The insurance company refuses to pay under compulsory motor insurance - only the court will help? What to do if the insurance company refuses to pay for comprehensive insurance? Refusal of insurance payment

Insurance should significantly reduce possible material losses in the event of natural disasters, actions of third parties or other unforeseen circumstances.

When an insured event occurs, the insured person collects the necessary package of documents and receives an insurance payment that fully or partially covers the damage caused.

But in difficult cases, attempts to prove your case and the right to receive money may drag on for several years and require litigation with the insurance company - you should also be prepared for this scenario.

What is an insurance payment and when does a company have an obligation to make it?

Insurance payment- this is the amount paid to the insured person under the terms of the contract upon the occurrence of insured event.

The risks that the company insures are always very clearly stated in the contract, each of them is specified: payment is not made for cases not directly specified in the contract.

The contract may provide for compensation for damage in full if the damage is covered by the insurance limit, partially if the amount of damage is greater than the maximum specified in the contract, or in proportion to the damage received.

Insurance case– this is a set of circumstances in the presence of which the damage caused will be compensated within the insurance limit or in proportion to the damage. In order for the insurer to have an obligation to transfer the agreed amount of compensation to the insured person, the damage must occur in precisely defined circumstances.

For example, a fire under an insurance contract is not any uncontrolled fire; this risk has many exceptions: carelessness or negligence of the property owner, acts of war, civil unrest and many others.

Therefore, even at the stage of choosing an insurer, you should very accurately imagine the risks against which you want to insure, and completely indicate them in the contract.

Payment of compensation is preceded by a standard procedure:

Notification of an insured event;
Collecting documents confirming the insured event and contacting the insurance company;
An examination appointed and paid for by the insurer or the insured person (in this case, the insurer may conduct its own alternative examination);
Making a decision on payment or refusal to pay. In case of refusal or underestimation of the amount of damage by the insurer, the insured person may go to court.

In what cases can an insurance claim be refused?

Most often, the refusal occurs due to the fault of the insured person himself, the reason may be:

Also, refusal can be caused by more formal reasons, for example, failure to provide property on time for the insurer's examination, even if an independent examination report is provided.

What to do if the insurance company wrongfully refused to pay insurance compensation?

You should be prepared for the fact that the insurer will do everything to refuse to pay you. The most common reason for refusal is that the damage was allegedly caused due to careless actions or the negligence of the insured person himself.

Large companies very rarely refuse to pay in obvious cases, but it is common practice for them to underestimate damage by several times. Even in auto insurance, “their own” expertise can significantly reduce the insurer’s costs for paying compensation, and not all insured persons go to court to recover full compensation for damage - this pays for possible legal costs.

But in any case, if you are faced with an unlawful refusal to pay, the only way to get money is going to court.

There is no need to be afraid of it; proceedings with insurers turn into a “war of experts”: an expert hired by the insurance company substantiates the underestimated amount of damage or violation of the terms of the contract by the insured person (for example, careless handling of gas equipment that caused a fire). The insured person, in turn, proves the opposite, and the court evaluates the objectivity of each of the submitted examinations.

It should be remembered that if a decision is made in your favor, in addition to the actual amount of compensation, the losing party will have to pay:

It is also necessary to keep in mind that the court can satisfy the claim not in full, reducing the plaintiff’s original demands, so it is better to indicate all possible damages in the claim.

You won’t be able to correctly formulate and justify your demands without a legal education – it’s better to involve them in the preparatory work professional.

Receiving payment for an insured event may not be as easy as it seems when reading advertising offers from insurers.

To avoid being denied a refund, you should remember a few basic rules:

Video about insurers’ refusal to accept materials from video recorders and refusal to pay

3 comments

It’s one thing when a payment is rightly refused. Then you understand that it is not the fault of the insurance company. But most often the opposite happens - you are denied when you have every right to compensation. In such cases, you should not delay, you need to act quickly and have all the necessary documents so that this matter does not drag out. Fortunately, most lawsuits are won by clients.

