The Supreme Court clarified the pre-trial procedure in insurance disputes

After the consumer protection law came into force in 2012, the courts began receiving a huge number of applications. Almost all cases were decided not in favor of the insurance companies. Fraudsters appeared who bought from drivers the right to go to court directly after an accident. The practice of going to court even before sending a claim to the insurance company has become more frequent.

To stop the speculation of auto lawyers, the Russian Union of Auto Insurers (RUA) appealed to the Supreme Court. The Supreme Court of OSAGO and RSA insurance-related claims considered. As a result, it was decided that since 2015, victims of road accidents are required to first submit a pre-trial claim to the insurance company under compulsory motor liability insurance. This rule also applies in 2021. If the victim goes to court before contacting the insurers, the claim will be returned by the court to the applicant.

Deadlines for the insurer to respond to a claim under compulsory motor liability insurance

The insurance company is obliged to respond within 10 calendar days. Non-working days and holidays are not taken into account.

Based on the results of consideration of the claim, the insurer may satisfy it in full or in part, or refuse it.

When to file a claim:

• If the established time for payment of compensation has passed and it has not been received;
• The compensation received is lower than the actual damage;
• If the insurer refuses to pay.

Possible reasons for delayed response

The reason for the delay in considering the application may be the failure to provide the victim with all the necessary documents. In this case, the insurance company will request an additional list and the period will be counted from the moment they are received.

Will they refuse me?

While waiting for the allotted time for the insurance payment, you may not receive the money not only for the reason that you will receive a letter in response with a referral for repairs. The fact is that the letter will arrive, but it will not contain the treasured “prescription for a car pharmacy”, but will be a refusal. By law, he must be motivated.

But, in fact, insurance companies have very few legal grounds for refusals. For example, these may include:

• if you refused to provide the car for inspection or examination,
• the damage clearly does not correspond to the circumstances of the accident,
• the culprit did not have MTPL insurance (this does not include cases where an unregistered driver was driving)
• and some others.

We reviewed the full list of reasons for refusal of payment, as well as what to do in this case, with all claims and lawsuits in court in a special article about this.

What compensation can you claim?

The victim may not be satisfied with the amount of monetary compensation and demand additional payment.

If compensation was provided by repair of the vehicle, the following facts may be the basis for filing a claim:

• The repairs were performed poorly;
• Not all breakdowns have been fixed;
• The car broke down during the warranty period;
• Failure to meet the deadline for handing over a repaired vehicle.

You can demand monetary compensation or send the car for re-repair to another service station.

How to write a pre-trial claim correctly

To avoid having your claim returned due to not providing all the data, it is better to use the official form, which can be obtained from the representative office or downloaded from the Insurance Company website.

What information must be included in the claim:

• Details of the defendant;
• Victim details;
• List of claims with explanation of the reasons for disagreement;
• Expression of disagreement with the amount of compensation;
• On the basis of what legislative acts the claim is made;
• Details for transferring funds;
• List of attached documents.

To get a positive result, you need to provide as much evidence as possible that the payments are underestimated.

In addition to the main documents that were provided when applying for compensation, you can attach:

• The result of the independent expert assessment;
• Confirmation of additional expenses;
• Documents confirming treatment expenses.

Result

As a result of working with us to resolve an insurance dispute, you will receive, by a court decision:

1. Insurance compensation (the main debt of the insurance company under the MTPL agreement);
2. Compensation for legal expenses (independent examination, legal services, notary, etc.);
3. Additional payments:
4. penalty for compulsory motor liability insurance (1 percent for each day of delay);
5. fine 50 percent of the amount of damage;
6. compensation for moral damage.

We use all legal methods to ensure that you receive the maximum possible payment, taking into account penalties and fines, and the amount of insurance coverage allows you to completely repair the car and still have money in your hands.

We are doubling your payouts!

What the law says

The deadline for considering a claim under compulsory motor liability insurance is established in Art. 16.1 Federal Law No. 40 dated April 25, 2002. The article determines in which case the victim can file a claim with the insurer, within what time it must be considered, and what penalties are provided for failure to meet the deadlines.

By law, if the victim does not agree with the way the insurer fulfilled its obligations, he can file a claim. It must be accompanied by documents that substantiate the requirement. The period for consideration of the application is set at 10 calendar days, excluding non-working days or holidays, from the moment the application is accepted by the insurer.

