Who is the insurer and the policyholder: in simple words. Who is the policyholder, what rights does he have and how is he different from the insurer?

Who it

Insurance covers financial protection for various aspects of life.
Motorists buy an MTPL policy, and the mortgage borrower must have real estate insurance. Sometimes the services of companies are required by law, without fail; in some situations, citizens of their own free will sign up for additional protection against unforeseen troubles. According to generally accepted definitions, an insurer is a company that, for a fee, undertakes to pay the amount of compensation upon the occurrence of an insured event. The policyholder is a person who has used the services of such a company, or a group of people who have purchased an insurance product. In simple words, one party orders services, and the second performs them.

The contract is signed solely on the initiative of the policyholder who intends to obtain financial protection. Often the initiator is the employer, who organizes an additional insurance package for employees.

It is important to correctly determine the beneficiary, since in the case of a loan, the lending bank plays this role until the debt is fully repaid.

Even if compulsory insurance is chosen, the client insures himself by choosing a company at his own discretion.

A person becomes an insured as soon as a contract is concluded with the company, and remains so throughout the entire period of validity of the document. For a certain fee, the policyholder receives the right to benefit from compensation if circumstances specified in the contract as an insured event arise (damage to health, property, the occurrence of certain life events).

Rights and obligations

After signing an agreement with an insurance company, an individual or legal entity becomes the policyholder. He has the following rights typical for any insurance contracts:

• Be informed about insurance products, the chosen company and its services, as well as changes in insurance conditions;
• terminate the contractual relationship with the insurance company at any time during the service, as well as receive a partial or full refund of the funds paid as a contribution for the insurer’s services;
• change insurance company at any time;
• receive payments stipulated by the contract subject to compliance with the conditions and provision of evidence and confirmation of the occurrence of the insured event;
• file a lawsuit against an insurance company that wrongfully refused to pay.

In this case, the policyholder is obliged to comply with the following conditions:

• Pay the insurance premium under the contract on time and in full;
• comply with the conditions for reporting an insured event;
• provide, at the request of the insurance company, additional documents confirming the occurrence of an insured event;
• Do not lie or misrepresent facts, personal information or other official information in documents.

It turns out that by paying a premium to the insurance company and observing the terms of the contract that was concluded with it, the policyholder receives the rights to payments for incidents that arise within the framework of the selected insurance package, and, accordingly, gains confidence in security.

Who is an insurer

An insurer is usually a company that provides insurance services to the public. The insurer must be a legal entity and have all licenses and permits to conduct such activities. Also, for insurance under compulsory motor liability insurance and some other types of services, the insurer must have connections with RSA.

On the part of the insurer, the potential policyholder receives information (including advertising) about possible services and areas in which the insurer offers services. Different companies can be either universal insurers or focus only on a few specific types of insurance.

Typically, the range of insurance services of a large company includes:

• Voluntary and compulsory car insurance in the Russian Federation and for trips abroad - CASCO, OSAGO, green card;
• packages to minimize the risk to health and life of those who are going to travel abroad - for some categories of visas such policies are required at the request of consulates or embassies;
• Compulsory medical insurance and voluntary medical insurance – medical policies;
• property insurance.

Rights and obligations

The insurer also has certain rights under the contract concluded with the policyholder:

• Terminate the contract unilaterally if the other party violates the terms under which it was signed - does not pay the premium on time, provides incorrect information about itself and about the object of insurance (for example, about a car);
• independently order examinations after reporting cases, study the circumstances of the case;
• make decisions on payments and their amount, taking into account additional information about the circumstances of the incident;
• receive truthful information about the insurance object and the insured;
• receive remuneration for your activities.

In this case, the insurance company is obliged to the policyholder:

• Pay the amount of compensation for losses after considering the circumstances of the event;
• do not transfer clients’ personal information to third parties;
• engage independent experts to determine the damage caused to the policyholder and the amount of possible payment;
• insure the client using the product he has chosen;
• offer potential clients truthful information about the conditions, types and costs of insurance services.

Thus, by offering insurance to the population, the company undertakes to fulfill certain obligations specified in the contract, but also has the right to demand that the client comply with its conditions.

