Sample claim for insurance compensation for road accidents

Application form to the insurance company for compensation of damages under MTPL

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The year 2014 was marked by another innovation for insurers and policyholders. The changes affected compulsory car insurance. A rule has appeared in the legislation that allows a citizen who has suffered damage, both material and health, to compensate for his losses directly, i.e., to use the so-called DCP (direct compensation for losses).

To do this, it is enough to contact your insurer, and not the insurance company of the culprit, as the law previously required. Thus, the time allotted for payment of compensation is significantly reduced.

Sample application for compensation of damages under compulsory motor liability insurance

How to properly take advantage of this opportunity and receive compensation from your insurer? To obtain a PPV, you need to contact your insurance company with a written application, of course. You should not delay, since any delay in filing an application reduces your chances of receiving compensation.

The document has the following structure and contains:

• Name of the insurer. It is clear that we are talking about the organization to which the application is being submitted. The name must be accurate; if you don’t remember something, take the data in the contract or policy;
• Full name of the policyholder, his address;
• If your representative acts on your behalf (submits an application signed by you, receives a payment), then his full details (full name, address);
• Full description of the incident. It is necessary to indicate when it happened, i.e. place, date, time, what exactly was damaged (property, people). Be sure to list all the circumstances of the past. The picture must be complete. Remember that PVU is paid only if the damage was caused by vehicles;
• Next, you need to indicate all the data that relates to the guilty party: information about the car, the driver responsible for the incident;
• Information about the victim, his property;
• Identification, study, assessment of damage. This refers to the procedure for inspecting a vehicle;
• Marks (at the conclusion of the document after the applicant’s signature) about when and by whom the application was accepted (date, time, recipient’s signature).

After the application is submitted and accepted, you need to receive an act (acceptance certificate) or a receipt for receipt of documents from the insurer’s representative.

It should contain the following points:

• List of documents accepted by the insurer;
• Details of the victim. They will be needed when receiving payments;
• Marks indicating that documents have been accepted for consideration;
• Additional Information. This item is completed by a representative of the insurer, if necessary.

Important! The application and other documents attached to it must be reliable and contain only accurate and truthful information. Marks in documents are not allowed. All fields are filled out without distortion, corrections, and legibly. Otherwise, compensation may be denied.

Documents for an application to the insurance company for compensation of losses under compulsory motor liability insurance

The application for compensation for damage incurred is accompanied by the following documents, which are its integral part.

How to get insurance under MTPL?

What to do if you paid less under compulsory motor liability insurance, read here.

The package of documents must include:

• notification of an accident. The form of this document is issued by the insurer when drawing up a contract and receiving a motor vehicle policy. It is filled out by both parties to the accident. The document describes the accident, all its aspects, lists the damage received as a result of the incident;

• If traffic police officers were present at the scene of the accident and conducted an investigation into the incident, then a certificate from the State Traffic Inspectorate (F-748) is also attached to the application. This certificate duplicates the notice, since it sets out all the circumstances of the collision;
• Copies of vehicle registration certificate, PTS. That is, those documents that indicate the victim’s ownership of the damaged car;
• Copies of the passport (other document proving the identity of the victim), driver’s license. If his representative acts on behalf of the victim, then a power of attorney is provided in his name (notarized), allowing him to act in the interests of the policyholder;
• If the accident involved a car that is owned by any legal entity, the package of documents also includes a waybill received by the driver at the dispatch center of this legal entity. The sheet must indicate the route prescribed for vehicles.

In the event that traffic police officers were also present at the scene of the accident, materials from the traffic police department, copies of protocols drawn up by employees, and decisions on the case will also be required. The entire package of documents is submitted to the insurer.

Where to submit an application for compensation for damages under compulsory motor liability insurance

A package of prepared documents is submitted to the insurer with whom the victim has an agreement within the established time frame (either by law or specified in the current contract). If an application for payment is submitted after the end of the established period, the insurer has the right to refuse compensation. Unless, of course, the violation of the deadline is agreed upon with him.

After the application is accepted, the insurer inspects and assesses the damage incurred. Then he makes a decision: to pay compensation or refuse payment. Duration – 15 days and no more.

The insurer has the right to compensate for its losses at the expense of the company responsible for the accident. This process is called subrogation. This will not affect the victim's compensation in any way.

