When does the insurance company compensate for damage?
The occurrence of an insured event within the framework of the law entails an obligation for the insurer to compensate for the costs incurred or the loss caused. This is precisely the meaning of compulsory motor third party liability insurance. So, according to Article 1 of Federal Law No. 40, the insurance company of the person responsible for the accident compensates for damage to a third party who was injured during the road accident.
If the policyholder was the victim of an accident, the costs of repairing his vehicle will also be covered by his insurance company.
Then the funds spent on car repairs will be recovered from the insurer of the person responsible for the accident. Thus, in almost any situation, policy owners are confident that losses incurred during an accident will be compensated based on the terms of the insurance contract.
What to do when CASCO does not cover damage?
If CASCO does not cover damage from an accident, the situation is easily resolved. With such insurance, the car owner practically does not worry about damage to the vehicle, so companies rarely underestimate the amounts paid. When there are not enough funds sent, you should boldly go to the nearest office and receive the difference.
What should the culprit of an accident do if insurance does not cover the damage? The maximum payments under CASCO reach 400 thousand rubles , so a lack of funds rarely appears. Moreover, representatives do not like to argue with demands, since, based on the legislation of the Russian Federation, a court decision in any case will have to transfer money to the car owner, as well as pay a fine in the amount of 50% of the payment.
What should the culprit of an accident do if compulsory motor insurance does not cover the damage? Use the services of a lawyer who can tell you how to draw up demands and file a claim. As a result, the person will definitely receive the necessary amount and repair the car.
Cases when the insurance company does not compensate for damage under compulsory motor liability insurance
By virtue of Article 12 of Federal Law No. 40, the policyholder has the right to expect compensation for losses incurred within the limit determined by Article 7 of Federal Law No. 40, that is, no more than 400 thousand rubles when restoring a car and 500 thousand when compensating for damage to health. However, in a number of cases the insurer has the right to refuse payment, in particular:
- if the repair or disposal of the car was carried out before the inspection of the damaged property by the insurer;
- if the policyholder or the victim did not provide a complete package of documents;
- if, based on the results of an independent technical examination, it is impossible to determine the amount of damages;
- if the policyholder has not fully fulfilled the terms of the contract upon the occurrence of an insured event.
Important! Regardless of the number of victims, the insurance payment is made jointly and severally within the limit. That is, if 4 people were injured in an accident, a payment of 500 thousand will be divided between them.
What to do when OSAGO does not cover damage?
If MTPL does not cover repair costs, you should not immediately think about personal investments. Even if you want to quickly restore your own vehicle, there are obligations that the other party must fulfill. Judicial practice shows that in recent years litigation has occurred frequently, and people have managed to get a positive decision.
What do I need to do?
- Independent examination;
- Drawing up a request for payment;
- Filing a claim in case of refusal.
If your insurance does not cover the damage in an accident, you should not give up. There are proven methods that tell you what to do if there is no payment under compulsory motor liability insurance. In such cases, a number of actions will be required that should be considered in detail. After which you will be able to draw the necessary conclusions, saving yourself from trouble.
Independent examination
An expert assessment of damage by the company is carried out in the same company. At this stage, there is deception and forgery of results, so the driver should contact a third-party agency. After all the necessary checks have been carried out, final conclusions will be made, which, in accordance with the legislation of the Russian Federation, have legal force. They will become evidence that plays a major role in court. So getting them is a top priority for the car owner. Moreover, it is necessary to notify the insurer about the implementation of these actions.
Making a request for payment
Next, the lawyer will help you draw up a demand for payment in full. It must be submitted to the nearest branch, as well as in writing to the company management. This will allow you to give official progress to your actions and give the other party the opportunity to sign a settlement agreement. Professionals correctly indicate the main nuances, so a trial after this stage is usually not required. No one wants to aggravate the situation by spoiling their reputation, although the solution does not always come so simply. Sogaz makes payments under compulsory motor liability insurance quickly, but it is almost impossible to refute them.
Filing a claim in case of refusal
In case of refusal, you should collect a package of documents and file a claim in court. The trial will begin as soon as possible, since the main data for its conduct is an independent assessment of damage in an accident. These conclusions should be based on in order to obtain a positive decision. It will oblige the insurance company to transfer the full amount of damage to the driver’s account so that he can restore his own vehicle.
