In what cases is insurance paid under compulsory motor liability insurance?

What damage is the insurance company obliged to compensate under compulsory motor liability insurance and in what cases can it refuse?

Every citizen injured in an accident has the right to receive compensation for losses incurred. Then there is compulsory motor liability insurance. However, even this law does not protect victims in all situations.

Insurance case

The law states that insured events under compulsory motor liability insurance are cases when, as a result of the operation of transport, property damage or harm to human health or life was caused.

You can count on payment if the driver caused harm to someone else’s health, as well as the life of another person during the operation of the vehicle. Damage to someone else's property is again an insured event.

However, few people know that OSAGO covers any property damage, and not just damage to vehicles. Among other things, insured events include incidents resulting in damage to:

House or other buildings.
Fence or fence.
Road infrastructure facilities.
Personal belongings of citizens.

Property damage also includes cases of harm to domestic, agricultural or wild animals. In this case, the owner of the downed animal will receive payment only if the driver is found to be the culprit of the incident.

Who is guilty?

Compensation for damage under the MTPL agreement is possible if the culprit of the incident is identified. He must have valid insurance, otherwise the victim will be left without insurance compensation.

Responsibility for an accident can be assigned to the driver solely by government agencies, in particular the court or the traffic police. The decision of the authority must be documented.

If the culprit of the incident admits that he provoked the accident, then paperwork is allowed without the participation of a traffic police inspector. To settle a loss without certificates, a number of additional requirements must be met.

When does RSA pay?

The Association of Domestic Auto Insurers regulates relations between insurance companies within the framework of the MTPL system. RSA specialists are in charge of the compensation fund. It is from it that money is taken to compensate for damages for the obligations of insurance companies that have been deprived of their license.

If an insurer is about to go bankrupt and its license is taken away, RCA compensates for property damage caused by a client of such a company. In addition, the union of auto insurers is obliged to compensate for damage to the health or life of a victim in an accident when:

The incident was caused by an unidentified driver.
The culprit of the accident does not have a valid MTPL policy.

In this case, the maximum amount of compensation is set within the limits of the current insurance amounts. That is, the final payment to each victim is limited to the following values:

Half a million rubles – harm to life or health.
Four hundred thousand rubles – property damage.

Thus, it is possible to receive compensation even after the insurance company's license is revoked.

Damage to health is compensated in any case, in particular when the accident was caused by an unidentified person.

Additional expenses

Victims have the right to receive compensation for indirect costs associated with the insured event. In particular, the insurer is obliged to compensate the victim’s transportation expenses if it is not the vehicle that is damaged, but some other property.

Such expenses include payment for the delivery of damaged property and a team of repairmen to the site of restoration work and back. The insurance company is also obliged to pay for the delivery of spare parts and materials necessary for repairs.

If the vehicle is damaged, its owner can count on paying for a tow truck and parking. However, it is advisable to coordinate such expenses with the insurance company in advance, otherwise they are unlikely to be compensated on a voluntary basis.

If there are victims, the insurer is obliged to reimburse the costs of transporting them to a medical facility. Naturally, this may require evidence of the justification of such costs.

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When exactly will they refuse?

Insurers are almost always obliged to pay, because they have virtually no grounds for refusal. However, in some cases, the victim may still be reasonably denied payment. The insurance company will definitely not compensate for damage caused under the following circumstances.

Exposure to radiation, radioactive contamination, as well as a nuclear explosion.
Military operations, military maneuvers, exercises and other events.
Popular unrest, as well as civil war.
Impact of force majeure.
The intent of the victim.
Strike.

In addition, the insurer will refuse compensation if the damage was caused due to the use of vehicles in tests or competitions, as well as during driving training at specialized training grounds.

Regardless of the circumstances of the incident, lost profits and moral damage are not compensated. At the same time, damage to the vehicle of the person responsible for the accident or its trailer, as well as additional equipment, is not subject to compensation.

Also, the insurance company will certainly refuse to pay for the at-fault driver:

Losses to an enterprise as a result of harm to its employee.
Damage due to loading or unloading work.
Damage caused by the driver to the cargo he is transporting.
Environmental pollution.

Cases of damage that fall under other compulsory types of insurance deserve special attention.

The victim will be denied payment under the auto insurance policy if the damage received is subject to compensation under other compulsory insurance.

In particular, this rule applies when harm is caused to the following categories of persons:

Passengers of public transport, including automobiles.
Employees of enterprises in the process of performing work duties.
Any person due to exposure to transported cargo.

Finally, it should be noted that the insurer is guaranteed to refuse to pay for damage due to damage to the following property:

Antiques or unique items.
Historical monuments, including structures and buildings.
Products made of precious metals, semi-precious or precious stones.
Securities, as well as cash.
Religious items.
Works of art, scientific works, literature.
Intellectual property objects.

Insurers cannot refuse payment for reasons other than those stated above. If the insurance company decides to break the law, a pre-trial claim should be sent to the insurer. Only after this does the car owner have the right to file a lawsuit or contact a financial ombudsman.

