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Sample statement of claim for recognition of an event as insured. Recognition of the event as insured. Free legal consultation

DEFINITION

Judge of the Sovetsky District Court of Ulan-Ude Badmaeva D.N.

under secretary Shonoeva O.B.,

having considered in open court a civil case based on the claim of A.B. Khingeyev. to JSC " Insurance group MSK" on recognition of the event as an insured event,

INSTALLED:

Khingeev A.B. filed a lawsuit against JSC Insurance Group MSK to recognize the event as an insured event, in support of its claim, indicating the following. DD.MM.YYYY on<данные изъяты> . <данные изъяты> <данные изъяты>, g/n No., which was under the control of A.B. Khingeyev. on the basis of a general power of attorney owned by Rinchine E.D. and vehicle<данные изъяты>, no., under the control of Zh., owned by B. Based on the administrative material, namely, resolution No. and explanations given by the participants in the accident, Zh., whose civil liability was insured by JSC Insurance Group MSK (policy No.), was found to be the culprit in this incident. In accordance with current legislation, to receive insurance payment, the plaintiff contacted the insurance company of the culprit DD.MM.YYYY For which all actions were performed on his part. However, on the day the claim was filed, the defendant did not make a decision on the insurance payment or acceptance of a refusal for this event. To obtain clarification, the plaintiff repeatedly contacted the insurance company, but a motivated response was never received. As a result, DD.MM.YYYY the plaintiff was forced to apply for extradition necessary documents to go to court, but no documents were presented and no answer was given regarding this fact. The plaintiff was forced to resort to the help of a specialist, whose services amounted to 35,000 rubles. He asks the court to recognize the event as an insured event, to recover from the defendant the legal costs of paying for the services of a representative in the amount of 35,000 rubles, the costs of issuing a power of attorney in the amount of 400 rubles, the costs of paying state fees in the amount of 200 rubles.

Plaintiff A.B. Khingeev and his representative of the plaintiff by proxy Glinsky M.L. did not appear at the court hearing, although they were duly notified of the time and place of the consideration of the case. The case file contains a statement from the plaintiff A.B. Khingeyev. on consideration of the case on the merits in his absence. According to the rules of Part 3.5 of Article 167 of the Code of Civil Procedure of the Russian Federation, the court decided to consider the case in the absence of the plaintiff himself and his representative, since it does not have data on the valid reasons for the non-appearance of the plaintiff’s representative M.L. Glinsky.

The representative of the defendant A.A. Dabalaev, acting on the basis of a power of attorney, did not agree with the claim, supporting the arguments set out in the document provided to the court written review. He insisted on terminating the proceedings in this case, citing the fact that the damaged vehicle<данные изъяты>, No. belongs by right of ownership to citizen Rinchine E.D. . Khingeev A.B. , not having the title of owner, is authorized only to perform a number of actions in accordance with the terms of the general power of attorney. In accordance with Article 3 of the Code of Civil Procedure of the Russian Federation, only an interested person has the right to go to court for the protection of violated or disputed rights, freedoms or legitimate interests. A literal reading of this rule indicates that a prerequisite for the exercise of the right to claim in a material sense is the violation or challenge of the rights, freedoms or legitimate interests of this person. According to Article 209 of the Civil Code of the Russian Federation, the owner has the rights to own, use and dispose of his property. In addition, according to general rule, it is the owner who bears the burden of maintenance and the risk of accidental death or accidental damage to property belonging to him (Article 210-211 of the Civil Code of the Russian Federation). Therefore, when property is damaged, the rights of the owner of the thing, and not the representative, are violated. By virtue of Article 185 of the Civil Code of the Russian Federation, a power of attorney is recognized as a written authority issued by one person to another person for representation before third parties. As is known, rights and obligations as a result of the commission of any transactions by a representative by virtue of powers based on a power of attorney arise and terminate directly with the represented person.

After listening to the arguments of the defendant's representative and studying the case materials, the court comes to the following conclusion.

As the plaintiff indicated in his statement of claim and is confirmed by the case materials, DD.MM.YYYY on<данные изъяты>a traffic accident occurred between a vehicle<данные изъяты>, g/n No., under the management of A.B. Khingeyev and vehicle<данные изъяты>, no., under the management of Zh., owned by B.