Rights and obligations

The Insurer interacts with the Policyholder on the basis of a contract. Each of them has rights and obligations, which are prescribed in it. Let's talk about what the Insurer can and should do.

Rights

Before accepting property or human life and health for insurance, the Insurer must assess the degree of risk in order to charge an adequate fee for it. From here follows the first right - to demand any documents that confirm this degree. To assess the risk, the Insurer has the right to inspect the property. And in the case of life insurance, require the client to undergo a medical examination in order to assess his state of health, and, accordingly, the degree of risk for himself. After signing the contract:

• Receive payment for insurance;
• When an insured event occurs, request documents confirming that the event occurred and that it has signs of an insured event;
• Refuse to pay insurance compensation if false information is found in the insurance application. The same applies to untimely notification of an increase in the degree of risk. These provisions are specified in all insurance rules;
• Investigate the circumstances of the occurrence of an insured event if there are reasonable suspicions that the Insured has committed fraud;
• Unilaterally terminate the contract if the Policyholder does not pay premiums (in case of installment payment).

Voluntary types of insurance are not public. This means that the Insurer can refuse insurance if, based on the underwriting (risk assessment), it considers it inappropriate. Either the risk is too high or there is reason to believe insurance fraud is occurring.

Responsibilities

The first duty is to provide the Policyholder with reliable and comprehensive information about the type of insurance that interests him.

The second begins after the insurance contract comes into effect. This is the main responsibility of the Insurer - to pay insurance compensation (or security in personal insurance) upon the occurrence of an insured event. Other responsibilities follow from the main one:

• Send an independent expert to inspect and evaluate the property in case of damage or loss;
• Draw up an insurance act within the period specified by the rules (or law);
• Compensate the Insured for losses incurred during the salvage of property;
• Maintain insurance secrecy.

An example of a public contract is compulsory motor liability insurance. Any Insurer who has a license for it is obliged to conclude an insurance agreement with the client.

Who is the Policyholder?

This is you and me – clients of the insurance company. Those who consider it necessary to provide themselves with financial protection in case of the same unfavorable, random events. The policyholder is the one who transfers the risk to the Insurer and pays him a reward (insurance premium) for this.

If you decide to enter into a personal insurance contract when receiving a loan, then, as a rule, you will be the policyholder (concluding the contract on your behalf), the insured person (you are insuring your life) and the beneficiary, i.e. upon the occurrence of an insured event, for example, temporary disability, the insurer will pay you an insurance payment in accordance with the concluded contract.

If you join a collective insurance agreement (why is it more profitable for the bank?), then the bank itself will be the policyholder and beneficiary in this case, and you will only be the insured person. In the above link, we tried to explain in simple words what the essence of group insurance is, and why banks love to use it to insure their borrowers.

As a party to the contract, the Policyholder also has rights and obligations.

Rights

The first is to obtain complete information about the service provided by the Insurer, as well as documents on the size of the authorized capital, publicly available information on the amount of fees and payments and licenses.

The second is to receive an insurance payment when an insured event occurs. And in case of refusal, receive a written explanation of its reasons.

The third is the early termination of the insurance contract and the fourth is the replacement of the beneficiary.

The Policyholder also has every right to challenge the Insurer’s decision to refuse payment in court.

Responsibilities

• Get a Raiffeisenbank credit card “110 days without interest” in 2 minutes with free service and withdrawal of 50 thousand ₽ without commission monthly
• Apply for a free Tinkoff Black debit card and receive profitable cashback from the bank under the standard loyalty program and promotions (5% on purchases over 5,000 in retail chains)
• Apply for a free Polza Home Credit Bank debit card with 10% per annum on the promotional balance
• Apply for a credit card “100 days without interest” from Alfa-Bank and withdraw 50 thousand rubles every month for free

There are slightly more responsibilities than rights, but they are not burdensome. If they are not followed, the Insurer will have the right to refuse payment. So, the Policyholder is obliged:

• Provide reliable information about the subject or subject of insurance in the insurance application. Circumstances affecting the degree of risk must also be brought to the attention of the Insurer;
• Pay the insurance premium in one lump sum or in installments;
• Provide the Insurer with the opportunity to assess the degree of risk (see section “Rights of the Insurer”);
• Within the period established by the Insurance Rules, bring to the attention of the Insurer information about the occurrence of an insured event in any available way and fill out an application for payment;
• In the event of compensation for damage by the guilty person, notify the Insurer about this within the period specified in the contract or rules.

