The Insurer Refused Payment
The insurer argues that the event is not insured, relies on an exclusion or alleges a breach of the policy terms.
INSURANCE DISPUTES
Insurance Disputes with Insurance Companies
Has the insurer refused payment, reduced the amount or argued that the event is not covered? We review the agreement, insurance rules, event documents and loss calculation. We determine what needs to be proven and which legal route should be used.
We handle disputes involving insurance of property, liability, cargo, real estate, equipment, vehicles and other types of insurance. We represent policyholders, beneficiaries and businesses across Russia.
What Happened?
In an insurance dispute, it is not enough simply to obtain the insurer’s refusal. The specific ground for the refusal and the documents that may rebut it need to be identified.
The Insurance Payment Was Significantly Reduced
The insured event was accepted, but the parties dispute repair costs, property value, restoration costs or the amount of the actual loss.
The Insurer Keeps Requesting More Documents
The insurer repeatedly asks for additional documents, delays consideration of the claim or makes payment dependent on formal requirements.
There Is a Dispute about the Cause of Damage
The cause of a fire, accident, flooding, breakdown, cargo loss or another event has become the basis for refusal or reduction of payment.
The Dispute Concerns Business Insurance
Property, equipment, real estate or cargo has been damaged, or another insured risk has arisen that may affect the company’s operations.
The Insurer Has Brought a Recourse or Subrogation Claim
The legal basis, amount of the alleged loss, the insurer’s documents and causation need to be reviewed.
Nikolay NemkovManaging Partner, Konsultant Law Firm
Managing Partner’s Commentary
Why an Insurance Dispute Does Not Start with a Lawsuit
Before going to court, the structure of the insurance coverage needs to be understood: what risk was insured, what actually happened, which exclusions the contract contains and how the amount of loss is proven. An error at this stage can determine the outcome of the entire dispute.
INSURANCE DISPUTE LOGIC
First Determine the Coverage. Then Prove the Payment.
The fact that damage occurred does not automatically mean that the insurer must pay the amount claimed. The policy terms, circumstances of the event, causation, amount of loss and compliance with the claims procedure all need to be established in sequence.
01
What Was Insured
We review the insured property or interest, insured risks, insured amount, deductible, policy period and applicable insurance rules.
02
What Actually Happened
We reconstruct the event using reports, opinions, correspondence, photographs, video, documents from public authorities and other evidence.
03
Why the Insurer Refuses
We analyze the specific basis of the refusal or reduction rather than arguing with the insurer in the abstract.
04
What Can Be Recovered
We determine the principal claim and any additional claims applicable to the particular situation and the client’s legal status.
The strategy is built around the specific insurance agreement and the specific insured event. There is no universal application that works the same way against every insurer.
WHAT WE DO
What Our Work on an Insurance Dispute Includes
Review the Agreement and Insurance Rules
We review the policy terms, appendices, insurance rules, exclusions, deductibles, limits and the parties’ obligations.
Analyze the Insurer’s Refusal
We determine which facts and policy provisions the insurer relies on.
Work with the Evidence
We identify the documents needed to prove the insured event, cause of damage and amount of loss.
Review the Payment Calculation
We compare the insurer’s calculation with the documents and the cost of the damaged property, repairs or restoration works.
Pre-Trial Work
We prepare the application, pre-trial claim, objections, calculation and supporting documents.
Expert Evidence
We determine whether valuation, technical, commodity, construction, fire-technical or another expert examination is needed.
Negotiations with the Insurer
We formulate the legal position and support negotiations concerning payment or settlement.
Court Representation
We prepare procedural documents, participate in hearings and work with expert evidence and the other party’s objections.
KEY QUESTION
What Exactly Does the Insurance Agreement Cover?
The name of the insurance product or policy is not enough. The agreement must be read together with the insurance rules, appendices and qualifications. Those documents define the insured risks, exclusions, liability limits, deductible and the policyholder’s duties after an event occurs.
The statement “the property is insured” does not by itself answer whether the insurer must pay in the particular situation.
