Actions of the insurer upon the occurrence of an insured event. Insurance case

When an insured event occurs under an insurance contract, the policyholder or beneficiary is obliged to notify the insurer about it immediately or within the time frame and in the manner specified in the insurance contract; the policyholder taking reasonable and available measures under the current circumstances to reduce possible losses; if the insurance contract is concluded in favor of a person other than the policyholder, the insurer has the right to demand from the beneficiary, when presenting a claim for insurance payment, to fulfill those obligations under the insurance contract that lay with the policyholder, but were not fulfilled by him. In this case, the beneficiary is responsible for the consequences of failure to fulfill or untimely fulfillment of obligations.

The insurer carries out a number of actions (liquidation of the consequences of the insured event): establishing the fact of the insured event (investigation of the circumstances of the incident, causes); calculation of the amount of damage and insurance payment; making insurance payments; taking measures to return amounts related to the insured event.

Grounds for releasing the insurer from the obligation to make insurance payment:

If the insured event occurred as a result of the intentional actions of the policyholder;

If the insured event under the property insurance contract occurred due to the gross negligence of the insured;

If the policyholder fails to notify the insurer or his representative in the cases established by law and within the stipulated time frame of the occurrence of an insured event, unless it is proven that the insurer learned about it in a timely manner without such notification or that the insurer’s lack of information about the insured event could not affect his liability make an insurance payment.

8. General characteristics of civil liability insurance

Liability insurance is a branch of insurance where the object of insurance is the liability of the insured to 3 persons (individuals and legal entities) who may suffer damage as a result of any action or inaction of the insured.

The immediate purpose of liability insurance is to provide insurance protection for the interests of policyholders as potential tortfeasors and third parties who suffered damage. The participants in liability insurance are the insurer, the policyholder and third parties not determined in advance.

Liability insurance provides the possibility of compensation for damage caused to both health and property of third parties.

Civil liability is of a property nature: the person who caused the damage is obliged to fully compensate the losses to the victim, i.e. to a third party. Through the conclusion of a civil liability insurance contract, this responsibility is transferred to the insurer. For the damage caused, the policyholder may bear criminal or administrative liability, i.e. be prosecuted by law for their illegal actions towards a third party. However, compensation for property damage caused to a third party is transferred to the insurer.

According to the terms of licensing of insurance activities on the territory of the Russian Federation, the following types of liability insurance include:

Civil liability insurance for vehicle owners;

Carrier civil liability insurance;

Insurance of civil liability of enterprises – sources of increased danger;

Professional liability insurance;

Liability insurance for non-fulfillment of obligations;

Insurance of other types of liability.

9.General characteristics of motor transport insurance: object of insurance, insurance risks, insurance period.

Objects of fear are transport vehicles that are subject to registration by the State Traffic Safety Inspectorate of the Russian Federation in the prescribed manner, i.e., these are light, cargo, and cargo-passenger vehicles; minibuses, including those with trailers; railway rolling stock; motorcycles, scooters, sidecars, snowmobiles, mopeds, tractors. Simultaneously with the transport medium m.b. stranded: driver and passengers; additional equipment and accessories to the transport system; baggage. If the fear is realized not only of transport equipment, but also of luggage, as well as the response of an auto driver, then this is called fear combined.

The main contract is for 1 year or from 2 to 11 months, the additional one is for the period remaining until the end of the main one. Transport risk insurance: full insurance (against all risks) - compensation to the insured for losses caused by loss or damage to the vehicle, physical injuries to people and damage to property of the 3rd party; transit insurance - up to 30 days, providing insurance coverage for the duration of the journey to the destination; insurance of drivers and passengers against accidents - the insurer pays the insured amount if, as a result of an accident, the insured is injured or injured, disabled or killed; cargo insurance - with liability for all risks, for a private accident, without liability for damage, except in cases of a crash.

