Non-insurance cases under compulsory motor liability insurance in case of an accident

OSAGO: insurance cases in 2019

Compulsory motor third party liability insurance (MTPL) often turns out to be vital. Automobile insurance is mandatory, as follows from the very name of this type of insurance, and for the absence of a policy you are fined. On the other hand, insurance cases under compulsory motor liability insurance arouse keen interest among motorists. Indeed, it is not always clear to us what incident falls under the definition of an accident and whether we can count on an adequate response from the insurer in a particular situation. Let's try to figure it out.

What is an OSAGO policy?

From the MTPL decoding it follows that the policy covers the personal liability of the car owner to third parties.

Insurance does not cover either the vehicle (vehicle) or the life or health of its owner, but exclusively protects the rights of victims of an accident.

The cost and procedure for registration are determined by the state. In particular, with the help of Federal Law No. 40-FZ of April 25, 2002. And the rules of work of insurers are regulated by the Regulation of the Central Bank No. 431-P dated September 19, 2014.

The standard contract period is one year. The policyholder can choose the insurance period depending on the seasonality of the vehicle’s use, as well as the number of persons allowed to drive it. The damage to the victim is compensated by the insurer of the culprit. In some cases, direct reimbursement (by your insurer) is possible.

It is possible to receive compensation from several insurance companies (IC) if the damage was caused by more than one participant in the incident. The payment may be maximum, and the number of such “maximums” in one insurance period is not limited. The mechanism is not entirely simple, but only at first glance.

What is considered an insured event under compulsory motor liability insurance?

The above-mentioned Law No. 40, dedicated to this type of insurance, gives a precise definition.

An insured event in an accident under compulsory motor liability insurance is the onset of liability of the car owner for damage caused to the life, health or property of victims while using the vehicle, followed by mandatory compensation for damage.

Any cases (regardless of the number of participants) when payments or restoration repairs are legally possible are considered insurance.

Recognition of an event as insured: criteria

It is important for a car owner to know which cases are covered by insurance. After all, the further development of events after a traffic accident (RTA) depends on this. Therefore, you should understand the definition of an accident and its varieties, since the criteria for recognizing an insured event are closely related to it.

According to clause 1.2 of the Road Traffic Rules (TRAF), a road traffic accident is an event involving a vehicle that occurred during its movement on the road, resulting in dead or injured people, damaged vehicles, structures, cargo or other material damage. We can say that the first criterion is movement, and the second is damage.

Next, we will consider what is an insured event under MTPL. The criteria for its establishment are the presence of:

The culprit of the accident. That is, there must be at least two participants.
Insurance from the culprit.

Here it is necessary to clarify what is considered a road and adjacent areas on which traffic is permitted.

List of insurance cases

Legislators do not provide a specific list of insurance cases under compulsory motor liability insurance; they limited themselves to listing the conditions that do not allow the situation to be recognized as such.

So, insurance is any case in which the insured person while driving a vehicle causes harm to someone else’s life, health or property.

But damage can occur not only as a result of direct contact between two vehicles. For example, if a tree fell on a car. However, such a case does not fall under the MTPL law.

What cases are not recognized as insurance?

Clause 2 of Article 6 of Law No. 40-FZ and Central Bank Regulation No. 431-P states in which cases compulsory motor liability insurance is not paid:

The accident was not caused by the same vehicle that appears in the contract.
For moral damage and lost profits.
For damage during tests, training rides or competitions, even in places designated for these purposes.
The damage was caused by the cargo being transported.
Damage to the life or health of employees caused during the performance of their duties, if it is compensated under other laws.
If the employer has an obligation to compensate the employee for losses.
For damage caused by the driver himself to the vehicle, trailer, transported cargo, equipment or any other property.
Damage caused during loading or unloading of a vehicle.
Antique valuables, historical buildings, products made of precious metals, objects of art, intellectual property and spiritual heritage were damaged/destroyed.
Damage was caused to passengers (property, life or health), if by law it must be compensated.

A non-insurance event is declared for any violation of the contract. These are:

violation of deadlines for applications, provision of an incomplete package of documents;
fake policy;
finding the victim guilty;
intentional accident;
bankruptcy of the insurer and other force majeure events noted in the contract.

Can an insured event occur without an accident?

It has already been noted what the MTPL policy covers. This is liability to third parties in the event of direct contact or collision with vehicles, pedestrians and other road users. You can also receive payments in case of a non-contact accident, if the presence of the culprit of the accident is proven. But hitting an obstacle is not considered an insured event.

Insurers often try to impose additional services, and this sometimes turns out to be useful. Here is what is included in the insurance case without an accident when drawing up such an additional agreement:

theft or theft of a car;
harm caused intentionally by third parties.
fire in a fire, arson;
disaster.

If the contract contains such a clause, the case will be considered insured and you can count on payment.

OSAGO in parking lots and courtyards

Internal territories, which include parking lots and courtyards, have recently been covered by the MTPL policy, since they are equated to public roads. In this case, the following conditions must be met:

At least two vehicles are involved, one of which must be moving at the time of the event.
Availability of insurance policies for all participants in the incident.
Both the culprit and the victim have been identified.

