Is your legal expenses insurer refusing your request to use the disputes procedure (geschillenregeling)? Ask for the precise reason and the applicable provision. The procedure is intended for certain disagreements about how a covered case is handled. A refusal may be wrong, but not every dispute about cover or every request for a second lawyer automatically falls under this procedure.
Nederlands: Lees dit artikel in het Nederlands: Geschillenregeling geweigerd door uw rechtsbijstandsverzekeraar
Türkçe: Bu makaleyi Türkçe okuyun: Hukuki koruma sigortacınız uyuşmazlık prosedürünü reddetti
Written by Onur Arslan, attorney at Arslan Advocaten. Onur Arslan practised for many years as a corporate lawyer and insolvency trustee (curator) and has extensive experience in financial law disputes. Do you have questions about your own situation? Get in touch.
What is your disagreement about?
Distinguish between the question of whether your dispute is covered and the question of how a covered case should be handled. The first concerns cover. The second may concern legal prospects, evidence, a settlement proposal or the need for proceedings.
Put your disagreement in concrete terms. For example: the case handler considers a wage claim hopeless, while you believe that three payslips and an email refute that assessment. That is easier to assess than simply saying you are dissatisfied. Ask for the final substantive position that is to be submitted to the independent assessor.
Common reasons for a refusal
Sometimes the insurer’s claims handler states that there is not yet a definitive difference of opinion. In that case, ask which substantive decision is still to follow and when. Sometimes it states that only cover is in dispute. Check whether that is correct or whether an assessment of the substantive prospects is being presented as a question of cover.
It may also be argued that the procedure has already been used. There is no unlimited right to put the same disagreement to a new assessor time and again. It must, however, be considered whether there are new facts or a genuinely different follow-up question. State precisely what has changed since the earlier advice.
Kifid’s explanation of a second opinion in legal expenses insurance (Kifid is the Dutch Financial Services Complaints Tribunal) explains the role of the disputes procedure. In addition, the specific procedure and its consequences must be checked in your own policy conditions.
Substantiating your request again
Send the insurer the disputed position, your own reading, the decisive documents and a proposal for a clearly defined question. Ask for a reasoned decision on whether the procedure applies. Also mention the deadlines in the main case and ask who monitors them in the meantime.
Do not attach hundreds of unsorted documents if a single piece of evidence determines the disagreement. A clear file helps the independent assessor and reduces the risk of the parties talking at cross purposes. Do make sure, however, that relevant unfavourable information is not left out.
Independent assessor or your own lawyer
A lawyer who acts formally as the independent assessor may be excluded by the policy conditions from handling the same case later. At ARAG, this restriction also applies to the assessor’s firm; see ARAG’s explanation of the disputes procedure. Check this before the appointment if you want Arslan to take over the main case.
Your own second opinion may also be useful in determining your position. Its costs are not automatically reimbursed. Nor does favourable advice in itself entitle you to have the case transferred to an external lawyer. Agree on the role, the instruction and the costs in advance.
If the refusal stands
An internal complaint may be followed by an assessment of the appropriate external route. Kifid only deals with complaints that fall within its jurisdiction and rules. In other situations, or in urgent cases, the court may be relevant. A complaint does not automatically suspend the deadlines in your employment, tenancy or personal injury case.
Frequently asked questions
May I use the procedure again?
That depends on the policy conditions and the new question. Mere disappointment with earlier advice does not in itself entitle you to a new round.
Is the free choice of lawyer the same as the disputes procedure?
No. Free choice concerns the legal representative in the situations intended for it; the disputes procedure assesses a disagreement about how the case is handled.
May Arslan first give an assessment and then take over the case?
Restrictions may apply where a lawyer acts formally as the independent assessor. Have this checked in advance.
What does Arslan need?
The policy, the substantive position, the refusal to apply the procedure, earlier advice and the most important deadlines.
Also read about your own second opinion and complaints about legal expenses insurance.
Have it assessed whether your request for the disputes procedure was rightly refused.
This page provides general information and is not legal advice on your own situation. No rights can be derived from its content.
