Written by Ömür Arslan, attorney at Arslan Advocaten, practising social security law. Registered in the specialisation register of the Netherlands Bar Association for tenancy law and social security law.
Nederlands: Lees dit artikel in het Nederlands: Medische deskundige inschakelen in een UWV-zaak: wanneer helpt een expertise?
Türkçe: Bu makaleyi Türkçe okuyun: UWV dosyasında tıbbi bilirkişiye başvurmak: bilirkişi incelemesi ne zaman işe yarar?
An independent medical expert can help when there is a specific difference of opinion about your limitations in a UWV case (UWV, the Dutch employee insurance agency). Start with the UWV report and ask yourself what may be missing from it or what is incorrect. Sometimes additional information from your treating practitioner is sufficient. In other cases, an insurance medicine expert assessment may be needed. A report does not guarantee a higher benefit, and the costs are not automatically reimbursed.
People who receive a WIA or Sickness Benefits Act decision do not always recognise themselves in the medical assessment. Your symptoms may well have been mentioned, but you feel that the capabilities attributed to you are too generous. Or UWV draws a different conclusion from the same medical information than you expected. An expert can investigate such a difference, provided the assignment is clearly defined.
First decide which question you want investigated
Write down in plain language what the dispute is about. Do you believe UWV overestimates your capacity, has missed a limitation on working hours or has not taken sufficient account of recovery after exertion? Or is the issue the expectation that your condition may still improve? These subjects do not always call for the same expertise.
An assignment such as ‘prove that I cannot work’ is too broad and, moreover, steers towards a predetermined outcome. A better approach is a research question that leaves room for an independent opinion. Consider, for example, the medical substantiation of a specific limitation on the date on which UWV assesses your entitlement.
Also have it checked whether the problem is genuinely medical. An incorrect reference wage (maatmanloon), an unsuitable job because of educational requirements or a wrong start date will not necessarily be resolved by a doctor. Sometimes a labour expert or a legal review is a better first step.
The difference between treatment information and an expert assessment
A treating practitioner focuses on your health and your treatment. Information about diagnosis, test findings, medication and the course of your condition can clarify important facts. A letter from a specialist can, for example, show that a complaint already existed before the UWV examination or that a treatment had not yet been completed.
An independent expert assessment has a different purpose: an expert assesses a clearly defined question on the basis of the file and, where appropriate, their own examination. An insurance medicine assessment is concerned, among other things, with translating medical data into functional capabilities. The report must explain how the conclusion follows from the facts.
A short letter from your practitioner stating only that you have serious complaints is therefore not the same as a reasoned assessment of your capacity for work. Both types of information can be useful, but they serve a different function in the proceedings.
First request the complete UWV reports
Collect the insurance physician’s report, the Functional Capabilities List (FML) if one was used, and the labour expert’s report. Add the decision and any earlier assessments. It is difficult for an expert to respond in a targeted way to an opinion that has only been summarised in a few sentences in the decision letter.
Check whether the file is complete. Important explanations are sometimes contained in a supplementary report or in a record from the objection stage. Note which versions exist and which of them form the basis of the current decision. An expert assessment based on an outdated FML may miss the point of the current dispute.
For the Sickness Benefits Act assessment, UWV describes the role of the physician and the labour expert. It is precisely the combination that matters: a medical point must ultimately be linked to the statutory assessment and to the demanding aspects of work.
The assessment date is essential
UWV proceedings are often about your health on a specific date. That may be the start date of a WIA decision or the day on which your Sickness Benefits Act benefit ends. An expert assessment that only describes how you are doing now does not then automatically answer the question the court has to decide.
You should therefore distinguish between complaints that already existed at the time and complaints that arose later. A later diagnosis can shed light on an earlier situation. The expert must then explain why the later findings say something about the relevant date.
Keep older treatment records, referrals and medication overviews. They can help with the reconstruction. Avoid presenting an uninterrupted history of complaints after the event if there is uncertainty about it. A careful report also identifies the limits of what can be established about the past.
Diagnosis and limitation are different questions
The existence of a condition does not tell you exactly how much someone can lift, how long they can concentrate or how many hours of work are feasible. People with the same diagnosis may have different limitations. For benefit proceedings, it is therefore above all the reasoned significance for your functioning that matters.
Describe specific situations from your daily life. What happens if you keep up an activity for longer? How much recovery time do you need? Which adjustments do you use? An activity that you manage thanks to help or breaks should not be presented as if it were possible without those conditions.
