July 24, 2020
The number of cars on the roads is constantly growing. It is important not to lose vigilance on the road so as not to get into an accident. Situations have become frequent when the culprit of an incident, after a long period of time, receives a summons demanding compensation from the insurance company for material damage. Is the claim legal, what to do in such a case?
Is it worth suing under compulsory motor liability insurance?
The law of the Russian Federation obliges all car owners to take out a compulsory insurance policy. Therefore, almost all transport on Russian territory is insured. And in the event of an accident, insurance organizations bear obligations to the victim, paying a certain compensation amount. To do this, in the event of an accident, a representative of the insurance company conducts an examination, based on the results of which compensation is calculated. But more often than not, the money transferred to repair the car is not enough, and the driver wonders: is it worth suing the insurance company?
First, you need to understand some factors:
- The company's specialists who assess the damage are not so independent. They carry out expertise in the interests of those for whom they work. Even if a violation of the assessment is visible, so to speak, “with the naked eye,” it is unlikely to be proven.
- When collecting damages through the court, you will first have to spend money on paying for the services of your own expert, a lawyer. But all costs are ultimately reimbursed by the insurance company. If the judge confirms that the victim is right, the insurer will also pay the missing amount.
Of course, whether it is worth seeking justice through the courts is up to the car owner to decide personally. But a competent lawyer will always help you win your case. And according to statistics, the majority of victims who appealed to the judicial authority for an increase in compensation won the dispute. In addition, insurance disputes have recently come under the law “On the Protection of Consumer Rights”. Victims now have the opportunity to receive compensation from the amount collected by the court.
Types of Insurance Claims
Health Insurance Claims
The costs of surgical procedures or hospital stays remain prohibitive.
An individual or group health policy frees patients from financial burdens that could otherwise cause serious financial harm. Health insurance claims submitted by health care providers on behalf of policyholders require little effort from patients; most medical decisions are reviewed electronically. Policyholders must submit paper claims if health care providers do not participate in electronic transfers but are charged for covered services provided. Ultimately, insurance coverage protects a person from the prospect of a large financial burden as a result of an accident or illness.
Property and Damage Claims
A home is typically one of the largest assets a person will acquire in their lifetime. A claim filed for damage from a covered peril is initially submitted online to a representative of the insurer, usually called an agent or claims adjuster.
Unlike health insurance claims, the responsibility for reporting damage to property rests with the policyholder. The adjuster, depending on the type of claim, inspects and evaluates the property damage for payment to the insured. After verifying the damage, the adjuster initiates the process of compensating or reimbursing the insured.
Life Insurance Claims
Life insurance claims require the submission of a claim form, a death certificate, and often the original policy. This process, especially for large face value policies, may require careful review by the carrier to ensure that the insured's death did not fall under a policy exclusion such as suicide (usually excluded within the first few years of the policy's inception). or death as a result of a criminal act.
The process typically takes 30 to 60 days without extenuating circumstances, providing beneficiaries with the financial means to replace the deceased's income or simply to cover the burden of final expenses.
Short review
Filing an insurance claim may increase future insurance premiums.
How to win a case under compulsory motor liability insurance?
The claim against the insurance company is sent to the court at the place of registration of the insurer or the place of registration of the injured vehicle owner. The claim shall indicate the name of the authority, last name, first name and patronymic of the applicant, place of registration, number of the policy and certificates of additional insurance with the name of the insurer.
An important point is to clarify the date when the document was concluded. This is a significant factor regarding the long statute of limitations, which reaches three years from the date of violation. In addition, the application contains information about the amount of payments for which there are claims. The claim will need to be accompanied by a package of documents confirming what is written. It is very important that all papers are collected confirming the fact of attempts to resolve the problem with the insurance company before the trial. The application is drawn up in any form and signed by the person submitting it. The claim for incompetence of actions is drawn up in two copies. One must be sent to the head office of the insurance company (not to the branch specified in the contract), the second to the court. After the application is submitted, you must wait 30 days. This period is legally allotted for making a decision. During this period, the victim will receive either a refusal or consent to compensation.
The insurer may not notify of the decision, delaying the payment process in every possible way. In this case, you can demand a penalty (if no information has been received within 30 days). But, you should know that according to the law, the penalty cannot exceed the amount of compensation. In addition, in order to receive a penalty, you will need to go to court. To be sure to win a dispute under compulsory motor liability insurance, it is better to engage an experienced lawyer who has repeatedly dealt with similar cases.
