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

2024 Author: Howard Calhoun | [email protected]. Last modified: 2023-12-17 10:16

We all deal with insurance activities one way or another 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", "insured", etc. mean, what rights and obligations the parties have and other important points.

The concept of the insured

The insured is a legal (company or individual entrepreneur) or natural person who has entered into an insurance contract with an insurance company. The insured can insure anything: he alth, 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 of contributions and is indicated in the title section of form 4-FSS (form of a quarterly report to the Social Insurance Fund). The cipher allows the Foundation to obtain information about who thethe insured, and about the rates to be guided by when collecting payments from the insured. You can determine your cipher yourself by referring to the directory of policyholder ciphers, which are in Appendixes No. 1, 2 and 3 to the Procedure for filling out Form 4-FSS, respectively. Each cipher includes three parts: 000/00/00. Let's figure out what each of them means.

The first 3 digits define the type of activity

The second part of 2 digits indicates the code characterizing the tax regime

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

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

Insurer concept

Just like the question "Who is an insured?", a similar question about the insurer is often not answered by most people. So, the insurer is the second party to the insurance transaction, a company that conducts financial activities for insuring 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 insured is the one to whom the losses are compensated.

Rights and obligations of the parties

The insured must know the rights and obligations of each of the parties. Otherwise, you can miss the detail and get big problems with the insurer in the future.

Rights of the insurer

1. Receivefull information about who the insured is, what he wants to insure.
2. Preliminary assessment of the degree of risk for a particular property, life and he alth of a potential insured. Expert inspection for risk assessment is possible. Refusal in the event of a decision on the inappropriateness of insurance.
3. Receive payment for the insurance service provided.
4. Demanding documents confirming the occurrence of an insured event and that it is such.
5. Refusal to pay insurance amounts if false information is found in the policyholder's data or the period given by law for notifying the insurer of the occurrence of an insured event has expired.
6. Investigation of the circumstances under which the insured event occurred, if the insurance company suspects the insured of fraud.
7. Unilateral termination of the contract if the policyholder does not pay premiums on time (if the insurance payment is paid in installments).

Obligations of the insurer

1. Providing the policyholder with information about the type of insurance that he is interested in.
2. Concluding a contract for the type of insurance that the insured needs when justifying expediency.
3. Payment of the sum insured, compensation for losses if an insured event occurs.
4. Preservation of the secrecy of insurance and personal data of the insured.
5. Send an independent expert to assess the property in the event of an insured event and draw up an insurance act on time.

Rights of the policyholder

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

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

Obligations of the policyholder

1. Provision of 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 allow, the insurance premium.
3. Notification of the insurance company about the occurrence of an insured event within the time period established by law (or the rules of the contract) or the subsequent provision of a document that can justify the delay in notification (sick leave, travel allowance, etc.).
4. Notification of the insurer within the period specified in the contract in case of compensation for harm by the person guilty of the occurrence of the insured event.

The concept of an insured event

Insured event is a situation thatprovided for in the insurance contract or by law, upon the occurrence of which the insurance company is obliged to pay the insured the financial amount assigned in the contract in full or as a percentage.

What are insurance benefits

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 it is written in the contract, the amount is also stipulated in the insurance contract.