In 2021, the deadline for considering a claim under compulsory motor liability insurance did not change.

Is it possible to find out the payment amount before transferring money?

Yes, you can. This is indicated by paragraph 4.23 of the Insurance Rules approved by the Bank of Russia, indicating that such information is obtained using the so-called insured event report.

But there are also deadlines here: 3 calendar days, excluding non-working holidays, from the day you submit a written request requesting such an act. And only if the corresponding act is already ready.

We discussed this issue in as much detail as possible in the article on requesting a calculation of the payment amount.

Answers on questions

Receive 20%-30% more insurance compensation under compulsory motor liability insurance due to penalties!

(Algorithm of actions with samples of a claim, statement of claim and other necessary documents).

Every time an insurance company underpays you under compulsory motor liability insurance, you must keep in mind that in this case you have the right to receive from it not only the amount of the underpayment, but also a significant penalty for violating the terms of payment of insurance compensation.

According to the law “On OSAGO”, the penalty is 1% of the amount of underpayment for each day of delay in payment and is accrued until the insurance compensation is paid in full.

Not everyone knows about the possibility of receiving a penalty, but it is precisely this that will allow you to receive on top of the full amount of the underpayment an additional 20-30% (and sometimes more) of its amount on top.

MORE ABOUT THE PENALTY

According to the law “On Compulsory Motor Liability Insurance”, the penalty begins to accrue after the expiration of the 20-day period allotted to the insurance company for payment, i.e. from the 21st day after the insurance company receives an application for insurance payment and continues to accrue until the insurance compensation is paid in full by the insurance company, which, as a rule, happens only after a claim is submitted to the insurance company accompanied by the conclusion of an independent examination of the cost of restorative repairs of the car.

And for the entire period of time during which you will be busy organizing and conducting an independent examination, filing a claim with the Investigative Committee, as well as for the period of its consideration and until the additional payment is transferred, a significant penalty will be charged.

Note: holidays declared as days off are not taken into account when calculating the 20-day period.

Even with the most prompt solution to these problems and going through all the stages, the entire process rarely takes less than ten days, and this is already 10% of the amount of the underpayment.

Example: As a result of an accident, the victim’s car was damaged, and therefore on September 5, 2021, he contacted the Insurance Company with an application for insurance payment.

The Investigative Committee assessed the damage in the amount of 80 thousand rubles, which it paid to the victim on September 25, 2021.

At the same time, according to the conclusion of an independent examination, the amount of damage amounted to 140 thousand rubles.

The victim, 3 days later, namely September 28, 2019, applies to the Investigative Committee with a claim, attaching an independent expert report.

On 10/05/2019, the insurance company makes an additional payment of 60 rubles. (up to 140 tr.).

In this example, the penalty will be accrued for the period from September 26, 2019 (21 days) to October 5, 2021 (day of additional payment), i.e. with a delay of 10 days. Accordingly, the victim has the right to demand from the insurance company a penalty in the amount of 10% of the underpayment, which corresponds to 6 tr. (60 tr.*10%).

6 t.r. not bad anymore, agree?! But this amount can easily be doubled or even tripled!!

How to do it?! It is elementary not to rush to file a claim, waiting 2-3 weeks after the 20-day period for consideration of the application for insurance payment has expired. In the example given, this is no earlier than mid-October 2021, and the due penalty in this case will already tend to the amount of 15 tr. and higher, which makes the question of obtaining it even more financially interesting, and therefore fundamental. Agree, two or three weeks of waiting for additional payment from the insurance company is unlikely to play a significant role for you (despite the fact that it is often impossible to overcome the procedure of passing an independent examination or filing a claim in a shorter period of time for objective reasons), and the possible inconveniences caused by this wait are more than compensated for by a noticeable monetary increase in the amount of insurance compensation.

Note: Waiting a longer period, trying to get an even larger penalty (in the amount of 100% of underpayment and higher), is in practice inappropriate, since this will be regarded as an abuse of the right on your part, aimed at unjust enrichment, which is prohibited by law and is prohibited by any insurance company known. And even if your dispute becomes the subject of legal proceedings, the amount of the penalty that is too high will be reduced by the court. Although of course there are exceptions!