The court found that the owner of the vehicle<данные изъяты>, s/n no., is Rinchine E.D. , which is confirmed by the copies of the vehicle registration certificate from DD.MM.YYYY No. and the vehicle passport No. from DD.MM.YYYY presented in the case materials (pp. 9, 10). Driver A.B. Khingeev drove this car on the basis of a power of attorney from DD.MM.YYYY issued by the owner motor vehicle Rinchine E.D. and certified by a notary of the Ulan-Ude notarial district I. in the register under No. (case file 8).

Believing the offensive insured event, the plaintiff contacted the company of the culprit in this accident, J. - OJSC "Insurance Group MSK", in which, on the basis of policy No., the latter's civil liability was insured, with an application for insurance payment. From the analysis of the power of attorney issued by the owner of the vehicle from DD.MM.YYYY it follows that Khingeyev A.B. has the right in the interests of Rinchine E.D. receive insurance compensation upon the occurrence of an insured event, represent his interests in insurance organizations, as expressly stipulated in the power of attorney. In addition, the power of attorney was issued with the right to be delegated in whole or in part to other persons.

As a general rule, the interested person has the right to go to court for the protection of violated or disputed rights, freedoms or legitimate interests in the manner established by the legislation on civil proceedings (Part 1 of Article 3).

By virtue of Article 209 of the Civil Code of the Russian Federation, the rights to own, use and dispose of their property belong specifically to the owner, who, at his own discretion, takes any actions in relation to his property that do not contradict the law and other legal acts and do not violate the rights and interests protected by law of other persons .

Thus, only the owner Rinchine E.D., being the title owner of a movable thing, in the event of a violation of his rights in the form of damage to his property, has the right to initiate this claim. It is not permissible to come to the conclusion that the rights, freedoms or legitimate interests of the representative by proxy, who is the plaintiff in this case, have been violated. The plaintiff is not the owner of the above-mentioned car, but is only authorized to perform a number of actions in accordance with the terms of the power of attorney from DD.MM.YYYY, which does not mean that he has the right to file a claim on his own behalf and in defense of his rights and legitimate interests.

Under such circumstances, the proceedings in this case are subject to termination under paragraph 1 of Article 220 of the Code of Civil Procedure of the Russian Federation - the case is not subject to consideration and resolution in court in civil proceedings on the grounds provided for in paragraph 1 of part one of Article 134 of this Code - in a statement submitted from in their own name, acts that do not affect the rights, freedoms or legitimate interests of the applicant are disputed.

According to Article 221 of the Code of Civil Procedure of the Russian Federation, the proceedings in the case are terminated by a court ruling, which states that a repeated appeal to the court in a dispute between the same parties, about the same subject and on the same grounds is not allowed.

Based on the above, guided by paragraph 1 of Article 220, Article 221 of the Code of Civil Procedure of the Russian Federation, the court

DEFINED:

Production according to civil case according to the claim of A.B. Khingeyev to OJSC "Insurance Group MSK" to stop recognizing the event as an insured event.

Explain to the plaintiff that a repeated appeal to the court in a dispute between the same parties, about the same subject and on the same grounds is not allowed.

The ruling can be appealed within 10 days to the Supreme Court of the Republic of Buryatia through the Sovetsky District Court of Ulan-Ude.

Judge D.N. Badmaeva

<данные изъяты>

<данные изъяты>

<данные изъяты>

<данные изъяты> 1

as part of the presiding judge Surkov *.*.,

under the secretary Kolesnik *.*.,

Having considered in open court the civil case No. on the claim FULL NAME1 against Renaissance Insurance Group LLC on recognizing the case as insured and imposing the obligation to send the damaged insured car for repairs to service center official dealer in accordance with the terms of the insurance contract,

Installed:

FULL NAME1 filed a lawsuit against Renaissance Insurance Group LLC to recognize the case as insured and impose the obligation to send the damaged insured car for repairs to the service center of the official dealer in accordance with the terms of the insurance contract and to collect interest for the use of others in cash. In support of his claims, he indicated that DD.MM.YYYY an agreement was concluded between him and Renaissance Insurance Group LLC voluntary insurance his Toyota Corolla car, no.

During the validity period of the insurance contract - from DD.MM.YYYY to DD.MM.YYYY, on the contrary, an insured event occurred, as a result of which the car suffered mechanical damage, which he reported to the insurer, but the car was not sent for repairs to the service center of the official dealer in accordance with the terms of the insurance contract.

As a basis for refusal to pay insurance compensation the insurer pointed to the conclusion of VPK LLC No. according to which the available vehicle the damage is not the result of a single event and could not have occurred under the conditions described.

