They brought a certificate to the police that a concussion was received in the brawl. What threatens this injured?
Answer
Hello, Natalia.
The assessment of the severity of harm caused to human health is carried out on the basis of the terms in which recovery occurs. In accordance with paragraphs 7-9 of the Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 N 194n (as amended on January 18, 2012) "On approval of the Medical criteria for determining the severity of harm caused to human health" (Registered in the Ministry of Justice of the Russian Federation on August 13, 2008 N 12118) to moderate damage to health includes, in particular, temporary disability lasting more than three weeks. Temporary incapacity for work up to twenty-one days, inclusive, refers to minor harm to health. Superficial injuries, for example: abrasions, bruises, bruises of soft tissues, superficial wounds and other injuries that do not entail a short-term health disorder, are regarded as injuries that did not cause harm to human health. With a concussion, the treatment lasts no more than 21 days, so this harm is classified as a slight harm to health. For intentional infliction slight harm health, criminal liability is provided for under part 1 of Article 115 of the Criminal Code of the Russian Federation with a penalty in the form of a fine in the amount of up to forty thousand rubles, or compulsory works for up to 480 hours, or corrective labor for up to one year, or arrest for up to 4 months. However, depending on the circumstances, other qualifications may be given, such as battery or light bodily harm out of hooligan motives.
A resident of Novosibirsk, along with his wife, had an accident. They were recognized as victims. The wife was injured, so the car owner turned to the insurance company of the culprit of the accident for damages. However, the insurer refused to pay the money. The victim received only a bruise, which is not considered harm to health, he explained. The first instance and the appeal agreed with this, but the Supreme Court decided otherwise.
At the end of December 2014 Andrey Dubin* in his Honda car collided with a Suzuki driven by Inna Murina*. The latter was recognized as the culprit of the accident. As a result of the accident, Dubin's wife, who was sitting in the passenger seat, received a concussion and bruised jaw. This was recorded in medical documents ( approx. ed.-she went to the hospital immediately after the incident). However, later the medical examiner found only a bruise in Dubina - the diagnosis of "brain concussion" was not confirmed. The car of the spouses was damage done in the amount of 402,000 rubles.
In the spring of 2015, Dubin applied for compensation to RESO-Garantia, where she was insured Civil responsibility responsible for the accident. By law, the victim cannot ask his insurance company for direct compensation for damage if the damage was caused not only to the vehicle, but also to the health of the passenger (Article 14.1 of the Federal Law "On Compulsory Insurance of Liability of Owners Vehicle"). However, RESO-Garantia refused to pay the money: in the documents from the traffic police there is no information about the passenger's injuries in this accident, motivated Insurance Company.
Harm or not?
Dubin turned to Leninsky District Court of Novosibirsk. He demanded to recover from RESO-Garantiya insurance compensation, a penalty for refusing to voluntarily pay money and compensation for moral damage (case No. 2-4188/2015 ~ M-2812/2015). The insurer, in turn, with reference to the conclusion of the forensic expert, stated that the injury by the Cudgel cannot be qualified as harm to health. And the judge Ludmila Vetoshkina came to a similar conclusion, dismissing Dubin's claim.
The injury claim is refuted by a medical report that denies the victim suffered a concussion, the judge said. A bruise is not formally considered a health hazard, the medical expert decided. In addition, attention is drawn to judgment, Dubina herself did not apply for insurance compensation or with claims to the defendant. The appeal upheld that decision.
It came to Supreme Court who disagreed with this approach. The Supreme Court clarified that the Novosibirsk courts did not take into account the provisions of the "Rules for calculating the amount insurance compensation when causing harm to the health of the victim". The document was approved by Government Decree of November 15, 2012 No. 1164 and clarifies that "Bruises, lacerations and other injuries of soft tissues are attributed to harm to the health of the victim and are subject to compensation by the insurer of the inflictor of harm" (p. 43). As a result, the "troika" under the chairmanship Vyacheslav Gorshkov the acts of the lower instances were canceled and the case was sent for a new consideration back to Novosibirsk Regional Court (approx. ed.-the dispute has not yet been settled).
Opinion of Pravo.ru experts: "It is wrong to divide insurers into "us" and "them"
According to lawyer Yevgeny Zabuga, this case clearly demonstrates that the lower instances ignore the literal content of the provisions of the OSAGO Law: “Article 14.1 of this law “on direct compensation for losses” that appeared in 2007, it would seem, should not cause any difficulties in application.” Relations under OSAGO, as a rule, are consumer and limiting the access of the victim to the insurer is a violation of the meaning of such interactions, the lawyer adds: "Insurance companies are professional and equal participants in the multimillion-dollar service market, therefore, from the point of view of protecting consumer rights, divide these companies into " "friends" and "strangers" is fundamentally wrong in relation to the injured party.
