Insurance Claim Denied in the Netherlands: Kifid Complaint Process

Insurance Claim Denied in the Netherlands: Using Kifid to Fight Back

The Netherlands has a highly developed financial services sector with comprehensive consumer protection infrastructure. If your insurance company has denied your claim — whether for health, life, motor vehicle, household, liability, travel, or any other insurance product — you have access to one of Europe's most effective and consumer-friendly dispute resolution systems: Kifid (Klachteninstituut Financiële Dienstverlening — the Financial Services Complaints Institute).

This guide explains the Dutch insurance regulatory framework, common reasons for claim denial, how to use Kifid effectively, and the role of the Authority for the Financial Markets (AFM) as the regulatory oversight body.

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The Dutch Insurance Regulatory Framework

Insurance in the Netherlands is primarily regulated by two authorities:

1. De Nederlandsche Bank (DNB): Supervises the financial soundness (solvency) of insurance companies — ensuring they have enough capital to meet their obligations. DNB is not a consumer dispute resolution body.

2. Autoriteit Financiële Markten (AFM — Netherlands Authority for the Financial Markets): Supervises the conduct of financial institutions, including insurers, toward consumers. The AFM enforces compliance with the Financial Supervision Act (Wet op het financieel toezicht, Wft) and consumer protection rules.

AFM Website: https://www.afm.nl

AFM Consumer Line: 0800-5400 540 (free, weekdays 9:00 AM – 5:00 PM)

The primary consumer dispute resolution body for insurance disputes is:

Kifid (Klachteninstituut Financiële Dienstverlening)

Kifid Website: https://www.kifid.nl

Kifid Phone: 0900-3552248 (weekdays 9:00 AM – 5:00 PM, €0.10 per minute from a Dutch landline)

Kifid Address: Postbus 93257, 2509 AG Den Haag (The Hague), Netherlands

Kifid is an independent institution established to provide consumers with free, accessible, and efficient resolution of financial services disputes, including insurance. Kifid's decisions (at the binding arbitration level) are binding on the insurer.

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Why Insurance Claims Get Denied in the Netherlands

1. Policy exclusions (uitsluitingen). Dutch insurance policies contain specific exclusions that insurers apply to deny claims. Common exclusions include intentional damage, criminal activities, business use on a private policy, and pre-existing conditions for certain insurance types.

2. Non-disclosure (niet-nakoming van de mededelingsplicht). Under Dutch law (Article 7:928 of the Civil Code — Burgerlijk Wetboek), policyholders are required to disclose material facts before insurance is concluded. Insurers may deny claims if they argue that undisclosed facts would have led to different underwriting terms.

3. Disagreement on the cause of loss. For property, motor, and home insurance, insurers frequently dispute whether the cause of damage falls within a covered peril. For example, whether building damage was caused by a covered storm versus excluded subsidence or wear.

4. Medical insurance disputes. The Netherlands' system of regulated private health insurance (Zorgverzekering) means that health insurance disputes often involve questions about whether a treatment falls within the legally defined "basic package" (basisverzekering) or whether supplemental insurance (aanvullende verzekering) covers the specific treatment.

5. Third-party liability disputes. Liability insurance (aansprakelijkheidsverzekering, both private — AVP — and professional) denial disputes arise about whether a claimed loss was caused by an insured act or omission.

6. Life insurance and disability insurance disputes. Disputes about disability classification (arbeidsongeschiktheid) and the definition of disability applicable to the policyholder's specific occupation are common in the Netherlands.

7. Late notification. Dutch policies typically require prompt reporting of insured events. Failure to notify within the stipulated period can lead to denial, though Dutch courts have generally interpreted this obligation reasonably.

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Your Rights Under Dutch Law

The Civil Code (Burgerlijk Wetboek, Boek 7) and the Financial Supervision Act (Wet op het financieel toezicht, Wft) provide Dutch insurance consumers with strong protections:

• Insurers must clearly communicate policy terms and exclusions before the contract is concluded.
• Denial of a claim must be in writing with specific reasons.
• The policyholder has the right to an internal complaint process before escalating to Kifid.
• If an insurer has not properly disclosed an exclusion at the time of sale, the exclusion may not be enforceable under Dutch law.
• The Wft imposes conduct obligations on financial service providers, including fair treatment of consumers in claims handling.

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Step-by-Step: How to Use Kifid to Challenge an Insurance Denial

Step 1: File a Formal Complaint with Your Insurer

Before approaching Kifid, you must exhaust the insurer's internal complaint procedure. This is a Kifid requirement.

Write a formal complaint (klacht) to your insurer's customer service or complaints department (klachtenafdeling). Dutch insurers are obligated by the Wft to have an internal complaints procedure and to respond within 6 weeks (or 3 months for complex complaints).