In what cases is compulsory motor liability insurance paid?

In case of an accident, compulsory motor liability insurance is paid if there are legal grounds for it, damage to the vehicle or harm to the health (life) of those involved in the accident. At the same time, policyholders are often interested in what to do to receive payments, in what cases the company may refuse payments, and how to proceed to obtain insurance. We will consider these and other questions below.

What to do after an accident?

To prevent the insurance company from refusing to pay under compulsory motor liability insurance, it is important to behave correctly in the event of an accident. We adhere to these tips:

We leave the car in the same place. To avoid new collisions, we put up a warning triangle and turn on the corresponding light alarm on the car.
We call the police and ambulance workers (if there are victims) indicating the address of the accident.
While the inspector gets to the scene, we record information about the culprit. Ideally, you need to know the insurance policy number and the name of the insurer.
We are recording the phone numbers of eyewitnesses to the accident who can help clarify the situation.

We pay the most attention to the last point, because in 7 out of 10 cases it is witnesses who help prove the driver is right. To receive insurance payment in case of an accident under compulsory motor liability insurance, you need to contact company representatives and inform them about the current situation within up to 5 days.

If the policyholder did not manage to apply within the specified period, he will have to fill out an application and submit it along with documents confirming the validity of the delay. The following options are possible here - a certificate from a medical institution about being an inpatient or a certificate from the place of employment about a long business trip.

Another task of the insurance company client is to keep the car in the same condition that it received after the accident. This is necessary to assess the damage. If the car owner decides to cheat (deceive) the insurer, he may be left without compensation for damage.

Evaluation Rules

Immediately after the accident, the injured party applies to the insurer to cover the costs of repairs. Insurance company employees have five days from the date of receipt of the document to assess the condition of the vehicle and make a decision regarding the cost of repairing (restoring) the car.

The insurer's employees agree on the place and time for the assessment work. In this case, the vehicle owner is obliged to provide the car for inspection on the agreed day and time. If the car was severely damaged in an accident, and it is not possible to drive it for inspection, an expert will personally go to the parking lot of the damaged vehicle.

After the examination, the insurance representative announces the amount of compensation. If the parties are satisfied with it, the insurer transfers compensation. If mutual agreement cannot be reached, an independent expert will have to be involved.

If the insurer delays the assessment and does not carry it out within five days from the date of submission of the application from the policyholder, the latter has the right to go to an independent expert company to obtain an assessment of the damage. In this case, the organization will have to pay for the service from your own pocket.

If during the assessment of the consequences it is not possible to determine the cause of the accident, as well as the optimal amount of payments, the car of the guilty party may be required for a more detailed analysis. After completion of the work, the results of the inspection are drawn up in the form of a conclusion signed by a representative of the expert organization, the insurer and the owner of the car.

During the assessment process, special attention is paid to the level of wear of the vehicle of those elements that must be restored at the expense of the insurance company. It happens that appraisal company specialists show the price of components based on the cost of new parts. This approach is incorrect and is not used today.

Receipt and amounts of payments

To obtain compensation in the event of an accident, it is important to know the nuances of insurance legislation. In particular, the presence of a policy does not guarantee timely payment of compensation within the agreed time frame. To receive compensation, the policyholder must adhere to the above rules. In addition, in case of an accident, you need to call not only a traffic police officer, but also an employee of the insurance company. If this rule is ignored, insurance payment may be denied.

As for the amount of insurance payments, this figure increases every year, and in 2019 it is 400,000 rubles. for car repairs, as well as 500,000 rubles. for treatment or compensation in the event of the death of a person. These are maximum figures, and in practice they are rarely listed. The amount of compensation is calculated taking into account many factors - the market price of the car, type of damage, level of wear and so on. Let's consider the amount of payments for different situations.

If there are casualties

If people were injured in an accident, measures must be taken to transport the person to the hospital. It is important to take into account that the amount of payments in relation to the owner of the car depends on the level of damage to the car, and in the case of damage to health, on the degree of injuries received. The maximum insurance amount is paid if, after an accident, a person becomes disabled in the 1st group or the disability is acquired by a child . In case of receiving the 2nd or 3rd group, the bonus amount will be equal to 350 and 250 thousand rubles, respectively. If the sternum or skull is broken as a result of an accident, compensation will be 35 or 75 thousand rubles, respectively. The amount of each payment is calculated individually, taking into account the damage.

In case of death

If a person died as a result of an accident, the allotted half a million rubles is divided into two parts. 25,000 rubles are sent to the funeral, and another 475,000 to relatives.

Drunk driver driving

The traffic rules state that you cannot drive while intoxicated. Despite this, many car owners neglect the rule, drive on the road under the influence of alcohol and often get into accidents. If an inspector catches a driver in this state for the first time, he may limit himself to a fine, and for a repeated violation, a more severe punishment is imposed, including deprivation of rights and criminal liability.