It is necessary to prove the guilt of another participant in an accident in a parking lot, but it is not so easy. The traffic police often recognizes both participants as culprits. Then there will be problems with payment, but the case is covered by insurance. If there is an accident with a cyclist who is at fault, the issue of compensation is resolved voluntarily or through the court.

Questions arise mainly in situations where there is no second participant. He escaped or the damage was caused by the elements. In the first case, the participant in the accident will be searched for, and then the issue of compensation will be resolved. In the second, you will have to prove that the damage was caused while driving. But this will have to be done in court. The same as in the situation if a stone hits the windshield from under the wheel of a car passing by or moving in front.

Actions in case of an insured event

What the victim should do immediately after the accident is set out in Art. 11 of the law on compulsory motor liability insurance:

Act in accordance with traffic rules.
Inform other participants in the incident your policy details and obtain information about their compulsory motor liability insurance (numbers, names and details of the insurance company).
Get a certificate about the accident.
Notify the insurer about the insured event and act according to its instructions.
Collect a package of documents, write an application and send it to the Investigative Committee.
Wait for the decision on reimbursement.

Today you can file an insurance claim without the traffic police - if the damage is small and the participants were able to come to an agreement. A European protocol form (notification of an accident) is issued along with the policy. Filled out by hand on the spot. Together with the necessary documents, it is sent to the insurer within 5 days.

Within 10 days from the moment of the accident, the damaged car must be presented to the insurer for inspection and examination. That is, it cannot be repaired for the first 15 days after the incident.

About payments under compulsory motor liability insurance

Insurance companies are now not obliged to compensate for damages with money. In what case of payment and in what case of repair, the insurer decides - independently or with the insured. Typically, a decision on payments is made if:

The vehicle was completely destroyed.
The cost of restoration exceeds the legal limit, but the owner does not want to pay extra.
The insurer cannot arrange repairs.

Only the owner of the car or his authorized representative can receive payment or a referral for repairs. The victim will be compensated for damage through the Russian Union of Auto Insurers (RUA) if:

The insurance company went bankrupt/lost its license;
the culprit has not been identified, is not insured, or does not have the right to drive the car.

Payment terms should not exceed 20 or 30 days if the victim, upon written request, organizes repairs on his own. The decision on compensation may be delayed indefinitely if the incident is under criminal investigation or the culprit is being sought.

An insurance event report under compulsory motor liability insurance, if necessary, will allow you to prove the fact of the occurrence of an insured situation and the procedure for calculating compensation. At the request of the policyholder, the document is issued within 3 days.

If the insurance company refuses to pay

If the insurance company has no legal grounds to refuse payments, it is first necessary to obtain written confirmation of the refusal. And then - influence the insurer using legal methods in order:

Send a complaint to RSA or the Bank of Russia.
File a lawsuit in the district court at the location of the insurance company.

If the refusal is found to be unfounded, the insurer will be required to pay compensation. Moreover, he will also pay a penalty (1% of the insured amount) and a penalty (0.05% per day of delay).

Finally, a few words about compulsory insurance. It is, of course, far from perfect, but still saves in many situations. And besides:

Although a specific list of insured events is not fixed by law, the list of situations when insurance companies can refuse compensation for damage under compulsory motor liability insurance is not so long.
If you have an additional agreement, you can receive payments for an insured event not related to an accident.
The policy is valid in courtyards and parking lots if it is proven that a traffic accident has occurred.
When an insured event occurs, it must be properly documented and promptly notified of the incident to the insurance company.
You can challenge the insurer’s refusal to pay or their amount in the RSA, the Bank of Russia or the court.

OSAGO: insured event. Video

Practicing lawyer with 10 years of experience. Specializations: criminal law, insurance law, administrative offenses.

Insurance and non-insurance cases under MTPL

The settlement of insurance cases under compulsory motor liability insurance often raises many questions, especially when controversial situations arise with insurance companies that refuse to recognize certain cases as insured. In this article we will try to analyze in detail in what situations the driver has the right to count on compensation for damage under the MTPL policy, which cases are insurable and which are not, and what legislative norms govern this.

What law governs compulsory motor liability insurance?

Due to the fact that compulsory MTPL insurance is regulated by the relevant Federal Law No. 40 of April 25, 2002, all basic principles and concepts are recorded and documented in it. This also applies to information about the conditions for the occurrence of an insured event and its recognition as such. Therefore, if any controversial situations arise, you should refer to this document.

Summarizing the main provisions of this law, we can draw the following conclusion:

Insured events are all events in which a citizen, having a valid MTPL policy in hand, while driving a vehicle, caused harm to the life or health of other persons or the property of these persons. If such an event occurs, the company is obliged to compensate for the damage caused.

At the same time, the law also specifies an extensive list of events that are not insured events and the occurrence of which is not covered by the policy.

The version of the law dated July 3, 2016 provides for a maximum amount of compensation of 400 thousand rubles for compensation for damage to property, and 500 thousand rubles for damage to life and health.

Criteria for recognizing an event as insured

According to the above-mentioned law, an insured event under compulsory motor liability insurance occurs when two main conditions are met:

Insured event: The driver was distracted and did not have time to brake in front of a pedestrian crossing, which is why he crashed into a car in front.

Non-insurance event: A citizen, leaving a shopping center, discovered a dent in the trunk of his car. There were no witnesses to the incident, as a result of which the culprit of the incident was not identified.

