Based on the current legislation of the Russian Federation, the insurer enters into voluntary property insurance contracts with legal entities and individuals - policyholders.
List of dangers from which insurance must be taken depends on the nature of the risk. For industrial risks, these are considered to be fire, explosion, breakdown of machinery and mechanisms, natural disasters, leaks of toxic substances, for environmental risks - pollution or other damage to the environment, for investment risks - various events leading to the loss of investment objects or profits as a result of investing funds.
The list of dangers within a specific insurance coverage is also determined by the choice of type of insurance. There is an established practice of combining in one insurance contract several risks that are similar in the reasons for their occurrence, the nature of the impact, the nature of the losses, etc. In this case, a situation may arise when various risks can be combined within the same insurance coverage. Therefore, the main task is not to determine in detail the conditions for the provision and types of insurance coverage (this task is solved jointly with the insurance company), but to understand what type and extent of coverage should be provided for individual risks.
Maximum insurance liability for each type of danger and type of loss must correspond to the amount of insurance compensation provided for individual risks in the event of the most unfavorable situation. It is advisable to set its maximum amount at the level of the maximum acceptable amount of loss determined in the process of risk analysis.
In general, the complex of insurance conditions includes the following components:
Conditions for providing insurance coverage;
Insurance scheme;
Conditions limiting the insurer's liability;
Amount and terms of payment of the insurance premium;
Responsibilities of the insurer;
Responsibilities of the policyholder;
Terms of concluding an insurance contract;
Conditions for the insurer's refusal to pay insurance compensation;
Procedure for payment of insurance compensation;
Conditions for the transfer of the policyholder's rights after payment of insurance compensation;
Other conditions.
The policyholder needs to determine the most important types of insurance for him.
As already mentioned, the classification of risks does not fully correspond to the classification of types of insurance. Many traditional types, such as property insurance for legal entities, include protection against various risks. Conversely, the same risk can be expressed in different types of insurance. For example, credit risk can be insured both under a liability insurance contract for non-fulfillment of obligations and under a financial risk insurance contract.
The policyholder has the opportunity to choose under which types of insurance it is desirable to receive insurance protection. Fundamentally, there are two different types of insurance contracts: special, which provide protection against only one type of risk or cover only one type of loss, and complex, which provide protection against all or most risks for the selected insurance object.
Concluding complex contracts has a number of attractive aspects for the policyholder. For example, this reduces the time spent on insurance negotiations, pays out insurance compensation faster, and achieves a better understanding of the interests of the parties. The complex tariff rate is always less than the sum of individual insurance tariff rates for the same set of risks. However, there is one complicating factor: the complex risk of an individual policyholder may be so great that it may not be possible to cover it within the framework of a separate insurance company.
From the general list of risks subject to insurance, it is useful to highlight those that are subject to mandatory insurance within the framework of the law or due to contractual circumstances.
For compulsory types of insurance carried out by force of law, there are various restrictions on the conditions for concluding insurance contracts. For example, some conditions for concluding insurance contracts for liability for damage caused by hazardous production facilities are enshrined in the Law of the Russian Federation “On Industrial Safety of Hazardous Production Facilities” dated July 21, 1997 No. 116-F3, in particular the minimum amount of the insurance amount depending on the degree of danger of the facility.
According to the current civil legislation, contracts for compulsory insurance can only be concluded with state insurance companies.
There may be contractual obligations to obtain insurance under other agreements or contracts. The insurance condition may be one of the conditions for granting a loan or making an investment. Both the direct risk of non-repayment of the loan and the property provided as collateral may be subject to compulsory insurance.
In the insurance market, the policyholder deals with several types of partners: insurance companies, associations of insurers - insurance pools, insurance brokers, agents and consultants.
The purpose of concluding an insurance contract is to acquire the policyholder's right to compensation for damage incurred caused by events recognized as insurable.
The object of insurance may be property owned by the insured, as well as property that the insured disposes of under contracts of hire, lease, rental, accepted on commission, storage or as collateral, if this property is not insured by its owner.
Property constituting fixed and working capital can be insured:
Buildings, structures, transmission devices, vehicles, machinery, equipment and other fixed assets;
Inventory assets acquired by this organization;
Inventory assets of own production;
Unfinished construction projects;
Products in the process of production or processing.
All property or a certain part of it can be insured. The object of insurance may also be the following reasonable expenses incurred by the policyholder upon the occurrence of insured events:
Expenses for measures to dismantle and/or move buildings, structures, equipment to a new location, undertaken to save property and/or to reduce losses.
Expenses for cleaning the territory specified in the insurance contract from debris (residues) of property damaged as a result of the insured event. The expediency of the listed expenses is determined by the insurer.
The following are not subject to insurance:
Buildings and structures, the structural elements and systems of which are in disrepair, as well as the property located in them;
Property located within the territory of insurance coverage that does not belong to the policyholder and was not received by him as a result of contractual relations.
Property is considered insured in the territory specified in the insurance contract. If the insured property is removed from this territory, insurance coverage is terminated.