Why does the insurance company not fully compensate for the damage?
Repairing a car in some situations requires huge costs, which are not comparable to the cost of a new car of the same brand, which is why a technical examination is carried out. In this case, the expert must also determine the scope of repair work, and the insurer, in accordance with the Regulations on a Unified Methodology, must approve the amount of expenses taking into account the wear of damaged parts and issue a referral to a service station in the manner specified in clause 15.1 of Article 12 of Federal Law No. 40.
However, in pursuance of this norm, service station employees do not have the right to install used parts and assemblies, which of course affects the total amount of repair costs. Thus, even if restoration is carried out within the limit or less, the insurance company compensates for damage only within the amount approved on the basis of a technical examination. The difference between the invoice issued by the service station and the insurance amount will be paid at the expense of the policyholder.
The insurance company underestimated the amount of compensation
If the amount of insurance compensation does not cover your repair costs as a result of the insurance company underestimating the amount of compensation, we recommend that you adhere to the following algorithm.
Step 1. Obtain from the insurer a copy of the insured event report
When considering the victim's application for insurance compensation, the insurer is obliged to draw up a report on the insured event. It describes the insured event (road accident), indicates its consequences, the amount of damage and insurance compensation, and also provides the calculation of insurance compensation (clause 4.22 of the OSAGO rules, approved by the Bank of Russia on September 19, 2014 N 431-P).
The insurer is obliged to issue a report upon your written request within three calendar days, excluding non-working holidays, from the date of receipt of this request - upon receipt of the claim after drawing up the report on the insured event or from the date of drawing up the report on the insured event - upon receipt of the claim before drawing up the report about an insured event (clause 4.23 of the OSAGO Rules).
Step 2. Check that the insurer's calculation is correct
The correctness of the calculation can be estimated approximately using reference books on the website of the Russian Union of Auto Insurers. If prices are too low, then the calculation of the amount of insurance compensation is incorrect (Article 12.1 of Law No. 40-FZ; Clause 39 of the Resolution of the Plenum of the Supreme Court of the Russian Federation dated December 26, 2017 No. 58).
Such verification is preliminary and does not replace expert research. But on its basis, you can form an initial idea of the prospect of a dispute with the insurer, without incurring additional costs.
Note!
If the accident was registered without the participation of police officers, the insurer will compensate for damage only up to 100,000 rubles.
In the event of an accident in the territories of Moscow, St. Petersburg, the Moscow or Leningrad region, as well as the absence of disagreements among the participants about the circumstances of the accident and (or) the nature and list of visible damage to vehicles, compensation is limited to 400,000 rubles. In this case, data on road accidents must be recorded using technical control means that ensure that information about road accidents is received in an uncorrected form based on the GLONASS signal, or using software that meets the established requirements, and transferred to the automated information system of compulsory insurance (clause 4, 5, 8, Article 11.1 of Law No. 40-FZ).
If the insurer's calculations were incorrect or you do not want to check the accuracy of the insurer's calculations, proceed to the next step.
Step 3. Obtain documentary evidence of the amount of damage
In the event of a lawsuit with the insurer, evidence of the amount of damage and the cost of restoring the vehicle will only be the conclusion obtained based on the results of an independent technical examination. Such an examination is carried out by an expert technician entered by the Ministry of Justice of Russia into the state register of expert technicians, in accordance with the Unified Methodology and using electronic databases of cost information (directories) approved by RSA (Article 12.1 of Law No. 40-FZ; Clause 7.4 of the Unified Methodology ).
To obtain this document, you must contact an expert technician or an organization that has expert technicians on staff and enter into an agreement to conduct an independent technical examination.
The register of technical experts is posted on the official website of the Russian Ministry of Justice. The cost of the examination usually depends on its complexity and the value of the damaged property.
Step 4. Contact your insurer with a written claim.
In this situation, it is necessary to follow the pre-trial procedure for resolving the dispute and contact the insurer with a claim. If this is not done, the court will return the statement of claim (Article 16.1 of Law No. 40-FZ; Article 135 of the Code of Civil Procedure of the Russian Federation).