Insurance is only at first glance very easy and simple, now there are a lot of companies that promise mountains of gold, but as soon as you dig deeper, reality begins. Initially, you need to find information and understand what insurance is; it doesn’t make sense to sign a contract without preparation! Personally, I had a negative experience (the very first one) when I, still a gullible person, came to insure a car, told me what I wanted, but basically, not understanding anything about the essence of the issue, took my word for it and signed the contract, which I regretted at the first minor accident. And indeed, not everyone is mentally prepared for the trial, when you arrive in full confidence that everything is in order!!! First, study the insurance company, what percentage of payments it has under contracts, then carefully study the insurance sector (home, car, etc.) and be as careful as possible when signing the contract!

Oh yes, this topic is so painful that you can gossip about it for hours. The problem is that talking won’t help matters - you must immediately contact the appropriate authorities. The most difficult thing to achieve payments from the insurance company is when your car was damaged as a result of some kind of mass unrest or, even worse, military action. I am sure that in Ukraine now insurers do not pamper clients with timely payments.

Not all motorists can receive insurance compensation. Often, owners of vehicles damaged in road accidents do not defend their rights.

Let's consider in what cases a refusal is considered legitimate, and when it is necessary to seek payment of the due funds. We will also figure out what to do for the owner of a car who has been involved in an accident and has been refused by the insurance company to pay compensation under the MTPL policy.

Grounds for an insurance company’s refusal to pay compensation under compulsory motor liability insurance – all reasons

The reasons for refusal to make payments from the insurance company are not provided for by the legislation of the Russian Federation.

But in practice, there are circumstances in which the court may side with the organization.

We list the most common reasons for which compensation is not paid:

The citizen who applied does not have an issued MTPL policy. For example, the situation may be such that the driver took out a policy from scammers - and did not know about it. When I contacted the insurance company, it turned out that they had not issued an official policy.
The MTPL policy is considered invalid. Read also our article: Where to buy and how to check an MTPL policy
The culprit in the accident was not identified. Typically, compensation is not provided unless fault has been established.
The victim was intoxicated. This must be confirmed by medical documents.
The documentation for the accident was not fully submitted.
6. Damage caused to participants in the accident or to vehicles was compensated at the scene of the incident. This may be evidenced by a receipt from the person responsible for the accident.
The car was repaired on its own, before contacting the insurance company. For example, before an insurance company specialist inspected the car, before an independent examination was carried out.
The company insisted that there was no insured event.
The fact of fraud was noticed after an investigation of the company. For example, the victim's actions were intentional.
The owner of the car did not notify the insurance company about the accident.
The transport was damaged due to radiation and a nuclear explosion.
The vehicle was involved in hostilities or military events.
Transport was damaged during the civil war, popular strike, etc.
The culprit of the accident fled the scene.
There were grounds for refusal provided for by regulations. They may be specified in the agreement concluded with the owner of the car.

All situations are controversial. The reason for refusal may be another case.

If you believe that your rights have been violated, you should defend them yourself - or with the help of lawyers.

What is meant by the refusal of an insurance company to pay under compulsory motor liability insurance - non-payment under compulsory motor liability insurance and partial payments

The owner of the car may be denied compensation for damage received in the event of an accident.

Refusal may be expressed in:

Ignoring citizen requests. If you do not receive any response, then you can assume that you have received a refusal. Deadlines must be met!
Written response from the insurance company with refusal. As a rule, only those who submit a written application can receive a written response. It must be issued personally by the owner of the vehicle. In the letter, the company representative must indicate the reason why the insurance company will not reimburse compensation under compulsory motor liability insurance.
A written response from the insurance company with a reduced payment. If the requirements were not fully satisfied, this action can also be considered a refusal.

In any of these cases, a citizen can defend his rights.

