Has your insurer rejected your claim on the basis of a report you have not received? Ask for the full report and the annexes on which the decision is based. You must be able to understand which facts and conclusions are being held against you. A request for supporting documents and a GDPR subject access request serve different purposes and may both be needed.
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Written by Onur Arslan, attorney at Arslan Advocaten. Do you have questions about your own situation? Get in touch.
Which report is the insurer referring to?
A file may contain a technical report, medical advice, an interview record, a surveillance report and an internal fraud analysis. Ask the insurer to list the documents it relied on separately. A summary in the rejection letter is not always enough to check the reasoning.
Also ask for the instructions given, the research questions and the relevant annexes. In a collision, original photographs and measurement data can be important. Where a statement is involved, the difference between the recording and the written record can be decisive. For medical information, an appropriate and secure way of providing it must be arranged.
What does a GDPR subject access request give you?
Article 15 of the GDPR gives you the right to access your personal data and to information about how it is processed. It is not an unlimited right to every document in an internal file. However, providing passages or documents may be necessary to present the personal data in an intelligible form. The rights of others and legitimate restrictions may play a role.
Ask, among other things, about the data, sources, recipients, purposes and retention periods. The general rule is a response within one month; under certain conditions this may be extended, provided you are informed in good time. See Articles 12 and 15 of the GDPR.
A specific request works better
State your file number, the decision and the date of the report. Ask which documents were used for the rejection of the claim, the termination, the recovery of costs and the registration. These decisions may be based on partly different data.
You could, for example, write: “I request the investigation report and the annexes on which your rejection is based, including the relevant photographs, statements and calculations. Please explain which documents you are not providing and on what grounds. Insofar as my personal data are processed in them, I also request access under Article 15 of the GDPR.” Tailor the request to your own file.
If documents are missing or refused
Ask for a reasoned refusal per category and for a less far-reaching alternative, such as partial disclosure. An appeal to internal confidentiality does not in itself answer every question. At the same time, not every internal legal consideration can simply be demanded.
In proceedings, a targeted route to disclosure of evidence may be explored. Specify which information is needed for which legal question. A request for everything that has ever been written about you may be too broad. In the meantime, keep an eye on the deadline for your response to the rejection and ask for an extension if necessary; the access request does not automatically suspend that deadline.
Frequently asked questions
Am I entitled to the insurer’s complete internal file?
Not automatically. The right to your personal data and the right to supporting documents each have their own conditions.
Can I ask for the original images?
Ask for the relevant images and the context on which the conclusion rests. The appropriate way of providing them depends on the content and the rights involved.
Can I respond without the report?
You can provisionally dispute the rejection and request specific information. A final response on the merits may only be responsible once you have received the necessary documents.
Can Arslan draft the access request?
We can identify the missing documents and link the request to your challenge against the insurer’s decision.
Read also about the burden of proof in fraud cases and unlawful investigations.
Have us assess which investigation documents you need to defend your claim.
This page provides general information and is not legal advice about your own situation. No rights can be derived from its content.
