What is the maximum payment today from the RSA, if the damage to health is determined to be serious, according to the table of fixed payments for each injury exceeds 500,000 rubles? In this case, the culprit of the accident died, and

The legislative framework

Reimbursement for damage to health in a traffic accident under compulsory motor liability insurance is made on the basis of the following regulations:

Federal Law of April 25, 2002 No. 40-FZ;
Government Decree of November 15, 2012 No. 1164;
Government Decree of 02/21/15 No. 150;
Regulations of the Bank of Russia dated September 19, 2014. No. 431-P.

If one of the participants in the accident is a carrier, then when calculating the amount of compensation, the provisions of the Federal Law of June 14, 2012 are additionally applied. No. 67-FZ.

Tables of standards for payments for damage to health under compulsory motor liability insurance

The amount of compensation depends on the type and degree of harm. The calculation tables were approved by Decree of the Government of the Russian Federation of November 15, 2012 No. 1164.

Skull bones. Nervous system

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Fracture:
external plate of the vault, facial bones, traumatic suture dehiscence	5	25
vault	15	75
grounds	20	100
vault and base	25	125
Open fracture	7	35
Penetrating injury without brain damage	7	35
Brain damage:
shake:
treatment period is 10 days or more	3	15
28 days or more (of which hospital stay should not be less than 7 days)	5	25
injury:
treatment period is 14 days or more	7	35
28 days or more (of which hospital stay should not be less than 14 days)	10	50
28 days or more (of which hospital stay should not be less than 14 days, with confirmed hemorrhage)	15	75
hematoma	20	100
intracerebral hematoma	25	125
Spinal cord injury:
concussion (while in hospital for at least 7 days and in outpatient treatment for 28 days or more)	5	25
bruise (with a treatment period of 28 days or more, of which a hospital stay of at least 14 days)	10	50
compression	25	125
complete break	75	375
Spinal injury	10	50
Penetrating spinal injury	7	35
Damage, rupture of nerves and plexuses:
partial or complete rupture	5	25
injury to the wrist and ankle	10	50
in the area of the forearm and shin	20	100
above the calf and forearm	40	200
complete rupture of the plexus	70	350
concussion, bruise, compression of spinal nerves	3	15

Organs of vision

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Trauma to one eye:
non-penetrating injury, penetrating injury, avulsion or rupture of the eyelid	5	25
penetrating injury to the eyeball - rupture of the membrane, 3rd degree burn	10	50
rupture or avulsion of the optic nerve	10	50
Consequences of injury to one eye:
iris defect, damage to the apple, presence of foreign bodies	10	50
decreased visual acuity	The amount of payment is determined depending on the comparison of the percentage of vision before and after the injury (notes to Resolution No. 1164)
Paralysis of one eye	15	75
Narrowing the field of view of one eye:
non-concentric	10	50
concentric	15	75
Pulsating exophthalmos of 1 eye	10	50
Orbital fracture of 1 eye	10	50
Damage to the muscles of the eyeball of 1 eye	10	50
Consequences of damage to the tear ducts of 1 eye	5	25

Hearing organs

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Damage to the ear:
missing one third part	3	15
half	5	25
more than half	10	50
Decreased hearing in one ear, after 3 months after injury, by at least 50 dB at frequencies 500 – 4000 Hz	5	25
Rupture of the eardrum	5	25

Respiratory system

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Nose fracture:
without treatment	5	25
during treatment	10	50
Lung damage
accumulation of blood or air	7	35
partial removal	40	200
complete removal	60	300
Chest wound	5	25
Suffocation due to trauma	7	35
Fracture:
chest	7	35
rib cartilage	2	10
first and second ribs	4	20
third and subsequent	2	10
Opening the chest:
if the organs are not damaged	5	25
if damaged	10	50
Airway injuries:
without surgery	4	20
when the operation is performed before 3 months after the injury	7	35
after 3 months	10	50

