When you consider filing a complaint with an insurer, it is of great importance that you know exactly what steps to take and what your legal rights are. A dispute with an insurance company can be particularly frustrating. This is especially true when you are dependent on a payout after a damage event or accident.
Insurers often use extensive and complicated policy conditions that are difficult for a layperson to comprehend. This can result in your claim being wrongfully rejected, the payout being lower than expected, or the handling being unreasonably slow.
In such cases, you are not alone. It is your full right to put up a defense and start a formal complaint procedure. In this article, we explain how you can effectively file a complaint and how the lawyers at Arslan & Arslan Lawyers can assist you in obtaining justice.
The first step: the internal complaint procedure of your insurer
Before you take external legal steps or file a complaint with an independent body, you must in most cases first go through the internal complaint procedure of your insurer. Every insurance company in the Netherlands is legally obliged to have an accessible and transparent complaint procedure. Start with a written complaint, preferably by registered letter or via the online complaint form. Address your complaint to the management or the complaints department.
Clearly and objectively describe the nature of your complaint, which policy conditions you are relying on, and why you disagree with the insurer’s decision. Attach all relevant evidence as appendices, such as correspondence, photos of the damage, and any expert reports. Keep a copy of your complaint and all appendices for your records.
The insurer then has a reasonable period to respond, usually six weeks. Is the response unsatisfactory or is there no response? Then consider lodging an objection against your insurer or taking further steps.
When does it make sense to consider filing a complaint with an insurer?
The decision to proceed with filing a complaint with an insurer often follows mounting frustrations or a fundamental disagreement about coverage. A common reason is the full or partial rejection of a damage claim. Insurers then rely on exclusion clauses in the policy conditions that are open to multiple interpretations. It may also be argued that you have breached your duty of disclosure when taking out the insurance.
Another reason is an unreasonable delay in the claims handling. When you have to wait months for a decision without a valid reason, this can lead to serious financial problems.
A damage payout that is too low can also be grounds for a complaint, especially if it is based on a unilateral expert report from the insurer. In such a case, you often have the right to have a counter-expertise carried out.
Furthermore, you can complain about an increase in your premium after a damage event or about a unilateral termination of your policy. Do not give up immediately, but have your case thoroughly assessed.
The importance of a well-structured complaint file
A successful complaint procedure stands or falls with the quality of your file. The better you document, the stronger your position in the discussion with your insurer or an external dispute committee. Start building a clear file immediately as soon as the dispute arises.
Keep all correspondence with the insurer, including emails, letters, and notes of telephone conversations. In addition, collect all evidence that supports your position. Think of purchase receipts, repair invoices, medical statements (in case of personal injury), witness statements, and photo or video material of the damage.
Study the policy conditions that applied at the time of the damage event. Highlight which articles speak in your favor. When engaging an expert, always request a copy of the full expert report. Do you disagree with the conclusions? Then consider an independent expert for a second opinion. An insurance law lawyer can assess the feasibility of your case and help compile a watertight file.
The route to the Kifid: an accessible alternative to the court
Does the internal complaint procedure not lead to the desired result? Then going to the Financial Services Complaints Institute (Kifid) is often the next step. The Kifid is an independent body that handles disputes between consumers and financial service providers, including insurers. A procedure is usually faster, more informal, and significantly cheaper than court proceedings. You can file your complaint digitally via the website of the Kifid.
File your complaint on time. You must do this within a certain period after receiving the final rejection from your insurer (usually within three months).
The Dispute Committee assesses your case and can issue a binding or non-binding advice. That depends on what you and the insurer have agreed in advance. In most cases, insurers choose to be bound by the rulings of the Kifid.
You are not obliged to hire a lawyer. However, in complex cases or with large financial interests, legal assistance is highly recommended, so that your arguments are optimally presented.
Litigating in court: when the Kifid offers no solution
A procedure at the Kifid is not always possible. You may also disagree with a non-binding advice from the Dispute Committee. Then you can submit your dispute to the competent civil court. This procedure is more formal and often more lengthy. For claims above €25,000, assistance from a lawyer is mandatory in most cases.