Insurers require proof of real losses
PJSC IC Rosgosstrakh (RGS), in turn, noted that in the practice of the financial ombudsman, there are indeed cases when insurers who unlawfully replaced repairs with payment under compulsory motor liability insurance are charged the cost of spare parts without taking into account wear and tear.
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“At the moment, the number of decisions made on this category of cases is no more than 30,” the press service of the RGS told Izvestia. They emphasized that the practice of making such decisions needs to be improved.
“Including the reason that the financial ombudsman must first of all be guided by the fact that the victim has incurred the actual costs of repairing the vehicle,” the RGS reported.
The press service of Rosgosstrakh stated that they could not agree with these decisions of the financial commissioner.
“In its ruling, the Supreme Court pointed out the need to take into account actual losses to victims, while the financial ombudsman ignores this fact. Thus, the Supreme Court came to the conclusion about the right to demand payment of insurance compensation without taking into account wear and tear on the basis of Art. 393 of the Civil Code of the Russian Federation, since the victim made the repairs on his own, that is, he suffered real losses,” the RGS reported.
They will answer without wear and tear3
Photo: TASS/Dmitry Serebryakov
They added that, in addition, in paragraph 5 of the resolution of the plenum of the Supreme Court dated March 24, 2016 No. 7 “On the application by courts of certain provisions of the Civil Code of the Russian Federation on liability for violation of obligations,” within the meaning of Art. 15 and 393 of the Civil Code of the Russian Federation, the creditor presents evidence confirming the existence of losses, as well as justifying with a reasonable degree of certainty their size and the causal relationship between the non-fulfillment or improper fulfillment of the obligation by the debtor and the named losses.
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“Thus, the Supreme Court clearly established that the difference between the cost of restorative repairs without taking into account wear and tear and the cost of restorative repairs taking into account wear and tear can be regarded as losses that were only actually incurred by the victim,” the RGS explained their position. — In the majority of applications submitted to the financial ombudsman, there is no evidence of losses to the victims, or evidence of the insurer’s guilty actions, due to which restorative repairs were not carried out. At the same time, the financial ombudsman continues to refer to the provisions of Art. 393 of the Civil Code of the Russian Federation without provided evidence confirming the consumer’s losses, as well as justifying with a reasonable degree of certainty their size and the causal relationship between the non-fulfillment or improper fulfillment of the obligation by the insurer and the named losses.”
According to the RGS, the financial ombudsman must take into account such circumstances as the will of the victim himself to receive an insurance payment in cash, the grounds provided for by federal legislation for replacing the form of payment from in-kind to cash and the payment made by the insurer within the period provided for by federal law, the consumer’s opposition to the in-kind form compensation.
They will answer without wear and tear5
Photo: RIA Novosti/Igor Zarembo
These circumstances, the RGS is confident, should not allow the financial ombudsman to make a decision on payment without taking into account depreciation.
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The RSG stated the need to develop clear criteria for applying the norm under discussion that comply with current legislation, taking into account the above. Without these changes, insurers will challenge such decisions in the courts.
“Such decisions of the financial ombudsman are mostly appealed by insurers. The ruling of the Supreme Court was adopted in one insurance case, therefore it only specifies the circumstances of this case. And it would be wrong to apply it to all other disputes by analogy,” the RGS concluded.
What documents are needed for the court under compulsory motor liability insurance?
To file a claim, you will need to collect the following documents:
- accident report;
- notification of an accident;
- policy;
- extracts from the policy of the culprit;
- the result of an independent examination;
- claim to the company with confirmation of receipt;
- medical examination results (in case of injuries);
- payment receipt.
Additionally, it is advisable to determine the costs before filing a claim. That is, calculate all the costs that the applicant incurred in initiating the lawsuit. This part includes the services of a lawyer, state duty, payment of independent experts, and the cost of postage. If in the end the cost is up to 50 thousand rubles, the claim should be sent to the magistrate’s court; when the amount exceeds this number, you will need to contact the district authority.
The money has arrived, but it is not enough - what to do?
First you need to understand whether you or the insurer are right. After all, the money under the MTPL Law in most cases is not enough for quality repairs, even if the payment has been made in full.