Feature of the fear of cars The fact is that insurance does not compensate the victim for damaged parts of the car, but pays for the restoration of the damaged car, costs and expenses for the rescue, protection and delivery of the damaged equipment to place of repair. Ground transport facilities m.b. insurances in the amount of their actual amount, including the amount of the trailer, or for a lesser amount, if agreed upon by both parties. When concluding an insurance contract, a preliminary inspection of the vehicle is required. The policy is usually issued to the policyholder after he has paid the insurance premium according to the terms of the contract. When the fear of the dog is closed A preliminary inspection of the transport facility is required. The policy is issued to the insurer after he has paid the insurance premium.

Upon inspection and seal of agreement The insurance company is obliged to provide information about the vehicle: car make, model, chassis number, engine number, year of manufacture, engine power and volume, cost of the vehicle, etc. By agreement of the parties SKey m.b. provided fear protection against the risks of damage and destruction of transport equipment resulting from: a derailment, accident, collision or derailment; fire, explosion; disaster (flood, hurricane, rain, earthquake, landslide, snowfall, lightning, tornado, hail); illegal actions of third parties.. From the moment the contract is concluded and the first payment is made, the fear of the insurance premium and the insurance company begins obligations which they must comply with.

When fear of an event occurs, fearmust: take measures to save the car, passengers and luggage, prevent their further damage and eliminate the causes; in the event of an accident, fire, explosion, theft of the car, parts and accessories and luggage, immediately report it to the police, traffic police, fire inspection authorities ; report any fear in writing; present to the Investigative Committee the damaged car before it is repaired or the remains of it; submit a certificate from the traffic police confirming the occurrence of an accident. When insuring vehicles, the average amount of damage is and the amount of insurance compensation is determined on the basis of the insurance act and documents attached to it confirming the fact insurancecase(accidents, theft, theft, fire, unlawful actions of third parties, etc.).

Fear compensation for a destroyed, damaged or stolen vehicle, payment is made in the amount of damage caused, but not higher than the corresponding amount.

Fear has the right to pay insurance costs for the restoration of the tran-go facility in the amount of the actual costs for its repair according to the prepared calculation. Insurance does not compensate for losses, arising fromreasons: intent to fear, violation of fire safety rules, storage and transportation of fire and explosive objects, operation of a faulty vehicle; driving without a license, while under the influence of alcohol or drugs; using trans for training purposes or to participate in competitions; military actions and events, as well as popular unrest, arrest.

If after payment there is no feardisplacement For a stolen vehicle, the vehicle was returned to its owner for some time, the insurer is obliged to return the amount of compensation received to the insurer.

When concluding a loan agreement with any bank, you will by default also need to enter into an agreement with an insurance company. Often an insurance company is part of a single structure with a bank, thus being affiliated with it. Of course, based on the principle of voluntary insurance, you have the right to immediately terminate the contract, but this rule is only valid if you have a consumer loan. The conclusion of an insurance contract is, in fact, mandatory, and if the borrower terminates the insurance contract, the previous terms of the loan no longer apply to him, in particular, interest on the loan will be charged at an increased rate.

In addition, lending agreements are necessarily accompanied by insurance, and the borrower cannot refuse it for these types of loans. Mandatory insurance of the collateral for a mortgage is stipulated by Federal Law No. 102-FZ “On Mortgage”. When lending a car, the collateral (car) is insured using the Auto Casco insurance system in accordance with Art. 343 of the Civil Code of the Russian Federation (“the pledged property must be insured at the expense of the pledgor against the risks of loss and damage”).

Purpose of borrower insurance

In addition, the borrower can insure his own risks: the risk of loss of life, work, productivity and health. These measures are understandable; they are aimed at insuring the borrower from negative changes in his situation, for example, from losing his job, health, etc. These are insured events, upon the occurrence of which the insurance company undertakes to pay compensation to the bank, thus taking on part of your obligations. But what if the insurance company does not pay when an insured event occurs? Go to law?