Aleksey Tokarev, Attorney-at-Law, Managing Partner at AB Trust, notes that controversial situation complicated the next aspect - the victim had no loss of health, that is, he could work and lead a former lifestyle, but at the same time spent money on diagnosing and treating a bruise. In the practice of the courts, such cases were exceptional, the lawyer emphasizes: “This case is indicative for the victims and the courts, because earlier the courts satisfied such statements of claim only if the victim was disabled from the injury."
* - the names and surnames of the participants in the process have been changed by the editors
According to the norms of domestic legislation, a strict list of persons who are subject to compulsory insurance. These include police officers who serve on the territory of Russia and abroad, reporting to the government of the Russian Federation. Depending on the circumstances of the work, the consequences of the harm caused, other features of the service and will be recorded insurance payments employees of the Ministry of Internal Affairs in 2020.
Legislative regulation of the issue
The main document that is used to regulate this issue is the federal law dated March 28, 1998 N 52-FZ "On mandatory state insurance life and health of military personnel, citizens called up for military training, private and commanding personnel of internal affairs bodies Russian Federation, the State Fire Service, employees of institutions and bodies of the penitentiary system and employees federal bodies tax police". The bill fixes on what grounds and in what order insurance payments for injuries to employees of the Ministry of Internal Affairs are compensated. Considering that the Law was adopted a long time ago, it has undergone a number of significant changes that are still in effect today.
According to this document, all police and military personnel are at risk. That is, due to the peculiarities of the performance of labor, injuries, mutilations and even death are possible. Therefore, the Ministry decided to force employees to take compulsory health and life insurance.
Also, the Pension Legislation deals with the regulation of this issue, and.
In what cases is an employee of the Ministry of Internal Affairs entitled to insurance payments
There are several grounds for applying insurance payments to employees of the Ministry of Internal Affairs when they receive an injury.. Such circumstances are called insured events and are subject to mandatory payment. The main ones include:
- injuries to a police officer during his service (during the period when the employee was involved in work);
- contusion or injury to the face, as well as receiving other damage, the severity of which is not more than average;
- depends on the extent of the injury;
- the insured person died due to an injury during work.
Attention! If the death of a person or the assignment of the status of a disabled person to him occurred within a year after the dismissal of a citizen from the internal affairs bodies, then there is a chance to receive insurance payments from the bodies of the Ministry of Internal Affairs.
List of injuries for payment of insurance to police officers
Federal Law of March 28, 1998 N 52-FZ "On Compulsory State Insurance of Life and Health of Military Personnel, Citizens Called for Military Training, Individuals and Commanders of the Internal Affairs Bodies of the Russian Federation, the State Fire Service, Employees of Institutions and Bodies of Criminal executive system and employees of the federal tax police" fixes the list of injuries for the payment of insurance to police officers. There are two categories of diseases that entail payments to the victim. Namely:
- Disorders resulting from insured event and are its integral consequences (wounds, injuries of any severity).
- The consequences that occurred as a result of the damage received (dismissal from service, disability, disability, death).
Procedure for receiving insurance payments
To get cash, the victim must follow a strictly defined procedure. Namely:
- fixing the occurrence of an insured event;
- preparation of a police officer's report on the circumstances of the offense;
- sending an application to the insurer for the calculation of monetary compensation;
- submission of related evidence to the insurance agent;
- making a decision with notification of the parties.
The amount of insurance payments in case of injury to an employee of the Ministry of Internal Affairs
The amount of insurance payments to police officers depends on the severity of the injury received, as well as on the consequences of the damage. Tellingly, the period of service in the Ministry of Internal Affairs, as well as the title and rank received, do not affect the amount of monetary compensation for insurance.
Table "The nature of damage and the procedure for making material payments"
If during the year, after the occurrence of the insured event, the consequences for the victim have worsened, then the insurance company will have to pay an additional amount under the contract.
Employees of the Ministry of Internal Affairs in case of injury in 2020 are compensated to the victim himself. But in the event of the death of the insured person, the funds are transferred to the relatives of the deceased. Recipients include:
- spouses;
- parents;
- Grandmothers and grandfathers;
- minor children;
- disabled children.
Documents required for an insurance company
Receiving payments is impossible without providing a list of such documents:
- the petition of the victim;
- management report;
- the conclusion of the medical commission regarding the disease received.
If the money will be paid to the relatives of the deceased employee, then the list of required documents should also include certificates confirming the relationship with the deceased.
When the insurance company does not pay compensation
In addition, there are a number of grounds for which, under the injury insurance of the Ministry of Internal Affairs, the amount of payments is equal to absolute zero. Such cases include:
- causing harm to the health of a police officer intentionally by the employee himself;
- at the time of the incident, the injured employee was in a state of drug or alcohol intoxication;
- harm to the victim was caused by his own unlawful acts.
According to the requirements of the legislation, the refusal decision must be made in writing. Notification must be given to all interested participants in the process within a maximum of 15 days. If the victim does not agree with the decision made against him, then there are all grounds for filing a lawsuit against the insurer in court.