The damage must have occurred when the culprit used an insured vehicle (VV). According to the law, such use is recognized as driving a vehicle associated with its movement on roads and adjacent territories on which the vehicle is intended to move. Here are examples of relevant insurance and non-insurance events for this situation:

Insured event: A dump truck drove past a car parked in a parking lot and accidentally crashed into it.

Non-insurance event: Poorly secured construction material fell out of a parked truck and damaged a neighboring car. The fact that the truck was moving was not recorded, and, therefore, it is pointless to expect that the insurance company will cover the damage.

What cases are not covered by insurance?

According to Article 6 of the above-mentioned Law “On Compulsory Motor Liability Insurance”, the following events are not recognized as insurance:

causing damage while driving a vehicle other than that specified in the MTPL policy. Insurance is issued exclusively for the vehicle, and not for its owner;
causing harm by cargo, the transportation of which is associated with risk. Such cargo must be insured separately by the owner;
moral damages and lost profits incurred by the victim in an accident (estimated income that could have been received if the accident had not occurred);
causing harm by a vehicle at competitions, during training driving and in other circumstances of this kind, occurring in places specially designed for these actions;
causing damage to the life or health of citizens who are in the performance of their work duties in the case where such damage is compensated by a separate type of insurance (social, individual);
the occurrence of other situations in which damage to the vehicle or property of the victim was caused directly by the driver of the vehicle;
damage caused during loading and unloading operations;
causing losses to the employing organization if an employee of this organization was injured on a vehicle (for which the policy was issued);
Damage caused to historical and cultural values (architecture, antiques, etc.), cash, jewelry is compensated not by the insurance company, but directly by the culprit of the accident, usually in court.

Is it possible to have an insured event without an accident?

From the content of the Law “On Compulsory Motor Liability Insurance” it follows that if the fact of an accident has not been documented, then you should not expect that the insurance company will pay anything. As noted above, the case must be traffic related. If there is a need to insure a vehicle against all kinds of risks not related to accidents on the road (natural disasters, theft, fire, spontaneous combustion and other troubles), you must also take out a CASCO policy.

However, there is one exception to this situation. Many companies like to impose additional services on the client, one of which is damage insurance and theft insurance programs. Therefore, if the client decides to additionally include one of these programs in the policy, then, of course, upon the occurrence of the stipulated insured event, he will be paid monetary compensation.

Does OSAGO apply in courtyards and parking lots?

Many car owners are interested in the question: will the policy be valid if an accident occurs not while driving on the road, but in the parking lot or yard where the car was left? According to the content of the law, courtyards and parking lots are areas adjacent to the road, which means that exactly the same rules apply regarding incidents that occur there.

It should be remembered that for these territories there are standard requirements for documents submitted to the insurance company to receive payment. Getting into a serious accident in a parking lot is difficult and is mostly limited to minor accidents with minor damage. Given this fact, drivers often do not want to spend too much time on paperwork, make many mistakes in the documents, and ultimately the injured party is left without monetary payment.

In addition, accidents often occur in parking lots due to inattention, even when the cars of both the victim and the culprit are not in motion at all. A typical situation of this kind is careless opening of car doors, leading to damage to a nearby car. This incident is not an accident, which means the Law “On Compulsory Motor Liability Insurance” will not apply to it.

Is it possible to repair a bumper under OSAGO or replace it?

After an accident has occurred and the victim has contacted the insurer with documents for damage compensation, the company must assess the condition of the car after the accident. Based on the examination, a conclusion is made on the recommended course of action - in this context, repairing the bumper or replacing it. Of course, the amount of payment will depend entirely on the expert’s conclusion. Repairing the bumper will obviously cost insurers less, so there are often cases when the assessment of the car’s condition is biased. In such a situation, you need to apply for an examination to another organization, and transfer the resulting conclusion with the cost of repairs to the insurance company. If the organization does not want to pay the specified amount, then there is only one way out - to go to court.

It should be remembered that the modernization and tuning of the car must be officially registered, otherwise there is a possibility that compulsory motor liability insurance will not cover losses. For example, if a car crashes into the back of another car and causes an accident. At first glance, the case is clearly an insurance case. But when registering an accident, it turns out that the stylish bumper on the car is not original, and this modernization has not been registered in any way. As a result, driving such a car may be considered illegal, and the incident may be considered uninsurable. Accordingly, no compensation can be expected in such a situation. And this regulation applies to all parts and components of the machine that are not included in the basic configuration.

Conclusion

Insurance and non-insurance cases under compulsory motor liability insurance are enshrined in law and compensation for damage is carried out only in accordance with the norms of legal acts. Under compulsory motor liability insurance, the insurance company provides compensation only in the event of an accident, while minor accidents in parking lots or in the courtyards of houses also qualify as insured events.

Occurrence of an insured event under OSAGO

Many policyholders are faced with a situation where, when applying for insurance compensation, the company protecting the interests of the guilty party refuses to pay compensation. Such situations are not uncommon, even when the fact of a traffic accident has been officially registered.

Of course, it is not profitable for insurers to cover the damage and they try to come up with excuses not to make payments. In order not to fall for the illegal tricks of the insurance company, it is important for car owners to know what can be considered an insured event under MTPL, and what really is not.

