Insurance payments under compulsory motor liability insurance in case of an accident 2021, maximum amount and terms of compensation

The legislative framework

Reimbursement for damage to health in a traffic accident under compulsory motor liability insurance is made on the basis of the following regulations:

• Federal Law of April 25, 2002 No. 40-FZ;
• Government Decree of November 15, 2012 No. 1164;
• Government Decree of 02/21/15 No. 150;
• Regulations of the Bank of Russia dated September 19, 2014. No. 431-P.

If one of the participants in the accident is a carrier, then when calculating the amount of compensation, the provisions of the Federal Law of June 14, 2012 are additionally applied. No. 67-FZ.

In what cases is carrier liability insurance required?

The main legislative document regulating the procedure for registering OSGOP is the Federal Law under number 67-FZ, which was approved on June 14, 2012.

Cases for which registration of OSGOP is mandatory:

• passenger transportation in accordance with concluded transportation agreements;
• transportation in accordance with concluded charter agreements;
• transportation related to the considered points, carried out without execution of contracts.

Thus, this insurance policy must be issued for railway, sea, and inland waterway transport. In addition, it is issued for city trolleybuses, trams, and buses. The body that controls the issuance of compulsory insurance policies for carriers is Rostransnadzor. In addition, the powers of this body include levying fines and applying other sanctions to violators. There is nothing complicated about how to check OSGOP. This can be done on the NSSO website (short for “National Union of Liability Insurers”).

Procedure

After a traffic accident, a traffic police officer will issue the victim with a certificate of the accident and a report from the scene of the incident . The protocol contains information about the insurance company in which the car owner at fault for the accident has a compulsory motor liability insurance policy.

To receive your compensation fee, follow the instructions:

1. write a statement to the Investigative Committee;
2. collect documents confirming the harm caused to health;
3. send the papers to the insurer.

The insurance company will calculate the amount and transfer it to the applicant’s bank account.

Statement

The document form is approved by Bank of Russia Regulation No. 431-P . In your application to the Investigative Committee, please provide the following information:

• personal data of the affected person;
• information about damaged property;
• information about harm caused to health;
• the nature and severity of the injuries;
• data on additional costs of treatment;
• whether there is any income lost during treatment;
• information about the insured event;
• Method of receiving money - cash or bank transfer.

Download the application form for insurance compensation or direct compensation for losses under OSAGO

At the end of the application, indicate the list of attached documents, put your handwritten signature and date. Send your application by mail or hand it over to the Investigative Committee office in person.

Documentation

When contacting the insurance company, provide the following documents:

• notification of an accident;
• certificate of traffic accident;
• a copy of the protocol on the administrative offense;
• photocopy of passport;
• bank details for transferring funds;
• a certificate from a medical institution confirming the severity of the harm caused to health.

In various situations, additional documents may be required. For example, if the victim has become disabled of group 1 or 2, then attach a medical report establishing disability.

Term

Contact the insurance company no later than 5 working days after the accident. Within 15 days from the date of submission of documentation for compensation, the insurer expects applications from other victims in this accident. At the end of this period, he reviews the papers and assigns payment within 5 days.

If there is a delay in transferring money from the insurance company, you can recover a penalty in court. It is calculated at 1% of the assigned amount for each day of delay .

Maximum payment amount under compulsory motor liability insurance in case of an accident

The amount payable under the liability policy is:

• in case of damage to property RUB 400,000
• in case of harm to health and life 500,000.

“The insured amount, within the limits of which the insurer undertakes to compensate the victims for the harm caused by each insured event (regardless of their number during the validity period of the compulsory insurance contract), is: a) in terms of compensation for harm caused to the life or health of each victim - 500 thousand . rubles; (as amended by Federal Law dated July 21, 2014 N 223-FZ); b) in terms of compensation for damage caused to the property of each victim - 400 thousand rubles. Federal Law of July 21, 2014 N 223-FZ); b) in terms of compensation for damage caused to the property of each victim - 400 thousand rubles; (as amended by Federal Law No. 223-FZ of July 21, 2014).” (Article 7 of the Federal Law of April 25, 2002 No. 40-FZ).