The insurer fulfills its obligations regardless of the driver’s condition (even if he was under the influence of alcohol or drugs). The difference is that after making payments, the insurance company has the right to apply to a judicial authority to withhold the entire amount from the guilty party.

Features of payment calculation

Many car owners are confused about the rules for calculating payments under compulsory motor liability insurance. This task is really not an easy one, but it’s not difficult to figure out. During the calculation process, you need to take into account many aspects, including the condition of the vehicle, the level of wear of components and others. In this case, the calculation is made individually, taking into account the prevailing circumstances.

It is worth considering that the concept of wear does not apply to some vehicle elements. We are talking about paintwork, airbag cushions, parts subject to restoration, as well as repair and restoration activities. When calculating repair costs, a number of other factors are taken into account, including geographic location (driver's address).

To determine the cost of spare parts, you need to know the name of the component, its number and manufacturer. In addition, when calculating costs, it is important to consider whether the service station has the necessary equipment to perform complex work.

When is refusal possible?

Let's consider an equally important point - in what cases is insurance not paid in case of an accident . The driver and participants in the accident do not receive money under compulsory motor liability insurance if the situation that arises is not included in the list of insured events. This includes accidents that were intentional or occurred due to force majeure. Alternatively, a large branch may fall on the car due to a gust of wind, or the car may end up in water due to severe flooding of the street.

If the insurance company suspects that the policyholder deliberately damaged the car, it will not pay compensation. In addition, compensation is not paid in a number of cases:

The guilt of the participant in the incident was proven in the judicial body.
The accident was not registered by the traffic police inspector.
The driver of the wrecked car took part in races (including in special places).
The car was damaged due to military action or other force majeure situations (for example, natural disasters).
The vehicle is damaged by a foreign object while driving.

When does the driver make payments?

If the driver is at fault for the accident, he is forced to cover the damage himself. Of course, first the insurer gets involved, transfers the money, but later takes the money through the court. This is possible in the following circumstances:

The person driving was drunk or on drugs.
The driver is a violation of the rules and caused an accident.
There are no documents for the car.
A crime was committed in the car.

In conclusion, we note that according to the law, payments from insurers are made taking into account a number of requirements. As noted, the driver submits the application to the insurer within 5 days. In this case, the insurance company has 20 working days to transfer the full amount of compensation. In case of refusal, the document is drawn up in writing with an explanation of the reason. If the company has violated the 20-day term, a penalty of 1% of the insurance amount is charged for each day of delay.

Thus, to obtain insurance from the driver, several steps are required - notify the traffic police, ambulance (if required) and the insurer about the event, prepare the necessary papers, submit the application within 5 days and wait for compensation.

In what cases will insurance be paid or not paid under compulsory motor liability insurance?

The occurrence of an insured event does not guarantee payment of insurance compensation to all participants in the incident. In what cases is insurance not paid in case of an accident? The list of these situations is quite extensive.

The main thing to understand is that a compulsory insurance policy only protects the insured who is innocent of the incident. But he may also be deprived of insurance benefits for a number of reasons.

When is insurance paid?

The basic rule when insuring motor third party liability under MTPL is that the driver’s liability is insured, and not he or his vehicle. It turns out that under certain circumstances, only the person innocent of the accident receives insurance compensation. So, in what cases is compulsory motor liability insurance paid?

The driver hit a person, causing harm to health or life.
The vehicle was damaged in the accident.
Damage was caused to the health of people who were in the car during the road incident.
Property was damaged in an accident (for example, a fence was broken, a house was damaged, etc.).

In all these cases, the injured person must apply to the insurance company of the person responsible for the accident for compensation for damages. If it is not installed or does not have a policy, documents must be sent to RSA. If the accident is registered under the European Protocol, you can apply for payment from your insurer.

Insurance compensation to heirs

Serious road accidents can also cause casualties. According to the Federal Law “On Compulsory Motor Liability Insurance”, in these situations, insurance compensation is paid to persons for whom the deceased participant in the accident was the breadwinner. Children, husband/wife, parents, as well as persons who depended on the deceased have the right to receive compensation.

In addition to the insurance compensation itself, the relatives of the deceased can count on funeral payments, as well as financial assistance in connection with the loss of a breadwinner.

If previously only dependents of the policyholder received this type of payment, then from 04/01/2017 new amendments came into force. According to them, the insurance company of the person responsible for the accident must pay any of the family of the deceased a maximum of 500 thousand rubles (25 thousand for burial and 475 thousand for financial support of the family).

If the total damage exceeds the maximum amount established under OSAGO, then the missing part of the amount is recovered from the culprit of the incident. If the parties are unable to reach a consensus, then this happens through the court.

When the insurance company refuses to pay

In essence, car insurance is a way to reduce probable financial losses in case of unforeseen circumstances. But sometimes compensation for damage under compulsory motor liability insurance completely depends on the actions of the policyholders themselves. So, what should you avoid in order not to lose legitimate insurance compensation?

