Reasons for refusal of insurance payment under compulsory motor liability insurance in case of an accident

Should I contact a car lawyer?

This question cannot be answered unequivocally. But with a high degree of probability it is worth it. The fact is that judicial and pre-trial processes always contain a large number of procedural actions, errors in which are worth the lack of certain evidence. And insurance companies have their own lawyers.

However, the procedure to follow if the insurance company refuses to pay or repair is not so complicated. It’s just that there are non-standard situations in the form of unpopular grounds for refusals (for example, an unobvious third party to an accident, an unobvious guilt of a person).

Your representative will always evaluate the prognosis of the case before proceeding with it and charging you for payment.

You can contact an auto lawyer absolutely free of charge, and he will be able to advise you specifically on your insured event!

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What nuances should you pay attention to when contacting a car lawyer when the insurance company has refused to pay under compulsory motor liability insurance:

1. a competent auto insurance lawyer will always study the case at the stage of getting to know you before concluding a contract; if the representative immediately proposes to conclude an agreement, then this is the “wrong lawyer”,
2. not all lawyers are equally useful; study the experience and number of cases won by an auto lawyer specifically regarding insurance refusals; you can do this simply by searching by the name of the representative on the websites rospravosudie.com and sudact.ru,
3. prices for the services of auto lawyers for refusals of insurance companies to pay or repair vary greatly: on average from 4-5 thousand rubles to 12-15 thousand; in such cases it is also often customary to give “prizes” - a certain payment if the case is won upon its completion.

When conducting business, you will need to conclude an agreement with your representative, pay an advance payment or the full amount at once and write out a power of attorney (power of attorney form below), which can be certified by your employer or notarized.

Legal grounds for refusing payment under compulsory motor liability insurance

But sometimes those who have the right to auto insurance are wrong themselves, because they simply do not know the legal grounds. The MTPL insurance company refuses to pay compensation to the injured party and the insurer is quite well-known and large, then most likely its grounds are legal.

Legitimate reasons for an insurance company’s refusal to pay compulsory motor liability insurance :

• The victim provoked (initiated) the accident;
• Natural disasters, radiation, war;
• The notification of the Investigative Committee about the disaster did not occur within the established period;
• The victim demands compensation for moral damage;
• The documents did not meet the required quantity;
• The owner bought a new vehicle, but did not replace it with compulsory motor liability insurance; in fact, the victim is not insured anywhere;
• The accident occurred at a driving training center, on specially equipped tracks;
• Unique and antique real estate was damaged;
• The policyholder was injured in an accident involving uninsured dangerous goods.

In general, if you receive a refusal to pay insurance compensation in such cases, nothing can be done, you will have to come to terms with it and try to sue the insurance company before the statute of limitations expires.

When is denial of insurance payment legal?

So, your motor third-party liability is insured under OSAGO. This means that you are insured against fault in an accident - the insurance company will compensate for the damage on your behalf if you are the culprit of the accident.

Part 25 of Article 25 of the Federal Law “On Compulsory Motor Liability Insurance” gives the insurer the right to refuse such compensation in cases provided for by law. Let's look at cases where the insurance company's refusal to pay is based on the law.

If you have an incomplete set of documents regarding an accident

We have already discussed in a separate article how to correctly submit a complete list of documents. It depends on whether the accident caused damage only to property or to the health and life of people.

If the package of documents is incomplete, then the insurance company has the right to legally refuse repairs or payment.

If you do not provide the car for inspection by the insurance company

This risk for the driver often appears when applying for a European protocol. The point here is that both in cases where the accident was registered with the help of it, and if without it, the driver is obliged not to begin repairing the car and not to dispose of it (or what’s left of the car) within 15 calendar days and request from the insurance company to provide the vehicle for inspection within this period.

If this is not done, there will be a refusal of insurance payment or repair, and it will be legal.

Free consultation with a traffic lawyer: 8 (Moscow and region), 8 (all of Russia - free call)

What to do if you refuse?

The subtlety of the auto law here is that, according to Part 20 of Art. 12 of the Federal Law “On Compulsory Motor Liability Insurance” (here and below this law will be implied), simply the fact of repairing a car or its disposal does not immediately cause a refusal. The latter is possible only if such an action by the car owner does not allow one to establish the very fact of the existence of an insured event or to estimate the amount of compensation from the insurance company.

But this also does not mean that you can simply immediately do an independent examination and, based on its results, apply for payment. As practice shows, in this case you will also receive a refusal, and judicial practice in 2021 and previous years supports the trend - if you do an independent examination and repair the car without inspecting the insurer, then the judges will support the insurance company’s decision to refuse to pay you.

As you can see, proving the opposite is a rather complicated procedure due to ambiguous judicial practice. Therefore, in this case, it is best to contact a car lawyer to assess the prospects of such a case.

If the insurance company did not satisfy your claim for compensation, demanding that you bring them a car, but it is not driving, and you stated this directly to the insurance company, then the refusal as of 2021 will be unlawful. Even if the car is not running, it was not the result of an accident. And, for example, due to a broken wheel and lack of a spare wheel. You don’t have to give a reason for this at all, but simply report that the car is not running.

