The insurance company refused to pay under MTPL or CASCO insurance

Can the insurance company refuse to pay?

Any insurer has the right to refuse to pay insurance compensation. This is provided not only in the text of the insurance contract and insurance rules, but also in the Civil Code of the Russian Federation, as well as the law “On the organization of insurance business”.

Reasons for refusal to pay under CASCO:

gross violation of traffic rules by the policyholder (for example, drunk driving);
transport malfunction even before an accident or other insured event;
unauthorized repairs without agreement with the insurer;
permission to drive persons not specified in the insurance;
violation of the loss settlement procedure described in the policy.

This is not a complete list of reasons for refusal. The reason may be non-payment of an insurance contract (for example, insurance for a credit car, which is renewed every year), obvious violations of the rules on the road (exceeding the speed limit, running a traffic light, crossing a double solid line and driving into oncoming traffic), an attempt at insurance fraud (rigged Road accident or overestimation of damage) and much more.

Sometimes an event is simply not recognized by the insurer as insurable. For example, if the car was scratched by animals, and the risk of falling icicles, hail or hooliganism was insured, then, naturally, a refusal will follow. The company also does not recognize the case of car theft from a yard or other place as insurance if the contract clearly states that it should have been stored only in a guarded parking lot.

Refusal for all the above reasons will be considered absolutely lawful. But there are also controversial grounds for refusal, which can be easily appealed in court. For example, these include the refusal to compensate for the loss of commodity value, which is real damage under civil law.

If the insurance does not indicate the risk of theft, the insurer has the right to refuse payment if the policyholder's car disappears.

Lawful refusal

Many insurance companies are equipped with modern technical facilities to conduct fast and high-quality examinations. This greatly simplifies the process and saves time.

Thanks to such an accurate examination, it is easy to restore the full picture of what happened. The company receives all the grounds for insurance payment or denial of it. There are several cases where a refund is simply not possible.

The insurer has all legal grounds to refuse payment under CASCO if:

the incident occurred when the policy was not valid (it turned out to be expired or had not yet entered into force);
the car was driven by a person who did not have the right to do so (the driver was under the influence of alcohol or drugs or was deprived of his driver’s license);
the damage to the car was intentionally caused by its owner;
the vehicle was damaged due to military conflicts or radiation contamination;
the vehicle was seized by executive authorities;
the car owner hid from insurers the fact that the car was rented by another person;
additional parts were installed on the machine that did not comply with the contractual conditions;
clauses of the contract regarding the conditions of operation of the vehicle were violated by the owner.

Errors when handling and reporting road accidents

After an accident, you must stop the car, turn on the emergency lights and put up a warning triangle (at least 15 meters from the car in the city and 30 meters outside it). If there are victims, you should call an ambulance immediately.

Next you need:

report the accident to the traffic police and the insurer (phone numbers are in the policy);
exchange contacts with other participants in the accident;
take a photograph of the accident scene;
collect contact information of witnesses in case of trial;
wait for the arrival of the emergency commissioner or another representative of the insurer.

The insurer's dispatcher must record the date and time of the accident, and also advise what to do next. This is the correct procedure, but not every car owner follows it.

Next, you will need to prepare a written application and submit it to the insurance company. Typically, insurers require that this be done within 5-7 days from the date of the accident, but in the case of theft or theft - within 1-3 days.

Erroneous actions:

leave the scene of the accident;
go to the first service station and pay for repairs out of your own pocket;
violate the application deadlines;
receive money from the guilty party without knowing the extent of the actual damage.

When registering an accident, it is important to ensure that all formalities are followed. We fill out a notification of an accident with a diagram of the accident directly at the scene of the incident (if there are no victims and the parties decided to resolve the dispute without involving the traffic police) or we monitor the receipt of documents from the traffic police confirming the fact of the accident.

When receiving documents, make sure that their contents are accurate. Any corrections must be certified by an official’s signature and seal.

What to do if the insurance company refuses?

If the policyholder did everything correctly, but received a refusal from the insurer, then he can appeal it. To do this, you will need to collect evidence of your case (certificate of an accident, notice and other documents), and prepare a claim. Sometimes it is also necessary to conduct an independent examination of the damage so that there is something to operate in court.

The policyholder must:

Collect evidence that you are right.
Prepare the text of the claim in two copies and send it to the insurer.
If you receive a refusal (after 10-30 days), you can file a complaint with the regulator.
If the complaint to the regulator does not help, you must file a claim in court.
Obtain a court decision (on the collection of insurance payments or on refusal to satisfy the claim).

Disputes with the insurance company can drag on for 3-6 months. and sometimes for a year. However, filing a lawsuit does not guarantee a positive result. It is worth deciding on legal battles only if you are firmly convinced that your rights have really been violated.

The insurance company does not pay CASCO: the main reasons for refusal

In situations where the insurance company refuses to pay for CASCO insurance, the applicant must receive a written refusal and an insurance certificate on the basis of which the calculations were made. All types of exceptions in which the insurer has the right to refuse must be listed in the insurance policy.

These are the reasons for refusal of CASCO payments.

