage your own car against a garage door, of course, the CMTPL payment will not be considered. For the insurance payment, the injured party is required, and it must suffer through your fault, in this case your insured civil liability will cover the costs caused to another participant in the accident.

It happens that the car was damaged during parking and it is not possible to identify the obvious culprit of the damage, no matter if it was something else vehicle or just an intruder scratched the coating of the car with a nail. In this situation, insurance will not be paid, since there is no one to collect it from.

If in the parking lot your car was damaged by another participant in the movement, and it was installed, then according to the OSAGO agreement, you will be paid compensation from the insured civil liability of the person who caused the accident.

According to this! For payment monetary compensation the damage caused must be received from another vehicle, the owner of which has been identified and found to be the culprit of the accident.

There are cases in which the owner of another car can cause harm to your vehicle, and not become the culprit according to OSAGO, such as when opening the door in the parking area. The door of his car may even leave a significant dent in your car, but the insurance company will not take into account such an impact. This means that the vehicle at fault must be in motion at the time of the accident.

In what cases can you expect insurance payments?

With one hundred percent probability, insurance will be paid to the injured party if:

1. A person was hit, he was injured or the outcome of the accident was the death of a pedestrian;
2. The driver and passengers arriving inside the car of the injured party were injured or killed;
3. As a result of an accident, another car or other vehicle was damaged by you;
4. Damaged private or state property(post, fence, road barrier);

In all these incidents, the insurance company will pay compensation to the injured party, the amount of which will be determined based on the damage received.

In case of harm to the health of the victims or if the accident has led to death, OSAGO insurance is limited to a payment of 500,000 rubles. A vehicle or other property damaged by you as a result of an accident is covered for no more than 400,000 rubles.

Collection of payments under the insurance policy can be issued at the branch of your insurance company closest to the place of the accident or at the company in which the policy was purchased by another participant in the accident.

You can increase the amount of insurance payment by purchasing an additional DSAGO policy, in which case the payment will be limited to 1,000,000 rubles.

What cases are not covered by OSAGO?

There are a number of peculiar moments in which insurers may not pay compensation, they must be remembered and tried to avoid:

• More than one year and one day has passed since the conclusion of the contract, in other words, the policy has expired;
• The damage was caused by a driver or a car not insured with OSAGO;
• Physical or material harm was not caused, the insurance payment does not provide for moral damage;
• Accidents in which the vehicle was used as a racing or training car for a person who does not have driving license(except for the conditions specified in the policy);
• The damage to the traffic participants was not caused by the vehicle itself, but by the cargo that it was carrying, with the exception of separately agreed conditions at the time of conclusion of the contract;
• If your vehicle was damaged in the course of work not directly related to traffic, if the harm from such work is not provided for by applicable law;
• In the event that the damage caused by you to an employee of any organization affected the interests of his employer, OSAGO insurance is not paid;
• Damage caused by uninsured cargo transportation equipment (trailer, trolley) is not indemnified;
• Material damage caused to the injured party during loading and unloading operations;
• Damage caused to any intellectual property, including luxury goods, works of art, historical objects, securities;
• Insured event in case of an accident CMTPL exceeding maximum amount payments must be repaid by the perpetrator of the incident in full;
• In case of intentional damage to the vehicle by its owner, insurance payment will not be made if this intent is revealed by an employee of the company during the investigation;
• If the perpetrator of the accident at the time of the accident was in a state of alcoholic or drug intoxication, and this fact was recorded by the relevant authorities, the payment under the policy will be blocked;
• If damage to life, health or property of the injured party was caused under the influence of force majeure.

Driver actions after an accident

The current legislation provides for a clear list of actions to be performed by each party after the accident, it will help minimize the negative impact of the accident.

You need to follow the required steps:

1. Immediately after the collision, you must stop the vehicle and fix it with all possible ways(put on speed, handbrake) to avoid its further movement;
2. Turn on the alarm warning other road users about the danger, as well as place a special warning triangle (mandatory in every vehicle) at a distance of at least 15 meters in front of the accident site;
3. If possible, provide assistance to persons injured during the accident, be sure to call the police and the ambulance;
4. When the victim is placed in the ambulance, you should leave your details with the medical officer and return to the accident site;
5. If it is clear that the life of the victim is in danger, and help will not arrive soon, then take him to the nearest medical institution in your car, with the consent of the victim;
6. When the police officers record all the details of the incident in the protocol, the vehicle should be removed from the roadway and the traffic should be released;
7. Record all contact details of witnesses to the incident;
8. Sign the documents provided by the traffic police officers, having previously read them;
9. Call the insurance company after completing all of the above steps.

If the harm caused did not affect the interests of other road users or pedestrians, then you can file an accident after calling the police, following the proposed instructions.

Life insurance along with health insurance is actively gaining popularity. People choose this type of insurance when they are afraid that their loved ones will face major material costs associated with death and do not want to put them in a difficult position. But for many people it still remains unknown how this type of insurance works in practice, what is considered an insured event, what is the procedure for receiving payments and who can claim it. We will consider these questions in this article.

What are the features of life insurance?

Most often, life insurance is cumulative (that is, the insured regularly makes a previously agreed payment) and provides for the following options for insured events:

• death;
• survival to a certain age;
• in some cases, disability or other damage to health as a result of an accident.

Depending on the specific contract, there may be nuances - for example, death due to an accident or accident may increase the amount of insurance payments, suicide can be considered as life insured event or not considered, there may also be restrictions on the causes of death, disability, disability, etc. Most often, the more possible risks are included in the policy, the less compensation will be in the event of an insured event.

An interesting option is the type of insurance, when the risk is considered to be surviving to the age specified in the policy (usually 70 years or more). In this case, the insured person will receive the entire accumulated amount of insurance payments or will receive a lifetime pension upon reaching the specified age. This type of life insurance is used as a guarantee financial support retired to be less dependent on government welfare payments.

A separate type of life insurance is a contract that provides for payment not only in case of death, but also in case of serious injuries or consequences of the illness of the insured person, leading to disability or disability. In this case, the occurrence of an insured event, as well as the amount of payments, is determined by the severity of the damage to health.

The procedure for receiving insurance payments

If an accident has occurred that has signs of an insured event, you must immediately contact the insurance company for the due payments. To do this, you must perform the following steps:

1. Within 10 days from the moment of occurrence of the insured event, contact the insurance company and inform about the incident;
2. Prepare and submit to the representatives of the insurer an application for the payment of insurance coverage.
3. Submit a list additional documents confirming the occurrence of an insured event:
   1. in the event of the death of the insured- death certificate, act on the causes of death, if the cause was an accident or violent death - extracts from the Ministry of Internal Affairs with confirmation, documents confirming the identity of the applicant (heirs of the first stage can act in this role, if they are not - the second, etc. .), a copy of the certificate of entry into the inheritance (if insurance contract beneficiaries are not specified);
   2. in case of an accident- an extract from a medical institution confirming the onset of disability / loss of ability to work and the reasons, an accident report, an extract from the register of the Ministry of Internal Affairs about the incident, if the cause was an accident or criminal acts.

In what cases does the insurance company have the right to refuse payments?

if the actions of the insured person were clearly aimed at the occurrence of an insured event (for example, suicide, if it is not provided as a variant of an insured event);

commission by the insured person of a crime, which became the cause of the insured event;

if knowingly incorrect information about the fact of the occurrence of an insured event is presented, including if such information is indicated in the documents provided;

in case of untimely notification of the insurer.