In recent years, classic insurance for bank loans has begun to be replaced by so-called “financial protection programs.” In essence, this is the same insurance, only under a different guise. In any case, the borrower, when taking out insurance, expects that if an insured event occurs, he will be insured, and the bank will receive appropriate compensation. However, even the most extensive insurance will not give you confidence that the occurrence of an insured event will necessarily result in compensation from the insurance company.

Interestingly, this situation, when an insured event occurs, but no payments are made by the insurer, is observed precisely with credit insurance. In such a situation, the question seems reasonable: isn’t credit insurance a useless tool if it is not able to protect the borrower in a difficult situation when, instead of receiving compensation from the insurance company, he still owes the bank?

Let's try to figure out what to do if the insurance company refuses to pay when an insured event occurs on the borrower's loan.

According to the terms of the insurance contract, the occurrence of an insured event is not the only condition for receiving compensation payments from the insurance company. In addition, the borrower is obliged to contact the insurance company only in accordance with a certain procedure and comply with additional formalities. However, even if all necessary conditions are observed, the borrower is faced with the fact that the insurance company seeks by all means to delay the fulfillment of its obligations or to reduce the amount of payments to a minimum. Knowing these features of the behavior of unscrupulous insurers, it becomes necessary to know your rights and obligations when executing a loan agreement.

The first thing you should do when an insured event occurs is to check the insurance contract and make sure that your case is actually covered in it. In general, of course, you should read the contract before signing it, but with regard to the insurance contract, few people follow this rule, since the insurance contract is usually signed simultaneously with the lending contract, and, as a rule, there is not enough attention to all the details of both contracts. You may find in the insurance contract that your case:

• Present and clearly and clearly marked.
• Absent at all.
• It seems to be present, that is, the wording in the contract is so vague and unclear that it can be interpreted in several ways.

It is clear that if your case is not specified in the contract at all, then you will not receive payment from the insurance company. It is more interesting with the option when the case is not clearly defined. In this case, the best thing you can do is contact an insurance lawyer who specializes in credit insurance. He will help you understand what is written in the contract and advise how you can apply this knowledge in a conversation with the insurance company.

Let's assume that your case is actually indicated in the insurance contract as an insurance case. What to do?

• First of all, you review the contract again to clarify the procedure for contacting the insurance company with initial notification in the event of an insured event and, most importantly, the timing of the complaint.
• If this information is clear, all we have to do is prepare the initial notification to the insurance company. Often, under the terms of the contract, the period for recourse in the event of an insured event is limited to several days, most often one or two days. During this period, you must draw up a notice and deliver it to the office of the insurance company in person or through an authorized representative. Try to get a mark confirming your acceptance of the document; the receiving person must put this mark on your copy of the notice, which remains with you.

The insurance company, having accepted your notification, will explain to you what documents it expects from you to confirm the occurrence of the insured event.

Usually this point does not cause complications. So, in case of death, a death certificate is presented, in case of illness or accident - medical certificates, and in case of loss of work - a copy of the order of dismissal for certain reasons.

If the insurance company refuses to pay compensation, what should you do?

Upon receipt of all documents from you, the insurance company begins checking the information provided. The inspection lasts for a certain time, established by the terms of the contract and internal work regulations. Based on the results of the inspection, during which the insurance company verifies the occurrence of the event specified by you in the notification, its proof and the possibility of recognition as an insured event, a decision is made on payment of compensation, its amount or refusal to pay (partial payment).

You receive a notification about the results of the inspection; if the insurance company refuses to pay compensation, it indicates in the notification the rationale for its decision to refuse.

You should review this document. Further actions will depend on the grounds specified by the insurance company for the refusal. The most common reason for refusal to pay insurance compensation, which is used by insurers, is failure to recognize the incident as an insured event. This argument may be due to various reasons. Often this happens precisely because of the vague wording of the definition of an insured event in the contract itself. Also, a limitation may occur if the contract specifies additional conditions, only upon the occurrence of which the event is considered insured.