However, this conclusion cannot be considered lawful and justified, since VPK LLC is located in Moscow, its employees did not inspect the insured car. In addition, the conclusions are formulated probabilistically. From these conclusions it follows that car damage is not the result of a single event. Meanwhile, the damage to the car, as he indicated, occurred in the period from DD.MM.YYYY to DD.MM.YYYY.

Referring to these circumstances, he asked the court to recognize the damage to the Toyota Corolla car, no. No., received in the period from DD.MM.YYYY to DD.MM.YYYY, on the contrary, as an insured event, to oblige Renaissance Insurance Group LLC to send the damaged insured car for repairs to the service center of the official dealer in accordance with the terms of the insurance contract and recover from Renaissance Insurance Group LLC in its favor the costs of paying the state duty in the amount

At the court hearing, the plaintiff clarified his stated demands. Regarding the collection of interest for the use of other people's funds, he refused.

The defendant's representative objected to the satisfaction of the stated demands and asked to dismiss the claim.

The court, having listened to the participants in the process and examined the case materials, comes to the conclusion that the claims are subject to satisfaction on the following grounds.

In accordance with clause 1 of Article 929 of the Civil Code of the Russian Federation under the contract property insurance one party (the insurer) undertakes to pay the contractual fee ( insurance premium) upon the occurrence of an event (insured event) provided for in the contract, compensate the other party (the policyholder) or another person in whose favor the contract was concluded (the beneficiary) for losses caused as a result of this event in the insured property or losses in connection with other property interests of the policyholder (pay insurance compensation) within the amount specified in the contract (sum insured).

The provisions of Article 964 of the Civil Code of the Russian Federation provide for the grounds for exempting the insurer from paying insurance compensation, unless otherwise provided by law or the insurance contract.

Paragraph 1 of Article 963 of the Civil Code of the Russian Federation provides that the insurer is exempt from paying insurance compensation or the insured amount if the insured event occurred due to the intent of the policyholder, beneficiary or insured person, except for the cases provided for in paragraphs 2 and 3 of this article.

The law may provide for cases of exemption of the insurer from payment of insurance compensation under property insurance contracts upon the occurrence of an insured event due to gross negligence of the insured or beneficiary.

In accordance with Article 56 of the Code of Civil Procedure of the Russian Federation, each party must prove the circumstances to which it refers as the basis for its claims and objections, unless otherwise provided by federal law.

From the case materials it follows that FULL NAME1 is the owner of the Toyota Corolla car, no.

The case materials confirm that DD.MM.YYYY between FULL NAME1 and Renaissance Insurance Group LLC concluded a voluntary insurance agreement for a car owned by him.

It was established that during the validity period of the insurance contract - from DD.MM.YYYY to DD.MM.YYYY, on the contrary, an insured event occurred, as a result of which mechanical damage was caused to the car, which he reported to the insurer. In his application, FULL NAME1 did not ask for payment of insurance compensation, but in accordance with the insurance rules, he asked to send the car for repairs to the service center of an official dealer in accordance with the terms of the insurance contract, but his request was refused.

Clause 11.4 of the Insurance Rules stipulates that the insurer, within 15 days, counting from the date of receipt from the policyholder of all necessary documents and fulfillment of obligations, is obliged to: make a decision on recognition or non-recognition of the event as an insured event (clause 11.4.2), .... Issue a referral to the insured for repairs at a service station (clause 11.6), if the event is not recognized as an insured event, send the insured a notice of refusal to pay insurance compensation in writing with justification of the reasons for the refusal (clause 11.4.2.2.), approve the act insured event (clause 11.4.2.1.3.), ... make insurance payment within 7 working days from the date of approval of the insured event report.

It was established that, to justify the reason for not sending the car for repairs, the insurer pointed to the conclusion of VPK LLC No., according to which the damage present on the vehicle was not the result of a single event and could not have occurred under the conditions described.

It was also established that VPK LLC is located in Moscow; its employees did not inspect the insured car. In addition, from the conclusions of the conclusion it follows that the damage to the car is not the result of a single event. Meanwhile, the damage to the car, as indicated by the plaintiff, occurred in the period from DD.MM.YYYY to DD.MM.YYYY. Thus, the car was not in his possession for a long time, during which the above damage could have been caused.

The court believes that this conclusion cannot be considered a legitimate basis for refusing to recognize the event as an insured event, since VPK LLC is located in Moscow, its employees did not inspect the insured car. In addition, the original of this report was never presented to the court by the defendant. At the time of consideration of the case on the merits, the defendant did not have it.