Submit a written application to the insurer, in which you demand to familiarize yourself with the results of the inspection and/or independent examination and to issue a certificate of the insured event. The period for issuing a copy of the act is 3 days. But there is a nuance, if at first a decision was made to restore your car, then the act may not be drawn up (clause 4.22 of Chapter 4 of the Rules on Compulsory Motor Liability Insurance).
Having these documents in hand, you can independently check whether all damage is indicated and taken into account, whether the amounts for spare parts from the RSA directory are indicated correctly, and also understand whether the insurer has underpaid or whether you are entitled to such a small payment under the Law.
How to get your money after a trial under compulsory motor liability insurance?
The period of payment under a court decision largely depends on the actions of the plaintiffs after the accident. Often, insurers try not to pay compensation, resorting to various tricks. For example, even when drawing up a contract, clauses are included, violation of which leads to refusal of payments, and so on. The victim must be directly involved in all stages after an accident: conducting an independent examination, drawing up certificates, recording information about the accident, information about a witness, and another participant in the accident. It is very important to avoid mistakes here, otherwise insurers will eventually have a reason to delay payment terms.
After the court has sided with the plaintiff and ordered the company to pay a certain amount, as a rule, it will take a long time to wait for the money. It is not uncommon for the victim to receive the awarded financial funds after a year or even more.
The main thing that must always be remembered when collaborating with an insurance company under MTPL or CASCO is that any relationship must be documented. Not only will this help in the process of obtaining payment, but it may also be the only way to obtain a refund in the first place. Agency employees often “lose” documents. And without confirmation that the insured provided the papers and recording the date of transfer, it will be difficult to prove anything.
In what situations is it necessary to file a lawsuit against an insurance company?
First of all, we note that you should sue the insurer if you were denied compensation or you received a sum of money that is much less than the amount of actual damage. At the same time, you contacted the insurance company with a corresponding claim in order to resolve the issue out of court. As a result, the insurer responded to you with a written refusal. Be sure to save this document; without it, the court will not consider your application.
The largest number of refusals to pay compensation occurs when insuring under a compulsory motor liability insurance policy. There are many reasons for refusal - the person responsible for the accident was drunk, was not included in the policy, fled the scene of the accident, etc.
It also makes sense to sue the insurer if you received a much lower amount of insurance compensation. This is due to the fact that the appraiser representing the interests of the insurance company quite often underestimates the amount of damage. The damage received is incorrectly assessed, as is the amount of repair work required to eliminate it. In addition, you should go to court if the insurer did not send you an official refusal, but also did not pay compensation.
We are starting to demand additional payment
First, you must use all pre-trial methods to resolve the dispute. To do this, the first step is to contact the insurer with a statement of disagreement.
You can do this in the following ways:
- send in the form of an electronic document by mail or on the insurer’s website (the review period will be 15 business days from the date of receipt, if no more than 180 days have passed since the date of violation of your rights by the insurer),
- send by letter with a description of the attachment and notification of delivery (the review period will be 30 calendar days from the date of receipt).
For electronic applications, a standard application form has been approved, which must be printed, filled out, signed and scanned.
- .
- View a sample application form.
Official email addresses can be found on the insurers’ website or on the RSA website, as well as in the Unified State Register of Insurance Business Entities.
For example:
- at Rosgosstrakh -,
- Alfa Insurance –,
- Ingosstrakh –,
- RESO-Garantiya –,
- Agreement -
If you send by email, do so with a delivery report. The more evidence you have, the better.
Important note!
- This article describes the basic principles of how legislation works. Meanwhile, in judicial practice everything depends on specific circumstances.
- In 96% of all cases there are subtleties that can affect the outcome of the entire case.
- Therefore, we recommend entrusting the matter to professionals who will study your business and select the right winning strategy.
The TonkostiDTP website employs professional road accident lawyers with experience in all major types of disputes (MTPL, guilt, administrative penalties).
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Do we need to conduct an independent examination ourselves?
Yes and no. No, because we will not find mandatory requirements for the need to submit an examination along with a statement of disagreements in the Law on Compulsory Motor Liability Insurance. Therefore, the costs of carrying it out may not be reimbursed.
On the other hand, it needs to be carried out in order to know the exact amount of damage from the accident and the legality of your claims.
But in any case, it is necessary to have photographs of a complete inspection of all damage after an accident. This also applies when your car is sent to a service center for repairs. This is done so that it is possible to argue and prove what condition the car was originally in, what damage there was and what repairs were required.
