Insurance payment for a military injury

What is happening

An insurance payment for a military injury does not depend on the insurer's goodwill: the schedule of injuries and the method of calculation are fixed by regulation. The dispute almost always comes down to two things — how causation is recorded in the documents, and which item of the schedule your diagnosis was placed under.

The usual story: the injury is treated as «minor» when the medical file shows something far more serious, or only one of several injuries is counted. Sometimes the insurer says the unit never sent the papers, and the file stalls between two organisations.

A separate case is refusal on the ground that the injury was sustained «not in the performance of duties». Here everything turns on the wording of the medical board finding and the internal inquiry file, not on letters to the insurer.

What the law says

• Compulsory state insurance of servicemen's life and health gives a right to payment for an injury sustained during service; the insurer has no discretion to decide otherwise.
• The payment rests on the military medical board's finding that the injury is causally linked to service, together with the unit's documents on the event.
• The amount depends on whether the injury falls in the severe or the minor group under the approved schedule. Every diagnosis is checked against the schedule separately.
• The insurance payment under Law No. 52-FZ does not replace the lump-sum payment under Presidential Decree No. 98 and the benefit under Law No. 306-FZ: these are separate entitlements, and one does not exclude the other.
• The general three-year limitation period applies to a claim against the insurer, but documents should be gathered at once: medical records in units and hospitals are not kept indefinitely.
• The insurer is liable in penalty interest for late payment, and we claim that along with the principal sum.

What we do

• We match your medical documents against the approved schedule of injuries and work out which group you are entitled to.
• We request from the unit and the hospital the documents the insurer treats as missing, and send them in ourselves.
• We prepare a formal claim to the insurer with a calculation and a list of discrepancies, recording the dispute before court.
• Where necessary we challenge the medical board finding or pursue a fresh examination.
• We conduct the case in court and, where the diagnosis is contested, apply for a forensic medical examination.
• We claim penalty interest for the delay and follow the payment through to transfer.

What we need from you

• The medical board finding and the certificate on causation, if already issued.
• The hospital discharge summary, your medical book, imaging and examination reports.
• The certificate on the circumstances of the injury and the internal inquiry file.
• Your correspondence with the insurer: application, refusal and any calculation sent to you.
• Extracts from service orders and from orders assigning you to tasks.
• Bank details and your identity document.