Under the insurance contract, the insurer undertakes to compensate the policyholder for damage in the event of damage or loss of property upon the occurrence of insured events for the following types of risks:
Fire (accidental occurrence and spread of fire over an object, inside an object or from object to object);
Water supply network failure;
Sewer system failure;
Heating system failure;
Flooding, water penetration from neighboring premises;
Action of groundwater;
Explosion;
Soil subsidence;
Theft, robbery;
Damage to property as a result of illegal actions of third parties.
At the request of the policyholder, property can be insured against all or certain of the listed groups (types) of risks. At the same time, the above groups (types) of risks must be specified depending on the reasons for their occurrence.
Coverage may be provided under schemes proportional and disproportionate insurance. Non-proportional insurance includes first risk insurance, deductible insurance, and marginal loss insurance.
Conditions limiting the insurer's liability include specific situations for which, although there are signs of an insured event, insurance compensation is not paid. For example, these are conditions when the insured event was the result of the insured’s malicious intent or the result of his collusion with third parties. Insurers often limit their liability in the event of government intervention in the activities of the enterprise. Force majeure events are also grounds for refusal to fulfill obligations to pay insurance compensation.
In all cases, damage resulting from:
Any kind of hostilities and their consequences, acts of terrorism, civil unrest, strikes, rebellion, lockouts, confiscation, requisition, interruption of work, seizure, destruction or damage to property by order of civil or military authorities, forced nationalization, declaration of a state of emergency or special state, rebellion , riot, putsch, coup d'etat, conspiracy, uprising, revolution;
Natural disasters when the territory of insurance coverage is declared a natural disaster zone before the conclusion of the insurance contract;
Exposure to nuclear energy in any form;
Intentional actions or gross negligence of the insured or his employees;
Failure by the policyholder to comply with instructions for storage, operation and maintenance of the insured object, as well as the use of this object for purposes other than those for which it is intended;
Spontaneous combustion, fermentation, rotting, aging, corrosion and other natural properties of objects and others.
When concluding an insurance contract, it is necessary to pay special attention to such clauses, since they are usually the reason for justifying the refusal to pay insurance compensation.
The conditions for the insurer's refusal to pay insurance compensation are usually written out as a separate block in the insurance contract. In addition to restrictions on the liability of the insurance company under various circumstances, these conditions may include the following points: failure by the policyholder to notify of the occurrence of an insured event within the agreed time frame, failure to comply with the terms of payment of the insurance premium, failure by the policyholder to provide all necessary documents, lack of certificates from government bodies confirming the occurrence insured event, etc.
The insurance contract also specifies insurance rates for individual risks and the amount of the insurance premium that the company must pay. The procedure for paying the insurance premium is also determined, which can be paid in a lump sum or in installments.
The insured amount is established by agreement of the parties on the basis of documents confirming the value of the property.
The insured amounts are set within the value of the insured property at the time of conclusion of the contract.
The cost of the insured property is determined:
When insuring buildings and structures - based on the cost of construction in a given area of a building or structure similar to the one insured, taking into account its wear and tear and operational and technical condition;
When insuring machinery, equipment and inventory, based on the amount required to purchase an object similar to the insured, taking into account its wear and tear;
When insuring inventory items (including raw materials, semi-finished products) purchased by the policyholder based on the costs required for their re-acquisition:
When insuring inventory items manufactured by the insured - based on the production costs necessary for their re-production;
When insuring property obtained as a result of contractual relations - in the amount of the property liability of the insured, but not higher than the value of the property determined in accordance with the insurance contract;
When insuring the finishing of premises, both owned by the insured and transferred to the insured under a rental agreement, without indicating their assessment based on the costs incurred by the insured or the lessor for repairs and/or finishing of the premises before the conclusion of the contract.
The insurance amounts are established separately for each insured object or for the totality of objects specified in the insurance contract.
The insurance amount for insured expenses is established separately from the insurance amount for the insured property.
The policyholder may set the insurance amount below the value of the insured property. In this case, insurance is valid as a share of the value of the property (incomplete insurance).
In this case, the difference between the insured amount established in the insurance contract and the value of the property is not covered by insurance protection, and payments upon the occurrence of insured events are made in proportion to the insured amount to the value of the insurance object.
The insurer is liable within the insured amount.
Tariff rates are set depending on the category of property, type and degree of risks, and the nature of the insurer’s activities.
When concluding an insurance contract, by agreement of the parties, a limit of the insurer's liability (the maximum insurance compensation paid) per one insured event and a deductible (the part of the damage that is not subject to compensation by the insurer) are established. If there is a deductible, the policyholder may be given a discount on the insurance premium.
The insurance premium is calculated based on the sums insured, tariff rates, insurance period, taking into account the benefits and discounts provided.
Payment of the insurance premium is made in cash or by bank transfer.
When concluding an insurance contract for a period of at least one year, the policyholder may be given the right to pay the insurance premium in two terms. The first part of the insurance premium in the amount of at least 50% of the annual insurance premium is paid upon concluding the insurance contract, but no later than 10 days from the moment the contract is signed by both parties. The remaining portion of the insurance premium is due no later than 3 months after the entry into force of the contract.
When insuring for a period of at least one year, the insurance premium (Pg) is calculated using the formula:
Pg = C x T/100 x M/12,
where: C - sum insured; T - tariff rate in %; M is the insurance period in months (a partial month is considered a full month).