What to do if the insurance company does not pay under compulsory motor liability insurance - where to complain and how to file a claim under compulsory motor liability insurance?

If you don't know what to do, just follow these step-by-step instructions:

Step 1. Collect a documentation package. We will look at what papers are required below.

Step 2: Prepare a claim with the insurance company. There is a special form that applicants can use. It is provided by the insurance company. You can contact your insurance company and ask for a claim form. In your appeal, you must indicate what circumstances forced you to file a claim, and the requirements for the insurance company must also be listed.

Step 3. Get a response from the insurance company. Within 5 days you must be told whether your claims will be satisfied or whether you will receive a refusal to pay compensation.

Step 4. Write a statement of claim to the court. If the answer is negative or not received at all within the prescribed period, then you should contact the judicial authorities. In the claim, you must indicate all the important points, and also attach to it the documentation that was sent to the insurance company and that you received from the company.

Step 5. Participate in the process and receive a court decision. If you do not want to participate in the proceedings, please contact a lawyer. He can act as your legal representative in court.

Going to court is the most effective way to resolve the issue. But first we have to try to resolve the issue pre-trial.

List of documents for a claim for refusal to pay OSAGO

Let's look at what is included in the documentation package that is submitted to the insurance organization along with the claim.

They may be asked to provide other documents, depending on the specific situation.

Complaint about refusal of payment or incomplete payments under compulsory motor liability insurance to the Russian Union of Auto Insurers - how to complain about an insurance company to RSA?

Another way to resolve the issue is to file a complaint with the Russian Union of Auto Insurers.

Please note that the most common complaints are filed with the RSA for the following reasons:

If compensation is not paid in full under compulsory motor liability insurance.
In case of inaction of insurance company employees.
In case of refusal to pay under compulsory motor liability insurance.

Along with the complaint, you should submit the documents that we have listed above.

Don't forget to submit a copy of your driver's license and passport. Without them, the complaint will not be considered.

The complaint can be written in any form. It should have three parts: introductory, main and final.

The document must indicate:

Who is the applicant? All personal data is recorded.
Which insurance company was responsible for the violation?
What rights of the vehicle owner were violated.
What actions were taken by the car owner to resolve the issue.
What demands does the applicant put forward to the insurance company and to the RSA.

A claim/complaint can be submitted to the RSA in person or through the organization’s official website. After contacting the RSA, the motorist can send a statement of claim to the court.

You can wait for the Union’s decision, but you shouldn’t delay.

Deadlines for filing a claim with the insurance company, deadlines for considering a claim for non-payment of compulsory motor third party liability insurance and statute of limitations periods

Let's note all the important deadlines that motorists should be aware of.

*Period*	*What is it needed for?*
5 days	Needed to report the accident to the insurance company.
20 days	Given to the company to consider the issue and determine further actions.
5 days	After 20 days, the citizen can submit a claim to the insurance organization. A representative of the organization must consider the application-claim within 5 days.
3 years	During this time, the vehicle owner can apply for compensation.
3 years	This is the statute of limitations. After this period, consideration of the application or claim will be refused.

Observe the specified periods - and do not rush to file a claim with the RSA or a lawsuit in court. You can call your insurance company and ask how your claim is going.

Perhaps the delay in payment was several days, and not through the fault of the insurance company, but through the fault of the bank. It's worth taking this into account as well.

Challenging the insurer's refusal to pay under compulsory motor liability insurance in court - procedure and judicial practice

In the event of a refusal from the insurance company, the issue of payment of compensation should be resolved in court.

Let's look at what the procedure is and how cases are handled in practice.

What to do when contacting the court authorities?

If you don't know what to do or where to go, our instructions will help you.

