An insurer that does not pay out, terminates your insurance or suspects you of fraud: it can have major consequences for your finances and your insurability. Arslan Advocaten helps clients from Alkmaar with disputes with insurers, from our office in Amsterdam. We assess the policy, the reasoning and the options for a complaint, negotiation or proceedings.
The first question is what exactly the dispute is about. A discussion about cover calls for a different approach than an EVR listing or a disagreement about how your legal expenses case is being handled. Below you will find, for each situation, which information is needed and which route deserves attention.
Have your insurer’s decision assessed. Mention the date of the letter and any deadlines for a complaint or response.
Which insurance law question is at issue?
| Dispute | The key question | Important documents |
|---|---|---|
| Damage is not paid or only partly paid | Is the event covered and is the calculation correct? | Policy, terms and conditions, claim notification and rejection or report. |
| Fraud allegation or registration | Which facts, ground for registration and balancing of interests are being used? | Investigation report, registration letter and your earlier statements. |
| Legal expenses cover is refused or stopped | Is it about cover, feasibility, approach or quality? | Policy conditions, feasibility assessment and file correspondence. |
The insurer does not pay: read the rejection alongside the policy
A rejection may be based on an exclusion, an obligation under the policy, uncertainty about the cause or missing evidence. The first step is to establish the exact reason. Where necessary, ask which provision the insurer relies on and what information is still needed. A general statement that something is “not insured” does not yet make clear how the assessment was reached.
Use the terms and conditions that belong to your own insurance and the relevant period. A current online policy may differ from the terms and conditions that apply to your event. Also keep clauses, supplements and amendments. The policy schedule, the terms and conditions and separate arrangements together form the basis for the assessment.
Covered, but a dispute about the amount
Sometimes the insurer accepts cover, but the payment differs from your loss. It then concerns, for example, repair costs, valuation, depreciation, the excess or the substantiation of individual items. First map out the difference between your calculation and the insurer’s. That makes clear which part actually calls for an explanation or counter-evidence.
In the event of disagreement about an expert’s report, we discuss whether additional information, a response to the report or a counter-appraisal makes sense. Whether that is possible and whether it will be reimbursed must be assessed separately. Read more about the position of the insurer’s loss adjuster.
Theft and liability insurance
In the case of theft, the circumstances, security conditions and available documents can be important. With liability insurance, a distinction must also be made between your liability towards a third party and the cover provided by your own insurer. The fact that someone holds you liable does not automatically mean that every loss is covered by your policy.
Read our specific explanation of car theft where the insurer does not pay and refused cover under a liability insurance policy. When you contact us, tell us whether a third party has already brought a claim or proceedings against you.
EVR, IVR and CIS: what has been registered and why?
A registration can affect taking out or continuing insurance. Different registers have different purposes and consequences. It must therefore first be clear which register it concerns, which data have been recorded, for how long and on what ground. The mere statement “you are registered” is not enough to formulate a removal request properly.
In the case of a fraud allegation, we look at the specific facts and the information on which the insurer bases its conclusion. The consequences for you and the justification of the duration may also be relevant. A removal request calls for a targeted response to that assessment; a general denial does not answer every allegation.
Prepare your response carefully
Request the registration letter and relevant underlying information. Keep your original claim notification and later statements. Draw up a factual timeline and indicate which points you believe are incorrect or incomplete. Do not tacitly adjust an earlier statement; explain the reason for an addition or correction.
Our page on having an EVR listing removed goes into this in more depth. If the insurer relies on an investigation you do not have, also read the explanation of requesting an investigation report.
Problems with your legal expenses insurer
Legal expenses cover can be refused or terminated for various reasons. Perhaps the insurer believes that the conflict already existed, that a waiting period applies or that your legal position has insufficient prospects of success. A complaint about slow communication or a mistake made is yet another question. Specify which decision you want to have reviewed and why.
Distinguishing cover, feasibility and quality
The disputes procedure (geschillenregeling) may be relevant in the event of a difference of opinion about legal feasibility or approach, depending on the policy. It is not automatically the route for every dispute about cover or every complaint about the service. So look at both the content of the decision and the applicable terms and conditions.