These cases are regulated by the provisions of traffic rules and Federal Law, therefore, in the event of controversial situations, it is necessary to resort to these documents.

Insurance cases under compulsory motor liability insurance

Car owners who purchase a compulsory car insurance policy hope that, thanks to it, the victim will be able to receive compensation for the restoration of a vehicle damaged in a car accident without any delays.

But insurance organizations do not always recognize insured events (CA), even if the insured car has damage of various types.

That is, it is important for the insurance company that, when accepting an application from the insured of a victim of an accident, it confirms the presence of a guilty and injured party, the location of the incident that is suitable for the CC and other circumstances. Otherwise, such an event will not be recognized as insurable under compulsory motor liability insurance.

The compulsory car insurance policy itself protects the car owner from financial penalties that may be imposed on him if he is found guilty of a car accident. In this case, car insurance covers damage to the injured person as if on behalf of the culprit.

Consequently, it is not the initiator of the accident who pays for the damage, but his insurance company. But in order for insurers to pay compensation, you need to know what is included in an insured event under compulsory motor liability insurance, so as not to waste time filing an application and know in advance in what case a refusal will follow.

In 2018, according to the current Federal Law “On Compulsory Motor Liability Insurance”, there are only a few situations that are included in the list of insured events, namely:

An event that occurred on roads and adjacent areas, resulting in damage to people and their lives. A sign of SS in this situation is the harm to health and life suffered by innocent car owners, their passengers or pedestrians.
An event that occurred as a result of the movement of a vehicle on the road, in which the property of an innocent car owner was damaged. Here, only the victim’s vehicle falls under SS.

It is these two situations that constitute an insured event under compulsory motor liability insurance, but each of them has certain subtleties in its definition. To understand in more detail, let's look at examples.

Insured event under compulsory motor liability insurance in case of an accident

So, we know that insurers are in no hurry to recognize all accidents on roads as an insured event for which they are obliged to pay compensation.

Consequently, the occurrence of an insured event under compulsory motor liability insurance is recognized only if the following conditions are met::

Damage to property (vehicle) as a result of an accident was recorded.
Damage to the health of other persons was caused as a result of the movement of the vehicle.
The at-fault party was insured at the time of the accident.
When drawing up the European Protocol, traffic police officers or participants independently identified both the guilty and the injured parties.
A car accident or minor accident occurred on the territory of a qualifying road and adjacent objects (parking lots, parking lots, alleys, roadsides).

That is, if an accident occurs, but there is no victim, i.e. the application was not sent to the insurance company, then the SS as such will not exist, since there will be no one to pay compensation. If the incident occurs on the territory of a special racing track, then this will also not qualify as an insured event in case of an accident, even if the culprits are identified.

The law and the insurer decide in what cases under compulsory motor liability insurance in case of an accident compensation is paid. The presence of damage does not guarantee that the company will recognize this CC and pay compensation to the injured party.

When we talk about the cases in which compulsory motor liability insurance is paid, we need to remember what exactly this type of car insurance protects. Thus, this insurance is paid by the company representing the interests of the car owner who initiated the car accident.

That is, the MTPL policy implies payment of compensation to the party injured in a car accident instead of its initiator. Consequently, the “motor citizen” protects the car owner’s liability to third parties. The protection applies to incidents that occur on the road involving only two or more vehicles.

This means that if the vehicle was damaged not by another car, but by a fallen tree or an intruder, then such insurance cases under MTPL without an accident are not recognized. To obtain compensation in such incidents, i.e. those that did not occur on the road will have to buy additional Casco insurance to cover damage in such situations.

When insurance cases are not recognized

As you already understand, only the injured party has the right to receive compensation from the insurance company under a compulsory auto insurance policy. Consequently, if the initiator of the incident wants to receive compensation, then he needs to have a voluntary auto insurance policy, since the “automobile insurance” protects his liability and does not cover the damage to the culprit.

In order not to waste time collecting documents, it is advisable to know in what cases insurance is not paid in an accident:

If a vehicle not listed in the vehicle license was damaged in a car accident. That is, the at-fault party does not have a valid auto insurance policy.
The victim wants to receive compensation citing lost profits. What is not an insured event cannot be obtained from compulsory motor liability insurance, because with such an appeal you can go to court and recover compensation from the culprit directly.
The injured party became such because of the load carried in the culprit's car. If a vehicle is transporting dangerous cargo, it must be insured separately.
The accident occurred on a training track, competition or other types of training driving.
Moral compensation is in non-insurance cases of compulsory motor liability insurance, but it can be demanded through the court.
Damage to green spaces, architectural monuments or buildings are also cases when insurance is not paid.

Registration of an insured event under compulsory motor liability insurance

We have already said earlier that in order to receive compensation and recognition of the incident by the SS, there must be an injured party. That is, the settlement of insurance cases under compulsory motor liability insurance occurs only if there is a culprit and a victim.

The latter must submit an application to the company within the prescribed period so that it will consider it, inspect the damage and make a payment. The main thing that needs to be done after an accident is to report the insured event to the insurance company.

Notifying the insurer about an incident involves filing an application with a request for payment of compensation, as well as providing the necessary documents and certificates. If the victim is not insured, then he contacts the company of the insured culprit, but if the innocent party also has an auto insurance policy, then he can contact his insurance company.

