What to do when the insurance company does not pay for compulsory motor liability insurance

What to do if the insurance company does not pay under compulsory motor liability insurance, underestimates the amount of compensation, delays payment terms, does not respond to claims and complaints; procedure for pre-trial and judicial conflict resolution

The adoption of a law on compulsory motor third-party liability insurance makes it possible to solve many problems arising in connection with a road accident and the need to compensate for the damage caused to injured persons.

However, there are often cases when the insurance company does not pay for compulsory motor liability insurance at all or delays the payment deadlines for a long period of time. What can be done in this case, you will learn from the article.

When the insurance company does not pay for compulsory motor liability insurance

Each policy holder should be well versed in the nuances of “automobile insurance” and understand when the injured party is entitled to compensation, in what amount, and during what period it is paid.

The law provides for a number of reasons why the insurer has the right to refuse to pay compensation.

You can familiarize yourself with them by studying carefully:

Civil Code of the Russian Federation,
Federal Law on Compulsory Motor Liability Insurance,
OSAGO rules approved by the Bank of Russia.

According to these regulations, the insurance company does not pay for compulsory motor liability insurance if:

there is no confirmation of the fact of an insured event or it is not possible to determine the exact amount of damage (for example, if the damaged car was promptly repaired or disposed of);
the person at fault for the accident did not have a valid policy at the time of the accident;
the insurer did not receive a notification about the accident from the policy owner;
the injured person wants to receive compensation for lost profits, moral damage;
the car was damaged during competitions, tests, training driving on a special site;
the cause of the damage was a special cargo transported by car (subject to mandatory transportation insurance);
the culprit of the damage is the policyholder himself, who provoked the accident or caused damage to his own car;
the vehicle is damaged during loading;
harm caused to persons in the performance of their duties will be compensated under compulsory medical insurance or another policy;
damage to passengers during transportation will be compensated under another type of insurance;
damage was caused to special types of property listed in Article 6 of the Federal Law on Compulsory Motor Liability Insurance (cultural monuments, antiques, etc.);
damage caused to nature and the environment (for example, a fuel spill);
force majeure – circumstances that are unpredictable and beyond human influence (flood, war, etc.).

All of the above reasons are legal grounds for refusal; in other situations, the insurer is obliged to compensate for the damage.

Legitimate reasons for refusal to pay under compulsory motor liability insurance

Vehicle owners are required to know in what cases they are entitled to pay under compulsory motor liability insurance, and when the insurance company refuses quite legally. Such situations include cases:

the driver injured in the accident did not take out a motor vehicle liability policy;
the essence of client claims is compensation for moral damage;
the expiration date of OSAGO has expired;
violation in the procedure for registering an accident, incorrectly drawn up European protocol;
the circumstances of the accident are questioned: whether it really happened;
the victim refused a medical examination;
the victim’s claim is for compensation for damage to health that arose for reasons other than the traffic accident;
The vehicle was damaged as a result of a collision with structures, supports, buildings, cultural or architectural monuments, etc.

To be fair, let us remind you that illegal arguments are:

the culprit was drunk or refused a medical examination;
the culprit has a fake MTPL policy, is not insured, or has an expired motor vehicle license;
the insurer of the person at fault for the accident is bankrupt or has a revoked license;
the culprit is deprived of the right to drive a car.

In cases where the insurance company refuses to pay, you can and should act. You should not let the situation take its course, because the driver injured in the accident aims to receive compensation legally.

When the insurance company pays little

There are also cases when the insurance company pays little under compulsory motor liability insurance. Motorists should remember about the vehicle license limit.

According to current legislation, it is:

400,000 rubles – for property,
500,000 rubles – in case of death or harm to human health.

In cases where the amount of damage exceeds the established limit, the missing amount is recovered from the culprit.

The loss is calculated either in accordance with the standards established by law or according to the assessment of the insurer itself.

In the first case, if a person dies, funeral expenses are reimbursed in the amount of 25 thousand rubles, and the remaining 475 thousand, within the limit, are paid to the relatives of the deceased.

The second option is more flexible and allows insurers to underestimate the amount of compensation using various tricks (denying the connection of the damage with a specific insured event, not including individual parts in the list of damages, etc.).