There are times when insurance does not cover damage. These include:

• a person not specified in the policy was involved in the accident;
• The amount of compensation exceeds 400 thousand rubles;
• the accident was the fault of the student, and the accident occurred at the designated place of study.

You should also be aware of your right to go to court. In some cases, insurers have grounds to return the amount they paid to the victim of an accident:

• Deliberate sabotage
• intoxication,
• Without documents
• No OC
• OSAGO has expired
• Fleeing from the scene,
• violation of procedure in the case of the European protocol,
• damage more than 400 thousand rubles,
• false information in the liability policy.

If the culprit of the accident decides to pay the amount of compensation himself, and then contacts the insurance company and provides the necessary documents, the insurance company will not compensate for the payment already made, since this is not provided for by law.

How is the compensation amount calculated?

The table of payments for compulsory motor liability insurance is presented in the appendix to Government Decree No. 1164. It consists of two columns:

• nature and severity of damage to health;
• the amount of the insurance premium (in percent).

The maximum amount that an insurance company can pay is half a million rubles. To calculate the amount of insurance, you need to multiply 500,000 by the amount of the insurance premium established by Government Decree.

Download the table of payments under compulsory motor liability insurance for harm to health

Example: a citizen received minor health damage as a result of an accident - a concussion. He was in outpatient treatment for 7 days. According to the payment table, compensation for such an injury is set at 3%. The amount to be reimbursed will be 35,000 rubles (500,000*3%).

If the victim received numerous injuries of varying severity, then all injuries are divided into categories, and the amount of insurance is calculated by adding up the payments.

Example: a victim has a disfigured face, for which insurance is provided at 40% of the maximum established amount, and at the same time there are soft tissue bruises - 0.05% of the maximum amount. The total amount of insurance compensation will be 200,250 rubles ((500,000*40%)+(500,000*0.05%)).

In some cases, the amount may be subsequently recalculated in favor of the injured person. For example, when going to the hospital after an accident, the average severity of harm to health was determined. After contacting the Investigative Committee and receiving compensation under compulsory motor liability insurance, my health deteriorated, and as a result of an additional examination it was determined that the body had suffered serious harm.

In this case, the victim should transfer new papers to the insurer. The Investigative Committee will review the medical examination report and recalculate the amount of compensation.

How to receive monetary compensation under OSAGO

Despite the priority of insurance payment in kind, the law still leaves the opportunity for the driver to receive compensation in money. This can be done in the following cases:

1. if the car cannot be restored
2. if the cost of repairs exceeds the maximum limit (400 thousand rubles) and the owner does not want to pay the difference
3. if the repair will last more than 30 days
4. if the service station is more than 50 km away and the insurance company refuses to pay for transporting the car
5. if the vehicle is not damaged as a result of an accident (for example, a laptop is damaged or a phone is broken)
6. if the fault in the accident is recognized as mutual

If the insurance payment does not cover the costs

When calculating compensation, possible additional costs for rehabilitation or treatment of possible complications are not taken into account. Often such medical services are paid and are not covered by compulsory medical insurance.

Therefore, if the insurance compensation did not cover the costs of treatment, the victim can count on additional payments .

Additional payments can cover the following expenses:

• therapeutic nutrition;
• nursing services;
• prosthetics, etc.

To obtain additional insurance, provide the insurance organization with documents confirming the need for such treatment. These can be certificates from medical institutions, doctor’s prescriptions, etc.

Documents for receiving payments under compulsory motor liability insurance

In order for the insurance company to transfer funds, the applicant must submit the package of documents required by regulations.

In accordance with the provisions of the regulatory legal act issued by the Central Bank of the Russian Federation, the package of documents includes:

• Application for the need to pay insurance compensation for a loss;
• Notification that a traffic accident has occurred;
• Accident Report;
• A copy of the administrative violation protocol;
• Identity document.