In the latter case, read below for instructions on asserting your rights in the event of refusal of payment or repair due to failure to present the car.

If the OSAGO policy is fake

Obviously, when the policy of the culprit turns out to be fake, the insurance company is not obliged to pay compensation for the accident to the victim, and in this case, you will also have to apply for compensation from the culprit. But fake insurance does not always lead to refusal. We discussed such cases and what to do in such cases separately in the article about a fake OSAGO policy.

If the insurance company is bankrupt

Then you will have to contact the Russian Union of Auto Insurers, which already insures the insurance companies themselves against bankruptcy.

The procedure for contacting this body is similar to applying to the insurance company with the same set of documents. The only difference is that refusal from RSA is much less likely than from insurance, and also no repairs - only payment in money. Instructions for applying in this case are on the official website of the RSA.

If you contacted the wrong insurance company

The insurance company refuses to pay if you apply to the wrong address. The fact is that the law clearly regulates when you need to contact your insurance company, and when - only to the insurer of the culprit.

So, you need to contact the company where you took out your MTPL policy when:

1. damage was caused only to cars or other property, but there were no injuries or deaths,
2. all participants in the accident have a valid MTPL policy.

If you require compensation for damage not covered by MTPL

The auto insurance policy does not insure all the driver’s risks, but only the main ones. There are a number of exceptions when the insurance company can legitimately refuse to pay or repair, and the instructions in this case simply will not help.

So, the insurance refusal is legal in the following cases:

• You have applied for compensation for moral damages from an accident,
• You have applied for compensation for lost profits, compensation for lost working hours,
• at the time of the accident, the car was participating in competitions or conducting training driving,
• You are seeking compensation for damage caused to the environment or rare or unique objects, as well as if cash, jewelry, shares and copyrights were destroyed as a result of the accident.

All these points are regulated by Article 6 of our law.

When the insurance company does not pay under compulsory motor liability insurance and it is right

Over the 17 years of OSAGO’s existence, everyone has gotten used to it and expects payments after an accident. But there are several situations in which it is impossible to obtain compensation. And these are not obstacles from insurance companies, but legislative norms. And it’s better to know about them in advance.

Let us remind you that under MTPL it is not the car or the driver that is insured, but the driver’s liability. If he becomes the culprit of an accident, he will not have to pay from his own pocket for the restoration of damaged property or the health of victims in the amount specified by law. The insurance company from which he purchased the policy will do this for him. This implies the first condition under which there will be no compensation.

There is no culprit for the accident

This item may have several options. The most understandable one is that an accident occurred with one car due to road conditions, pedestrians, driver inattention, and for no reason at all. Since, according to the law, payments under compulsory motor liability insurance are made by the company of the at-fault driver, but there is none here, there will be no money. This does not negate the fact that you can try to get compensation from road services, pedestrians or other persons, but this will have to be done in court.

A rarer, but possible option is that the two participants in the accident are not at fault. If they do not violate a single paragraph of the Traffic Rules, then none of them is recognized as the culprit and none can qualify for payments under the motor vehicle license.

A driver who fled the scene of an accident can also become a reason for refusal of payment. In this situation, there is a culprit, but his identity needs to be established and found. Until a specific person appears with an MTPL policy, the insurance company will not make payments.

If the participants in the accident are both at fault, they are entitled to a payment proportional to their innocence, but most often they receive half of the amount due.

And we smoothly move on to another reason for refusing payment.

The culprit does not have compulsory motor insurance

If the at-fault driver has not insured his liability, he will have to pay for the damages himself. This is not affected by the insurance policy of the victim, who will most likely have to recover money for repairs through the court.

Moreover, the culprit’s lack of compulsory motor liability insurance may or may not be completely conscious. The policy does not work if it has expired, even if the accident occurred the next day, and the owner forgot to renew the contract. Nowadays, more and more often, situations arise when a person seems to have insured liability, but did it with an imaginary agent, who took the payment, but did not conclude a real contract, and issued either a high-quality fake as a policy, or the document was previously written off by the insurance company. In this case, you will most likely have to seek payment through the courts.

After an accident, you should always check the policy of the at-fault driver on the RSA website. According to its status, it must be “in the hands of the policyholder” and valid at the time of the accident.

Until recently, insurance companies refused to pay on the grounds that the at-fault driver was not included in the policy, was drunk, did not have the right to drive, or the insured event occurred outside the specified insurance period (but the policy itself was still valid). The Supreme Court ordered insurers to pay the victim in all these cases, and then return what was spent through a recourse claim against the culprit. The main thing is that the car is insured under MTPL.

To reduce risks when the person responsible for the accident does not have a compulsory motor liability insurance policy, some insurance companies have begun to offer drivers affordable additional programs, the purchase of which guarantees payment to the victim.

The accident occurred off public roads

The probability of meeting another car in the forest or field is extremely small, but it exists. If suddenly an accident occurred in a place where the traffic police cannot reach, it means that it will not be able to be registered. And there will be no payments for it. Another place where it is better not for cars to collide is the closed territory of any enterprises, including training grounds and sports tracks. Ordinary courtyard driveways and parking lots are among the public roads on which OSAGO operates. Here you just need to take into account that the culprit’s car must move with the driver inside, and the situation with scratches due to an open door does not fall within the scope of motor vehicle civil rights.

