Has there been an insured event? Insurance companies often try to save money on their clients. And refusal to pay insurance to an individual is not always justified. A person is faced with a one-on-one problem: how to receive his legal insurance payments and what to do if the insurance company does not pay for CASCO?
The main ways to evade paying insurance premiums
Insurance companies usually choose the tactic of ignoring. They often do not respond to phone calls or letters, deliberately delaying all reasonable deadlines. The insurance company violates the legislation of the Russian Federation. And we need to respond to this immediately. Managers of insurance organizations evaluate the client, and they can refuse, hoping for the incompetence of the insured person. A person who does not know the laws and his rights easily falls for tricks of this nature. Carefully read the terms of the insurance contract, which often stipulate hidden fees and interest. To protect yourself from unscrupulous insurers, intuition alone will not be enough. You will need a competent, professional lawyer who will tell you about all the pitfalls.
If payments are unavoidable, the insurance company may try to artificially lower them. Therefore, an examination conducted at the initiative of the injured person will not be superfluous. If the case ends in litigation, the court will collect all of your legal costs from the defendant (insurance company). In court, it is quite difficult to prove the involvement of an insurance company in illegal non-payment of insurance premiums. But as judicial practice shows, the truth is still for the most part on the side of the plaintiff.
How to avoid rejection from an insurance company?
To receive insurance payments, you must contact the insurer immediately. There is no need to delay and wait for managers to call you. This most likely won't happen. The period for consideration of an application for transfer of compensation for an insured event under CASCO is about thirty calendar days. Upon expiration of the period, the insurance company notifies by letter of the payment of funds or the refusal to pay insurance compensation. A correctly written application is one of the guarantees of success in insurance disputes. You need to collect as much documentation as possible and, if necessary, conduct an independent examination.
Do not hesitate to remind insurance company representatives about yourself. Request clarification on the progress of your application. Contact the company management if you see that attempts at dialogue with managers are not productive. Each insurance company values its name and reputation. Threaten legal action if you are still denied compensation.
Claim and judicial procedure for collecting funds from insurance organizations
If you believe that the refusal to pay funds under CASCO is unjustified, then you will have to comply with certain rules of pre-trial proceedings. In particular, you should write a letter of claim to the insurance company. Do not write a claim yourself if you are not confident in your legal knowledge. It is better to contact a lawyer or lawyer who will promptly draw up a competent claim, making it easier to protect your interests in judicial organizations. The claim is written in free form, indicating the main violations on the part of the insurance company. The letter must contain notification, that is, read and received by a representative of the company.
If, after a complaint, the organization does not meet you halfway, you should think about filing a claim to recover funds from the company under the social insurance contract. You can write a statement of claim yourself; fortunately, there are plenty of claim forms on the Internet. But in particularly difficult cases, lawyers advise not to save money and work with professionals. The statement of claim is submitted at the location of the insurance organization. The claim specifies all the circumstances of your problem; the claim itself is accompanied by an agreement for the provision of insurance services, examinations, and regulations. You will have to wait about two months for the case to be considered; if the decision is unsatisfactory, you can appeal the judge’s verdict on appeal.
Where else can you complain about an insurance company?
You can send your complaints about the actions of insurers to the prosecutor's office, Rospotrebnadzor, the commission for regulating the financial services market for the population, interregional unions for the protection of policyholders, or the Federal Insurance Supervision Service in Russia. Don't be afraid to defend your rights, act quickly. And only in this case will you be able to achieve your insurance payments.
According to the Federal Service for Financial Markets of Russia (FSFM) for the first half of 2012, among the leading 20 insurance companies in the Russian Federation, the share of refusals to pay CASCO payments ranged from 1 to 6%. But is the percentage of non-payments an absolutely objective indicator of the insurer’s disloyalty to its client?
As practice shows, some car owners, when taking out a CASCO policy, do not go into the details of the contract and do not read the insurance rules, believing that CASCO is property protection for absolutely all occasions.
Therefore, when the insurance company refuses to compensate for damage on the basis of a gross violation of insurance rules, and no legal proceedings even come close to helping to save the situation, this comes as a complete surprise to inattentive policyholders.
Meanwhile, the CASCO rules clearly list the circumstances in the presence of which the insurance company will have every right to refuse payment.
And, despite the fact that the list of exclusions from insurance coverage varies slightly among different insurers, there are several provisions common to all companies that are an indisputable reason not to pay under a CASCO policy.
Insurance companies do not compensate for damage under CASCO in the following cases:
- If it is proven that the car owner, passengers or drivers included in the policy intentionally caused damage to the vehicle. Actions when the policyholder did not take objective measures to preserve his car will also be considered intentional. For example, I left it at a construction site.
- If the car was driven under the influence of alcohol, drugs, toxic substances or under the influence of medications, which are not recommended to be taken before driving.
- If a person who was not included in the CASCO policy was driving at the time of the accident. Of course, this point does not apply to theft or theft.
- If the vehicle was rented or leased without informing the insurance company first, because the risks and CASCO tariffs for such categories of transport are somewhat different.