The culprit in the accident

As a general rule, only persons who are not at fault for an accident receive insurance compensation. However, in practice, sometimes very ambiguous situations arise. For example, if an incident involves not two, but more vehicles, and a particular driver is both the victim and the culprit. That is, another participant in the accident also committed a traffic violation against him. In this situation, payment is due not only to the injured party, but also to the guilty party. Most often, such cases are resolved in court.

If the perpetrator of a traffic accident dies, his relatives do not receive funeral payments. The only exceptions are situations where a pedestrian dies who caused an accident - his relatives receive payments under compulsory motor liability insurance. As practice shows, vehicle drivers are most often found guilty, despite how the collision actually occurred.

Another nuance. If it is impossible to establish the guilt of a specific driver insured under compulsory motor liability insurance, then the second participant cannot receive compensation. According to the Law on Compulsory Motor Liability Insurance, there must be a culprit in an accident, then there will be a victim. In order to defend his right to payment, the injured policyholder must order an additional examination. If this does not produce results, you must go to court. If the second participant is insured under CASCO, then carry out additional insurance. There is no need for an examination, the insurance company will compensate for the damage anyway.

If the fault in the incident is mutual, then the degree of guilt of each of the participants is determined in court. For example, when it turns out that the drivers are equally guilty, then each will receive only 50% of the actual amount of damage.

Lack of compulsory motor liability insurance policy

If there is no insurance, then there is no insurance company that is obliged to compensate the injured person for the damage. This is very unpleasant for the driver, but nothing can be done about it. The situation is similar if the harm-doer has a compulsory motor liability insurance policy in his hands, but it has expired. As in the first case, there is no insurer obligated to cover losses to the injured car owner.

Let's consider another situation. The owner of the car that was involved in the accident has insurance with a list of persons allowed to drive the car, but it does not include the name of the citizen who caused the accident. In this case, the injured driver has the right to receive insurance compensation, but then it will be claimed by the Insurance Company from the culprit.

The accident occurred abroad

Compulsory and voluntary insurance policies are valid only in the territory of the country in which they were received, that is, in Russia. When planning a foreign car trip, you must purchase a special policy - a Green Card. It is this that will allow you to receive insurance compensation in the event of an insured event abroad.

Incomplete package of documents

The insurer is obliged to pay the insured the due insurance premium only if the full package of documents is submitted in a timely manner. Therefore, as soon as you have a certificate of an accident in your hands (please note that since October 20, 2017 it has been canceled and you need to get another document to replace it), a decision to initiate or refuse to initiate a criminal case, immediately go to the Investigative Committee and fill out an application . You should attach all the documents you currently have. If necessary, the remaining papers can be delivered later. This way, you will not exceed the statutory deadline for submitting documents – 5 days.

If the accident is registered according to a simplified scheme, then the insured also has only 5 days to submit an application to the insurance company (to his company). Fortunately, when drawing up the Europrotocol, the injured person must only submit an application for payment and a notice drawn up and signed by both parties.

The vehicle was not provided for inspection

Clause 20 Art. 12 of the Federal Law “On Compulsory Motor Liability Insurance” allows insurers not to compensate for damage to policyholders who did not provide a damaged car for inspection at the agreed place and time.

If the policyholder did not do this, or restored the car before the damage was assessed, or disposed of it, then he has no right to count on insurance compensation.

Federal Law of April 25, 2002 N 40-FZ (as amended on July 26, 2017) “On compulsory civil liability insurance of vehicle owners”

Article 12. The procedure for making insurance compensation for harm caused to the victim

20. The insurer denies the victim insurance compensation or part thereof if the repair of damaged property or disposal of its remains, carried out before the inspection by the insurer and (or) an independent technical examination, independent examination (assessment) of the damaged property in accordance with the requirements of this article, does not allow reliably establish the existence of an insured event and the amount of losses subject to compensation under a compulsory insurance agreement.

On-site calculation

If the drivers agreed on the amount of compensation without involving traffic police officers, then in the future you cannot count on any money from the insurance company, even if it turns out that the amount received is not enough to fully restore the car. Firstly, you will not have documents about the incident. Secondly, you cannot receive money twice for the same case (first from the guilty party, then from the insurer).

The party transferring the money must obtain a receipt from the recipient confirming that the cash has been accepted and that there are no claims against him in the future, even if hidden defects are discovered in the car. In general, it is better not to resort to this method, since after some time the victim may contact the traffic police and report that you illegally left the scene of the accident.

Alcohol intoxication

If the culprit was drunk at the time of the collision, his insurance company will still pay the victim the compensation due, but will then require the culprit to compensate him. If the victim turns out to be drunk, then the situation is somewhat different. Firstly, this fact still needs to be proven.

Its reflection in a certificate of an accident based on the results of a “national examination” called “blow into a tube” is not enough. In order to refuse payment, the insurer must rely on the results of a medical examination.

