Application for the allocation of the necessary funds for the payment of insurance coverage in 2021

If circumstances arise due to which an employee cannot work, the employer is required by law to pay him insurance coverage. To reimburse these funds, he can submit an application to the Social Insurance Fund, attaching an approved list of documents to it.

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This is legislatively enshrined in Law No. 255-F3, which regulates payments for temporary disability or in connection with maternity.

What else do you need to provide?

In addition to writing the application, the employer's representative must create a package of several more papers. These include:

calculation according to form 4-FSS;
copies of documents serving as evidence of the validity and reliability of expenses for compulsory insurance payment.

The latter include pregnancy certificates, birth certificates, certificates of incapacity for work issued in clinics and antenatal clinics, as well as payment forms drawn up in accounting departments with the amounts of payments for these benefits indicated in them and other papers. All of them must be current and properly certified.

You also need to attach a certificate confirming that there is no debt to the fund or, if there is a debt, data on its amount; in addition, you must have on hand a list of social payments made during the compensation period.

How long to wait for a refund

After the collected package of documents is transferred to the Social Insurance Fund, the policyholder can wait to receive funds within no more than ten days from the date of transfer of the papers.

However, it should be remembered that in some cases, the insurer may initiate a desk or on-site audit in order to analyze the fairness and reliability of the costs of paying benefits.

This is due to the fact that from the beginning of 2021, the responsibility for administering and monitoring the payment of insurance premiums has transferred to the tax authorities. During the inspection, inspectors may request additional information and papers from the organization.

In such cases, the duration and even the very possibility of paying insurance coverage depends solely on the results of the verification event.

In this case, the organization must receive the insurer’s decision no later than three days after its adoption.

If the company does not agree with the results of the inspection, it can appeal them in court (of course, it is better to do this only when there is one hundred percent confidence in its own rightness).

Who should compile

The application is drawn up by the employer himself. This happens regardless of whether he is an individual entrepreneur or a legal entity. It is submitted to the FSS along with other documents.

First, they are checked by the fund, then transferred to the tax office for a more thorough check. For this reason, you must not make mistakes in documents or indicate false information in forms. As a result, a decision is made to refuse or to issue the requested amount to the organization.

Drawing up an application

The application for the allocation of funds for the payment of insurance coverage has a unified form , which is recommended for use. You must be extremely careful when drawing up your application, trying to avoid any mistakes or inaccuracies.

If some error nevertheless crept into the document, there is no need to try to correct it, it is better to issue a new form. And even more so, it is unacceptable to include unreliable or deliberately false information in the application - if such facts are discovered, the organization and its management may face serious punishment.

Filling out the document

At the beginning of the document we write the addressee: the name of the institution to which the application is being submitted, the position of the head and his last name, first name and patronymic.
Then detailed information about the insured is entered: the name of the enterprise, its constituent details: registration number in the Social Insurance Fund, subordination code, tax identification number, checkpoint, legal address.
Next, enter the amount that is required for compensation (in numbers and words), as well as the specific reason.
After this, the form includes information about the bank details of the recipient company.
Finally, the application is signed by the responsible employees: the director and the chief accountant.

It is not necessary to certify the application using a seal or stamp - from 2021 this must be done only if the standard for the use of stamped products is enshrined in the internal regulations of the company.

The application is written in two copies, one of which is submitted to the social insurance fund, the second, after being endorsed by a representative of the Social Insurance Fund, remains in the hands of the employees of the applicant organization.

In what cases is it necessary

An organization applies to the Social Insurance Fund if the amount of funds actually paid for insured events is greater than those accrued. Then the fund reimburses the specified difference.

An organization can apply to the Social Insurance Fund if it has made benefits payments in connection with:

temporary disability of the employee;
the birth of a child;
pregnancy;
an employee receiving disability at work.

These benefits are paid partly by the employer, partly by the Social Insurance Fund:

the first 3 three disabilities are paid by the employer;
starting from the 4th day, payment is made at the expense of the Social Insurance Fund.

From the part paid by the employer himself, personal income tax is calculated and withheld.

A prerequisite for applying to the Social Insurance Fund is that an official contract with the right to insurance coverage must be concluded with the employee, otherwise the funds spent by the organization will not be reimbursed.

How to submit an application

There are several ways to submit your application:

The fastest, most accessible and easiest way today is electronic means of communication. True, there are some peculiarities here:
secondly, sending a letter in this way does not guarantee that it will not accidentally get lost in the recipient's mailbox.
Handover personally into the hands of an FSS employee.
Sending an application through a representative.
via regular Russian Post by registered mail with acknowledgment of delivery.

All these methods guarantee that the letter reaches the addressee and will be read and processed by him.

Deadlines for consideration and response, payments

If a person is involved in an incident that is classified as insurance, he must immediately contact the company that provided the policy.
A certain amount of time is allotted for the action. The application form can vary significantly depending on the company with which a person works. However, the essence of all forms is the same.

In order for an organization to accept an application, it must indicate:

policy owner details;
passport information;
policy number;
date when the incident occurred;
time of occurrence of the event;
description of the insured event.

Application forms vary depending on what insures the person and against what incidents. This is done in order to reflect the most complete information about the event. The features of the form allow you to enter all the data that can have a significant impact on the possibility of receiving compensation.

