An insurance law attorney can help you when your insurer refuses a payment, cancels your policy or registers you on the basis of alleged fraud. Disputes with insurers are legally complex and can have significant financial consequences. In this comprehensive article you can read when you need an insurance law attorney, what rights you have vis-à-vis your insurer and how we act strategically to protect your interests.
What does an insurance law attorney do?
An insurance law attorney handles disputes between insured parties and insurers. This can involve private insurances, such as home contents or liability insurance, but also commercial insurances, disability insurance or directors’ liability.
Common issues include:
- Refusal of a damage payment
- Dispute about policy coverage
- Termination of the insurance
- Registration in CIS or EVR
- Suspicions of fraud or deception
- Disputes over intent or gross negligence
In all these situations it is important that an insurance law attorney legally analyses the file and assesses whether the insurer is acting rightly.
When do you need an insurance law attorney?
Not every disagreement requires immediate legal action. Nevertheless, there are situations in which it is wise to engage an insurance law attorney quickly:
- Your claim is completely rejected
- The insurer invokes an exclusion clause
- You receive a letter suggesting fraud
- Your insurance is terminated with immediate effect
- You are entered in a warning register
The earlier an insurance law attorney is involved, the greater the chance that escalation can be prevented.
Refusal of payment: what are your rights?
An insurer may not simply refuse a payment, but the burden of proof is divided, and that division determines which documents you need.
- You state and substantiate that the event falls within the cover and how large your loss is (Article 150 of the Dutch Code of Civil Procedure, Rv).
- The insurer bears the burden of proving the facts on which its defence is based: an exclusion, reliance on non-disclosure, or intent to deceive. In a non-disclosure case, this means in practice that it must use its acceptance policy at the time to substantiate what it would have done with the correct information.
The ordinary civil standard applies: the court must find the alleged facts sufficiently plausible. Nothing has to be proven “beyond any doubt”. Read more about objecting to your insurer.
Registration: the CIS database and the EVR are not the same
These two are often lumped together, while the threshold and the route differ fundamentally.
The CIS database of Stichting CIS mainly contains ordinary insurance and claims data: claim reports, guarantee fund reports, driving disqualifications and confidential notifications after a policy has been cancelled (royement). No suspicion of fraud is required for this. A claim report only shows that a claim for cover was once made and says nothing about fault or cover; correction is therefore only possible if there is a factual error.
The EVR (Extern Verwijzingsregister, external referral register) is part of the warning system for fraud and other incidents, governed by the Protocol Incidentenwaarschuwingssysteem Financiële Instellingen (PIFI). Each participating financial institution keeps its own EVR; other participating institutions only see whether you are registered, not why. Where there is such a registration, we test it against the cumulative requirements of Article 5.2.1 PIFI:
- the conduct was or is a threat to the interests of clients, employees or the institution, or to the continuity or integrity of the financial sector;
- it has been sufficiently established that you were involved; a suspicion is not enough, and criminal offences are in principle reported to the police;
- the principle of proportionality has been observed, both for the registration itself and for its duration (a maximum of eight years, Article 5.3.2 PIFI);
- the required balancing of interests was actually carried out and recorded, and you were informed about the registration (Article 9.1 PIFI).
More information about privacy rights can be found at the Autoriteit Persoonsgegevens.
If you want to read more about registrations, you can also visit our page about removing a CIS registration or removing an EVR registration.
Coverage and interpretation of policy terms
A common dispute concerns the interpretation of policy terms. In insurance law it applies that ambiguities in consumer insurances are generally to be interpreted in favour of the insured. Nevertheless, we regularly see insurers applying a very strict interpretation.
An insurance law attorney analyses:
- The exact wording of the policy
- Any clauses and exclusions
- The reasonable expectations of the parties
- The formation of the insurance
That can be decisive for the question whether you are entitled to a payment.
Step-by-step plan in a dispute with your insurer
In a dispute with your insurer we go through four steps: file building, legal analysis, written defence and — if necessary — a civil procedure. Our strategic approach strengthens your position at every stage.
Procedure against an insurer
When consultation does not lead to a solution, a procedure can be initiated. This may include:
- A bodemprocedure (full merits proceeding) before the civil court
- A kort geding in cases of urgent interest
- A complaints procedure at Kifid
An insurance law attorney determines together with you which route is most effective.
Read more about litigation on our page about procedural law.
Practical example
An entrepreneur reported fire damage to his business premises. The insurer held that there was a breach of the duty to disclose when entering into the insurance and refused payment. After thorough analysis it appeared that the alleged inaccuracy was not relevant to the risk. The insurer nonetheless proceeded to make the payment. This illustrates how an insurance law attorney can be decisive in complex files.
Relationship with other areas of law
Insurance law often touches on other areas of law. Think for example of:
- Personal injury in liability matters
- Employment law in cases of illness and incapacity for work
- Tenancy law in cases of fire or water damage
- Directors’ liability in commercial claims
An insurance law attorney therefore often works in a multidisciplinary manner.
Costs of an insurance law attorney
In non-personal-injury cases we also work, if you qualify, on a legal aid basis (toevoeging). That means that the Raad voor Rechtsbijstand (RvR — Legal Aid Board) reimburses a large part of the attorney’s fees when your income is below a certain threshold. You then only pay a statutory own contribution.
We assess in advance whether you qualify for funded legal assistance. That way you know immediately what to expect.
Why engage an insurance law attorney?