The cardiovascular system

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Damage to a vein or artery:
not resulting in vascular insufficiency:
at the level of the forearm, shin	5	25
higher	10	50
leading to vascular insufficiency	25	125
Heart damage:
not leading to cardiovascular failure	15	75
entailing the specified consequences after 3 months	30	150

Digestive organs

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Fracture of the upper jaw or lower jaw, zygomatic bone, dislocation of the lower jaw, its loss:
isolated	3	15
full of one jaw	5	25
double one or both	10	50
loss of part of the jaw, with the exception of the alveolar ridge	30	150
total loss	50	250
Loss of teeth:
2-3	5	25
4-6	10	50
7-9	15	75
10 or more	20	100
Loss of tongue:
from 1 cm to 1/3	5	25
from 1/3 and more	20	100
Trauma to the gastrointestinal tract, liver, gallbladder, spleen:
1-2 organs, with a treatment period in hospital and outpatient settings of at least 14 days	5	25
3 or more organs	10	50
if cicatricial narrowing, deformation of the stomach, intestines, anus, or liver failure occurs after 3 months	20	100
if intestinal enterovaginal or pancreatic fistula occurs after 3 months	40	200
loss of the gallbladder, part of the liver, up to two-thirds of the stomach, up to two-thirds of the intestines	20	100
loss of the spleen, part of the pancreas	30	150
loss of two-thirds or more of the stomach, two-thirds or more of the intestines	40	200
complete loss of stomach, intestines	50	250
Damage to the trunk, abdominal organs and retroperitoneal region and abdomen:
removal of foreign bodies	1	5
muscle and tendon surgery	3	15
abdominal incision	7	35
Damage to the pharynx, esophagus, intestines, stomach	5	25

Urinary and reproductive systems

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Contusion of the kidney, its rupture, as well as the ureters, excretory and emission canals, bladder	5	25
Removal of part of the bladder, ureter, excretory canal	20	100
Removal of part of the kidney, development of failure after 3 months	30	150
Development of fistulas	40	200
Complete kidney removal	45	225
Removal of the fallopian tube, one ovary	10	50
Removal of both fallopian tubes and ovaries	30	150
Removal of the uterus with appendages, penis or part thereof	40	200
Surgery of the external genitalia	5	25
Abortion:
up to 12 weeks	30	150
after	540	250

Soft fabrics

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Burn or frostbite 1-2 degrees (%):
3-5	5	25
over 5 to 10	10	50
more than 10	15	75
Burn or frostbite 3-4 degrees (%):
1-2 (for 4th degree burns – 0.25-1)	10	50
2-4	15	75
4-6	20	100
6-10	30	150
more than 10	40	200
Burns or frostbite of the face, neck – 1-2 degrees, from 1% or more	3	15
Burns or frostbite of the face, neck – 3-4 degrees (%):
1-2	10	50
2-4	15	75
4-6	20	100
6-10	30	150
more than 10	40	200
Wound, soft tissue rupture (sq.cm):
3-10	5	25
10-20	10	50
20-50	25	125
more than 50	50	250
Wound, soft tissue rupture (sq.cm):
3-10	5	25
10-20	10	50
20-50	25	125
more than 50	50	250
Facial disfigurement	40	200
Other bruises and lacerations	0,05	250 rubles

