Has the insurer stopped your personal injury advance payments while your costs keep mounting? Immediately ask for written reasons, an up-to-date overview of the losses accepted and a decision on the undisputed amount. An investigation, a new claims handler or a dispute about one head of loss does not automatically mean that every payment may be halted.
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Written by Onur Arslan, attorney at Arslan Advocaten. Do you have questions about your own situation? Get in touch.
Why does an insurer stop paying?
The reason may lie in liability, the causal link between the accident and your symptoms, the amount of the loss or a suspicion of incorrect information. Sometimes the insurer argues that the advance payments already made cover the loss established so far. In other cases a recent statement of loss is missing or the insurer is waiting for medical advice.
Ask which reason applies in your file. “The file is under investigation” is of little help if it is not clear what still needs to be established. A targeted question might be: which specific information is preventing payment of which head of loss, and when will a decision on it follow?
Set out your current payment needs clearly
Update your statement of loss and deduct the advance payments received. Attach documents for costs demonstrably incurred and lost income. Separate established losses from projections. A realistic and verifiable overview provides a stronger starting point than a general request for more money.
Also describe the urgency: rent arrears, necessary treatment, the cost of assistance or loss of income. Add evidence of the relevant payment deadlines. Financial pressure can be a reason to act quickly, but it does not in itself prove the legal extent of the loss.
Investigation or suspicion of fraud
Where fraud is suspected, ask what the alleged inaccuracy is and which documents it is based on. Respond on the substance and in a verifiable way. Also have it assessed whether a disputed item can justify refusing other items. A claim under your own insurance policy and a claim as an injured party against a WAM insurer (the compulsory motor liability insurer) are based on different legal principles.
The insurer cannot simply apply the same statutory forfeiture of cover in both situations. The distinction has been confirmed in, among others, ECLI:NL:HR:2018:1103. This does not give rise to an automatic entitlement to every advance payment requested; the loss and liability remain relevant.
Complaint, consultation or proceedings
A first step may be a reasoned request for payment with a short, feasible deadline for a response. If necessary, ask for a meeting with a claims handler who has decision-making authority. The Code of Conduct for Personal Injury Claims (GBL) can help to put delays and communication on the table in concrete terms.
If consultation does not lead to a solution, proceedings can be considered. A partial dispute procedure (deelgeschil) is intended to remove an obstacle in the out-of-court settlement; interim relief proceedings require, among other things, sufficient urgency and a proper assessment of the claim. Not every payment dispute lends itself to the same route. Legal costs and the risk of having to repay must be discussed in advance. See also the judiciary’s explanation of personal injury proceedings.
Avoid a hasty final settlement
A low final offer may seem attractive once advance payments have stopped. Before signing, check which future losses will be closed off by a full and final discharge. An advance payment, a partial settlement and a final settlement agreement have different consequences.
Frequently asked questions
Does an admission of liability entitle me to every advance payment?
No. The plausible loss, earlier payments and the substantiation of the amount requested also count.
Can I request payment while a medical examination is ongoing?
Sometimes the part that is sufficiently established can be paid. Identify that part separately and substantiate it.
Do I have to repay a reclaimed advance payment immediately?
First ask for the legal basis and the calculation. The reason for the recovery and any agreements made must be assessed.
Can a complaint suspend my time limits?
Do not assume so. The limitation period and time limits under procedural rules or the policy each need to be monitored separately.
Are interim relief proceedings always the quickest solution?
They may be appropriate in urgent cases, but their suitability and risks depend on the file. Sometimes a targeted piece of evidence removes the deadlock more quickly.
Can Arslan take over my file?
We can assess the payment stop, the necessary next steps and funding. Please include the latest statement of loss and the overview of advance payments.
Read more about loss of income, complaints about lengthy claims handling and full and final discharge.
Have the suspension of your advance payments and the options for resuming them assessed.
This page provides general information and is not legal advice about your own situation. No rights can be derived from its content.
