What is the difference between an insured event and an insured event?
28.10.08

What is the difference between an insured event and an insured event? Some experts perceive “insured event” and “insured event” as synonyms. Others understand by “events” possible misfortunes covered by the contract; and by “incident” - a nuisance that has already occurred, the financial responsibility for compensating the consequences of which falls on the shoulders of the insurance company. We will consider “event” and “case” synonymous.

So, an insured event is some kind of unfortunate coincidence of circumstances in which the insurance company’s obligations to the client come into force. Definition of insurance

case is specified in each specific insurance contract.

For example, according to the company’s voluntary medical insurance program, the insured event is: “the insured person’s application to a medical institution in order to receive consultative, diagnostic, treatment, surgical or other medical care that requires the provision of medical services(within the list established by the policy), in case of a health disorder associated with an acute illness, exacerbation of a chronic disease or injury.” It turns out that the event is not considered to be a broken arm or poisoning itself, but the fact that the client went to the hospital.

According to the auto insurance contract of a comprehensive insurance company, an insured event is “an event stipulated by the contract that occurred with the vehicle, as a result of which material damage was caused, and with the occurrence of which the insurer’s obligation to pay compensation arises.” In this example, depending on the content of the contract, an insured event may be understood as:

• damage to the vehicle due to illegal actions of third parties;
• floods;
• fire;
• car theft, etc.

But not a client going to a service station to receive repair services or going to the police to report a car theft.

Let's consider another example - a property insurance contract (premises and property in it) of a company. By this document an insured event is “an event that occurred as a result of an insured risk, as a result of which direct losses were caused to the property interests of the insured associated with the possession, use or disposal of the insured property, in connection with which the obligation of the insurance company arises to pay insurance compensation" Insured risks include natural disasters, the influence of liquids from water supply, sewer and heating systems, theft, robbery, illegal actions of third parties, the fall of manned aircraft, their parts or luggage from them. That is, here, by an insured event, financiers understand the client receiving material damage.

Evidence comes first

As you know, an insured event requires confirmation. By voluntary health insurance, insurance for people traveling abroad and other types that involve the provision of services by a third party at the expense of the insurance company, confirmation is the client’s very request to a third party (to an assistance company, clinic, etc.). In this case, the insurance company receives a notification from a third legal entity (usually its partner) that such and such a client has contacted it with an agreement of this number. The client receives the service, the insurance company pays its cost to a third party.

In other situations, the client must justify to the company's expert why a fire in the country or car theft is an insured event. This is where the fun begins– the client is required to have a bunch of supporting certificates from various authorities, and the insurance company, to the extent of its own integrity or dishonesty, can accept these certificates for consideration or begin to find fault with every comma and ask the client to wait until the insurance company employees check everything.

Alas, at the current stage of development of the Ukrainian insurance market nothing can be done about this order of things. Alternatively, you can hire insurance broker, who will “conduct a conversation” with the insurer on behalf of the client. While protecting his nerves, the citizen will have to pay for brokerage services from 0.5% to 5% of the insurance amount “knocked out” by the intermediary, but in an amount of at least $100-200 - for an insured incident of minor or moderate severity.

Money loves precision

Let us note that it is precisely in determining the insured event that most insurance companies “catch” clients whom they want to refuse payment. A typical excuse from company employees may be: “your event is not insurable.” In order not to become a participant in the discussion on the topic “who is right - the client or the insurer?”, in which the arbiter is usually, and unfortunately, a judge, you should clarify what your insurer understands by an insured event. Moreover, do this at the stage of signing the contract. To do this, the client should make sure that the contract:

• Risks are specified. So, if the policy contains a clause “natural disasters”, but there is no definition of what kind of freaks of nature the insurer covers, it is better not to risk it and ask for clarification in the policy.
• Exclusions from insured events are specified. The list of reasons exempting financiers from paying compensation should not contain ambiguous, inaccurate or incomprehensible wording. After all, when an event occurs, insurance company lawyers will certainly try to fit each exception to the client’s case, and interpret each clause of the contract in favor of the employer.

