Is the insurer disputing your loss of income after an accident? The difference between your actual income and the income you would probably have earned without the accident must be carefully substantiated. A dispute about turnover, cash income or hours worked is not automatically a fraud case. Ask which calculation or statement the insurer is disputing exactly.
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Written by Onur Arslan, attorney at Arslan Advocaten. Do you have questions about your own situation? Get in touch.
Employee, self-employed or irregular work
For an employee, payslips and an employment contract provide an important starting point. Overtime, variable pay, career development and pension may also play a role. The gross loss of wages is not automatically the same as the final net loss. Benefits, continued payment of wages and tax consequences must be taken into account.
For a business owner, loss of turnover is not the same as loss of income. Lower turnover may go hand in hand with saved costs, while hiring a replacement actually causes extra costs. Annual accounts, tax returns, quotations, order books and information about the business operations help to make a realistic comparison. For a start-up business, concrete assignments and substantiated expectations are often more important than a long historical average.
Why the insurer asks for bank statements or hours
The insurer may ask for substantiation, but the request must relate to the specific head of loss. Ask what the data is meant to establish and over which period. For medical limitations, bank transactions are no substitute for a medical assessment. For income actually received, however, they can be relevant.
Make sure your records, bank receipts and loss calculation reconcile with one another. Explain any discrepancies: an invoice may have been paid later, a deposit may be a loan and a higher annual turnover may result from work done by a replacement. A verifiable explanation prevents ordinary administrative differences from being needlessly interpreted as suspicious.
Cash income and undeclared income
Work paid in cash is not unlawful in itself. It must, however, be proven and treated correctly for tax purposes. Undeclared income raises additional questions of evidence and tax. A calculation may not simply assume that tax will continue to be evaded. Have it assessed which lawful net income is plausible and which corrections are needed.
Do not create backdated invoices and do not let clients sign an incorrect statement. Existing agreements, diaries, messages, purchases of materials and consistent statements can, however, contribute to a reconstruction. Being open about missing records is better than creating a false sense of certainty.
Working during recovery
A partial return to work does not mean that you are fully able to work again. You may work fewer hours, perform different tasks or need help. Record which tasks you carry out and which ones you can no longer do. A LinkedIn profile or an advertisement for your business does not in itself show who actually carried out the work.
Conversely, income received must be correctly included in the loss calculation. A claim that demands the full former income while disregarding new earnings needs to be adjusted. A vocational expert and a financial expert can assess different elements; their roles are not interchangeable.
From dispute to solution
Draw up a statement of loss per period, with the starting points, supporting documents and payments received. Ask the insurer to state which heads of loss it accepts. An advance payment on the part that has been sufficiently established may be open to discussion while a calculation of future loss is still being investigated.
If the insurer alleges fraud, the alleged intent must also be assessed. An overly optimistic forecast or a calculation error does not in itself prove a deliberate intent to deceive. Consider the amount of the loss, any recovery of payments and a threat of registration separately. The Code of Conduct for Personal Injury Claims (GBL) sets out principles for careful claims handling.
Frequently asked questions
Is a drop in turnover my full loss?
No. Costs, replacement, taxes and the development of profits must be taken into account. The loss depends on how your business actually operates.
Can I include a future promotion?
A substantiated prospect of career development may be relevant. A mere wish without any supporting indications is not enough for a reliable calculation.
May the insurer ask for all my bank statements?
Ask about the relevance and the period. A targeted selection may be appropriate, as long as no necessary information is left out as a result.
Is cash income always excluded?
No. However, the evidence, the tax treatment and the plausibility of the income require particular attention.
Can I receive an advance payment while there is a disagreement about the calculation?
That depends on liability and on the part of the loss that has been sufficiently established. Ask for a decision on the undisputed part.
Can Arslan check my calculation?
We can assess the legal starting points and the insurer’s defence and, if necessary, prepare a financial or vocational expert investigation.
Read more about social media as evidence, discontinued advance payments and household help.
Have the dispute over your loss of income and the substantiation required assessed.
This page provides general information and is not legal advice about your own situation. No rights can be derived from its content.