Subject of Insurance
What property, interest or liability was insured.
Risk
What event must occur for coverage to arise.
Exclusions
What circumstances the agreement excludes from coverage.
Limits
Within what limits and under what rules the payment is calculated.
INSURER’S REFUSAL
The Wording of the Refusal Does Not by Itself Prove That It Is Lawful
The insurer should connect the refusal to the policy terms and the actual circumstances of the event. We therefore review not only the refusal letter but also the evidence on which its conclusion is based.
- whether the disputed term is actually contained in the agreement and applicable rules
- whether it applies to the event that actually occurred
- whether the circumstances relied on by the insurer are proven
- whether there is causation between the alleged breach and the resulting consequences
- whether the insurer correctly interpreted the documents and expert findings
- whether its position is consistent with the other materials in the insurance file
A refusal needs to be broken down by legal and factual grounds. Sometimes the dispute is about interpreting the contract, sometimes about the facts, and sometimes about the amount of loss.
Documents That May Determine the Outcome of an Insurance Dispute
The evidence depends on the type of insurance and the event that occurred. The earlier the evidence is assembled, the lower the risk of losing important information.
Insurance Agreement
Policy, agreement, insurance rules, appendices and amendments.
Event Documents
Reports, certificates, official records and materials from emergency services, police, EMERCOM and other organizations, if such documents were prepared.
Photos and Video
Documentation of the property, damage, location of the event and consequences.
Correspondence
Insurer notices, applications, responses, document requests and electronic correspondence.
Loss Valuation
Estimates, invoices, specialist opinions, valuation reports and repair or restoration documents.
Business Primary Documents
Contracts, delivery notes, acceptance certificates, inventory records, accounting documents and documents confirming the property’s value.
AMOUNT OF LOSS
Recognizing the Insured Event Does Not Mean Agreeing with the Amount of Payment
Even when the insurer recognizes the event as insured, the dispute may continue over the cost of damage, calculation method, scope of required works, depreciation, property value or application of deductibles and limits.
We review separately:
- which calculation method the insurer used
- which damage was included and excluded
- whether the calculation reflects the actual condition of the property
- which documents confirm restoration costs
- whether an independent valuation or expert examination is justified
- whether the deductible and insured-amount limits were applied correctly
In some cases, the dispute is not about the insured event itself but about a few figures in the calculation. Those figures may determine the amount recovered.
BUSINESS INSURANCE
When the Insured Event Affects the Company’s Operations
For a business, an insurance dispute often concerns more than the damaged asset. An accident, fire, damage to equipment, real estate or cargo may stop production, deliveries or performance of obligations to counterparties.
Real Estate
Fire, flooding, utility-system accidents, damage to a building or premises.
Equipment
Breakdown, accident, damage to production lines, machinery and other fixed assets.
Cargo
Damage, loss or shortage during transportation.
Liability
Disputes over the existence of coverage when claims are brought against the insured person.
Company Property
Inventory, machinery, equipment and other assets.
In corporate insurance, it is particularly important to compare the insurance agreement with the company’s business documents and the actual circumstances of the event.
A Separate Mandatory Pre-Trial Route May Apply
The required procedure depends not only on the type of insurance but also on the legal status of the policyholder or beneficiary. For certain consumer financial-services disputes, the legislation provides a special pre-trial procedure involving the financial ombudsman. Commercial insurance disputes involving legal entities follow a different procedural logic.
Before preparing a lawsuit, we therefore first determine which pre-trial procedure applies to the specific dispute and which steps need to be completed for the court to consider the claim on the merits.
DO NOT DELAY
An Insurance Dispute Is Better Assessed as Soon as the Problem Arises
After the event, documents are created, the condition of the property is recorded, inspections are conducted and causes of damage are identified. Over time, evidence may be lost, the property repaired and the circumstances harder to reconstruct.
- keep the agreement and insurance rules
- keep all applications and insurer responses
- document the condition of the damaged property
- do not destroy documents or correspondence
- keep inspection and expert materials
- before materially changing the condition of the property, assess whether enough evidence has already been collected
The earlier the future line of the dispute is understood, the easier it is to collect evidence specifically for that position.
