Is your insurer refusing to pay out, is the extent of the damage disputed or have you received a letter about a listing? Arslan Advocaten in Amsterdam helps assess your position under insurance law. We look at the policy, the insurer’s reasoning and the options for a targeted response.
Discuss your situation with Arslan Advocaten. Mention straight away if a time limit is approaching.
Insurer not paying: what reason is given?
A rejection can have various causes. The insurer may claim that the incident is not covered, that an exclusion applies or that the loss has not been sufficiently substantiated. There may also be a dispute about the amount of the compensation. For each reason, different facts and documents are relevant.
Ask for written reasons with reference to the policy conditions. Collect the policy schedule, the conditions that apply to the relevant period and any special clauses. A current version of the conditions on the internet is not automatically the same as the version that applies to your loss.
Also make a timeline of the event, the notification and the responses. Has the insurer previously confirmed cover or asked for additional documents? Then that correspondence must be taken into account. The assessment starts with the whole file, not just the latest rejection letter.
Cover and the amount of the loss are separate discussions
Cover concerns the question of whether the insurance must respond in the circumstances of the case. The amount of the loss concerns what is compensated under the policy. An accepted event does not automatically mean that every amount claimed will be paid. Conversely, a lower loss estimate does not resolve a dispute about cover.
Examine which description of the insured risk, exclusions and obligations is being used. Is it clear how the clause is applied to the event? Have the relevant facts been represented correctly? A concrete explanation of the dispute makes it possible to respond in a targeted way instead of merely repeating that you thought you were insured.
In a calculation, the excess, depreciation, the basis of valuation and proof of the loss may play a role. Check which items have been included and which have been rejected. Ask for the underlying calculation and reports. A total amount without explanation is difficult to compare with your own overview of the loss.
Which documents should you bring?
Start with the policy schedule, conditions, claim notification, correspondence and any loss assessment reports. Add photos, quotations, invoices and other evidence insofar as relevant. Keep the original files and indicate which information the insurer already has. That way we prevent a response from once again revolving around the same documents.
Write a short explanation for each disputed point. For example: the insurer uses a different date for the event, assumes improper use or disregards an item of cost. Refer to the document that supports your position. Avoid altering original documents; a separate explanation is clearer.
A fictitious example: with water damage, the parties disagree about the cause and the extent of the repairs. Photos of only the new furnishings do not show how the damage occurred. The first photos, a report on the cause and itemised repair quotations can then support different parts of the discussion. The example gives no view on cover in your own case.
Loss assessment and counter-investigation
An expert report can be important, but it must be read in the light of the instructions given. Which questions were examined, which documents were used and which assumptions were made? A conclusion about the extent of the loss is not necessarily a legal judgment on cover.
If you disagree with the report, discuss which specific points call for further investigation. A counter-investigation is not necessary in every case, nor is it automatically at the insurer’s expense. The policy conditions, statutory rules and the reasonableness of the costs must be considered before instructions are given.
Timing is also important. Sometimes a damaged object or situation must still be available for inspection. Repairs may be necessary, but preserve evidence where possible and consult about an inspection before everything disappears. Limit the damage in a responsible way and record which measures you took and why.
Duty to provide information and a suspicion of fraud
An insurer may ask questions about the notification and substantiation. Respond carefully and factually. If an earlier answer was incorrect or incomplete, explain what needs to be corrected and why. Do not speculate about matters you no longer remember, and do not adopt an investigator’s wording without checking it.
An accusation of fraud can have more far-reaching consequences than just a rejected claim. A dispute may arise about the termination of insurance policies, investigation costs or a listing. Ask exactly which measure has been taken, on what grounds and for how long. It must be possible to assess the different measures separately.
With a listing, it is important in which register the data are recorded and what the consequences are. Not every listing has the same nature or access. See our explanation of EVR and CIS listings. We assess the substantiation and a possible response without promising in advance that a listing will be removed.
