Who is a policyholder, an insurer? Some concepts from the insurance industry

With insurance we all somehow collide constantly. But not everyone can operate or even explain the basic concepts used in the insurance contract, and accurately call their status a legal language. In the article we will talk about what the concepts of "insurance", "insurer", "policyholder" and others mean, what rights and obligations the parties have and other important moments.

The concept of the insured

The policyholder is a legal entity (company or individual entrepreneur) or an individual who has concluded an insurance contract with the insurance company. The insured can insure anything: health, real estate, a car, a dog, a smile, etc.

What is the cipher of the insured

This concept people rarely hear, and even more so many do not know what it means. The cipher of the insured is a sequence of figures that characterizes the payer of contributions and is indicated in the title section of the form 4-FSS (the form of the quarterly report to the Social Insurance Fund). The code allows the Fund to obtain information about who the policyholder is and about the rates to be used when charging the insured. You can determine your own code by referring to the directory of the ciphers of the insured, which are in annexes 1, 2 and 3 to the Procedure for filling out the 4-FSS form, respectively. Each cipher includes three parts: 000/00/00. Let's see what each of them means.

• The first 3 digits determine the type of activity.

• The second part of 2 digits indicates the code characterizing the tax regime.

• The third part of the cipher describes the source of the payer's capital.

If something changes in the payer's data (source of capital, type of activity, tax regime), then the cipher of the insured person also changes.

The concept of the insurer

As well as the question "Who is a policyholder?", A similar question about the insurer in most people often does not have an answer. So, the insurer is the second side of the insurance transaction, the company that conducts financial activities for insurance of anything has a license for this and takes obligations to recover damages arising from the occurrence of insured events stipulated in the insurance contract. The policyholder is the one to whom damages are compensated.

Rights and obligations of the parties

The rights and obligations of each party to the insured must be known. Otherwise, you can skip the detail and in the future get big problems with the insurer.

Insurer's rights

1. Getting full information about who such a policyholder is, what he wants to insure.
2. Preliminary assessment of the degree of risk for a property, life and health of a potential insured. Expert examination for risk assessment is possible. Refusal in the case of a decision on the inexpediency of insurance.
3. Receiving payment for the provided service on insurance.
4. Demand for documents confirming the occurrence of an insured event and the fact that it is such.
5. Refusal to pay insurance amounts if false information is found in the policyholder's data or the time limit expired is given by the law to notify the insurer about the occurrence of the insured event.
6. Investigation of the circumstances under which the insured event occurred, if the insurance company suspects the insured of fraud.
7. Termination unilaterally of the agreement, if the policyholder does not pay contributions in a timely manner (if payment for insurance is paid in installments).

Obligations of the insurer

1. Providing the insured information about the type of insurance that interests him.
2. Conclusion of the contract for the type of insurance that is necessary for the insured when justifying the expediency.
3. Payment of the insured amount, compensation of losses, if an insured event occurs.
4. Preservation of insurance secrets and personal data of the insured.
5. Direction of an independent expert to assess the property in the situation of the occurrence of an insured event and drawing up an insurance certificate within the prescribed period.

Rights of the insured

Who is a policyholder? This is a person / company that must comply with their rights and obligations, otherwise the insurer has a legal right to refuse to provide services.

1. Obtaining full information about the service provided by the insurance company, about the company, the license.
2. Receipt of insurance payment under the conditions of notification of the insured event and all further actions.
3. Termination of the insurance contract ahead of schedule if necessary and return of unused insurance premium.
4. Replacement of the insurer at will.
5. The right to challenge in court the decision of the insurance company to refuse payment.

Obligations of the insurant

1. Provision of reliable and complete information about the subject, the subject of insurance in the application and the subsequent contract, as well as the degree of risk and the ability of the insurer to verify the information.
2. Payment at a time or in installments, if the terms of the contract allow, insurance premium.
3. Notification of the insurance company of the occurrence of the insured event within the time period established by law (or the rules of the contract) or the subsequent provision of a document that can justify the delay in notification (sick leave, travel, etc.).
4. Notification of the insurer in the period specified in the contract in case of compensation of harm to the guilty in the occurrence of the insured event by the person.

The concept of an insured event

An insured event is a situation that is envisaged in an insurance contract or by law, when the insurance company is obligated to pay the financial amount attributed to the insured in the contract in full or in the form of a percentage.

What are insurance benefits?

Insurance payment (amount) is the amount of money, which in the situation of the insured event comes from the insurance company the insured. Payments are made if this is stipulated in the contract, the amount is also stipulated in the insurance contract.