When you are confronted with damage and involve your insurer, you expect a fair and objective assessment. Sometimes a second-opinion damage appraisal is necessary to enforce your rights. It regularly happens that the expert engaged by the insurer estimates the loss significantly lower than you expected, or that certain heads of loss are rejected entirely. Fortunately, the law and your insurance policy allow you to appoint your own independent expert for a contra-expertise (independent counter-appraisal under Dutch insurance practice). In this article we discuss your rights, how the second-opinion process works, who bears the costs, and which steps you can take if the experts’ outcomes differ.
What is a second-opinion damage appraisal?
A second-opinion damage appraisal, often referred to in the insurance world as a contra-expertise (independent counter-appraisal), is an independent investigation into the scope and cause of a loss, carried out by an expert you appoint yourself. When you submit a claim to your insurer, the insurer will in most cases appoint its own loss expert. Although this expert is expected to act independently and objectively, he or she works on behalf of the insurer. This can create a tension, where the outcome of the investigation may appear to favor the insurer.
Your counter-expert will reassess the loss anew and entirely independently. The aim of this second opinion is to provide an objective counterweight to the insurer’s report. The counter-expert takes a fresh look at the situation, checks the first expert’s calculations, and investigates whether any heads of loss may have been overlooked. Engaging your own expert creates a level playing field. You are no longer standing alone opposite the insurer and its specialists.
When are you entitled to a second-opinion damage appraisal?
The right to a second-opinion damage appraisal is a fundamental right you enjoy as the policyholder. In virtually all insurance policies there is a clause giving you the right to appoint your own expert if you disagree with the insurer’s expert’s findings. Even if this is not explicitly stated in your policy terms and conditions, this right follows from the law. Under Dutch law, the policyholder is entitled to reimbursement of the reasonable costs incurred to determine the loss. These include the costs of a contra-expertise.
You may consider a second opinion in various situations. The most common reason is a substantial difference of opinion about the amount of the loss. If the insurer assesses the loss at an amount with which you cannot possibly restore the damage, it is wise to appoint your own expert. Disagreement can also arise about the cause of the loss. Also, when the insurer alleges that you breached your duty of disclosure or when you are faced with a rejection of the claim by the insurer, an independent investigation by a counter-expert can be crucial to prove you are right.
How does the contra-expertise process work in practice?
The contra-expertise process starts with your decision not to accept the insurer’s findings. Once you have made this decision, you look for a qualified, independent counter-expert. It is advisable to choose an expert who is affiliated with a recognized professional organization to ensure quality and professionalism. After you have appointed the expert, you formally notify your insurer. Your counter-expert will then contact the insurer’s expert to make arrangements for the further course of the investigation.
During this joint investigation, the experts will try to reach agreement in mutual consultation. They compare their findings, discuss the policy terms and conditions, and try to bridge any differences in opinion. This consultation often leads to a compromise acceptable to both parties. The agreements are then recorded in a so-called deed of appraisal (akte van taxatie in Dutch insurance practice), which is signed by both experts. This document is binding on both you and the insurer, which means the insurer is obliged to pay the agreed amount.
Who pays for the second opinion?
One of the most frequently asked questions is who bears the costs of the second opinion. Many fear that they will have to foot the bill for the high fees of a counter-expert, which deters them from taking this step. Fortunately, this fear is unfounded in most cases. The law provides that the reasonable costs of determining the loss are for the account of the insurer. This means that, in principle, the insurer is obliged to reimburse the costs of your counter-expert, provided these costs are considered reasonable.
The reasonableness test means that both the decision to engage an expert must be reasonable and the amount of the invoiced costs must be reasonable. In practice, many counter-experts work in line with the policy conditions and invoice their costs directly to the insurer, so you do not have to worry about this yourself. If, unexpectedly, a dispute arises about reimbursement of these costs, an insurance law attorney can assist you in enforcing your right to full reimbursement.
What if the second opinion differs from the first appraisal?