Also, insurance cases that occurred abroad can be considered a “territorial” reason for refusal. Russian OSAGO policies are valid only within domestic borders.

Incorrectly completed documents

Some circumstances for refusal of payment may arise after the accident and its registration.

In order to receive payments, the victim must provide his insurance or the culprit’s insurance with a complete package of documents - an application for payment, a notification of an accident, a copy of the protocol on an administrative offense, a resolution on an administrative offense case or a ruling on refusal to initiate a case, a passport , STS. If something is missing or there are errors in the documents, the insurer may deny the right to compensation. Eliminating this reason is quite simple - you need to correct typos and supplement the package.

Deadlines for submitting documents have been missed

This is especially true for those who filed an accident according to the “Euro protocol” scheme, without calling the traffic police. The victim is given five days to submit the documents to the insurer. If the accident was registered with the traffic police, then the documents can be submitted within three years. If these terms are violated, insurers have the right to refuse payment.

The damaged vehicle was not provided for inspection

The inspection takes place simultaneously or after submitting documents for payment. The victim's vehicle must be assessed by an insurance company expert before restoration repairs are made or the remains of the vehicle are disposed of. If this does not happen, the insurance company may legally refuse to pay, and no independent examination will prove the presence and nature of damage. The exception is cases when the car cannot be delivered to the insurer for examination, then by mutual agreement an independent assessment is carried out. Also, an examination is usually not needed when the damaged car is sent for restoration by the insurer - the car service reports about the damage and its costs.

Fraud

This is the most controversial reason for refusing payment, but it occurs in practice. The insurer shifts all the blame to the owner, who allegedly damaged the car on purpose. Such cases of consumer vandalism do occur. Especially often they try to cover up real accidents with fake accidents. But still, there are not many people who are ready to crash their car in order to receive 400,000 rubles (this is the maximum amount of payments according to the law), and sometimes respectable drivers have to prove the legitimacy of their claims in court.

You won’t be able to “earn money” from compulsory motor liability insurance by demanding compensation for moral damage; it can only be paid by the person at fault for the accident. The insured event does not cover damage received from the transported cargo or during its loading and unloading.

If the car was damaged by third parties, be they local vandals or negligent car service employees, or it was damaged due to the elements (an icicle, a tree, a piece of roof fell), then OSAGO has nothing to do with these situations. To reduce your expenses in such situations, you need to apply for comprehensive insurance.

As can be seen from the above, insurance companies sometimes have every right to refuse payment under compulsory motor liability insurance. In order to avoid this, you need to carefully study the insurance rules and follow them. Well, if the insurer still does not want to fulfill its obligations, seek compensation through the court.

When does the insurance company have no right to refuse payment?

Meanwhile, a large number of cases cannot be the basis for the insurer to refuse compensation for damages. Such cases include:

• Missing the deadline for reporting, including when registering an accident under the European protocol,
• refusal of the insurance company to go to a car that is not running, and this is indicated in the application for payment,
• if the OSAGO policy is fake, but the form itself belongs to the insurer (more details in the article),
• if the injured driver was drunk, refused to testify and committed any other violations that do not affect his guilt in the accident,
• if you do not have MTPL insurance, in this case you just need to contact the company at fault,
• if the insurance company requires documents that are not on the mandatory list, and you did not provide them,
• You or the culprit do not have a diagnostic card,

Legitimate reasons for refusal to pay compensation

In some cases, the insurance company has the right to legally refuse to indemnify or compensate for damage incurred in an accident. According to Federal Law No. 40, refusal is allowed if:

• the fact of the accident was falsified, deliberately distorted data on the incident and the insured objects were provided (and this has been proven);
• the participants committed the accident using criminal intent and actions (and this has been proven);
• there are no regulations and protocols of the traffic police, which makes it impossible to identify the guilty party;
• The accident occurred as a result of a natural or nuclear disaster, military action, civil unrest or riots, or other force majeure factors;
• the culprit of the accident has already paid the victim the damage;
• the current accident insurance policy is expired;
• The client of the insurance company has debts on insurance premiums.

In addition, unlike PCA, the insurance company may refuse to pay if the culprit of the road accident is not found or determined. It must be found or you will not receive a refund.

The insurer is obliged to inform the policyholder in writing about the presence of one of the listed reasons for a legal refusal. In all other cases, you are required by law to receive insurance compensation, but payments may be delayed until the circumstances are clarified.

Contacting the insurance company - step-by-step instructions

So, what to do if an insured event occurs? In fact, the procedure is simple:

1. You need to collect all the documents regarding the accident, fill out a notice and write an application for insurance payment.

2. Next, you need to either take these documents personally to the insurance company, but then demand an act of acceptance of documents (which, in fact, they are not required to give you), and film the process of submitting documents one by one on video.

But it is better to send a set of documents by registered mail with acknowledgment of receipt, and keep the receipt and notification. Next, when the letter is received by the insurance company, you will receive a notification of delivery - you also need to keep it, and also remember the date of delivery - the countdown of the compensation period begins from there.