When insuring for a period of more than one year, the insurance premium is subject to recalculation every year, starting from the date of entry into force of the insurance contract.
For insurance for a period of less than one year (short-term insurance), the insurance premium is paid at a time when concluding an insurance contract, but no later than 10 days from the moment the contract is signed by both parties. The calculation of the premium in this case (Pk) is made according to the formula:
PC = Pg x K,
where Pg is the insurance premium for insurance for one year; K is the short-term coefficient. During the validity period of an insurance contract concluded for a period of at least one year, by agreement of the parties, changes may be made in terms of the amount of the insured amount and tariff rates, as well as the types of risks for which insurance is provided.
If the insured amount increases, an additional insurance contract is concluded and the policyholder makes an additional payment of the insurance premium, calculated based on the full months remaining until the end of the contract. In this case, an incomplete month is taken as a full one.
A reduction in the sum insured can be made only on the condition that the policyholder has not previously been paid insurance compensation under this agreement. If the insured amount decreases, part of the insurance premium (B) is returned to the policyholder, the amount of which is determined by the formula:
D =
(P2-P1) x T/P. B = (N x P1-P2) x T/P,
where: D - additional payment of premium; B - refundable part of the premium; P1, P2 - premiums for the initial and final insurance amounts, respectively; T - the number of full months until the expiration of the insurance contract from the moment the insured amount changes; P - insurance period in months (incomplete month is considered full). The H coefficient takes into account the insurer's standard expenses for conducting business.
After payment of the insurance indemnity, from the moment the insured event occurs, the insured amount under the contract is reduced by the amount of the indemnity paid. When restoring or replacing damaged property, the amount of the insured amount can be restored to its original value.
Policyholders who continuously insure property and do not apply for insurance compensation during the term of the insurance contract are given an annual discount on the insurance premium in the amount of 5%, but not more than 50% in the aggregate, when renewing the insurance contract. To conclude an insurance contract, the policyholder provides the insurer with a written application in the prescribed form or otherwise declares his intention to conclude an insurance contract.
An insurance contract is concluded on the basis of an application from the policyholder and the results of an inspection (examination) of the insured property. To draw up an insurance contract, additional documents may be required that characterize the degree of risk.
When concluding an insurance contract, a certificate or inventory is drawn up indicating the value of the property, which is certified by the signature of the manager and chief accountant, and the seal of the enterprise (for legal entities). If necessary, a written description of the object is drawn up. After drawing up an insurance contract, these documents become an integral part of it. The policyholder is responsible for the accuracy and completeness of the data provided in the contract and certificate (inventory).
The preparation of a certificate or inventory of property owned by the policyholder and property that he disposes of under contractual conditions is carried out separately. An insurance contract may be concluded in favor of a third party - the beneficiary. This person may be appointed by the policyholder upon concluding the insurance contract, or he or she may be the legal heir(s) and/or successor(s). An insurance contract can be concluded for a period of up to one year, for a year or more than a year. An insurance contract is considered short-term if it is concluded for a period of up to one year.
After drawing up an insurance contract, the policyholder pays the insurance premium or its first installment:
When paying in cash - simultaneously with receiving an insurance policy.
For non-cash payments - within ten days from the date of signing the insurance contract by both parties.
The insurance contract comes into force after the policyholder pays the insurance premium or the first part thereof:
When paying in cash - from 00 o'clock on the day following the day the insurer's representative receives the money;
For non-cash payments - from 00 o'clock on the day following the day the bank writes off money from the policyholder's current account for crediting to the insurer's current account.
The insurer bears liability under the insurance contract within the period stipulated by the contract. If the policyholder loses the insurance policy during the validity period of the insurance contract, he is issued a duplicate. Once a duplicate is issued, the lost insurance policy is considered invalid and no payments are made under it.
The insurance contract is terminated from 00 o'clock on the day recognized as the day of termination of the contract. Changes to the terms of the insurance contract are made by mutual agreement of the policyholder and the insurer based on an application from one of the parties within five days from the receipt of the application by the other party.
If any of the parties does not agree to make changes to the insurance contract, the issue of the validity of the insurance contract on the same terms or its termination is decided within five days.
The insurance contract terminates:
If the policyholder fails to pay the entire insurance premium or the first part thereof from the agreed date after the date of signing of the contract by both parties;
If the policyholder fails to pay the remaining part of the insurance premium from the agreed date of the fourth month of insurance after the day of payment of the first part of the premium;
After the expiration of the period specified in it, from the day following the day specified in the policy as the day of termination of the contract;
When paying insurance compensation in the amount of the insured amount, from the date of final settlement;
If the court makes a decision to declare the contract invalid;
If the policyholder loses the right of ownership of the insurance objects or in the event of liquidation (reorganization) of the policyholder from the day following the date of signing the relevant documents. The policyholder or his successor may reissue (renew) the insurance contract within an agreed period from the date of termination. In this case, the agreement re-enters into force from the next day after its re-registration (renewal) and is valid until the end of the period specified in the previous agreement;
Upon liquidation of the insurer in the manner established by legislative acts of the Russian Federation.
The insurance contract may be terminated early at the request of the policyholder or insurer. The parties are obliged to notify each other in writing of their intention to terminate the insurance contract early no less than the agreed number of days before the expected date of termination of the insurance contract. In this case, from the date of receipt of the notice by one of the parties until the moment of termination, the validity of the insurance contract is suspended.
