Policy conditions

What we do

In the policy conditions, the insurer includes the relevant general provisions. These therefore specify which types of damage the insurer covers and under what conditions. In addition, the rights and obligations of the policyholder are included in the policy conditions. Furthermore, any maximum limit on the compensation payable is included in the policy conditions. The policy conditions are always part of the policy that an organization receives when taking out insurance. At the time of taking out insurance, it is important that the conditions are subjected to a legal review. Our legal specialists can provide support in this regard. Additionally, an analysis can be conducted to determine whether the damage suffered is covered under the policy conditions.

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.

How policy conditions are interpreted: Haviltex, collective labour agreement standard and contra proferentem

Legally speaking, policy conditions are general terms and conditions, and their interpretation is often decisive in a dispute. The court looks not only at the literal text but at various standards. For conditions that have been individually negotiated, the Haviltex standard applies: it depends on the meaning that the parties could reasonably attribute to a provision in the given circumstances. For standard exchange and consumer policies, which have not been negotiated, a more objective interpretation applies (comparable to the collective labor agreement standard): the wording of the provision, read in the light of the policy conditions as a whole, is in principle decisive. In the Chubb/Dagenstaed judgment, the Supreme Court ruled that the interpretation of such a policy depends primarily on objective factors.

If reasonable doubt remains regarding the meaning of a clause after interpretation, the contra proferentem rule applies: the ambiguity is interpreted to the detriment of the insurer who drafted the terms and conditions. For consumers, this is even legally enshrined in Article 6:238 paragraph 2 of the Dutch Civil Code: clauses must be clear and understandable, and in case of doubt, the interpretation most favorable to the consumer prevails. We assess which standard applies in your situation and build the interpretation defense upon it. If the dispute escalates, please refer to our page on coverage disputes or policy disputes.

Primary coverage, exclusions and preventive warranties

Not every provision in the policy conditions works the same way. The distinction between the primary coverage description, exclusion clauses, and preventive guarantees is decisive for the outcome of a claim. The primary coverage description determines which risks are covered at all; if your damage falls outside of this, the principles of reasonableness and fairness will, in principle, not come to the insurer's aid. An exclusion, on the other hand, removes a risk that is covered in itself from coverage and is subject to stricter scrutiny. Preventive guarantees (such as a mandatory alarm system or a specific locking method) link the coverage to a duty of conduct.

Anyone who confuses these categories unnecessarily loses a dispute with the insurer. We dissect your policy down to the clause level, assess whether the insurer is legitimately relying on an exclusion or guarantee, and whether it was sufficiently clearly discernible. This is work for both the in-house counsel who helps think through your business policy and the lawyer who conducts the defense in court.

Obligations for the policyholder arising from the policy conditions

Policy conditions impose obligations not only on the insurer but also on you. Violation of these is a frequently cited reason for refusing or reducing a payout. The most important statutory obligations are:

• Duty of disclosure upon entering into an agreement (Article 7:928 of the Dutch Civil Code): before concluding the agreement, you must disclose all facts relevant to the risk assessment. See also our page on breach of the duty of disclosure and/or duty to inform.
• Duty to report damage (Article 7:941 of the Dutch Civil Code): you report the damage as soon as reasonably possible and provide the relevant details.
• Duty to mitigate (Article 7:957 of the Dutch Civil Code): you take reasonable measures to limit impending or further damage.
• Statute of limitations (Article 7:942 of the Dutch Civil Code): in principle, a legal claim against the insurer is time-barred after three years.

We assess whether the insurer is justified in invoking a breach of these obligations, and whether a discount or forfeiture clause is proportionate.

The transparency requirement and the “fine print”

Insurers may define the limits of coverage themselves, but in a manner that is sufficiently clear to the average policyholder. This transparency requirement means that hidden, ambiguous, or unexpectedly restrictive clauses can be held against an insurer. When taking out business or consumer insurance, we assess in advance whether the policy conditions align with your actual risk and whether there are any surprises hidden in the fine print. A check before signing prevents you from discovering only when a claim occurs that the coverage is narrower than expected. Also read our pages on business insurance and consumer insurance.

Policy conditions within insurance law

This page is part of our Insurance Law. Whether you are an international group having a complex stock exchange policy reviewed or the baker on the corner wondering why a claim is not being paid out: our mixed teams of lawyers and in-house counsel think along with you. We combine preventive policy checks with sharp litigation when an insurer wrongfully invokes policy conditions.

Frequently asked questions about policy conditions

What exactly are policy conditions?

Policy conditions are the general and specific provisions that accompany your policy. They determine which risks are covered, which exclusions apply, what obligations you have, and the maximum amount the insurer pays out.

The insurer refuses to pay out based on a clause. What now?

Have the policy legally reviewed. Often, it revolves around the interpretation of a clause (Haviltex or CLA standard) or the question of whether an exclusion is sufficiently clearly discernible. In cases of reasonable doubt, the contra proferentem rule usually works in your favor.

Do different rules apply to a consumer policy than to a business policy?

Yes. In consumer insurance, Article 6:238 paragraph 2 of the Dutch Civil Code provides additional protection, and unclear clauses weigh in the consumer's favor. In business and exchange policies, the emphasis lies more strongly on an objective interpretation of the text.

Can you check the policy terms and conditions before I sign?

Certainly. A preventive check is often the most valuable: we identify restrictive clauses, unclear exclusions, and preventive warranties before you commit.