Despite the widespread use of comprehensive insurance in the Russian Federation, many consumers of this service still have the opinion: “I have full insurance, and to get reimbursement, I just need to notify the insurance company.” Unfortunately, this is far from the case.
All obligations of the policyholder in the event of an insured event are reflected in the insurance rules, which are an integral part of the comprehensive insurance contract. The insurer will demand full compliance with these conditions, until they are fulfilled it will not pay, and if the conditions are not met, it may refuse to reimburse.
How should the policyholder act in order to receive the insurance indemnity in full and with the least amount of time?
First, the car should be operated taking into account the requirements of the SDA and the manufacturer. The rules of many insurers contain formulations that allow refusal to be refunded in case of any non-conformities. The most common examples of violations are installation of equipment not certified by the manufacturer, tinting of the front windows and tire wear. The causal link between the violation and the case is sometimes obvious, and often the insurer can be guided by a formal sign.
Secondly, it is necessary to fulfill the obligations stipulated by the contract and be sure to inform the insurer about the events reflected in the section “Changing the degree of risk”. Particular attention should be paid to the storage of registration documents, keys and key fobs from the alarm, as well as the operability of anti-theft devices, if they are provided for by the contract.
If the car is damaged as a result of any event, all reasonable measures must be taken to prevent further damage and report the incident to the competent authorities and the insurer. Before calling the competent authorities, it is necessary to determine whose competence is the investigation and documentation of the event. A call can be made to number 112 from a mobile phone, where the operator will connect to the desired recipient or provide the desired number.
All cases that occurred while the vehicle was in motion are within the competence of the traffic police. The competence of this service also includes damage to a parked car, if the nature of the damage clearly indicates the participation of another vehicle (wide scuffs with traces of paint, characteristic dents, etc.). In accordance with the instruction of the Central Bank of the Russian Federation No. 3380-U dated September 12, 2014, insurers are obliged to provide in the insurance rules the possibility of an accident statement drawn up without the participation of the traffic police in the procedure established by the law on motor third party liability insurance and traffic rules. But in order to avoid controversial situations, study the rules of insurance for the presence of a corresponding reservation.
Registration of any other cases, except for a fire, whether it is damage by unauthorized persons or animals, ice falling from the roof of a house or branches from trees, theft of a car and its individual parts, or damage as a result of a natural phenomenon, are executed by the police department. Cases of fire are the responsibility of the fire service, which, when the fact of arson is established, will independently inform the police officers.
Until you receive instructions from representatives of the competent authorities and the insurer, do not move the car away and do not remove items related to the case (the advice does not apply to a number of accidents, as from July 1, 2015, changes to clause 2.6.1. SDA provide for a different procedure). Try to find witnesses to the case and record their contact details. If there is a potential culprit of the case (formally it is in all cases due to violation of the rules for the operation of buildings and territories by relevant organizations), it is necessary to establish and record its data (full name or name of organization) and address of registration / location. In case of an accident, additionally write down the number and validity of the insurance policy and the name of the insurer that issued it, but it is better to fill out a notice about the accident. It is advisable to fix the place of the incident, the surrounding territory, damage to the car with the help of a photo or video recording, which will allow the competent authorities and the insurer to “restore” the circumstances of the damage as fully as possible and capture the originals of the documents of the culprit in case of errors in writing their details.
Wait for the arrival of police officers and make sure that the case is correctly recorded in the relevant documents. The documents must contain the date, time and place of the event, the identification data of the car and the owner (in the case of an accident and the driver), clearly interpreted circumstances of the case, indicating the information of the culprit (if any) and a full list of visible damage or stolen parts of the car. Make sure that the circumstances indicated in the documents do not differ from the real and previously reported to the insurer.
Do not try to fix the damages received in circumstances other than those declared to the insurer and the competent authorities, or “collect” all the damages on the car in one case. In most cases, proving the opposite with the help of a trasological examination is not very difficult for the insurer. The risk of obtaining documents from police officers in which “the date, time and circumstances of the case are not established”, and in the worst case, initiating a criminal case under article 159.5 “Insurance fraud”, the composition of which is ideally applicable to the described situation, also increases. In most such cases, a full or partial refusal of payment will follow.
When submitting a written application to the Department of Internal Affairs, avoid the phrases: “I have no complaints to anyone, I applied for information to fix the fact of damage to the car” and “the damage is insignificant for me (including due to the availability of insurance)”. On the basis of such phrases, police officers may refuse to initiate criminal proceedings with a certain wording (including due to the absence of a crime event, clause 1, part 1 of article 24 of the Criminal Code of the Russian Federation), and the insurer, on the basis of this wording, refuse to pay.
In practice, such cases are becoming less common, since police officers are increasingly using different wordings, and insurer’s refusals on such grounds are unpromising in a judicial dispute. A number of insurers continue to use the appropriate wording in insurance policies. So, for one of the largest Casco insurers in the current insurance rules, the risk of personal income tax is designated as the actions of third parties qualified by authorized bodies on the grounds of offenses and (or) crimes stipulated by the legislation of the Russian Federation. With this wording, a refusal to initiate a criminal case under paragraph 1 of part 1 of article 24 of the Criminal Code of the Russian Federation will not allow the event to be recognized as an insurance case.
If, as a result of damage, access to the car is facilitated (windows are broken, doors do not close, etc.), after completing the case, the competent authorities must ensure that the car is stored in a guarded parking lot. A number of insurers can provide such a service at one of the contractual services, as well as the evacuation (if necessary) to the parking lot. The availability of such an opportunity must be clarified in the insurer’s support service.
Your further actions – a written statement to the insurer about the occurrence of the event and the provision of supporting documents. It does not make sense to dwell on the list of documents in detail, since their list is given in the insurance rules of all insurers . To reduce the time for visits to the insurer, upon receipt of documents from the competent authorities, it is necessary to carefully study them for correct filling (there should be no discrepancies and errors in writing the reflected information, all visible damage resulting from the incident should be reflected, and if the document requires certain columns, then all of them must be filled). If an error is found, you should ask the police officer to fix it and verify the correction.
After writing the application, it is necessary to take a receipt from the representative of the insurer in the receipt of the application and documents (the application forms for insurance cases used by insurers usually require special sections for this), agree on the compensation form (repair or money), as well as the date and place of inspection. Having provided a clean car if possible for inspection at the agreed time, you will fulfill your obligations under the contract, and you will only have to wait for the insurer’s decision to recognize the event as an insured event.
In the event of the car’s death or theft, after the event is recognized as an insured event, it is necessary to draw up a number of documents transferring ownership of the car to the insurer or leaving the remainder with the insured .
The procedure does not change if the loss is settled using the emergency commissioner or the remote settlement service at the dealer service. Only the place of submission of documents is changing.
Many insurers provide the opportunity to report a number of cases without contacting the competent authorities, limiting the payment to any condition (amount of damage, number of damaged elements). The service is certainly convenient, but before using it you need to carefully study the interpretation of the relevant clause of the contract and insurance rules. The greatest difficulty in using such a service is the determination of the amount of damage.
PS The Council is not focused on current judicial practice, according to which most of the grounds for refusal or non-recognition of a case as insurance, reflected in the current insurance rules of various insurance companies, are void. Current practice has developed in favor of the insured, which is largely the fault of the insurers themselves. It is very likely that in case of refusal on many of the grounds listed in the council, compensation will be collected in court, but this is an additional time cost, and judicial practice may change. Just five years ago, in a lot of controversial issues, judicial practice was the opposite.