Important! You will not be able to receive compensation twice. It is unacceptable to receive compensation from both your insurer and the insurer of the person responsible for the accident.

In essence, this is fraud and law enforcement agencies will consider such an act as a criminal offense with all the ensuing consequences (criminal prosecution, and possible trial).

The introduction of a PWU helps reduce the time for reviewing, assessing damage, and receiving payments in case of a minor accident.

If the documents are drawn up correctly, payment can be received within 3 to 8 days. This period largely depends on what rules are established by the victim’s insurer.

Application form for receiving payments under compulsory motor liability insurance and procedure for registering an insured event

Any driver has the right to submit an application to the insurance company for compensation for damages in an accident if an insured event occurs. Such a petition helps to compensate for losses, but the procedure itself provides for a lot of controversial issues that must be taken into account in the process of drawing up the form.

Who should write an application to the insurance company for compensation for damage in an accident?

The application should be written directly to the citizen who issued the insurance policy or is listed in the MTPL. If the insurance covers more than one person, they are all entitled to compensation.

When registering an accident without involving the traffic police, you must submit a petition to your organization where you received the policy. If the incident was registered by the traffic police, then it is necessary to demand payment from the insurance company where the person responsible for the incident took out the policy.

There are a number of cases when, after the compensation procedure, the victim has new facts indicating harm to health in the event of an accident. Moreover, if the victim’s insurance company has already paid compensation for vehicle repairs, then he can contact his company with a request for compensation for damage to health.

What data is needed

Filling out the application involves entering mandatory information relating not only to the driver, but also to the entire incident. When drawing up a request for an insurance payment, you must indicate the name of the insurance company to which the victim applies. And also the following data:

1. FULL NAME. the victim
2. Registration address and place of residence.
3. Personal data of the person for whom the power of attorney is issued.
4. Date, time and place where the incident occurred.

The applicant must describe in as much detail as possible what type of damage was received, indicate the circumstances of the accident, and record it.

If a Europrotocol was drawn up, then this form must be drawn up in accordance with the established rules.

At the moment, the priority is to pay compensation through repairs at a partner service station, but there are ways to receive payment in money. Therefore, in the application you can indicate the desired method of compensation.

Sample application to the insurance company for compensation for damage in case of an accident

The application form can be requested from the insurance company or downloaded from the official website of the insurance company. A notification of an accident or a European Protocol is issued to the driver upon registration of compulsory motor liability insurance. In addition, you can always contact a lawyer, he will help you draw up a document correctly and take into account all the important points to receive compensation.

Which papers should I attach?

Insurance companies require that a number of documents be attached to the application, allowing specialists to quickly understand the case and confirm the authenticity of the information contained in the application.

1. A copy of the vehicle owner's passport.
2. If the driver drives by proxy, documents confirming the identity of the owner of the vehicle are required.
3. PTS.
4. Details for receiving compensation.
5. A certificate confirming the fact of the accident.
6. The notification is submitted in the absence of traffic police officers at the time of the accident. Such a document is confirmed by the signatures of both parties.
7. A copy of the protocol and resolution of the offense that occurred.
8. Refusal to go to court to punish the perpetrator.

If harm has been caused to health, in addition there are documents such as certificates confirming the presence of injuries, a conclusion from a medical institution.

Deadlines for submitting and considering an application to the insurance company

The victim of an accident is obliged to notify the insurance company about the event immediately. All you need to do is call the hotline or your insurance agent.

The citizen is given 5 days to collect documentation. This period increases to 15 days if the accident occurred far from the place where the insurance and car were registered.

If a citizen does not meet the specified deadlines, the insurance company has every right to refuse compensation.

Within three weeks from the date of submission of documents, an expert assessment of the damage must be carried out. After the procedure, the victim must receive compensation within 20 days.

Do I need to pay fees to file an insurance claim?

Article 333 of the Law on the Protection of Consumer Rights states that vehicle drivers in the event of an insured event occurring and registering are exempt from paying state duty.

The same decision was made in the event that the injured party goes to court to resolve a dispute with the insurance company.

Reasons for refusal of payments under compulsory motor liability insurance and how to achieve justice

The insurance organization has the right to refuse the injured party if the accident was planned in advance in order to receive compensation.