All our problems with Insurers stem from the fact that we do not know our rights and obligations. And often it is our fault that we do not receive payment or receive it in a smaller amount. Gentlemen, Policyholders, the insurance rules are a very useful thing, you need to read them!

Can the policyholder and the insured person not be the same?

The coincidence of the policyholder and the insured person is not always noted. For example, if an insured event occurs under a life insurance contract, the beneficiary may be another person, since the policyholder is physically unable to receive payment. In this case, the insured person is the policyholder and by his decision appoints the beneficiary fixed in the agreement.

Another clear example is a mother insuring her child under the VHI system. In this case, the woman acts as the policyholder, and the baby is the insured person. Although the beneficiary and the insured in this case are the same, since the mother will receive a payment to pay for the medical expenses of the child if the latter has not reached the age of majority.

In case of a collective insurance agreement, if in order to obtain a loan from a bank, the client joins such an agreement.

In this case, three parties agree:

• bank as insurer;
• the insurance company is the insurer;
• a client who applies to a bank for a loan is an insured person.

The beneficiary in this agreement is the bank, since it is to this financial organization that the insurer will pay the insurance if the client does not pay off the loan obligations.

Normative base

Insurance in Russia is regulated by several legislative acts, the main one of which is the Law of the Russian Federation of November 27, 1992 No. 4015-1 “On the organization of insurance business in the Russian Federation.”

Additional information about who the policyholder is is indicated in:

• Article 927 of the Civil Code of the Russian Federation (Part 2) dated January 26, 1996 No. 14-FZ;
• Article 1 of the Federal Law of April 25, 2002 No. 40-FZ on compulsory motor liability insurance, as well as other acts related to various sectors of the market.

According to the legislative acts of the Russian Federation, an insured in Russia is considered to be a person who has purchased a policy from an insurance organization. It doesn’t matter the method of purchase (online or in the office, from representatives), the type of service and the premium - anyone who initiates the conclusion of an insurance contract acts as an applicant.

Persons and organizations acting in the interests and on behalf of insurers

In addition to insurance companies, there are several entities operating on the market that provide insurance services to all interested clients. These entities operate on the basis of federal legislation in compliance with a number of mandatory rules. Moreover, the share of insurance contracts they issue is 25-30% of the number of all insurance agreements concluded in the Russian Federation during the calendar year.

Insurance agents

An insurance agent is an individual permanently residing on the territory of the Russian Federation, who is an individual entrepreneur, or acting on the basis of a civil contract with an insurer.

Agents can work in two directions:

• Representation of the interests of potential policyholders - selection of a suitable insurance program from the list of insurers with which the agent has a valid agreement.
• Representing the interests of insurers – searching for potential policyholders in order to increase the client base of the company/companies with which the agent has a partnership agreement.

Insurance agents are not recognized as persons acting without an agreement with the insurance company. In addition, the insurer itself or its full-time employee who is a member of the company on the basis of an employment agreement has no right to perform the duties of an agent. Also, persons who have a criminal record that has not been expunged or expunged, or who held a management position in an insurance company for 2 years before being declared bankrupt are not recognized as agents. And finally, the functions of an agent may not be performed by persons holding any position in subsidiaries or affiliates of the insurer.

The main responsibility of the agent is the selection and sale of services. In the vast majority of cases, the agent is paid as a percentage of the amount of each insurance agreement he concludes. The parties agree on the amount of remuneration when drawing up a civil agreement. After the client concludes an agreement with the company, the agent’s work ends.

All subsequent legal relations between the policyholder and the insurer are formed directly, without the participation of third parties. The agent does not and cannot bear any responsibility for the actions and decisions of the insurance company. One insurance agent can simultaneously cooperate with several insurers - no restrictions are set in this regard.

