Insurance disputes in road accidents

The most common type of insurance dispute today is disputes over road traffic accidents. Challenges to an insurance company's refusal to pay insurance indemnity are often related to the falsification of accident documents.

The main misconception of insurance company lawyers here is their belief in the integrity of certain traffic police (GIBDD) officers. For example, insurer representatives often file motions asking the court to request confirmation of the fact of the road traffic accident from the traffic police. The main mistake is that the insurer is confident that some traffic police officers will help expose other traffic police officers who falsified the accident documents.

In reality, when a court request in a civil case is received, the heads of traffic police units who "catch" the court's request often cover for their subordinates and prepare the "right" answer, which completely destroys the insurer's position.

A similar situation may arise with requests sent to the preliminary investigation bodies of the internal affairs agencies in cases of theft of or damage to insured objects. Police officers will only care about proving to the court that all actions in the criminal case (inquiry, administrative file) were carried out on time, in compliance with all procedural rules and current legislation. Thus, while protecting their own interests, they will simultaneously support the policyholder's position.

Without knowing the "inner workings" of these bodies, a request carefully worded and thought through by the insurer's lawyer will only help the opposing party fabricate a false answer and "clean up" other documents in case of a future inspection.

Recommendations:

1. If insurance fraud is suspected and the policyholder believes that their actions will not be proven, it is better to initiate criminal proceedings followed by investigative actions that make it possible to uncover hidden evidence;

2. Try to obtain evidence through other services, for example those that carry out scheduled inspections and audits;

3. When drafting requests, avoid questions about specific persons and incidents. For example, instead of: "Please advise whether a road traffic accident involving a Moskvich-2141 car, registration number O 555 AN, took place on 12 August 2011" you should write: "Please provide information on road traffic accidents that took place on 12 August 2010".

Conflict No. 4. "The Insurer and the Forensic Expert Institution"

It would seem that expert institutions, both state and commercial, are meant to serve a single purpose – to help the court and investigators establish the truth by applying specialized knowledge. Unfortunately, however, the widespread practice of financially persuading an expert to produce the "right" opinion exists in the forensic laboratories of the Ministry of Justice, in the forensic departments of the Russian Ministry of Internal Affairs and in private expert firms alike.

In practice, there are several scenarios that are unfavorable for the insurer:

Scenario one – the policyholder comes to court with a study (expert examination) already carried out and submits it as evidence. Often, in addition to paying for the examination itself, the policyholder has also paid for the expert's "services". You will agree that it makes no sense for the policyholder to submit a "wrong" expert report in support of their position.

Scenario two – the policyholder files a motion for an examination to be carried out by a specific expert or at a specific institution. Quite often, the policyholder has already found an expert they know, and now their goal is to have the court assign the examination to that particular expert.

Scenario three – the insurer files a motion for an examination at the institution where it is usually carried out. There are cases when an insurer unfamiliar with the "history" of the expert institution blindly trusts the experts, considering them impartial, objective and competent specialists.

However, as numerous examples show, some experts, taking advantage of the "scientific incomprehensibility" of the expert examination itself for the other participants in the proceedings, as well as complete impunity for giving a knowingly false opinion (which still has to be proven!), formulate the conclusions that benefit their "partners".

Example.

In one case, the policyholder learned that the insurer intended to conduct a pre-trial examination at a specific expert institution. The insurer's representative went to see the expert to clarify the scope of the questions for the examination and the timing for submitting materials. During the conversation with the insurer's representative, the expert asked to be given the originals of all available materials and showed clearly inappropriate curiosity about the arguments the insurer would use in court. After the meeting, the insurer's representative decided not to have the examination carried out by this expert, and turned out to be right. Later, this very expert was called by the policyholder's side to substantiate their legal position.

Recommendations:

1. When ordering an expert examination, do not turn to institutions with a poor reputation and dishonest staff.

2. If the policyholder has already had an expert examination carried out, a second examination must be ordered at a different expert institution.

3. If the policyholder insists on an examination by a specific expert, raise the question of having the examination carried out at another institution, possibly at the court's discretion.

4. In the event of informal meetings and conversations between the policyholder and the expert, challenge the expert or prepare a complaint addressed to the head of the expert institution.

5. In any disputed matter concerning an expert examination, insist on a panel examination involving professional experts.

We have considered only some of the possible conflicts of interest; in fact, there may be many more. From the very beginning of an insurance dispute, the insurance company's representative must clearly understand what interests each party involved in the litigation is pursuing. This will help avoid mistakes and win the case.