People who have not dealt with insurance often concepts such as insured event and insured event are confused, believing that these are common synonyms used by insurers. However, if you carefully read the insurance contract, it will immediately become clear that an insured event and an insured event are by no means synonymous, but different concepts, confusion in which can lead the insured person to very unpleasant consequences. Which, in fact, is what many unscrupulous insurance companies take advantage of.

Temporary worker's salary is insufficient to pay withholdings

You can only make a registration change for this event once. Generally, double enrollment is prohibited unless you or a family member would otherwise lose coverage. For example, both your children and your spouse's children will be covered in the same self-determination and family enrollment.

Even much smaller-scale natural disasters - fires, explosions, mudflows, tsunamis, typhoons, dust storms, etc.

Your carrier should contact the operating offices involved in detecting the unauthorized dual filing case. One of the enrollments must be withdrawn or withdrawn from the start date of dual enrollment. Health benefit benefits you paid during the ineligible enrollment will be refunded and your hiring office must make a corresponding adjustment to the government contribution. A carrier that is canceled or terminated may require you to repay any benefits paid pursuant to an undocumented enrollment, although those benefits may be due under an authorized enrollment.

The difference is that an insured event is a certain event, circumstance or bad combination of circumstances, as a result of which, for the insured person, the circumstances of the insurer immediately come into legal force. Simply put, an insured event is the occurrence of an event stipulated by the insurance agreement, for which, in fact, the interested party is insured. And as soon as such an event described in the insurance contract occurs, the insurer immediately becomes obligated to pay damages to the insured person.

If you and your spouse cannot agree on which registration to proceed, the spouse's registration with a court order to provide coverage for the children will continue. Otherwise, the second registration must be canceled or cancelled.

When is dual registration allowed?

Your employee must obtain permission for dual enrollment and allow it only if you or an eligible family member would otherwise lose coverage. Some examples of acceptable double enrollment include.

And here an insured event is nothing more than potentially probable harm or damage to the insured object, in relation to which the insurance contract is concluded. That is, an insured event differs from an insured event precisely in that an insured event is an already existing possibility of causing harm or damage to the object of the insurance contract. It is best to understand the difference between an insured event and an insured event using elementary examples.

Brief coverage overlap avoids gaps in coverage. . You must tell participating carriers which family members will be covered and receive benefits for which you are enrolling. If you or a family member receives benefits from more than one plan, it is considered fraud and you will be subject to disciplinary action.

Unless you want to do an open season

You do not need to do anything if you want to continue with your registration.

Switching from one health plan to another during the open season

You do not need to contact your old health plan to unenroll.

If a person has insured his property against fire (for example, a dacha), then in this case the dacha will be an insured object, and the fire itself will be an insured event. In the event that the cottage is not subject to fire during the entire period of the insurance period, but any other damage was caused to it, then it is considered that the insured event did not occur. Since there was no occurrence of the insured event (that is, a fire). But if it burns, and this is the occurrence of an insured event in this case, then it can be argued that the insured event has occurred and the insurer is obliged to pay compensation to the policyholder.

You will not be charged premiums for your previous plan and your new plan. When you move from one office to another, your enrollment continues without interruption unless you have a service interruption of more than three calendar days. This is regardless of whether your transfer is designated as a transfer. You don't need to do anything to ensure permanent enrollment, but you do need to recruit office work.

If you are enrolled in a plan sponsored by a union or employee organization and you transfer to another agency, you are not eligible to enroll in another plan because of your transfer. Your current registration will continue until. You change plans when you have one, or a plan. . Vincent is hired by the State Department and enrolled in the Foreign Service Benefit Plan.

The policyholder decided to insure his car against theft. In this situation, it is the theft that will be the insured event and nothing else for which the policyholder has already paid the insurer. If the car is not stolen within the period specified in the insurance contract, then the insurance payments remain with the insurer, and if the car is stolen, the insurer is obliged to pay compensation to the policyholder in the amount specified in the insurance contract. Theft is an insured event, which means an insured event has occurred.