Going to court involves costs, such as court fees and lawyer fees. On the other hand, there is a very thorough legal review of your case. The judge analyzes the policy conditions, the circumstances of the case, and the mandatory legal provisions from the Dutch Civil Code (Burgerlijk Wetboek). A strong writ of summons is essential. Your claim must be legally substantiated in a watertight manner.
For more information about the working methods of the courts, you can consult the official website of the Rechtspraak. Court proceedings can seem intimidating. With the right legal representation, it is often the most effective way to force a stubborn insurer to pay out.
The role of the duty of disclosure and exclusion clauses
Two of the most common grounds on which insurers reject claims are the breach of the duty of disclosure and the reliance on exclusion clauses. When taking out insurance, you are legally obliged to answer all questions from the insurer truthfully. If the insurer discovers afterwards that you have concealed relevant information, for example about your medical history or previous damages, this can lead to the forfeiture of your right to a payout.
However, insurers cannot just use any inaccuracy to refuse coverage. There must be an intention to mislead the insurer, or the insurer must make it plausible that it would not have concluded the insurance if it had known the true state of affairs.
In addition, insurers often rely on exclusion clauses in the policy conditions, which determine in which specific situations there is no coverage (for example, in case of intent or recklessness). The interpretation of these clauses often leads to heated legal debates. A specialized lawyer can assess whether the insurer rightly relies on an exclusion clause and whether the clause might be unreasonably onerous.
Why legal assistance is indispensable in complex insurance disputes
In theory, you can file a complaint yourself and conduct the discussion with your insurer. However, practice shows that the assistance of an experienced insurance law lawyer often makes the difference between a rejection and a successful claim. Insurers have departments with specialized jurists and claims adjusters. They assess claims daily and defend the interests of the company. As an individual policyholder, you are therefore quickly at a disadvantage.
A lawyer knows the legislation, the jurisprudence, and the tactics of insurers inside out. He or she objectively analyzes the policy conditions, exposes the weak points in the insurer’s defense, and builds a convincing legal argumentation.
Moreover, a lawyer takes a lot of worries and stress off your hands. You can focus on your recovery or your business. Whether it concerns a negotiation process, a procedure at the Kifid, or a lawsuit, professional legal assistance maximizes your chances of a just outcome and fair compensation.
Frequently Asked Questions
How long does the internal complaint procedure at an insurer take on average?
The duration of an internal complaint procedure varies per insurer, but legally they must handle your complaint within a reasonable time. In practice, most insurers use a response time of a maximum of six weeks. If the investigation requires more time, they must inform you of this in good time. It is important to keep a close eye on these deadlines and, if necessary, remind the insurer of their obligations.
Can I still go to court if I disagree with the ruling of the Kifid?
This depends on the nature of the Kifid’s advice. If you and the insurer have agreed in advance to a binding advice, the ruling is in principle final and you can only have it marginalized by the court in very exceptional cases. If you have chosen a non-binding advice, the path to the civil court is still fully open to you to have the case reassessed on its merits.
What are the costs of a lawyer in an insurance dispute?
The costs of a lawyer can vary, depending on the complexity of your case and the time required. Many lawyers work on the basis of an hourly rate, but in some cases fixed price agreements are possible. If you have legal expenses insurance, the lawyer’s fees are often (partly) reimbursed. In addition, if you win the proceedings, the judge can order the insurer to pay a contribution towards the legal costs, significantly reducing your own costs.
Read also
- Filing a complaint with the Kifid – your rights, step-by-step plan, and tips
- Objection against an insurer: what can you do in case of a rejection?
- Insurance law lawyer: expert help with conflicts
Need help?
Is your damage claim being wrongfully rejected or are you unable to reach an agreement with your insurance company? The experienced specialists at Arslan & Arslan Lawyers are ready to vigorously defend your interests. We have years of experience in successfully conducting proceedings against insurers. Contact us for a free initial consultation via our website: Contact us for a free initial consultation. We will gladly discuss your situation and advise you on the best legal next steps.
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