How to use the insurance policy

How to use the insurance policy

The OSAGO system has existed for more than ten years and during this time has undergone quite significant changes. Motorists often have questions in the insurance case on how to properly use the policy. Here are answers to the most common questions.

How to make an accident

Today there are two options available for registering accidents: without involving traffic police officers (Europrotocol) or with involvement. About how to properly arrange Europrotocol, we wrote in detail earlier . This method of completing an accident will save time, but may lead to problems with obtaining insurance payments due to incorrect paperwork or incorrect assessment of the possibility of using the euro protocol. Non-compliance by the culprit with the conditions in the direction of his part of the form to the insurer and the presentation of the vehicle (TS) for inspection will allow the insurer to recover from him the amount of payment in recourse.

If the registration of the Euro protocol is not possible, it is necessary to fix the accident in the traffic police. From July 1, 2015, depending on the situation, the traffic police officer when receiving a call can indicate the place of registration of the incident: either at the scene of an accident, or at the nearest post or at the traffic police department. During the waiting period for police officers, it is necessary, together with other participants, to fill out a road accident notice form. If the registration does not occur at the scene of an accident, then, according to paragraph 2.6.1. Traffic regulations, it is necessary to fix the circumstances of the accident (video plan, vehicle position, braking traces, etc.) using video and photography, and only then leave the scene of the accident.

If the culprit of the accident disappeared from the scene, it is imperative to call the traffic police and transfer all available information about the culprit. The insurance payment will be made only if there is an identified culprit of the accident and the data of his insurance policy.

When processing any documents, it is desirable to control the correctness of their filling, which in the future will help to save a lot of nerves and time. All fields must be filled, and the information should not be contradictory. In the Europrotocol and in the certificate of accident, all visible damages must be recorded, otherwise they will be excluded when calculating the payment.

In addition to a certificate of an accident, it is necessary to obtain copies of all documents drawn up as part of an administrative or criminal procedure (protocols, decisions, definitions). In case of harm to life or health, documents are added to them confirming this or that damage (death certificate, medical documents, etc.).

In the event that there was damage sustained before the accident on the element of the car damaged in the accident, damage in the amount of non-related damage will not be compensated. This is motivated by the absence of losses in accordance with paragraph 2 of Article 15 of the Civil Code. The logic is this: if the element required repair earlier, then when new damage occurred with the same amount of repair, additional losses did not occur. Upon receipt of new injuries after an accident, it is advisable to fix them in the competent authorities.

Where to go in case of an insured event

Since August 2, 2014, the regulation on “non-alternative direct compensation for losses” has been in force. You need to contact your “insurer” in the same cases when it is possible to use the Euro Protocol, but if there are traffic police documents there is no restriction of 50,000 rubles. In other cases, you need to contact the insurance company responsible for the accident or to its representative in the region. If there are several culprits of the accident, the victim has the right to contact the insurer of any of the culprits.

After submitting the application and the necessary documents, the insurance company must conduct an inspection on its own or appoint an independent examination. It is necessary to provide the vehicle for inspection within five days, the time and place of the inspection must be agreed with the victim. If the insurer has not conducted an inspection or an independent examination, the victim has the right to conduct an examination on his own, and the insurer must use it to determine the amount of payment. Examination costs are included in the insurance benefit.

When making an accident within the framework of the Euro protocol, both parties are obliged to provide their insurers with their copies of Euro protocol forms within five days from the moment of the accident and not to repair the vehicle within 15 days, since the insurer can request the vehicle for inspection.

If the culprit does not have a CTP policy, the culprit must compensate the damage. The exception is accidents that have resulted in harm to life or health when you need to apply for a compensation payment to the Russian Union of Auto Insurers (RSA).

If a license is revoked from the insurer, bankruptcy proceedings are started, or the insurer is excluded from the direct compensation of losses agreement, the victim contacts the insurer of the perpetrator, and if the perpetrator uses the same sanctions, compensation is paid to the RSA. In addition to these cases, compensation payments can be made for harm to life and health if the culprit of the accident is unknown. The procedure for applying to PCA is no different from the standard procedure for resolving losses.