Transfers to or from the District of Columbia government

The effective date of transfer of an application for a hiring position is the first day you enter your rosters. The government should request copies of your health benefits forms when it requests other employment information from a loss-making federal hiring office. The government for personnel files copies health benefit forms at the same time it requests personnel records transcripts.

Two HR departments must verify your health insurance status so that the lien can begin with the initial pay period, even if documentation has not yet arrived from the losing office. Government, your registration has been terminated because...

Confusing an insured event with an insured event, clients of insurance companies very often get caught at an insured event, which is what insurers actually take advantage of by refusing to pay compensation under the insurance contract. Therefore, it is so important in a timely manner, before signing any insurance papers, to define the concept of an insured event and find out exactly what insured events are implied in the contract of this insurance company, and what exactly falls under the definition of an insured event.

Senate and House of Representatives

If you leave a Federal agency and obtain employment in the U.S. Senate or House of Representatives without a break in service of more than three calendar days. If you leave employment in the U.S. Senate or House of Representatives and are employed by a federal agency without a break in service of more than three calendar days, your registration will become effective at the end of the month that you separate. Payments and contributions will be made for the entire month. Getting hired by the office will ask you for a copy of the termination. Health Benefits Enrollment Change Notice, Verify Eligibility to Continue Enrollment, and Request Loss of Office for Office Use of Copies of Your Health Benefits Forms.

The occurrence of an insured event and its main features

The list of all insurance events and their characteristics are strictly recorded in the law of the Russian Federation “on insurance”, as well as in the mandatory rules of this process. Therefore, the occurrence of an insured event is usually associated with signs that are damage or losses that were caused or inflicted on the insured person or object during the loss (loss, destruction, etc.) of the insured property.

If you die in service while studying in Me and Family, registration for your family members automatically continues when they meet. Typically, your registration can last up to 365 days. You must pay employees a share of the premium for each pay period during which your enrollment continues.

Restoring debt after erroneous deletion or suspension

If you are suspended without payment, your registration may continue for up to 365 days. If you are removed from the Service, your enrollment will be at the end of the payment period in which you will be removed. If your enrollment is terminated and you are ordered to reinstate service because the suspension or removal was unjustified or unjustified, you have a choice.

Events and signs of the occurrence of an insured event:

– the occurrence of a fire, explosion from gas, lightning, causing damage to the property of the insured;

– within 24 hours from the occurrence of the insured event, inform the insurer in documentary form about the occurrence insured event with an accurate description of the damaged or destroyed property and an indication of it estimated value and the amount of insurance payment;

After separation from service

The suspension or retirement period does not count toward your determination if you enroll within 60 days of the date you order the reinstated debt. If you lose health insurance because you separate from federal service, whether voluntary or involuntary, you have a choice.

With the development of productive forces, society encountered a new, very significant source of danger: the so-called technical risks.

These rights are based on the termination of the temporary assignment - prior separation is not relevant. If you are eligible for a pension and you receive a temporary assignment, your annuity will be suspended. Your office working in the office must notify the system pension provision about transferring your credit back to your office. If your temporary assignment ends and your previous division is still standing, your registration will be transferred back to the retirement system.

– the policyholder must immediately take personally all necessary measures that can somehow help reduce the damage resulting from the occurrence of the insured event;

– the policyholder must provide the insurer with all the necessary documents, certificates and information that will make it possible to conduct an investigation into the circumstances that caused the occurrence of the insured event and the insured event. Also, the policyholder must, until the arrival of experts, preserve as much as possible the picture of the incident that led to the occurrence of the insured event.

An insured event as an element of an insured event should be considered as a danger that can affect the insurance object in such a way that, as a result of this impact, the policyholder, beneficiary or insured person suffers property damage

If you return to duty and your temporary assignment ends, you can choose to have your medical care covered. This amount can be applied to the premiums you owe retroactively. Actuaries use mathematics and statistics to estimate the risk of what happens, how much it costs to finance that risk, and how much your premium is worth. They help insurance companies design coverage and advise them on the level of financial reserves needed to meet claims.