The best way to avoid artificially underestimating damage is an independent examination, to which you can invite a representative of the insurer.

○ Problems with payments from the insurance company.

First of all, you need to figure out exactly how compensation for damage with the help of compulsory motor liability insurance “works” from the point of view of the law. In what cases can a company refuse to pay under the law, within what time frame must the money be transferred, and what amount must insurers reimburse.

✔ Refusal to pay.

All cases where the insurer actually has the right to refuse payment on legal grounds are listed in the following regulations:

Civil Code of the Russian Federation.
Federal Law “On compulsory civil liability insurance of vehicle owners” (hereinafter, for brevity, the Federal Law on Compulsory Motor Liability Insurance).
Rules for compulsory civil liability insurance of vehicle owners, approved by Bank of Russia Regulation No. 431-P dated September 19, 2014 (hereinafter referred to as the MTPL Rules).

In accordance with these regulations, the company has the full right to refuse payment of funds for damages in the following cases:

The company cannot be sure that the insured event occurred at all, or cannot accurately determine the amount of damage. This is possible if the owner of a car damaged in an accident hastened to completely repair it or managed to sell the car for scrap.
There was no policy issued for the car.
The accident occurred during a period when the MTPL policy was not in effect.
The owner did not report the accident to the company.
The car owner is trying to recover lost profits from the insurer.
We are talking about recovery of moral damages (including for suffering suffered due to injury during an accident).
The accident occurred during training driving, auto racing or while testing a new car design - provided that the training, competition or test took place in a specially designated place.
The damage was caused due to the special nature of the cargo that was transported by car - provided that the transportation was insured under another type of compulsory insurance.
The driver himself caused the accident or somehow caused damage to his car.
Causing harm during loading operations on a vehicle.
The harm was caused to employees in the performance of their official duties, if this harm should be compensated under another type of insurance (for example, compulsory medical insurance).
Damage was caused to the life, health or property of passengers, if the damage must be compensated by compulsory insurance for passenger transportation (this is another type of insurance).
Damage was caused to cultural monuments, antique property, religious and religious objects and some others specifically identified in Art. 6 Federal Law on compulsory motor liability insurance for types of property.
The harm consists of pollution of nature (for example, a spill of fuel from a fuel tanker during an accident is not compensated by OSAGO).
There is “force majeure” - that is, the damage was caused during a war, riots, natural disaster and other circumstances that could not be foreseen and which the person responsible for the damage could not influence in any way.

In fact, the above list is exhaustive. The insurance company should not allow refusal in other situations.

✔ Violation of the payment deadline.

In addition to an unjustified refusal, another example of a violation of the law on the part of insurers is delay in payments. What are the rules regarding this?

According to the MTPL Rules, to consider the issue of compensation to the insurance company, the following is given:

20 days – in general.
30 days - if, under the MTPL agreement and with the consent of the company, the victim began to repair the car in a workshop with which the insurer has concluded a corresponding agreement.

Deadlines are calculated in calendar days, but do not take into account weekends and holidays. During this time, the insurer is obliged to:

Or pay a refund.
Or give a written and reasoned refusal to pay, which the victim can then appeal in accordance with the procedure established by law.

✔ Not paid enough.

Finally, in addition to complete refusal and delay, there is a third trick of insurers - underestimating the amount of payments. How much do they have to pay by law?

Federal Law on OSAGO in Art. 7 indicates that the insurer is liable within the following amounts:

If damage is caused only to property - 400 thousand rubles.
If people were injured or killed – 500 thousand rubles.

Moreover, if the damage is more than these amounts, the missing amount can already be recovered from the culprit directly.

The amount of compensation that the insurer must pay is determined in two ways:

According to strict standards established by law. For example, if a person dies in an accident, the insurance company is obliged to pay relatives 475 thousand and reimburse funeral expenses within 25 thousand.
According to the assessment of damage caused by the insurance company.

It is in the latter case that problems usually arise: insurers, taking advantage of the fact that damage is an assessment category, try in every possible way to underestimate the amount of payments. Any methods are used - from “undetected” damage to denying the connection between the decrease in property value and the insured event.