What documents are needed

If the compulsory motor liability insurance contract for the person responsible for the accident is concluded in the same company where the innocent car owner is insured, then the procedure for registering an insurance policy usually follows a simplified scheme. But even if an application is submitted to other insurance companies, the procedure for registering an insured event will be the same.

To accept an application from the injured policyholder, he will need the following documents:

An application written in free form (or on a special form) with a request for payment of compensation.
Civil passport or other identification document.
A certificate issued by a traffic police inspector.
Notification (protocol) of an incident on the road.
Information about an accident.

Deadlines for application and consideration

In order not to be denied payment, the party injured in a car accident must submit a statement to the insurance company within a certain time. The period of notification to the insurance company about the incident is also limited for the initiators of the accident.

It is advisable to contact the insurer as soon as the fact of an accident has been recorded, but both parties have several days. Thus, the “motor citizen” will be able to compensate for damage only if the policyholder contacts the company regarding the accident no later than 5 days from the date of the incident.

After submitting the application, you must obtain a certificate from the insurer, which will indicate the date of acceptance of the application. It is from this moment that the time allotted for the insurer to consider the application, inspect the car, and pay compensation will begin. The IC is given 15 days for this.

Today, compulsory motor liability insurance is paid only in kind, i.e. by providing repair work in specialized service stations. Previously, policyholders had the opportunity to choose between receiving monetary compensation or being referred for repairs. Now, all cases, with the exception of total loss of the car, are subject to repair work, which is paid by the insurance company.

A similar situation occurs with respect to compensation for personal injury. That is, the insurance company will pay for treatment, medications and other expenses necessary to restore the health of the injured car owner.

In the case of compulsory car insurance, the amount of payments is strictly limited. If the amount of damage exceeds the established limit, then the culprit must pay the remaining amount.

Thus, under the “automobile insurance” policyholders can count on compensation in the following amount::

For damage caused to a vehicle - a maximum of 400,000 rubles.
In case of harm to life or health - 500,000 rubles.

If the insurance company refuses to pay

We have already said earlier in what cases insurance is not paid in case of an accident, but the refusal of the insurance company is not always justified. Thus, unscrupulous insurers may refuse to pay the insured car owner due to the fact that the person at fault does not have a compulsory insurance policy.

Of course, if the initiator of the accident is not insured anywhere, then from whom should we demand compensation? But in this situation, this issue should be dealt with by the victim’s insurance company. Consequently, if a car owner injured in an accident contacts the company with a request for payment of compensation, then the insurer is obliged to collect compensation from the culprit in court, and not refuse its client.

If the opposite situation occurred, i.e. the victim is not insured, then the refusal is also illegal. In any case, the injured party was paid insurance in case of an accident, covering the costs of restoring the car or health.

What does an insured event include under compulsory motor liability insurance and what should the victim do?

Settlement of insurance claims is a complex process fraught with many problems. Insurance companies often refuse to recognize certain situations as insurable. To understand when you can count on compensation, you need to understand in detail what an insured event is under MTPL.

The concept of an insured event under MTPL

An insured event (SI) is the onset of civil liability of an individual as a result of causing harm to the health or life of another person, as well as causing damage to someone else’s vehicle through the use of one’s own vehicle.

The result of an insured event is a mandatory insurance payment to the victim.

There are two categories of SS:

It is important to understand that the insurance policy only covers the injured party. It covers the car owner's personal liability to a third party. The policy does not cover the life, health, or vehicle of the owner.

From the legislative side

Compulsory motor third party liability insurance is regulated by the Federal Law “On Compulsory Motor Liability Insurance” No. 40 and the Civil Code. These legal acts set out and document the basic principles and concepts of the SS, as well as indicate the reasons for classifying any incident as one of them.

In 2018, amendments to the Federal Law “On Compulsory Motor Liability Insurance” were adopted. According to them, the following situations are considered SS:

An event that occurred on a road or adjacent territory, as a result of which people and their lives were damaged. A sign of SS in this case is the physical damage suffered by the injured drivers, their passengers or pedestrians.
An event that occurred as a result of the movement of a vehicle on a road or adjacent territory, as a result of which the property of the injured party was damaged. A sign of SS is physical damage to the vehicle.

Also, this document lists other situations that cannot be considered insured events.

What is included in an insured event under compulsory motor liability insurance?

Insurance companies are in no hurry to recognize every incident as insurable. In order to be guaranteed compensation for the harm caused to the victim, you need to make sure that the current incident meets certain conditions.

To recognize an incident as insurable, it must meet several conditions:

Presence of the culprit of the accident. It is necessary to establish a person who will bear civil liability for damage to someone else's property and harm to the health or life of the victim.
The fact of causing harm to human life or health. Also causing damage to the vehicle or cargo.
The damage was caused by the insured vehicle. Restoration of damage occurs at the expense of the insurance company with which the person responsible for the incident has entered into an agreement.
The damage was caused by a moving vehicle on the road or in the area adjacent to it, where traffic is also permitted.
The presence of a protocol drawn up by traffic police officers, or an independently drawn up European protocol, where the injured and guilty parties are identified.

An example of an insured event: a driver driving past a car parked in a parking lot did not calculate the trajectory and hit it.