At the request of a potential policyholder, the insurance agent provides documentary evidence of the legitimacy of his authority. The insurance company, in turn, is obliged to maintain an internal register of all its insurance agents and provide clients with information about each of them upon request.

Insurance brokers

Another market participant is insurance brokers. In accordance with Art. 8 Federal Law No. 4015-1 they are persons permanently residing in the territory of the Russian Federation, as well as organizations acting in the interests of insurance companies and having the appropriate powers. In this case, individuals must have the status of an individual entrepreneur with valid OKVED 66.22. Organizations must have the status of a full-fledged legal entity operating autonomously.

Insurance brokers act in the interests of companies or policyholders, but on their own behalf. This is the difference with insurance agents, who only have the right to provide intermediary functions. In turn, insurance brokers are responsible for additional functions defined in the agreement with the insurer. Brokers are not authorized to act as an insurer or reinsurer, or as an insurance agent. In addition, brokers do not have the right to engage only in intermediary functions in processing compulsory types of insurance. Their main features:

• In the vast majority of cases, a broker is a company (legal entity) that has entered into an agreement with several insurers.
• Brokers have the authority to enter into insurance contracts on their own behalf, but in the interests of the insurer or policyholder.
• During the execution of the contract, the policyholder can contact the broker, without a direct relationship with the insurer.

Most often, insurance brokers operate in cities that do not have their own representative offices of insurance companies. This is extremely convenient for potential policyholders: you can go to the office of an insurance broker and choose the most suitable insurance program. In this case, the insurer can only offer its own insurance products, and the broker can offer offers and programs from a number of companies with which it has existing partnerships.

Among other responsibilities of brokers, a key place is occupied by informing clients that they are not insurers, but only perform intermediary functions. The same information is posted on the official website of the organization. Brokers must provide policyholders with comprehensive information for each insurance company so that the client can verify the legality and legitimacy of the authority of the intermediary organization.

Who can perform

In Art. Art. 5 Federal Law No. 4015-1 dated November 27, 1992 “On the organization of insurance business in the Russian Federation” states that not only an individual, but also an organization can act as a client of a company.

Individuals

According to the law of November 27, 1992 No. 4015-1, the policyholder can be any legally capable person. According to Art. 60 of the Constitution of the Russian Federation, full legal capacity of Russians occurs at the age of 18 years. During the period from 14 to 18 years of age, citizens are considered partially capable: parents or legal representatives (guardians) bear full responsibility for them.

People with limited legal capacity cannot initiate contracts with the insurance company. But their representatives have the right to arrange the service on their own behalf, indicating them as insured persons.

Basic requirements of insurers:

• The client has an identification document. Preferably a Russian passport, but not only. Foreign citizens can also insure themselves, loved ones and real estate in Russia. They must present a document by which they can be identified.
• Age from 18 years. In other cases - with the consent of the representative or parent.
• Additional documents, depending on the insurance industry. Driver's license, technical passport and diagnostic card - according to OSAGO. Loan agreement, appraiser's conclusion, certificates from the developer - when drawing up a collateral policy.

REFERENCE! A complete list of mandatory requirements for individuals is available on the financial institution’s website. It is recommended to clarify the information before visiting the office, online or in the company itself.

Legal entities

Legal entities are policyholders in the following cases:

• Drawing up collective agreements, for example, for employees.
• Reinsurance. When a change of insurer occurs, the previous company changes from a seller of services to the status of a buyer-client.
• Purchasing policies for companies. For example, in real estate insurance for legal entities.

Differences between an insurer and a policyholder

The participants in one financial case, which is a contract, assume the functions of a seller and a buyer. This means that the procedure for providing the service is completely voluntary, which complies with legal requirements. The initiator in all cases is an individual. Sometimes the head of an enterprise acts on his behalf when the activities of his subordinates involve a risk to life and he is required by law to insure them.

The definition of “insurer” refers exclusively to legal entities operating on the basis of an issued permit.

Regardless of the form of ownership and the size of the authorized capital, all insurance companies operate according to the same rules, deviation from which is punishable by law.

Note! Even if a citizen carries out compulsory insurance ( MTPL , compulsory medical insurance), the principle of voluntariness still remains, since the insured have the right to choose the company and the terms of the policy.