3. Now you need to wait 20 calendar days (this does not include days that are officially considered non-working holidays) for payment or referral for repairs. Also, from the date of receipt of the letter with the documents or handing them over to you personally in the office, the insurance company has 5 days to inspect the car.

4. Based on the results of this period, there are 3 possible outcomes of events:

• You will receive payment or a referral for repairs within 20 days (or a little later),
• You will receive a reasoned refusal to pay or repair from the insurance company,
• the insurance company will not react in any way - there will be no refusal or compensation for damage.

The last point, in fact, is tantamount to refusal. We will consider below what to do in each such case.

What to do if your insurance claim is denied?

What should be the policyholder's procedure if the insurer refuses to pay or underestimates the due payment, so:

1. Contact your insurer and get a car inspection certificate. It indicates all the damage that was identified and recorded by the insurance company representative during the inspection. Based on it, an independent technical examination should be carried out, which will show the real damage caused to the car.
2. Contact the bank branch and get a statement indicating how much was paid, if any payment was made.
3. When applying to the insurance company for payment of compensation, the policyholder submitted the original documents. This could be a certificate of an accident, a resolution on administrative liability, a notice of an insured event, etc. If the insurer does not have copies of these documents on hand, you should ask the insurance company to make them. Alternatively, copies should be obtained from the competent authorities.
4. Conduct an independent technical examination. Do not forget to invite a representative of the insurance company to inspect the car by an independent expert, notifying him of the date in writing against signature.

Having collected all the documents, you can begin to prepare a claim to the insurance company.

We receive a refusal and evaluate the prospects

So, if you have failed and you are faced with one of the last 2 items in the list above, then you should not despair. The insurance company’s refusal may not be a failure at all, but an additional “bonus” if the case is won, which can result in amounts exceeding the cost of compensation for damage from an accident.

What are these “bonuses”? We will look at them in detail below, but here is a short list:

• the actual amount of damage will be assessed by an independent organization, which means that it will not be underestimated or less underestimated (due to the calculation method taking into account wear and tear),
• after 20 days of the period for compensation, the insurance company pays 1% for each day of delay of the amount of damage,
• in case of refusal to pre-trial settlement of the dispute, the insurer is entitled to a fine of 50% of the amount of payment in favor of the plaintiff,
• It is often possible to recover a small amount of moral damages .

And all this without taking into account the fact that if you win the refusal, the insurance company will reimburse you for all current expenses, including a car lawyer, examination, forwarding mail, telegrams and others, if any.

As we understand, the main thing we need is to win the trial. And for this we need to understand on the basis of what we were refused. There can be a lot of reasons.

And it is at this stage that we recommend consulting with a competent auto lawyer, who may not take the case upon himself, but will be able to assess your risks and chances of proving you are right.

What to do if the insurance company refuses to pay under MTPL?

Good afternoon. In today's post I want to talk about a popular problem - the insurance company refused to pay under compulsory motor liability insurance.

The main task of any insurance company is to make a profit. What is her income? This is the difference between the amount of payment for insurance contracts at the time of their conclusion and the amount of mandatory payments in the event of the occurrence of established insured events.

Today there are quite a lot of conscientious and reputable companies that care about their clients. However, along with them, there are many insurers on the market who may illegally refuse to pay insurance compensation. This is especially often true for payments under compulsory motor liability insurance. You simply cannot turn a blind eye to such a violation of the law and obediently agree with the insurer. It is very important to assert your own rights.

Here is a short video on the topic from car lawyers:

Reasons for legal refusal of insurance payment under MTPL.

To begin with, it should be noted that the insurer does not compensate for damage in the following insured events:

• The intention of the victim himself.
• War and various social unrest.
• Hurricanes and earthquakes.
• Nuclear explosion or increased levels of radiation.
• The reasons why damage is not compensated under compulsory motor liability insurance are as follows:
• The injured policyholder did certain actions or manipulations with the car, due to which it is not possible to correctly assess all the damage.
• Late notification to the insurer.
• The required documents were not provided.
• The insured event occurred during any competition or while learning to drive.
• Environmental damage was caused.
• The vehicle to which the damage was caused is not insured under compulsory motor liability insurance at all.
• Only moral damage was caused.
• The employee harmed his own employer.
• The driver damaged the cargo and the vehicle.
• Damage was caused to a variety of unique objects and antiques.
• The damage was caused to passengers who should have separate insurance.
• Damage occurred during unloading or loading.

Thus, there are quite a lot of reasons for the legal refusal of insurance payment under compulsory motor liability insurance.

How do insurers like to deceive drivers?

In order not to pay the insurance required by law, insurers may resort to various tricks. Thus, a client may be denied payment if he did not pass a special test for alcohol intoxication within a couple of hours after the accident, or if he did not call the company from the scene of the accident.

Also, in insurance agreements, organizations often include a clause where they reserve the right to decide to pay half of the total compensation, or not cover it at all, if a citizen has grossly violated traffic rules. However, insurance agreements generally provide for an extremely broad definition of the combination of words “gross violation of traffic rules” and therefore, almost any violation of traffic rules falls under its wording. Another term that is often manipulated by insurance companies. Virtually any actions of the insurer's client can fall under it.

