Insurance lawyer in Eindhoven: AOV and rejected claims

What does your policy mean by disability?

Begin with the policy schedule, relevant conditions and insured occupation. Some policies focus on your own occupation; other provisions may use a different test. Do not assume an everyday description of being unable to work is identical to the contractual definition.

Describe your work before the illness or accident. A self-employed person may combine specialist work, customer contact, administration, management and travel. A job title alone does not explain the demands of the actual role. Identify the tasks you can no longer do and those you perform differently.

Support that account with diaries, assignments, working-time records and arrangements with colleagues or substitutes. If the insurer uses a different division of tasks, the assessment may change. Clarifying the insured occupational profile can therefore be as important as discussing a medical report.

Medical reports, occupational assessments and the decision

Ask which reports support the insurer’s position and what questions the experts were asked. A medical adviser addresses different issues from an occupational expert. The insurer’s final percentage or payment decision should be read alongside both rather than treated as an automatic medical conclusion.

Check the facts first. Are the correct tasks and hours recorded? Was relevant information considered? Identify specific inaccuracies and the evidence supporting a correction. Saying that you feel unheard is understandable, but a precise objection gives the reviewer something concrete to examine.

Medical records require care. Discuss which information is relevant and the appropriate way to provide it. You do not need to send your complete medical history indiscriminately with a first enquiry. If further or independent assessment is useful, clarify the expert’s instructions, questions and costs beforehand.

When benefits are reduced or stopped after reassessment

A reassessment may involve recovery, a different occupational opinion or application of another contractual test. Request the reason, effective date and calculation separately. A lower percentage does not explain by itself what the insurer believes has changed.

Compare the new decision with earlier reports and payments. Has your health changed, does the insurer consider other tasks possible, or is the same information being evaluated differently? Include previous assurances and correspondence, even if a former case handler issued them.

If payment is about to stop, describe the practical urgency with concrete information about obligations and available resources. Urgent court proceedings are not automatically suitable because the benefit is important. Evidence, legal basis and procedural risks also matter. The substantive response to the reassessment must still be prepared.

Alleged non-disclosure when the policy was taken out

An insurer may allege that a health declaration or application omitted relevant information. We need the exact questions, original answers and dates. A later summary may miss important wording. What you knew when you completed the form must be distinguished from information obtained afterwards.

Articles 7:928 to 7:930 of the Dutch Civil Code address pre-contract disclosure and its consequences. A breach does not automatically justify every measure. The relevance of the omitted fact, the insurer’s acceptance position and any alleged intent to mislead can matter. Policy terms and whether mandatory rules apply must also be checked.

Ask what fact was allegedly omitted, when the insurer discovered it and what consequence it applies. A changed premium, exclusion, refusal of benefit and termination are separate issues. An assertion that the insurer would never have accepted the risk requires examination of the supporting material. See our explanation of non-disclosure.

A public AOV judgment: breach did not settle every consequence

The district court of Oost-Brabant considered an AOV dispute involving a self-employed consultant who answered a question about drug use incorrectly. This was a public case, not one handled by our firm. The insurer refused benefits and terminated the policy.

The court found a disclosure breach but no intent to mislead. It was insufficiently clear how the application would have been treated with correct information, and the alleged connection with disability was not adequately supported. The policy had to continue. The insurer still had to address entitlement to benefits; the judgment did not simply award every payment claimed.

The decision is dated 17 September 2025: Read the published judgment. It illustrates why the precise consequence of a breach needs separate analysis. Your outcome depends on your policy and evidence.

Turnover is not the same as work actually performed

An entrepreneur may receive money for work completed before becoming unable to work. Conversely, falling turnover can have causes unrelated to illness. The policy determines the relevance of income, so working hours, personal effort and revenue should not be mixed together.

Keep invoices, assignments, payment dates and agreements with substitutes. Explain which income relates to which period and whether a partner or employee performs your tasks. Identify any additional costs. This helps an assessment focus on verifiable information.

If working hours are estimated, label them as estimates and explain the basis. Do not present a reconstructed figure as a contemporaneous record. Where the insurer draws a different conclusion from the accounts, a targeted explanation may be more useful than resending an unorganised collection of financial records.

Changes in occupation and the insurance adviser

Your activities may change after the policy begins. A tradesperson might move into management or a consultant might offer different services. Check the contractual requirements for reporting changes and any correspondence about amendments to the policy.

Send advice records, quotations and messages explaining what the adviser or insurer knew. The insurer’s coverage obligations and a possible failure by the adviser are different questions. An uninsured event does not automatically prove negligent advice. The adviser’s duties, conduct and any resulting loss need assessment.

Sometimes both routes need investigation without prematurely conceding that the policy gives no cover. The factual account should remain consistent. A claim against a person responsible for an accident may also overlap with an AOV claim; existing payments and the legal basis of each must be considered together.

Protect periodic claims and complaint deadlines

A continuing internal discussion does not necessarily preserve every claim. Limitation, complaint periods and deadlines for responding to a procedure are separate. Send the first refusal, later reassessments and payment statements so that the periods involved can be identified.

Article 7:942 of the Dutch Civil Code contains rules for limitation of insurance payment claims, including written claims and unequivocal rejection. Periodic benefits can involve different payment periods. The appropriate action needs to be assessed for your claim rather than assumed from a general three-year reference.

Kifid eligibility must also be checked for the complainant and particular product. Being self-employed does not settle the answer for every policy. Kifid’s current eligibility information explains the general conditions. Its complaint periods are distinct from civil limitation.

A settlement can affect future benefits

An offered payment may be an advance, reimbursement of an identified period or a final settlement. Read the proposed agreement as a whole. Does it address future benefits, continuation of the policy, costs or other claims? An attractive immediate amount can have broader consequences.

Where medical or occupational circumstances are still developing, uncertainty should be made explicit. Clarify what remains open and what is being released. Do not rely solely on an informal explanation that the document is “standard”. The written terms need to reflect the agreement.

We discuss the practical choice between further evidence, negotiation and proceedings. No route guarantees payment. Costs, urgency and the quality of the available evidence should guide the decision. The aim is to understand what you gain and give up before accepting a final arrangement.

Eindhoven and the appropriate court

Our office address is Croy 7C, 5653 LC Eindhoven. Call 040 711 30 99 to discuss an appointment. Telephone or digital preparation may help when documents are extensive. Consulting this office does not itself determine the court with jurisdiction.

Eindhoven falls within rechtbank Oost-Brabant, with hearing locations in Eindhoven and ’s-Hertogenbosch. Allocation depends on the type of proceedings. Larger commercial civil cases are generally handled through ’s-Hertogenbosch. The court papers and applicable rules determine the venue.

A lawyer is not mandatory before the kantonrechter; other civil proceedings can require representation. Kifid is a national route where eligibility is satisfied, and health-insurance complaints may involve SKGZ. The type of insurance must be identified before choosing a forum.

Documents and costs for the first assessment

Prepare four points: your insured occupation, the date you became unable to work, payment history and the decisions you challenge. Include the policy, health declaration and relevant medical and occupational reports. List documents still to be requested rather than delaying every step until the file is complete.

Explain your goal: resumed payment, restoration of cover or a sound reassessment. Mention an upcoming response date or immediate financial difficulty. We also check possible conflicts of interest before accepting an engagement.

The initial assessment is free. Further work, independent experts and court proceedings are discussed separately. An insurance dispute is not automatically paid by the insurer you challenge. Read our guide to an AOV benefit that is refused or terminated for related practical information.

Frequently asked questions