In short. This module sets out the basic framework of Estonian insurance law on which all later modules build: who the parties and other persons involved in an insurance contract are, how indemnity differs from payment of an agreed sum, and where to look for the answer.
Learning outcomes
After completing this module you will be able to:
- distinguish the policyholder, the insured person, the beneficiary and the injured party;
- distinguish the logic of indemnity from the payment of an agreed sum;
- choose the right source of law for a question (VÕS, KindlTS, special statutes, EU law).
Key points
The contract and the persons involved
Under an insurance contract the insurer undertakes, on the occurrence of an insured event, to compensate the resulting loss, to pay an agreed sum or to perform the contract in another agreed manner, and the policyholder undertakes to pay premiums (VÕS § 422(1)). The insured person is the policyholder or a third person whose risk is insured (§ 424(1)); the beneficiary is the person entitled to the benefit or agreed sum when the insured event occurs (§ 425(1)). In liability insurance there is also the injured party, to whom the policyholder has caused damage (§ 510).
Roles follow from the contract
Who is a party and who may claim is determined by the policy, the terms and the statute, not by who benefits economically. Where the risk of a third person is insured, that person may claim performance from the insurer but may not dispose of those rights without the policyholder's consent (VÕS § 463(1)); his or her knowledge and conduct are treated as those of the policyholder (§ 465(1)).
Indemnity and agreed sums
In non-life (indemnity) insurance the insurer compensates the insured person for the loss caused by the insured event in accordance with the contract (VÕS § 476(1)) and need not pay more than the actual loss (§ 477). Life insurance pays an agreed sum (§ 532). Accident insurance may provide for an agreed sum or for compensation of pecuniary loss (§ 548). The product name does not tell you which logic applies: the contract does.
A map of the sources
For insurance contract questions the starting point is the insurance contract provisions of the Law of Obligations Act (VÕS, from § 422 onwards); the requirements for insurers and intermediaries, including distribution, are in the Insurance Activities Act (KindlTS); motor third party liability has its own statute (LKindlS). EU regulations such as Rome I and Brussels I bis apply directly. The Principles of European Insurance Contract Law (PEICL) and foreign doctrines are comparative and interpretative material, not applicable law in themselves.
Read before the quiz
Articles on this site:
- Estonian insurance statutes: VÕS, KindlTS, LKindlS and more
- Estonian insurance contract law: overview for foreign insurers
- Lines of insurance in Estonia: property, BI, liability and more
- Insurable interest, insurable value and sums insured in Estonia
Legal sources:
Practical case
Write down your own answer before opening the suggested approach.
A company concludes a group accident insurance contract for its employees and pays the premium. The contract pays an agreed sum if an employee becomes permanently disabled. An employee's spouse asks whether she can claim the benefit. Draw up a map of the roles and list the documents needed to answer the question.
Suggested approach
The policyholder is the company as the contracting party (VÕS § 422(1)). The insured person is the employee whose risk is insured (§ 424(1)). The beneficiary follows from the contract (§ 425(1)); the recipient of a permanent disability benefit is usually the insured person, not the spouse, and a family relationship does not in itself create a right to claim. The policy, the terms, the list of insured persons and any designation of beneficiaries are needed. As the contract provides for an agreed sum, the payment does not depend on the actual medical costs.
Self-check quiz
Answer the three questions and press "Check answers". An explanation is shown for each question.