In addition, insurance agreements almost always state that the insurer may delay insurance payment if there are certain doubts about the accuracy of the documents that were provided by the client. According to lawyers, it is almost impossible to confirm the validity of such doubts. Thus, the company's client risks not receiving legal compensation for as long as possible.

If an insurance company cannot or simply does not want to pay insurance to its own client, then it finds fault with various nuances. This little detail may well be the indication in the official application for insurance compensation of the client’s real place of residence, and not the place of registration according to the passport. Such an error may well be regarded as providing incorrect information and this will become an important reason for a complete refusal of payment.

There are other interesting tricks and ways to deceive drivers. Insurance rules are an important component of any insurance agreement. In the text of the latter, at the very end, it is often written in very small print that the potential client fully agrees and is familiar with the insurance rules. However, the text of the rules themselves is not offered to the potential policyholder. What is this connected with?

The rules are approved by the insurer and officially agreed upon with the State Financial Services Commission, so they are the same for everyone. The client must take into account the fact that these rules are a large document, which may also contain regulation of various issues that are not directly addressed in the agreement at all.

Thus, the insurer, based on the rules, can easily refuse to pay insurance under MTPL.

How to receive a written refusal of insurance payment?

First you need to understand the main reason for denial of insurance. If it is absolutely not justified, then the client must seek to receive insurance money.

After this, you need to request a written refusal from the insurance company, because all further actions without it will be simply meaningless. If the insurer refuses to issue this document, you must insist on its prompt receipt.

If you receive a refusal, it is important to study it carefully. This document must necessarily contain the necessary details: signatures of authorized persons and official seals. There definitely shouldn't be any discrepancies there.

What to do with a refusal?

Step 1 - contact the RSA and the Central Bank.

RSA and the Central Bank are very respectable institutions. RSA today is the body that exercises control over motor vehicle liability insurance in Russia. The Central Bank is another agency that is responsible for payments to Russian citizens.

First, you will need to submit an official complaint to the Central Bank. Today this can be done using different methods:

• Via Russian Post by special registered mail.
• Using an application on the official Internet portal of the bank.
• Directly into the hands of a bank specialist.
• You can also submit an official complaint to the RSA using mail or the official website.

The problem of paying insurance through the institutions described above can be solved quickly. Thirty days are given to consider the complaint.

Step 2 - pre-trial claim.

If contacting the RSA and the Central Bank of the Russian Federation does not help, you will have to write a claim to the management of the insurer demanding compensation for all damage as soon as possible. This is currently a valid requirement of Russian legislation.

To submit a special complaint, you can use the following methods:

• Using Russian Post services.
• Personal delivery to the company branch. In such a situation, two copies will be required.
• You will also have to obtain special confirmation that your claim has been accepted.

Such confirmation is a postal notification of delivery, or an incoming number with an official signature and an authorized person on the second copy. Your complaint will receive an official response within 10 days.

If there is no response, you will have to follow the step described below.

Step 3 - filing a claim and going to trial.

To resolve the issue of non-payment of insurance under compulsory motor liability insurance, the court is the last official authority where a defrauded client can turn. If the damage caused does not exceed 50,000 rubles, then the claim is filed in the magistrate's court.

If the amount of loss is greater, then the claim in this case is filed in the district or city court.

It is important to note that the state fee is not paid, because client - consumer of insurance services. A citizen can participate in the court process in person or through special representatives (traffic lawyers). It is strictly not recommended to let such a matter take its course.

As a result of going to court, the client of the insurance company will receive a decision on the claim and a so-called writ of execution. After this, it will be possible to solve the problem of payments.

Step 5 - insurance compensation.

With papers confirming the insurer's debt, it will be possible to receive the company's money legally. How to do it?

First way. Submitting an official application to the financial organization where the bank account of the debtor insurer is opened for their further write-off. The application must be accompanied by a writ of execution from the court. Funds usually arrive in the creditor’s bank account after three business days.

Second way. You can also contact the bailiffs who are implementing the court decision, provided that the debtor company has no money in its bank account. If it does come to this, then you should definitely think about whether the chosen insurer is preparing for bankruptcy.

In the event of bankruptcy of the insurer, you will have to apply for payment to the RSA.

To sum up all of the above, it is obvious that defending your rights will require a lot of time, effort, money and nerves. Therefore, in order for everything to go smoothly and quickly, and for your insurance payments to actually be returned to you, it is recommended to use the services of professional auto lawyers. Such specialists, for a fee, will make sure that your compulsory motor liability insurance is paid in full.

Conclusion

Having seen that a particular person is completely ready to go to any lengths to defend his rights, insurance companies will most likely pay the amount due to repair the vehicle. An important factor for the insurer to pay out legal insurance in this case is that in court they will be charged much more.

That's all for me today. I hope that the article fully answered the question of what to do if the insurance company refused to pay under compulsory motor liability insurance.

If you have any questions or if you want to add to the article, write comments.