The best way to avoid understatement is to conduct an independent examination with the involvement of a representative of the insurance company.

Pre-trial decision

Litigation in court takes a lot of effort and time and is a last resort that should be resorted to in exceptional cases. If the insurance company does not pay for compulsory motor liability insurance, first try to solve the problem in other ways.

Independent examination

If you have any doubts about the honesty of the insurer and the accuracy of loss calculations, contact an independent expert. You can do it like this:

Select a company or individual licensed specialist and enter into an agreement.
Agree on a time for an independent examination.
Notify the insurer of the time and place of its holding. The best way is to send a telegram or registered letter with return receipt requested to ensure that the insurer has been notified of the examination in advance.
The examination may be carried out in the presence of a representative of the insurer or without him if he does not appear at the specified time. This does not affect the result or reliability of the procedure. The insurer present on site can ask questions and monitor the work of the independent expert.
Send the expert's report with photographs attached to it to the insurer along with your claim. Keep the second copy with you; it may be useful in court.

Filing a claim

If you do not agree with the actions of the insurer and the amount of compensation for the loss, then you must first file a claim. In it, indicate the mistakes made by the insurer (underestimated amount of compensation, delay, illegality of refusal to pay, etc.).

The law obliges insurers to resolve this issue within 10 working days. During this time, he is obliged to correct these errors or issue a written refusal, with which the policyholder can go to court.

Complaint to RSA

You can also complain to RSA as a higher authority, which is responsible for the actions of all Russian insurers. Write a complaint, attach all the documents and photos necessary to confirm your claim, and send it all to RSA.

If the essence of the issue is the amount of insurance compensation, then it is better for you to immediately go to court. RSA usually deals with gross violations of the law (for example, refusal to pay, requirement to provide additional documents not provided for by the rules) and payments in the event of bankruptcy of the insurer.

Complaint to the Central Bank of the Russian Federation

You can complain about your insurer to the supervisory authority that controls the activities of all financial organizations - the Bank of Russia. However, the Central Bank of the Russian Federation also does not deal with conflicts, but reacts only to direct violations of the law.

What to do if the insurance company doesn't pay?

If there are no payments after the time allotted for insurance payment has expired, it is recommended to proceed according to the following algorithm:

Find out the reason for the lack of payments . You can establish the reason for the lack of required payments using a telephone call, a personal visit to the insurance company, or a written request. In any case, it is necessary to require a written explanation of the reasons for the refusal if nothing can be understood from oral communication. A reasoned refusal from the insurer will be required in the future to appeal it in the manner prescribed by law.
Submitting a claim to the insurer . The claim in writing is sent to the insurance company at its legal address. In justifying the requirements, it is necessary to indicate disagreement with the previously provided written refusal (or indicate its absence). Attach a copy of the contract, documents confirming the insured event and the amount of payments (if any). Additionally, the claim can also be sent to the Central Bank of the Russian Federation, which acts as a supervisory authority over the insurer, and to the Russian Union of Auto Insurers. The insurance company is obliged to consider the claim within 10 days from the date of delivery, supervisory authorities - within 30 days.
Applying to court with a statement of claim . When preparing a claim, it is necessary to collect the entire package of documents justifying the illegality of the actions of the insurance company; it is also a good idea to attach documents confirming the filing of the claim to the defendant. The statement of claim is drawn up according to the number of participants in the trial and can be filed with the court at the place of residence or stay of the plaintiff or the location of the insurance company. In addition to claims for payment of insurance, the plaintiff has the right to additionally demand payment of a penalty for each day of delay in fulfilling the obligation, compensation for moral damage, payment of a fine in the amount of 50% of the amount awarded in favor of the plaintiff, as well as compensation for legal expenses associated, for example, with provision of legal services.

IMPORTANT : completed actions according to the specified algorithm will allow the policyholder to prove his case and receive the required insurance compensation.

Trial

If the insurance company refuses to pay under compulsory motor liability insurance or does not respond to a claim regarding an underestimated amount of compensation, the best way to get your money is to file a claim. It is the court that is responsible for collecting fines for violations of laws, compensation for damage caused and compensation for moral damage.