In case of early termination of the insurance contract, the insurance premium is returned to the policyholder in full.
The insurance contract may be renewed if it was terminated due to failure by the policyholder to pay the second part of the insurance premium. To renew the contract, the policyholder must pay a penalty in a certain amount of the entire amount of the insurance premium and the unpaid part thereof. The validity period of the contract will not be extended. The insurer is not liable under the insurance contract during the period from the moment of its termination until the moment of its renewal.
The insurance contract is considered invalid from the moment of its conclusion if:
This is provided for by the current legislation of the Russian Federation;
It was concluded after an event recognized as insurable in accordance with the insurance rules;
The object of insurance is property subject to confiscation on the basis of a relevant court decision that has entered into legal force.
The insurance contract is declared invalid by a court, arbitration or arbitration tribunal.
If the insurance contract is declared invalid, the insurance premium is returned to the policyholder minus the insurer's expenses for conducting the business, and the insurance compensation paid is returned to the insurer in full.
The insurer who paid the insurance indemnity receives, within the limits of the amount paid, the right of claim that the insured (or other person who received the insurance indemnity) has against the person responsible for the damage caused.
If the policyholder has received compensation for damage from third parties, the insurer pays only the difference between the amount payable under the terms of insurance and the amount received from third parties. The policyholder is obliged to immediately notify the insurer of the receipt of such amounts.
The policyholder is obliged to return to the insurer the paid insurance compensation (or the corresponding part thereof) if a circumstance is discovered that completely or partially deprives the policyholder of the right to insurance compensation.
Disputes arising under the insurance contract are resolved through negotiations, with the involvement, if necessary, of a specially created expert commission.
If an agreement is not reached, the dispute is referred to the court (arbitration court) in the manner prescribed by the current legislation of the Russian Federation.
Payment of the premium occurs in a lump sum at the beginning of the insurance period. When calculating a lump sum payment, the insurer must take into account the possible increase in the insured value of the property as a result of inflation. If there is an increase or decrease in the sum insured during the insurance period, it is possible to pay the insurance premium with cost reduction . This method consists in the fact that at the end of the insurance period the insurance premium is recalculated, and one party compensates the other for the resulting difference.
Payment of premium in installments may in many cases be more preferable for the policyholder, since it reduces the severity of loss of funds with a large lump sum payment. However, the total insurance premium when paid in installments is higher than when paid in a lump sum.
The responsibilities of the insured include a standard set of obligations of the parties to pay the insurance premium, payment deadlines, fines for late payment, obligations to provide information, documents and other obligations of the insurer, including both ordinary general civil ones and specific ones for the payment of insurance compensation.
The policyholder is obliged:
When concluding an insurance contract, provide the insurer with all the information required from him, characterizing the circumstances that are important for the insurer to assume responsibility. Important are those risk circumstances that may influence the insurer’s decision to enter into an insurance contract or its content;
Inform the insurer about all insurance contracts concluded or being concluded in relation to this insurance object and the amount of insured amounts. If at the time of the occurrence of the insured event other insurance contracts for similar risks were also in force in relation to the insured property, compensation for damage is distributed in proportion to the ratio of the insurance amounts in which the insurance object is insured by each insurance organization. The insurer pays compensation only to the extent that falls to its share. The amount of compensation paid is reduced by the amount of the deductible if there is one;
Pay the insurance premium in the amount and manner determined by the insurance contract;
Take all reasonable precautions to prevent damage and increased risk;
Follow the instructions for storage, operation and maintenance of the insured object, and use this object only for its intended purpose;
If the degree of risk changes, within three days, notify the insurer in writing about this with a view to terminating or re-issuing the insurance contract;
Immediately inform the insurer of the location of the lost insured property, if the latter is found.
If damage occurs, the policyholder is obliged to:
Take all possible measures to reduce damage and save the insured property, including those recommended by the insurer;
Within 24 hours from the moment the damage is discovered, notify the insurer about it and immediately report it to the competent authorities;
Submit a written application in the established form for payment of insurance compensation, indicating the circumstances of the loss, as well as all documents requested by the insurer confirming the fact, causes and amount of damage;
Provide the insurer with the opportunity to inspect or survey damaged property, investigate the causes and extent of damage, and participate in measures to reduce damage and salvage the insured property;
At the request of the insurer, provide him in writing with all the information necessary to judge the amount and causes of damage or loss of the insured property;
Provide the insurer with an inventory of damaged, destroyed or lost property. These inventories must be submitted within the time period agreed with the insurer, but in any case no later than one month from the date of the insured event. Inventories are compiled indicating the value of damaged items on the day of the insured event. The costs of compiling the inventory are borne by the policyholder;
Preserve the damaged property in the same condition as it was after the insured event. Changing the picture of a loss is possible only if it is dictated by safety considerations and/or the desire to reduce the amount of damage;
Submit all documents to the insurer and take all measures to ensure that the insurer exercises its right of claim against the perpetrators.
The obligations of the policyholder arising from the contract, with the exception of the obligation to pay the insurance premium, apply equally to the beneficiary. Failure by the beneficiary to fulfill these obligations entails the same consequences as failure to fulfill them by the insured.