Who is the “policyholder” when applying for compulsory motor liability insurance?

Many car owners who want to conclude an agreement under MTPL believe that the “insured” and the “owner” are necessarily the same person. And they thoughtlessly register as the “insurer” the grandmother-owner of the vehicle, who lives in the village and has nothing to do with her property other than the formal right of ownership “planted” by relatives.

Meanwhile, the MTPL rules (part 1, clause 4) give the following definition: “the policyholder is a person who has entered into a compulsory insurance agreement with the insurer.” Simply put, the policyholder is the one who pays money for MTPL insurance and subsequently makes the necessary changes to the policy: changes the period of use, adds new drivers, asks for a duplicate, etc. And it is not at all required that the policyholder be the owner of the vehicle, have his notarized power of attorney or was included in the policy. One person can be the policyholder, another can be the owner, and third parties will have the right to drive the insured car. The responsibilities of the policyholder are simple.

• Provide reliable information, valid documents or their photocopies necessary for the correct calculation of the insurance premium and the conclusion of the MTPL agreement.
• Make the necessary changes to the policy in a timely manner, if any occur during the year.

Under the CASCO agreement

With CASCO insurance, the situation is approximately the same as with registration of a motor vehicle license. The policyholder can be any person or legal entity. The difference is this. Whoever takes out the MTPL policy, the beneficiary, by default, becomes the owner of the damaged car. Therefore, the concept of “beneficiary” is absent in MTPL insurance. In a motor insurance policy, in addition to the concepts of “insured” and “owner”, there is a clause in the agreement called “beneficiary”. Therefore, when insuring comprehensive insurance, several options arise for the terms of concluding a contract:

• The policyholder and the owner are the same person. The right to receive payments belongs only to him.
• The policyholder and the owner are the same person, but the driver included in the policy is indicated as the beneficiary in the contract, who must have a notarized general power of attorney from the owner, stipulating his right to receive insurance compensation.
• Policyholder is a person who owns and disposes of a vehicle under a general power of attorney with the right to receive insurance compensation. In this case, he will either be the beneficiary himself (automatically), or he can indicate the owner of the vehicle as the beneficiary.
• The policyholder and beneficiary are the owner of the vehicle. But at the same time, the CASCO agreement is concluded and signed by a person who has a notarized power of attorney from the owner with the right to conclude an insurance agreement on behalf and in the interests of the owner.

Difference between beneficiary and insured

The insured person and the beneficiary often differ in the insurance legal relationship. The life of the beneficiary is not covered by the insurance policy. For some types of insurance, the insurer independently indicates the beneficiary when concluding the agreement. But in the event of the death of the beneficiary, the insurance company does not pay financial compensation to anyone.

Typically, a close relative of the insured is designated as the beneficiary. But this could be a friend of the insured citizen or another person. If a citizen insures property or real estate, he can also appoint another person as the recipient of insurance compensation.

Another difference between the policyholder and the beneficiary is that the beneficiary becomes a priority person when receiving insurance compensation. But he may waive the right to receive payments in favor of the policyholder. In turn, the policyholder can take advantage of the beneficiary’s refusal, then he himself will become the recipient of money from the insurance company.

Who receives compensation in case of an accident?

After an accident occurs, the person for whom the MTPL insurance is issued will not be able to make decisions, since he is not the owner of the car. Namely these actions: write a statement about the accident that occurred and demand payment of compensation for damage. This is only possible if he has a formalized power of attorney from the owner of the car. In other situations, only the owner of the vehicle receives the payment.

The car owner will be able to receive payment for car insurance in cash at the insurer's cash desk or by bank transfer to the bank's personal account. To transfer money, the owner of the car needs to transfer bank information to the insurance company. But in most cases, you will need to receive a referral for car repair.

Policyholder, owner, beneficiary – one person or not

In accordance with the current procedure, the insured may not be the owner of the insurance object. It is enough to consider the example of compulsory motor liability insurance, when any person who has documents for a car can contact the insurance company. A power of attorney and other additional documents are not required - only a standard package for the car and documents of the person who contacted the insurer.