A penalty is accrued not only in case of violation by the insurance company of the deadline for payment of the amount of the restoration repair of the car, but also for untimely payment by the insurance company of the amount of the vehicle technical damage (loss of marketable value), as well as expenses associated with the accident (costs of evacuation, storage of the car after an accident, partial dismantling car for inspection, etc.), which by law are included in insurance coverage under MTPL.

Note: a penalty is also charged in case of violation of the IC’s 20-day deadline for issuing a referral for vehicle repair, as well as violation of the deadline for its repair (30 working days). In the latter case, the penalty will be 0.5% of the cost of repairs for each day of delay.

The maximum amount of the penalty under compulsory motor liability insurance is established by law, which cannot exceed 400 rubles. (in disputes with the insurance company regarding compensation for damage to a car or other property).

It is quite possible to receive a penalty from an insurance company on your own, for which it is enough to adhere to the following algorithm of actions.

ALGORITHM OF ACTIONS WITH SAMPLE DOCUMENTS

1. Receive an independent expert opinion on the cost of restorative repairs of a car after an accident.

Without special knowledge in the field of auto sales, it is not possible to find out the amount of underpayment on the part of the insurance company, on which a penalty is charged, and therefore you cannot do without contacting an expert who will give an accurate estimate of the cost of repairing your car.

In this case, the assessment will determine the cost of restoration repairs, both taking into account and without taking into account the wear and tear of the car parts being replaced. Both of them will be indicated in the expert's report.

Note: wear of replaced parts directly depends on the year of manufacture and mileage of the car (a number of other parameters) and is calculated as a percentage of the cost of the new part. In other words, when assessing, the cost of a new part is taken and reduced by the amount of wear that the car had on the date of the accident (the maximum amount of wear under compulsory motor liability insurance can reach up to 50% of the cost of the new part).

It is important to understand that, according to the law, the insurance company under compulsory motor liability insurance pays insurance compensation taking into account wear and tear. In addition, the calculation of the amount of insurance payments is carried out on the basis of the Unified Methodology of the Central Bank and reference books of the RSA (Russian Union of Auto Insurers) of the cost of spare parts, materials and standard hours, the prices of which are often significantly lower than the national market average.

Thus, the insurance payment under MTPL can cover only part of your actual repair costs in an amount insufficient to fully restore the car, which will require additional investments from your pocket.

Moreover, in this case, you have the legal opportunity to demand the amount of wear and tear, as well as the difference to the market cost of repairing the car from the person responsible for the accident!

For our part, we conduct examinations to determine both values ​​of the cost of repairs (according to the Unified Methodology of the Central Bank for OSAGO and the average market value), as well as the size of the vehicle insurance and, if necessary, formalize their results in one conclusion (and not in several, as is most often the case in practice) ), which allows you to save significantly and determine the amount of your claims not only to the insurance company, but also to the culprit of the accident with an accuracy of the ruble. More information about the cost of conducting an examination by our specialists can be found HERE>>.

Expenses for the examination are fully reimbursed by the insurance company. It is only necessary to formalize them correctly and document them. To do this, as a rule, the expert (appraisal) company enters into an agreement and issues a receipt and/or cash receipt. In this case, the contract must be signed by the owner of the car (and not a relative, acquaintance, colleague, etc.). The receipt must also be issued in the name of the owner, otherwise compensation for the cost of the independent examination may be denied.

2. Contact the insurance company with a claim for payment of insurance compensation in full (counting 2-3 weeks from the expiration of the 20-day period for consideration of your application for insurance payment).

SAMPLE CLAIM FOR PAYMENT OF PENALTY UNDER OSAGO

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• The claim must be accompanied by the original independent assessment report, the agreement with the assessment company (if one was drawn up), and the original receipt (cash receipt). You must first make and keep copies of all these documents, in case you go to court in the future, they will be needed.

• Submit the claim with attachments to the office of the insurance company against a signature confirming its acceptance on the second copy, or, at worst, send it by mail in a valuable letter with a list of the attachments, be sure to keep the documents about its sending (postal receipt, list of the attachments).

Note: When resolving disputes under compulsory motor liability insurance, the claim procedure is mandatory; in other words, going to court to the insurance company is possible only after filing a claim with it.

