What payments are due under OSAGO for personal injury 2021?

The civil liability protection agreement clearly states that this document is aimed at covering damage to third parties injured as a result of an accident that occurred due to the fault of the policy owner. This includes expenses not only for repairing the damaged car, but also for treating injuries received by the injured party during the accident. The amount of compensation for specific injuries provided for by the RSA regulations will be shown by the unified table of payments under compulsory motor liability insurance for injury to health, which we will read in the article below.

Briefly about OSAGO

OSAGO is a temporary form included in the list of documents required for driving vehicles. Unlike CASCO, its competence covers only one insured event - a traffic accident involving two or more cars. But compensation under the said agreement may be intended exclusively for the affected persons. The owner of the policy himself does not receive any financial compensation for vehicle repairs or restoration of health under the auto insurance policy.

Depending on social

category and actual condition of victims of road accidents who suffered harm to health, the amount of payment under compulsory motor liability insurance will range from 5 to 500 thousand rubles. But for movable property this limit does not exceed 125,000 rubles for one damaged vehicle, and 160,000 rubles for two or more damaged vehicles.

In addition, movement on public roads without a mandatory insurance policy on the territory of the Russian Federation is punishable by law. For the first time, the lack of insurance will entail liability for the driver in the form of a fine of 500 rubles. Well, subsequent disregard of the rules may result in his arrest for a period of 3-6 months.

Payments under compulsory motor liability insurance for treatment and injuries

Once injuries have been identified, appropriate treatment should be prescribed to the injured person. It is this that influences the insurance amount that must be transferred to the person.

If, during the course of treatment, a person incurs additional expenses that will be aimed at restoring health, and the need for which is confirmed by medical documentation, then the insurance organization will have to transfer additional funds.

As a rule, the main expenses of the victim are aimed at:

• Carrying out rehabilitation;
• Prosthetics;
• Purchasing necessary medications;
• The need to receive care from third parties.

Any expenses that are aimed at restoring health, subject to compensation by the insurance company, must be confirmed by medical documents, as previously noted. When calculating the amount of insurance transfer under the MTPL policy, the maximum amount of compensation must be multiplied by the percentage that corresponds to the established degree of severity.

In practice, insurance company specialists multiply 500,000 rubles by a percentage that corresponds to the specific injury identified in the injured person. If a person received multiple injuries as a result of an accident, then the multiplication results must be added together.

So, for example, a person who is a victim received the following list of injuries:

• Brain concussion;
• Shoulder fracture.

The percentage of payment in case of a concussion is 3, the percentage of payment in case of a fracture of the shoulder is 10. Accordingly, the specialist first multiplies 500,000 rubles by 3%, then multiplies 500,000 by 10%, after which the results are added together. If such damage is present, the victim can count on receiving an amount equal to 65,000 rubles.

Compensation for damage to health

In accordance with the RSA regulations, all citizens, without exception, have the right to compensation from the insurance company when injured in an accident, regardless of their status at the time of the accident (driver or passenger). Payments under compulsory motor liability insurance for personal injury in 2021 are calculated based on the following indicators:

• The amount of money spent by the victim on purchasing necessary medications, visiting doctors at the clinic, diagnostic procedures and even a nurse;
• The amount of the wage penalty for the period of rehabilitation of the injured person, if after a traffic accident the loss of ability to work is recorded;
• Costs for the further stay of the accident victim in a sanatorium, if such preventive measures were prescribed by the doctor on the basis of the post-traumatic stress she suffered;
• Costs for purchasing additional equipment (crutches, wheelchair, etc.).

At the same time, the insurance company does not undertake to cover the above-mentioned damage if the injured person was on duty at the time of the accident, since in such situations compensation for damage falls on the shoulders of his employer.

What payments are due?

As we found out earlier, the table of payments under compulsory motor liability insurance can guarantee a maximum limit of half a million rubles, which is provided for the most severe cases. The average damage received by a person in an accident is estimated by insurance companies at approximately 10-20% of the mentioned figure, which in monetary terms reaches 50-100 thousand rubles. But for minor bodily injuries and fractures, a citizen should expect an amount of 250 - 50,000 rubles, depending on the number of injuries and his general health.

