Complaint against the insurance company regional insurance center. How to file a complaint against an insurance company for OSAGO How to file a complaint against an insurance company

The services of an insurance company are a necessary part of modern life. However, there are situations when she does not fulfill her duties in good faith. In such situations, it is extremely important to know where to turn in order to hold the insurer liable.

Grounds for filing a complaint against OSAGO

Any interested person has the right to file a complaint against the insurance company when it does not fulfill its obligations.

Ordinary policy

In practice, the insured faces the following violations:

1. Refusal to conclude an insurance contract under OSAGO.
2. Unreasonable imposition of additional conditions or coercion to such within the framework of the “avtograzhdanka”.
3. Late or incomplete submission of information regarding the cost of the policy.
4. Delaying the payment period in comparison with the legislation of the Russian Federation.
5. Unreasonable reduction in the amount of payment.
6. Violation of the terms of consideration of the appeal by the insurer.
7. Refusal to conclude an agreement (“we do not serve your region”, the forms have run out, etc.).
8. Requiring additional documentation that is not actually required.
9. Refusal to pay insurance compensation for far-fetched reasons.

This list is indicative. In fact, many customers also face other violations that insurance organizations allow.

Electronic

The main claims against insurance companies associated with this type of policy:

• inability to buy insurance;
• no e-policy by e-mail;
• refusal of employees to report the series and number of electronic OSAGO;
• the imposition of additional services by the UK;
• creating "hindrances" when selling online. For example, this is observed among citizens of “unprofitable” regions or drivers who do not fit in any way;
• unreasonable reduction in the amount of payment.

First steps: what to do before filing a complaint, an algorithm of actions

If the client's rights have been violated, then he should file a claim with the company's management. In most cases, this is due to the negligence of the employees of the organization, and not because of its internal policy. Most often, it is at this stage that all violations are corrected.

If within 10-14 days the client does not receive a response from the insurer or the problem has not been resolved, he needs to contact the supervisory authorities with a claim on the organization. There is no single governing body. That is why you should choose the addressee based on the problem.

If the violations relate to the financial side (reduction of payment, refusal of insurance compensation), you must immediately go to court. Before this action, it is recommended to prepare confirmations of your position. It is advisable to make an independent assessment of the damage to the vehicle, collect copies of letters to the insurance company, and so on.

You should find an experienced lawyer who specializes specifically in litigation with OSAGO insurers. Not every lawyer will take such a case.

The procedure for compiling and filing a complaint with various organizations. What can help and in what cases, what can not. Terms of consideration and response, decision and appeal

Depending on the violation of the UK, a citizen has the right to file a claim with the relevant institutions. Moreover, you can complain at once to several authorities authorized to accept the relevant complaints.

TSB RF

The division is engaged in the financial activities of the insurance company. According to the decree of the President of Russia dated July 25, 2013 No. 645, it was this structure that took over the powers of the abolished FFMS.

The Central Bank of the Russian Federation has the following powers:

• issuance or withdrawal of a license for insurance activities;
• consideration of cases of administrative violations committed by the UK (in accordance with Article 23.74 of the Code of Administrative Offenses of Russia). For example, the imposition of services by the insurer. According to the results of the audit, the Central Bank has the right to impose fines on the organization.

The Central Bank is obliged to consider the complaint no later than 30 days from the date of its receipt and registration. However, if additional verification is necessary, the period may be extended up to two months.

Usually the review takes place within 10-15 days. Then the authorized official makes a decision.

Possible results issued by the Central Bank:

1. The Central Bank satisfies the requirements of the client and instructs the insurer to eliminate the violation.
2. Initiates a case on an administrative offense when, during the audit, it turned out that it had taken place.
3. Refusal to satisfy the claim: when the complaint is not within the competence of the Central Bank or no violations were found.

FAS

The Federal Antimonopoly Service monitors compliance with the law and protects free competition in the Russian market. Insurance services are under the jurisdiction of the organization.