The policyholder has the right:
To receive insurance compensation in the amount of direct actual damage within the limits of the insured amount, taking into account the specific conditions stipulated in the insurance contract;
To conclude an insurance contract in favor of third parties. In this case, the person who owns the insurance policy enjoys the rights to receive insurance compensation under the insurance contract;
To change the terms of the insurance contract;
To terminate the insurance contract;
To receive benefits under an insurance contract.
The insurer has the right:
Check the information provided by the policyholder and the compliance of the insurance object with the description;
Check the condition of the insured object, as well as the compliance of the information about the insurance conditions communicated to him by the policyholder with the actual circumstances, regardless of whether these conditions have changed;
Participate in the rescue and preservation of the insured property, as well as give written recommendations to reduce damage, which are mandatory for the insured. However, these actions cannot be considered as recognition of the insurer’s obligation to pay insurance compensation;
Independently find out the causes and circumstances of the insured event;
Proceed to inspect the damaged property without waiting for the insured to notify of the loss.
The policyholder has no right to prevent the insurer from doing this;
Require from the policyholder the information necessary to establish the fact of an insured event or the amount of insurance compensation to be paid, including information constituting a commercial secret;
If necessary, send a request to the competent authorities for the provision of relevant documents and information confirming the fact and reason for the occurrence of the insured event;
Receive into your ownership the remains of the insured property or the property itself for which the insurance indemnity has been fully paid.
The insurer is obliged:
Familiarize the policyholder with the insurance rules;
Do not disclose information about the policyholder and his property status, except for cases provided for by current legislation;
Upon receipt of the policyholder's notification of a change in the terms of insurance, within five days, make changes to the insurance contract or terminate it, notifying the policyholder about this;
After receiving an application for payment of insurance compensation, the insurer is obliged to:
Inspect the insurance object within 48 hours from the receipt of the policyholder's application (not counting weekends and holidays);
With the participation of the insured, draw up a report on the occurrence of damage;
Together with the policyholder, draw up an estimate of the damage and determine the amount of insurance compensation;
If the event is recognized as insured, pay the insurance compensation in cash;
If a refusal to pay insurance compensation occurs, the insurer is obliged to notify the policyholder in writing with a reasoned explanation of the reasons for the refusal.
Damage means the value of stolen property and/or the lost value of destroyed (damaged) property. The amount of damage is determined by the insurer on the basis of an examination, taking into account the value of the damaged property at the time of concluding the insurance contract. Each party has the right to request an independent examination. The examination is carried out at the expense of the party that requested it. The costs of conducting an examination for cases recognized as non-insurable after its completion are borne by the insured. Experts cannot be persons who are competitors of the policyholder or have business contacts with him, as well as their employees.
Damage is determined:
If property is stolen - in the amount of its value at the time of concluding the insurance contract;
In case of loss of property - in the amount of its value minus the value of existing remains suitable for further use based on the application of prices in force at the time of concluding the insurance contract;
In case of damage to property - in the amount of costs for its restoration, using prices and tariffs at the time of concluding the insurance contract.
Restoration costs include:
Costs of materials and spare parts required for restoration;
Costs of paying for restoration work.
Restoration costs are determined minus the cost of wear and tear of materials and spare parts replaced during the restoration (repair) process.
Restoration costs do not include:
Expenses associated with changes and/or improvement of the insured object;
Expenses caused by temporary (auxiliary) repairs or restoration.
Payment of insurance compensation is made after receipt of the insurance premium or its part established in the insurance contract to the insurer's settlement account.
Insurance compensation is paid within the insured amount. In this case, the insured amount from the moment of the occurrence of the insured event is reduced by the amount of the insurance compensation paid.
If the insured amount at the time of the insured event was lower than the value of the property currently insured, then the insurer compensates for damage only in proportion to the insured amount to this value. The amount of insurance compensation (IC) in this case is determined by the formula:
SV = U.S/SI - F,
where: Y - the amount of damage based on the value of the insured property at the time of concluding the insurance contract; C - sum insured; SI - the value of the property at the time of concluding the insurance contract; F - deductible (if available).
If changes have been made to the insurance contract regarding the amount of the insured amount, the insurer shall compensate for damage taking into account the latest change.
The insurer is not obliged to pay the policyholder compensation that exceeds the amount of damage, even if at the time of the insured event the insured amount exceeded the value of the insured property.
Without the consent of the insurer, the policyholder does not have the right to refuse the property remaining after the insured event, even if it is damaged. The residual value of such property is subject to deduction from the amount of damage.
Payment of insurance compensation is made within an agreed period after establishing the fact of an insured event, confirming this fact and determining the amount of compensation made on the basis of relevant documents. The payment day is the date the money is written off from the insurer's current account. In the case of reinsurance of large risks, the period for payment of insurance compensation may be extended, which must be reflected in the insurance contract.
If the insurance payment is not made on time, the insurer pays the policyholder a fine in the amount of one percent of the amount of the insurance payment for each day of delay.
In some cases, if the time interval between the establishment of the fact of an insured event and the end of determining the amount of damage exceeds two weeks, the insurer, at the request of the policyholder, may make an advance payment of insurance compensation. The amount of the advance payment is determined by the insurer, which is subsequently taken into account in final settlements.