If necessary, additional documents may be attached to the above documents:

• Power of attorney for a representative if the victim does not appear in person;
• Bank account details of the person;
• Consent of legal representatives if the victim is a minor.

In order to prove the fact of causing harm to health, it is necessary to have a person:

• The victim’s medical card, issued by the medical organization where the victim was treated;
• Documentation of the diagnosis made in the emergency department;
• MSE report, in case of disability;
• Certificate confirming receipt of disabled status.

The insurance organization may additionally require:

• Documentary proof of the person's income;
• Certificate of family composition;
• Marriage registration document;
• Documentary proof that you have children;
• Victim's death certificate.

The list of specific documents can only be determined in each specific case. Remember that it is a good idea to save all invoices and checks that you received to pay collection services.

Insurance compensation in case of death of a citizen

If the victim died as a result of a traffic accident, then his relatives - spouse, children/parents, and other dependents - can claim compensation. The amount of compensation for such persons is 475,000 rubles. If several relatives have the right to compensation at the same time, then the amount of the insurance premium is divided equally between them.

Insurance in the amount of 25,000 rubles can be obtained by other persons who have incurred the costs of burying a deceased person as a result of a traffic accident..

To receive funds upon the death of a citizen as a result of an accident, when contacting the insurance company, attach:

• a copy of the death certificate;
• document confirming the right to receive compensation - marriage certificate, birth certificate, etc.

In what cases does the insurance company have the right to refuse payments?

There are circumstances in which an organization is not required to make payments. The right to receive benefits arises if the injury results from a motor vehicle accident. There are cases where applicants wanted benefits but were denied. For example, the plaintiff asks to pay for dental prosthetics, but as a result of the accident he received only minor scratches. In this case, the insurer's refusal will be completely justified.

Compensation is not paid in the event of an accident for the following reasons:

• the intent of the victim;
• force majeure circumstances: floods, fires;
• hostilities;
• radiation, explosion.

The grounds for refusal are mistakes made by the victim:

1. The deadline for submitting documents has been missed. You can try to challenge these reasons in court.
2. The application is filled out incorrectly or contains errors.
3. No evidence was collected.
4. The victim did not seek medical help.
5. This accident was compiled on the basis of a European document.

The injured party must prove that an accident occurred. If he is not listed in the documents as a participant in the accident, this means that he cannot receive payment. So when an insurer won't pay, you must first determine what the problem is. If the reasons are legitimate, eliminate them if possible. If you receive a response containing illegal or controversial arguments, you must contact the Russian Union of Auto Insurers (RUA) and the Central Bank. If the problem is resolved at this stage, you will not have to file a lawsuit. If there are disputes, the claim is first sent to the insurer, and if it is denied, a lawsuit is filed in court.

Insurance coverage for the culprit of an accident

OSAGO provides liability insurance for a motorist who has committed an accident to third parties. That is, compensation for costs does not apply to the guilty person.

This rule applies only to obvious accidents in which the culprit is clearly identified. But not all car accidents are like this. Many road accidents occur when it is mutual fault.

If another car owner is found to be at fault in relation to the main at-fault driver, then the main at-fault driver will also be entitled to receive insurance.

In the event of a trial, lawyers can divide a single incident into several episodes, in one of which the culprit will be the victim.

Independent examination in case of road accidents

When involved in an accident, the driver is required to report it to the insurance company. Sometimes after this, the company offers to send an appraiser to the site, who will record all the details of the accident and estimate the amount of upcoming repairs. Sometimes such an inspection of the car by an expert occurs later, but its period should not exceed 5 days from the moment of the accident, otherwise the insurance company may begin to shirk its obligations to compensate for damage.

But as experience shows, appraisers on the part of the insurance company usually act in its interests, underestimating the cost of compensation for damage. Therefore, a driver injured in an accident often has to seek an assessment from independent experts. And their assessment is usually carried out fairly, and sometimes increases the cost of compensated damage by 100-200 thousand rubles.