At the same time, your capabilities must be stated honestly. An expert needs a complete picture, including of activities that go better. A report that selects only unfavourable examples without discussing the rest may be less persuasive.
When can additional treatment information be sufficient?
Sometimes the UWV assessment rests on a factual misunderstanding that is easy to correct. For example, that a test showed no abnormalities while a specialist later reported a relevant finding, or that treatment was recorded as completed while it is in fact continuing. In that case, targeted additional information can be a logical first step.
Do not ask your practitioner for a standard statement containing a legal conclusion. Indicate which factual question is unclear and for which period information is needed. A brief but specific explanation can be more useful than an extensive file with no relation to the dispute.
Then discuss with your representative whether UWV has responded to that information on the merits. If a relevant medical question remains open, an independent expert assessment may still become worthwhile. The choice therefore does not have to be between doing nothing and an extensive investigation straight away.
Which expert suits your UWV case?
The appropriate expert depends on the question. A medical specialist can investigate a specialist issue concerning a condition. An insurance physician can assess the translation into capacity. A labour expert then examines how capabilities and the demands of a job fit together.
Ask about training, registration, experience with the relevant question and working method. An expert with experience in personal injury does not automatically have the same assignment as someone who examines a UWV assessment. The legal standard and the date must be expressly taken into account.
Independence also means that the conclusion is not agreed in advance. Avoid providers who promise a successful outcome. A professional report may support your position, qualify it or indeed show that certain objections have little medical basis.
Drafting a useful set of questions
A good assignment states the relevant date, the documents received and the specific points from the UWV report. Ask the expert to distinguish between what has been established as fact, what comes from your own account and which medical conclusions can be drawn from it.
Possible questions concern the completeness of the examination, the substantiation of limitations and any differences from the FML. In WIA cases, the prognosis may also be relevant, depending on the dispute. Have a lawyer assess which questions are needed to be able to review the benefit decision.
Ask for reasoning, not just a list of alternative limitations. A report is stronger when it becomes clear why the expert departs from UWV on a particular point and which medical data support that view. Uncertainties and alternative explanations should also be visible.
Preparing for the examination
Draw up a chronological overview of complaints, tests, treatments and attempts to return to work. Note important changes and the reason why work did not succeed or, on the contrary, was possible. Keep facts and your own interpretation separate.
Bring an up-to-date overview of your medication and describe relevant side effects, insofar as you experience them and they can be discussed medically. Do not stop or change medication in order to present a different picture during an examination. Discuss medical questions with your own healthcare provider.
Answer questions fully and in your own words. If you do not know something or no longer remember it precisely, say so. The examination is intended to obtain a reliable picture, not to assess a rehearsed presentation.
Costs, planning and reimbursement
Ask for a written cost estimate in advance. It should state what the assignment covers: review of the file, interview, physical examination, report and any answers to further questions. Check whether additional work is charged separately.
Also discuss the delivery time. An expert assessment that only becomes available after an important procedural deadline may require additional coordination with UWV or the district court. Where necessary, therefore, first lodge your objection or appeal in time and request, with reasons, the opportunity to supplement it later.
Reimbursement of expert costs depends on the proceedings and on the conditions, including reasonableness and relevance. Winning a case does not necessarily mean that every invoice will be paid in full. In the case of subsidised legal aid, it must also be examined separately how expert costs are treated.
Can the district court appoint an expert itself?
The administrative court may see reason in a case to appoint an independent expert. This does not happen automatically because you disagree with UWV. Make clear which medical doubt remains and why the available reports do not answer that question sufficiently.
The request can be supported by specific contradictions or missing substantiation. A general distrust of UWV is less useful than a precisely described medical problem. Also discuss whether you have had sufficient opportunity to provide evidence to the contrary.
An expert appointed by the district court investigates the questions put by the judge. The parties can usually respond to the report within the proceedings. Read the conclusions carefully and distinguish factual inaccuracies from a substantive opinion with which you disagree.
After receiving your own expert report
First check whether personal details, dates and the account of your medical history are correct. Report factual errors in the way the expert provides for this. That is different from demanding that an unfavourable conclusion be amended because you do not want to use it.
Then discuss with your lawyer how the report will be submitted in the proceedings. Identify which ground of objection it supports and which passage from UWV it challenges. A report without an accompanying explanation may needlessly conceal relevant points.
UWV may respond on the merits. A new difference of opinion sometimes calls for a further explanation from the expert. Not every response requires a second full examination. Determine which remaining question actually matters for the outcome.