Prepare your documents . Make sure that copies do not need to be certified. You can read about the requirements for claims applications in Article 132 of the Code of Civil Procedure of the Russian Federation.
Write a statement of claim to the court. It must comply with the requirements specified in Article 131 of the Code of Civil Procedure of the Russian Federation.
Submit your claim and documents to the district court secretariat. As a rule, magistrate judges consider the application.
Receive a notification receipt on the acceptance of documents to the authority.
Come to the court hearing. The plaintiff must be informed of the appointed date by letter. It is better to indicate not only the address, but also a contact phone number.
During the hearing, the plaintiff may request an independent examination and recalculation of the amount of compensation.
Wait for the authorities' decision - and receive a writ of execution.

As a rule, the writ of execution is sent to the bailiff department. They will monitor the implementation of the court decision.

Judicial practice - how is compensation calculated, and what else can be returned through the court?

The algorithm for calculating the final amount of insurance compensation is as follows:

The due amount stipulated by the contract is taken into account.
The penalty is calculated. For each overdue day (after the required 20 days) 1% is withheld.
Determines whether the company should be prosecuted and fined. Typically the fine is 50% of the total compensation.

Through the court, the applicant or plaintiff as a victim will be able to recover from the insurance company amounts for:

Paid government fee.
Legal services.
The work of specialists conducting an independent examination.
Penalty for late response to a request from the owner of the car. For each day of delay, you can claim 0.05% of the total amount of compensation.

Some borrowers are faced with a situation where they need to obtain life insurance for a loan (to reduce the annual interest rate on the mortgage), but insurance companies refuse to issue insurance. This problem occurs in people who:

Have any type of disability or health problems (cardiovascular, oncology, HIV, hepatitis). The rules of most insurance companies directly state that the policy is not valid for them, even if it is concluded. Also, when filling out a medical questionnaire, the insured must answer truthfully about the presence of diseases. Providing false information about the state of health is grounds for invalidating a life insurance contract (although judicial practice on such claims is very contradictory, even for persons who are disabled at the time of taking out insurance).
Age borrowers. In practice, it is generally very difficult for persons over 60 years of age to obtain life insurance, since companies do not accept them for insurance. The logic of insurers is quite understandable - the probability of an insured event is very high.
Persons in certain dangerous professions: military, miners, etc. Some insurers agree to insure such clients, but large increases are applied to the rates. Such a policy will be 3-5 times more expensive than a regular one.
Pregnant women.

You can do this in our online calculator, but there is no way to calculate these categories of borrowers. On the other hand, personal insurance refers to a public contract from the point of view of the Civil Code (Articles 426 and 927 of the Civil Code of the Russian Federation). This means that the company does not have the right to give preference to certain categories of consumers over others, or to refuse to provide services. Therefore, formally, such restrictions by insurers are unlawful (although, in our opinion, publicity cannot be applied to life insurance; this norm is outdated).

Discussions are also currently underway between the State Duma and market participants to make life and health insurance for mortgage accessible, i.e. so that companies would not have the right to refuse disabled people, people with HIV, etc. But this is still at the negotiation stage.

There are already companies that can accept insurance for clients from these categories with the proviso that death/disability that is in a direct cause-and-effect relationship with the declared disease will not be recognized as an insured event. For example, if an insured person with cancer dies in an accident (no connection), then the case will be recognized as insured and payment will be made.

Also, if you are faced with the fact that life insurance for a mortgage is impossible to obtain or is only very expensive, you may be able to. In the article at the link you can read about this in more detail using specific examples of savings calculations.

In this regard, we discourage you from trying to deceive the insurer if the reason for the refusal is health problems, i.e. provide false information about your health status. As a result, when an insured event occurs, the truth may be revealed and the insurer will insist on invalidation of a life insurance contract due to the provision of false information about diseases.

We also advise you to call those accredited insurance companies from the list that are, as they say, “unheard of.” Perhaps they will not be so scrupulous in assessing risk and will agree to accept a riskier client for insurance.

Car damage or theft is a nuisance that any car owner can face. No less of a “surprise” is the case when the insurance company refuses to pay for the damage incurred. The reasons for this may be different, and some that are difficult to imagine. The better the policyholder is informed about what can lead to denial of insurance payments, the greater his chances of avoiding serious financial losses.