Secondly, most often such cases are considered in court. It is there that the degree of guilt of each of the participants in the event is determined. If it is determined that the tortfeasor is 60% to blame, and the drunken victim is 40% at fault, then the first will be paid only 40% of the damage, and the second – 60%.

Fraudulent schemes

If during the trial the car owners are convicted of fraud, you can forget about any payments. If the insured who is innocent of the accident is confident in his integrity and believes that the insurance company is simply trying to evade its obligations, he must go to court and defend his right to insurance compensation.

Bankruptcy of the insurance company

Such cases are not at all uncommon in Russian reality. Therefore, before signing an insurance contract, make sure that the company is reliable. This is not difficult to do - there is publicly available information on the Internet regarding reliability ratings, financial solvency, percentage of insurance cases being considered in court, etc.

But if, nevertheless, an insured event occurred, and the insurance company declared itself bankrupt or was deprived of its license, you should prepare a package of documents and send it to the RSA. It is this organization that is responsible for the MTPL obligations of bankrupt companies.

This rule does not apply to CASCO insurance - receiving payment under a voluntary policy from RSA is much more problematic than under a mandatory one.

Availability of accident insurance

If persons injured in an accident have a CASCO policy that insures against road accidents in transport, the insurance company has the right to refuse compensation under compulsory motor liability insurance, since it is under accident insurance that the insured will receive payment.

Cases of recourse

Art. 14 of the Law “On Compulsory Motor Liability Insurance” allows the insurer to demand compensation for its losses from the culprit of the incident. That is, first the insurance company pays compensation in full to the injured person, and then issues a recourse claim against the culprit of the accident.

This is only possible in certain situations, namely when the culprit of the accident:

According to the medical report, he was drunk, under the influence of drugs or any other kind of intoxication.
Left the scene of the collision.
He had no legal right to drive a car.
Had intent to cause harm.
Did not provide a copy of the notification of the accident within 5 working days (if a European protocol was drawn up).
Did not provide your car for inspection within 15 days (holidays and calendar days are not taken into account), repair it, or dispose of it.
Not covered by insurance.
When issuing an electronic policy, OSAGO provided the insurer with knowingly false information.
Provoked an accident during a period that is not covered by insurance (if compulsory motor liability insurance is issued under the condition that the car was used during the period specified in the insurance agreement).
He drove a bus, a taxi, a truck and special vehicles intended for the transportation of dangerous goods whose diagnostic card had expired.

All other cases in which the insurance company tries to impose a recourse claim on the policyholder are considered illegal and can be appealed in court.

The procedure for insurance payment in case of an accident under compulsory motor liability insurance

There are more and more car owners every year, which affects the number of accidents. Fortunately, most people deal with only cosmetic damage to the car, but even minor repairs are quite expensive. If the accident was more severe, then the amount of losses becomes excessive. Therefore, drivers need to know in what cases MTPL insurance is paid.

This will allow you to defend your rights, because it is not profitable for insurance companies to inform clients about all the nuances.

Who is compensated for damage?

OSAGO policy is compulsory insurance for all cars. You cannot do without purchasing it, since any transport police officer will issue a fine when examining documents. This allows drivers to be taught to respect traffic rules responsibly.

Who is compensated for losses if an insured event occurs? Features of compensation for losses:

The main recipient is the victim. Moreover, if OSAGO was purchased before April 28, 2017, you can choose monetary compensation or car repair. After this date, the owner can only have the car repaired at a service station with which the insurance company has an agreement.
If the health of the injured party is damaged, then in addition to repair work, treatment is also paid. This clause applies to both motorists and pedestrians.
If the victim dies, compensation is paid to the family or beneficiary.
When the culprit of an accident dies, his relatives are not paid the insurance amount. They can only count on the help of the Russian Union of Auto Insurers (RUA), in the form of funds for burial.

These are standard cases in which the person responsible for the incident cannot claim compensation for damage. But there is a case when all participants in the accident can receive compensation: if they are found partially to blame for the accident, then insurance companies must compensate for damages in proportion to the degree of guilt.

In all other cases, the amount is paid only to the victims. But in order to receive funds, you need to know who should compensate for the damage.

Who pays MTPL insurance to the victim?

Once it becomes clear who can claim compensation for damage, it is important to find out from whom to claim it. The injured party (or its authorized representative) must collect all documents indicating the causes of the accident and who is at fault. If your health has been damaged, you need to apply for compensation from the insurance company that sold the compulsory motor liability insurance to the person responsible for the incident. It is she who considers the degree of damage caused and pays for it, without going beyond the limits established by law.

