Insurance contracts will not have any significance if the company does not fulfill its obligations and does not pay when an insured event occurs. Insurance payment is one of the main guidelines when choosing an insurer, and its size and speed of transfer are of paramount importance to the affected persons.
Consider what the insurance payment is, how it is provided, and how this indicator can be used to judge the work of the insurance company.
The concept of insurance payment
In textbooks on insurance, insurance payment is defined as material or financial means aimed at compensating for harm caused to the health or property of the victim. The list of factors due to which the payment of funds is possible is called an insured event. The types of insured events are described in detail in the contract between the insurer and the insured person.
An insurance contract may provide for both full and partial coverage of the damage caused. As a result, the insurance claim may be the equivalent of cash protection.
It is worth noting that various types of insurance also involve different types of payments, and moreover, the insured person is not always entitled to direct compensation.
Obligations of the insurer
In most cases, the insurance payment is the amount agreed between the insurer and the policyholder. This rule is known as the supplier limitation principle. The maximum amount of insurance payment is indicated in the policy or established by law. The insurer has the right not to pay more than the indicated amount. The limitation of the maximum payment was confirmed by the Civil Code of the Russian Federation, in particular, this is stated in Art. 929, 942,934,947.
Consideration of the issue of calculating the amount of insurance payment is based on the insurance certificate or emergency certificate. This document is drawn up by a representative of the insurance company on the basis of an examination confirming the occurrence of an accident. If necessary, the insurer has the right to request information about the insured event from various state and commercial enterprises, law enforcement agencies, banks, medical institutions.
Organizations and enterprises of any form of ownership are required to provide the insurer with the necessary data, including those that constitute a commercial secret. The insurer is required to maintain confidentiality in obtaining information, otherwise it may be brought to court for the disclosure of private commercial information.
What needs to be done to get paid?
First of all, the victim must write an application for insurance payment and attach documents confirming the occurrence of the insured event to it. Pull with the submission of documents should not be - the victim is given for this only a month. The package of papers is different for different types of insurance. Among other necessary documents, they may require:
- an act certifying an accident - for compensation under compulsory motor third-party liability insurance, comprehensive insurance;
- a document confirming the appeal to law enforcement agencies - in case of theft, damage to property;
- a medical certificate, an extract from the medical record, certified by the office of the medical institution, a conclusion on the assignment of a disabled group - if we are talking about health insurance;
- the original policy, an extract from the medical report and a certificate from the registry office on the occurrence of death - if we are talking about an insured event with a fatal outcome.
A list of documents that must be provided upon the occurrence of the circumstances described in the policy is available on the website of each insurance company. It would be useful to clarify this list when buying a policy from an insurance agent.
How long documents are considered
Based on the documents submitted by the victim, the insurance company makes a decision on payment. For this, the insurer is allocated by law from five to fifteen days. Based on the relevant documents, the insurer makes a decision on payment or refusal of monetary compensation. The last decision must necessarily be confirmed by objective reasons (an accident that does not fall under the clauses of the insurance contract, etc.).
Sometimes this period may be delayed due to the need for a more thorough verification of the circumstances that provoked the occurrence of the insured event. But be sure to notify interested parties of this. In some cases, the application for payment cannot be considered due to circumstances - the current criminal or civil process. Then the insurer has the full right to suspend payment until a court verdict is issued.
Payout and denial of payment
If the insurance company makes a positive decision, wait for crediting money to your current account within ten to fifteen banking days. Payment can be one-time or consist of several parts. If you have been refused, the insurer must justify such a decision. There is always the opportunity to appeal the refusal in court.
How to evaluate the insurer's reliability by the size of payments
All insurance companies are obliged at the end of the year to publicly present the results of their business activities. Such financial statements should be freely available on the websites of all insurers. They contain indicators of collection of insurance premiums, the number of accepted and reviewed applications, as well as the percentage of compensatory insurance payments. This value is essential for a potential policy holder.
According to various experts, the most acceptable indicator of payments is about 30-50% of all funds raised. If the indicator is less, there is a high probability that legal insurance indemnity will have to be knocked out in court.
The reverse option is not very good for the insurance holder - if more than half of the submitted claims for insurance payment are satisfied. This, most likely, indicates the irrational use of insurance reserves. Any insurance company must support itself, and its contributions are precisely the contributions of ordinary insurers. If claims payments are excessively large, it is entirely possible that the insurer will soon declare bankruptcy and cannot guarantee insurance payments.