Powers of the FAS:

• the absence of secret agreements dividing the Service Market;
• elimination of the abuse of established dominance;
• elimination of the refusal to formalize OSAGO agreements.

The Federal Antimonopoly Service considers claims within a period of less than one month. However, if the 30-day period is not enough to consider the complaint, the period may be extended by another 1 month. In this case, the citizen will receive a written notification.

Based on the results of consideration, the FAS can satisfy the client's requirement by imposing a fine on the UK. The insurer receives an order that the existing violations be eliminated.

When the FAS refuses to satisfy the complaint, the citizen has the right to apply to the court with a claim already for this service. However, in this case, the chances of a positive decision are extremely low.

SAR

The Union of Motor Insurers - is a non-profit association of all insurance companies that provide services for the "car insurance". The competence of the organization includes cases related to the incorrect use of KBM.

In the case of PCA, the one-month rule also applies. During this time, the organization is obliged to consider the citizen's appeal. The term is regulated by the Rules for the Protection of the Rights of Policyholders and Victims, approved by the Presidium of the RAMI in 2004.

When a thorough check is required or additional documentation is needed, the period may be extended. In the latter case, it lasts as long as necessary to obtain these papers.

The RSA may decide:

• get the IC to change the terms of the contract or compensate for the damage;
• refuse to satisfy the complaint.

Rospotrebnadzor

A citizen who applied to an OSAGO insurance company is a consumer of its services. It turns out that the actions of the insurer must comply with the requirements of the legislation of the Russian Federation "On the protection of consumer rights." In case of refusal of services or violations by the IC, Rospotrebnadzor must take appropriate measures.

OSAGO is a public contract. Its conditions must be the same for all clients who have applied to the insurer.

The organization is obliged to consider the received complaints within 3 days from the date of receipt of the letter with a claim. Within 1 month, Rospotrebnadzor is obliged to consider the complaint. The organization has the right to extend the period up to 2 months. In this case, the citizen will receive a written notice.

If Rospotrebnadzor reveals violations of the Legislation, it issues an order to the UK in which it requires them to be eliminated. In case of an unfounded claim or if the organization is incompetent in a particular issue, the client receives an official decision with a refusal.

Prosecutor's office

This is the supervisory body of the Russian Federation, which monitors compliance with laws. The powers of the prosecutor's office are to supervise:

• compliance with the law;
• absence of human rights violations;
• law enforcement and enforcement.

Employees of the structure have the right to control the activities of not only state, but also commercial institutions, including insurance companies.

In accordance with the order of the General Prosecutor's Office of Russia dated January 30, 2013 No. 45, the state structure must consider the claim within 15 days if there is no need for additional verification and 30 days if there is one. The period starts from the date of receipt and registration of the complaint by the prosecutor's office.

The organization has the right to extend the period for another 1 month. Further, an additional extension is possible only by the Prosecutor General.

Decisions that the Prosecutor's Office can take:

1. Making a presentation. The paper indicates what kind of violation the IC committed and measures to correct them. The insurer must liquidate them within 30 days.
2. Issuance of a decision. The prosecutor's office initiates a case under the Code of Administrative Offenses of Russia, when the offense is not related to administrative cases, which is examined by the Central Bank.
3. Issuing a warning. In case of repeated violation by the UK, the structure holds it liable under the law.

In case of unfounded complaints, a written refusal is sent to the applicant.

Court

This is the last resort where a citizen has the right to apply in case of problems with the OSAGO insurer. It is recommended to apply to the court in such situations:

• recovery of the unpaid amount. In the event of a financial dispute, it is better for a citizen to file a lawsuit than to waste time on claims to the supervisory authorities.
• ignoring a repeated complaint from the UK;
• refusal of supervisory institutions for one reason or another.

Based on the results of the consideration, the court will satisfy the claim or refuse it. He can achieve a compulsory agreement in case of an unreasonable refusal of the insurer, recover losses caused to a citizen. A lawsuit is the last chance to restore justice and bring an unscrupulous IC to justice.