Also, a problem may arise if errors or inconsistencies occur in the documentation confirming the fact of the incident. If the insurance is expired, the client has no right to claim compensation.

If there are no reasons for refusal, the organization must pay the citizen the full amount within 30 days. The IC sometimes takes a delay to carry out a transaction, but cannot refuse the transfer.

An application to the insurance company is written after an insured event has occurred and the client needs monetary compensation. The form must be drawn up as competently as possible so that the organization that assumes the responsibility to compensate for losses does not have any questions.

Sample claim to the insurance company in case of an accident

In the article you will find a sample claim to an insurance company in case of an accident, which fully complies with the requirements of the current Law of the Russian Federation “On Compulsory Motor Liability Insurance”.

Victims who have decided to go to court with a claim to recover insurance payments must first submit a claim to the insurer.

A claim for compensation for damage caused by a traffic accident must be drawn up in accordance with the rules established by the Law of the Russian Federation “On Compulsory Motor Liability Insurance”.

Failure to comply with legal requirements for the form and content of a claim entails refusal to satisfy it.

The sample claim presented to your attention reproduces the circumstances of a traffic accident involving vehicles, set out in an article posted on our website.

Article to help:

A sample claim to the insurer, drawn up in the pre-trial procedure for resolving a dispute about insurance payment, meets all the requirements of Article 16.1 of the RF Law “On Compulsory Motor Liability Insurance” as amended.

To the Head of OJSC "Insurance Company "EcoStrakh"

legal address: Moscow, Sokolova Avenue

building 1234 building 99 office no. 1111

from Ivanov Ivan Illarionovich, living in

address: N-sk, st. 40 years of Victory, 21 apt. 25.

SAMPLE CLAIM

/for payment of the amount of insurance compensation under the contract

compulsory civil liability insurance/.

On September 10, 2014, between me and the Insurance Company OJSC "Insurance Company "EcoStrakh" (hereinafter referred to as the Insurer), an agreement was concluded for compulsory civil liability insurance of the owner of a vehicle of a Nissan Almera car, state registration plate P 245 MS/150, insurance policy series CCC number 0272254970.

November 5, 2014 at 13:10 on the section of the road adjacent to house No. 22 on the street. Varlamova, N-sk, Moscow region, a traffic accident occurred in which the driver of a Kia Rio car, state registration plate X 707 OR/ 150, Karabanova Ekaterina Alekseevna, violated clause 9.10 of the Traffic Rules of the Russian Federation, did not provide a safe lateral interval and allowed a collision with car Nissan Almera state registration plate P 245 MS/150, which was driven by me, Ivanov Ivan Illarionovich. The circumstances of the road traffic accident are confirmed by the certificate of road accident No. 125/02 -2014, issued on November 5, 2014 by the traffic police department of the Russian Ministry of Internal Affairs for the city of N - sk:

Driver Karabanova E.A. For her violation of the Traffic Rules of the Russian Federation, she was brought to administrative responsibility under Part 1 of Art. 12.15 CRF about AP. Risk of civil liability of the driver Karabanova E.A. insured by Ru-Strakh LLC under insurance policy CCC 0675259977 dated October 2, 2014. The validity period of MTPL agreements concluded by the tortfeasor and the victim with their Insurers is one year.

In accordance with Article 7 of the Federal Law of April 25, 2002 N 40-FZ, as amended on July 21, 2014, “On compulsory insurance of civil liability of vehicle owners,” the Insurer is obliged to make an insurance payment to the victim in the event of damage to property within the insured amount, not exceeding 400,000 rubles.

In compliance with the requirements of Article 14.1 of the Federal Law of April 25, 2002 N 40-FZ (as amended on July 21, 2014) “On Compulsory Motor Liability Insurance”, I contacted the Insurer with an application for payment of insurance compensation in the form of direct compensation for losses. I attached to the application the documents provided for in paragraph 3.10 of the “Regulations on the rules of compulsory insurance of civil liability of vehicle owners”, approved by the Bank of Russia on September 19, 2014 N 431-P. Based on the results of consideration of my application, the insurer made an insurance payment in the amount of 68,760.33 rubles. This amount does not cover the cost of repairing a damaged vehicle.

