Delaying and violating deadlines, reducing payments, imposing services, and other tricks of insurers.
Certain types of insurance and the conditions for their provision are determined by current legislation, for example, Federal Law No. 4015-1 of November 27, 1992, but in practice, consumers are faced with situations when the products offered to them imply many exceptions and clauses, including those not provided for by law.
The article summarizes the main situations when insurers or their representatives can impose on the consumer favorable conditions for themselves, which, as a rule, entail a refusal, a decrease in insurance payments, or require significant costs from the consumer that are not mandatory.
Discrimination in life insurance payments
To obtain insurance under such an agreement, before concluding it, you must carefully read the list of insured events.
Some insurers do not recognize as insured events death or disability as a result of an accident or illness resulting from the insured person’s pregnancy or events related to it (care, interruption, etc.).
In addition, at-risk (special conditions of the contract) are disabled and people suffering from cardiovascular diseases, cancer, HIV-infected persons, the elderly, and others.
Abuse in credit insurance through bank life and health insurance
Insurance through a bank, when concluding a loan agreement, is often accompanied by the following “traps” for the consumer:
- the choice of an insurance company is limited – as a rule, it is an organization affiliated with the bank;
- therefore, at the time of signing the contract (policy), the consumer buys a “pig in a poke”;
- often an insurance product is imposed that is not suitable or is simply not needed, while a significant part of the amount withheld from the borrower remains with the bank as a commission from the insurance company;
- including insurance in the body of the loan, the bank also charges interest on it, thereby increasing the cost of the loan;
- many banks deliberately do not inform consumers about the possibility of withdrawing insurance during the “cooling period”;
- most borrowers face difficulties in returning the insurance policy: both during the “cooling period” and early repayment of the loan.
Scanty payments for investment life insurance (ILI)
Analysis of consumer complaints shows that the victims of insurance fraud are often bank customers, to whom the IOL is often sold under the guise of a deposit. Bank managers say that an investment life insurance policy is a complete analog of a deposit, but with a higher yield. At the same time, it is silent that:
the funds invested in the ILI are not insured by the DIA (deposit insurance agency) and the state does not guarantee their safety;
before the end of the contract (up to 5 years), it is impossible to withdraw money without losses ;
income is not guaranteed (the company in whose management the money is transferred may have losses or show minimum profitability).
The listed conditions are essential, but banks do not warn about these risks. According to the data of the Bank of Russia, the average yield on the three-year ILI contracts that ended in 2017-2018 was 3.3% per annum, and for five-year contracts – only 2.4%.
Imposing services when insuring bank cards
Recently, insurance of plastic cards (debit and credit) has become popular, and very often the card is issued with insurance, even if its owner did not ask for it. After all, the bank’s employees are motivated: the more options they connect, the higher the salary bonus! The list of insurance risks is approximately the following:
- loss of a card as a result of a robbery or robbery;
- taking possession of the PIN-code of the card by using violence or threats;
- forgery of the client’s signature when withdrawing money at the bank office;
- fraud with the use of technical means (phishing, skimming).
Judging by the list, the cardholder pays a significant part of the insurance premium for what is already guaranteed to him by law, since the bank is obliged to ensure the safety of the funds entrusted to him.
According to the data of the Bank of Russia, in 2019 the volume of transactions performed without the client’s consent using electronic means of payment amounted to 426.5 million rubles. Moreover, 69% of transactions were carried out as a result of deception or abuse of the client’s trust. Such cases are usually excluded from the scope of insurance obligations.
Delay in payments for property insurance
Taking advantage of the fact that special laws governing the contract of voluntary insurance of property of citizens (Chapter 48 “Insurance” of the Civil Code of the Russian Federation, Law of November 27, 1992, No. 4015-1), liability for violation of the terms of payment of insurance compensation are not provided, many insurers “pull” with payments even admitting an insured event.
To counteract this practice, the Presidium of the Supreme Court of the Russian Federation in its ” Review on Certain Issues of Judicial Practice ” dated December 27, 2017, noted that in cases where the insured states a claim to recover a penalty provided for in Art. 28 of the Law on the Protection of Consumer Rights (dated 07.02.1992 No. 2300-1) for failure by the insurer to fulfill its obligations, such a claim is subject to the satisfaction, and the penalty is calculated depending on the amount of the insurance premium (clause 16 of the Review).