IMPORTANT : The driver has the right to organize an independent examination only after his car has already been inspected by employees of the insurance company. Otherwise, there is a risk that the independent expert’s assessment will not be taken into account.

When the insurer has the right to refuse money under compulsory motor liability insurance

The insurance company may refuse to pay compensation for injury to health in an accident if:

• the driver does not have a license to drive a vehicle;
• The accident was pre-planned;
• there is no compulsory motor liability insurance policy or the insurance has expired;
• OSAGO is fake;
• the money was transferred by another insurer;
• The accident occurred while learning to drive a car;
• The application period has expired - 5 working days.

In the cases listed in Art. 18 Federal Law No. 40, instead of the insurance company, compensation payment will be made by RSA (Russian Union of Auto Insurers). Such cases include:

• declaring the insurance company bankrupt;
• revocation of the company's license;
• unknown person who caused harm to the victim;
• absence of compulsory motor liability insurance.

To receive money from RSA, submit an application and documents confirming your right to receive the compensation amount.

Compensation for health damage under compulsory motor liability insurance

The amount of money you can recover from your insurer for your injuries depends on the type and severity of the injuries. Compensation is made for each injury, but cannot exceed the maximum amount. Compensation is paid before treatment is completed, based on the severity of the victim’s condition.

To receive compensation, the victim must provide the following documents to the insurance company:

• OSAGO policy;
• passport;
• application form;
• protocol or resolution from the traffic police;
• a certificate from the hospital detailing all injuries and necessary treatment.

Additional papers may also be required:

• notarized power of attorney, if the submission of documents is not carried out by the victim himself;
• card or bank account number when receiving a non-cash payment;
• a court decision if any proceedings took place (for example, determining the culprit) regarding the accident;
• consent of parents or guardians, if the victim has not yet reached the age of eighteen.

There are legitimate reasons why an insurer may refuse compensation. Such as:

1. The injuries sustained are not the result of an accident or there is no convincing evidence to the contrary.
2. The victim caused the accident.
3. The accident occurred as a result of any natural or man-made disasters (fires, explosions, floods, radiation contamination).
4. The accident occurred due to military operations.

It may also be refused if the victim committed the following violations of the procedure:

• missed the application deadline;
• filled out the application incorrectly or with errors;
• did not collect the necessary evidence;
• did not seek medical help.

When drawing up a European protocol, the victim has no right to receive compensation.

If the insurance company does not fulfill its obligations, you can sue it. Such cases include:

• payment is overdue by more than one month;
• the amount of compensation is less than what is required according to the table;
• the insurer refuses to transfer without legal grounds;
• the costs of burying a person who died in an accident have not been paid;
• documents from the victim were not accepted.

What to do in case of an unreasonable refusal

If the insurer refuses to pay compensation or has not paid it in full, go to court. Before this, carry out the pre-trial settlement procedure. To do this, send a written claim to the insurer.

The Investigative Committee is given 30 days to consider and send the applicant a response to the claim. Oral communication with the insurance company is not considered by the court as a pre-trial settlement. All documents must be in writing.

The claim must have an incoming number and date of receipt. If the claim is sent by mail, send it by registered mail with notification.

The statute of limitations for disputes regarding compensation for personal injury resulting from a car accident is 2 years . To increase your chances of getting money through court, enlist the help of an experienced lawyer.

What can a victim of an accident be asked to do?

In court, you can receive not only compensation for injuries sustained in an accident:

• compensation for property damage caused to your vehicle, wheelchair, bicycle, personal belongings, including communication equipment (mobile phone), if the insurance company refused to pay compensation or did not pay it in full;
• Payments for compensation for harm to the health of a citizen (pedestrian, passenger, driver), this includes expenses for visiting a doctor, tests, medical examinations and manipulations, as well as the purchase of medications and orthopedic equipment;
• Punitive damages caused as a result of an accident (pedestrian, passenger, driver), which is not limited in amount and depends on the individual situation of each person (read about this topic of recovery of moral damages at the link);
• payments related to lost wages and other income that you did not receive due to recovery;

In addition, if a person died as a result of an accident (a pedestrian, passenger or other driver was hit), we will help the heirs both in obtaining maximum compensation for moral damage, compensation associated with burial, and in actions to bring the culprit to criminal liability under Article 264 of the Criminal Code of the Russian Federation, this procedure is not new for us, since our specialists have the status of a lawyer and have repeatedly participated in similar processes.