You can file a claim at any time if the insurer does not satisfy your claim or respond to it in a timely manner. This should be done as follows:

Write a statement of claim, indicate in it the violations committed by the company, provide evidence that the insurer acted illegally.
Pay the state fee.
Make photocopies of documents confirming that you are right and that the insurers violated the rules for considering the case: the claim, the company’s response with a refusal to pay, the conclusion of an independent examination, a telegram about its conduct and other important evidence you have. Copies will be attached to the case file; you will have to present the originals at the court hearing.
Submit the claim, photocopies of documents and payment receipt to the court. This can be done in person by contacting the court office, or sent by registered mail.

At the court hearing you must prove your case. You can use photographs, videos, witness statements, documentation and any other arguments.

You have the right to ask the court for help if you are unable to obtain any evidence on your own. Then the judge will request it officially from the department that can provide it.

After considering the case, the court will make a decision in favor of one of the parties. If you are denied compensation, you can appeal the verdict to a higher court.

Arbitrage practice

The car damaged in the accident was considered completely destroyed and was subject to disposal.
Valid leftovers were not used. The plaintiff demanded full compensation, but refused to give them to the insurer, on the basis of which he was refused compensation. The court ruled that based on Art. 15. According to the Civil Code of the Russian Federation, real damage is determined taking into account the part that the plaintiff continues to use, so the insurance company was obliged to make a payment without taking into account the cost of the usable balances.

Expert advice

If after sending a claim the insurance company has not given its response within 10 working days, you can write a complaint to the RSA or the Central Bank or immediately file a claim in court.

The 10-day period is counted from the moment the claim is filed:

if you submitted it in person at the company office - from the day of reception,
if sent by mail - from the day the letter was received by the addressee (the notification must contain the date and signature of the representative).

Moral damage is compensated within the framework of the Law “On Protection of Consumer Rights”. However, if you believe that the refusal or untimely payment of compensation under compulsory motor liability insurance has caused you additional psychological damage, then theoretically you can demand compensation in court.

You will have to provide convincing evidence that you suffered from the insurer's unlawful actions.

In fact, it is possible to achieve such compensation, but in most cases the court either refuses compensation for moral damage at all or lowers the required amount to the minimum.

Many motorists are interested in the question of whether the insurance company pays the person at fault for the accident under compulsory motor liability insurance. We remind you that compulsory motor liability insurance is insurance of civil liability to third parties, therefore all payments are made not to the culprit of the accident, but to those affected by his actions.

Losses associated with damage to the car of the perpetrator of a traffic accident are covered by another type of car insurance - comprehensive insurance.

Now you know how long it takes to process losses and claims by insurers, where to complain if you suspect a company is dishonest, and how to achieve fair compensation for losses through the court.

We hope that this will help you quickly and correctly resolve all issues with the insurer in the event of an accident and damage to your car.

How long does the insurance pay out?

In accordance with Part 21 of Art. 12 of the Federal Law of April 25, 2002 No. 40-FZ “On compulsory insurance of civil liability of vehicle owners,” the insurer is obliged to make a positive or negative decision on the insured event within 20 working days from the date of receipt of the relevant application from the victim. The period will be 30 days if the car is sent to a service station.

Unlike the MTPL policy, the period for payment of insurance under the CASCO agreement is not regulated by a special law or regulatory act. The period of time required for insurance compensation may be specified in the contract or in the insurance rules.

The average duration of compensation under CASCO insurance ranges from two weeks to one month. An increase in this period indicates problems with insurance payment and the need to take appropriate actions to eliminate them.

Watch the video on our YouTube channel and you will learn how to file a claim with the insurance company, what to do and where to start. Write your question in the comments - an insurance dispute lawyer will answer you for free.

Let's sum it up

If the reason for refusal to issue MTPL is legal, you will receive a written notification and will be able to correct the shortcomings and contact the insurer again.

If it is simply not profitable for the insurance company to enter into an agreement, you will not receive an official refusal. This is a violation of the law.

Therefore, they use different options: lack of forms, sending for inspection to a distant point, technical failures in the system, impossibility of entering data into the RSA database.

If you avoid the unnecessary hassle of contacting regulatory authorities, find another reputable insurance company.