Disability insurance: when are you entitled to benefits?
A disability insurance policy (AOV) provides financial protection when you can no longer work due to illness or an accident. For self-employed individuals and entrepreneurs in particular, an AOV is of great importance, as they are not entitled to WIA benefits. At Arslan Advocaten, we assist clients who experience problems with their disability insurance.
What is a disability insurance policy?
An AOV is a private insurance policy that provides a monthly benefit when you become incapacitated for work. Unlike the statutory WIA benefit for employees, an AOV is a private-law agreement between you and the insurer. The policy terms determine when and how much is paid out.
The amount of the benefit depends on the insured amount, the degree of incapacity for work, and the chosen coverage. Most policies distinguish between occupational disability (you cannot perform your own profession) and suitable work disability (you cannot perform any suitable work).
Conditions for benefits
To qualify for benefits, you must meet the policy conditions. The following requirements generally apply: you must be demonstrably medically incapacitated for work, the waiting period (excess period) must have elapsed, and you must have reported the incapacity to the insurer in a timely manner.
The waiting period varies per policy and can range from 30 days to 2 years. During the waiting period, you do not receive benefits. The longer the waiting period, the lower the premium. After the waiting period, the benefit commences, provided you are still incapacitated for work.
Assessment of incapacity for work
The insurer engages a medical adviser or occupational health expert to determine the degree of incapacity for work. This assessment determines the benefit percentage. If you disagree with the assessment, you can request a second opinion or engage an independent physician.
It is important to know that the insurer is bound by the Insurers' Code of Conduct and the guidelines of the Dutch Association of Insurers. The assessment must be conducted carefully and independently.
What if the insurer refuses to pay?
Unfortunately, it does occur that insurers wrongly reject a claim. This may have various reasons: a difference of opinion regarding the degree of incapacity for work, alleged breach of the duty of disclosure, or a dispute about the policy terms.
If the insurer refuses, you can file a complaint with the Financial Services Complaints Institute (Kifid) or initiate legal proceedings. Arslan Advocaten has experience in contesting rejections by insurers and can assist you in this process.
Tips for policyholders
Always report incapacity for work immediately to your insurer. Keep a medical file and save all correspondence. If in doubt about the assessment, seek assistance from an independent medical adviser. And consult a specialised lawyer if your claim is rejected.
Arslan Advocaten can help you
At Arslan Advocaten, we assist policyholders who experience problems with their disability insurance. Whether it concerns a rejected claim, a benefit that is too low, or a dispute with the insurer, we help you obtain justice. Contact us for a no-obligation consultation.