Insurance payment is The amount of insurance payments

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

Insurance contracts will have no effect 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 amount and speed of transfer are of paramount importance for affected persons.

Let's consider what an insurance payment is, how it is provided, and how this indicator can be used to judge the work of an insurance company.

The concept of insurance payment

In textbooks on insurance, an insurance payment is defined as material or financial resources aimed at compensating for harm caused to the he alth or property of the victim. The list of factors due to which the payment of funds is possible is called an insured event. Types of insured events are described in detail in the contract, which is concluded 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 payment may be the equivalent of protection, presented in cash.

It is worth noting that different types of insurance involve different types of payments, moreover, it is far from always insuredthe person is en titled to direct compensation.

Obligations of the insurer

In most cases, the premium is the amount agreed between the insurer and the policyholder. This rule is known as the principle of limited supplier. 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 also confirmed in 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 made on the basis of an insurance act or an emergency certificate. This document is compiled 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 are commercial secrets. The insurer is obliged to maintain confidentiality when receiving information, otherwise he may be sued for disclosing private commercial information.

What do I need to do to get paid?

First of all, the victim must write an application for insurance payment and attach documents confirmingoccurrence of an insured event. You should not delay filing documents - the victim is given only a month for this. The package of papers is different for different types of insurance. Other required documents may require:

• act certifying an accident - in case of compensation under OSAGO, hull;
• document confirming the appeal to law enforcement agencies - in case of theft, damage to property;
• a medical certificate, an extract from a medical card certified by the office of a medical institution, a conclusion on the assignment of a disabled group - if we are talking about he alth insurance;
• 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.

The 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. The insurer has five to fifteen days to do this. Based on the relevant documents, the insurer decides whether to pay or refuse monetary compensation. The last decision must be confirmed by objective reasons (an accident that does not fall under the clauses of the insurance contract, etc.).

Sometimes thisthe 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 about this. In some cases, an application for payment cannot be considered due to circumstances - an ongoing criminal or civil process. Then the insurer has every right to suspend payment until a court verdict is issued.

Payment and refusal of payment

If the insurance company makes a positive decision, wait for the money to be credited to your current account within ten to fifteen banking days. Payment can be one-time or consist of several parts. If you have received a refusal, the insurer must justify such a decision. It is always possible to appeal the refusal in court.

How to assess the reliability of an insurer in terms of payments

All insurance companies are required to publicly disclose the results of their commercial activities at the end of the year. Such financial statements should be freely available on the websites of all insurers. They contain indicators of the collection of insurance premiums, the number of applications accepted and considered, as well as the percentage of compensatory insurance payments. This value is essential to the potential policyholder.

According to various experts, the most acceptable payout rate is about 30-50% of all funds raised. If the indicator is less, there is a high probability that the legitimate insurance compensation will have to be beaten out incourt.

Not very good for the insurance holder and the opposite option - 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 source of income is precisely the contributions of ordinary insurers. If claims payouts are excessive, it is possible that the insurer will soon declare bankruptcy and be unable to guarantee the insurance payment.