Refusal of payments for property insurance
Arbitrarily interpreting the terms of the contract, the insurance company may refuse to pay. The “ Review of Judicial Practice ” sets out the following case: the plaintiff (citizen) insured the car from the defendant (insurance company) under a voluntary CASCO insurance contract (risks: “damage” and “theft”). The plaintiff’s car was stolen by an unidentified person, and at the same time, the investigator opened a criminal case on the basis of a crime under Part 3 of Art. 159 of the Criminal Code of the Russian Federation (fraud).
The insurer refused to pay the insurance indemnity on the basis that theft of a car by fraud is not an insured event in its Vehicle Insurance Rules.
The Presidium of the Supreme Court of the Russian Federation expressed its opinion on this matter, namely: in case of doubts about the interpretation of the terms of the contract set forth in the policy and insurance rules, and the impossibility of establishing the actual general will of the parties, taking into account the purpose of the contract, contra proferentem should be applied – the most favorable interpretation for the consumer, especially when these conditions have not been individually agreed with him.
With regard to the case under consideration, this means that since the contract provides for the obligation of the insurer to pay insurance indemnity in the event of theft of the car, the claim of the plaintiff must be satisfied.
Failure to pay compensation for travel medical insurance
The minimum package of medical insurance for tourists traveling abroad includes emergency services, including:
- transportation to the clinic;
- outpatient and inpatient treatment with a threat to life and health;
- emergency dentistry;
- evacuation of the injured tourist to his homeland.
However, not all insurers promptly respond to these cases. As practice shows, the insured person has to pay for the treatment himself, since the payment for it from the insurer is not timely transferred for various reasons.
Upon returning home, there is hope to receive compensation. However, here too there are many obstacles: from the collection and submission of numerous supporting documents to the clarification of the fact that the treatment provided during the trip does not belong to the insured event. A good payout can only be if the tourist gets a disability.
Reduction of compensation for luggage insurance
Damage or loss of luggage during a trip is not a pleasant experience. This is used by insurers, promising their clients substantial payments when insuring such risks. However, the insurance contracts they offer contain many “traps” that allow either not to pay insurance compensation, or to limit the number of payments to the minimum amount.
For example, luggage insurance rules may stipulate that compensation will be paid taking into account the depreciation rates from the original cost of lost items – but only if the owner confirms it with sales (cash) receipts or other documents. If such supporting documents are not provided, the insurer will make payments at the minimum rate.
9. Delaying payments on insurance against travel abroad
Medical insurance should not be confused with travel cancellation insurance. These are two different things. Travel cancellation insurance should protect you from losing money in case the trip is canceled for any reason (for example, the hotel went bankrupt, or a visa was not given, etc.). Maybe that’s why it costs, as a rule, 5-10% of the tour cost, which is a lot.
However, even in these cases, getting insurance is very difficult. If, when drawing up a policy and receiving money from a client, almost all insurance companies use an electronic form of communication (through the website and the client bank), then if an insured event occurs, their Insurance Rules come into force, according to which documents are accepted from the insured only at the office or when sending through the Russian Post.
In this case, before issuing a policy, the policyholder must make sure that the procedure for paying out insurance compensation will be as prompt as the payment for this policy.
10. Assessment of the insured event by an interdependent expert
Usually, the Insurance Rules provide for the possibility of an independent choice of an expert appraiser by the insured, because otherwise it will be recognized as illegal. However, in practice, many insurers refuse to pay for the services of an independent expert, referring to the company’s internal regulations.
In real life, the insured is offered to contact an “independent” expert firm, which at the same time has not advertised connections with the insurance company. This becomes clear from the amount of damage that their expert will indicate in the report.
In such cases, the insured needs to be calm about the meager amount of payments. It is necessary to obtain insurance since the fact of payment will be proof of recognition of the insured event by the insurer. Then you will need to contact a truly independent expert and receive an official statement of damage assessment, which will serve as the basis for contacting the financial institution or a court. If such an act is recognized, then a decision will be made on the additional payment of the difference to the insured according to two expert assessments.