What to do if the insurance does not pay for compulsory motor third-party liability insurance, underestimates the amount of compensation, delays the terms of payments, does not respond to claims and complaints; procedure for pre-trial and judicial settlement of the conflict
The adoption of the law on compulsory motor third party liability insurance allows solving many problems that arise in connection with an accident on the road and the need to compensate for damage caused to injured persons.
However, there are frequent cases when the insurance does not pay for compulsory motor third-party liability insurance at all or delays the payment terms for a long period of time. What can be done in this case, you will learn from the article.
When the insurance does not pay CTP
Each policy holder should be well versed in the nuances of the “auto citizen” and understand when compensation is due to the injured party, in what amount, for how long it is paid.
The law provides for a number of reasons why the insurer has the right to refuse to pay compensation.
You can familiarize yourself with them by studying carefully:
- Civil Code of the Russian Federation,
- Federal Law on CTP,
- OSAGO rules approved by the Bank of Russia.
According to these regulations, an insurance company does not pay for compulsory motor liability insurance if:
- there is no confirmation of the fact of the insured event or it is not possible to determine the exact amount of damage (for example, if the injured car was promptly repaired or disposed of);
- the culprit of the accident did not have a valid policy at the time of the accident;
- the insurer did not receive traffic accident reports from the policy holder;
- the injured person wants to receive compensation for lost profits, moral damage;
- the car was damaged during competitions, trials, training driving on a special site;
- the cause of the damage was a special cargo transported by car (subject to mandatory transportation insurance);
- the culprit of the damage is the policyholder himself, who provoked an accident or caused harm to his own car;
- the vehicle is damaged during loading;
- harm caused to persons in the performance of their duties will be reimbursed under the MHI or other policy;
- damage to passengers during transportation will be reimbursed for another type of insurance;
- the damage was caused to the special types of property listed in article 6 of the Federal Law on compulsory motor third-party liability insurance (cultural monuments, antiques, etc.);
- damage to nature and the environment (e.g. fuel spills);
- force majeure – circumstances that are unpredictable and not amenable to human influence (floods, war, etc.).
All of the above reasons are a legitimate reason for refusal, in other situations the insurer is obliged to compensate for the damage.
When insurance delays the payment period
The rules provide for specific periods for payment of compensation:
- 20 business days are given for consideration of the general case,
- 30 working days are allotted to resolve the issue of reimbursement if the car was put in for repair after approval by the insurer.
Within the specified time period, the insurer must make a payment or issue a written refusal indicating the reason. The injured person has the right to appeal the refusal in court.
When insurance pays little
There are also frequent cases when insurance under low liability insurance pays a little. Motorists should remember about the limit on the “citizenship”.
According to the current legislation, it amounts to:
- 400 000 rubles – on property,
- 500 000 rubles – in case of death or damage to human health.
In cases where the amount of damage exceeds the established limit, the missing amount is recovered from the culprit.
The loss is calculated either in accordance with statutory standards or in accordance with the assessment of the insurer.
In the first case, when a person dies, the cost of a funeral in the amount of 25 thousand rubles is reimbursed, and the remaining 475 thousand within the limit are paid to the relatives of the deceased.
The second option is more flexible and allows insurers to underestimate the amount of compensation using various tricks (the connection of damage with a specific insured event is denied, individual details are not included in the damage list, etc.).
The best way to avoid artificially lowering the damage is an independent examination, to which you can invite a representative of the insurer.
Court proceedings take a lot of time and energy and are an extreme measure that should be resorted to in exceptional cases. If the insurance does not pay for compulsory motor third-party liability insurance, first try to solve the problem in other ways.
If you have any doubts about the honesty of the insurer and the accuracy of calculating the loss, contact an independent expert. You can do it this way:
- Select a company or individual licensed specialist and enter into an agreement.
- Agree on the time for an independent review.
- Notify the insurer of the time and place of the event. The best way is to send a telegram or registered letter of acknowledgment of receipt in order to obtain confirmation that the insurer has been notified of the examination in advance.
