Terug naar Encyclopedie
Verzekeringsrecht

Insurer's Right to Refuse: When Can Your Claim Be Denied?

In the vibrant port city of Rotterdam, where bustling harbors and resilient communities thrive, residents rely heavily on insurance to safeguard against life's uncertainties—from flood risks along the

4 min leestijd

In the vibrant port city of Rotterdam, where bustling harbors and resilient communities thrive, residents rely heavily on insurance to safeguard against life''s uncertainties—from flood risks along the Maas River to everyday mishaps in daily life. Yet, understanding "Weigeringsbevoegdheid verzekering"—the insurer''s right to deny claims—is crucial for protecting your rights under Dutch law. This article demystifies when and why your claim in Rotterdam might be rejected, empowering locals to navigate disputes effectively.

Title: Insurer''s Right to Refuse: When Can Your Claim Be Denied?

Insurer''s Right to Refuse: When Can Your Claim Be Denied?

When you file a claim with your insurer, you expect it to be paid out. Unfortunately, insurers often refuse claims. But when is that justified? In this article, we explain what the insurer''s right to refuse entails, the grounds for refusal, and what you can do if you disagree. We keep it practical and understandable, so you know where you stand.

What is the Right to Refuse?

The right to refuse is the insurer''s entitlement to reject a claim. This is not arbitrary: it must be based on the policy conditions and the law. The policy is your contract with the insurer. It specifies exactly which risks are covered, under what conditions, and what exclusions apply.

Under Dutch law (in particular the Financial Supervision Act and the Civil Code), an insurer must act in good faith. A refusal must therefore be properly motivated. If not, you can object. Approximately 20-30% of claims are (partially) refused, often due to misunderstandings about coverage.

Common Reasons for Refusal

Insurers may refuse a claim if it does not comply with the policy conditions. Here are the main grounds:

1. No Coverage Under the Policy

  • Example: Damage due to a defect in your own car is often not covered under third-party liability insurance.
  • Or: Water damage from a leaking washing machine does not fall under home contents insurance if it is not a ''sudden and unexpected'' event.

2. Own Fault or Gross Negligence

  • If you caused the damage yourself through reckless behavior, such as driving under the influence, the payout may be refused or reduced.
  • For fire insurance: if you smoke in bed and it causes a fire, gross negligence is a reason for refusal.

3. Failure to Report Within the Deadline

  • Policies often require reporting within 3-8 days after the damage. Too late? You risk refusal.

4. Previous Claims or Risky Situation

  • For repeated claims or if you withheld information when taking out the policy (e.g., an undisclosed health risk in health insurance).

5. Exclusions in the Policy

  • Theft from a building without signs of break-in, war damage, or damage caused by your own pet.

Important: Small claims (under €250-500) are sometimes not paid out due to the deductible or franchise.

When is a Refusal Unjustified?

Not every refusal is lawful. An insurer may not deviate arbitrarily from the law. Refusals are unjustified if:

  • The motivation is missing or vague.
  • The damage is covered, but the insurer interprets it creatively.
  • Discrimination or unfair commercial practices (prohibited by the Unfair Commercial Practices Act).

The Disputes Committee for Insurance annually rules in hundreds of cases that refusals were unjustified.

Step-by-Step Plan: What to Do in Case of Refusal?

Follow these concrete steps to protect your rights. Act quickly: deadlines are strict!

Step 1: Check the Refusal Letter

  • Review the policy (often available digitally). Note the policy number, coverage, and exclusions.
  • Request full motivation if it is missing (within 1 month).

Step 2: File an Objection with the Insurer

  • Write a letter or use the online form. Explain why you disagree, with evidence (photos, invoices, witness statements).
  • Example sentence: "The damage occurred suddenly and falls under article X of the policy."
  • Standard response time: 6 weeks.

Step 3: Seek Assistance

  • Legal Aid Office (Juridisch Loket): Free advice (call 0900-8020 or online).
  • Legal Expenses Insurance: Use it if you have it.
  • Consumers'' Association or Homeowners'' Association: For model letters.

Step 4: Go to the Disputes Committee or Court

  • No solution? File a complaint within 12 months with Kifid (free, binding up to €25,000).
  • For higher amounts: go to court via the district court (court fee €85-500).

Step 5: Prevent Future Refusals

  • Document everything: take photos and note details immediately.
  • Check your policy annually for changes.
  • If in doubt, ask your insurer for prior permission or advice.

Tips for Success

  • Be polite but assertive in correspondence.
  • Keep all mail and emails.
  • For more complex cases: hire an expert (costs often reimbursable).

Conclusion

Verzekeraars hebben het recht om claims te weigeren, maar alleen op grond van de polis en de wet. Ken uw rechten, handel snel bij weigering en documenteer alles goed. Zo maximaliseert u uw kans op een uitkering. Bij twijfel: schakel hulp in!