An example of a non-insurable event: poorly secured construction materials fell out of a truck parked in a parking lot and scratched a neighboring car.

In this situation, the third condition is not met. There is no evidence of vehicle movement.

Non-insured events under MTPL

Federal Law No. 40 “On Compulsory Motor Liability Insurance” also provides a list of incidents that cannot be considered insurable.

These include:

Lack of documented evidence of an accident.
Accident with another vehicle.
Damage caused by cargo, the transportation of which is associated with risk.
Moral damage and lost profits.
Lack of an accident report or a conclusion from a technical inspection commission.
Drivers' inaction.

There are other non-insurable incidents that have their own nuances.

Without accident status

Based on the definition, the MTPL policy covers incidents involving direct collisions between vehicles, pedestrians and other road users. However, despite this definition, there are insurance clauses without road accidents, which are also compensated to the injured party.

These include:

Vehicle theft.
Intentional harm caused by a third party.
Spontaneous combustion or arson.

Very rarely, the list of SS MTPL includes damage from natural disasters. In most cases, for incidents of this category, it is necessary to apply for CASCO insurance.

All other situations without an accident do not qualify as insured events and compensation for them is not paid.

Other transport

Each MTPL insurance policy is issued for a specific vehicle. If damage is caused while driving a vehicle not specified in the insurance, all payments will be borne in full by the person responsible for the accident.

Special risks

Special risks include damage caused by cargo on the vehicle. In this situation, the insurance policy under compulsory motor liability insurance will not have legality. According to the rules, the owner of the cargo must insure it separately.

Moral damage

Moral damage caused to a person as a result of an accident is also not an insured event. If desired, the victim can file a claim in court for payment of moral compensation, but the MTPL policy does not directly provide for this.

There is no way to assess the damage

One of the main conditions for classifying a situation as CC is the presence of proven damage. In the absence of a traffic police report from the scene of the accident or a European protocol replacing it, it is not possible to establish the extent of the damage. In this situation, the insurance company may refuse to pay compensation.

If the injured party intends to take advantage of the insurance payment, then he should not repair the car himself.

The insurer may require a reassessment of the damage and, based on new data, make a decision on payment of compensation and its amount.

Drivers' inaction

It is quite a rare situation when the insurance company comes to the conclusion that the culprit of the accident deliberately caused damage to the injured party through his inaction. The result may be a complete refusal to pay appropriate compensation.

Other options

Other non-insurable events include various traffic accidents that occur on racing tracks and during training driving.

Also, compensation is not paid if harm is caused to a person’s health if he is in the performance of his official duties and is insured with a separate type of policy.

What to do if an insured event occurs under MTPL

When an insured event occurs, the injured party must submit an application to its insurance company to investigate the incident and to pay compensation.

If the culprit does not have auto insurance, the entire amount to pay off the damage is paid to him directly.

What documents are needed

To accept the application, the victim must provide the necessary package of documents within the allotted time. If both participants in the accident entered into a contract with the same company, then the procedure for registering an accident insurance will follow a simplified procedure.

If the insurance companies are different, then the victim will need the following documents:

When causing physical harm to a person, a medical report must also be attached.

Deadlines for application and consideration

In order not to receive a refusal from the insurance company to pay for damages, the injured party must submit a corresponding application within a certain period of time. This rule also applies to the initiator of the accident.

To avoid unpleasant situations, it is better to submit an application for compensation immediately after recording the fact of an accident.

The maximum period for contacting the insurance company is 15 days. However, it is better to deal with the situation in no more than 5 days.

From the moment the application is submitted, the company begins to consider this CC. According to the legislative act “On Compulsory Motor Liability Insurance”, the final decision must be made no later than 20 days from the date of filing the application.

Currently, insurance companies pay compulsory motor third party insurance only in kind. This means that they pay for car repairs or hospital bills, but do not provide monetary compensation directly to the injured party.

As a rule, each insurance company has a list of service stations where the victim can carry out paid repairs.

The only exceptions are cases of complete unsuitability of the car and death of a person.

Payments for SS in 2019:

Harm to human health and life – 500 thousand rubles.
Funeral expenses – 475 thousand rubles. to a close relative and 50 thousand rubles. distant
Damage to property – 400 thousand rubles.
Compensation for damage based on the European protocol – 100 thousand rubles.
Damage to a vehicle – 100 thousand rubles.

All insurance cases have a strictly limited amount of payments. If the damage exceeds the amount paid, then the person responsible for the incident undertakes to pay the missing part.

What to do if the insurance company refuses to pay

If the insurance company refuses to pay on illegal grounds, then the vehicle owner has several ways to solve this problem.

The procedure is as follows:

First, you must receive written confirmation of the refusal.
Along with this document, you need to send a complaint to the RSA or the Bank of Russia.
If there is no result, then it is necessary to file a claim in the district court at the location of the insurance company.

If the refusal to pay is confirmed to be unfounded, the insurer undertakes to pay compensation in full. Along with it, he is also obliged to pay a penalty and a fine.

What to do in case of disputed insurance claims in case of an accident

Insurance companies do not want to fully pay compensation for damage under the MTPL policy. Most often, they deliberately underestimate the amount of payments, but they may simply not recognize the event as an insured event.