The insurer has the right to defer payment of insurance compensation if:
He has reasonable doubts about the eligibility of the policyholder to receive insurance compensation. No compensation will be paid until the required evidence is provided;
The relevant internal affairs bodies have initiated a criminal case against the policyholder or persons authorized by him and are conducting an investigation into the circumstances that led to the damage. No compensation will be paid until the investigation is completed;
If the stolen insured property was returned to the policyholder, he is obliged to return to the insurer the insurance compensation received for it minus the costs associated with the theft for repairing or putting in order the returned property. If the policyholder refuses to return the insurance compensation to the insurer, all rights to this property pass to the insurer.
The insurer has the right to reduce the amount of insurance compensation if the policyholder, after the occurrence of the insured event, did not ensure the safety of the surviving (fully preserved or partially damaged) property;
Insurance compensation is not paid, and the contract may be terminated due to loss of confidence in the policyholder, if the policyholder (any of his full representatives and/or persons working for him):
Did not take measures agreed with the insurer in the insurance contract aimed at preventing damage and reducing the degree of risk;
Intentionally or through gross negligence committed or allowed an action (inaction) that led to damage;
Did not comply with the instructions for storage, operation and maintenance of the insured object, and also used this object for purposes other than those for which it was intended;
Did not report and/or provided the insurer with incorrect (knowingly false or incomplete) information about the object and conditions of insurance requested by the insurer;
Did not inform the insurer about the change in the degree of risk;
Did not take measures to prevent or reduce damage;
Failure to notify the insurer of the occurrence of damage, as a result of which it became impossible to determine the cause and amount of damage.
Did not submit the application and the documents and information requested by the insurer to the insurer;
Obstructed the insurer or its representatives in determining the circumstances of occurrence, nature and extent of damage;
Intentionally misled the insurer or its representatives when determining the causes and/or amount of damage;
Received full compensation for the damage from the person responsible for causing it;
Relinquished the rights of claim against the guilty persons (or the exercise of these rights turned out to be impossible due to his fault). If the insurance compensation has already been paid, the policyholder is obliged to return the amount of the paid compensation to the insurer.
The procedure for calculating and paying insurance compensation is highlighted in the insurance contract as a separate block. At the same time, the procedure for filing a claim by the insured for an insured event, the documents required for consideration of the claim, methods for determining the amount of losses that are taken into account when calculating insurance compensation, and the timing of payment of compensation are established.
The conditions for the transfer of the rights of the policyholder to the insurer after payment of insurance compensation relate to the possibility of filing recourse claim on behalf of the insurer to the persons responsible for the occurrence of the insured event, as well as the possible transfer of rights to the remains of property destroyed as a result of the insured event. In addition, liability insurance contracts may contain conditions stipulating the transfer of rights to property not to the insurer, but to the beneficiary the policyholder. Personal insurance contracts usually stipulate the transfer of the right to receive insurance compensation (security) to the heirs in the event of the death of the insured person.
It is also possible to include any other conditions of a general civil and special nature, for example, confidentiality, dispute resolution procedures, cooperation in eliminating losses and limiting the amount of damage, etc.
Selecting an insurance partner is an important part of developing an insurance strategy. The policyholder may prefer to deal directly with several insurance companies, each time choosing the most suitable one to insure a certain type of risk. Otherwise, it can turn to the help of a broker or consultant, entrusting him with the work of selecting a partner and the optimal insurance scheme.
In the case of independently searching for a suitable insurance company, the enterprise analyzes the capabilities of each of them with a view to providing the most favorable insurance conditions. It is also necessary to check the financial statements of each company in order to ensure its financial stability and solvency, as well as its ability to bear the required amount of risks.
The most preferable method for insuring large risks is to use insurance pools, which make it possible to attract the combined capital of many companies to insure risk and thus provide a significant margin of solvency for each of its participants in the event of a large insurance payment. There may be already established groups of insurers in the market to insure risks of a certain type, and the entire group is managed by a company - the leader of the pool or an insurance broker.
Contacting an insurance broker can bring significant benefits to the company in providing favorable insurance conditions. The broker has significantly more complete information about the state of the insurance market. He can be entrusted with selecting a suitable company, forming an insurance pool, as well as choosing a general risk allocation scheme. He can make recommendations on the best combination of insurance and non-insurance risk management methods, selection of deductibles or other methods of non-proportional insurance.
An insurance broker may also be entrusted with the settlement of losses upon the occurrence of an insured event. As a rule, brokers manage the entire document flow of the insurance pools they create, distribute risk and losses between pool members, and control cash settlements.
Therefore, choosing the right insurance broker is essential to manage risk through insurance. An analysis of the supply on the brokerage firm market should focus on the experience, size and location of the firm, the services it provides, the availability of qualified specialists, additional or specialized services.
Brokerage firms can be ranked according to the following criteria:
Availability of a license;
Size of brokerage office, staff of specialists;
Field of activity;
Technical equipment;
Compliance of the services offered with the needs of the enterprise;
Advantages over competitors;
Efficiency;
Quality of examination;
Cost of services.
In addition to insurance brokers, similar services for selecting partners and choosing insurance schemes can also be provided by consulting firms, and independent consultants.
