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11 march 2024, 11:33
Disputes with insurance organisations under contracts of mandatory state life and health insurance of servicemen and other persons equated to them should be considered within the framework of compulsory pre-judicial dispute settlement procedure, i.e. consideration of such disputes falls within the Financial Ombudsman’s competence. This approach was approved by the Financial Ombudsman Service (FOS) Expert Council at the meeting on February 22.
As Financial Ombudsman Viktor Klimov reported at the meeting, the Service has been receiving appeals on such disputes. And the Service in its practice now proceeds from the understanding that their consideration falls within the Financial Ombudsman’s competence.
However, this position has not always found support in court. For example, the Financial Ombudsman made a decision to satisfy the stated requirement on such an appeal, but the insurance organisation appealed against it in court. The first-instance court cancelled the Financial Ombudsman’s decision, with which the Financial Ombudsman disagreed. Ultimately, in this case the Financial Ombudsman was refused to transfer the cassation appeal for consideration in a court session of the Russian Supreme Court Judicial Board for Civil Cases.
The Supreme Court agreed with the conclusions of the first-instance court that the consideration of claims arising out of the said agreement did not fall within the Financial Ombudsman’s competence. The Court noted that the beneficiary in these relations is not a consumer of financial services within the meaning of the Law on the Financial Ombudsman, and the insured event occurred in connection with injury to the health of the insured, who was on duty during the period of service, therefore, “there occur service (labour) legal relations between the insurer and the insured”.
According to Viktor Klimov, the Financial Ombudsman Service proceeds from the implication that the relations between the insurer and the beneficiary under the contract of mandatory state life and health insurance have a civil-law nature, despite the fact that they are based on service relations between the serviceman and the insurer, which have a public-power nature, and are included in the general public-law machinery.
The obligation to conclude and execute the said contract does not relate to the labour obligations of the Russian Ministry of Defence and other insurers, but is a state guarantee for members of certain professions that involve risks.
According to Federal Law No. 52-FZ of 28.03.1998 (which regulates mandatory state life and health insurance), an insured event is understood as the occurrence of certain events during the period of service or military training. At the same time, the law does not link insured events directly to the performance by the insured of official duties at the time of the occurrence of the event.
In addition, in case of the death of the insured, the beneficiaries are his/her spouse, minor children and other persons. However, they have no labour relations with the insured at all, Viktor Klimov pointed out.
These arguments are in favour of the conclusion that the contract of mandatory state life and health insurance is also a contract in favour of a third party, whose relations with the insurer may not have an official or other public-power nature.
Upon occurrence of an insured event, the beneficiary (servicemen or their family members) applies for insurance payment to insurance organisations, which, on the basis of the submitted documents, decide on the payment, its amount or refusal of payment. The relationship of making an insurance payment does not relate to labour relations, but is of a civil law nature and is related to the provision of insurance protection guaranteed by the state to servicemen.
Thus, the beneficiaries under mandatory state life and health insurance contracts are consumers of financial services within the meaning of Article 2(2) of the Law on the Financial Ombudsman. Consequently, in resolving disputes arising from mandatory state life and health insurance contracts, the Financial Ombudsman does not exceed the limits of his/her competence, the Financial Ombudsman concluded.