INSURANCE - this is a system of relations associated with the protection of property interests of individuals and legal entities upon the occurrence of certain events (insured events) by specialized organizations - insurance companies at the expense of what is formed from the contributions of policyholders (premium) insurance fund, from which losses incurred by policyholders as a result of insured events are compensated. There are voluntary and compulsory insurance. Voluntary insurance is carried out on the basis of an agreement between the policyholder and the insurer. Rules voluntary insurance, defining the general conditions and procedure for its implementation, are established by the insurer independently in accordance with the law. Specific insurance conditions are determined when concluding an insurance contract. Insurance is required by law. Types, conditions and procedure compulsory insurance are determined by the relevant laws of the Russian Federation.

Pure and speculative risk

Also known as loss regulator. Sometimes the expert will need to ask more questions, inspect the property, or talk to someone else involved in the claim, such as another driver, a neighbor, or the police. The Australian Prudential Regulatory Authority is the prudential regulator of the Australian financial services industry. He oversees insurers and other financial companies such as banks, Insurance companies and pension funds. It regulates these companies to make sure they manage their risks in a way that ensures they can pay policyholder claims and minimize the likelihood of financial loss.

PARTICIPANTS

INSURER - is an insurance company created to carry out insurance activities and has received, in accordance with the procedure established by the current legislation of the Russian Federation, a license to carry out insurance activities in the territory Russian Federation, which enters into an agreement with the policyholder, i.e. assumes the risk.

This form of coverage is for an unintentional, one-time incident that causes damage to your property or its contents. For example, accidentally spilling red wine on your new white carpet. It does not cover general wear and tear or damage that occurs over time.

The amount for which you and your insurer agree to insure your car. You may choose this if your car is fairly new, has modifications, is in better than normal condition, or has extras that do not take into account its normal market value. Deciding between the two depends on your financial circumstances, the value you place on your car, the level of risk you are willing to accept and the confidence you have, as well as other factors such as whether your car is financed.

POLICY HOLDER - a legal or capable individual, a party to an insurance contract, insuring its property interest or the interest of a third party. Under the insurance contract, the policyholder is obligated to pay an insurance premium to the insurer for his assumption of responsibility to compensate the policyholder for losses upon the occurrence of an insured event. The policyholder can conclude an insurance contract both in his own favor and in favor of another person.

BENEFICIARY - a person to whom insurance compensation must be paid upon the occurrence of an insured event. It may be the policyholder himself, the bearer of the policy, or the successor. As a rule, it is indicated in the insurance policy.

INSURANCE AGENT - an employee of an insurance organization who, on behalf of and on behalf of the insurer, enters into insurance contracts.

INSURANCE CONDITIONS

INSURANCE RISK - a probabilistic event or a set of events, in the event of which insurance is carried out (personal, property, liability insurance).

INSURANCE PREMIUM, - this is the policyholder's payment for insurance, which he is obliged to pay to the insurer in accordance with the insurance contract or law. In other words, this is a fee for insurance service. IN international practice The insurance premium is also called the insurance premium or insurance payment.

INSURANCE VALUE - this is the actual (actual) value of the insurance object (there is also market price, negotiated price, etc.)

ENTERPRISE PROPERTY INSURANCE

Any enterprise - be it a manufacturing or trading company, an office or a warehouse - has its own set of basic and working capital, that is, property. About 40% of the total number of fires occurred at enterprises that have state or municipal property under economic control or operational management. In a market economy, 43% of enterprises cannot resume their activities immediately after a fire, 28% of enterprises restore their businesses within three subsequent years, and only 23% of enterprises function normally after a fire.