On my instructions, an independent expert - technician V.G. Dmitriev. My car was inspected and the amount of material damage caused to me was calculated. According to expert opinion No. OA -160/14, the cost of restoration of a Nissan Almera car, state registration plate P 245 MS/150, taking into account the wear of spare parts, components and assemblies to be replaced, is: 114,827.27 rubles. (p. 13 Conclusions).

The estimated amount of damage from damage to the car not compensated by the Insurer is:

114827.27 rubles –68760.33 rubles = 46066.94 rubles.

Due to a traffic accident, I incurred the cost of evacuating my car from the scene of the accident to the parking lot in the amount of 3,000 rubles. The cost of expert services is 5,000 rubles.

The total amount of damage not compensated by the Insurer is:

46066.94 rubles + 3000 rubles + 5000 rubles = 54066.94 rubles.

In accordance with the above, guided by Article 16.1 of the Federal Law of April 25, 2002 N 40-FZ (as amended on July 21, 2014) “On OSAGO”

Within 10 working days from the date of receipt of this claim, pay me an insurance compensation in the amount of 54,066.94 (fifty-four thousand sixty-six rubles, ninety-four kopecks).

Please transfer the specified amount using the following details (indicate account and bank details).

In case of failure to comply with the requirements specified in the claim, I reserve the right to apply to the court for forced collection from the Insurer of the amount of the specified insurance payment, a penalty (penalty) for late claims for insurance payment, a fine and legal expenses.

a copy of the agreement - invoice No. 127 dated November 5, 2014 for payment for tow truck services, a receipt for payment for the services of an expert - technician, expert opinion No. OA -160/14 on the cost of restoration of a Nissan Almera car, state registration plate R 245 MS / 150.

December 01, 2014

Dear readers, using the example of a sample claim to an insurance company in case of an accident, we examined one of the possible options for filing the victim’s claims against the insurer arising from the MTPL agreement.

It should be remembered that the content of the claim in each individual case is determined by the nature and extent of the harm caused, as well as the degree of violation of the rights of the victim.

How to submit an application to an insurance company for compensation under compulsory motor liability insurance?

If an insured event occurs, the car owner can count on compensation from the insurance company for the losses incurred. To do this, a statement is written to the insurance company.

The application must be filled out exactly according to the rules. How quickly and to what extent the injured party can expect to receive an insurance premium depends on how well it is drawn up.

The application form can be obtained directly from the insurance company’s office or downloaded in advance from the insurer’s website and filled out at home in a relaxed environment.

How to compose it?

When filling out an application for insurance compensation for losses, the following is written::

1. The name of the insurance company (it must be full) where the document is being submitted. If an accident on the road is registered under the Europrotocol, then the payment (up to 100 thousand rubles) is received from the company with which the agreement on insurance compensation for material damage was concluded. In other cases, the application is written in the name of the insurer, which has an agreement with the person at fault for the accident.
2. Full name of the affected person, if it is a legal entity, then its name.
3. Victim's address.
4. If the applicant is not the owner of the car, but his representative, then the data of the representative and details of the power of attorney are needed.
5. The date and time of the accident on the road, the location is also indicated.
6. What damage was caused as a result of the accident (write separately whether damage was caused to property or to human health and life).
7. Detailed circumstances of the accident on the road, they may be relevant to obtaining insurance compensation.
8. How was the accident recorded?
9. Detailed information about the vehicle driven by the party at fault in the accident (model, make of car, registration numbers, etc.). Details of the at-fault party's insurance policy are provided.
10. Information about the property of the victim who suffered damage (model and make of car, state sign, VIN number, etc.).
11. Possibility of sending a damaged car for examination.
12. Additional expenses incurred by the injured party after the accident (payment for a tow truck, storage of the car and other expenses).
13. The method by which the injured party wishes to receive insurance payment for damages in an accident.

• Download the application form for insurance payment under MTPL
• Download a sample application for insurance payment under MTPL

Deadline for filing an accident

An application for an insured event and payment of compensation must be submitted to the insurance company no later than 7 days. As for the timing, there may be a different rule; it must be reflected in the insurance contract.

The insurer can be notified in different ways:

• you can contact the insurance company office directly with a statement;
• make a phone call;
• There is a special form on the insurance company’s website through which you can apply.