For example, the dismissal of a borrower at his own request or for a disciplinary act is unlikely to be assessed by the insurance company as an insured event. That is, some reasons for dismissal are considered as limiting conditions under which compensation is not paid. If the borrower presents, for example, his disability in the initial notification of the occurrence of an insured event, the insurance company may refuse due to the fact that the onset of disability occurred before signing the contract, while the borrower, knowing about his disability, did not inform the insurance company about it at the time signing the contract.

If the insurance company has refused to pay insurance compensation, you can immediately go to court, since it is obvious that even if you present all the documents confirming these circumstances, the insurance company has already made its choice, and instead of wasting time trying to - to prove, it is better to immediately transfer the dispute to the judicial level. Moreover, you must pay loan obligations that are not removed from you, despite the obvious occurrence of an insured event.

In order to comply with the necessary procedure for pre-trial dispute resolution, the first step is to send a written claim to the insurance company, in which, listing the circumstances that you interpret as the occurrence of an insured event, you must demand that the insurance company fulfill the terms of the contract on its part.

Also, the insurance company may agree to pay, but pay it not in full or with a delay, or refuse to pay compensation in full, or simply not give you any response to your appeal within the prescribed period. In all such cases, you must also promptly submit a written claim to the insurance company, thereby officially beginning the pre-trial phase of the proceedings.

Along with your claim to the insurance company, you have the right to send official complaints to other authorities, for example, to Rospotrebnadzor and the Bank of Russia, as the main insurance supervisory authority. Such complaints, even if they do not directly contribute to the payment of insurance compensation from the insurance company, will nevertheless be additional evidence that you are right in court and will put some pressure on the insurer.

In addition, legal assistance is provided, to which you can also send a complaint about the actions of the insurance company.

Make sure you have evidence of filing a claim with the insurer. If you are submitting a claim in person, try to get a mark of acceptance of the document, which should be placed on your copy of the claim by the official who accepted the claim from you. If you are submitting your claim by mail, send it by certified mail with return receipt requested and a description of the attachments.

After receiving a response from the insurer, or even if the insurer ignored your claim and did not respond within the prescribed period, you can file a claim in court. In the application, you must express a claim on your behalf in favor of the creditor bank, because under the insurance contract it is the bank that is the beneficiary. The requirements you express in your favor should be:

1. Demand to recover from the insurance company: court costs, expenses for legal assistance, interest for the use of other people's funds and compensation for moral damage.

If your claims relate not only to the insurance company, but also to the bank, and you express a demand to terminate the loan agreement and involve the insurance company and the bank as defendants, your demands may be as follows:

1. Demand that the event be recognized as an insured event.
2. Demand that the refusal of the insurance company to pay insurance compensation in favor of the bank be declared illegal.
3. Demand to oblige the insurance company to fulfill its obligations under the insurance contract in full by paying compensation to the bank.
4. Demand that the bank be obliged to use the received insurance amount to pay off the loan debt.
5. Demand that the loan agreement be recognized as terminated, and if the agreement contains a pledge, the pledge agreement be recognized as terminated.

You should check with your lawyer for a specific list of requirements that will be specific to your case. It will depend on the terms of the loan agreement, on the grounds that the insurance company has put forward for refusing to pay the insurance, and on your goals in the process. Without legal assistance, it will be difficult to achieve the desired result, so before you take action, find a lawyer who specializes in insurance issues when lending.

A similar step should be taken if the insurance company requires, in addition to the already collected package of documents, certain papers that are not included in the policy/contract. The company has 10 days to consider the claim. It should be remembered that the bank still requires timely loan payments. It is advisable to send the claim by registered mail with notification.

Most often, the outcome of a claim is refusal or silence from the insurance company. In this case, the next stage is the trial. The claim should demand:

• collection of insurance compensation in favor of the bank;
• compensation for moral damage to the plaintiff;
• collecting interest from the insurance company for using someone else’s money;
• payment of a fine in favor of the plaintiff for violation of consumer rights provided for by law (refusal of pre-trial payment after filing a claim).