Best regards, administrator

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Let's sue the insurance company - step-by-step instructions (+ pre-trial claim)

So, we received a refusal from the insurance company to compensate for the damage, and the question arises of what to do next. We will break down the answer to this question into 3 important steps:

• independent examination,
• pre-trial settlement of the issue,
• filing a lawsuit for refusal.

Independent examination

It is done for a financial assessment of the damage - in order to file a claim with the insurance company, we need to know the amount of money that we want to recover. It may not be required if the insurance company itself assessed the damage and issued you an assessment or examination report with a known amount of damage. But it may also be underestimated.

It is impossible to independently conduct such an examination by simply monitoring prices and compiling a table of them - neither the insurance company nor the court will accept such a calculation.

Carrying out an independent examination is paid and costs on average from 5 to 15 thousand rubles, depending on the degree of damage and the pricing of the office itself. These expenses are reimbursed if the case is won.

1. To do this, simply contact an independent expert who will do everything himself.
2. The expert will set a date and time for the examination; it should be no earlier than 5 days after your application. After this, you need to send a telegram to the legal address of the insurance company and invite its representative for an examination no earlier than just these very 5 days. This is an optional procedure, but the courts evaluate this point in a positive way for you. Most often, in practice, insurance representatives do not come.
3. Based on the results of the examination, you should be given a check, a copy of the contract for its implementation and, most importantly, an expert opinion with a table of prices for spare parts and labor, photographs of damage and the total amount to be reimbursed. All these 3 documents are important and you will need them in the future. Ask for a duplicate of the expert report, and also take a flash drive or other electronic media with you and ask to upload a photo of the examination to it - you will also need all this.

The calculation is made taking into account wear, alas. Depreciation can be no more than 50% for cars older than 5 years. But it is considered only for spare parts and components. Work must be calculated without taking into account wear and tear.

Also, if the car is not older than 5 years, then an expert at your request (you must ask to do this) can separately calculate the loss of marketable value (LCV) of the car. This is compensation for the fact of the accident itself, because when sold in the future, due to the presence of an accident in the history, your car will cost less on the secondary market.

The TLC is usually about 8-10% of the damage amount.

Pre-trial claim

This is an important step in the dispute with the insurance company and should not be skipped. The case of an insurance company’s refusal to repair or pay is a matter of consumer protection law, and a mandatory attempt at pre-trial settlement of the dispute is required.

For pre-trial settlement you will need the following documents:

1. original independent expert report,
2. all checks to substantiate the amounts indicated in the claim,
3. all the same documents that you submitted when contacting the insurance company, as a result of which the insurance company refused payment and repairs.

How to write a pre-trial claim?

In fact, there is nothing complicated here. You need to describe the nature of the accident, why you contacted the insurance company, on the basis of which you consider the insurance company to be wrong in refusing compensation for damage, and what exactly you are demanding.

There is no approved official form for this document; you write it in free form.

We provide all this data with links to the legislation in force for 2021 in a sample. (DOC format for filling out on a computer).

Next, the claim must be sent by registered mail with return receipt requested to the legal address of the insurer that refused to pay you or make repairs. After the date of delivery, the insurance company has 10 days (indicated in the claim form, it can be increased) to satisfy the “pre-trial”, after which you can file a claim in court.

Something else useful for you:

• Collecting payment without depreciation under compulsory motor liability insurance from the culprit - is it legal and what to do?
• If the person at fault for an accident does not have compulsory motor liability insurance, what to do and how to recover damages?
• Mutual fault under compulsory motor liability insurance - how is payment made?

Lawsuit

So, if the insurance company did not satisfy the pre-trial demand, but refused to pay or send it for repairs, then our next action is to file a claim in court.

There is nothing complicated here either. Since the refusal of an insurance company is a matter falling under the Law on the Protection of Consumer Rights, you can sue the insurer in the city or district court at the place of registration of the plaintiff - that is, at your registered address. The most convenient way to do this is here. Select your region of residence, enter your registration address, and the search service will find the correct court.

Now you need to correctly draw up a statement of claim, indicating all the necessary data with references to the laws on the basis of which you specifically demand from the defendant. The statement of claim does not have an approved form to fill out, but it is important to write it correctly. You can also entrust this matter separately to a car lawyer.

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Next, this claim must be taken and handed over to the office, having received an incoming number and wait for the subpoena. You, the insurance company that refused to send for repairs or payment, as well as the third party who caused the accident will be called. Depending on the region of residence and the specific court, you will have to wait from 3 weeks to 3-4 months. Alas, the courts cannot cope with the flow of people wishing to sue for insurance compensation and other disputes.

What to do if your insurance claim is denied

Law firms are often contacted by people who, for one reason or another, have been denied insurance benefits. The number of such situations increases from year to year and can be associated with a variety of cases.

Most often, car owners refuse to pay insurance, since they represent the bulk of policyholders in Russia. Problems also often arise with real estate: insurance companies find reasons not to pay insurance after fires or damage from neighbors. Problems with medical insurance arise least often in the Russian Federation, largely due to their low popularity.

What to do if your insurance claim is denied?

In any case, anyone who decides to insure their health or property should understand that sooner or later it may be necessary to contact a lawyer about insurance payments and recover funds through the court.