In such circumstances, taking into account that the defendant did not fulfill his obligations to recognize the damage to the insured car as an insured event and did not send the damaged insured car for repairs to the service center of the official dealer in accordance with the terms of the insurance contract, but did not provide evidence of the validity of his actions, the court comes to the conclusion the conclusion that the plaintiff’s demands are justified and subject to satisfaction.

The amount paid when going to court is also subject to recovery. state duty at the rate of

Based on the aforesaid and guided by Article. Art. 194-198 Code of Civil Procedure of the Russian Federation

Claim FULL NAME1 - satisfied.

Recognize the damage to the Toyota Corolla car, no. No., received during the period from DD.MM.YYYY to DD.MM.YYYY, on the contrary, as an insured event.

Oblige Renaissance Insurance Group LLC to send the damaged insured car for repairs to the service center of the official dealer in accordance with the terms of the insurance contract.

To recover from Renaissance Insurance Group LLC in favor of FULL NAME1 the costs of paying the state duty in the amount

The decision can be appealed to Samara regional court through the Leninsky court within 10 days.

The motivated decision was made on 05/04/2011.

Chairman/signature/ Surkov *.*.

Correct copy: judge

Anapa District Court of the Krasnodar Territory composed of:

presiding Barsukov *.*.

With Secretary Loginova *.*.

Having considered the case in open court on the claim of Balasyan *.*. against Aviva Insurance Company CJSC for recognition of disability as an insured event and recovery of the insured amount, counterclaim of Aviva Insurance Company CJSC against Balasyan *.*. on declaring an insurance contract invalid and applying the consequences of declaring transactions invalid

Installed:

Between the Borrower Balasyan *.*., and the Operations office in Anapa of the branch of OJSC National Bank "Trust" (hereinafter referred to as the Bank), loan agreements were concluded for the provision of loans for urgent needs 000 dated December 11, 2009 in the amount of 150,000 rubles (one hundred fifty thousand ) rubles and 000 dated July 19, 2010 in the amount of 200,000 (two hundred thousand) rubles, with a return period until December 11, 2012 and 07.20.2015, respectively, with the condition of paying interest under the 000 agreement dated December 11, 2009. in the amount of 17 (seventeen)% per annum, under agreement 000 dated July 19, 2010 in the amount of 15% per annum (hereinafter referred to as the Loan Agreements).

When concluding loan agreements by the Plaintiff and the insurer - CJSC Insurance Company"Aviva" concluded insurance contracts and issued accident and illness insurance policies No. 000 dated 12/11/2009 to loan agreement 000 dated 12/11/2009 in the amount of 150,000 rubles (one hundred fifty thousand) rubles and to loan agreement 000 dated July 19, 2010 No. VTS - 756722/2010 in the amount of 200,000 (two hundred thousand) rubles.

In order to fulfill its obligations to pay insurance premium citizen Balasyan *.*. *.*. in favor of CJSC IC "Aviva" was paid from the loan proceeds: under policy 000 dated 12/11/2009, 8,550 rubles, one-time to the insurer's current account at OJSC NB "Trust", under policy 000 dated 07/19/2010, 19,000 rubles, in a lump sum to the insurer's current account at OJSC National Bank "Trust". Thus, Balasyan *.*. *.*. in accordance with Art. 37 of the Federal Law “On the Protection of Consumer Rights” fully paid the price of the service provided by ZAO IC Aviva in accordance with the insurance policies.

Insurance policies state that... an insured event is and is subject to 100% compensation for “permanent incapacity for work (disability) acquired (established) during the insurance period.

Section I, i.p. d (pages 16-17) Rules for insurance against accidents and illnesses of ZAO IC Aviva dated September 11, 2008, approved general director Company

IC "Aviva" Dubinin *.*., it is stipulated that when the second disability group is established, compensation is paid in the amount of 80% of the insured amount

On October 27, 2010, the Plaintiff suffered a permanent loss of ability to work, in connection with which, the Branch of Bureau 000 of the Federal State Institution “GB MSE in the Krasnodar Territory” established the second group of disability for a general disease for the Plaintiff (certificate ITU-2009 000 dated October 27, 2010)

12/27/2010 Balasyan *.*. *.*. submitted an application and documents, according to the list, to Aviva Insurance Company CJSC (representative office in Anapa, where the insurance policy was issued) for payment of the insured amount, since the policies clearly indicate that the insurance payment upon the occurrence of an insured event is “persistent” disability" is paid in the amount of 100% of the insured amount. In the attachment to the application for insurance payment to Aviva Insurance Company CJSC Balasyan *.*. *.*. were attached: a copy of the ITU-2009 000 certificate dated October 27, 2010, an extract from the medical history 000, a referral for an ITU, an application for undergoing an ITU, a cardiologist’s report, a medical specialist’s report, a copy of the Plaintiff’s passport, a copy of the policy, a copy of the outpatient card) .