Practice shows that with the proper package of documents, courts meet citizens halfway, obliging insurance companies to make payments.

A variety of misfortunes can await a person in life. And most of them in one way or another materially harm it: a fire or flood can damage valuables and real estate, an accident can damage a car, various accidents can harm health or even take life, and so on.

Fortunately, you can get insurance against almost any misfortune. Although it will not prevent losses, it will smooth them out as much as possible with payments or with the help of in-kind compensation. However, this compensation still needs to be received correctly. In this article we will tell you how to get the compensation you are entitled to in the event of an insured event.

What is an insured event?

An insured event is an event during which some damage was caused. However, not every misfortune can be considered an insured event. Firstly, the event must be clearly stated in the insurance contract. Secondly, it should fully comply with the specified characteristics. Third, the damage must be caused by a third party, and not by the insurance client himself. And the last thing is the case should not be included in the list of exceptions, established by the contract. Thus, only the event from which the policyholder protected his property with the help of a contract can be recognized as an insured event.

Let's look at an example. A client of an insurance organization protected his home from fire. In this case, the following will not be insured:

• Flooding (there was no mention of it in the agreement);
• Explosion (although the property was destroyed by fire, it cannot be regarded as a fire);
• Deliberate arson by the owner of the house (this may be regarded as fraud in order to receive payments);
• Destruction of a house by fire during a military conflict (this point is most often an exception).

What to do when it occurs?

So, an accident occurred, from which the insurance contract protected you. What should you do next? It is quite difficult to answer this question right away, since further actions of the victim will depend entirely on what kind of agreement was drawn up and what exactly was written in its text. So, for example, actions in case of damage to health and actions in case of destruction of property will be completely different. Therefore, we will try to consider all standard insurance contracts.

Health insurance

If some accident happened to you that caused damage to your health, then you don’t have to worry about any additional actions and immediately go to the hospital. This is due to the fact that both and allow receive unlimited medical care if necessary– the difference will only be in the quality of service.

If the insurance also covers the purchase of medicines or the provision of paid medical services, then compensation for the money you spent can be obtained from the insurer, by writing an application on the letterhead of the organization itself. However, you will have to confirm the fact of spending with checks or hospital statements. But if you insured yourself against disability or death, then the list of actions will be slightly different. First of all, you will need to obtain either the result of the examination or a document recording the fact of death. Then the representative or heir can contact the insurer’s office and, having provided a document - the basis, will be able to write an appropriate application for compensation.

Auto insurance

In car insurance, it is necessary to clearly distinguish between the types of insurance contracts. First, let's look at compulsory motor liability insurance - compulsory insurance that protects not only the car itself, but also the driver. When an insured event occurs, it is necessary to clearly distinguish between damage to the car and damage to health. According to the new law, compensation can be received in the form of in-kind compensation for repairs or spare parts(except for some cases when repair is impossible for one reason or another). Everything is simple here - in the event of an accident, the driver receives a package of documents documenting the insured event, provides them to the insurer, and then they agree on the progress of the repairs. In this case, it will also be necessary to conduct an assessment of the damage, which will be performed either by an independent specialist or by an appraiser from the insurance company.

In case of damage to health, obtaining compensation under compulsory motor liability insurance is somewhat easier. When an insured event occurs, the victim simply must provide the same package of documents documenting the accident, as well as medical certificates stating that he was injured as a result of the accident. Having these documents in hand, he will be able to write an application for payment of compensation on the organization’s letterhead, indicating all the costs of treatment. In this case, expenses will also need to be confirmed with checks and receipts.

CASCO insurance is additional car insurance. It does not protect the driver's liability or liability. However, at the same time, it allows you to include in the contract itself more insurance cases not provided for by compulsory motor liability insurance. In order to receive monetary compensation under CASCO, you will also need to confirm the fact of the event(for example, a statement of theft or a certificate from the scene of an accident) and Write a statement on the insurer's letterhead. There should be no problems with this, since the payment process itself is stipulated in advance in the contract.

