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INSURANCE CASE IN THE INSURANCE CONTRACT

 The client of the insurance company in case of a situation that can be regarded as an insured event, must collect all supporting documents. The insurance contract describes in detail which case is insured, specifies the necessary documents that are provided to confirm the insured event. Depending on the terms of the contract, several situations may be provided, which can be regarded as an insured event.

  Payment of funds in the event of an insured event?

 In the event that an accident, accident or other event provided for in the insurance contract has occurred with the insured person, it is necessary to inform the insurer. Paragraph 5 of Article 21 of the Law of Ukraine «On Insurance» stipulates that the insured must notify the insurer of the insured event within the period prescribed by the terms of insurance, as well as provide documents and certificates confirming the occurrence of the insured event on which payment will be made.

What documents are required to receive an insurance payment?

 Payment under the insurance contract is assigned directly to the insured person in any case other than his death. To confirm the insured events, the following documents must be provided:

  • Application for payment of the amount under the insurance contract;
  • A copy of the insurance contract;
  • Identity documents;
  • Medical certificates of damage to health, or certificates of property damage;
  • Relevant documents of the medical institution, allowing to establish the amount of insurance indemnity in which the consequences of injuries for working capacity, health, as well as information about possible complications are indicated, or documents, allowing to establish the amount of insurance indemnity for material losses;
  • Certificates confirming the cost of treatment, or the cost of repairing material damage, etc.

 Payment for the insured event directly depends on the provision of documents confirming the events that led to the insured event.

In what situations is it possible to refuse to pay for the insured event?

 The legislation provides general grounds for the possibility of refusing to make payments if it is proved that intentional actions were taken, which led to the occurrence of the insured event.

 In addition, the grounds for refusal to pay include the provision of false information related to the occurrence of the insured event, the identification of personal interest between the insurance company and the person in whose favor the insurance contract is concluded, and other circumstances provided by law.

 Also, insurance companies refuse to pay funds if the insured has not notified the insurer of the occurrence of the insured event within the period prescribed by the terms of insurance.

 In case of refusal, the insurance company must notify the insured person in writing of such a decision, if it does not see the events of the insured event, while motivating their actions.

 However, the insured has the right to appeal such actions of the insurer in court.

 The terms of the insurance contract provide for the procedure of refusal of insurance payments. The grounds for refusal to pay damages and the procedure for appealing by the parties of mutual claims are prescribed and approved at the signing of the contract and, accordingly, require special attention.

Author: Vladimir Pipko

assistant lawyer

«Prikhodko & Partners» Law Firm

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