In what cases can a CASCO insurer refuse to pay an insurance premium? This is spelled out in more detail in the policy itself. Typically, the insurance company denies insurance payments to the policyholder in the following cases.

The driver got behind the wheel drunk.
In the accident, intent was found, that is, the deliberate creation of an accident in order to obtain insurance payments.
The car was damaged as a result of violations of fire safety rules - during the transportation or storage of explosive or flammable materials. This is considered a sufficient reason for the insurance company to refuse to pay for CASCO insurance.
The accident occurred when the car was not used for its intended purpose - for example, when participating in racing, learning to drive, or transporting materials not intended for this purpose.
If the accident was the result of operating a faulty car, this may not be considered an insured event. The only document that confirms the serviceability of the car is the inspection certificate. If a car that has not passed inspection is involved in an accident, its owner is unlikely to be able to receive insurance payments.
If defects were found on some parts of the car body during insurance (for example, scratches and dents on the door), then in the event of an insured event, its correction and painting will be excluded from their insurance compensation.
At the time of the accident, the car was driven by a person who was not included in the insurance policy.

There are also more rare cases of non-payment of insurance. For example, if a CASCO policy was purchased in installments, and before getting into an accident the car owner missed the required payments, the insurance company may consider this a sufficient reason not to pay the insurance.
As a rule, the car owner's losses incurred as a result of the execution of a court decision or other lawful order of the authorities - for example, during the arrest and confiscation of property - are not compensated.

The insurance company refuses to pay for an insured event if the property was damaged as a result of force majeure circumstances - terrorist attacks, street riots and unrest, etc. Unless, of course, these cases are specifically covered in the contract as insurance.

Often, incorrectly executed documents become the basis for non-payment. Any event related to an insured event requires documentary confirmation. An exception may be minor damage to the car, but only if the policy specifically stipulates the possibility of insurance payments for them without mentioning them in the documents.

Experienced car owners are advised to always carry with them a list of documents drawn up in case of an accident - a kind of cheat sheet. You need to not only carefully fill out the documents yourself, but also make sure that the emergency commissioner and the traffic police officer do not accidentally make a mistake when filling out the papers. Including expressions such as “unidentified place” or “unidentified person” may result in refusal of insurance payments.

The safety of documents is no less important. For some reason, insurance papers sent to insurers tend to get lost, either on the way or upon arrival at the site. In this case, the policyholder must have a copy of each document in order to, if necessary, fill in the missing papers. Each copy of the document submitted to the insurance company must have the signature of its employee, date and seal. Punctuality in this case cannot be excessive.

Pay special attention to your insurance policy. The presence of errors or corrections in it, as a rule, leads to the fact that the insurance company refuses to pay under such a policy. And no one will take into account that it was not you who made the mistake, but the employee who took out the insurance. And, of course, all data entered into the insurance policy must be absolutely accurate. If the insurer concludes that the policyholder provided false information about the car or persons allowed to drive it, he will not receive insurance payments.

Reasons for refusal of insurance payment

What other actions of car owners can lead to refusal of insurance payments under CASCO?
Failure to comply with deadlines for filing an insurance claim. ICs are jealous of this fact. If documents are not submitted on time, this gives them suspicion, which they readily turn into an insurmountable obstacle to insurance payments. Be sure to submit your application in writing, even if an IC employee says that a call is enough.

Unauthorized leaving the scene of an accident. Until the traffic police officer gives permission, you cannot remove the damaged car from the scene of the accident, even if it creates obstacles for traffic.
Repair of the damaged vehicle until it is inspected by a representative of the insurance company and an expert who must make a conclusion about the extent of the damage. First inspection and examination, then repair, and not vice versa.

Improper storage of the vehicle, that is, leaving it unattended. At night, the car must be kept in a locked garage or guarded parking lot. If the car is stolen or damaged if these rules are not followed, problems may arise with insurance payments.