It often happens that your counter-expert’s findings differ from those of the insurer’s expert. This is, after all, often the reason you requested the second opinion. When there is a difference of opinion about the cause of the loss or the amount of the loss, the two experts will consult with each other to try to reach a joint conclusion. In many cases, they succeed by exchanging arguments, adjusting calculations, and reaching compromises. If they reach agreement, this is recorded and the matter is settled.
When this situation arises, most policy conditions contain a standard procedure to break the deadlock. Before the two experts start their investigation, they jointly appoint a third, independent expert, often called the arbiter. This third expert acts as a kind of referee. When the first two experts cannot reach agreement together, the dispute is submitted to this third expert. He or she will study the arguments and reports of both parties and then issue a binding decision. This decision is binding on all involved.
The role of the appointed third expert and arbitration
The role of the third expert is crucial when the regular experts are at an impasse. This person must have impeccable expertise, be completely independent, and be trusted by both your expert and the insurer’s expert. The third expert is usually appointed at the beginning of the contra-expertise track, before the actual investigation starts. The third expert will initially remain in the background and will only act when he or she is formally requested to issue a binding opinion on the points in dispute.
Although the third expert’s decision is binding, this does not mean you are entirely without recourse if you strongly disagree with the outcome. A binding opinion can, in exceptional cases, be set aside by a court, but the threshold for this is very high. Besides these procedural aspects, it is also possible that the discussion is not limited to the scope of the loss but concerns policy coverage itself. In such cases, you will need to take legal steps, such as submitting the case to Kifid (the Dutch Financial Services Complaints Institute) or the civil court.
Why legal assistance is crucial in a dispute
Although a counter-expert is invaluable for the technical and financial determination of the loss, the role of a lawyer is essential when the dispute with the insurer takes on a legal character. An expert primarily looks at the factual loss, but an insurance law attorney assesses the legal tenability of the insurer’s positions. Is your claim rejected on the basis of alleged non-disclosure, fraud, or a complex policy condition? Then you need legal expertise. A specialized lawyer can analyze the policy terms and conditions and assess whether the insurer is within its rights.
In addition, a lawyer can guide you in the strategic choices during the process. When is the time to file a complaint, and when is it wiser to proceed directly to issuing a summons? If it comes to formal proceedings, professional legal assistance is indispensable. We take the legal work off your hands, ensure deadlines are monitored, and vigorously defend your interests. Even during the contra-expertise phase, coordination between your expert and your lawyer can be of great value to ensure that both the factual and legal arguments align seamlessly.
Frequently asked questions
Am I obliged to let the insurer’s expert in?
Yes, under the policy terms and conditions you are obliged to cooperate with the loss investigation. This means that you must give the expert engaged by the insurer the opportunity to inspect the damage. Refusing to cooperate may lead the insurer to suspend coverage or reject the claim. However, you always have the right to appoint your own expert in addition.
Can I still request a second opinion afterwards?
It is possible to request a second opinion afterwards, but it is strongly recommended to do so as soon as possible. The more time passes, the harder it becomes for a counter-expert to determine the original loss and its cause accurately, especially if repair work has already been carried out. Inform your insurer of your intention in good time.
What if the insurer refuses to pay my expert’s costs?
If the insurer refuses to reimburse the reasonable costs of your counter-expert, you can object to this. The law provides that these costs are for the account of the insurer. In case of continued refusal, it is wise to seek legal advice. A specialized lawyer can help you enforce reimbursement through a complaints procedure or through the courts.
Also read
Do you want to know more about your rights in disputes with your insurer? Then also read our other informative articles on this topic:
- Claim rejected after loss investigation – what now?
- Filing a complaint with Kifid – your rights, step-by-step plan and tips
- Objection against insurer: what can you do after a rejection?
Need help?
Do you have a dispute with your insurer about the amount of a payout or is your claim wrongly rejected? The specialists at Arslan & Arslan Advocaten are ready to defend your interests. We have extensive experience in insurance law and are happy to help. Contact us for a free first consultation via https://arslan.nl/contact/ and discover what we can do for you.