Fictional example: complaints recognised, but no limitation on working hours
A client with long-term fatigue complaints sees various limitations reflected in the FML, but no limitation of working hours. According to the client, an activity is only possible if followed by a long period of rest. The treatment information describes the clinical picture but says little about sustaining exertion throughout the day.
A targeted expert assessment can examine what medical substantiation exists for a limitation on working hours on the relevant date. For that purpose, the account of a typical day, treatment records, earlier attempts to work and UWV’s reasoning are important. The expert does not have to reach the same conclusion as the client.
This fictional example shows that the formulation of the questions is decisive. Proving once again that a diagnosis exists does not necessarily resolve the dispute about sustained exertion. The expert assessment should instead examine the missing link.
Assessing a quotation for a medical expert assessment
Before an examination, ask exactly what is included in the assignment. Will only documents be read, or will there also be an interview or examination? Will you receive a draft for factual corrections, and is a response to questions from UWV included? Such arrangements affect both the usefulness and the total costs.
| Item | Question for the expert |
|---|---|
| Expertise | What experience do you have with this medical question and this type of assessment? |
| Reference date | Can you examine the situation on the date of the contested decision? |
| File | Which documents are still missing for a reliable assessment? |
| Report | Will findings, limitations and substantiation be set out separately? |
| Follow-up questions | How will additional questions from UWV or the district court be handled? |
An expert should reach a conclusion independently. The assignment should therefore not prescribe a desired outcome. A request to confirm a specific percentage of incapacity for work may, moreover, fall outside medical expertise where labour expert steps are required.
Make practical arrangements about the planning. A careful report that only becomes available after an important procedural deadline requires timely coordination with the body handling the case. Discuss whether an extension will be requested and which interim information can already be submitted.
If the report does not fully support your objection
An expert assessment may also confirm that certain limitations were rightly not accepted. Therefore, first read the report in full and discuss what it means for your case. Selecting only favourable sentences can give a misleading picture and make the further assessment more difficult.
Have factual errors corrected through the route intended for that purpose. An incorrect date of birth, an inaccurately described treatment or a missed document is something other than disagreement with the professional opinion. The expert must be able to assess those elements on their own merits.
Sometimes the report mainly helps to narrow the dispute: one limitation is well substantiated, other points are not. A targeted follow-up may then be stronger than repeating every original argument unchanged. Discuss how the remaining medical points affect the labour expert assessment.
Giving the expert the right file
Send the expert an organised file with the contested decision, the relevant UWV reports and the medical information relating to the research question. Arrange the documents by date and add a short table of contents.
State which documents you believe are still missing. An expert must be able to see whether a conclusion is based on a complete picture. Do not deliberately omit unfavourable but relevant information; that can undermine the reliability of the examination.
Discuss how medical data will be sent and who will receive the final report. An employer or family member does not automatically need to receive all medical details. Make sure the arrangements match the purpose of the expert assessment and the proceedings in which the report will be used.
Frequently asked questions
Do I always need my own expert for an objection?
No. Sometimes a targeted response and additional treatment information are sufficient. Start by identifying the specific error or missing substantiation. An expert assessment is a tool, not a standard requirement.
Is a report from my specialist the same as a counter-expert assessment?
Not necessarily. Treatment information mainly describes health and treatment. A counter-expert assessment independently examines a defined opinion or issue. Both can be useful, but they serve a different function.
Does UWV have to follow my expert?
No. UWV must carefully assess relevant information and give sufficient reasons for a differing position. The quality, the questions asked and the substantiation of the report are important. A report you commission yourself does not automatically take precedence over other medical data.
Can a later diagnosis change my old decision?
It may be relevant if the diagnosis says something about limitations on the earlier assessment date. The expert must explain that connection. A new condition that only arose later does not in itself prove that the old decision was wrong.
Who pays for the examination?
That must be agreed in advance. Any reimbursement depends on the proceedings and the applicable conditions. Do not assume automatic payment by UWV, the district court or under subsidised legal aid.
What if the report does not support my position?
Discuss the outcome with your representative. It can help to define the proceedings more realistically or to determine which other points are still relevant. An independent assignment means that an unfavourable conclusion is possible.
First get the dispute clearly defined
Are you unsure whether a medical expert assessment is needed? Submit your UWV reports to Arslan Advocaten. Through objection against UWV you can discuss the legal route. Also read about challenging the incapacity percentage. A targeted set of questions prevents unnecessary costs and makes any report more useful.
Read also
Sickness benefit stopped after the first-year assessment: objecting to the EZWb
Benefit stopped and no income during the objection: provisional relief against UWV
UWV has miscalculated your daily wage: review and objection