May 17, 2011 Balasyan *.*. *.*. called the insurance company to inquire about the result of reviewing his documents, they explained to him that copies of notarized documents from the outpatient card “cannot be read”, and demanded that he send the outpatient card to the office of ZAO IC Aviva in Moscow, 05/25/2011. The plaintiff sent it parcel post (for which there is a corresponding postal receipt with a delivery note).

Since insurance payments Balasyan *.*. *.*. never received, on August 19, 2011 (and again by fax on September 6, 2011) A claim was sent to the Defendant, to which there was also no response.

According to paragraph 2 of Art. 9 of the Law of the Russian Federation of November 27, 1992 “On the organization of insurance business in the Russian Federation”, an insured event is an event that has occurred, stipulated by the contract insurance or law, upon the occurrence of which the insurer becomes obligated to make an insurance payment to the policyholder, insured person, beneficiary or other third parties.

In support of the claim for compensation for moral damage, in accordance with Art. 15 of the Law “On Protection of Consumer Rights”, moral damage caused to the consumer as a result of violation of his rights, provided for by laws And legal acts RF, are subject to compensation for moral damage if the cause of harm is at fault. The amount of compensation is determined by the court and does not depend on compensation for property damage. In accordance with the explanations given in paragraph 25 of the Resolution of the Plenum Supreme Court RF dated December 20, 1994 No. 10 “On the practice of courts considering cases on the protection of consumer rights”, the amount of compensation for moral damage depends on the nature and extent of moral and physical suffering caused to the consumer in each specific case. We believe that Aviva Insurance Company CJSC is at fault, since they deliberately do not pay the insurance premium under insurance policies and do not issue a written reasoned refusal to pay it, relying on the legal illiteracy of the insured, the incapacity and hopelessness of his situation. The fact that citizen Balasyan *.*. *.*. penalties and fines are accrued by the creditor - OJSC National Bank "Trust", the latter even made a demand for full early repayment loans, is known to the insurer through claims. Due to non-payment of insurance compensation by CJSC IC "Aviva" in favor of OJSC NB "Trust", namely, it is the beneficiary of the insurance policies, the Claimant's health condition worsened, and he is already a disabled person of the second group, due to a general illness (due to illness hearts). Moreover, the moral suffering of Balasyan *.*. *.*. turned out to be all the more powerful because, despite the subsequent realization that the insurance company deliberately does not refuse payment, does not respond to claims and considers its documents from December 27, 2010 to the present, Balasyan *.*. *.*. can't change this situation and influence the actions (inactions) of Aviva Insurance Company CJSC.

In connection with the above, he believes that Aviva Insurance Company CJSC is obliged to compensate for moral damage caused in the amount of 10,000 (ten thousand) rubles.

In accordance with Art. 17 of the Federal Law “On the Protection of Consumer Rights”, claims for the protection of consumer rights can be brought to court at the location of the organization, the place of residence or stay of the plaintiff, the place of conclusion or execution of the contract.

Requirements of OJSC National Bank "Trust" to Balasyan *.*. *.*. amount to 362,988.76 rubles.

Insurance rules provide for compensation of 80% - 290,391 rubles

Cost of claim: 290,391 rubles (compensation) + 10,000 (moral damage) = 300,391 rubles

Recognize the establishment of disability Balasyan *.*. *.*. insured event under insurance contracts No. VTS - 545554/2009 dated December 11, 2009 and No. 000 dated July 19, 2010 1. To recover insurance payment from Aviva Insurance Company CJSC in favor of the beneficiary under the insurance contracts - OJSC National Bank "Trust" in the amount of 290,391 rubles to pay off the debt on loan agreements 000 from 12/11/2009 and 000 from 12/11/2009 1. To collect from the defendant in favor of Balasyan *.*. *.*. compensation for moral damage in the amount of 10,000 rubles.

The defendant's representative did not arrive at the court hearing, did not report the reasons for his failure to appear, the case contains a postal notice of delivery of a summons, the reason for the failure to appear is not valid, the dispute was considered in accordance with Art. 167 Code of Civil Procedure of the Russian Federation

CJSC IC Aviva did not recognize the claim and went to court with a counterclaim according to which on December 11, 2009 between Balasyan *.*. *.*. and ZAO IC Aviva entered into an accident and illness insurance agreement (Policy No. VTS-545554/2009) in accordance with the Accident and Illness Insurance Rules dated September 11, 2008. - Appendix 000 to the Policy (hereinafter referred to as the Insurance Agreement).