The insurance company must consider the claim and make an additional payment up to the amount determined in the examination conclusion, as well as pay a penalty within the following terms:

— within 15 working days when a citizen applies (or 30 days if more than 180 days have passed since the moment of incomplete payment/refusal of payment by the insurance company);

- within 10 days upon application from the organization.

However, we cannot exclude the possibility that the insurance company will refuse to pay the penalty, and in this case the only way to get it will be to contact the financial ombudsman and then to the court.

Please note that due to changes in legislation that came into effect on June 1, 2019, an appeal to the financial ombudsman is a mandatory stage in the resolution of a dispute with the insurance company under compulsory motor liability insurance, without which it is impossible to go to court. Otherwise, the claim will not be accepted by the court for consideration. You can find out more about this procedure HERE>>.

The period for consideration by the financial ombudsman of the application is 15 working days, and this period can be extended by him by another 10 working days (if necessary, an independent examination (assessment) of the subject of the dispute).

3. If the insurance company refuses to pay the claim and appeals to the Financial Commissioner to no avail, file a claim in court.

SAMPLE STATEMENT OF CLAIM AND SEQUENCE OF ACTIONS WHEN GOING TO COURT FOR COLLECTION OF PENALTY UNDER MTPL.

MORE>>

Important: please note that the period for applying to court to the insurance company from the moment of introduction of the institution of the financial ombudsman is significantly limited and is only 30 working days from the date of entry into force of the decision of the financial ombudsman, which in turn occurs on the 11th working day from the date of its issuance (total period is 40 working days). Missing this deadline risks losing the opportunity to seek justice through the courts.

You can also go through the judicial procedure yourself or entrust it to us. Moreover, we offer both full legal support with a guarantee that you will receive money from the insurance company, and significantly less expensive remote support, which includes drawing up a statement of claim on our part with the necessary attachments, providing detailed instructions and advice on the procedure for filing a claim yourself and participating in court and execution of a court decision, which is most important for relatively small amounts of claims (20 thousand rubles - 30 thousand rubles), where it is financially impractical to fully engage a specialist, but at the same time you are not “burning with the desire” for your part to refuse money funds due to you by law.

You can find out more about our working conditions HERE>>.

In this case, the costs of our services will be borne by the losing party of the process and will be fully compensated by the insurance company.

It is not uncommon for the prospect of legal squabbles to frighten the average citizen, since it is associated with the seemingly complex and overwhelming procedure, the uncertainty of the result and an elementary lack of time. But, as a rule, the resolution of such cases does not require the participation of the applicant, and they are considered in his absence, which minimizes labor costs and time losses. Not to mention the fact that the procedure for executing court decisions and receiving money from the insurance company has been worked out to the point of automaticity. You just need to adhere to the proposed algorithm of actions, which describes all the stages step by step - from the moment of drawing up and filing a claim in court to the stage of executing the court decision and receiving money from the insurance company, and also presents all the templates required to fill out and submit the documents. And even if you encounter difficulties along the way of restoring justice, we are always ready to advise you on the issue that has arisen, especially since on our part this will be done absolutely free of charge!

Note: you do not need to pay the state fee for such disputes (if the value of the claim is less than 1 million rubles)!

Another argument for going to court is the fact that through the court you will receive an amount much larger, and in some cases you will be able to double the amount for which you originally claimed. This occurs through the court’s application of penalties to the insurance company, as well as the collection of compensation for moral damages, which are awarded to you in full if the court resolves the dispute in your favor.

Important: You still have the opportunity to receive a penalty for all previously occurring underpayments for insured events under compulsory motor liability insurance, for which no more than 3 years have passed since the initial payments! In this case, the algorithm of actions is the same. You first need to make an examination of the cost of car repairs (if the payment of insurance compensation has not yet been made in full by the insurance company).

Note: in case the car has been repaired by this time, the examination can be carried out using the calculation of the insurance policy for compulsory motor liability insurance (insurance accident act) or using photographs of damage to the car

Then you send a claim to the insurance company with a request to make an additional payment of insurance compensation and/or a penalty, attaching a report on the assessment of the cost of repairs. And if filing a claim does not produce results, then you turn to the financial ombudsman, and then to the court.

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