Who pays in case of an accident if the cars are insured:

If more than 2 cars were involved in the accident, then the insurance company of the culprit used to pay for the damage, but now the victims can turn to their own insurance companies. If it is not possible to determine the culprit on the spot or he refuses his responsibility, then additional examination and trial are required.
When it is determined in court that there are several culprits in an accident, their insurance companies compensate the claimed amounts in proportion to the degree of fault. Payments are handled by the victim's insurance company. She then sends a request for a refund to the culprit’s company.
When 2 or more cars are damaged, and there is only one culprit, the insurance company pays the amount of damage without exceeding the established limits. If the total damage claimed is greater than the limit amount, then a proportionality coefficient is calculated (limit/total damage). This is done to divide the limited funds among the victims in proportion to their losses. Car owners can receive the missing money only after a trial and directly from the culprit.
Your own insurance company pays for damages regardless of the cause of the accident if the victim has a CASCO policy. But after identifying the culprits, the insurer sends a request to the company that issued the compulsory motor liability insurance to the violator for reimbursement.

When you have decided who will pay the insurance, you need to find out about cases when the insurance company refuses responsibility for the actions of the driver.

In what cases will a victim be denied compensation?

There are a number of situations when the insurance company of the culprit refuses to pay the victims the declared amounts of damage. All these circumstances are considered standard and are written down in all auto insurance contracts.

The culprit does not have a policy

Although MTPL is a mandatory policy, some motorists break the law and drive without insurance. In this case, the victim has nowhere to file claims for compensation. To receive money, he needs to initiate an examination and demand compensation from the defendant in court.

But even if there is compulsory motor liability insurance, there is a possibility that the insurance company will refuse to pay. This may be motivated by the fact that the driver was a person who was not listed as a driver in the policy. Most often this happens when car owners want to save money and register only those who have more driving experience - this affects the cost of insurance. In this case, you also need to defend your claims in court.

Refusal of financial responsibility may provoke a violation if the person responsible for the incident did not have the right to drive.

Late submission of documents

According to the law, an insurance company may refuse to consider an application for insurance payment if it is not provided with documents on time. After an accident, you need to apply for funds as quickly as possible.

If the accident was registered according to the European Protocol - 5 calendar days (drivers filled out the accident form themselves, without involving the police). Such an agreement is valid only if there was no damage to health in the accident, and all participants in the accident agree on who is to blame for it.
If the accident was recorded by police officers - also 5 calendar days.

An application must be submitted as soon as documentary evidence of the accident appears. In this case, you do not need to provide the entire package of documents at once - it can be brought gradually. The main thing is that the date of contacting the company falls within the allotted time limit.

The car was not provided for inspection

Before paying out, the insurance company wants to make sure that the accident was real and not a scam. It is also important for her to understand that the stated amount is fair. Therefore, the car must be submitted to the insurer for assessment or an independent technical examination must be carried out, if he has not organized the assessment himself within 5 days.

Insurance will be denied in whole or in part:

When they refuse to provide a car for evaluation.
When the car was repaired before the assessment was carried out.
When a car or part of it was disposed of before the insurance company assessed its condition.

In this case, difficulties in obtaining money may arise, even if the examination was carried out in the manner prescribed by law. The company may delay payments due to the fact that its own appraisers did not draw up reports.

The motorist cannot choose the method of compensation; he only has access to repairs at the expense of the insurer. This can also cause refusal of payments if the car has already been repaired.

The participant in the accident was intoxicated

The insurance company refuses financial liability to the victims if it is established that the culprit of the incident was driving a vehicle under the influence of psychotropic substances. These include:

Alcohol (more than 0.16 ppm in exhaled air, and 0.35 ppm in a blood test).
Narcotic substances.
Medicines with effects similar to narcotic substances (strong painkillers, etc.), which affect cognitive abilities, the ability to adequately perceive and respond to situations that arise while driving a car.

All these conditions are considered unacceptable from the point of view of civil and criminal law. The company reimburses funds if the accident was unintentional. And in this situation, the person deliberately violated the traffic rules.

In this case, a preliminary conclusion about being intoxicated is not enough. After all, a portable device can only determine the approximate amount of alcohol in the blood, only from the exhaled air. Most often, if a breathalyzer detects an excess of the norm during an accident, a blood test and a medical examination are performed. Only with this document can the insurance company refuse the victim. At the same time, it is impossible for the culprit to be absent or disappear from the sight of law enforcement agencies. Any other reasons are considered unfounded.

Insurance company bankruptcy

If an insurance company is not managed properly, it may go out of business. It is in this case that the company does not pay the money. But it is important to understand that if the insured event occurred before the start of the bankruptcy procedure, and this procedure did not begin within the period allotted for payment of compensation, then the insurance company’s refusal of liability is illegal.

When a company has already gone bankrupt or is in the process of closing, the Russian Union of Auto Insurers assumes responsibility. It is to him that a request for compensation for damage should be sent. The procedure is the same as when contacting an insurer. If all steps are followed, the accident will be compensated.

If the Central Bank revoked for some reason the insurance company’s license to operate or service compulsory motor liability insurance, then the situation is similar to bankruptcy. Responsibility for valid policies lies with RSA.

Fake OSAGO

If the OSAGO policy is not real, then the insurance company is not responsible for the actions of the driver, since an agreement on the provision of services was not concluded with him. If a motorist indicated a fake policy number, then this situation is equivalent to a lack of insurance.