Beneficiary is the person who receives compensation in the event of an insured event. It is the owner of the insured object, unless otherwise provided by law. Consequently, the beneficiary can be either the policyholder himself or the person who legally owns the insured property.

Who are the policyholder and the insurer in insurance?

In accordance with current legislation, the insurance procedure can be mandatory or voluntary. The first category includes the protection of health, credit real estate and vehicles that are objects of collateral. And even then, such a concept as obligation is relative, since people come to the UK on their own and without coercion. The fact is that if they do not sign the agreement, they will become lawbreakers or will not be able to fully participate in social programs.

Who the policyholder is is specified in the Law “On the Organization of Insurance Business in the Russian Federation”. It is an individual or legal entity who wishes, on the basis of available statistics, to obtain a guarantee of their financial interests against risks that may arise for one reason or another. For this, a citizen or organization pays money to a corporate fund, which is used to pay off damages for those who experienced an insured event specified in the contract.

Then you need to decide who the insurer is. In accordance with the mentioned law, the insurer is the insurance company and its employees authorized to perform legal actions for the sale of the policy, drawing up the contract and bearing responsibility for its implementation upon the occurrence of the events specified in it. The activity of the insurance company has its limitations within the limits of the state license.

The scope of coverage can be specialized or extend to all areas of protecting the interests of citizens.

An example of providing universal insurer policies:

• life and health;
• real estate;
• vehicles (voluntary and compulsory insurance);
• travel abroad;
• Compulsory medical insurance;
• Civil responsibility.

Who is the insured person in the Pension Fund

The list of insured persons in the compulsory pension insurance system is determined by the provisions of Art. 7 of Federal Law No. 167, adopted in December 2001 and regulating pension insurance issues in the Russian Federation.

The opportunity to become an insured and beneficiary of the OPS applies to the following persons who are Russian citizens living in Russia or abroad, as well as foreigners employed in the territory of the Russian state:

• have officially entered into an employment agreement with the employer;
• businessmen and other persons who provide themselves with work independently;
• those employed abroad, but paying contributions to the Pension Fund;
• engaged in the traditional craft of individual peoples of the North, Siberia and other regions;
• clergy.

The main condition for belonging to the compulsory insurance system is the payment of insurance contributions to the Pension Fund.

Substitution in the contract

The need to replace the policyholder or beneficiary, in accordance with the concluded agreement, may be due to the following circumstances:

• his death, as a result of which the rights of this person pass to the heir or to the one specified in the agreement;
• loss of legal capacity or its limitation - in this case, the functions of the policyholder are transferred to his guardian or trustee.

Replacement of the insured person and beneficiary is possible until the insured event occurs, and is issued on the basis of a written notification to the insurer sent by the policyholder. The insured person or beneficiary can be replaced by the policyholder, with amendments to the insurance contract concluded by the parties by an additional agreement.

The insured person in most cases is the beneficiary under the terms of the policy. But it is necessary to take into account that this situation is not always observed and the beneficiary may be different, which is important to understand when concluding an insurance contract.

Who has a relationship with social insurance?

Social insurance relations arise:

• for policyholders with hired employees - from the moment of signing the employment contract (the employer must pay mandatory contributions for his workforce);
• for policyholders with insurers - from the moment of official registration with the Social Insurance Fund;
• for insurers with insured persons - from the moment of the beginning of official labor relations with the employer, who carried out the mandatory registration of his employees in the fund;
• for insurers with insured persons who independently provide themselves with work - from the moment of their registration.

In accordance with Russian legislation, from the moment the employment contract is signed, all parties have insurance obligations:

1. the insured person is obliged to fulfill his work duties;
2. the policyholder is obliged to calculate the insurance fee monthly (when calculating wages) and transfer it to the fund’s current account;
3. The insurer is obliged to register, accept contributions, check their completeness, as well as the documentary validity of insured events.

For any violations, subjects of compulsory social insurance, their characteristics determined depending on the insured event, may be brought to administrative liability.

Changes in compulsory insurance relations may arise in the following cases:

• upon dismissal of an employee;
• when transferring an employee to another position that provides for an increase in wages;
• if the employee loses his ability to work, etc.