- If fire and technical safety rules were violated. For example, flammable objects or cargo were stored or transported in a car not intended for these purposes.
- If the car was not used for its intended purpose: for racing, driving lessons. CASCO insurance for such cars is significantly more expensive.
- If the car was transported as cargo.
- If the damage was caused as a result of a nuclear explosion, military action, any kind of civil unrest, or terrorist acts.
- If the property was damaged during confiscation or arrest by order of government authorities.
- If, after an insured event, it turns out that the car owner, when drawing up a CASCO contract, provided deliberately false information about the drivers allowed to drive or about the vehicle itself.
On our website we have repeatedly addressed the topic of failure of insurance companies (ICs) to fulfill their obligations to insured clients. In particular, we have already given examples of typical motivations for insurance companies who do not want to pay their own obligations.
It is possible that the insurance company did not refuse payments, but paid a clearly underestimated amount. In this case, you organize an independent examination and immediately proceed to step 3. In the claim, you demand to revise the amount (pay the missing amount), based on the assessment report, a copy of which is attached to the claim.
If the insurance company does not refuse to pay, but is delaying payments, again in the claim you demand to make payments, referring to the deadlines established by the Insurance Rules.
Next - according to the algorithm.
In any case - and at any stage of your fight for rights - you may need the help of a qualified and experienced lawyer. And the specialists of Moscow Auto Lawyers are always ready to provide it to you.
CASCO is a voluntary type of insurance. This means that the owner of the vehicle decides whether to enter into such an agreement or not.
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Many insurance companies today offer their clients a variety of programs, which differ not only in terms of registration, but also in the list of insurance cases when the car owner can receive insurance compensation.
For example, many insurance companies only insure a vehicle against theft. This means that if the car was damaged in other ways, its owner will not be able to receive compensation, and the insurance company will refuse to pay.
All insured events, upon the occurrence of which the owner of the vehicle can count on receiving insurance compensation, are specified in the contract concluded with the insurance company.
In practice, there are very often cases when an insurance company refuses to pay for CASCO insurance. What should be done in such situations, and what should be taken into account?
Possible reasons for refusal to pay
In practice, most often, insurance companies refuse to make payments under CASCO insurance if the policyholder has committed any violations.
In this case, the policyholder may violate both mandatory legal requirements and the conditions specified in the insurance contract.
Applicants also very often receive a refusal in cases where a particular case is not specified in the contract as an insurance case and is an exception.
The insurance company's refusal can be either legal or illegal. The most common reasons for legal refusal include:
- the policy has expired or is invalid;
- violation of the deadlines provided for in the contract for submitting an application in order to receive insurance compensation;
- provision of false documents about the occurrence of an insured event;
- driving a vehicle by a person not specified in the insurance contract;
- providing incorrect or incomplete accident data;
- vehicle malfunction during an accident, etc.
These are the main cases when insurance companies refuse to pay. In practice, very often vehicle owners cannot receive insurance compensation due to the bankruptcy of the insurer.
After this, you need to wait for a response from the insurance company. As a rule, insurers respond to such applications within 3-10 days from the date of their receipt (the application can be sent by registered mail with notification of receipt: in this case, the applicant will know exactly when the insurer received his letter).
If the insurance company refuses to pay for the second time, then in this case you need to resort to other authorities. Many people mistakenly write applications to the RSA. But this body is authorized to solve only problems related to.
In case of disputes related to CASCO insurance, you must contact the Central Bank of the Russian Federation. In practice, many disputes are resolved by this body. But the applicant must submit all documents for consideration.
After this, the Central Bank demands clarification from the insurance company and obliges it to reconsider its decision.
If submitting an application to the Central Bank does not produce results, then it is necessary to go to court.
Procedure
If, after submitting an application, the policyholder receives a refusal from the insurance company, he should carefully read this document and find out the reasons for the refusal.
To do this, you will also need to study the insurance contract. If the policyholder believes that the insurance company’s refusal is unlawful, he can try to resolve the dispute out of court.
In this case, a clause may be included in the contract, according to which pre-trial settlement of the dispute is mandatory. In this case, the policyholder must make a written claim.
If the answer from the insurance company is again negative, you can safely proceed to drawing up a statement of claim.
A claim is a procedural document that must be drawn up in accordance with certain legal requirements. In particular, it must be presented to the court at the location of the defendant.
In addition, it must contain the following information:
- data of the parties to the proceedings;
- the name of the court to which the claim is filed;
- plaintiff's claims;
- facts that support these claims;
- reference to the relevant legislative acts, as well as to the clauses of the CASCO insurance contract.
The statement of claim must be accompanied by documents that prove the plaintiff is right. It is also necessary to pay the amount of the state fee and present to the court a receipt for its payment.
If the claim has been drawn up in accordance with all legal requirements, the court will accept it for consideration and schedule a hearing.
As a rule, in such cases several court hearings are scheduled, and only after that a final decision is made. But it can also be appealed to a higher court, which delays the process.