How is severity determined?

In accordance with the regulations of the Insurance Company, the following injuries are considered a serious outcome after a traffic accident when compensating for harm to life and health under compulsory motor liability insurance:

• Loss of a limb (jaw, arm, leg, etc.) or any organ (stomach, intestines, part of the lung);
• Burns of III - IV degrees, observed on an area exceeding 4% of the entire skin;
• Spinal fracture (more than 4 links).

Moderate injuries received by a victim as a result of an accident usually include:

• Loss of the front row of teeth (from 7 to 9 pieces);
• Deterioration of hearing or vision;
• Closed and open fractures;
• Loss of one or more fingers;
• Burns of categories I – II, occupying more than 10% of the entire skin.

The table of payments for damage to health under compulsory motor liability insurance includes the following for minor injuries in an accident:

• Cuts and open puncture wounds;
• 1st degree concussion;
• Banal bruises and deep scratches;
• Loss of teeth (up to 3 pieces);
• Minor fractures and burns, the size of which reaches 3-5% of the total area of ​​the skin.

It is worth noting that the last category of injuries occurs most often in practice. But moderate and severe conditions are rare when contacting the Investigative Committee, since the listed degrees of harm are quite difficult to document.

What if the victim of an accident becomes disabled?

If a person becomes disabled as a result of an accident, he receives compensation in accordance with the disability group received.

If the victim is a child, he is entitled to the largest possible payment, that is, half a million rubles.

How to determine the amount of compensation

Having learned to distinguish between three types of injuries in an accident, a citizen can easily find out approximately how much money the company undertakes to compensate him under the contract. The injured party can more accurately calculate the amount of damage using the MTPL payment table below:

It is important to know! If the insurance company refuses to pay the calculated amount of compensation voluntarily, then the injured party reserves the right to file a written claim for compensation for health damage to the RSA or to a local court.

Example of compensation calculation

The amount of compensation that the victim can count on is determined by the formula: X% × 500 thousand, where x is the value taken from the table. Next, all the resulting numbers are added together.

For clarity, you can take a piece of the table related to soft tissue injuries.

Example 1 . A man severely injured his face as a result of an accident. He is entitled to 40% of the maximum compensation. 500 thousand × 40% (i.e. 500 thousand × 0.4) = 200 thousand.

Example 2 . In addition to the facial damage from the previous case, the victim has a wound on his body with an area of ​​13 square meters. cm and many small scratches. In this case, he should already receive 200 thousand + 50 thousand + 250 rubles. Total – 250250.

Example 3 . The man was lucky and received only minor scratches and minor bruises during the accident. In this case, he is still entitled to compensation of 0.05% of 500 thousand, i.e. 250 rubles.

Refund procedure

If you are involved in a traffic accident that results in injuries to third parties (including pedestrians), the person at fault must immediately contact their insurance company and notify them of the tragedy. Further, so that the Investigative Committee does not refuse compensation to injured citizens, the driver is obliged to prepare a package of required documents describing the details of the accident and confirming the condition of the injured people.

After the collected papers are submitted to the agency for consideration, both parties to the conflict will only have to wait for the verdict from the insurers. On average, it takes the insurance company about 3-5 days to calculate the amount for compulsory motor liability insurance and further transfer money to the account of accident victims. The maximum period for carrying out this procedure, in accordance with Art. 12 Federal Law, cannot exceed two weeks. Otherwise, the policy holder has the right to file a complaint against the company’s employees with the RSA or the local judicial authority.

Required documents

In order to receive compensation for damage caused to health in a traffic accident, the client of the insurance company must provide the following package of documents for verification:

• A valid contract for the protection of civil liability;
• Internal passport;
• Written application (filled out in free form);
• Protocol of the State Traffic Inspectorate from the scene of an accident;
• An extract from the clinic about the condition of the victims.