WHAT RISKS CAN YOU PROTECT YOUR PROPERTY AGAINST BY CONCLUSING AN INSURANCE AGREEMENT
Insurance based on named risks. When concluding an insurance contract, the manager can choose any set of risks below:
- fire, lightning strike
- water damage from plumbing, heating, sewer and fire protection systems
- natural disasters
- burglary, robbery
- illegal actions of third parties
- collision, blow
- terrorism, sabotage

OBJECTS OF INSURANCE
Companies accept for insurance both real estate and movable property, which can be an object of ownership, the object of rental, collateral, leasing relations. This may be property accepted for safekeeping or commission. Property is assessed both at book value and at replacement cost:
- buildings, engineering structures, internal communications, including finishing.
- electronic, engineering and technological equipment
- furniture and equipment
- inventory
- stocks of raw materials and materials
- display glass
- additional costs (for clearing rubble, etc.)

At the request of the policyholder, selective insurance of property (for example, only buildings) or individual objects of this type (one building) can be concluded.

The insured amount is determined in the property insurance contract.

Wherein sum insured should not exceed the insurance (actual) value of the insured property.

TRAVEL AND BUSINESS TIP

Insurance for citizens traveling abroad implies, first of all, compensation medical expenses problems that may arise during a trip - a sudden illness or an accident.
The insurance rules of the companies are similar. But there are differences, so it is advisable for the traveler to study them in advance. For example, sunburn is a covered event and is covered, but some companies exclude it.
It is very important to understand how payments are made for this type of insurance, how insurers work with Western medical service companies. Because there are options for working with assistance companies in the West, when such a company is called to provide medical services and the costs of treatment are borne by the insurer. Another possibility of providing medical care is when the victims are directly paid for insured services and then upon return receive compensation. And, of course, you need to pay attention to whether the phone number is indicated in the policy and whether there is a Russian-speaking operator.
Another area is insurance of medical expenses for people who travel to other regions of Russia, for example on business trips. Sometimes in other cities there are difficulties in obtaining free medical care. Accordingly, those enterprises whose employees are often on the move are interested in this type of insurance, and this is an integral part of the social package so that the employee can quickly and efficiently receive medical care outside your city.

The insurer's liability begins from the moment the insured person crosses the border when leaving Russia and ends the moment the insured person crosses the border when returning to the country.

ACCIDENT INSURANCE

Accident insurance differs from risk life insurance programs in that only harm to life and health that is caused by external factors is considered an insured event, that is, in the literal sense, an accident. Almost all insurance companies offer several standard programs:
- Protection in case of death - the insured event is the death of the insured as a result of an accident. - Protection in case of disability - an insured event is the assignment of disability group I, II or III to the insured as a result of an accident.
- Protection in case of bodily injury provided for in the table of insurance coverage amounts. The duration and territory of insurance are specified in the insurance contract. You can enter into an agreement under the terms of which insurance protection valid 24 hours all over the world.
The minimum contract period is 1 year.

Unlike voluntary health insurance, the beneficiary here is the policyholder (or his heirs), and not medical institution. Also, the amount of compensation is not determined actual cost operations, but is calculated based on the insured amount established at the conclusion of the contract.

WHEN DETERMINING THE SIZE OF PAYMENT, the following rules apply:
- In the event of the death of the insured, the payment is 100% of the insured amount.
- In case of permanent loss of ability to work (disability) of the Insured, the amount of insurance payment is determined depending on the established disability group.
- Insurance in case of injury. The amount of insurance payment to the insured person depends on the nature and severity of the injury he received. Payment is made according to the table of insurance payments, where for each type of injury the percentage of payments from the insured amount is indicated. The client can familiarize himself with the payout table in advance.

The insured may act:
- legal entity of any form of ownership,
- a capable individual.

Companies most often choose to enter into collective agreements for accident insurance.

This is a form of financial protection for an employee or his family in the event of unfavorable events for the employee associated with an accident, or in the event of the loss of a breadwinner in the family.

PROFESSIONS WITH INSURANCE

The activities of lawyers, notaries, auditors, appraisers, doctors, and customs brokers are associated with high economic risk.

This type of insurance is intended to provide insurance protection for persons of certain professions against claims for compensation to clients (patients) for material damage as a result of negligence, error, etc., committed in the performance of official duties.

Insurance coverage applies exclusively to the legal liability of notaries, doctors, architects, pharmacists, lawyers, etc. and does not apply to moral liability. In many countries, having professional liability insurance is a requirement for obtaining a license to practice in private practice.