If the lawsuit is won and the decision is made in favor of the applicant, then he can receive the amount of insurance compensation.
And if the insurance company refuses to pay even in this case, the policyholder can request a writ of execution from the court and receive the money forcibly.
In fact, this procedure is quite complex and lengthy, and many prefer to seek the help of qualified and experienced lawyers. After all, without the appropriate legal education, it is difficult to succeed in court.
How to make a claim
If the contract contains a clause requiring pre-trial settlement of the dispute, the policyholder must first draw up a claim and present it to the insurer: only after receiving his response can a statement of claim be drawn up and submitted to the court.
If there is no such provision in the contract, then you can safely file a claim. Although in practice, many people prefer to file a claim first, because the trial can drag on for quite a long time.
The legislation does not establish a single form of claim: it can be drawn up in any form.
But it should contain the following information:
- data of the policyholder (full name, address, etc.);
- number and date of conclusion of the insurance contract;
- description of the insured event;
- date of application for insurance compensation;
- date of receipt of refusal;
- reasons for disagreement with the insurance company’s refusal;
- reference to relevant legislative acts and clauses of the insurance contract.
You can attach documents to the claim that substantiate the policyholder’s claims. It must be sent by registered mail with acknowledgment of receipt or delivered directly to the insurance company's office.
In the latter case, the employee must make a note about receipt of the claim on its second copy, which remains with the policyholder.
Below is a sample claim.
Non-payment for theft
According to legislative changes that came into force back in 2012, insurance companies are required to make payments under a CASCO policy in case of vehicle theft.
This is a mandatory legal requirement and the terms of the CASCO agreement do not have any significance.
But even in such a situation, the policyholder must present documents that substantiate his claims. As evidence, for example, you can present a decision of an authorized body to initiate a criminal case.
It is also necessary to remember that the application for insurance compensation must be submitted within the time limits specified in the insurance contract.
If for some reason the policyholder does not submit an application on time, he may lose the opportunity to receive insurance compensation.
In practice, there are cases when insurance companies refuse to make payments when a car is stolen.
If the policyholder has complied with all the mandatory terms of the contract, he can appeal the actions of the insurance company in court.
CASCO insurance includes insurance against risks, damage, and theft of a vehicle. When purchasing an Autocasco policy, you need to know in what cases you can rely on it and what CASCO insures against.
What will CASCO protect you from?
There is a certain list of cases for which the CASCO policy insures
*Traffic accident
* Theft or theft of a vehicle
* If parts or certain units of your vehicle are stolen
* Intentionally caused harm
* Fire. Spontaneous combustion, lightning strike, natural disaster
* Falling objects that could cause damage to the vehicle
When concluding a contract - read!
When receiving insurance services, sometimes we have to “bite our elbows” because when signing a contract we are more interested in the cost of the policy itself and not in the nuances specified in the contract, which may not turn out to be the most profitable way. It is possible that you will be paid much less than you expected or not paid at all. Or you will have to wait quite a long time for this payment. All these nuances are indicated in the contract, which needs to be studied in detail.
Insurers agree that clients have problems obtaining insurance mainly due to their inattention when signing the contract.
Often, those points with which you may not agree may be on the reverse side of the contract, or insurers simply will not inform you of dubious points.
Nuances worth paying attention to
Due attention should be paid to the wording in the insurance contract that deals with theft.
The term "theft" has several meanings. The first is used in the interpretation of criminal law; it can be safely formalized, since this concept of theft is very broad, and it covers all possible insurance cases. The second has a different meaning, a narrower one, in which a lot of nuances will be indicated in favor of the insurance company; these nuances can significantly limit you in a possible insured event. When signing such an agreement, the policyholder should think twice.
You can often find a clause that says that CASCO can be valid if your car was stolen at night (from 18:00 to 8:00), provided that your car was parked exclusively in a paid parking lot (the address must first be indicated) and with the alarm necessarily turned on, but if these conditions are not met, you will not be paid.
There are companies in which it is a mandatory clause in their contracts that insurance is paid only after the criminal case is closed.
Under such an agreement, payment may not be forthcoming due to a pre-specified clause in the agreement limiting the period of payment, because the duration of the legal process may be delayed.
To avoid such a situation, you need to carefully study the contract and discuss such nuances with the insurance agent. If it happens that the insurance contract has already been signed, the car is stolen, an investigation is underway, but there is no compensation, the client has the right to go to court and try to prove that the contract is invalid.
CASCO payments are almost never paid if the client was drunk at the time of the accident, under the influence of drugs or medications, or was not among the persons allowed to drive a car, if he did not have a driver’s license.
Also, payments are not made if the vehicle is seized by a court decision.
The insurance company must bear all costs if an insured event occurs with your property. It should be borne in mind that the insurance rules of not all insurance companies, for example, clearly indicate that the amount of insurance compensation includes the costs of towing a damaged car to the place of repair or parking, and in some - only after agreeing on the cost of evacuation with the insurance company or within a clearly stated amount.
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