TIP: Please watch the video, in addition to the fact that the driver must pay compensation, he may face criminal liability.

Summary

To receive compensation for personal injury under compulsory motor liability insurance, remember:

• contact the Investigative Committee with a statement within 5 days from the date of the accident;
• To receive payment, contact the insurer's office in person or send documents by mail;
• from the moment of application to the moment of transfer of funds no more than 20 days should pass;
• the amount depends on the severity of the injuries received;
• if the drivers are both at fault, both participants in the accident will receive insurance;
• in the event of the death of the victim, compensation will be paid to his relatives;
• in certain cases, the insurer may refuse compensation;
• If the insurance company unreasonably refuses to pay, go to court.

More…

1. Limit of payments under compulsory motor liability insurance: according to the European protocol, in case of mutual fault, in case of death or harm to health, in case of total damage to the car.
2. Total loss of a car under compulsory motor liability insurance: what is it, examples of payment calculations
3. What documents are needed to file an insurance claim under MTPL?
4. Is the culprit of the accident paid insurance under compulsory motor liability insurance?

Payment in case of drawing up a European protocol

Several years ago, the concept of a European protocol was introduced in our country, that is, drivers were given the opportunity to file minor accidents without calling a traffic police inspector. The main conditions for registering an accident under the European protocol are:

1. no casualties in the accident,
2. mutual understanding reached between drivers (admission of guilt),
3. small scale of damage;
4. Only 2 cars were involved in the accident.

If these conditions are met, the injured party can count on a maximum insurance payment of 100,000 rubles, and for accidents that occurred in Moscow and the region, St. Petersburg and the Leningrad regions - up to 400,000 rubles.

And from October 1, 2021, the maximum payment under the MTPL under the European protocol will be equal to the method of registering an accident with a traffic police visit and will be equal to 400,000 rubles for all regions of the country. At the same time, if the cars are equipped with the GLONASS system, then mutual understanding between the participants becomes an optional condition.

What to do if an accident occurs

Initially, government authorities are notified and must schedule an examination of the traffic accident. During the examination, exact data will be known in order to calculate your opportunities for receiving monetary compensation under compulsory motor liability insurance.

Regardless of what or who was harmed in an accident, if the amount of payments exceeds the threshold of 120 thousand rubles, the victims should not count on compensation under compulsory motor liability insurance.

If they absolutely do not agree with the amount of monetary compensation, then on the basis of an independent automotive technical (sometimes auto-merchandising examination) you can file a claim in any civil court at the place where the compulsory motor liability insurance agreement was concluded.

Evidence of the insurer’s unlawful actions will be the opinion of an independent expert.

Do not forget that after notifying the insurance company about the occurrence of an insured incident, it reviews the application as soon as possible and sends a specially authorized person to the scene of the incident, who assesses the incident and decides whether such damage is subject to coverage under the policy or not. Based on the results of the assessment, a special act is issued.

When does the insurance company have the right to refuse compensation?

Refusal to pay is possible in the following cases:

• the damage was caused by an uninsured vehicle;
• only moral damage was caused;
• the damage was caused by a vehicle that was used for training or testing;
• harm to health was caused by the cargo that the car was transporting;
• the harm was caused by the employee in the performance of his work duties, if this type of harm should not be compensated by law;
• the amount of harm exceeds the maximum established limit.

Deadline for submitting an application to the insurance company

The 2021 amendments to Federal Law No. 40 establish that the driver is obliged to provide the insurance company with all documents about the accident within 5 working days from the date of the accident .

