Article 18. Conditions and procedure for insurance payment The Law On Compulsory Tourist Insurance

Home / RLA / Article 18. Conditions and procedure for insurance payment The Law On Compulsory Tourist Insurance

1. The claim for insurance payment to the insurer is submitted in writing, including through the insurer's Internet resource in accordance with the regulatory legal act of the authorized body, by the insured or the assistance company when providing assistance to the insured with the attachment of documents necessary for the insurance payment.

At the request of the insurer, the applicant is obliged to provide the originals of the documents required for the insurance payment to the insurer, with the exception of documents available in electronic form in databases and (or) information systems of government agencies to which the insurer has access.

2. The following documents must be submitted to the insurance claim::

1) a copy of the identity document or passport of the insured with marks of the structural subdivision of the territorial subdivision of the Border Guard Service of the National Security Committee of the Republic of Kazakhstan on crossing the State border of the Republic of Kazakhstan and (or) the document that is the basis for the insured's stay in the insurance territory;

2) the original or a notarized copy of the document confirming the occurrence of the insured event and the amount of damage caused to the life and health of the insured, including:

medical documents indicating the address and contact details of the medical institution and the doctor, containing information about the date of seeking medical help, the insured's state of health at the time of seeking medical help, the diagnosis, the appointment (prescription) of the doctor, the medical manipulations performed and the medicines provided, broken down by quantity, date and cost;

documents confirming the fact of payment for medical and other services provided to the insured as a result of the insured event, indicating the amount, currency, and date of payment;

documents confirming the fact of payment for goods and services (commodity receipts, invoices, payment receipts, and other documents) indicating their name, quantity, and cost;

medical documents on the establishment of the fact of psychoactive substance use and intoxication of the insured are submitted in case of an accident;

documents of law enforcement, judicial and other competent authorities confirming the fact of an accident and the circumstances of its occurrence are submitted in case of an accident.;

a copy of the death certificate or notification, the conclusion of the forensic medical examination or the protocol of the pathoanatomic autopsy shall be submitted in the event of the insured's death.;

documents confirming the cancellation or exchange of travel documents (tickets, boarding passes), cancellation of a room booked at a hotel, as well as other tourist services provided to the insured for the unused part of the period of stay abroad are submitted in case of forced longer stay in the country (place) of temporary stay or early return to the territory of the Republic of Kazakhstan due to occurrence of an insured event;

travel documents (ticket, boarding passes) – for transportation of minor children and (or) close relatives of the insured;

documents confirming making phone calls and messages to the insurer and the assistance company using the phone numbers specified in the insurance certificate or insurance policy;

documents confirming expenses related to taking measures to prevent and reduce losses;

documents confirming the identity and rights of the beneficiary, if necessary.

3. The insurer who accepted the documents is obliged to provide the applicant with a certificate indicating the full list of submitted documents and the date of their acceptance.

If the applicant submits an application for insurance payment electronically, the insurer may provide him with this certificate in electronic form.

4. When making an insurance payment, the insurer has no right to require the insured (beneficiary) to accept conditions limiting his right to claim against the insurer.

5. The beneficiary is a person designated by the insured, and in the event of the insured's death, his heirs.

6. Insurance payment is made by the insurer by:

reimbursement of the insured's expenses due to the occurrence of an insured event and receipt by the insured of medical assistance in an emergency without notifying the assistance company for valid reasons no later than fifteen working days from the date of receipt of the documents provided for in paragraph 2 of this Article.;

payment of the cost of services rendered by the medical and other institution to the insured in agreement with the assistance company in accordance with the procedure established by the regulatory legal act of the authorized body.

7. In cases where the amount of the insurance payment is disputed by the parties to the tourist's compulsory insurance contract or the beneficiary, the insurer is obliged to make the insurance payment in that part of it, which is not disputed by any of the specified persons, within the period specified in paragraph 6 of this Article.

The disputed part of the insurance payment must be paid by the insurer within three working days from the date of entry into force of the court's ruling on the settlement agreement or the court's decision on the dispute, unless the court's decision is addressed to immediate enforcement.

8. A claim for insurance payment for damage caused during the period of validity of the tourist's compulsory insurance contract may be submitted to the insurer within three years from the date of occurrence of the insured event.

9. In case of late payment of insurance, the insurer is obliged to pay the insured (beneficiary) a penalty in the manner and amount established by the Civil Code of the Republic of Kazakhstan (General part).

The Law of the Republic of Kazakhstan dated December 31, 2003 No. 513.

This Law regulates public relations arising in connection with compulsory tourist insurance and establishes the legal, economic and organizational basis for its implementation.

President

Republic of Kazakhstan

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