Essential terms of the insurance contract defined in Art. 942 Civil Code. The content of the contract is the totality of its terms or clauses expressing the will of the parties. In legal practice, the terms of a contract are usually divided into essential, ordinary, mandatory and individual.
Essential conditions are necessary for certain types of contracts. The contract is considered concluded only if there is agreement between the parties on all essential points. If the parties do not reach an agreement on at least one of the essential conditions, then the contract cannot be concluded.
Essential terms of the insurance contract:
In property insurance, the essential conditions of insurance include: the condition on the amount of the insured amount; condition on the duration of the contract; a condition about property or property interest that is the object of insurance; a condition on the nature of the event in the event of the occurrence of which the insured event is insured.
In personal insurance, the essential insurance conditions include: the condition about the insured person; condition on the amount of the insured amount; condition on the duration of the contract; a condition on the nature of the event against the occurrence of which in the life of the insured person insurance is provided (Article 942 of the Civil Code of the Russian Federation).
Article 434 of the Civil Code of the Russian Federation distinguishes two ways to conclude an agreement:
1) by drawing up one document agreed upon and signed by the parties;
2) by exchanging documents that would indicate the parties’ desire to conclude this agreement.
The document certifying the conclusion of the insurance contract must contain the following data:
1) name of the document;
2) name, legal address and bank details of the insurer;
3) last name, first name, patronymic or name of the insured’s organization and its address;
4) the amount of the insured amount;
5) indication of the insurance risk;
6) the amount of the insurance premium, the timing and procedure for its payment;
7) duration of the contract;
8) other (special) conditions by agreement of the parties, including additions to the rules or exceptions to them; procedure for changing and terminating the contract, etc.;
9) signatures of the parties.
Let us remind you that an agreement in which there is no insured amount is considered not concluded, since in accordance with Art. 942 of the Civil Code, the insured amount refers to the essential terms of the insurance contract.
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There is one exception to this rule. In Art. 4 of the Law of the Russian Federation “On Medical Insurance...” provides standard forms of medical insurance contracts, which are approved by the Decree of the Government of the Russian Federation dated January 23, 1992 “On measures to implement the Law...”. From these standard forms it follows that the insurer is obliged to pay for all medical services provided to the insured in accordance with the insurance program and the possibility of limiting payment to any amount is not provided. Consequently, a person insured under a health insurance contract has the right to unlimited payment for medical services in accordance with the program attached to the policy, regardless of whether there is an insured amount in the contract or not (Article 970 of the Civil Code).
Along with the essential conditions, the contract also contains a number of conditions belonging to different categories.
Usual terms of the contract- these are the conditions present in any contract and provided for by law in the event that the parties do not wish to establish anything else. This is information about the place where the contract was concluded, the form of the contract, etc.
Mandatory terms of the contract are prescribed to the parties by law for agreement. In insurance contracts, these are, for example, details of the parties, terms of payment, start date of insurance coverage, etc. As a rule, the contract comes into force from the moment the insurance premium is paid by the policyholder, unless otherwise provided in it.
Unlike mandatory individual conditions are included in the contract at the request of the parties. The law allows the establishment of any conditions that do not contradict the law in a contract by mutual agreement, which contributes to maximum consideration of the wishes of the parties. Individual agreements in insurance contracts relate to an individual specific risk. Moreover, such an individual agreement always has advantages over the general content of the contract. In practice, in such cases, it is recommended to use the following rule: the conditions developed on the basis of an individual agreement precede the standard conditions.
Along with the mandatory requirements and norms regarding insurance contracts contained in legislative acts, in world insurance practice there is the concept customary law which is also important for the developing Russian insurance industry. Common law is the so-called unwritten law, socially accepted and universally applied rules that are not included in any law due to their obviousness, for example, compliance by parties with the terms of a contract. By the way, the corresponding clause in Russian practice is usually included in the insurance contract. For insurance, such norms of customary law are important as the policyholder’s trust in the explanations of insurance company agents regarding the content and scope of insurance protection.
Insurance rules- represent a document developed and approved directly by the insurer - an insurance organization, or an association of insurers, and in compulsory types of insurance - OSAGO, OSOPO - by the state. Fedorova T.A., Bogoyavlensky S.B. Insurance: textbook / Ed. T.A. Fedorova. - 3rd ed. - M.: Master, 2009. - 1006 p. - P. 277. Of the associations, in particular, the All-Russian Union of Insurers is developing standard rules for the types of insurance activities for use by insurers. At the same time, every insurer is given the right to use them when concluding insurance contracts. In general, insurance rules represent some general terms of insurance contracts of the relevant type, which can conveniently be used as a basis for reaching an agreement.