After the insurer is notified that an accident has occurred, the victim must collect all the necessary documents within 5 days (if the accident occurred in the city) or within 15 days (if the accident occurred in a remote area).

Insurance payment is made on the basis of a written application and documents that confirm the occurrence of an insured event (more information about what constitutes an insured event under MTPL can be found here). In order to receive insurance compensation without problems, you must adhere to the deadlines established by law and the concluded compulsory insurance agreement.

What documents should I attach?

When an application is submitted, certain documents should be attached to it that confirm the occurrence of an insured event (compulsory car insurance rules, chapter 3, clause 3.10) :

1. A notarized copy of the passport of the driver who is applying for insurance compensation. The passport does not have to be certified by a notary; this can also be done by an employee of the insurance company.
2. If the application is submitted by a person who acts under a power of attorney, then a copy of his passport and power of attorney is needed.
3. Documents for the car (title, registration certificate, rental or leasing agreement).
4. Bank details of the person who will receive compensation for damages in case of an accident. Such a document must be provided if compensation will be paid in money.
5. If traffic police officers were present at the accident, then a certificate of the accident is required.
6. If traffic police officers were not called to the scene of the incident, a completed notification is required. Such a notice is signed by both parties to the accident.
7. Copies of the protocol on administrative violation.
8. Refusal to initiate criminal proceedings.

If, as a result of an accident, the victim’s health was harmed, then additional documents must be provided (clause 4.1 of Chapter 4 of the OSAGO Rules):

If the victim was provided with medical assistance at the scene of the accident, then a certificate from the ambulance is needed.

If the victim went to the hospital himself, medical documents are provided.

If the policyholder has lost the ability to work for a certain period of time, a conclusion from a medical commission is required.

You can find out more about the assessment of damage caused to health during compensation for moral damages in an accident here, and in more detail about how to obtain compensation for health damage under compulsory motor liability insurance in the event of an accident, you can find out in this material.
If the victim demands compensation for lost income, then you need (clause 4.2) :

1. Medical certificate that the victim is incapacitated.
2. A certificate of average income is provided from the place of work.

If you need to compensate for additional expenses (payment for medications, prosthetics, etc.), then the insurer must provide the relevant documents (medical reports, paid checks). If any documents are missing, the insurance company has the right not to pay anything.

Once the refund application and all necessary documents are submitted, the insurance company has 20 days to pay compensation to the policyholder . If, as a result of the accident, damage was caused not only to the car, but also to health, then a claim is submitted to the insurance company of the person responsible for the accident.

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Sample claim for insurance compensation for road accidents

• Car insurance
• Housing disputes
• Land disputes
• Administrative law
• Participation in shared construction
• Family disputes
• Civil law, Civil Code of the Russian Federation
• Consumer rights Protection
• Labor disputes, pensions

• home
• Pre-trial claim to an insurance company (OSAGO): for insurance compensation or direct compensation for losses

In order to comply with the mandatory pre-trial procedure for resolving disputes from the compulsory motor liability insurance contract, the victim requests (select the desired option of the claim and to which insurer or RSA it is addressed):

• make insurance compensation within the period established by law;
• make additional payment of insurance compensation in accordance with the established procedure.

_________ (name of the
victim’s liability insurer for direct compensation of losses/
or the tortfeasor’s liability insurer/

or the Russian Union of Auto Insurers
for compensation payments) address: _____________

from __________ ( name or full name of the victim )
address: _________, telephone: ________, fax: _______,
email address: ______________

Demand (claim)
for insurance compensation or direct compensation
for damage caused by an accident

As a result of a traffic accident (accident) that occurred “___”_______ ___ year at _____ hours ____ minutes at the address: ___________ under the following circumstances: _________________ involving vehicles _____________ ( indicate the full name of the drivers, make, model, state registration numbers of vehicles, names of insurers, details of MTPL insurance policies ) the vehicle ( as an option: other property ) _________ ( indicate the name or full name of the victim ) suffered damage in the form of _________ ( for example, mechanical damage... list specific damage ) in the amount of _____ rubles, which is confirmed by _________ ( for example, the conclusion of an independent examination (assessment) dated "___"_________ ___ year N _____ ).

_____________ was found guilty of the said accident, which is confirmed by ___________ ( for example: a protocol and a resolution on an administrative offense or a ruling refusing to initiate a case for an administrative offense, a notification of an accident in the case of registration of documents about an accident without the participation of authorized police officers ).

