1. Get the refusal in writing
Under article 955 of the Civil Code (part two), the insurer must report the decision to refuse payment not later than fifteen days after your application, and must give a reasoned ground for the refusal. Do not accept an oral refusal. Ask in writing for the reason and for the exact clause of the contract it relies on.
2. Check the contract
The definition of the insured event; the list of exclusions; the notification period; the list of required documents. Terms in the insurance rules that are not included in the policy bind you only if the policy refers to those rules directly and the rules are set out in one document with the policy or attached to it (article 930). Terms that worsen the position of a citizen compared with the legislation are replaced by the rules of the legislation (article 929).
3. Is the refusal lawful
Article 955 lists the grounds for refusal: the contract ended before the insured event; the contract is void in itself; the insurer is released from payment under articles 951–954 (for example, the event happened through the intent of the insured person or the beneficiary; and, unless the law or the contract provides otherwise, through a nuclear explosion or military action); the insurer has filed a court action to recognise the contract invalid or to terminate it.
You must notify the insurer of the event at once, or within the period stated in the contract. But even if the notice is late, a refusal on that ground is not possible when it is proved that the insurer learned of the event in time, or that the absence of the information could not affect the duty to pay (article 951).
4. Send a claim
State the insured event, the sum demanded and its calculation, and the reference to the clause of the contract. Keep the proof of delivery.
5. Court
Under article 955, you can challenge the refusal by filing a court action against the insurer. If the payment is late, you can recover the penalty (neustoyka) provided by the contract or the law, or interest for the use of another person's money (article 327 of the Civil Code, part one). Article 11 of part one lists compensation of moral harm among the ways to protect a right.