The car does not have an anti-theft system or is kept inactive. If the insurer determines that the stolen vehicle did not have an anti-theft system or that it was disabled, insurance claims will most likely be denied.

On a note! If a car that is under warranty gets into an accident and, in accordance with the insurance contract, is sent by the insurer for repairs, it may lose the warranty.

The opposite case is also possible, when after an accident the car is serviced at the manufacturer's service center. If this leads to the fact that the insurance company refuses to pay for CASCO insurance, what should be done in this case? The best option is to prevent the situation itself by including in the insurance contract the right of the car owner to choose the place of repair.

Insurer tricks or insurance pitfalls

Insurance conditions can be deliberately written in such a way that the insurer in certain cases will be relieved of insurance payments. For example, many companies do not make insurance payments for damaged tires and wheels if other parts and components of the car were not damaged.

Terms are of great importance - how they are interpreted. For example, according to the Criminal Code, theft and theft of a car are two different things. Theft presupposes the selfish purpose of appropriating someone else's property. And theft is called taking possession of a car without selfish intentions - “I just decided to go for a ride...”.

If your car is insured against theft, the insurer may refuse to pay the insurance on the grounds that, in its opinion, theft was committed and not theft. To avoid such troubles, it is necessary that the policy stipulates compensation for both theft and theft.

Sometimes CASCO insurers include traffic violations in the list of reasons for refusing insurance payment. And not in a direct form, but in a veiled way. For example, this one is “compliance with regulatory legal acts of the Russian Federation.” This expression can be interpreted by the UK as “compliance with traffic rules.” When concluding an insurance contract, it is necessary to exclude the possibility of the insurer refusing payments due to traffic violations.

Attention! A car owner who purchased a car and registered CASCO insurance for it at the dealership risks losing insurance payments if the accident occurred before the car was registered. For some insurers, insurance liability begins only after the car is registered.

The insurance company refuses to pay for compulsory motor liability insurance: what to do?

The insurer's refusal to compensate the car owner for damage caused as a result of an accident can take different forms.

The insurer refuses to pay under compulsory motor liability insurance, sending the policyholder a reasoned refusal.
The insurer pays an amount that does not cover the actual damage to the car.
The insurance company does not react in any way to the policyholder’s application, that is, it does not pay money and does not send a reasoned refusal.

In any of these cases, the car owner must send a claim letter to the insurer. This is a mandatory pre-trial form of dispute resolution. Depending on the answer to it, the policyholder will decide whether to file a claim against the insurance company or not.
The claim is written according to certain rules, which require a consistent presentation of all the information that is necessary to resolve the insurance issue.
The “header” of the document contains information about who the claim is being sent to (usually the head of the insurance company) and about the insured (his full name, address and telephone number are indicated).
The body of the claim consists of information blocks. The first describes all actions that have been taken by the policyholder up to this time. Then follows a block with requirements - what exactly the policyholder requires. For example, pay him the insurance amount in full. The following sets out the intentions that will be taken by the car owner if his demands are not met. Usually this is filing a lawsuit against the insurance company in order to force it to pay not only insurance compensation, but also penalties and a fine.
In conclusion, a list of attached documents is indicated, the main one of which is an independent expert report on damage to the car.
All documents are copied. One copy is handed over personally or by mail (with notification of receipt) to the insurance company, the second, with the signature of the responsible person and the seal of the insurer, remains with the policyholder.
If even after filing a claim the insurance company refuses to pay under compulsory motor liability insurance, what to do in this case? To put more pressure on the insurer, you can submit an application to the RSA - another way to pre-trial resolve the dispute. But truly the most effective solution would be to file a lawsuit.

Video on the topic: the insurance company refuses to pay for an insured event

For those who perceive video and audio information better than text information, it will be useful to watch videos that talk about cases of refusals to pay insurance under CASCO and OSAGO.