Some types of professional liability insurance, such as auditors' liability insurance, become mandatory by law. When insuring professional liability, the object of insurance is the property interests of the policyholder associated with the obligation to compensate for harm caused to life or health, or material or property damage to third parties when he (the policyholder) carries out professional activities. In this case, a private professional must have a license, certificate or other document confirming the right to carry out professional activity.

AUDITORS
An auditor's liability insurance policy guarantees compensation for damage caused to the property interests of his clients during the conduct of audit activities as a result of unintentional errors, negligence or any other omissions. The insured event in this case is the imposition by the tax authorities of financial sanctions on the auditor's client for violating financial and economic discipline, if such violations were not noted by the auditor, and the recovery from the insurer of the costs of conducting a re-inspection.

MEDICAL WORKERS
The contract insures the property interests of the policyholder associated with the obligation to compensate for harm caused to the life or health of the patient during the performance of medical activities. Both medical institutions and privately practicing doctors registered as individual private entrepreneurs, as well as those who have the appropriate qualifications of a medical worker and have received a license to carry out medical activities, can be insured. Insurance compensation is paid in the event of a medical professional’s error in diagnosing a disease, prescribing medications, carrying out treatment, surgical operations, and also when caring for patients. In addition, the risk of harm to the patient due to deficiencies or defects in medical equipment used by medical professionals in providing medical care is covered.

NOTARIES
Notaries - private individuals who have received a license to carry out notarial activities or intend to obtain one - can insure their liability. The contract covers the risk of harm to third parties due to an unintentional professional error. For example, if the notary did not explain to clients their rights and obligations or did not warn about the consequences of the notarial actions performed, did not check the legal capacity of the parties to the agreement, etc.

APPRAISERS
Insurers can be private individuals registered as individual entrepreneurs and having a certificate confirming receipt professional knowledge in the field of valuation activities.
The risk of harm to third parties due to improper performance by the appraiser of his duties when assessing various objects is insured.

REALTORS
To purchase a professional liability insurance policy, a realtor - an individual must be registered as an individual entrepreneur, have a qualification certificate, as well as a license to carry out real estate activities.
The insurer guarantees payment insurance compensation to third parties due to violation of their property rights (property rights, lifelong inheritable possession, economic management, operational management, etc.) as a result of unintentional errors, negligence or omissions in the implementation of real estate activities, For example, if an error was made by a realtor when checking the rights of persons on the real estate object that is the subject of the transaction, or the legal capacity of the parties to the transaction, etc.

PHARMACISTS
Individuals who are registered as an individual entrepreneur and have a license to carry out pharmaceutical activities can purchase a pharmacist liability insurance policy. The insurer guarantees compensation for harm caused to the life or health of injured persons during the implementation of pharmaceutical activities as a result of unintentional errors or negligence. For example, if a pharmacist violated the rules and procedures for dispensing medicines, dispensed a medicine without a doctor’s prescription, etc.

LAWYERS
Insurers insure the liability of individuals registered as individual entrepreneurs who have a higher education and provide paid legal services. As a rule, insurers require a certain minimum experience in providing legal services.
The insurer's obligation to pay insurance compensation arises when harm is caused due to an unintentional professional error of a lawyer. For example, if the lawyer did not explain to clients their rights and obligations, and did not warn about the consequences of the legal actions taken.

The concept of “insurance event” means the potential ability of an insured event to occur, in the event of which the insurance company becomes obligated to compensate the insured or beneficiary for the losses (damages) specified in the contract or the obligation to pay compensation amounts.

The difference between an insured event and an insured event

As you can see, the concepts of “insured event” and “insured event” are not identical. The first concept includes the actual, and not the potential (possible in the future), occurrence of the need for insurance payments. The insured event must be confirmed and recognized in order to transfer it to the category of “insured event”. If an agreement is reached on the possible occurrence of an insurance event, the contract necessary for you is concluded. To avoid misunderstandings in the future, do not be afraid to ask questions, clarify, and make suggestions.