- The examination may be carried out in the presence of or without the representative of the insurer, if he did not appear at the indicated time. This does not affect the result and reliability of the procedure. An insurer present at the place can ask questions, monitor the work of an independent expert.
- Send the expert’s opinion with the attached photographs to the insurer along with your claim. Keep the second copy at home, it can be useful in court.
Filing a claim
If you do not agree with the actions of the insurer and the amount of compensation for loss, then you must first file a claim. In it, indicate the mistakes made by the insurer (underestimated amount of compensation, delay, illegality of the refusal to pay, etc.).
The law obliges insurers to resolve this issue within 10 business days. During this time, he is obliged to correct these errors or issue a written refusal with which the policyholder can go to court.
You can also complain to RSA as a higher authority that is responsible for the actions of all Russian insurers. Write a complaint, attach all the necessary documents and photos to confirm your claim, send it all to the PCA.
If the essence of the matter is the amount of insurance compensation, then you better go to court immediately. The PCA usually deals with gross violations of the law (for example, refusal to pay, the requirement to provide additional documents not prescribed by the rules) and payments in case of bankruptcy of the insurer.
Complaint to the Central Bank of the Russian Federation
You can complain about your insurer to the Bank of Russia supervisor. However, the CBR does not deal with conflicts, but only responds to direct violations of the law.
If the insurance company refuses to pay CTP or does not respond to a claim regarding an underestimated amount of compensation, filing a lawsuit will be the best way. It is the court that collects fines for violation of laws, compensation for damage caused and compensation for non-pecuniary damage.
You can file a lawsuit at any time if the insurer did not satisfy your claim or did not give a timely response to it. This must be done as follows:
- Write a statement of claim, indicate in it the violations committed by the company, provide evidence that the insurer acted illegally.
- Pay the state fee.
- Make photocopies of documents proving your correctness and the fact of violation by the insurers of the rules for considering the case: a claim, a company’s refusal to pay, an independent expert opinion, a telegram about it and other important evidence that you have. Copies will be attached to the case, the originals you will need to present at a court hearing.
- Submit the claim, photocopies of the documents and the receipt of payment to the court. This can be done in person by contacting the registry of the court, or send by registered mail.
At the hearing, you must prove your case. You can use photographs, videos, witness statements, documentation, and any other arguments.
You have the right to ask the court for help if you are not able to independently obtain any evidence. Then the judge will officially request him from the agency that can provide him.
After consideration of the case, the court will decide in favor of one of the parties. If you are denied compensation, you can appeal the verdict to a higher court.
If after sending the claim the insurance company within 10 working days did not give your answer, you can write a complaint to the RSA or the Central Bank or immediately file a lawsuit.
A 10-day period is counted from the moment of filing a claim:
- if you submitted it personally at the company’s office – from the day of reception
- if sent by mail, from the day the recipient received the letter (the date and signature of the representative should be in the notification).
Non-pecuniary damage is compensated under the law “On the Protection of Consumer Rights”. However, if you believe that the refusal or untimely payment of compensation under OSAGO caused you additional psychological damage, then theoretically you can demand compensation in court.
You will have to provide convincing evidence that you have suffered from the unauthorized actions of the insurer.
In fact, such compensation can be achieved, however, in most cases, the court either refuses moral damages in general, or underestimates the required amount to a minimum.
Many motorists are interested in the question of whether the insurance pays the culprit of the accident for compulsory motor third-party liability insurance. We remind you that compulsory motor third-party liability insurance is third party liability insurance, therefore all payments are made not to the culprit of the accident, but to persons affected by his actions.
Losses associated with damage to the car of the culprit of a traffic accident are covered by another type of car insurance – comprehensive insurance.
Now you know the deadlines for considering losses and claims by insurers, where to complain if a company is suspected of dishonesty, and how to achieve fair compensation for losses through a court.
We hope that this will help you quickly and correctly resolve all issues with the insurer in the event of an accident and damage to your car.