Has your AOV benefit been denied or terminated? Then it is understandable that you want clarity quickly. A disability insurance policy (AOV) can be important for your income if illness or an impairment means you can work less or not at all. Still, a denial is not automatically the end of the matter, nor is it automatically wrong. The first step is therefore: read exactly what the insurer has decided, which policy condition the decision is based on and what information was used.
An AOV benefit is not a WIA benefit and not a personal injury compensation. It concerns a private insurance with its own terms. Cover depends, among other things, on the policy, the insured occupation, the definition of incapacity for work, the waiting period, the term and the facts of your situation. In this article you will read which information you should collect and how to carefully assess a denial or termination.
Short answer: start with the denial letter and the policy
When an AOV benefit is denied, a calm, written fact-check is usually the best start. Do not only ask whether the insurer will reconsider the decision. First ask which policy condition, medical or occupational expert information, calculation or factual circumstance is considered decisive by the insurer.
| Situation | What to check first | Why this matters |
|---|---|---|
| The AOV benefit is denied | The full denial letter and the cited policy provisions | You can see what the insurer based the decision on |
| An ongoing benefit is terminated | The reason for termination, the effective date and the assessment used | You can check what has changed since the earlier decision |
| The benefit is lower than expected | The calculation, the insured amount and the applicable conditions | A difference can have various causes |
| You disagree with the assessment | Which information is missing or incorrect in your view | A concrete, substantiated position is stronger than a general complaint |
Store the letter, the enclosures and relevant emails immediately in one file. Also note the date on which you received the decision. Good administration prevents important questions from getting mixed up later.
What does a denied AOV benefit mean?
A disability insurance is an agreement with terms that can differ per policy. The insurer assesses a claim on the basis of those terms and the available data. A denial or termination may, for example, relate to whether there is incapacity for work according to the policy, whether the waiting period has expired, which occupation or tasks are insured, whether an exclusion applies, or which information is required for the assessment.
That does not mean you have to guess the reason yourself. The denial letter should provide sufficient guidance to understand what step the insurer has taken. Is the reason too general or is there no reference to the relevant policy condition? Then ask in writing for clarification. Include your policy number and quote the specific passage you do not understand.
Important: a WIA assessment and an AOV assessment are not the same. One decision does not automatically determine the outcome of the other, because the scheme, purpose and conditions may differ.
For general information about insurances in case of personal injury, also read Which insurance policies pay out for personal injury?. That page describes the role of different insurances, but an AOV claim always requires assessment of its own policy.
Which documents do you need?
Create a file with documents that make the sequence of events and your position clear. Do not circulate documents unnecessarily, but do keep what you receive and send.
| Document | What to look for |
|---|---|
| Policy schedule and policy terms | Insured occupation, insured amount, waiting period, term, definitions and exclusions |
| Denial or termination letter | The exact reason, cited provisions, date and any next steps |
| Correspondence with the insurer | Which questions were asked, which answers were given and which documents were received |
| Overview of your work activities | What you actually did before and during the claim period; describe this as concretely as possible |
| Relevant medical or expert documents | Only insofar as they are relevant to the claim; check what you share and with whom |
| Financial and business documents | Only when the policy or the insurer requests them and they are relevant for the assessment |
The aim of this list is not to create a standard outcome. The documents help to check whether the facts used are correct and whether the insurer is answering the same question as the one at issue in your file.
Check the policy step by step
1. Which occupation or tasks are insured?
With many AOV policies, the insured occupation is an important starting point. Therefore compare the description in your policy with the tasks you actually performed. A general answer such as “I can no longer work” often says less than a concrete description of tasks, hours, physical strain, responsibilities and the limitations you experience in that context.
Did your work change over the years? Then record carefully when and how. Whether a change affects cover depends on the policy and the circumstances. Do not draw your own conclusion that cover lapses or exists, but do present the relevant information clearly.
2. Which definition of incapacity for work does the policy use?
A policy can provide its own definition of incapacity for work and its own method for determining the percentage. Therefore check which definition the insurer applies and which clause in the conditions is cited. If anything is unclear, ask which specific tasks the insurer believes are still possible and on what that assessment is based.
A difference of opinion about work capacity or tasks is not the same as proof that the decision is wrong. It does make clear which facts and documents require further attention.
3. Are waiting period, exclusions or end date mentioned?
A denial letter may refer to a waiting period, an exclusion, a pre-existing condition, a change in the risk or an end date of cover. Read the clause cited in full, not just the sentence quoted in the letter. Then check whether the facts on which the insurer relies are presented correctly and completely.