Musculoskeletal system

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Complete rupture of muscles and tendons, if surgery is necessary (number of tendons)
1-2 at foot level	5	25
1-2 hands and forearms	7	35
1-2 in other places	10	50
3 or more on the foot	10	50
3 or more on the hand and forearm	12	60
3 or more elsewhere	15	75
Fractures:
vertebral bone fragments	4	20
1 vertebra	10	50
2-3	20	100
4 or more	30	150
46. Rupture of intervertebral ligaments, subluxation of the vertebrae, with a treatment period of at least 3 weeks	7	35
Isolated fractures:
1 vertebra	4	20
each subsequent additional	1	5
Sacral fracture	10	50
Damage to the coccyx:
dislocation	3	15
fracture	7	35
Fracture of clavicle, scapula:
fragments	4	20
epiphysiolysis	5	25
one joint with dislocation	7	35
two bones or joints	12	60
Shoulder injury:
fracture	3	15
gap	4	20
isolated fracture	5	25
traumatic dislocation	10	50
separation of fragments	4	20
double or triple fracture	15	75
Damage to the elbow joint:
fracture	3	13
gap	4	20
dislocation of one bone	5	25
dislocation of both bones	7	35
fracture of both shoulders	10	50
fracture and dislocation of both forearms	12	60
Forearm fracture:
separation	4	20
fracture of one bone	7	35
double and triple	8	40
both bones	10	50
both dice, one or both of which are double, triple	12	60
Wrist injury:
rupture, with continuous treatment for at least 3 weeks	4	20
dislocation	5	25
fracture of one bone	7	35
two	10	50
Wrist injuries:
gap	3	15
rupture of two ligaments	4	20
fracture of 2-3 bones	8	40
fracture of 4 or more bones	12	60
Upper limb surgery:
removal of foreign bodies	1	5
on nerves, muscles, tendons, capsules, ligaments, bones of the hand and fingers, collarbone, processes	5	25
on the bones of the forearm, shoulder, scapula	7	35
joint replacement	15	75
Amputation or loss:
parts of the nail phalanx	3	15
phalanges of the first finger	5	25
both phalanges of the first fingers	6	30
one finger	7	35
2	15	75
3-4	20	100
all fingers	26	130
hands to wrist level	35	175
upper limb to forearm	50	250
to the shoulder blade or collarbone	60	300
Pelvic injury:
fracture	3	15
gap	4	20
epiphysiolysis of each bone	5	25
rupture of one joint	7	35
2	12	60
3 or more	15	75
Hip fracture:
separation	4	20
fracture	10	50
double or triple	15	75
Knee injury:
fracture	3	15
gap	4	20
rupture of two ligaments	5	25
tibia fracture	10	50
Patella fracture	7	35
Shin fracture:
separation	4	20
fracture of one bone	12	60
both	15	75
double, triple fracture	18	90
Ankle injuries:
gap	4	20
rupture with subluxation	5	25
tarsal fracture	6	30
talus	8	40
calcaneus	10	50
Foot injuries:
separation	4	20
dislocation of 1-2 bones, fracture of one	5	25
fracture of 2-3 bones	7	35
4 or more dice	10	50
Lower limb surgery:
removal of foreign bodies	1	5
skin grafting	2	10
reconstruction of nerves, muscles, tendons, capsules, ligaments, bones of the foot and fingers, skin plastic surgery on the face, anterolateral surface of the neck	5	25
reconstruction of the leg, pelvis, thigh	7	35
joint replacement	15	75
Amputation or loss:
nail phalanx	2	10
phalanges of the first finger	4	20
each phalanx of the first finger	5	25
one finger, 2-3 phalanges	6	30
two fingers	12	60
3-4	15	75
all fingers	22	110
feet	30	150
lower limb to knee	45	225
to the pelvis	50	250

Complications

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Prolonged compression:
extremely severe form (more than 4 hours)	30	150
heavy	25	125
average	215	17
light	7	35
Traumatic shock	10	50
Vascular injuries:
acute thrombosis	10	50
acute thrombosis, with damage to the pulmonary artery	20	100
Purulent complications:
soft tissue fistulas	5	25
osteomyelitis	10	50
Wound infection	7	35

Poisoning

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Accidental poisonings during the following continuous treatment periods (in days):
7-14	2	10
more than 14 days, in case of outpatient treatment; 7-14 inclusive, in case of inpatient and outpatient treatment.	5	25
15-30	10	50
31 or more	15	75

Bleeding

Type and severity of injury	Insurance payment percentage	Amount of payments (thousand rubles)
Internal (losses in ml/% of total circulating volume):
1000/20	7	35
more than 1001/21	10	50
External (losses in ml/% of total circulating volume):
1000/20	5	25
more than 1001/21	7	35

Procedure

After a traffic accident, a traffic police officer will issue the victim with a certificate of the accident and a report from the scene of the incident . The protocol contains information about the insurance company in which the car owner at fault for the accident has a compulsory motor liability insurance policy.