Property insurance

The process of receiving compensation for those who have applied for it is devoid of any difficulties or features. If, as a result of an insured event, some personal property that was protected by the contract was damaged, then the process of obtaining compensation will completely depend on the contract itself. As a rule, a separate paragraph is either devoted to this, or the process of action itself is described in the general rules of the insurer. In general, two standard algorithms can be distinguished:

• If the item is completely destroyed, then the policyholder first confirms the fact of destruction during the insured event with a corresponding document, and then receives compensation. Its size is usually set by the appraiser in advance. Often, a depreciation coefficient is also applied to the destroyed value, which depends on the property itself.
• If the item is damaged, then the fact of an insured event is first confirmed, and only then a specialist assesses the damage. After the amount of losses has been established, the policyholder will have to write an application on the insurer's letterhead and submit it with a complete package of documents.

If an insured event occurs on a loan, but the insurance company does not pay, you can always appeal this decision in court.

Almost all loans today are accompanied by an offer from the bank to enter into an insurance agreement. The insurer is usually a partner company or a company that is part of a single holding structure along with the bank. Recently, classic insurance has begun to be replaced by financial protection programs, although, if you don’t go into legal details, these products do not have any special differences. In the consumer lending system, insurance is voluntary, and even if the bank managed to impose insurance, it can be refused. For mortgages and car loans, insurance is required, but this only applies to collateral.

In general, credit insurance is generally accepted practice, either on a voluntary or mandatory basis. And if the borrower takes out insurance, then, of course, he expects that if the insured event specified in the conditions occurs, he or the bank will be able to receive monetary compensation. But those who have already encountered issues with insurance payments note that even the most extended insurance does not provide a 100% guarantee of receiving money.

There is nothing special in the credit insurance system in terms of refusal to pay insurance that would not be encountered in other legal relations. The same reasons, the same arguments on the part of insurance companies. Only the consequences are somewhat different: you not only do not get what you expected and paid for, but you also remain in debt, and insurance thereby turns into a useless tool.

Unfortunately, the occurrence of an insured event in itself is not the only condition for payment of compensation. You also need to follow the procedure for contacting the insurance company and a number of other formalities. But you may encounter another situation in which the insurer will try in every possible way either to avoid fulfilling its obligations or to reduce the amount of payment to a minimum. Knowing your rights and skillfully using available tools to protect them is the main condition for effectively combating unscrupulous insurance companies.

How to interact with the insurance company in the event of an insured event

Whatever insured event occurs, first of all you need to make sure that it is indicated in the terms of the insurance contract. The practice is that many borrowers do not read the agreement carefully when signing: at best, they will glance at it, and at worst, they will take the manager’s word for it. As a result, it may turn out that the event that happened to you is not specified in the contract at all. Or the wording is so vague that what happened can be viewed in the context of the terms of the contract in different ways. Unfortunately, if the case is not listed as insurable, you will not be able to claim compensation. If everything looks controversial and incomprehensible, be sure to contact a lawyer specializing in credit insurance. If there is an ambiguous interpretation, you are unlikely to figure out on your own who is right and who is wrong - you or the insurance company. In such a situation, judicial practice will also be of great importance, and here a specialist, in any case, is more competent than a legally unskilled person.

So, you have determined that the event is an insured event. How to proceed next:

1. We carefully study the contract (policy), the memo of the insured person regarding the procedure (procedure) for contacting the insurance company (or bank) in connection with the occurrence of an insured event. The main task is to find out how, where and within what time frame it is necessary to submit the initial notification.
2. We are preparing a notification. Usually, a fairly short period of time is allotted for the initial notification of the insurance company (or bank) - within a couple of days, sometimes a little more, depending on the event (insured event). It is important to meet the allotted deadline, and even better - apply immediately. Under no circumstances should you delay your application, and it is advisable to do this personally or through a proxy.