In Russian legislation, the mandatory insurance rules for the insurer are established by Article 943 of the Civil Code of the Russian Federation. This article gives the policyholder or beneficiary the right to refer to the rules if there is a reference to them in the insurance contract. Along with this, the parties to the insurance contract are allowed to change certain provisions of these rules by agreement between all parties. These insurance and insurance rules contain the main terms and conditions of the insurance contract, concluded by the insurer delivering to the policyholder, on the basis of his written or oral application, an insurance policy (certificate, receipt) signed by the insurer. If the policyholder accepts these documents, then this will mean his consent to conclude an insurance contract on the terms proposed by the insurer. Civil Code of the Russian Federation (part two) dated January 26, 1996 N 14-FZ (as amended and supplemented, entered into force on January 22, 2015), © ConsultantPlus, URL: http: //base. consultant.ru/cons/cgi/online. cgi? req=doc; base=LAW; n=170140
It should be noted that in order for the terms of the insurance rules to become mandatory for the policyholder, this fact must be indicated in the contract, and in addition, the rules must become an integral part of the contract. This means that if these rules are attached to the contract, the fact of their delivery must be recorded directly in the contract itself, i.e. there should be a corresponding entry there. The policyholder or beneficiary, in defense of his interests, has the right to refer to the relevant rules referred to in the insurance contract, even if these rules are optional for him by virtue of this article.
So, the standard insurance rules defined by law contain the following points:
General provisions.
Conclusion, validity and termination of an insurance contract.
Object of insurance.
Subjects of insurance.
Insurance premium.
Sum insured.
Determination and payment of insurance compensation.
Consequences of changes in risk level.
Rights and obligations of the parties.
Insurance case.
Changes and additions to the insurance contract.
Settlement of disputes.
In practice, insurance rules comply with the above requirements: usually each of the listed provisions is devoted to an appropriately titled section. At the same time, there is some freedom in constructing the text of the insurance rules for any other system, provided that all of the above provisions are disclosed in their content.
Systematization of rules by type is carried out depending on the insurance object, according to the classification established by the state body for supervision of insurance activities. Typically, insurance rules cover one particular insurance object. But in addition to this, rules are applied that cover two or more insurance objects, which are called - combined.
If we talk about the meaning of insurance rules, then in insurance practice they have administrative and contractual meaning. However, such a distinction is very conditional, since the circumstances that determine the insurance rules from an administrative point of view can influence the contractual relations of the parties. In particular, the insurer’s departure from the insurance rules under which it was issued a license may be regarded as exceeding the limits of the insurer’s legal capacity, which may give rise to a lawsuit demanding that the contract be invalidated.
It is clear that the administrative significance of insurance rules applies primarily to the insurer itself, as well as to various regulatory and supervisory authorities over insurance activities. Therefore, among the documents submitted to the federal body for supervision of insurance activities in order to obtain a license, insurers must be provided with insurance rules by type of insurance. Any significant deviation from the insurance rules in terms of expanding the list of insurance objects and insured events, in comparison with the insurance rules on the basis of which the license was issued, may be regarded as a violation of the requirements of insurance legislation, with all the ensuing consequences for the insurer. The scientific literature rightly notes that the concept of “type of insurance” in our legislation does not have a precise definition. Consequently, when assessing the administrative significance of insurance rules, different interpretations are possible. Based on the administrative meaning of the insurance rules, we can conclude that these rules limit the legal capacity of the insurer, to the extent that they determine the type of insurance, in accordance with the license issued to him.
As for the contractual meaning of insurance rules, it consists in filling them with provisions that determine the composition, sequence and other characteristics of actions for the conclusion, execution, amendment and termination of insurance contracts of a certain type. At the same time, as already noted, the agreement expressed in the insurance contract may differ significantly from the terms of the insurance rules.
Polisnye cargo insurance conditions may have significant differences depending on the nature of the cargo, type, method, route and other individual parameters of transportation.
Below are the main cargo insurance conditions that can be found in a classic insurance contract.
All types of cargo, with or without packaging, can be accepted for insurance, including oversized And dangerous.
The following cargo requires separate approval:
Excise goods;
- cash;
- precious metals, stones, jewelry and ornaments;
- drawings, paintings, sculptures and other works of art;
- live animals;
- flowers and plants
- military products (weapons, ammunition, etc.)
Insurance period (start and end of insurance)
Insurance is valid within the limits of the start and end dates of transportation specified in the policy. As a rule, the insurance period is indicated based on the planned transit time for the entire transportation period, taking into account storage, reloading (transshipment).
In the event of an increase in cargo delivery time, the Policyholder has the right to request an extension of the insurance contract. At the same time, the Insurer has the right to request payment of an additional insurance premium if the conditions of transportation change (route, carrier, etc.)
In addition, the insurance policy specifies specific operations with cargo, limiting the beginning and end of the insurance coverage. Such actions may be the beginning or end of loading onto the carrier’s vehicle (car, ship), transfer of cargo to the first carrier, to the terminal, airline warehouse, etc.
In Russian practice, by default, insurance coverage does not include loading and unloading operations.
In a cargo insurance contract, as a rule, such a concept as a conditional franchise is used. This term refers to the procedure for settling a loss and denotes the non-reimbursable part of it, i.e. the application of an UNCONDITIONAL deductible automatically reduces the amount of insurance compensation by its value.
The deductible is expressed as a percentage of the insured amount (the cost of the cargo) or the actual monetary value. At the same time, the value of the deductible affects the tariff: the larger the deductible, the lower the tariff, and, accordingly, vice versa.
On the one hand, the franchise in cargo insurance serves as a certain psychological factor that promotes a more careful attitude of the Insured to the insured cargo. On the other hand, the deductible is one of the factors by which insurance rates can be adjusted.
