Who is the insured, the insurer? Some concepts in the insurance industry

In one way or another, we all face insurance activity all the time. But not everyone can operate or even explain the basic concepts used in the insurance contract, and accurately name their status in legal language. In the article we will talk about what the concepts of "insurance", "insurer", "policyholder", etc. mean, what rights and obligations the parties have and other important points.

Insurer concept

The policyholder is a legal entity (company or individual entrepreneur) or an individual who has entered into an insurance contract with the insurance company. The policyholder can insure anything: health, real estate, car, dog, smile, etc.

What is the policyholder code

This concept is rarely heard by people, and even more so many do not know what it means. The policyholder’s code is a sequence of numbers that characterizes the payer and is indicated in the title section of form 4-FSS (quarterly report form to the Social Insurance Fund). The cipher allows the Fund to receive information about who the policyholder is and about the rates that should be guided when collecting payments from the policyholder. You can determine your code by yourself, referring to the directory of ciphers of policyholders, which are located in Appendixes 1, 2 and 3 to the Procedure for filling out Form 4-FSS, respectively. Each cipher includes three parts: 000/00/00. We will understand what each of them means.

• The first 3 digits determine the type of activity.

• The second part of 2 digits denotes a code characterizing the tax regime.

• The third part of the cipher characterizes the source of the payer's capital.

If something changes in the data of the payer (source of capital, type of activity, tax regime), then the code of the insured also changes.

Insurer concept

Like the question “Who is the insured?”, Most people often have no answer to a similar question about the insurer. So, the insurer is the second side of the insurance transaction, a company that carries out financial activities to insure something, has a license for this and assumes obligations to compensate for losses arising from the occurrence of insured events specified in the insurance contract. The policyholder is the one to whom losses are compensated.

Rights and obligations of the parties

The rights and obligations of each party must be known to the insured. Otherwise, you can miss the detail and get big problems with the insurer in the future.

Insurer Rights

1. Obtaining full information about who the policyholder is and what he wants to insure.
2. Preliminary assessment of the degree of risk for a particular property, life and health of a potential insured. An expert examination is possible to assess risks. Failure in the event of a decision on the inappropriateness of insurance.
3. Getting paid for the provided insurance service.
4. The demand for documents confirming the occurrence of the insured event and the fact that it is such.
5. Refusal to pay insurance amounts if false information is found in the data of the insured or after the time period specified by law for notifying the insurer about the occurrence of the insured event has expired.
6. Investigation of the circumstances in which the insured event occurred if the insurance company suspects the policyholder of fraud.
7. Unilateral termination of the contract if the policyholder fails to pay premiums on time (if insurance payment is paid by installments).

Obligations of the insurer

1. Providing the policyholder with information about the type of insurance that interests him.
2. Conclusion of an agreement on the type of insurance that the policyholder needs when justifying expediency.
3. Payment of the insured amount, indemnification if an insured event occurs.
4. Keeping secrets of insurance and the personal data of the policyholder.
5. Direction of an independent expert for the assessment of property in the event of an insured event and the preparation of the insurance act in a timely manner.

Policyholder Rights

Who is the policyholder? This is a person / company that must respect its rights and obligations, otherwise the insurer has the legal right to refuse to provide services.

1. Obtaining full information about the service provided by the insurance company, company, license.
2. Obtaining insurance payment subject to the conditions of notification of the insured event and all further actions.
3. Termination of the insurance contract ahead of time, if necessary, and return of the unused insurance premium.
4. Replacing the insurer at will.
5. The right to challenge in court the decision of the insurance company to refuse payments.

Policyholder Responsibilities

1. Providing reliable and complete information about the subject, the subject of insurance in the application and the subsequent contract, as well as the degree of risk and the possibility of verification by the insurer of information.
2. Payment at a time or in installments, if the terms of the contract, insurance premium allow.
3. Notification of the insurance company about the occurrence of the insured event within the time period established by law (or the rules of the contract) or the subsequent provision of a document that may justify a delay in the notification (sick leave, travel, etc.).
4. Notification of the insurer within the period specified in the contract in case of compensation for damage to the person responsible for the occurrence of the insured event.

Insured event concept

An insured event is a situation that is provided for in the insurance contract or by law, upon the occurrence of which the insurance company is obligated to pay the insured the financial amount ascribed in the contract in full or in the form of interest.

What are insurance benefits?

The insurance payment (amount) is the amount of money that the policyholder receives from the insurance company in the event of an insured event. Payments are made, if specified in the contract, the amount is also specified in the insurance contract.