By decision ___________ ( indicate the name of the victim's liability insurer for direct compensation of losses / or the tortfeasor's liability insurer / or the Russian Union of Auto Insurers for compensation payments ) dated "___"_______ ___ year N ___) ___________ ( indicate the name or full name of the victim ) insurance compensation was refused (as an option: insurance compensation was paid in the amount of ________ rubles (not in full)).

According to paragraph 1 of Art. 16.1 of the Federal Law of April 25, 2002 N 40-FZ “On compulsory insurance of civil liability of vehicle owners”, before filing a claim against the insurer containing a claim for insurance compensation, the victim is obliged to contact the insurer with a statement containing a claim for insurance compensation or direct compensation losses, with documents attached to it, provided for by the rules of compulsory insurance.

If there are disagreements between the victim and the insurer regarding the latter’s fulfillment of his obligations under the compulsory insurance contract before a claim is filed against the insurer arising from non-fulfillment or improper fulfillment of his obligations under the compulsory insurance contract, the victim’s disagreement with the amount of the insurance payment made by the insurer, or the service station’s failure to comply with the transfer deadline to the victim of a repaired vehicle, violation of other obligations to carry out restoration repairs of the vehicle, the victim sends a claim to the insurer with documents attached to it and substantiating the claim of the victim, which is subject to consideration by the insurer within ten calendar days, with the exception of non-working holidays, from the date of receipt. During the specified period, the insurer is obliged to satisfy the demand expressed by the victim for the proper fulfillment of obligations under the compulsory insurance contract or send a reasoned refusal to satisfy such a demand.

Based on the above and guided by paragraph 1 of Art. 16.1 of the law on compulsory motor liability insurance, I ask you to make insurance compensation ( as an option: additional payment of insurance compensation ) in the amount of ________ rubles by ________ in the following order: ________.

Note: insurance compensation is carried out in the form of an insurance payment by receiving the amount at the insurer's cash desk or transferring the amount of the insurance payment to the bank account of the victim (beneficiary) or by organizing and paying for the restoration of the damaged vehicle at a service station.. (See paragraph. 33 Resolution of the Plenum of the Supreme Court of the Russian Federation dated December 26, 2017 N 58 “On the application by courts of legislation on compulsory insurance of civil liability of vehicle owners”)

Appendix:
1. Copy of the Compulsory Civil Liability Insurance Agreement for vehicle owners dated “___”________ ____, N ___.
2. A copy of the protocol and resolution on an administrative offense or a ruling on refusal to initiate a case on an administrative offense.
In case of registration of documents about a traffic accident without the participation of authorized police officers, a notification about the traffic accident is provided. 3. Documents confirming the amount of damage caused.
4. Power of attorney of the representative dated “___”_________ ___ city N ___ ( if the request is signed by the applicant’s representative ).
5. Other documents confirming the circumstances on which the applicant bases his claims.

“__”_______ ___ city ______________ / Signature ________ / Full name

Comments:

Taking into account that paragraph two of paragraph 1 of Article 16.1 and paragraph 3 of Article 19 of the Law on Compulsory Motor Liability Insurance establishes a mandatory pre-trial procedure for resolving disputes arising from the compulsory motor liability insurance agreement, the victim has the right to file a claim from the day he learned or should have known:

• on the insurer’s refusal to provide insurance compensation or direct compensation for losses by organizing and paying for the restoration of the damaged vehicle at a service station or issuing the amount of the insurance payment, or
• about the implementation of insurance compensation or direct compensation for losses not in full.

In addition, the victim has the right to file a claim from the day following the expiration of the twenty-day (thirty-day) period (except for non-working holidays) from the date of filing the application for insurance compensation with the submission of all necessary documents for the insurer to make a decision on organizing and paying for the restoration of the damaged vehicle funds at a service station or for the issuance of the amount of insurance payment (clause 15.3 and clause 21 of Article 12 of the Law on Compulsory Motor Liability Insurance).

For more details, see paragraphs. 92 - 96 Resolution of the Plenum of the Supreme Court of the Russian Federation dated December 26, 2017 N 58 “On the application by courts of the legislation on compulsory insurance of civil liability of vehicle owners”