Previously, this period was 15 days, which left drivers some time to collect documents. Now it is obvious that there is no point in delaying the process of submitting documents to the insurance company for compensation for damage after an accident.

If the driver, for objective reasons, is unable to provide the necessary documents within this period, he can notify the insurer of this by letter, attaching a copy of documents that confirm force majeure (sick leave, confirmation of hotel reservation, etc.)

How to correctly determine the amount of damage?

In order to accurately determine the extent of the damage caused and not make a mistake in registering an accident according to the European protocol, you first need to thoroughly inspect the car and identify all the damage. It wouldn't hurt to take a photo of them right away.

After all the damage has been found, you need to assess the extent of the damage yourself or ask knowledgeable people.

The PCA price guide can help in this difficult matter, according to which the insurer will calculate the amount of damage. But to check the cost of spare parts, you will need catalog numbers of specific parts; they can be obtained from the official ELCATS directories for your car.

If you are in doubt whether a part needs to be replaced or repaired, then always assume that it is replaced, so the possible amount of damage will be maximum.

I would not recommend listening to the culprit’s advice about the cost of this repair. For them, the damage is always a couple of thousand, and their friend in the garage will do it for a tenner, so you most likely will not hear an objective assessment.

Nevertheless, rummaging through catalogs and the RSA reference book while on the road is such an undertaking! Therefore, it is better to imagine in advance the cost of the most vulnerable parts (bumpers, including their amplifiers and decorative elements, fenders, headlights and lanterns, trunk lid, windows and others). But even on the road you can find the approximate price of spare parts quite quickly in search engines.

When is compulsory motor liability insurance paid in 2021?

To ensure that persons who are entitled to compensation can solve their problems without delay, accruals are carried out strictly according to the regulations. The deadline for payment under compulsory motor liability insurance in case of an accident is established by law in clause 21 of Art. 12 of Law No. 40-FZ, and is 20 calendar days (except for non-working holidays). It can reach 30 days if the vehicle is repaired by an organization with which the insurance company does not have an agreement to provide this type of service (clause 15.3 of the same article).

The deadline for reporting an accident to the insurance company under compulsory motor liability insurance is also established by law. it is determined by the insurance contract (Article 11), and if the accident is registered according to the European Protocol, it is 5 working days. If the deadline is missed and there are no valid reasons, the insurance company has the right to refuse payment.

Other beneficiaries may contact the insurance company within 15 calendar days after acceptance of the first application.

List of services provided by our lawyers for compensation of damages under compulsory motor liability insurance

• Providing independent expert services
• Support of car transactions (sale, purchase);
• Low insurance payments for CASCO insurance in case of loss of a car
• Insurers are trying to recover damages from the person responsible for the accident.
• Filing a complaint regarding warranty service;
• Conflicts with the traffic police when calculating the degree of guilt of the initiator of an accident
• Conducting an independent examination of a defective car;
• Protection of the car owner in case of a claim from the insurance company
• Help from a car accident lawyer

Are there any chances for maximum possible insurance compensation?

Of course, the limits on the amount of insurance payments in the law have increased. But this does not oblige insurers to pay everyone the maximum. Quite the contrary, insurance companies try to minimize payments under any pretext.

Typically, insurers use manipulations with an expert assessment of the damage caused to the car during an accident. They also look at the number of victims in road accidents. One of the most reliable ways to reduce the amount of compensation is to calculate the degree of wear of the machine and individual parts. The worst luck in this scheme is for the owners of cars from the local automobile industry, especially if the car has a lot of mileage or is very old. Insurers pay the owners of such cars the minimum, which is obviously not enough for normal repairs.

You can try to get insurers to increase the amount of insurance payment peacefully, through negotiations. But this doesn't work often. Then only the court can correct the situation. But you need to prepare for it, conduct an independent expert assessment of the damage (at this stage you will have to pay for the examination yourself). And if the results of the examination prove that the insurers significantly underestimated the payment of compensation, then the court will most likely be on your side.