Compensation for material damage is resolved in court, without involving the insurance company whose policy was falsified.

Reimbursement deadline

How quickly the refund will be received depends directly on when the application is submitted. After all, the insurance company has the right to consider the application within 20 days. Moreover, if national holidays fall within this period, the processing time is increased by the number of non-working days. During this time, the insurance company must issue the client a referral to the service station, which was indicated when signing the contract.

If the insurer cannot send the car to the required workshop, then it is obliged to give the client a choice - to receive monetary compensation or repairs at another service station. In this case, consideration of the case and payment may take no more than 30 days.

When the insurer believes that it should not be held liable, it must send an official refusal. In this case, the document must be certified that it was sent before the end of the allotted period.

If the insurance company delays making a decision:

When a referral for repairs or compensation was accepted in violation of the deadlines, then for each day in excess of the limit, a penalty in the amount of 1% of the amount of damage is collected from the insurance company.
When the refusal to compensate for damage was accepted later than permitted by law, a penalty is imposed for each day in the amount of 0.5% of the claims.

All fines are transferred to the benefit of the client who had to wait too long.

An accident is a nerve-wracking situation, so it’s best to know in advance how to proceed to get compensation for your damages. This will solve the problem with the minimum possible losses.

Payment of insurance under compulsory motor liability insurance in 2019 - the amount and maximum amounts of insurance compensation in case of an accident

The maximum insurance payment in case of an accident is a topic that interests every car owner. It is with this that the greatest number of questions, disputes and misunderstandings are associated.

Car enthusiasts are interested in:

What does the OSAGO policy cover (what risks)?
What amounts does the insurance company pay in case of an accident?
Who receives payment under compulsory motor liability insurance?
How much does insurance pay?
How are payments made to the victim?
The procedure for paying insurance compensation in case of an accident.
To whom is insurance compensation paid in the event of an accident?

In this article we will try to answer these and other popular questions.

What does the OSAGO policy cover?

Compulsory motor third party liability insurance guarantees that the victim receives compensation for damage resulting from an accident.

Payment of insurance compensation to the victim is made by the insurance company of the culprit in accordance with Federal Law No. 40 “On compulsory insurance of civil liability of vehicle owners” dated April 25, 2002.

The law controls all issues related to compulsory motor liability insurance: from the list of insured events, the amount of insurance coverage, risks, deductibles, registration of an accident and terms to the conditions, procedure and form of payment of insurance compensation.

The MTPL policy covers the following risks:

Property – damage caused to the property of third parties (victims) is compensated. This applies not only to cars, but also to real estate and other property owned by individuals or legal entities.
Life and health - the costs of treatment or associated with the death of persons injured in an accident are reimbursed.

The OSAGO policy does not cover moral damages and lost profits . These costs will be borne by the person responsible for the accident in accordance with current legislation.

It is also worth remembering that the MTPL policy only covers cases of road accidents (a detailed list of cases that are insured is given in the MTPL Law). This means that those involved in an accident cannot claim money from the insurance company if they left the scene of the accident without properly filing the accident.

The cost of a compulsory car insurance policy depends on the “break-even” of the car. The more often a driver causes an accident, the more expensive the insurance for the culprit’s car will be when calculated for the next period. For this purpose, a system of coefficients that increase the cost of the policy has been developed. This practice disciplines car owners and is a kind of accident prevention.

Figure 1. Calculation of payment under compulsory motor liability insurance

The cost of compulsory motor insurance policies (insurance rates) is regulated by the Bank of Russia in accordance with this Federal Law.

What amounts does the insurance company pay in case of an accident in 2019?

Since April 1, 2015, the limits of sums insured for car insurance policies have increased and currently amount to:

for damage caused to the life or health of each victim - 500 thousand rubles.
for damage caused to the property of each victim - 400 thousand rubles.

When calculating compensation payments to victims, insurance companies now also take into account factors such as the make, model and year of manufacture of the car, its actual wear and tear at the time of the accident, the driver’s driving experience and the place where the vehicle was used.

What are the payment terms for the MTPL policy?

The timing of payment of compensation for damage resulting from an accident, as well as the amount of payments, are prescribed in the Law “On Compulsory Motor Liability Insurance”. Part 21 of Article 12 (Procedure for the implementation of insurance compensation for harm caused to the victim) of the Federal Law of April 25, 2002 No. 40 establishes the following deadlines:

20 calendar days, excluding non-working holidays, from the date the victim’s application for insurance compensation was accepted for consideration - in the case where the victim agrees to receive compensation from the insurance company to repair the damaged car at the service station where the insurance company sends it.
30 calendar days, with the exception of non-working holidays - in the case when the victim independently organizes the restoration of the damaged car (subject to written confirmation from the culprit's insurance company) at a service station with which this insurance company does not have a cooperation agreement.