The insurance contract provides for a one-time insurance premium of 8,550 rubles.

insurance;

Death of the Insured that occurred during the insurance period.

The insurance amount is set at RUB 150,000. 00 kop. The insurance period is from December 11, 2009 to December 10, 2012.

July 19, 2010 between Balasyan *.*. *.*. and Aviva Insurance Company CJSC entered into an accident and illness insurance agreement (Policy No. 000) in accordance with

The insurance contract provides for a one-time insurance premium of 19,000 rubles. 00 kop.

The insurance premium was paid by Balasyan *.*. *.*. V in full and on time.

According to the Balasyan Treaty *.*. *.*. is the Policyholder and the Insured for the risks:

Permanent disability: disability acquired (established) during the term

insurance;

The insurance amount is set at 200,000 rubles. 00 kop.

Insurance period from July 19, 2010 to July 18, 2015 According to the section “Other conditions and reservations” the said agreements(Policies), the Policyholder/Insured hereby confirms that at the time of conclusion of this Agreement:

is not disabled, and no medical decision was made regarding him to refer him to establish his disability group;

is not registered with a psychoneurological and/or drug addiction clinic;

he has not been diagnosed with a mental illness and/or disorder;

is not a carrier of HIV infection and does not have AIDS;

he has not been diagnosed with cardiovascular disease or cancer.

If it is discovered that the Policyholder has provided the Insurer with knowingly false information about the above circumstances, the insurance contract is considered not concluded, and the Insurer returns to the Policyholder the insurance premium paid by the latter. In addition, such a contract may be declared invalid at the request of one of the parties to the insurance contract.

This condition introduced by the Insurer into the standard form of the insurance contract (insurance policy), due to the fact that the insurance conditions and exclusions from insurance coverage are based on insurance rates that do not provide for the possibility of insuring persons with the above diseases and conditions at the time of concluding the insurance contract, since the likelihood of insurance risks for this category of persons increases significantly. Persons with the above diseases and conditions may be insured with the consent of the Insurer under a life and health insurance contract, but on different terms.

Having signed the Insurance Contracts, Balasyan *.*. *.*. confirmed that he has received the Insurance Rules, has read and agrees with the provisions of the Rules and policies (including the Section “Other Conditions and Disclaimers”) of insurance.

April 06, 2011 from Balasyan *.*. *.*. Aviva Insurance Company CJSC received applications for insurance payments and the following documents attached to them: a notarized copy of the certificate of the ITU-2009 000 series, a certified copy of the referral for a medical and social examination, a certified copy of the cardiologist’s report from the State Healthcare Institution “Regional Clinical Hospital No. 1” , copies of Policy No. 000

Considering the fact that based on the *.* provided by Balasyan. *.*. documents, it was not possible to recognize the event that happened to him as an insured event, in accordance with clause 8.4. The rules of insurance against accidents and illnesses, on the basis of which the above insurance contracts were concluded, CJSC IC Aviva asked Balasyan *.* by telephone. *.*. additional document, explaining the circumstances of the occurrence of an event that has signs of an insured event, namely a certified copy medical card outpatient for the last three years.

June 14, 2011 from Balasyan *.*. *.*. The original of his medical card for outpatient 000 was received from the Polyclinic of the Municipal Healthcare Institution “City Hospital UZ Adm. MO" (hereinafter referred to as medical record).

According to the cardiologist's note dated 00.00.0000 on pages 27 and 28 of the medical record on this day Balasyan *.*. *.*. went to the doctor with complaints of increased fatigue, frequent headaches in the back of the head, pressing-searing pain in the left chest with increased physical activity. The described phenomena lasted for two years, deterioration for about three months - more often disturbing, increased blood pressure up to 160/110 was noted. The cardiologist diagnosed a complex of cardiovascular diseases: “IHD (Coronary Heart Disease). Angina pectoris FC 2-3. Hypertension stage 3, risk 4. CHF (Chronic heart failure) 2A FC 2.” Balasyan *.*. *.*. It was recommended to undergo additional examinations and take medications(a copy of the medical record was attached to the objections of Aviva Insurance Company CJSC regarding the claims Ex.000 dated October 20, 2011).