Questions about information provided before the insurance was taken out require extra care. The legal assessment may depend on the specific questions, answers, policy conditions and further circumstances. Do not be guided by general assumptions in such a situation and, if necessary, seek targeted legal advice.
How should you respond substantively to the denial?
A good response is factual, structured and verifiable. Start with the decision you contest and then state, for each element, why you request further explanation or reassessment.
You can, for example, use the following structure:
- State your name, policy number and the date of the denial letter.
- Briefly describe the decision taken: denial, termination or change of the benefit.
- Identify which policy condition or factual finding you do not understand or contest.
- Explain which document, correspondence or specific circumstance in your view is missing or incorrect.
- Request a written response and the documents on which the insurer relies, insofar as they are not already available.
Avoid accusations you cannot substantiate. A targeted question about a policy condition, your tasks or a concrete calculation is generally easier to assess than a general statement that the decision “does not feel fair”.
Medical information and an AOV claim
Medical information can be sensitive. Therefore share it purposefully and always check which document you provide, to whom and for what purpose. When an insurer asks for additional information, you can ask which information is needed exactly for the assessment of your claim and which function or expert will use it.
Also keep copies of statements, authorisations and correspondence. It is advisable to make a chronological overview: when did the complaints arise, when did you report sick, which information was shared and which decision followed? This way you keep facts separate from interpretations.
This article cannot assess which medical information is needed in your individual file. The appropriate approach depends on the policy, the insurer’s questions and your specific situation.
First a written complaint to the insurer
If, after clarification, you still believe that the decision is incorrect, submit a clear written complaint to the insurer. This is also relevant if you later want to consider whether Kifid can handle your complaint. Kifid states that a complaint must first be submitted in writing to the financial service provider before you file it there.
State in your complaint what you are asking for: for example, an explanation, correction of a factual error, reassessment or a response to a specific policy clause. Only attach documents that fit that purpose and keep a copy of what you sent.
More general information about a complaint against a financial service provider can be found at Kifid. The organisation also describes the route for submitting a complaint. Whether Kifid can handle a specific AOV case depends on the current rules, the service provider involved and the facts of the file. Therefore use the quick test in advance and check the current conditions.
For a broader explanation of the procedure you can also read: Kifid procedure explained.
When can legal assistance be sensible?
Legal assistance can be useful when the consequences of the decision are significant, when the policy conditions are complex, when medical and occupational information is difficult to interpret, or when an internal complaint does not produce a clear solution. A lawyer can help to assess the policy, the denial letter and the relevant documents in conjunction.
That is not the same as a promise that a benefit will still be granted. The outcome remains dependent on the policy, the facts, the available information and the applicable procedure. Would you like your situation to be assessed? Contact Arslan Advocaten. For an overview of our services you can also visit Insurance law.
Frequently asked questions about a denied AOV benefit
Does a denied AOV benefit mean I no longer have any right to income?
Not necessarily. A denial of a private AOV claim must be distinguished from other possible sources of income or schemes. The exact consequences of the decision depend, among other things, on your policy and your personal situation. Therefore start with the denial letter and the policy.
Can an insurer terminate an ongoing AOV benefit?
Depending on the policy and the facts, that may be at issue. Check which reason, policy condition, date and assessment the insurer cites. Ask for a written explanation if it is not clear what the insurer believes has changed.
Do I have to complain to the insurer first?
If you contest the decision, a written internal complaint is a logical step. Kifid also states that you must first submit the complaint in writing to the financial service provider before you file it with Kifid.Kifid
Is a WIA decision decisive for my AOV benefit?
Not automatically. A WIA assessment and an assessment under a private AOV policy have different starting points. Therefore read the definition and conditions in your own policy.
Which documents should I keep?
Keep at least the policy, policy terms, the denial or termination letter, relevant correspondence and the documents the insurer cites for the assessment. Also keep your own response and proof of dispatch.
Summary
When an AOV benefit is denied, a careful approach starts with separating facts from conclusions. Check the denial letter, read the cited policy conditions in full and organise the relevant documents. Then ask specifically for an explanation or reassessment if you believe the facts or reasoning are incorrect. A written complaint to the insurer may be a necessary next step before you consider whether Kifid can handle your case.
Do you have questions about a denied or terminated AOV benefit? Contact Arslan Advocaten for an assessment of your situation.
Sources and further reading
- Kifid — a financial complaint
- Kifid — how do I submit my complaint?
- Arslan Advocaten — Kifid procedure explained
- Arslan Advocaten — Insurance law
