A spinal cord injury can affect movement, personal care, housing and work. If someone else is liable for the accident, compensation requires a coherent assessment of your current and future needs. An amount for the initial care costs is then not enough. Aids, accessibility, support, income and compensation for pain and suffering (smartengeld) may also form part of the claim.
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Written by Onur Arslan, attorney at Arslan Advocaten. Registered in the specialisation register of the Netherlands Bar for employment law and personal injury. Last updated: 17 September 2026.
The situation varies greatly from person to person. Not every spinal cord injury leads to the same limitations or the same care needs. An appropriate settlement must therefore be based on your medical situation, capabilities and daily life. Below you can read which experts can help and how to prevent important costs from being overlooked.
In brief
- With a spinal cord injury, the claim concerns care, aids, home adaptation, transport, loss of income and smartengeld. Some of these continue for life (care and aids, for example), but not all: a home adaptation is often a one-off cost with periodic replacement, loss of income runs until retirement age and then turns into pension loss, and smartengeld is a lump sum. Have the period of calculation determined for each head of loss.
- Public provisions (Zvw, Wmo, Wlz) and the claim must be coordinated, without double counting and without gaps.
- Adapting your home or moving is a far-reaching decision: have the necessity, alternatives and quotations recorded before the work is carried out.
- Care provided by a partner or family may be a separate head of loss. With a spinal cord injury, it usually involves more than domestic help: see care costs and informal care for personal care and supervision, and the domestic help guideline for the household part.
- Do not forget loss of earning capacity and pension loss: these continue long after the claim has been settled.
The medical situation as a starting point
A spinal cord injury is damage to the spinal cord, with consequences that depend on factors such as the location and severity of the injury. Your practitioners can explain which functions are affected and what development is expected. This article does not provide a personal prognosis or treatment advice.
For the claim, a careful description of limitations and capabilities is needed. This is not only about walking or wheelchair use. Stamina, hand function, personal care, transfers and other daily activities may also be relevant. Medical details are shared only insofar as this is necessary for the assessment.
An early treatment report is sometimes still provisional. During rehabilitation, it may become clearer which support is needed in the long term. The handling of the claim must follow that development. At the same time, urgent facilities should not be kept waiting until every future question has been fully answered.
Liability and the link with the accident
For compensation, there must be a basis for liability. In a road traffic accident, for example, this concerns the circumstances of the accident and the responsibility of those involved. In a workplace accident, the employer’s duty of care may be central. An accident during sport or recreation may raise other legal questions.
Preserve relevant information about the event as soon as possible. Think of witnesses, photographs, reports and details of the insurers involved. If you cannot do this yourself, a family member or representative can help. A serious medical process should not mean that important evidence disappears unnoticed.
The medical link between the accident and the injury must be clearly established. If treatment or complications also play a role, additional expertise may be needed. Acceptance of liability for the event does not automatically mean that all future loss has already been established. That extent is investigated separately.
A plan for care and support
A useful care plan describes which activities require help, how often, and by whom that help can be given. Distinguish between personal care, nursing, support, supervision and household tasks. The right classification helps to coordinate applications and the assessment of the loss.
Also note when help is needed. A need at fixed times can be organised differently from unexpected help or night-time support. Not every hour of presence is equal to care actively provided. At the same time, availability and supervision may in certain situations constitute a real need that must be assessed by an expert.
Where extensive care is involved, an independent expert overview is often useful. It shows which help is necessary, which facilities are available and where a shortfall remains. The assessment should match a workable plan, not just a theoretical number of hours.
Informal care and the burden on family members
Family members often take over tasks as a matter of course. As a result, professional care costs may initially appear low, while the actual need for help is considerable. Record which additional work is being carried out. Think of help with transfers, personal care, accompanying you to appointments and organising facilities.
Unpaid care may give rise to recoverable loss under certain conditions. Compensation is not automatically equal to the salary a partner forgoes. The legal basis, reasonable extent and type of help must be investigated. It must also be considered which care would have been customary within the family without the accident.
A solution that only works as long as one family member is available without limit may become unsustainable over time. Discuss replacement, respite and professional support. The personal injury assessment must take into account a realistic organisation of care, insofar as that need is sufficiently substantiated.
Health insurance, Wmo and Wlz alongside the claim
Various systems may play a role in care and support. Which scheme applies depends on the nature and extent of the need and the statutory conditions. An assessment of eligibility or a facility must be applied for and assessed through the competent organisation.
The liable party and public provisions do not automatically apply the same assessment criteria. Draw up an overview for each need: what is needed, which application is pending, what has been granted and which part remains uncovered? Keep decisions and the reasons given. This also makes it possible to assess whether an objection to a refusal makes sense.