Thus, before concluding insurance contracts Balasyan *.*. *.*. diagnoses of cardiovascular diseases were established and Balasyan *.*. *.*. it was known that he had these diseases. Having signed the insurance contracts Balasyan *.*. *.*. confirmed that at the time of concluding insurance contracts he had not been diagnosed with a cardiovascular disease, thereby providing ZAO IC Aviva with knowingly false information that is essential for determining the likelihood of an insured event occurring and the amount of losses from its occurrence, thus violating the the right of ZAO IC Aviva to a comprehensive assessment of what is accepted for insurance insurance risk and determining possible losses from the occurrence of an insured event.

In accordance with clause 5.3. of the Accident and Disease Insurance Rules dated September 11, 2008, on the basis of which the above insurance contracts were concluded, a person who, at the time of conclusion of the Contract, was diagnosed with a cardiovascular, oncological or other life-threatening disease, can be the Insured only on the condition that about the above health condition of this person The Insurer was notified in writing by the Policyholder before concluding the Policy (upon receipt of the application for insurance). If this condition is not met, the Agreement concluded in relation to such person may be declared invalid on the grounds provided for Civil Code Russian Federation (a copy of the Insurance Rules was attached to the objections of ZAO IC Aviva regarding the claims Ex.000 dated October 20, 2011).

According to clause 1 of Article 944 of the Civil Code of the Russian Federation, when concluding an insurance contract, the policyholder is obliged to inform the insurer of circumstances known to the policyholder that are significant for determining the likelihood of the occurrence of an insured event and the amount of possible losses from its occurrence (insurance risk), if these circumstances are not known and must be known to the insurer. In any case, circumstances specifically stipulated by the insurer in the standard form of the insurance contract are recognized as significant ( insurance policy) or in his written request.

According to paragraph 3 of Article 944 of the Civil Code of the Russian Federation, if, after concluding an insurance contract, it is established that the policyholder has provided the insurer with knowingly false information about the circumstances specified in paragraph 1 of this article, the insurer has the right to demand that the contract be declared invalid and the consequences provided for in paragraph 2 of Article 179 be applied. Civil Code of the Russian Federation, that is, the return of the premium paid by the policyholder under the insurance contract to the income of the Russian Federation.

The above-mentioned insurance contracts provide for a condition that improves the position of the policyholder in the event of providing them with knowingly false information, in comparison with the norms provided for by the Civil Code of the Russian Federation. In particular, the Section “Other Conditions and Reservations” establishes that if it is discovered that the Policyholder has provided the Insurer with knowingly false information about the above circumstances, then the insurance contract is considered not concluded, and the Insurer returns to the Policyholder the insurance premium paid by the latter. In addition, such a contract may be declared invalid at the request of one of the parties to the insurance contract.

Thus, if the Insurer, after concluding the insurance contract, discovered that the Policyholder provided knowingly false information when concluding the insurance contract, the Insurer notifies the Policyholder that the insurance contract is not concluded and informs of its readiness to return to the Policyholder the premium paid under the contract in full. This condition represents the possibility of resolving a dispute in a pre-trial voluntary manner, and provides an opportunity for the Insured to return the premium paid by him in full, while in the event of the insurance contract being declared invalid in judicial procedure the premium paid by the Policyholder will be recovered from the Insurer to the income of the Russian Federation.

If the policyholder does not agree to the recognition of the insurance contract as not concluded in accordance with the terms of the insurance contract, the insurance contract may be declared invalid in court using the consequences of declaring the transaction invalid, provided for in paragraph 2 of Art. 179 of the Civil Code of the Russian Federation.

The plaintiff insured in the original claim filed a motion to leave statement of claim without consideration because the pre-trial procedure for resolving the dispute was not followed, while indicating that the Insurer had indeed sent him notifications that the insurance contract was not considered concluded and indicated the reasons that were not discussed between the parties pre-trial.

Taking into account that the counterclaim contains a reference to the fact that it is possible to resolve the dispute out of court, the court finds that the petition must be satisfied in order to avoid unnecessary legal costs

In such circumstances, the application should be left without consideration.

Guided by Article 222 of the Code of Civil Procedure of the Russian Federation, the court

Defined:

Statement on the claim of Balasyan *.*. against Aviva Insurance Company CJSC for recognition of disability as an insured event and recovery of the insured amount, counterclaim of Aviva Insurance Company CJSC against Balasyan *.*. on the recognition of the insurance contract as invalid and the application of the consequences of recognizing transactions as invalid shall be left without consideration due to non-compliance with the pre-trial procedure for resolving the dispute.