The sequence of filing complaints with different authorities (where first, where later in case of inaction or a negative decision)

Often claims are considered and satisfied at the local level. In the absence of a response within two weeks, the clients of the insurance company have the right to apply to higher authorities.

Depending on the type of claim, a citizen can file a complaint with the Central Bank of the Russian Federation, the FAS, Rospotrebnadzor or the RSA. When human rights are violated, he must file a complaint with the prosecutor's office for verification.

If the applicant does not agree with the actions of any of these institutions or they gave a negative answer, he can file a complaint with the court. When the latter refuses to satisfy the claim, the client of the UK has the right to appeal the act to a higher authority, up to the Supreme Court of the Russian Federation.

Conclusion

In some cases, the insured has to deal with an unscrupulous insurance company that does not properly do its job. In these cases, he has the right to complain about it to the authorities: the Central Bank, the RSA, Rospotrebnadzor, the Federal Antimonopoly Service, the prosecutor's office and the court. When filing a claim, these structures will conduct an audit, based on the results of which they will make a decision: to satisfy the complaint or refuse.

Health care curators, the so-called insurance representatives of the third level, are starting to work in the compulsory medical insurance system. They will remind patients by phone about the doctor's recommendations after the medical examination and the need to take medication. There are already about 1.2 thousand such specialists in the staff of insurance companies. According to experts, the creation of the system is designed to improve the quality of medical care and increase the life expectancy of the population. However, for the full-fledged work of such curators, there should be many times more.

In addition to doctors, the health of the patient will now be monitored by employees of insurance companies of the compulsory medical insurance system, the so-called representatives of the third level. They started working in January of this year. As the Federal Compulsory Medical Insurance Fund (FFOMS) told Izvestia, there are now about 1.2 thousand specialists in the quality of medical care on the staff of organizations. Some of them are still in training.

Curators will analyze the health of a patient who has a compulsory medical insurance policy. They will monitor the implementation of the recommendations of doctors based on the results of the medical examination, by phone they will remind you of the need for tests, taking prescribed medications, and they can accompany the client to hospitalization. Separately, insurers will monitor the condition of chronic patients.

In the case of dispensary registration for a disease, the insurance representative works with each patient individually, taking into account his diagnosis, recommended requests for medical help, ensures compliance with the terms of hospitalization, interacts with the medical organization to possibly reduce the waiting time, - Izvestia was told in FFOMS.

Insurance representatives will also resolve conflicts between physicians and patients, resolve customer complaints, and, if necessary, conduct an examination of the quality of care. The FFOMS could not explain whether all insurance companies already have such specialists and when their services will be provided to patients in full.

The fund recalled that the institute of insurance representatives started operating in Russia in 2016. Now there are more than 7.5 thousand specialists of the first and second level in the country. They give clients advice on CHI services, remind them of the need to undergo medical examinations (by phone and via SMS). Third-level specialists are trained according to a program developed on the basis of the Department of Sociology of Medicine, Health Economics and Medical Insurance at Sechenov University.

General Director of the insurance company "Reso-Med" Yuri Demin confirmed that representatives of the third level are already starting to work with patients. But there is no clear regulation on how many such specialists should be in each company. So far, according to him, they proceed from such a scheme: one insurance representative of the first level - for 41 thousand insured persons, the second level - for 35 thousand, the third level - for 142 thousand.

With those companies that will not do this, the territorial CHI funds can terminate financial security agreements, - said Yuri Demin.

This is not only concern for citizens, but also a strategically important point, an emphasis on the prevention of disease detection. To seamlessly cure all non-communicable diseases, they must be detected at an early stage. Therefore, they are trying to involve Russians as fully as possible in regular checks of their health, the expert noted.

Natalia Aksenova, chairwoman of the Public Council under the Ministry of Health, noted that 1.2 thousand third-tier insurance representatives throughout the country are not enough, they will not be able to respond quickly to the requests of the insured and solve the problems that have arisen. Much more curators are needed, and they must be as competent as possible.