Your complaint should:

• Identify your policy number and claim reference
• Clearly state why the denial is incorrect
• Reference the specific policy clause and why it does not apply to your situation
• Attach all supporting evidence

Request a written final response (eindoordeel).

Step 2: Receive the Insurer's Final Response

Wait for the insurer's final written response. This is the trigger for your right to go to Kifid. If the insurer does not respond within 6 weeks (or 3 months for complex matters), you can proceed to Kifid without a final response.

Step 3: File Your Kifid Complaint

File your complaint with Kifid within 3 months of receiving the insurer's final response.

How to file:

• Online: Via the Kifid website (kifid.nl) — the online complaint portal is available in Dutch. An English-language guide is also available on the website.
• By post: Postbus 93257, 2509 AG Den Haag.
• By phone: 0900-3552248 for initial guidance.

Your Kifid filing should include:

• The insurer's final response letter
• Your original complaint to the insurer
• All policy documents
• The denial letter
• All supporting evidence (medical records, police reports, invoices, repair estimates, etc.)
• A clear statement of the outcome you seek

Kifid filing is free for consumers.

Step 4: Kifid Mediation (Bemiddeling)

Kifid first attempts mediation between you and the insurer. A Kifid mediator contacts both parties and facilitates discussion aimed at reaching a voluntary settlement. This stage resolves many disputes without the need for a formal ruling.

If mediation succeeds, the outcome is documented as a binding settlement.

Step 5: Kifid Dispute Committee (Geschillencommissie) Binding Ruling

If mediation fails, your complaint proceeds to the Kifid Dispute Committee (Geschillencommissie Financiële Dienstverlening). The Committee:

• Reviews all written submissions from both parties
• May request additional information or hear oral arguments
• Issues a binding decision (bindend advies) that the insurer is legally obligated to comply with

Kifid binding decisions are enforceable in Dutch courts. If an insurer refuses to comply, you can apply to the court to enforce the decision.

Timeline: Kifid aims to complete the full process (mediation + Committee decision if needed) within 12 months of receiving a complete complaint, though simpler cases are often resolved more quickly.

Kifid jurisdiction: Most personal insurance products fall within Kifid's scope. Business insurance disputes may be excluded or limited.

Step 6: AFM Complaint (for Conduct Violations)

If the insurer has violated the Wft's conduct-of-business rules — for example, by failing to disclose exclusions properly at the point of sale or by engaging in unfair claims handling practices — file a report with the AFM through the AFM website or consumer line (0800-5400 540). The AFM can investigate and impose regulatory sanctions on the insurer.

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Health Insurance (Zorgverzekering) — Special Rules

The Netherlands' basic health insurance (basisverzekering) is governed by the Health Insurance Act (Zorgverzekeringswet — Zvw). All Dutch residents are required to hold basic health insurance from a private insurer.

Basic health insurance denials typically involve:

• Whether a treatment is included in the legal basic package
• Reimbursement vs. care-in-kind model disputes
• Referral requirement disputes

For basic health insurance disputes, the Dutch National Healthcare Authority (Nederlandse Zorgautoriteit — NZa) is the relevant regulator, and disputes about package coverage can ultimately be decided by the healthcare ombudsman or court. Kifid handles disputes about supplemental (aanvullende) health insurance.

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Common Mistakes to Avoid

Not sending the internal complaint in writing. Kifid requires proof of a written internal complaint. Phone calls do not count.

Missing the 3-month Kifid filing deadline. After the insurer's final response, you have exactly 3 months to file with Kifid. Set a calendar reminder immediately.

Not attaching all evidence at the time of filing. Kifid bases its decision on what is submitted. If you leave out important documents at the outset, it may be difficult to add them later.

Not requesting a formal "eindoordeel" (final position). If the insurer responds informally or provisionally, insist on a formal final written position before going to Kifid.

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Drafting Your Complaint Letter

A well-organized complaint letter that sets out your case clearly is essential for an effective Kifid filing. ClaimBack at claimback.app helps you generate a professional, structured appeal letter tailored to your specific denial situation in the Netherlands. Even if you ultimately submit in Dutch, a clear English-language framework ensures you cover all necessary arguments.

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Conclusion

Kifid is one of Europe's most effective insurance consumer dispute resolution systems — it is free, accessible, relatively fast, and its decisions are binding on insurers. The Dutch insurance regulatory framework, backed by the AFM and the Civil Code, gives consumers meaningful protections against unfair denials. Follow the process: internal complaint first, then Kifid within 3 months, then AFM complaint if warranted. For a professional appeal letter framework, visit ClaimBack at claimback.app.