When contacting in person or in response to a notice, the insurance company will most likely offer to prepare and submit documents confirming the occurrence of the insured event, if they were not included in the notice. It is not difficult to prepare documents. For example, if you lost your job, it is enough to provide a copy of the order or other document from the employer confirming the fact of dismissal and its basis. In case of illness or accident, medical documents are provided, and in the event of death of the insured borrower, a corresponding certificate is provided.

During the period of time established by the regulations of the insurance company, the circumstances that gave rise to the application for insurance compensation are checked. Deadlines vary. As part of such a check, the insurance company determines the existence of an event, its confirmation (proof) and the possibility of recognizing this event as an insured event with a decision on payment of compensation, its amount or refusal to pay in full or in part. The policyholder is notified in writing of the decision made. In case of complete refusal or limitation of payment, the grounds for making such a decision must be indicated. Study these grounds carefully, preferably with the assistance of a lawyer.

The most common reason for a complete refusal to pay insurance is the non-recognition of the event as an insured event. There are many reasons that can be given, and they vary depending on the situation. As a rule, this is due to the fact that in the terms of the contract, insured events are given without specifics, in the form of general formulations, or the issue of recognition/non-recognition of an event as insured depends on a number of related factors and conditions.

For example, the borrower may consider his dismissal an insured event under any circumstances, while the insurance company will most likely refuse payment, citing the fact that the dismissal occurred at his own request or for a disciplinary offense, and this is considered as a limiting condition specified in the contract . There are also cases when the borrower's disability is not recognized as an insured event, even if it is expressly designated as such in the contract. Here, when refusing, the argument is often made that the policyholder knew about his illness at the time of signing the contract and did not inform the insurance company about it when filling out the questionnaire.

If the insurer refuses to pay insurance, without recognizing the case as insured, it is useless to argue - it is more effective, as practice shows, to immediately transfer the issue to the trial. It is unlikely that the insurance company will change its decision, even if you additionally submit a huge package of supporting documents. And you will only lose time and money in a dispute with the insurer, since the bank will not relieve you of the obligation to repay the loan while you deal with the insurance. To comply with the formalities, it is enough to prepare and send a written claim to the company demanding the fulfillment of obligations under the insurance contract in full.

At the initial stage, a written claim is sent in the following cases:

• failure to receive any response from the insurance company within the prescribed period to the appeal regarding the insurance payment;
• agreement with payment, but its delay or incompleteness;
• refusal to pay compensation in full (partial compensation).

Along with the claim, you can file complaints about the insurance company violating your financial rights. There are two main options here - Rospotrebnadzor (the most popular) and the Bank of Russia (the main insurance supervisory authority). In these cases, achieving insurance payment is a small probability, but such a step can put some kind of pressure on the insurance company, and if a positive decision is made on the complaint, it will become additional evidence that you are right. You can also file a complaint with the Interregional Union for the Protection of Insured Rights, a specialized organization that provides legal assistance, although not free.

If none of the options for pre-trial dispute resolution help, you will have to file a claim in court. In this case, the claim is made by the borrower-insurer, but in favor of the bank, which is the beneficiary in the credit insurance system. In your favor the borrower may require:

• recognize the event as an insured event (mandatory, if this is precisely the reason for the refusal to pay);
• to recover compensation for moral damages, interest for the insurance company’s use of other people’s funds, as well as court costs and expenses for legal assistance.

If an insurance company and a bank are involved as defendants, which is usually done to solve an additional problem - termination of the loan agreement, then the requirements might look like this:

1. recognize the event as an insured event;
2. recognize the refusal to pay insurance as illegal;
3. oblige the insurance company to fulfill its obligations under the contract in full by paying compensation to the bank;
4. oblige the bank to repay the loan debt at the expense of the insured amount;
5. recognize the loan agreement as terminated, and if there is collateral, recognize it as terminated.

Specific requirements depend on the situation, the grounds for refusal to pay insurance, and the goals that the borrower or his heirs plan to achieve. It is important to take into account that you will not only have to prove your case, but also refute the arguments of the insurance company, and often the bank, which may side with the main defendant.