If the offender intentionally violated traffic rules, and under serious charges. For example, if the driver was drunk, crossed a double line or ran a red light and these actions caused an accident.
If the car had serious damage at the time of the accident (it was technically faulty).
If the cause of the accident was spontaneous combustion of another car. In fact, there was no accident and it would be illegal to demand compensation from the insurance company. For example, if the electrical wiring of a nearby car caught fire in the parking lot, the fire spread to other cars. In this case, compensation to the victims will have to be paid by the owner of the car that caused the fire.
If your car is stolen, you need to go to the police and file a report of the theft. Car theft is not an insurance event.
The policyholder has provided an incomplete package of documents or the documents provided contain incorrect information about the accident. For example, if the causer of harm fled the scene of an accident, but there is no information about this in the protocol, etc.
If the victim writes a statement to the police that he has no claims against the culprit of the accident, this is a reason for refusal. The fact is that in some cases the insurer has the right to claim through the court the funds paid from the person responsible for the accident. However, if the victim wrote this statement, then the insurer does not have the right to recourse.

In other cases, when the insurance company does not pay for CASCO, you must first consult a lawyer about this and then file a claim in court.

Situations are also possible when the insurance company underestimates the amount of payments in order to obtain benefits. When determining the amount of damage, these types of errors are most common.

The certificate from the traffic police does not indicate all the damage; based on this certificate, the insurance company calculates losses.
In order for all types of damage to be included in the road accident documents, the victim needs to contact the traffic police and write a statement “On additions to the explanation of the accident.” Important! When compiling a calculation regarding the amount of loss, the insurance company cannot rely only on the certificate of the accident; for this it is necessary to carry out an examination of the vehicle.
Often, the amount of payments, according to the insurer’s expertise, differs greatly from the actual cost of the loss. In this case, an independent examination will be required. If in court both parties to the conflict rely on their own different types of examinations (independent and from the insurance company), then an additional forensic examination will be appointed.
There may also be disputes regarding the relevance of prices for spare parts and repair work. Thus, the amount of loss is measured according to the market value of repair work at the time of the accident, but not at the time of the legal conflict.

Important! The statute of limitations for disputes related to property insurance is two years from the date of the insured event. So, if the victim previously made repairs, and a year later demands compensation for repair work according to the market value, then the amount that was actually spent on repairs will be reimbursed.

When the insurance company does not pay for CASCO, what to do in such cases? It is important to collect a complete package of documents and submit all your requirements in a claim to the insurer. If the claim does not yield results, then you need to go to court.

Where can I go?

To protect your rights, you can contact the chairman of the company’s board, and then the court or the Bank of Russia or the prosecutor’s office.

The policyholder's appeal to law enforcement agencies or a financial regulator may lead to an inspection of the insurer and even revocation of its license if serious violations are identified.

If the claim is up to 50 thousand rubles, then you can contact a magistrate. In all other cases, you need to submit documents to the district court at the location of the defendant (insurance company).

The insurance company does not pay for CASCO: what to do?

CASCO insurance disputes require a professional approach. There is no point in hoping that you will be able to independently resist the insurer’s resourceful lawyers in order to make an objective decision. Moreover, after numerous visits to the “defaulter”, tedious negotiations and futile promises, the injured party is often guided by emotions that interfere with the process of initiating a CASCO trial.

Experienced experts will help you, putting aside emotions, correctly draw up a statement of claim, displaying indisputable facts proving violations on the part of the insurance company.

How to properly file a claim?

After receiving a written refusal to pay compensation, you can begin to file a claim. The text is compiled arbitrarily, but in compliance with certain rules.

The claim must include:

contacts of the policyholder;
description of the problem (date of the accident, amount of damage, steps already taken to resolve losses);
requirements and deadlines for their implementation;
Bank details (if required).

All contact information must be included in the complaint. Be clear about when and where the accident occurred, exactly how your vehicle was damaged, and what the amount of damage was.

The insurer must be required to eliminate the violation of the law and pay the money within the established time frame (for example, within a month).

If the company decides to pay for the repairs, then the issue can be considered closed, but if a refusal follows, then it is necessary to move on to the next stage - resolving the dispute in court. If the requirements are partially satisfied, you can also go to court.

When to go to court?

There are reasons for refusal that can be challenged in court. These include, for example, refusal due to a violation of the deadline for submitting an application for payment. If the plaintiff complies with the statute of limitations, then judges consider such claims.

If the company refuses to compensate for the loss of marketable value, then this can also be appealed, since according to the civil code this is real damage. True, judicial practice in such cases is different - there are also refusals to pay compensation.

The courts are also loyal to attempts to challenge the refusal to pay due to a late insurance payment. In this regard, the Civil Code of the Russian Federation also gives recommendations to pay money, but with the amount of the overdue contribution offset against the insurance amount.

○ Reasons for refusal to pay.

First, you need to decide on what grounds the company can provide insurance compensation to the owner of a CASCO policy. As a rule, the reasons are the following:

The client has lost his copy of the contract or insurance policy.
The deadline for contacting the insurer has been missed.
There is no traffic police resolution on road accidents.
There is no MOT or STS coupon for the car.
The car was stolen along with the keys and documents left inside.
The car did not have an alarm system.
The company does not consider car damage an insured event.
At the time of the accident, control was transferred to a person who was not specified in the contract.
The report drawn up by the police indicates that the owner of the car has no claims against anyone.

This list is indicative; companies may try to refuse payments for other reasons. In addition, another option is non-payment for no reason. In this case, the insurer simply delays the deadline, not responding to the client’s requests, or getting off with general phrases like: “Your question is being considered, please wait.”

Finally, you also need to take into account the content of the contract. The fact is that “full CASCO” is extremely rare. As a rule, the company indicates a certain list of insured events when payments will be made - and if something happens that is not included in this list, it will be impossible to achieve payments. Unfortunately, many companies get off with vague wording, without describing insured events in detail, but only making a general classification of them - and then quite convincingly try to prove to the client that his case is not covered by the insurance policy.