To receive your compensation fee, follow the instructions:

write a statement to the Investigative Committee;
collect documents confirming the harm caused to health;
send the papers to the insurer.

The insurance company will calculate the amount and transfer it to the applicant’s bank account.

Statement

The document form is approved by Bank of Russia Regulation No. 431-P . In your application to the Investigative Committee, please provide the following information:

personal data of the affected person;
information about damaged property;
information about harm caused to health;
the nature and severity of the injuries;
data on additional costs of treatment;
whether there is any income lost during treatment;
information about the insured event;
Method of receiving money - cash or bank transfer.

Download the application form for insurance compensation or direct compensation for losses under OSAGO

At the end of the application, indicate the list of attached documents, put your handwritten signature and date. Send your application by mail or hand it over to the Investigative Committee office in person.

Documentation

When contacting the insurance company, provide the following documents:

notification of an accident;
certificate of traffic accident;
a copy of the protocol on the administrative offense;
photocopy of passport;
bank details for transferring funds;
a certificate from a medical institution confirming the severity of the harm caused to health.

In various situations, additional documents may be required. For example, if the victim has become disabled of group 1 or 2, then attach a medical report establishing disability.

Term

Contact the insurance company no later than 5 working days after the accident. Within 15 days from the date of submission of documentation for compensation, the insurer expects applications from other victims in this accident. At the end of this period, he reviews the papers and assigns payment within 5 days.

If there is a delay in transferring money from the insurance company, you can recover a penalty in court. It is calculated at 1% of the assigned amount for each day of delay .

If you are not satisfied with the amount of payment under OSAGO

Compulsory car insurance, by its very nature, should guarantee every driver the opportunity to receive compensation for damage caused by another car owner as a result of an accident. However, in practice, in order to receive the necessary compensation, you have to fight with the insurance company.

Very often, insurance company appraisers deliberately underestimate the cost of repairs and do not notice hidden damage. And although the methodology for calculating compensation is the same for everyone, the input data is entered there based on an expert assessment, so very often drivers receive compensation 1.5-2 times lower than the market cost of repairs.

If you have any doubts that your payment has been underestimated, you will have to resort to the services of independent experts. And if the difference in their assessment and the assessment of the insurance company’s experts is more than 10%, you can prepare documents for judicial resolution of the conflict. Before going to court, it is worth writing a pre-trial claim to the insurer; very often already at this stage (understanding the client’s determination) the insurance company agrees to enter into a dialogue and begins to “bargain”. If the proposed conditions suit you, then agree. If not, pay the state fee and go to court. By the way, it is imperative to include in your statement of claim all the expenses you have incurred, including those for an independent examination.

How is the compensation amount calculated?

The table of payments for compulsory motor liability insurance is presented in the appendix to Government Decree No. 1164. It consists of two columns:

nature and severity of damage to health;
the amount of the insurance premium (in percent).

The maximum amount that an insurance company can pay is half a million rubles. To calculate the amount of insurance, you need to multiply 500,000 by the amount of the insurance premium established by Government Decree.

Download the table of payments under compulsory motor liability insurance for harm to health

Example: a citizen received minor health damage as a result of an accident - a concussion. He was in outpatient treatment for 7 days. According to the payment table, compensation for such an injury is set at 3%. The amount to be reimbursed will be 35,000 rubles (500,000*3%).

If the victim received numerous injuries of varying severity, then all injuries are divided into categories, and the amount of insurance is calculated by adding up the payments.

Example: a victim has a disfigured face, for which insurance is provided at 40% of the maximum established amount, and at the same time there are soft tissue bruises - 0.05% of the maximum amount. The total amount of insurance compensation will be 200,250 rubles ((500,000*40%)+(500,000*0.05%)).