PRACTICE
Results in Real Cases
RUB 2,737,500
After Refusing the Claim, SOGAZ Paid RUB 2.74 Million
During the proceedings, SOGAZ paid RUB 2,737,500 under a personal insurance policy linked to a bank loan: RUB 2,411,252.10 to Gazprombank and RUB 326,247.90 to the two heirs. On appeal, the total penalty awarded to the heirs under Russian consumer protection law was increased to RUB 163,123.94.
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Konsultant Law Firm
The firm has been practicing since 2007. We handle litigation and complex legal matters for businesses in Krasnoyarsk, Moscow and other regions of Russia.
Since 2007
in legal practice
1,000+
court proceedings
Across Russia
Krasnoyarsk • Moscow • other regions
PRACTICAL APPROACH
Not Every Insurance Refusal Should Immediately Become a Lawsuit
The economics and prospects of the dispute should be assessed first: the amount claimed, quality of evidence, need for expert evidence, possible costs and the insurer’s position.
If the problem can be resolved by additional documents, a corrected calculation or a reasoned pre-trial claim, court proceedings may not be the first or only option.
If the parties’ positions fundamentally conflict, the evidence should already be prepared with future litigation in mind.
The goal is not to send the insurer as many letters as possible. The goal is to obtain a legally and economically justified result.
How We Start Working on the Matter
01You Send the Documents
The agreement or policy, insurance rules, notice of the insured event, the insurer’s refusal or calculation, and the available loss documents.
02We Analyze the Insurer’s Position
We identify the basis for refusal or reduction and test it against the agreement and actual circumstances.
03We Develop the Strategy
We determine the evidence, pre-trial route, need for valuation or expert evidence and the prospects of litigation.
04We Handle the Legal Work
We prepare the documents, communicate with the insurer and, where necessary, represent the client in court.
MANAGING PARTNER
Konsultant Law Firm Lawyers
Managing Partner, Konsultant Law Firm
Nikolay Nemkov
More than 20 years of practice in complex property and corporate disputes. Practicing insolvency practitioner.
Insurance Dispute Questions
The insurer refused payment. Is it worth going to court?
The refusal itself does not show the prospects of the case. The ground for refusal, the insurance agreement and the evidence of the event need to be reviewed first. Only then can it be assessed whether there are grounds to demand payment.
What if the insurer recognized the event but reduced the payment?
The calculation method, damage included, restoration costs, policy terms and restrictions applied by the insurer need to be reviewed. In some cases, an independent valuation or expert examination becomes the key evidence.
Can a refusal based on breach of the policy terms be challenged?
It depends on what term was breached, how it is worded and whether the breach is connected with the circumstances of the insured event. A formal reference by the insurer to a breach does not by itself mean that the refusal is justified.
Do you handle business property insurance disputes?
Yes. We handle disputes involving insurance of real estate, equipment, property, cargo, liability and other business insurance products.
Do you handle CASCO disputes?
Yes, where the dispute concerns the insurer’s obligations: recognition of the insured event, refusal, amount of payment or the policy terms. Other automotive legal issues are handled under a separate automotive-law practice.
Is it always necessary to apply to the financial ombudsman?
It depends on the client’s legal status, the nature of the claim and the insurance agreement. Before filing a lawsuit, we determine which pre-trial procedure applies to the specific situation.
Is an independent expert examination required?
Not always. The disputed fact needs to be identified first. Expert evidence makes sense when its conclusions are actually needed to prove the cause of the event, the nature of the damage or the amount of loss.
Which documents should I send for the initial review?
The policy or insurance agreement, insurance rules, notice of the insured event, the insurer’s decision or refusal, payment calculation and the available documents proving the circumstances of the event and the amount of loss.
CASE REVIEW
We Will Review the Insurer’s Refusal or Calculation
Briefly describe what happened and what the insurer said. If documents are already available, prepare the policy, insurance rules, refusal or payment calculation — they will be needed to analyze the insurer’s position.