Separately, it is worth mentioning the constituent entities of the Russian Federation, where insurers moved the claims settlement centers to a considerable distance from the capitals. The most suitable option in such cases is an independent organization of examination with notification to the insurer of the date and place of inspection and sending a full package of documents to the official address of the insurer by mail with notification of delivery.

Determining the size of the payment and its maximum size

Sum insured has been increased relatively recently. For contracts concluded after September 1, 2014, the maximum amount of payment for property damage is 400 thousand rubles for each victim. For contracts concluded after April 1, 2015, the limit of payment for harm to life and health is 500 thousand rubles for each victim (previously – 160 thousand rubles). The amount of payment for harm to life is fixed and amounts to 475 thousand rubles, which are paid to the close relatives of the victim, whose circle is fixed by law. Additionally, documented burial expenses in the amount of not more than 25 thousand rubles are paid to the person who incurred expenses.

The amount of payment for harm to health is determined by a special table approved by government decree No. 1164 of October 15, 2015, and depends on the severity of the injuries. If the actual costs of treatment and lost earnings exceed the payment, the victim has the right to demand additional payments, confirming the expenses with documents.

The amount of payment for damage to property is determined by the results of inspection of damaged property by an insurer or an independent examination. The methodology for determining the extent of damage to vehicles is approved by the Bank of Russia, and the cost of materials and spare parts is approved by the RSA and is periodically reviewed. Particular attention should be paid to the completeness and correctness of the description of damage in the inspection report, on the basis of which the calculation is made. If the cost of the repair repair exceeds the cost of the car before the accident or if the car cannot be restored, the cost of the car before the damage is paid minus the value of the remaining balances.

If mutual guilt is established or if the culprit of the accident could not be established, the payment shall be made in equal shares, unless otherwise established in court.

Upon receipt of payment under the Euro Protocol, the victim has the right to demand compensation for losses in excess of the established limit only if harm has been caused to life and health, which the victim did not know about at the time of the accident. In this case, the victim turns to the insurer of the culprit.

How is payment made?

Payment for damage caused to the car is possible both in cash and in the form of a referral to a service station. Payment in kind covers most of the issues related to insufficient assessment of damage (except for vehicles with significant depreciation), but there are questions about the choice of service that suits the parties. Today, without the consent of the insurer, such a payment is impossible.

In all other cases, payment is possible only in cash. Payment is made within 20 calendar days (excluding holidays). At the same time, the insurer, if there is reason, must send a reasoned refusal to pay.

In case of violation of the terms of payment, the insurer is obliged to pay a penalty in the amount of 1% of the amount of payment, and if the deadlines for sending the refusal are not observed, a sanction of 0.05% of the amount of the insurance amount should be made according to the type of damage caused for the day of delay.

If the payout is not enough

It is necessary to determine whether the insurer has fulfilled its obligations in full, since due to the depreciation and fixed cost of spare parts and materials, absolutely legitimate payments may not be enough. Request from the insurer an insurance certificate with an inspection report and costing of damage that he must provide within three days after the request, and if necessary, make an examination. The existing methodology for calculating damage recognizes as a statistical error a discrepancy of up to 10% between the calculations of two examinations. If the payment is underestimated, be sure to apply with a pre-trial claim, enclosing documents justifying the need for an additional payment. The insurer must respond to the claim within five days. If there is no surcharge, go to court.

When interacting within the framework of a loss settlement procedure, insurers are very formal in their approach to all procedures, which is probably inevitable. It is important to act in the same formal vein. Stormy emotions when dealing with employees of insurers usually do nothing. If there are disagreements, it is better to require formal (written) answers. When concluding a contract, try to choose the most loyal insurer, since in most cases you will have to turn to him. The best idea of ​​loyalty is given by the “People’s Rating” , compiled on the basis of customer reviews, and you can always calculate the cost of the service on a special calculator .

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