These should be professionals in their field, from among doctors, maybe even having a second higher education - a law. Information about these insurance representatives of the third level should be available to citizens, - explained Natalya Aksenova.

”, this year the Ministry of Health tripled the plan for medical examination. The examination must pass at least 63% of those who are entitled to it.

From July 1, insurance representatives will start working in the system of compulsory medical insurance (CHI) throughout Russia, said Dmitry Kuznetsov, president of the Interregional Union of Medical Insurers (IMS). These are call centers with specialists in the protection of the rights of the insured and expert doctors who will have to help people quickly solve problems associated with treatment under compulsory medical insurance.

The main goal is to build a unified system of relationships between insurers and CHI clients and convey to people that the easiest way to solve problems is to contact the insurance company, and not write a complaint to the Ministry of Health, the Federal Compulsory Medical Insurance Fund (FFOMS) or another department.

“If the issues relate to the lack of medical personnel, the lack of necessary diagnostic equipment in a medical organization, the provision of subsidized medicines, this is the competence of the health authorities. Here it is better to contact the head physician of the medical institution or Roszdravnadzor, - Interfax quotes Kuznetsov. “But if the issues are related to the organization of the provision of medical services, their timeliness and proper quality, consultation of the compulsory medical insurance insurer, insurance representative will help.”

Call centers are created on the basis of the territorial funds of the FFOMS, it follows from his words. All specialists of the new information center will be divided into three levels depending on their competencies and the complexity of the problems being solved. Employees of first-level call centers will answer typical questions: where to get a policy, how to attach to a polyclinic, how it works. Specialists in the protection of the rights of the insured will advise on how to resist the imposition of paid services, talk about other rights of citizens under compulsory medical insurance, and also help solve problems, for example, with hospitalization. An expert doctor will advise on the quality of medical care, the adequacy of recommendations for obtaining medical services, Kuznetsov points out.

Much of what is being introduced is already working in large federal insurance companies, he admits, and now it will appear throughout Russia in a single format. Different companies had their own advantages in solving some issues in a particular territory, the creation of this system is an attempt to combine all the positive experience, he says.

Whip for doctors

On June 7, the government submitted to the State Duma a bill on the introduction of fines for violations of patients' rights. For individuals, they amount to 15,000–20,000 rubles, for legal entities - up to 300,000 rubles. Penalties will be applied, among other things, for failure to provide the patient with information about his rights.

In addition, call center specialists will have a new function - to remind them of the need to undergo a preventive examination. An adult is supposed to take it every three years, Kuznetsov continues. The Ministry of Health expects that the introduction of this system of reminders will help increase the number of people who undergo medical examinations in a timely manner, one of the major insurers, who is present at meetings with representatives of the department, admits.

Insurers are ready for innovation. Alfastrakhovanie-OMS has already trained specialists at all levels to start full-fledged work from July 1, says Yegor Safrygin, director of the Medicine department: “People often do not know what is included in the basic compulsory medical insurance program, where is the line between paid and free. Experts will be able to advise, give the necessary instructions. Ingosstrakh-M also announced its readiness for work.

A significant part of the work of call center employees will consist precisely in increasing the interest of citizens in undergoing medical examinations, says Lyudmila Romanenko, adviser to the general director of Sogaz-med. They will also track people's satisfaction with the quality of medical care, its timeliness, find out the reasons for refusals to hospitalize, she lists.

With the consent of clients, especially those with chronic diseases, insurance representatives will even remind you of the need for dispensary observation in order to rule out relapses, she says. Lists of people will be provided by medical institutions.

In countries with a healthcare insurance model, citizens turn to the insurer with emerging questions, says Nina Galanicheva, CEO of Rosno-MS (part of Allianz). But this form of insurance representatives, according to her, is a unique experience for Russia. This is a movement towards the formation of a patient-centered model, she points out. She believes that one of the main tasks of the new system is to provide assistance to the insured in obtaining free medical care.

The representative of the Ministry of Health did not answer the questions of Vedomosti.