This is not due to the fact that they do not pay insurance on principle or because of the desire to cause harm to a specific person. The reluctance of insurance companies to part with their funds is quite natural. Especially when it comes to the possibility of legal refusal and controversial cases.

If your insurance claim is denied or reimbursement is illegally delayed, you should immediately contact insurance lawyers. At the first consultation, they will assess your chances of success in obtaining compensation. Don’t think that it’s impossible to win a case against an insurance company. In practice, such cases are far from uncommon. It all depends on the specifics of the situation and the real causes of the damage.

Insurance payment was denied: legal grounds

During the investigation of many cases, it becomes clear that the client was denied insurance payment under MTPL and CASCO on legal grounds. He just didn’t know some of the legal subtleties and decided that they wanted to deceive him.

If the insurance company does not pay according to the law, then it is impossible to receive compensation. Such cases include:

• the insured event was reported to the insurance company when it can no longer pay compensation;
• no measures were taken to reduce the loss, and these measures would not threaten either human health or the condition of property;
• the property was damaged with the deliberate purpose of obtaining payments from the insurance company;
• the owner showed gross negligence, which led to an insured event;
• payment for damage in case of natural disasters, natural disasters, or military actions is not made, unless otherwise specified in the contract with the insurance company (sometimes insurance is paid for fallen trees and other damage from nature);
• It is impossible to determine the fact of an insured event and the amount of damage due to troubleshooting before an independent examination and recording of damage (if the examination was carried out before repairs, it is valid).

Despite the existence of well-defined legal grounds for refusal to pay, a competent insurance claims lawyer can help you obtain insurance in the most difficult and ambiguous situations. Everything is determined by his experience, literacy and ability to operate legislative norms in the right direction.

Before obtaining insurance, you must carefully study the contract with the insurance company. If there are gross legislative errors in it, it is declared invalid, and it is much easier for the specialist to proceed further.

How does an insurance claims lawyer work?

If your insurance claim is denied illegally, you can obtain insurance without lengthy proceedings. You just need to get a written justification for the refusal from the insurance company and go with it to a lawyer.

An insurance claims lawyer determines whether the company has a legitimate reason not to pay, writes a claim, and sends it to the insurer. If the claim is ignored (there is no response within 10 business days), you can file a lawsuit.

Even if the first court hearing is lost, you can appeal to higher authorities. If there are strong arguments in favor of the client, an experienced lawyer will be able to recover the required amount from the insurance company. The sooner you turn to lawyers in any controversial situations, the greater the chances of successfully resolving the conflict situation.

How does the court proceed when a payment is refused?

On the appointed day and time specified in the summons, you come to the court, to the office also specified in the summons. Don't be surprised if you're the only one in court. Often the insurance company ignores attending court, although it depends on the insurance company (for example, representatives of Rosgosstrakh often come to court).

However, most likely, the insurance company will file objections as well as motions in court. They may contain:

• a request to conduct a forensic examination with an objection either to the existence of the fact of an accident or to the amount indicated in the examination report,
• objection regarding the guilt of the second participant in the accident.

Most often, the court grants requests for an examination. But what’s even worse is that it’s paid. It is initiated by the insurance company, but subsequently the costs fall on the losing party. If the amount of the claim is reduced as a result of a forensic examination, for example, by 25%, then 25% of the payment for the examination itself will fall on the plaintiff - that is, on you, and 75% - on the insurance company.

There is just one subtlety - the cost of a forensic examination, as a rule, greatly exceeds the prices of independent appraisers. On average, a forensic examination costs from 20 to 50 thousand rubles.

What questions will I be asked?

By the way, you don’t have to come to court at all, but this slightly increases the chances of getting your claim rejected under compulsory motor third party liability insurance. Therefore, it is better to attend the trial.

You may be asked for the following information:

1. tell the circumstances of the accident,
2. could you have prevented the accident,
3. about the nature of the accident and damage.

Don’t worry, the judge is unlikely to “load” you, but he needs to find out all the circumstances of the case about the insurance refusal, so it is important to tell the truth, concisely, but without missing important facts.

If a forensic examination is ordered

Alas, but then you will have to wait again. The case will be postponed and a forensic examination (traceological or conventional) will be ordered. According to the law, the decision on its implementation comes into force only after 15 days. Therefore, only after this period will movement on the issue begin.

An expert will contact you and ask you to drive to the specified address, or he will come himself if the car is not moving. If you have already repaired or sold the car, then the examination will be carried out using photographs. It will be better if you save electronic versions of the photos. It’s even better if the car still hasn’t been repaired. Otherwise, the expert may point out the impossibility of determining the fact that the damage was received as a result of this particular accident, and the court may refuse the claim.

After the examination, the amount of payment will be decided. Yes, now we have bad news for you! Most likely, the judge will reduce the amount of the fine and penalty. Article 333 of the Civil Code of the Russian Federation gives him the basis to do this. It happens that the size of the penalty is reduced tens of times.