Based on the results of consideration of the claim, the insurer will pay you or refuse to satisfy your claim (clause 5.2 of the MTPL Rules).
In case of refusal or failure to receive a response from the insurer within ten calendar days, with the exception of non-working holidays, you can go to court (paragraph 2, paragraph 1, article 16.1 of Law N 40-FZ).
Note. The specified ten-day period for consideration by the insurer of the victim’s claim is subject to application to the relationship between the insurer and the victim that arose in connection with an accident that occurred after 07/04/2016 (clause 4 of article 3 of the law of June 23, 2016 N 214-FZ).
Step 5. Prepare a statement of claim and present it to court
In the statement of claim, you can make demands for recovery (clause 21 of article 12, clause 6 of article 16.1 of law N 40-FZ):
1) the difference between the amount of damage (according to the conclusion of an independent examination) and the amount of insurance compensation received;
2) penalties for violating the deadline for payment of the specified difference - 1% of the difference in payment for each day of delay, but not more than the maximum limit of the insured amount, and/or financial sanction for violating the deadline for sending a reasoned refusal of insurance compensation - 0.05% of the maximum the limit of insurance compensation for each day of delay if the insurer violated the deadline for sending you a written refusal.
As a rule, the minimum set of documents attached to the statement of claim are:
1) copies of documents confirming the submission of a claim to the insurer;
2) copies of documents confirming ownership of the vehicle;
3) copies of documents about road accidents issued by the traffic police;
4) a copy of the insured event report;
5) a copy of the conclusion of an independent technical examination;
6) a copy of the statement of claim and the documents attached to it for the insurer.
You can submit a statement of claim and the documents attached to it at the location of the insurer (its branch or representative office), or at the place of your residence or stay, or at the place of conclusion or execution of the insurance contract (Clause 2, Article 16.1 of Law No. 40-FZ; clause 2 of article 17 of the law of 02/07/1992 N 2300-1).
If the cost of the claim is no more than 1 million rubles, you are exempt from paying the state duty (clause 4, clause 2, article 333.36 of the Tax Code of the Russian Federation; clause 2, article 16.1 of Law No. 40-FZ).
If claims of a property nature are made and the price of the claim does not exceed 50,000 rubles, then the claim is submitted to a magistrate (Article 23 of the Code of Civil Procedure of the Russian Federation).
If the cost of the claim exceeds RUB 50,000. or if you also make demands of a non-property nature (for example, to establish the degree of fault in an accident), then the claim should be filed in the district court (Article 24 of the Code of Civil Procedure of the Russian Federation).
If the court satisfies the claims of the plaintiff, which were not satisfied by the defendant voluntarily, the court collects from the defendant in favor of the plaintiff a fine in the amount of 50% of the difference between the amount of the insurance payment determined by the court for collection and the amount of the insurance payment made by the insurer voluntarily (clause 3 Article 16.1 of Law N 40-FZ).
The insurance company demands compensation for damages under compulsory motor liability insurance.
By virtue of Article 14 of Federal Law No. 40, the insurer that has made compensation charges in relation to its client recognized as a victim in an accident receives the right to claim recourse against the culprit of the accident or his insurance company.
Thus, the insurer of the victim may demand compensation for expenses incurred if:
- the harm was caused intentionally;
- the driver was intoxicated;
- the person driving the car did not have a driver’s license or was not included in the contract;
- the person responsible for the accident fled the scene;
- the car was scrapped or sent for repairs before inspection by insurers and technical expertise.
Important! When calculating the cost of an insured event, the amount of losses includes not only the costs of repairs, but also the costs of conducting a technical examination, as well as other costs incurred in the course of fulfilling the terms of the insurance contract.
Does the insurance company compensate the person at fault for the accident?
Drivers found guilty of an accident almost always face a situation where the insurance company demands compensation for damage. However, the company does not always have the right to claim recourse payments. So, if an accident occurred as a result of the failure of one of the units after a technical inspection that confirmed the complete serviceability of the vehicle, the operator who issued the diagnostic card is held liable.
If the driver causes a traffic accident due to traffic violations or due to inattention or due to intoxication, the insurer will not compensate him for the damage. In such a situation, the insurer, on the contrary, has the right to deduct from the culprit the costs incurred in paying compensation to the victim and his insurance company.