Double compensation for the same costs must be avoided. At the same time, it is undesirable for parties merely to refer to each other while necessary help is lacking. Discuss who provides interim funding and how accounts will be settled later. Record such agreements in writing, so that urgent care does not remain dependent on unclear expectations.
Overview of facilities: need, funder, application and shortfall
This overview prevents the two classic mistakes: being compensated twice for the same item, and leaving a gap because everyone assumes someone else will pay. Fill it in with the decisions and quotations alongside it.
| Need | Who normally funds it? | How do you apply? | Where does the shortfall arise? |
|---|---|---|---|
| Wheelchair for daily use | Wmo (municipality), or Wlz with an eligibility assessment | Notification to the municipality, followed by an intake interview (keukentafelgesprek) and a decision | The standard facility does not match your use: a sports, active or second wheelchair |
| Medical aids (catheters, mattress) | Health insurance (Zvw) | On prescription from the practitioner | Compulsory excess and personal contributions; non-reimbursed versions |
| Personal care and nursing | Zvw (district nursing) or Wlz | Assessment by a district nurse or the CIZ (Care Assessment Centre) | Hours that are not assessed as eligible but are nevertheless needed; care by family members |
| Domestic help | Wmo | Notification to the municipality | Hours granted versus actual need; personal contribution |
| Home adaptation | Wmo | Application with quotations, before the work is carried out | The difference between the amount granted and the actual costs; a move that the municipality considers cheaper |
| Adapted car or transport | Wmo (transport facility), UWV for commuting | Application to the municipality or UWV | Purchase and adaptation of your own car; replacement after depreciation |
| Workplace adaptation | UWV, or the employer | Application for a facility from the UWV | Facilities with a new employer or as a self-employed person |
| Replacement and maintenance in the longer term | Varies per facility | Reapply upon depreciation | This is where a gap most often arises: the first purchase is arranged, the replacement in eight years’ time is not |
Wheelchair and other aids
An aid must suit your body, environment and use. A wheelchair for daily use requires a different assessment from a specific facility for work or sport. Seating support, transfers and maintenance may also be part of the need. The choice lies with you and the experts involved.
For the claim, a functional justification and an itemised quotation are important. Why is this facility needed, which alternatives have been explored and what is reimbursed elsewhere? A higher price is not in itself unreasonable, but must be explained by the required function and quality.
Include maintenance, repair and any replacement where these can reasonably be expected. The lifespan is not the same for every aid or every user. An estimate with substantiated periods is better than a general assumption that everything must be completely replaced after a fixed number of years.
Home adaptation and the choice between renovating or moving
Your home must be usable for your daily life. Think of access, doorways, the bathroom, the bedroom and sufficient space to manoeuvre. An expert can assess which adaptations are needed and whether the existing home is suitable for them.
Sometimes renovation is appropriate; sometimes moving is explored as an alternative. Do not compare only the initial building costs, but also usability, location, care network and reasonable incidental costs. Not every housing wish is accident-related loss. What matters is the additional need that has arisen as a result of the injury.
Discuss major decisions in good time with your representative and the funding parties involved. Obtain quotations and record the considerations. A far-reaching renovation that has already been carried out may be harder to assess afterwards if necessity and alternatives were never discussed. Urgent temporary solutions can be arranged separately in the meantime.
Transport and accessibility
Treatment, work and social contacts must remain within reach. Adapted transport or an adaptation to a vehicle may be necessary. Which solution is suitable depends on your capabilities, the distances and the available alternatives. Fitness to drive and medical questions require assessment through the designated channels.
For the loss, what matters are the reasonable additional costs compared with the situation without the accident. If you already had a car before, not every purchase expense is automatically entirely new loss. At the same time, necessary adaptations, higher maintenance or suitable replacement transport may constitute a concrete additional burden.
Keep track of journeys and costs and make clear which facility is used for which purpose. This helps to prevent overlap and to substantiate a structural budget. A transport solution must work in practice, not just appear to be the cheapest on paper.
Returning to work, retraining and loss of income
A spinal cord injury does not mean that working is impossible for everyone. The possibilities depend on limitations, occupation, workplace and support. A vocational expert can investigate which tasks are feasible and which adaptations or retraining may be worthwhile.
The calculation of the loss compares your situation with the accident with the likely situation without the accident. For employees, salary and career developments may be relevant. For the self-employed, business results, replacement and reorganisation are also investigated. A desirable picture of the future is not the same as a sufficiently substantiated expectation.
