Accident Insurance Payments - Compensation Amount

In unforeseen life circumstances, the insurance policy provides material support to the insured against possible unfortunate precedents. It is convenient that the insurance amount can be chosen by your own financial capabilities and risk exposure, and insurance will compensate for many costs.

What factors affect the amount of payments in the event of an accident

Possible accident insurance programs provide a guarantee of lump-sum compensation to injured persons in the event of insurance events that are determined by the contract. In this case, the maximum paid volume depends on the tariffs applied by the insurer and the amounts in the contract between the company and the policyholder. Money is paid as a percentage of the damage to health.

Each insurer himself approves the program, which defines the conditions of insurance: insurance premiums (package prices) and payments, types of injuries. The paid volume consists of a combination of factors:

  • Type of risk. The company determines all possible types of injuries, injuries, injuries, even death in the event of an accident.
  • Sum insured. Its size is established by agreement of the parties.
  • The age of the insured. Compensation depends on the age of the insured person, so children and the elderly are a high-risk group.
  • Circumstances of the precedent. An insured event does not consider a number of events, for example, a person’s intentional actions with the aim of obtaining insurance or damage to health due to an exacerbation of the disease.

Insurance payout table

The insurance contract determines the events that entail damage to health, and the amount of insurance coverage, depending on the severity of the injury. Each company develops detailed coverage as a percentage of the nature of damage to organs, vital systems. The accident payment table is a mandatory annex to the contract:

Type of risk (insurance event)

Amount of payments (%% of the sum insured)

Injury, bodily injury, illness due to an accident, for example:

- dislocation of the ankle;

- hand burn;

- fracture of bodies, arches and articular processes of 3-5 vertebrae (with the exception of the sacrum and tailbone)

3

5

15

Temporary disability (used more often with group insurance of employees).

0.1-2 (The amount is fixed for each day of disability)

Complete disability, disability:

- I group,

- II group

- III group.

- appointment of the category "disabled child"

100

75

50

100

Death of the insured

100

How to get accident insurance compensation

In order to timely and fully receive life insurance payments, it is necessary to observe the following algorithm of actions:

  1. Seek medical attention immediately at a medical institution. There must be issued a medical document upon receipt of an injury.
  2. Check that the event complies with the terms of the insurance contract.
  3. Report the insured event to the insurer within the time period specified by the contract. The notification period is 20-30 days from the moment of the accident.
  4. Send an application for payment to the insurance company with documentary evidence of the circumstances that led to the injury. Basically, in all situations besides death, the recipient of the insurance is the insured. In case of death (death) of the insured, its beneficiary or heir shall present to the insurer a certificate of his right to receive payment.
  5. The insurer considers the application within 1-3 months. If there are no contradictory circumstances and there is no need to provide additional certificates, funds are paid.

Insurance claim application

The company itself can establish sample applications. If the insurer does not have special requirements for such a document, the application shall indicate:

  • name of the insurer;
  • Name, address, contacts of the applicant;
  • a statement of the unfortunate event that occurred, indicating the place, time;
  • a statement of your eligibility for insurance benefits;
  • inventory of attached documentation;
  • signature, date.

List of required documents

A set of documentation for accident insurance benefits is collected depending on the specific situation. A typical list is:

  • insurance policy;
  • statement;
  • medical certificates that serve as the basis for the payment of insurance;
  • applicant's passport (photocopy).

Sample list of supporting papers in case of arm fracture:

  • extract from the medical record for the entire time of treatment;
  • research results (X-ray, functional, computed tomography, electro-physiological) with findings confirming the diagnosis;
  • conclusions of physicians (traumatologist, surgeon);
  • surgical protocol;
  • sick leave for the time of disability, certified by the employer;
  • occupational accident report / traffic police protocol in case of accident, etc.

Reasons for refusal of payments

In case of disagreement with the amount of insurance or the refusal of the insurer to pay it, the policyholder may file a complaint with the supervisory authority - the Central Bank of Russia. The grounds for refusal are conditionally divided into legal and illegal:

Good reasons

Illegal reasons

Non-compliance of the insured event with the terms of the contract

Passing by the insured for a valid reason (severity of illness)

Deliberate distortion of information (falsification of documents, etc.)

Submission of an incomplete set of documents (checked upon receipt of the application)

Violation of certain clauses of the contract (industrial injuries on overtime work are not reimbursed)

Incorrectly written application (the document is checked upon receipt)

WORK WITH THE INSURANCE COMPANY AFTER THE INSURANCE EVENT # insurance case

Watch the video: How much money can I get for my car accident settlement? Injury attorney answers your questions. (February 2020).