Typical problems with payouts

  • refusal — the insurer does not recognise the event as an insured event;
  • delay — new documents are requested, the inspection is postponed;
  • underpayment — the calculation is lower than the real cost of repair or treatment.

Russia has a clear procedure for such disputes: a formal claim to the insurer, an application to the financial ombudsman and court. Many issues are resolved at the first two stages without major costs. Time works against you, so it is better to act straight away.

Step 1. Understand the reason for refusal

Ask for a written reply citing the clause of the rules or the law and compare it with the text of the contract:

  • is the event really listed among the exclusions;
  • have the deductible and wear and tear been applied correctly;
  • were the notification deadlines met and the documents handed over — keep inventories and acknowledgements of receipt.

Under the Civil Code of the Russian Federation, an insurer may refuse only on grounds provided by law or the contract. For example, late notification of an insured event entitles the insurer to refuse only if it did not know about the event and this prevented it from establishing the fact or the amount of the loss.

Step 2. Send a formal claim

A formal claim (pretenziya) is a written demand to pay compensation or make up the difference. State the policy number, the date of the event, your demands and their justification, and attach copies of documents and, if available, an independent assessment. Send it in a way that leaves a trace: through the insurer's online account, by registered mail with a list of enclosures, or in person with an acknowledgement of receipt. As a general rule, the insurance company must reply to such an application within 15 working days.

What to attach to the claim

  • a copy of the policy and the insurance rules;
  • the insurer's refusal or your correspondence with it;
  • documents on the event: certificates, reports, records;
  • a calculation of the loss: an expert report, an estimate or service station invoice, medical bills;
  • bank details for the payment.

Step 3. The financial ombudsman

If the answer does not satisfy you or there is none, apply to the financial ombudsman (Federal Law No. 123-FZ). For individuals this is a mandatory pre-trial stage in disputes with insurers:

  • for most types of insurance — if the claim does not exceed 500,000 rubles;
  • for OSAGO (compulsory motor third-party liability insurance) — regardless of the amount;
  • the application is free of charge and can be filed online;
  • the review period is 15 working days from acceptance of the application; if necessary, the ombudsman orders its own expert assessment.

The financial ombudsman's decision is binding on the insurer. If you disagree with it, you may go to court within 30 calendar days after the decision takes effect. If the insurer fails to comply with the decision on time, the consumer may obtain a certificate that serves as an enforcement document, and the insurer is charged a fine of 50% of the unpaid amount.

Step 4. Court

You go to court if the ombudsman's decision does not satisfy you, the insurer has not complied with it, or the claim is outside the ombudsman's remit. In addition to the compensation itself, you may claim:

  • under OSAGO — a penalty of 1% of the compensation amount for each day of delay and a fine of 50% of the amount not paid voluntarily;
  • under voluntary insurance of individuals — a fine of 50% under the Consumer Protection Law and compensation for moral damage;
  • reimbursement of legal costs — for expert assessment and representation.

If the dispute is complex or the amount is large, it makes sense to hire a lawyer specialising in insurance cases: the insurer always has lawyers.

Step 5. Complaint to the Bank of Russia

In parallel, you can complain to the Bank of Russia through its online reception if the insurer misses deadlines, imposes services or does not answer your requests. The regulator will not recover money for you, but it may carry out an inspection and take action against the company.

If the insurer's licence has been revoked

Under OSAGO, the payment in this case is made by the Russian Union of Motor Insurers, and for life insurance the ASV guarantee system will start operating in 2027. Read more in our article on guarantees of insurance payments.

How to reduce the risk of refusal in advance

  1. Read the insurance rules and the exclusions section before paying.
  2. Provide accurate information in your insurance application: errors and omissions are a common cause of disputes.
  3. When an insured event occurs, notify the insurer immediately and record everything in photos and videos.
  4. Keep copies of all documents and correspondence.
  5. Do not repair or dispose of damaged property before inspection.

Learn more about policies in the OSAGO and KASKO sections, and find other case reviews in the Insured event section.