What to do if your claim is denied

To begin with, let us clarify that even the expiration of the application period is not a sufficient basis for a complete refusal of all due payments. The main thing in such a situation is to prove that the insurer was notified of the accident or to indicate that, according to paragraph 2 of Article 961 of the Civil Code of the Russian Federation, untimely filing cannot become a reason for rejecting the application.

If the insurer nevertheless used an illegal basis as the main reason for the refusal, then the driver should initiate legal proceedings. Let's look at this process in more detail.

Receiving documents on refusal

You should go to court on the basis of refusal documents from the insurer - a notice of refusal to pay under compulsory motor liability insurance with justification of the reasons for the refusal. The driver must independently contact the Investigative Committee to request the issuance of such a document.

Quite often, the entire procedure stops at this stage - in most situations, the insurance company knows that it is acting illegally and makes a payment after requiring a written notice.

Appeal to the Central Bank and RSA

Having received a notification and discovered a serious and obvious violation of his rights, the driver must contact the responsible authorities, which are the RSA and the Central Bank. Perhaps the issue will be resolved at this stage.

It is recommended to contact the Central Bank directly. The complaint can be filled out on a standard form provided specifically for such a situation. You should describe as accurately and competently as possible what rights were violated, and also attach all available evidence and the notification previously received.

Pre-trial claim

If the refusal was issued for a less obvious violation, then the case will be considered by the court. In this case, the claim cannot be filed immediately - the law requires a pre-trial procedure.

To initiate it, the driver must file a complaint with the insurance company with the appropriate claim. Additionally, it must indicate:

• valid contact details;
• insurance contract number;
• details for transferring the required funds.

There is no established template for a claim, but an approximate sequence for its preparation can still be drawn up:

• a detailed analysis of the fact of violation of legal rights indicating the relevant legislative acts;
• justification for the payment required from the insured amount (to determine it, the driver must conduct an independent examination - all costs will be reimbursed if the case is won);
• a description of the driver’s further actions that will be taken if the requirements are not met;
• specific time frame within which the insurance company must review the claim and make its decision.

The need to attempt a pre-trial settlement of the issue is explained simply - the driver must have confirmation that he tried to contact the Investigative Committee and was refused. The fact that all attempts to obtain payment without going to court have been futile will have a significant impact.

The pre-trial procedure is considered completed after the Investigative Committee refuses to pay or does not respond to the request within 30 days. You can go to court immediately after meeting these conditions.

Filing a claim

The choice of a specific authority depends entirely on the amount the victim is claiming:

• damage up to 50,000 rubles – the claim is filed in the magistrate’s court;
• damage exceeding 50,000 rubles - the claim is filed in the district court.

During the trial, the driver may qualify for the following types of payments in addition to the standard compensation that he was initially entitled to:

• penalty;
• additional payment for violation of the law by employees of the insurance company.

In order for the claim to be drawn up as correctly as possible, it is necessary to use the services of a competent, trusted lawyer. When submitting an application, the following documents will be required:

• certificate of accident;
• documents issued by traffic police officers;
• MTPL policy from the culprit;
• an application to the insurance company with a note that it was accepted;
• vehicle assessment data after the incident;
• a document containing an assessment of the damage received.

The completed set will be attached to the main application. If the first court refuses to comply with the driver’s demands, then you should contact the authorities at a higher level. As practice shows, appeals are satisfied quite often.

If a decision is made in favor of the victim, the court will issue a sheet, upon presentation of which to the bailiffs or the bank you can receive the due compensation.

The lawsuits have been won - what to do next?

When your claims are satisfied, the insurance company will be obliged to transfer the amount specified in the decision to your account. But all this after the court decision entered into legal force, of course. To do this, the court issues a writ of execution, which is sent directly to the insurance company.

If the insurance company does not pay for it for a long time, then the writ of execution is sent to the bailiffs, and they can already write off the necessary amount from the defendant’s accounts in your favor.

Judicial practice regarding insurance refusals

The most convenient way to familiarize yourself with the full judicial practice in civil cases on issues where the insurance company has refused to pay and repair is on the website of Judicial and regulatory acts of the Russian Federation. Go to the page of litigation regarding insurance refusals.

There is a convenient filter where you can select applicable laws and articles or clauses of laws, or use the search to find solutions similar to your insurance refusal.

You can also search for the judge's last name to find his specific court decisions. You will find out the name of the judge at the step after submitting the statement of claim to the court.

Here are examples of several court decisions on insurance company refusals:

• refusal to satisfy a claim against the insurance company due to lack of evidence of an accident,
• a significant reduction in the insurance payment by the judge in the form of penalties and fines, and one more thing,
• Satisfaction of a claim regarding the insurance company's refusal to pay.

Wrongful refusal to pay insurance

If you weren’t able to receive compensation under compulsory motor liability insurance, then you need to know what to do. There are many reasons for refusals to pay insurance compensation, and sometimes the insurance company’s arguments are completely unfounded. Often an insurance company takes unlawful actions due to lack of profit, trying to protect itself from payments and preserve its capital.

But when the insurance company refuses to pay, and there are no specific reasons, then it is necessary to go to court. But sometimes the insurance company refuses to pay by blaming its client, so it’s good to know in which cases their actions are legal and in which cases there is a clear violation.