First an internal complaint, then a suitable route
A well-substantiated internal complaint may give the insurer reason to reconsider the rejection. Set out which decision you dispute, why you believe the reasoning is wrong and which solution you are asking for. Add targeted evidence and ask for a final position in writing.
In suitable cases, Kifid can be a possible next step. The institute sets conditions relating to, among other things, the service provider, the complaint, prior handling and timely submission. You must first have submitted a complaint to the financial service provider. Consult Kifid’s admission requirements and have the specific time limit checked.
Proceedings before the court can be another route. Which choice is appropriate depends on the case, jurisdiction and the consequences of the chosen procedure. The choice between a binding or non-binding decision, where applicable, also deserves attention. Do not start several procedures without assessing how they relate to one another.
Time limits: contact with the insurer is not enough
A file can be under consideration for a long time while legal time limits continue to run. Limitation, complaint deadlines and procedural time limits are different topics. A general expectation that an insurer ‘will get back to you on the matter’ does not automatically preserve all your options.
So send along the first notification, rejections and any final positions. We look at which rights need to be safeguarded and how this should be done. The content of earlier letters is relevant: an acknowledgement of receipt is not the same as an acknowledgement of a claim.
In the event of financial hardship or other urgent consequences, a quick assessment may be necessary. Describe which payment is missing and what specifically threatens to happen as a result. Not every payment dispute is suitable for urgent proceedings. The evidential position, urgency and possible outcome must first be weighed.
Legal expenses insurance and the costs of a lawyer
A legal expenses insurance policy can itself be the subject of the dispute, for example in a disagreement about cover or the handling of a case. In that case, look at the applicable scheme, any disputes procedure and the conditions for external assistance. Free choice of lawyer does not mean unlimited reimbursement of all costs in every situation.
If you have cover elsewhere for the current dispute, ask about consent and cost conditions before instructions are given. An insurer is not automatically obliged to pay every invoice afterwards. We discuss how the assignment will be funded and which costs may remain for your account.
In proceedings, court fees, expert costs and a risk of having to pay the other side’s costs may be involved. Even if you succeed, actual lawyers’ fees are not always reimbursed in full. That consideration is part of determining the approach. Sometimes a targeted response or negotiation is more proportionate than lengthy proceedings.
Insurance dispute or personal injury claim?
A conflict with your own insurer is not the same as recovering personal injury damages from a liable opposing party. Both can play a role at the same time, but the legal basis differs. So state which insurance is involved and who you think should pay. That prevents the wrong conditions or arguments from taking centre stage.
If it concerns injury after an accident and the liability of someone else, also look at personal injury in Amsterdam. With concurrent claims, compensation already received and the connection between the claims must be examined. The same loss cannot simply be recovered twice.
Contact with Arslan Advocaten in Amsterdam
For an initial assessment, you can submit the policy schedule, the rejection and your main question through our office in Amsterdam. Mention straight away if a complaint or response deadline is approaching. We then determine which additional documents and work are needed.
We record who is handling the case, what the assignment covers and which cost arrangements apply. More background is available on our insurance law page. A clear initial analysis helps you choose between additional substantiation, a complaint, negotiation or proceedings.
Frequently asked questions about insurance law in Amsterdam
My insurer has rejected my claim. Is a complaint worthwhile?
That depends on the reason and the substantiation. First have the policy, the facts and the reasoning compared. A targeted complaint can be worthwhile if specific arguments or documents have not been properly taken into account.
Can every insurance case go to Kifid?
No. Conditions apply to, among other things, the complaint, the service provider and timely submission. The internal complaints procedure must also have been completed first. Suitability is assessed case by case.
Do I have to pay for a counter-expert myself?
That depends on the policy, the applicable rules and the reasonableness of the costs. Discuss funding and consent before you give instructions.
Is a CIS listing always a fraud listing?
No. There are different listings with different purposes and consequences. Have the exact listing and its reasoning examined before drawing conclusions.
Which letter should I send first?
The rejection or the final position, together with the policy schedule and the relevant conditions. Add the time limit stated and a short description of the dispute.
Request an assessment of your situation. We will discuss the next steps and the cost arrangements.