This significantly simplifies the procedure for filling out the application and minimizes the likelihood that the information will not be provided in full. Most companies have online chat on their website. If a person encounters difficulties in filling out the form, he can contact a consultant.

It should be remembered that the insurance company requires the applicant not only to report the incident, but also to document its occurrence. The list of required papers is contained in the Rules and Conditions for the provision of the policy.

Documentation can also be sent via the Internet. To do this, all papers must be scanned and attached to the application. It should be remembered that the possibility of remote access is not provided in all institutions. Its availability must be confirmed in advance.

When the company has conducted an inspection and recognized the event as insured, it will be necessary to draw up an additional application to receive payment. It must indicate the details, using which the company will be able to transfer money to the policy owner.

The paper can be prepared in advance. If a person decides to take advantage of this opportunity, he must attach an application to receive payment to the notification of the occurrence of the insured event.

Payment of insurance amounts under insurance contracts against accidents is carried out within the time limits specified in the insurance contract. In practice, this period does not exceed 30 days from the date of the decision to make payments. The exception is situations related to the initiation of criminal proceedings and the emergence of doubts about the authenticity of the documents provided.

Compulsory civil liability insurance for car owners is fully regulated by law. The main regulatory legal acts are Law No. 40-FZ dated April 25, 2002 and Regulations of the Central Bank of the Russian Federation dated September 19, 2014 No. 431-P, in accordance with which insurance rules are established, the procedure for participants in an accident to receive compensation under the MTPL policy.

Under the MTPL policy, the driver’s civil liability to third parties is insured; accordingly, only the party injured in the accident can receive compensation when an insured event occurs. To do this, the car owner, recognized as an injured participant in the accident, must contact the insurer with a corresponding application.

In accordance with the Rules, the car owner must report the incident and provide a package of documents to the insurance company as soon as possible, but no later than 5 working days from the date of the accident (clause 3.8 of Regulation No. 431-P).

In other cases, if the insured person violates the deadlines for filing an application, the issue of receiving compensation is resolved in court.

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Limitation periods

The limitation period under compulsory motor liability insurance is limited to a certain period of time. The limitation period itself refers to the period during which a person whose rights have been violated can defend his position in court.

Compensation for damage under the MTPL policy is provided only in a number of specific cases:

the insured driver hit a pedestrian while driving the car specified in the policy, as a result of which the injured person was injured or died;
a car owner who has an MTPL policy, while driving a car, collides with another vehicle, resulting in injuries to the passenger and/or driver of the other car;
the insured car owner collided with another vehicle, thereby causing damage to the property of a third party;
other property (fencing, building, etc.) was damaged in the accident.

If one of the above cases occurs, the insurance company will be obliged to pay compensation to the party injured in the accident.

The insurance contract specifies the rights and obligations of the parties to the transaction. In addition to the list of insured events where damage compensation is due, the contract also specifies a number of situations in which the insurer has the right to legally refuse payment to the applicant. The following circumstances may be grounds for refusal:

the culprit of the accident is not included in the compulsory motor liability insurance policy;
the deadlines for contacting the insurance company with an application for compensation for damage by the injured person were violated;
the policy had expired at the time of the incident;
the car was damaged as a result of racing competitions;
The vehicle was damaged as a result of transporting large-sized or improperly secured cargo;
the injured participant in the accident was performing his official duties at the time of the incident and should have had an individual insurance policy;
intentional collision for the purpose of obtaining compensation from the insurer.

Bankruptcy of the insurer is not grounds for refusal to pay. In this case, the car owner needs to apply for compensation to the Russian Union of Auto Insurers (RUA).

The application form, as a rule, can be obtained from the insurer's office, where employees also provide a sample for filling it out. The application must include the following information:

name of the insurance company to which the appeal is addressed;
details of the injured participant in the accident (full name, address, passport details);
information about the vehicle responsible for the accident (car make and model, license plates, information about the driver who was driving the car at the time of the accident);
information about the car of the injured participant in the incident (car make and model, VIN code, STS series and number, registration plates);
an accurate description of the scene of the incident, indicating the time and address;
details of the accident, including a list of damage sustained by the vehicle and/or damage caused to the health of the injured party;
series and number of the MTPL insurance contract of both the injured party and the culprit of the accident;
a list of additional expenses associated with the incident (calling a tow truck, paying for parking, etc.).

The injured participant in the accident submits a complete package of documents to the insurance company that issued him the MTPL policy, if the incident caused damage only to property, and both participants have valid insurance (Clause 1, Article 14.1 of Law No. 40-FZ). If people were injured in an accident, then it is necessary to contact the insurer of the person responsible for the accident.

The package of documents can be provided in the following ways:

during a personal visit to the company’s office;
by post.

By mail, documents should be sent by registered mail with a description of the contents and a return receipt.

The insurer is obliged, within 20 calendar days from the date of receipt of the full package of documents, to consider the application of the car owner injured in an accident, draw up a document on compensation for losses indicating the amount of compensation and make a payment. If compensation is made in the form of payment for restoration repairs, then the insurer must organize this procedure within 30 days (clause 4.22 of Regulation No. 431-P).

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