If a return to work is still on a trial basis, the settlement must recognise that. A few hours worked do not prove full lasting employability. Conversely, lifelong total incapacity should not be assumed without investigation. A realistic plan links medical capacity with concrete employment opportunities.
Pension loss and long-term financial consequences
Working less over a long period may affect pension accrual. Whether loss actually arises depends partly on the pension scheme and any premium waiver in the event of incapacity for work. Request pension statements, scheme rules and decisions of the pension administrator.
The calculation must reflect what would probably have been accrued without the accident and what is actually being continued. A fixed percentage of the loss of salary is usually too crude for this. Changes to the scheme and future career may also be relevant assumptions that must be clearly stated.
With a lump sum, tax consequences and effects on income-related schemes also deserve attention. Compensation intended for future care may be treated differently in legal terms from what you would expect based on its purpose. Have this investigated before the final settlement and record appropriate agreements.
Smartengeld and the personal impact
Smartengeld relates to pain, loss of independence and other non-pecuniary consequences. The severity of the injury, treatments, permanent limitations and changes in your life are relevant. Your personal situation must become visible without you having to justify every difficult moment over and over again.
Describe relevant changes in activities, relationships and daily routines. This concerns not only what is no longer possible, but also extra effort and dependence. Medical information and concrete examples help to make that impact understandable.
Smartengeld is not a substitute for a care budget. Pecuniary loss such as help, aids and loss of income should be calculated separately. For certain close relatives, affection damages (affectieschade) may be explored under statutory conditions; that is a different claim from your own non-pecuniary compensation.
Future loss and uncertainties in a settlement
With long-term care and facilities, calculations can look far ahead. Assumptions about needs, cost developments, duration and funding then become important. Ask for a breakdown per head of loss and an explanation of the starting points used. A large total amount may be inadequate if it misses important recurring costs.
Not every future change can be predicted precisely. Sometimes scenarios can be calculated; sometimes a reservation or other payment arrangement may be appropriate. Which solution is legally and practically workable depends on the uncertainty. A general promise that things will be looked at later is not sufficiently clear.
With a full and final settlement, pay attention to what is definitively closed. If care needs or the housing solution have not yet been sufficiently investigated, further investigation may be needed. The choice of a settlement must be made consciously, based on the concrete needs and the consequences of the agreement.
Fictitious example of a housing and care plan
A road traffic victim with a spinal cord injury leaves the rehabilitation centre. In this fictitious example, liability has been accepted. The victim’s own home has a bathroom that is difficult to access. The family provides a great deal of help, but cannot continue to do so indefinitely.
An expert examines the home and a care adviser maps out the daily support. It is recorded which facilities have been applied for and which costs remain for the victim’s own account. An advance payment is discussed for urgent needs, while the structural solution is worked out further.
The final settlement is not based solely on the first few months, in which the family absorbs almost everything. Replacement of aids, a sustainable organisation of care and employment opportunities are also investigated. The example shows how a claim must be aligned with a workable life and care plan.
An overview that everyone involved can use
Keep one up-to-date file overview with the most important needs and decisions. This prevents an aid from appearing in several partial estimates, or nobody being responsible for a necessary application. The overview can be kept up to date by your representative.
- Medical limitations and outstanding questions about the prognosis.
- Care tasks with frequency, provider and funding.
- Aids with purchase, maintenance and expected replacement.
- Housing and transport solutions with quotations and decisions.
- Work, income and pension with the underlying data.
- Advance payments, facilities received and remaining loss.
Update the overview whenever a facility is granted or the need changes. A good overview is not a one-off list, but a way of keeping the handling of the claim verifiable. This keeps your actual situation as the starting point.
Continuity when a facility is temporarily unavailable
A care and aids plan must also work in practice when something goes wrong. What happens if a wheelchair is being repaired, a lift is unavailable or a regular carer drops out? Discuss such foreseeable interruptions with the experts and providers involved.
Not every conceivable emergency leads to a separate head of loss. However, a reasonable back-up or replacement solution may be necessary to safeguard daily care and accessibility. Have the necessity, expected frequency of use and costs explained in concrete terms. This helps to distinguish an appropriate solution from an unlimited safety margin.
Keep agreements on servicing, availability and replacement with the overview of facilities. If an offer covers only the purchase, check whether maintenance and temporary alternatives are arranged elsewhere. A financially complete plan is not only about owning aids, but also about their usability in daily life.
Evaluate the plan when your housing situation or care organisation changes. A solution that is adequate in a rehabilitation setting may make different demands at home. That transition deserves attention before final financial agreements are made.
