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Disability Insurance Claim Denied in Netherlands

It's incredibly frustrating when you've become disabled and unable to work, but your disability insurance (arbeidsongeschiktheidsverzekering or AOV) refuses to pay out. You've been paying premiums for years for this protection, and now when you need the insurance most, it's letting you down. Fortunately, as a policyholder under Dutch law, you have important rights and there are concrete steps you can take to still receive your benefits.

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What's happening?

A disability insurance should pay out when you can no longer work due to illness or accident. However, insurers in the Netherlands regularly refuse payouts, often for financial reasons. They may claim you're not completely disabled, that your condition already existed before taking out the insurance, or that you haven't provided sufficient medical evidence. Sometimes they also interpret policy terms differently than you as a policyholder would expect.

What does Dutch law say?

Dutch insurers must comply with strict rules from the Financial Supervision Act (Wet op het financieel toezicht) and the Dutch Civil Code (Burgerlijk Wetboek). They have a duty of care towards policyholders and must assess claims carefully. Policy terms must be clear and may not be misleading. When there's ambiguity, this is usually interpreted in favour of the consumer.

1Article 6:231 BW (Dutch Civil Code): The insurer must pay out when conditions are met and may only refuse on valid grounds
2Article 6:233 sub a BW (Dutch Civil Code): Unclear policy terms are interpreted in favour of the policyholder
3Financial Supervision Act: Insurers have a duty of care and must handle claims within reasonable time and carefully

What are your rights?

As a policyholder under Dutch law, you have strong rights when your insurer wrongfully refuses to pay out. These rights are legally established and give you various options to still get your claim honoured.

1Right to a reasoned refusal: Your insurer must explain precisely why your claim is being refused
2Right to access your file: You may see all documents the insurer has collected about you
3Right to a second opinion: For medical assessments, you can often engage an independent doctor
4Right to object and appeal: You can formally object and go to a disputes committee or court

What can you do now?

Tackle this situation systematically with the following steps to maximise your chances of success.

1Step 1: Request a written, reasoned refusal and gather all your medical documents and correspondence
2Step 2: Submit a formal objection letter to your insurer within the set deadline (usually 6 weeks)
3Step 3: Engage Kifid (Financial Services Complaints Institute) if the objection is rejected
4Step 4: Consider legal assistance from a lawyer specialised in insurance law for complex cases

Sample letter or template

A well-drafted objection letter is crucial for your chances of success. MijnRecht.AI can help you draft a professional and legally sound letter specifically tailored to your situation and the reasons why your insurance has refused to pay out.

Where can you get help?

For help with disability insurance problems in the Netherlands, you can contact the Legal Counter (Juridisch Loket) for free legal advice. For disputes, you can file a complaint with Kifid, which handles disputes between consumers and insurers. For more complex cases, you might consider engaging a lawyer specialised in insurance law.

Conclusion

Don't be discouraged by a refusal of your disability insurance claim. Many claims that are initially refused are later honoured when policyholders know their rights under Dutch law and take the right steps. With the proper approach and documentation, you can often still receive your well-deserved benefits.

Frequently Asked Questions

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