In some cases, the amount may be subsequently recalculated in favor of the injured person. For example, when going to the hospital after an accident, the average severity of harm to health was determined. After contacting the Investigative Committee and receiving compensation under compulsory motor liability insurance, my health deteriorated, and as a result of an additional examination it was determined that the body had suffered serious harm.

In this case, the victim should transfer new papers to the insurer. The Investigative Committee will review the medical examination report and recalculate the amount of compensation.

Who pays for damages under compulsory motor liability insurance?

The damages to the victim are paid by the insurance company of the culprit. A participant in an accident can also contact his insurance company to receive compensation under the PPV. The insurance amount to be paid cannot exceed the amounts established by law. If the damage exceeds these payments, the victim can go to court and recover the remaining funds from the culprit.

At the same time, you need to figure out who will receive the payments - the policyholder or the owner of the car, if these are different people. The legal framework provides for situations where the owner and the policyholder are different persons. Moreover, the contract even provides separate columns for them.

The policyholder is the person who pays for the policy; he must be recorded as the driver. But, regardless of who pays for the insurance, payments are due to the owner of the car. The policyholder can receive it only if there is a general power of attorney from the owner.

If the insurance payment does not cover the costs

When calculating compensation, possible additional costs for rehabilitation or treatment of possible complications are not taken into account. Often such medical services are paid and are not covered by compulsory medical insurance.

Therefore, if the insurance compensation did not cover the costs of treatment, the victim can count on additional payments .

Additional payments can cover the following expenses:

therapeutic nutrition;
nursing services;
prosthetics, etc.

To obtain additional insurance, provide the insurance organization with documents confirming the need for such treatment. These can be certificates from medical institutions, doctor’s prescriptions, etc.

Calculation of damages under compulsory motor liability insurance

Compensation for damage includes the following components:

repairing property or purchasing a new vehicle if the damage cannot be restored;
burial;
treatment;
purchase of medicines;
compensation for damage due to temporary disability;
reimbursement of costs for towing a car, etc.

Both the insurance company itself and an independent expert can calculate the cost of payments in case of an accident.

Insurance compensation in case of death of a citizen

If the victim died as a result of a traffic accident, then his relatives - spouse, children/parents, and other dependents - can claim compensation. The amount of compensation for such persons is 475,000 rubles. If several relatives have the right to compensation at the same time, then the amount of the insurance premium is divided equally between them.

Insurance in the amount of 25,000 rubles can be obtained by other persons who have incurred the costs of burying a deceased person as a result of a traffic accident..

To receive funds upon the death of a citizen as a result of an accident, when contacting the insurance company, attach:

a copy of the death certificate;
document confirming the right to receive compensation - marriage certificate, birth certificate, etc.

Compensation for damage to health in an accident under compulsory motor liability insurance in 2021

Road traffic accidents often cause injuries to drivers, passengers and pedestrians. If you think that auto liability insurance can only cover property damage, you are wrong.

Nowadays, compensation for injury in a car accident under third party liability is paid even for bruises and abrasions.

Knowing your rights will allow victims of road accidents to receive monetary compensation in a timely manner and use it to restore lost health or rehabilitation.

Under compulsory motor liability insurance, compensation is paid only for injuries (and their consequences) received by a person as a result of a mechanical shock in a vehicle collision. These include bruises, abrasions, cuts, fractures, damage to internal organs, loss of limbs and, as a result, disability or death of a person. There are mild, moderate and severe degrees of health impairment

The person who causes the accident is solely responsible for the damage caused, so the insurance company must pay the claim. If there is no liability policy, all payments will be made by the person who caused the accident or the owner of the vehicle.

Compensation for non-material damage in case of an accident is not paid from civil liability insurance, so it can be recovered directly from the culprit of the accident in court

Until 2015, insurance companies refused to pay compensation to victims of road accidents if they received free treatment as part of compulsory health insurance.

The exceptions were cases when there was no VHI policy or the victim died. After the adoption of Decree of the Government of the Russian Federation No. 150 of February 21, 2015.

The situation has changed - now the presence of medical or other insurance is not taken into account when calculating compensation.