Call to Honest

Before filing a lawsuit, the injured party is advised to consult with a consumer rights attorney.

In Russia, the most recognized company is Honest. Among its employees there are not only experienced lawyers, but independent experts and criminologists.

Expertise

If the victim intends to challenge the decision of the insurance company, then he must independently organize an assessment of the damage caused and a trace examination.

The first procedure will help more accurately assess the damage to the vehicle, and the second will establish all the circumstances of the accident.

Pre-trial claim

If a controversial situation arises, the first thing the victim needs to do is send a pre-trial claim to the insurance company. It should include a damage assessment and the conclusions of a trace examination.

Usually at this stage, many insurers accommodate the claimant and pay the damage in full.

If the company refuses to pay insurance, it is worth protecting its interests through legal action. If the cost of the claim is less than 50 thousand rubles, then you should go to the magistrate’s court. If more - to the district.

Consumer rights lawyers will help you competently draw up a claim while respecting all the interests of the injured party.

Conclusion

Despite the fact that an insured event under compulsory motor liability insurance is not fully established at the legislative level, the number of situations when an insurance company may refuse to pay is not large.

What is an insured event under MTPL and what is the procedure?

In the event of an accident, the victim and the owner of compulsory motor liability insurance must adhere to a certain sequence of actions in order not to lose the right to payment. Let's consider in what cases insurance compensation is due and what measures need to be taken in the first minutes after an accident.

What is an insured event?

An insured event under compulsory motor liability insurance is recognized as the occurrence of civil liability of the car owner for causing harm to the life, health or property of victims of an accident on the road (drivers, passengers or pedestrians).

With a traffic accident

OSAGO insurance protects the driver in case he becomes the culprit of an accident on the road. Typical insurance cases involving road accidents:

the driver hit a pedestrian;
an accident occurred and the car was damaged;
the persons in the other car were killed or injured in an accident.

The law provides for a limit on payments in case of damage to a car or other property - up to 400 thousand rubles, and in case of injuries, bruises and other health problems of victims - up to 500 thousand rubles.

If the damage was caused only to the car, and even then visually it can be estimated at no more than 50 thousand rubles, the accident can be registered according to the Europrotocol procedure, i.e. without calling a traffic police inspector, but with the obligatory filling out of the Notice by both participants in the accident. This possibility is also provided for by the Traffic Rules (clause 2.6.1).

No traffic accident

If the policyholder has driven into a bus stop, shop window or other property of other persons, such cases are also covered by compulsory motor liability insurance. Victims have the right to file a claim for payment with the insurance company or file a civil lawsuit in court.

What is not an insured event?

There is a whole list of events that will not be considered insurance. It is very important to know them, since the insurer’s decision in the event of an application for payment depends on it. No money will be paid if:

the damage was caused by the car owner who did not pay the policy on time;
the victim demands payment for moral damages;
the accident was caused by a learner driver during training;
the damage was caused by an undeclared cargo, trailer or worker in the performance of their duties;
force majeure circumstances;
cultural and historical structures were damaged;
the established damage limit has been exceeded;
there was a staged accident and damage.

How to proceed?

When an insured event occurs, you need to remain calm. The main thing is to prevent violations of the insurance contract (do not move the car, do not run away from the scene of an accident, do not refuse a medical examination). It is also very important to collect all contacts of witnesses, the victim, photograph the scene of the accident and call the traffic police, if necessary.

What measures to take in the first minutes?

Below you can familiarize yourself with the sequence of actions in case of an accident. The actions of the insured immediately after an accident depend on whether there were people injured in the accident or not, and what kind of damage was caused to the car (major or not).

If there are injured (dead) people

If drivers or pedestrians were injured in an accident, you will have to deal with them first, and only then with the formalities associated with registration. The policyholder must:

stop the car and put the handbrake on;
urgently call an ambulance and try to provide first aid;
if there are dead, call the police;
turn on the hazard warning lights and install a warning triangle;
call the insurer (the number is indicated in the policy);
exchange contacts with victims and witnesses;
call and wait for the traffic police to arrive (if the damage is extensive).

Next, the policyholder is obliged to sign the protocol drawn up by the traffic police officer or, if he does not agree with the data presented, to make a note of disagreement.

In the absence of human casualties

If there are no casualties in the accident, the procedure is the same, but an ambulance is not called. In case of minor damage (up to 50 thousand rubles), you can write a Notification of an accident and not call the traffic police.

To receive payment, the question of fault in the accident will be very important, so mark the signs of braking and objects after the accident, take a photo, supervise the preparation of the protocol and diagram of the accident. Be sure to report the incident to your insurer.

Keep the damaged car until it is inspected by a representative of the insurer. There is no need to call the traffic police only if there are no injuries or drunks in the accident, and the damage to the car is minor. You can also fill out an Accident Notice if the offender pleads guilty. In all other cases, you need to call the traffic police.

How to draw up a protocol?

An accident is documented by a protocol with a detailed description of all damage, which is drawn up by a traffic police officer, or by an Accident Notice, which is filled out by the participants in the accident. The documents describe the accident, the damage, draw up a diagram of the accident, and make a note about the fault.

What should the victim do?

The victim needs to find out all the contacts of the person responsible for the accident (full name, phone number, information about the insurance company, policy number). It is also advisable to find witnesses and exchange phone numbers. Next, within 5 days you need to contact the office of your insurer to fill out an application for payment.