This list of papers and certificates is considered minimal. But depending on the chosen one, “RGS”, “Tinkoff”, etc.), it may be supplemented with other documents:

• A general power of attorney from the policy owner, issued in the name of the victim (required if the accident victim decides to seek compensation independently);
• Bank account number for transferring funds for treatment;
• The decision of the judicial authority, which indicates the guilty party;
• Parents' consent to receive financial assistance from the insurance company (for persons under the age of majority).

It is important to know! The RSA regulations do not provide for a broader list of documents for such procedures. This means that the requirement for additional papers on the part of the Investigative Committee employees can be perceived as illegal.

What to do if compensation does not cover treatment costs

Sometimes it happens that the compensation paid by the insurance company does not fully cover the expenses of the injured party for treatment and further rehabilitation. After all, the table of compensation for health damage under compulsory motor liability insurance is not capable of calculating the associated costs of clients. In such a situation, you need to act according to the following algorithm:

1. The injured person submits a written claim to the person responsible for the accident, demanding additional payment from him in a specific amount;
2. The policy owner, in turn, transfers the received paper to the insurance company, along with a certificate from the hospital, which indicates specific numbers and expenses;
3. If the company refuses to make an additional payment, despite the legality of the client’s demand, then the case with all related materials is transferred to the Russian Union of Auto Insurers or to a local court.

It must be remembered that the insurance company has the right to a negative answer in a number of circumstances prescribed in the unified regulations of the RSA. Therefore, the policyholder should review this list before filing a complaint.

Insurance payments under compulsory motor liability insurance

Regulation of relations related to the payment of insurance compensation is regulated by Federal Law No. 40 of April 25, 2002, which was amended in 2014. This regulatory legal act defines the list of persons who have the right to claim payment of insurance compensation, determines the period of time during which this payment must be made, as well as the maximum amount of compensation that can be received by a victim involved in an accident.

So, first you need to understand what MTPL is. OSAGO is insurance that is carried out by persons driving vehicles. In accordance with current legislation, vehicles are a source of increased danger. In this regard, the legislator requires mandatory insurance for the risk of possible damage to third parties.

Insurance payment is intended to compensate for damage that was caused as a result of using the car. It also happens that compensation is carried out by another body - RSA (Russian Union of Motor Insurers).

Reimbursement by this organization is carried out in the following cases:

• The culprit did not insure his liability;
• The insurance organization was declared bankrupt or its license was revoked for other reasons.

Remember, any person driving a vehicle must have an insurance policy with them while driving the car. In relation to vehicles that are registered on the territory of a foreign state, a requirement has been established for the mandatory registration of a Green Card.

All types of compensation paid by insurance organizations can be divided into the following categories:

• Compensation for damage caused to property;
• Compensation for damage caused to health.

Property damage is damage that was caused either to the machine or to the objects that were in it.

Compensation for personal injury represents the costs incurred by the victim for treatment and restoration of health. In the event that a victim dies as a result of an accident, the insurance organization, at the request of the victim’s representatives, can pay funds for the person’s burial.

All other payments, based on practice data, can only be obtained by applying to the court.

This category of payments includes compensation for moral damage and lost earnings of the victim.

In what case will payment be refused?

Today, citizens can receive a refusal from the insurance company to compensate for damage to health in an accident for only 5 legal reasons:

• The person was not injured in a traffic accident described in the traffic police report;
• The injured party did not prepare the evidence base;
• The accident occurred as a result of natural disasters (flood, fire, hurricane wind, etc.);
• The accident was determined to be intentional;
• The cause of the road tragedy was military action.

It is important to know! Also, a negative response from insurers is allowed if the policy holder fails to comply with the application deadlines, or if the structure of the execution of any of the submitted documents is violated. But in practice, refusal more often arises precisely due to the first 5 circumstances.

We learned what payments are provided under compulsory motor liability insurance for minor, moderate and severe injuries in an accident, and how to calculate their exact amount using a table. In conclusion, it is worth adding that independent calculation of compensation is not mandatory, but it is necessary to carry it out for your own safety. Otherwise, you will have to pay the missing funds for treatment from your own pocket.