The ruling can be appealed to the Krasnodar Regional Court within 15 days through the Anapa District Court.

The document form “Statement of Claim for recognition as an insured event” belongs to the heading “Statement of Claim”. Save the link to the document in in social networks or download it to your computer.

IN _____________________________

Plaintiff: ______________________________
Address: ______________________________

Defendant: Society with limited liability «______________»
Head office address: _________________
Postal address: ___________________________

STATEMENT OF CLAIM

I, _______________________ _________ born I am the owner land plot located at the address: _______________________, which is confirmed by the relevant Certificate of state registration rights _________ dated _________
On the indicated plot there is house No. ___, which is also my property.
____________, an agreement (policy series _____ No. _________) was concluded between me and LLC “___________” for voluntary insurance of apartments, home/other property, civil liability, according to which, the house located at the address: _____________________________ was insured against damage in the amount of ___________ rubles. ___ kop.
_____________, strong gusts of wind tore off sheets of corrugated sheets from my house, resulting in flooding of the house and the property in it.
The fact that there was indeed strong wind on the specified day is confirmed by the corresponding weather report.
Having applied to LLC “___________” for payment, I received an unmotivated, unlawful refusal (I have attached a copy).
Thus, when an appraiser inspected our house, it was determined that the flooding was due to the release of groundwater, and not due to a hole in the roof. The insurance company, having considered the defendant’s arguments, in a letter dated _________ informed me that it was refusing insurance payment due to the fact that my property was damaged not by the flood, but groundwater, which is not an insured event.

At the same time, neither the expert nor the insurance company paid any attention to the fact that the flooding actually occurred due to the absence of part of the roof.

I believe that the refusal to recognize the case as insured and to pay the appropriate monetary compensation is not based on the factual circumstances of the case and is subject to cancellation in court.
In fact, on the part of ____________ LLC, there is evasion from fulfilling obligations under the insurance agreement.

In accordance with Art. 309 of the Civil Code of the Russian Federation, obligations must be fulfilled properly in accordance with the terms of the obligation and the requirements of the law, other legal acts, and in the absence of such conditions and requirements - in accordance with business customs or other usually imposed requirements.
In accordance with Art. 310 of the Civil Code of the Russian Federation, unilateral refusal to fulfill an obligation and unilateral change of its conditions are not allowed.

Moreover, the relationship that arose between me and the Defendant is regulated not only by civil law, but also by the Law of the Russian Federation “On the Protection of Consumer Rights.”
In accordance with Art. 15 of the Law of the Russian Federation “On the Protection of Consumer Rights” moral damage caused to the consumer as a result of violation by the manufacturer (performer, seller, authorized organization or authorized individual entrepreneur, importer) consumer rights provided for by the laws and legal acts of the Russian Federation governing relations in the field of consumer rights protection are subject to compensation by the causer of harm if he is at fault. The amount of compensation for moral damage is determined by the court and does not depend on the amount of compensation for property damage.

I believe that the unlawful actions of the Defendant caused me moral harm, the amount of which I estimate at...

Also, in order to draw up this statement of claim, I was forced to seek legal assistance, the cost of which was __________ rubles. ___ kop.
Payment costs legal assistance were actually incurred by me and are supported by documents, and therefore, I consider it reasonable to recover their cost from the Defendant in full.

In accordance with Art. 98 of the Code of Civil Procedure of the Russian Federation, the court awards the party in whose favor the court decision is made to reimburse the other party for all legal expenses incurred in the case.

Based on the aforesaid and guided by Article. 131, 132 Code of Civil Procedure of the Russian Federation

1. Oblige the Defendant to recognize the case dated __________ as insurance and pay the Plaintiff insurance amount at the rate of ___________.
2. To recover from the Defendant in favor of the Plaintiff compensation for moral damage in the amount of ________________
3. To recover from the Defendant in favor of the Plaintiff the costs of payment legal services at the rate of ______________

Application:
1. A copy of the certificate of state registration of the right;
2. A copy of the Insurance Agreement (policy);
3. Copy of Act No. ___________ dated ___________.
4. A copy of the response to the application dated ___________;
5. Copies of the weather report;
6. A set of documents on the number of persons participating in the case;

" "____________2014 __________________________________________



  • It is no secret that office work negatively affects both the physical and mental state of the employee. There are quite a lot of facts confirming both.

  • Every person spends a significant part of his life at work, so it is very important not only what he does, but also with whom he has to communicate.

  • Gossip in the workplace is quite commonplace, and not only among women, as is commonly believed.
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