Consumer insurance

What we do

Insurance comes in many shapes and sizes. The form and content often depend heavily on the status of the insured: from private individuals to professionals, and from companies to non-profit organizations. Our lawyers have expertise in all types of insurance, such as consumer insurance:

• Liability insurance
• Car insurance
• Contents insurance
• Buildings and home insurance
• Legal expenses insurance
• Life insurance
• Funeral insurance
• Disability insurance
• Accident insurance
• Health insurance

We have the experience and expertise to assume diverse roles, from advisory services to dispute resolution. We have an experienced team of lawyers and legal experts in insurance law. Contact us to discuss the possibilities.

Consumer insurance within insurance law

Consumer insurance is taken out by a private individual acting outside of a professional or business capacity. This distinction is legally important: under insurance law, extra protection compared to a business policyholder. While a business is expected to fully understand the policy conditions itself, additional safeguards apply to the consumer regarding the interpretation of conditions and the information the insurer must provide. Our lawyers and in-house counsel know this playing field inside out and assist both international corporations and the baker on the corner who, as a private individual, finds themselves in a dispute with the insurer.

When may the insurer refuse a payout?

An insurer cannot simply refuse a payout. In principle, the insured must demonstrate that the damage falls under a covered event in the policy; if the insurer subsequently invokes an exclusion, the burden of proof rests with the insurer. The main grounds on which an insurer attempts to refuse coverage are:

• Violation of the duty of disclosure when taking out the insurance (Article 7:928 of the Dutch Civil Code);
• Intent or conscious recklessness on the part of the insured, or an intent clause in liability insurance;
• An exclusion or limitation in the policy conditions;
• Premium arrears resulting in suspension or cessation of coverage;
• Failure to report the damage in a timely manner or insufficient cooperation with the investigation.

A rejection based solely on suspicion, an unclear condition, or a disproportion between the violation and the sanction often does not hold up. Reasonableness and fairness (Article 6:248 of the Dutch Civil Code) can also set aside an appeal based on a ground for refusal in exceptional cases. We rigorously assess whether the refusal is legally justified.

Explanation of policy conditions in favor of the consumer

The core of many consumer disputes lies in the interpretation of policy conditions. Unlike business policies, a consumer does not negotiate the wording; the conditions are drafted unilaterally by the insurer. Therefore, pursuant to Article 6:238, paragraph 2 of the Dutch Civil Code, an unclear provision or one open to multiple interpretations must be interpreted in the manner most favorable to the consumer. This is the so-called contra proferentem principle: ambiguities are at the expense of the drafter of the policy. In addition, the conditions must be transparent and understandable. We assess whether an insurer can rely on a condition or whether the provision must be interpreted in your favor.

Duty of disclosure and concealment by consumers

When applying for insurance, the policyholder must answer the questions on the application form correctly and completely (Article 7:928 of the Dutch Civil Code). If the consumer conceals or distorts relevant information, the insurer may invoke the consequences thereof. However, the law sets conditions for this: the insurer must respond within two months of discovery and point out the possible consequences to the policyholder (Article 7:929 of the Dutch Civil Code). Whether this leads to the complete forfeiture of benefits depends on whether there was intent to deceive (Article 7:930 of the Dutch Civil Code). For consumers, this distinction is crucial; we assess whether a claim of concealment is proportionate and justified.

Statute of limitations: pay attention to the time limit

In principle, a claim for payment lapses three years after the insured became aware of its enforceability (Article 7:942 of the Dutch Civil Code). Insurers frequently invoke the statute of limitations to avoid paying out. Sometimes this plea is justified, sometimes not, for example because the time limit has been validly interrupted. Therefore, do not wait too long to seek legal assistance; acting promptly prevents your right to payment from expiring.

Kifid or the court?

A dispute regarding consumer insurance does not always have to begin in court. Private individuals can submit a complaint to the Financial Services Complaints Institute (Kifid) after completing the internal complaints procedure with the insurer. A ruling by the Kifid Disputes Committee can be binding. In other cases, for example involving significant financial interests or complex evidentiary issues, recourse to the civil courts is the more appropriate course of action. We advise on the most promising route and assist you in both processes. If your case requires further in-depth analysis, please also consult our page on Insurance Law as a whole.

How we help you

Our mixed teams of lawyers and in-house counsel handle consumer insurance cases in a practical and goal-oriented manner. We assess your policy and the rejection, conduct correspondence with the insurer, initiate Kifid proceedings or legal proceedings if necessary, while keeping an eye on costs and your ultimate goal: a fair payout or a reasonable settlement. Whether you are a private individual with a rejected claim or a business owner with a personal dispute with your insurer, contact us to discuss the possibilities without obligation.