The maximum withdrawal amount is 500,000 rubles.

Currently, compensation is paid when:

bodily injury, damage to internal organs and death of the victim;
sensory impairments (vision, hearing, etc.)
onset of disability;
expenses for treatment and rehabilitation;
compensation for lost wages during treatment.

In the latter case, the question arises whether the OC includes payment of sick leave in the event of temporary disability.

Insurance coverage for the culprit of an accident

OSAGO provides liability insurance for a motorist who has committed an accident to third parties. That is, compensation for costs does not apply to the guilty person.

This rule applies only to obvious accidents in which the culprit is clearly identified. But not all car accidents are like this. Many road accidents occur when it is mutual fault.

If another car owner is found to be at fault in relation to the main at-fault driver, then the main at-fault driver will also be entitled to receive insurance.

In the event of a trial, lawyers can divide a single incident into several episodes, in one of which the culprit will be the victim.

When the insurer has the right to refuse money under compulsory motor liability insurance

The insurance company may refuse to pay compensation for injury to health in an accident if:

the driver does not have a license to drive a vehicle;
The accident was pre-planned;
there is no compulsory motor liability insurance policy or the insurance has expired;
OSAGO is fake;
the money was transferred by another insurer;
The accident occurred while learning to drive a car;
The application period has expired - 5 working days.

In the cases listed in Art. 18 Federal Law No. 40, instead of the insurance company, compensation payment will be made by RSA (Russian Union of Auto Insurers). Such cases include:

declaring the insurance company bankrupt;
revocation of the company's license;
unknown person who caused harm to the victim;
absence of compulsory motor liability insurance.

To receive money from RSA, submit an application and documents confirming your right to receive the compensation amount.

In which case there will be no compensation

In practice, insurance companies do not always pay out insurance. Refusal to pay compulsory motor liability insurance in case of an accident may occur in the following cases:

The culprit of the accident has not been identified. If the driver considers himself to be an injured party, he can order an additional examination or go to court to conduct a forensic examination.
An uninsured vehicle was involved in the accident.
The victim missed the deadline to apply.
The insurance policy has expired.
A training vehicle was involved in an accident if the accident occurred while taking tests or undergoing practical training.
Damage to property was caused by transported cargo.
The victim was performing his job duties at the time of the accident.
The insurer went bankrupt.

Also, the insurance company may refuse compensation if an incomplete package of documents is submitted or if fraudulent activity is detected.

What to do in case of an unreasonable refusal

If the insurer refuses to pay compensation or has not paid it in full, go to court. Before this, carry out the pre-trial settlement procedure. To do this, send a written claim to the insurer.

The Investigative Committee is given 30 days to consider and send the applicant a response to the claim. Oral communication with the insurance company is not considered by the court as a pre-trial settlement. All documents must be in writing.

The claim must have an incoming number and date of receipt. If the claim is sent by mail, send it by registered mail with notification.

The statute of limitations for disputes regarding compensation for personal injury resulting from a car accident is 2 years . To increase your chances of getting money through court, enlist the help of an experienced lawyer.

Summary

To receive compensation for personal injury under compulsory motor liability insurance, remember:

contact the Investigative Committee with a statement within 5 days from the date of the accident;
To receive payment, contact the insurer's office in person or send documents by mail;
from the moment of application to the moment of transfer of funds no more than 20 days should pass;
the amount depends on the severity of the injuries received;
if the drivers are both at fault, both participants in the accident will receive insurance;
in the event of the death of the victim, compensation will be paid to his relatives;
in certain cases, the insurer may refuse compensation;
If the insurance company unreasonably refuses to pay, go to court.

More…

Limit of payments under compulsory motor liability insurance: according to the European protocol, in case of mutual fault, in case of death or harm to health, in case of total damage to the car.
Total loss of a car under compulsory motor liability insurance: what is it, examples of payment calculations
What documents are needed to file an insurance claim under MTPL?
Is the culprit of the accident paid insurance under compulsory motor liability insurance?