In other cases, you need to contact the insurer of the person responsible for the accident (when more than two cars were involved in the accident and damage was caused to life, health or property other than the vehicle). Then you need to:

Wait until the insurance company draws up a report on the insured event.
Receive a decision on payment or refusal within 20 days.

It is prohibited to repair the car yourself in the first 15 days after the accident. The insurance company can easily refuse compensation in this case, since the damaged car must be inspected and the damage assessed by experts.

Collection of documents

The application for payment is drawn up in any form and signed personally. All additional documents specified in the inventory are attached to it, namely:

copy of the passport;
notification of an accident (if issued);
certificate of accident (issued by the traffic police);
a copy of the MTPL policy;
copies of documents for the car;
power of attorney (if issued);
death certificate of the victim (if there was a deceased person);
protocol and resolution on an administrative offense (if drawn up);
bank details for monetary payment to the victim or for transfer to a service station for repairs.

Event decoration

You need to write a statement about an insured event to the insurance company. The document will need to describe the event, indicate dates, car brands, contacts of the parties, and policy numbers. Next, the insurer will conduct an inspection, assess the damage and draw up a report on the basis of which a decision will be made on compensation and its amount.

Payment deadlines are stipulated by law and cannot be violated. For each day of delay, the insurer will be required to pay a penalty in the amount of the insured amount. The period is up to 20 days from the date of submission of documents.

Expertise

If the victim does not agree with the amount of damage assessed by the insurance expert, he has the right to order an independent examination. This will allow the examination data to be used in court, proving that the insurer underestimated the amount of losses in order to save on payments.

What should the culprit do?

It is enough for the culprit of the accident to inform the victim of the series and number of his OSAGO policy. You can tell him that he should contact his insurance company for direct compensation for losses.

Procedure

The actions of the person responsible for the accident when settling losses are minimal. But you may need to undergo an intoxication test (it is not advisable to refuse) and provide your car for inspection. If the policyholder is at fault for the accident, his task is:

Notify the insurer about the accident by phone.
Give your policy details to the victim.
Ensure that the accident is properly documented and the damage is assessed accurately.

Practical recommendations

If the accident was issued with a Notice, it is very important for the person at fault to send his copy to the insurer within 5 days after the accident. Otherwise, the company has the right to apply to him with a recourse claim.

What situations might there be?

Road accidents are different. It is very important to behave correctly so that the insurance company does not have a reason to refuse payment or recourse.

If you hit a pedestrian. If you hit a pedestrian, you need to get out and provide first aid, then call an ambulance, the insurer and the traffic police. The victim must be dragged to a safe place. Next, we install the emergency lights and wait for all services to arrive.
If the person at fault for the accident does not have compulsory motor insurance. If an accident occurs and there is no insurance policy, this seriously complicates the situation. Most likely, the culprit will be fined for lack of insurance, and then the victim will file a claim for damages.

Features of compensation for losses

OSAGO is one of the most unprofitable types of insurance for insurers. Payments are made quite often, but there are also refusals for far-fetched reasons. For example, companies may refuse to compensate the relatives of those killed in an accident or those who were injured in an accident due to a drunken policyholder.

The reason may also be a suspicion of an intentional accident. All these refusals can be appealed in court. However, if the culprit of the accident was not indicated in the list of drivers under the compulsory motor liability insurance agreement, a completely legal refusal of compensation is possible.

How to receive payments?

If the insurer has decided to pay compensation, the money is transferred to the service station’s account. The victim does not even see them, but he has the right to appeal the amount of compensation if he believes that it is underestimated.

Payment in cash can be received:

in the event of the death of the victim;
complete loss of the car in an accident;
if the victim is disabled or has received serious or moderate harm and has chosen this type of payment.

When choosing a cash payment, you must indicate in the application the number of your bank account where the compensation amount will be transferred.

How to repair a car?

The insurer issues a referral for repairs to a service station with which it cooperates. The work must be completed within a month. Delaying repairs is unacceptable and can be appealed. If the victim wants to repair the car at his service station, this issue will need to be agreed upon in advance.

Subrogation and recourse

The insurer that paid the money under compulsory motor liability insurance can demand it back from the culprit of the accident. Subrogation means the transfer of the right of claim to the insurer (Article 965 of the Civil Code of the Russian Federation). In this case, the company has the right to file a recourse claim against the driver who caused the accident intentionally, against the road organizations that did not repair the road on time, as well as the insured himself, if he was drunk at the time of the accident or without documents.

Regression also applies to those who committed an accident, but fled the scene, and also drove a broken car, which caused the accident.

Assignment agreement

The assignee company, which purchased the right to receive compensation, receives its income in the form of a percentage of the payment. In some cases, this can be beneficial if payment is required very urgently, and the victim does not have time to sort things out with the insurer or an illegal refusal of compensation has already occurred.

OSAGO is a very important type of insurance for drivers. It's not just about the obligation to buy a policy, but also about the real benefits in the event of an accident. If you get into an accident without insurance, you will have to compensate the losses of other drivers from your own pocket. If there is compulsory motor liability insurance, payments up to 400-500 thousand rubles will be covered by the insurance company.