Read the explanation of the disputes procedure for legal expenses insurance. Kifid also provides information on a second opinion in the event of disagreement with the legal expenses insurer.
Engaging an external lawyer
Check in advance whether and under what conditions the insurer reimburses the costs of an external lawyer. A second opinion you choose yourself is not automatically an insured engagement. The same applies to invoking the free choice of lawyer: the applicable situation, conditions and cost arrangements must be assessed.
If a case handler may have made a mistake, loss, liability and evidence can play a role alongside the complaints procedure. For that, see our explanation of liability for a professional error by the legal expenses provider.
First a substantiated complaint, then the right next step
A strong complaint makes clear which decision you are challenging, which facts are incorrect and what result you are asking for. Only attach documents that support the core and refer precisely to the relevant passages. Ask for a written, reasoned response. Keep the date of submission and the response, as these may be important for next steps.
- Define the decision: cover, amount of loss, registration or legal expenses.
- Check the policy and the file: which terms and conditions and documents are relevant?
- Respond in a targeted way: your objections, substantiation and desired solution.
- Assess the next route: internal consultation, Kifid or the court, depending on the case.
- Monitor deadlines: a complaints procedure does not automatically mean that every other deadline has been safeguarded.
When can Kifid deal with a complaint?
Kifid assesses, among other things, whether the complainant and the financial service provider fall under its rules and whether the complaint was submitted in time. In principle, you first go through the internal complaints procedure. Not every business insurance dispute falls within Kifid’s scope. The choice of a binding ruling also deserves attention in advance.
Check the current conditions for handling by Kifid and the explanation of the course of the complaints procedure. A deadline in a rejection letter must be assessed immediately; do not wait until the last day to seek legal advice.
What should you bring for an initial assessment?
Collect the policy schedule, the applicable terms and conditions, the claim notification and the most recent decision. Add important investigation or expert reports if you have them. Make a short timeline of the event, your notifications, requests for information and responses received.
Hypothetical example: after water damage, a policyholder receives a partial payment, but does not understand which repair costs have been struck out. An overview with the quotation, the items paid and the insurer’s reasoning shows whether it concerns cover, extent or evidence. Making that distinction first prevents the complaint from missing the core.
If a document is missing, say so. You do not have to wait for a complete report to notify us of a running deadline. Also let us know whether you have already started a complaint or proceedings or entered into a binding arrangement.
Costs and insurance law assistance for Alkmaar
For clients from Alkmaar, our office in Amsterdam is the point of contact. At the intake we discuss what you want to achieve, the work required and the costs. The size of the case partly determines whether a limited assessment, a letter of complaint or a more extensive process is appropriate.
Reimbursement of legal costs is not automatically insured because the dispute concerns insurance. Discuss possible cover, subsidised legal aid or other cost arrangements in advance. You can find more about the various topics on our main page insurance law.
Frequently asked questions about insurance law in Alkmaar
Can I object to a final rejection?
A letter with the word final does not necessarily mean that every further option has lapsed. Have the reasoning, the policy, the earlier handling of the complaint and the deadlines assessed. With an insurer, do not automatically speak of the same objection procedure as with a government decision.
Do I first have to answer all the insurer’s questions?
You may be obliged to provide relevant information. If in doubt about the scope or wording, it is wise to have the request assessed in good time. Do not ignore the request, but discuss which response is correct and complete.
Can an EVR listing disappear immediately?
That depends on the ground, the evidence and the balancing of interests. There may be reason to explore removal, shortening or another measure. An outcome or fixed processing time cannot be guaranteed in advance.
Can I go to Kifid and the court at the same time?
The relationship between procedures must be examined in advance. The rules on handling and the consequences of a binding ruling can affect your options. So do not start several routes for the same dispute without an assessment.
My insurer is based elsewhere. Can you handle my case?
Yes. The insurer’s place of business does not have to be the same as your place of residence. Do let us know which insurer and policy are involved, especially in the case of foreign insurance or an international event.
Where do I start if my legal expenses insurer does not think the case has good prospects?
Request the written feasibility assessment and the relevant policy provision. Then check whether the disputes procedure applies and which question can be put to an independent assessor.
Discuss your conflict with the insurer — help for Alkmaar from Amsterdam.