The legal basis for very serious injury
With a spinal cord injury, the provisions on assessing loss are particularly important:
- Article 6:162 of the Dutch Civil Code (BW), Article 185 of the Road Traffic Act (WVW) or Article 7:658 BW the legal basis, depending on the circumstances: unlawful act, road traffic accident or workplace accident.
- Article 6:97 BW the court assesses the loss in the manner most consistent with its nature; with very complex loss, an actuarial report is often used.
- Article 6:105 BW future loss may be assessed in advance, as a lump sum or as periodic payments. Lifelong care costs, aids and home adaptations are covered here.
- Article 6:107 BW the basis for care costs: costs incurred by third parties on your behalf and care provided by family members, insofar as you could have claimed them yourself. The Dutch Personal Injury Council (Letselschade Raad) has drawn up a recommendation on care costs for this purpose.
- Article 6:96 BW pecuniary loss and the reasonable costs of experts: vocational expert, occupational therapist, building surveyor and actuary.
- Article 6:106 BW smartengeld, taking into account the far-reaching consequences for independence, work, relationships and future prospects.
The articles have been checked on wetten.overheid.nl. With loss of this magnitude, an integrated plan with all experts on the same page is more important than negotiating over individual items.
Frequently asked questions about spinal cord injury and compensation
Who pays for my long-term care after an accident?
This may be a combination of health insurance, public provisions and compensation from a liable party. The applicable scheme and remaining loss must be investigated for each need. Avoid both double compensation and unclear shortfalls.
Can I claim for a home adaptation?
Yes, if the adaptation is necessary and reasonable because of the accident injury and is not fully reimbursed elsewhere. An expert assessment and quotations help. Sometimes renovation must be compared with a suitable move.
Does unpaid care from my partner count?
It can, under certain conditions. Record the additional tasks and their extent. Compensation is not automatically equal to your partner’s lost wages. Long-term feasibility and overlap with professional care also deserve attention.
Do I have to be fully unfit for work to claim loss of income?
No. A partial loss of earning capacity may also give rise to loss. The actual limitations, employment opportunities and income are compared with the situation without the accident. A general medical percentage is not enough for the calculation.
Can an advance payment also be requested for aids?
Yes, if liability and necessity are sufficiently established. Submit a substantiated request with an estimate and information about other reimbursements. Make clear whether it concerns temporary or structural needs.
Is a high amount of smartengeld enough to close the case?
No, the amount says nothing about the completeness of other heads of loss. Care, aids, housing and income must have been investigated separately. Check the entire calculation and the meaning of a full and final settlement.
What if my care needs change later?
That depends partly on the agreements in the settlement. Future uncertainties must be carefully dealt with in advance. A reservation or another form of payment can sometimes help, but is not automatically included and must be recorded in concrete terms.
How do the Wmo and Wlz relate to my claim?
Not as a fixed rule, but in practice often as a starting point: what the municipality or the care office actually reimburses is, to that extent, no longer loss; you cannot be compensated twice for the same costs. That is different from an obligation to exhaust all public routes first. Whether you could reasonably be expected to apply for a facility is a question of reasonableness in your specific situation: how long does the application take, does the facility granted match what you need, and what is the effect of the personal contribution? An insurer that simply refers you to the Wmo overlooks this. What you pay yourself, such as personal contributions, and the difference between the facility granted and the facility you actually need, does remain loss. Keep careful records of decisions and refusals.
Should I renovate first and claim afterwards, or the other way round?
Preferably discuss major adaptations before the work is carried out. Obtain several quotations, have the necessity substantiated by an occupational therapist or building adviser, and record in writing the considerations between renovating and moving. A far-reaching renovation that has already been carried out is harder to assess afterwards. For urgent temporary solutions, you can request an advance payment.
Can the case be settled if my care needs may still change?
Yes, but it must then be clear which uncertainties have been factored into the amount. Options include a wider margin for future care, a reservation for specific developments or periodic payments. Make sure that every oral agreement is also clearly reflected in the settlement agreement.
Have your loss assessed as a whole
Arslan Advocaten can discuss with you how medical information, care needs and financial loss are investigated together. Bring any available plans, decisions and correspondence. This makes it possible to determine which expertise and which advance payments are needed to settle your situation carefully.
You can find more information under personal injury. You can also contact us to discuss your case.
Related articles
- Informal care and personal care after an accident
- Pension loss after an accident
- Domestic help guideline
- Personal injury and domestic help
- Loss of income and loss of earning capacity
- Full and final settlement: do not sign too quickly
- The Dutch Personal Injury Council
Sources and further information
- The Dutch judiciary on personal injury
- The Dutch Personal Injury Council (Letselschade Raad) on guidelines