It is worth noting that within the specified time frame the victim must receive from the insurance company the culprit (one of three):

insurance payment (in case of direct compensation for losses).
direction for repair of the vehicle, indicating the service station where the car will be repaired and where the insurance company will pay for the restoration repairs, as well as the repair period (in case of insurance compensation for losses).
reasoned refusal of insurance compensation (in case the event is recognized as not insured due to violation by participants of the terms of insurance or registration of an accident).

It is important to know that if the insurance company recognizes the case as insured, but does not comply with the specified payment deadlines, the victim has the right to compensation for a penalty in the amount of 1% of the amount of insurance compensation established by law for the type of harm caused to each victim.

As for failure to comply with the deadlines for refusal to pay insurance compensation, for each day of delay the insurance company pays the victim money in the amount of 0.05% of the statutory insured amount for each victim according to the type of harm caused.

How are payments made under compulsory motor liability insurance in case of an accident?

According to the amendments of April 28, 2017 to the Law on Compulsory Motor Liability Insurance, now compensation for victims of road accidents will be made primarily in the form of repair work, when the insurance company pays directly to the service station that carries out these repairs. Insurance payments in cash remain, but are less common.

It is possible to receive money from the insurance company as compensation for damage if there is no qualified car service center within a radius of 50 km from the scene of the accident or the victim’s place of residence.

What is the procedure in case of an accident?

Depending on the circumstances of the accident, there are two ways to report the incident:

simplified procedure - filling out the Europrotocol (in this case there is no need to call the traffic police officers).
The standard procedure is to call the traffic police.

Let's consider both cases.

You can draw up a Europrotocol on the spot and not call the traffic police:

If there are no casualties in the accident.
Only 2 vehicles are involved in the accident.
Both drivers have valid MTPL policies (or “Green Card”).
The participants in the accident came to an agreement regarding the circumstances of the accident (one of the two must plead guilty to the accident).
The amount of damage caused will not exceed 25 thousand rubles.

It is important to remember: in order to take advantage of the simplified procedure for registering an accident, all the listed conditions must be simultaneously met. Otherwise, calling the traffic police is mandatory.

Directly at the scene of the accident, the participants themselves fill out the Europrotocol. Additionally, it is necessary to take photo or video recording of the accident scene, photograph the damage, draw a general plan of the accident site, take the details of insurance policies, and exchange contacts. If possible, take contact information from witnesses to the accident.

After filling out the Europrotocol, the participants in the accident can disperse . Within the period established by the Law, it is necessary to contact the insurance company of the culprit with the Europrotocol and issue a notice of the insured event.

How to register a traffic accident with a call to the traffic police

Figure 2. Communication with traffic police officers

If all the necessary conditions for registering an accident using the Euro Protocol are not met or it is impossible to establish even the approximate amount of damage, you must immediately call the traffic police,

Before the arrival of the competent authorities, the participants in the accident need to exchange details of their MTPL policies, clarify passport details and contacts, and vehicle details.

At the scene of an accident, traffic police officers draw up a protocol of administrative violation. You also need to obtain a certificate of accident from the traffic police. Particular attention should be paid to the accuracy and completeness of the description of the circumstances of the accident and damage recorded by employees of the competent authorities.

What documents to submit to the insurance company

It is worth noting that both the victim in an accident (to declare intentions to receive insurance compensation) and the culprit must contact the insurance company. If the culprit does not contact the insurance company with a notification, the insurance company, according to the Law, will have the right to recover from the culprit the amount of insurance compensation paid to the victim by way of recourse.

Within 3 days from the date of the accident, the culprit must contact the insurance company to submit a notice.

The person at fault for the accident submits the following documents:

A certificate from the traffic police about a traffic accident.
Protocol of administrative violation (copy).
A decision or refusal to initiate a case regarding an administrative violation, provided that they were received from the traffic police.

The deadline for contacting the insurance company of a victim after an accident under compulsory motor liability insurance in 2019 is 5 days.

In turn, the victim of an accident submits the following documents to the insurance company of the culprit:

Application for payment of compensation.
Documents for the car in a copy: STS, PTS, OSAGO policy, power of attorney, if the applicant represents the interests of the owner of the car.
Passport (copy).
Confirmation of the call for inspection (copy of telegram, fax).
Damage assessment report.
Documents confirming the expenses incurred by the applicant after the accident (postage costs, expenses for additional examinations, etc.).

The insurance company orders an examination of the damage, which is carried out by a certified expert appraiser. Based on this assessment, a damage calculation is made. According to the Law on Compulsory Motor Liability Insurance, within 90 days from the date the parties submit all the necessary documents, the insurance company is obliged to pay insurance compensation to the victim.

How is payment made under compulsory motor liability insurance if there are victims?

If as a result of an accident not only cars, but also people were injured, it is obligatory to call the traffic police officers to register the accident.

The maximum limit of the insured amount for damage to life and health is 500 thousand rubles per victim. No limit on the number of victims.

Depending on the severity of the damage caused, payments to victims of road accidents may differ: