When does the insurance company compensate for damage?
The occurrence of an insured event within the framework of the law entails an obligation for the insurer to compensate for the costs incurred or the loss caused. This is precisely the meaning of compulsory motor third party liability insurance. So, according to Article 1 of Federal Law No. 40, the insurance company of the person responsible for the accident compensates for damage to a third party who was injured during the road accident.
If the policyholder was the victim of an accident, the costs of repairing his vehicle will also be covered by his insurance company.
Then the funds spent on car repairs will be recovered from the insurer of the person responsible for the accident. Thus, in almost any situation, policy owners are confident that losses incurred during an accident will be compensated based on the terms of the insurance contract.
Cases when the insurance company does not compensate for damage under compulsory motor liability insurance
By virtue of Article 12 of Federal Law No. 40, the policyholder has the right to expect compensation for losses incurred within the limit determined by Article 7 of Federal Law No. 40, that is, no more than 400 thousand rubles when restoring a car and 500 thousand when compensating for damage to health. However, in a number of cases the insurer has the right to refuse payment, in particular:
- if the repair or disposal of the car was carried out before the inspection of the damaged property by the insurer;
- if the policyholder or the victim did not provide a complete package of documents;
- if, based on the results of an independent technical examination, it is impossible to determine the amount of damages;
- if the policyholder has not fully fulfilled the terms of the contract upon the occurrence of an insured event.
Important! Regardless of the number of victims, the insurance payment is made jointly and severally within the limit. That is, if 4 people were injured in an accident, a payment of 500 thousand will be divided between them.
What to do if insurance does not cover damage from an accident
And it’s not just about comfort and quality of the product. You know, I want to live and preferably for a long time. But the trouble is, the amount of insurance payment under compulsory motor liability insurance does not keep up with the prices for repairs, spare parts and inflation in the country. Not only do insurance companies try to underestimate the amount of payments and drag out their transfer for as long as possible, but the unfortunate motorist is also faced with the question: who will pay for everything that exceeds the unfortunate 120 thousand? The situation is, of course, unpleasant, but not fatal. Back to the past
Remember how issues with compensation for damage from road accidents were resolved before July 1, 2003? That's right, either through the lads or through the courts. With the adoption of the Federal Law “On Compulsory Motor Liability Insurance” everyone relaxed and felt like citizens of a civilized country. However, it is too early to forget the invaluable experience of past years; it will still be useful to us. Because the difference between the actual damage and the maximum insurance payment under the law in the amount of 120 thousand rubles (and if there were several victims, then even less) will have to be recovered from the tortfeasor. We are supporters of legal methods of resolving conflicts, therefore we recommend collecting money only through the courts.
The serpent with three heads
Why three-headed? In fact, ideally, he has only one head - this is none other than the culprit, that is, the defendant, but the realities of today are such that the insurance company under compulsory motor liability insurance is dragging its feet with payments - here is another co-defendant for you, and if you are lucky enough to be insured also according to KASK and they also don’t want to pay, then the third co-defendant arrived in time. You will have to face them in court and convince the court that you are right. At the same time, you still need to manage not to get confused in the requirements for each of the defendants. Let's look at a few situations that depend only on the number and type of your opponents, as well as the order of actions:
Culprit-OSAGO-CASCO
The most inconvenient option. Rarely occurs, but still. It occurs according to the scheme described above. If a lawyer has advised you of such a scheme, then you should think about his qualifications as a proceduralist. In this case, you need to clearly understand what you want from each of the defendants, because there is no question of joint and several compensation for harm here and the court will not be able to independently determine who to pay and how much. Procedural complicity in this case is dictated by the fact that your demands arise from the same basis and their homogeneity - harm caused to you and your right to compensation. Your opponents, of course, will try in every possible way to absolve themselves of responsibility, complaining about the lack of money, a sick grandmother, and so on. None of this should worry either you or the court. Your task is to confirm your position:
Evidence of the guilt of the harm-doer. As a rule, this is a resolution in a case of an administrative offense against the culprit and materials on this case: a diagram, a certificate, a protocol for examining the scene of an accident, etc. Sometimes judges like to joke with the plaintiff. The judge may ask the plaintiff why he claims that the decision in the case is unconditional evidence of guilt for the judge, because this is neither a sentence nor a decision of another court that has entered into legal force, pre-establishing certain circumstances for the court, and there is no need for their additional proof (Article 61 of the Code of Civil Procedure of the Russian Federation). This question usually causes confusion for the plaintiff. Such a provocation of the judge can be answered by the fact that this resolution is admissible written evidence in the case and must be considered by the court in conjunction with other evidence, and the information specified in this document in no case is of a predetermined nature for the court. Evidence confirming the size of your claims. This is usually a report estimating the cost of refurbishment. And it is in your interests that the certificate of inspection of the car for damage (a mandatory element of the report) contains the signature of the culprit or that you have evidence of notifying the other party about the inspection. Otherwise, in court, he may disagree with the appraiser’s conclusions and demand an additional inspection and propose his own appraiser, which will negatively affect the calculated amount. You may even be left without money if, in the interval between the disputed assessment and the assessment ordered by the court, you recklessly made repairs to your car.
If, on top of everything else, you intend to seek compensation for moral damages, then pay attention to this.
Evidence of contacting insurance companies. This evidence will be copies of the statements you submitted to the insurers. Therefore, when submitting these applications, always keep copies with a note indicating receipt.
The situation under consideration can be significantly simplified, unless you are concerned about collecting moral damages, which, in principle, can wait until the main issue is resolved. If at the time of the accident you had a valid CASCO policy, then you don’t need to drag a bunch of people to court. I recommend that you contact your insurer regarding collection issues. First, the amount of insurance coverage is usually equal to the value of the car at the time you purchased the policy and will be sufficient to meet your requirements. Secondly, if you go to court, there is no need to spend extra money on paying the state duty, since CASCO insurance is subject to the Law “On the Protection of Consumer Rights”, according to which plaintiffs in such cases are exempt from paying the state duty (Article 17 of the Law). Thirdly, a fine imposed on the insurer in the form of 50% of the amount collected by you (Part 6 of Article 13 of the Law) should make the insurer more accommodating. And finally, fourthly, you will simply save the court and yourself from having to do the same work two more times without any need.
The culprit is OSAGO
For you, these are two separate characters, and, as in the previous case, you need to decide on the requirements. One thing needs to be understood: according to compulsory motor liability insurance - compensation of up to 120 thousand rubles, provided that there is only one victim in the case, everything in excess of 120 thousand rubles, plus moral damages, is recovered from the culprit. In this case, all the above recommendations regarding providing yourself with evidence apply. You will have to spend a little money on state fees.
Culprit
Lord, a miracle happened! The culprit's insurance company paid on time and every penny, exactly 120 thousand, as expected. But there is still no happiness. Because repairing your car, for example, costs 200 thousand. We demand the rest of the money from the person responsible for the accident. Our evidence is still the same. We pay state duty like everyone else. In this case, there is a high probability that the court’s decision will be in your favor, but the actual implementation of this decision may be difficult due to the culprit’s lack of money and property (during the trial, smart people manage to “get rid” of everything valuable from friends and relatives) . Or your debtor will go even further and submit an application to the court for a deferment (installment plan) of execution of the court decision (Article 203, Article 434 of the Code of Civil Procedure of the Russian Federation) and at the meeting declare his distressed property situation. Neither the period nor the number of delays are defined by law, so enforcement proceedings can drag on for years on completely legal grounds.
Why does the insurance company not fully compensate for the damage?
Repairing a car in some situations requires huge costs, which are not comparable to the cost of a new car of the same brand, which is why a technical examination is carried out. In this case, the expert must also determine the scope of repair work, and the insurer, in accordance with the Regulations on a Unified Methodology, must approve the amount of expenses taking into account the wear of damaged parts and issue a referral to a service station in the manner specified in clause 15.1 of Article 12 of Federal Law No. 40.
However, in pursuance of this norm, service station employees do not have the right to install used parts and assemblies, which of course affects the total amount of repair costs. Thus, even if restoration is carried out within the limit or less, the insurance company compensates for damage only within the amount approved on the basis of a technical examination. The difference between the invoice issued by the service station and the insurance amount will be paid at the expense of the policyholder.
The insurance company demands compensation for damages under compulsory motor liability insurance.
By virtue of Article 14 of Federal Law No. 40, the insurer that has made compensation charges in relation to its client recognized as a victim in an accident receives the right to claim recourse against the culprit of the accident or his insurance company.
Thus, the insurer of the victim may demand compensation for expenses incurred if:
- the harm was caused intentionally;
- the driver was intoxicated;
- the person driving the car did not have a driver’s license or was not included in the contract;
- the person responsible for the accident fled the scene;
- the car was scrapped or sent for repairs before inspection by insurers and technical expertise.
Important! When calculating the cost of an insured event, the amount of losses includes not only the costs of repairs, but also the costs of conducting a technical examination, as well as other costs incurred in the course of fulfilling the terms of the insurance contract.
Steps taken by the culprit when deliberately underestimating damage
If insurance does not cover damage from an accident, the culprit has the hardest time. A third-party company can file a claim in court if the participant in the incident had CASCO, and the victim, when the calculation of the payment under compulsory motor liability insurance turned out to be incorrect. The issue should be resolved in advance so as not to subsequently encounter an unexpected payment, because the maximum period for claiming funds is 3 years.
In such cases, it is worth using the services of a lawyer. If insurance does not cover damage from an accident, if you do not want to go to court for a long time, you can order an independent examination and go to the office with a package of documents. Often such cases are resolved amicably, since it is not profitable for companies to delay the hearings. It is more useful for them to quickly understand the situation and continue working.
It is possible to refute the underestimation of damage. If your insurance does not cover damage from an accident, you should not be upset and prepare the specified amount. It's time to prepare a complete package of documents, supplementing them with the results of independent examinations and a correct assessment of damage. After this, it will be possible to achieve justice by spending a minimum of time.
Does the insurance company compensate the person at fault for the accident?
Drivers found guilty of an accident almost always face a situation where the insurance company demands compensation for damage. However, the company does not always have the right to claim recourse payments. So, if an accident occurred as a result of the failure of one of the units after a technical inspection that confirmed the complete serviceability of the vehicle, the operator who issued the diagnostic card is held liable.
If the driver causes a traffic accident due to traffic violations or due to inattention or due to intoxication, the insurer will not compensate him for the damage. In such a situation, the insurer, on the contrary, has the right to deduct from the culprit the costs incurred in paying compensation to the victim and his insurance company.
How to recover the difference from the culprit of an accident
Theoretically, the injured person can demand from the culprit both the missing amount of damage and compensation for damage to health and moral damage. Additionally, the subject may request reimbursement for legal costs, storage of the vehicle in the parking lot, services of a tow truck, expert, etc.
An interesting point: the law provides for the possibility of the victim recovering the full amount of repairs from the culprit, without taking into account the depreciation of the vehicle’s spare parts.