IMPORTANT!!! The insurance contract itself must always contain a list of insured events, upon the occurrence of which the compensation specified in the contract is made.

The most common insurance events under the contract personal insurance- this is n accident, illness and death.

Necessary actions in the event of an insured event

Such actions are:

Contact the 24-hour service of your company where you provided insurance, specify the address and operating hours of the loss settlement department. Take all available documents with you, preferably with a copy of each document for yourself. Ask that each photocopy of the document be marked with a mark indicating acceptance of the original from you (signature, transcript of the signature of the employee who accepted the documents from you, and a prerequisite - affixing the date);

Behave as correctly as possible in the company, with the employee. Try to address him by his first and patronymic. Almost always, such organizations conduct both video and audio recordings, but we also don’t need proceedings regarding insults and slander. Specify the time frame within which your application will be considered; what actions the employee will take to review your insurance event, and what your further actions should be.

If you have been refused, and in your opinion, unreasonably, do not despair!

You can contact:

Every serious insurance company has its own quality service (they were created for this purpose, and as practice shows, they resolve most controversial issues without going beyond the company).

in case of conflicts with car insurance - Russian Union Auto insurers, You can also officially contact Federal service insurance supervision of the Russian Federation. And no one canceled the trial!

Also remember! If it turns out that you intentionally committed actions that led to the occurrence of an insured event, you will not only be deprived compensation payments, but they can also be held accountable (administrative, civil or even criminal)!

Many experts believe " insurance case" and "insured event" are synonymous. Some understand by “incident” a trouble that has already occurred, and cash payments its consequences are borne by the insurance company; and under “event” - possible accidents - risks within the competence of the contract. We agree to consider these two concepts synonymous.

Insurance case- this is a certain event or simply an unfortunate coincidence of circumstances, upon the occurrence of which the insurance company’s obligations to the client come into force. The very concept of an insured event is provided for in detail in each specific insurance contract.

Insured events are also prescribed in the laws: reaching retirement age, recognition of disability, death of the breadwinner, injury, illness, industrial or professional accidents. diseases, pregnancy and childbirth, etc.

For example, an insured event for VHI program in one popular insurance company it is considered: “an application by a person who has an insurance policy to a medical institution in order to receive treatment and surgical, diagnostic and advisory or other medical services that require prompt assistance for health problems caused by acute, chronic diseases or injury " That is, the fact of the insurance holder’s visit to the clinic can be considered an event, and not poisoning or a broken leg.

Let's consider another example - under the "auto CASCO" insurance contract in a popular company, an insured event is considered to be the event specified in the contract that happened to the car vehicle and entailed material damage, and obliges the insurance company to pay monetary compensation.

For example, depending on the contents of the pole, the following can be considered an insured event:

— traffic accident;

- damage caused by car theft;

— damage caused by illegal actions of third parties;

- flood;

- exposure to fire.

In this example, an insured event does not include a client contacting the police with a report of a car theft or receiving repair services at a service station.

First of all - evidence

When an insured event occurs, it still needs to be confirmed, as is known. Confirmation and provision of services by a third party at the expense of the insurance company, in the case of insurance for traveling abroad, voluntary health insurance and other types, is the client’s own request to the assistance company (to the third party). In this case, the insurance company receives notification from its partner (third legal entity) about the client’s appeal specified number insurance contract. The insurance company pays the cost of the service to a third party. In other cases, the client is required to provide a lot of supporting documents and certificates from various authorities. That is, the owner of the insurance is obliged to prove to the insurance company experts why the accident that happened to him can be considered an insured event. The big disadvantage of our legislation is that there is no established procedure for this procedure.

Accuracy is the key to success

Thus, in most cases, clients “get caught” in determining the insured event. This is what insurance companies use to deny compensation to clients. To avoid this, before signing an insurance contract, find out in detail what the insurance company means by “insured event”. For example, specify the risks: ask the insurer to clarify exactly what natural disasters mean the item “ disaster" You shouldn't take risks!