Insurance law has its own statutory rules (Title 7.17 of the Dutch Civil Code), policy conditions, protocols and rules of evidence. They require knowledge of the rules and experience with insurers. A general approach is often insufficient when the stakes are high.
An insurance law attorney:
- Knows insurers’ strategies
- Understands how evidence is assessed legally
- Can negotiate effectively
- Proceeds to litigation decisively if necessary
Especially in cases of suspected fraud or registration, knowledge of the PIFI, the insurers’ codes of conduct and the privacy rules matters.
Conclusion: acting in time prevents greater damage
A conflict with your insurer can have far-reaching financial and personal consequences. An insurance law attorney helps you to secure your rights and challenge unjust decisions. The sooner you obtain legal advice, the stronger your position.
Would you like your file reviewed by an insurance law attorney? You can contact us for an initial analysis of your situation.
The legal dynamics in disputes with insurers and the role of an insurance law attorney
When an insurer refuses to pay an asserted damage claim or decides to unilaterally dissolve the insurance contract on the grounds of alleged misrepresentation, insured parties are confronted with a complex legal reality. Dutch insurance law, anchored in Title 17 of Book 7 of the Burgerlijk Wetboek (Dutch Civil Code), regulates the precise rights and obligations of both the insured and the company. An insurance law attorney plays a crucial role in safeguarding the contractual and statutory balances, particularly when the insurer unjustly relies on exclusion grounds, forfeiture periods or intrusive statutory sanctions that seriously disadvantage the policyholder’s position.
The statutory duty of disclosure and the consequences in claims (Article 7:928 BW)
One of the most common legal battlegrounds in rejected damage claims concerns the breach of the duty of disclosure as laid down in Article 7:928 of the Burgerlijk Wetboek. When entering into the insurance contract, the prospective insured is obliged to provide all facts truthfully which he ought to understand the significance of and which may influence the insurer’s assessment of the risk. If it later appears that an incorrect or incomplete statement was made, Articles 7:929 and 7:930 BW determine the consequences. The insurer must point out the breach to you within two months of discovering it. The payment remains in full if the undisclosed fact was not relevant to the risk as it materialised. Otherwise it is reduced in proportion to the higher premium or lower sum insured, or calculated as if the insurer’s other conditions had applied. It lapses only if the insurer would not have concluded the insurance at all, or if you acted with intent to deceive. Cancellation with immediate effect is only possible in those last two cases.
In practice there is frequent debate about whether the insured acted with intent to deceive or made a mistake in good faith. The insurer must prove the facts on which it relies: the intent to deceive or, by reference to its acceptance policy at the time, that it would not have concluded the insurance or would have done so on different terms. A mere finding of an inaccuracy is therefore not enough for immediate cancellation or total refusal; which sanction is possible depends on what the insurer can prove.
The scope of the damage payment and the pleading and evidential burden of the insured
Besides the formation of the contract, the actual determination of damage is a frequent source of disputes between the parties. Article 7:944 BW defines damage insurance as insurance intended to compensate for pecuniary loss that the insured might suffer. The insured must in principle allege and, if necessary, prove that the damage falls within the coverage and arose from an insured risk. Insurers often engage a loss adjuster and consult the CIS database to check previous claims and registrations. If the results of such investigations are unilaterally interpreted by the insurer to refuse payment, legal assistance is necessary to organise an independent counter-expert opinion and to critically test the factual grounds of the damage calculation against both the policy terms and the standards of reasonableness and fairness.
Going to the Klachteninstituut Financiële Dienstverlening (Kifid) versus the civil court
When an amicable settlement with the insurer definitively fails to materialise, the insured has the option of formal dispute resolution. Those affected can file a complaint with the Klachteninstituut Financiële Dienstverlening (Kifid). For consumers, the ruling is non-binding unless both you and the insurer choose binding advice. Kifid assesses financial disputes against both the Burgerlijk Wetboek and the applicable codes of conduct and general terms and conditions. Kifid often provides a more accessible and faster alternative to the regular court, although complex cases with extensive evidentiary requirements, witness hearings or substantial financial damage amounts often lend themselves better to a summons procedure before the civil court. An expert attorney can carry out a thorough risk and feasibility analysis prior to this step, so that the insured’s position is optimally safeguarded against the financially strong legal departments of professional insurance companies.
For the current principles you can consult the statutory regulation on wetten.overheid.nl.
Frequently asked questions
When should I engage an insurance law attorney?
Have your situation assessed if your claim is completely rejected, the insurer relies on an exclusion clause or on non-disclosure, or if you have been entered in a warning register. The sooner you seek help, the sooner deadlines and evidence can be secured.
What can an insurance law attorney do for me in the event of a refusal to pay damages?
The attorney assesses whether the insurer is acting rightly by examining whether the damage falls within the coverage, whether there has been a breach of the duty of disclosure, or whether intent or fraud is involved. In this way they protect your legal position and rights.
What should I know about registration in CIS or EVR?
A claim report in the CIS database is not a fraud signal. An EVR registration is only permitted if, among other things, it has been sufficiently established that you were involved in a serious incident. An attorney assesses whether the registration is proportionate, whether you were heard beforehand and whether less intrusive measures were possible.
How can an insurance law attorney help me with disputes about policy coverage?
The attorney analyses the policy terms and assesses whether the insurer is disputing the coverage on proper grounds. This provides clarity and strengthens your position in disputes.
