What may an insurer recover after fraud?
Brief definition: If an insurer determines fraud, they may recover paid benefits and investigation costs. However, recovery must be proportionate and there are legal limits. You have the right to dispute the fraud determination and the amount of recovery.
What can the insurer recover?
Upon established fraud, the insurer may recover:
- Paid benefits: The full amount or partially
- Investigation costs: Costs of fraud investigation
- Expert costs: Costs for expert reports
- Legal costs: Reasonable costs for legal action
Limits to recovery
The insurer may not recover everything indefinitely:
Proportionality requirement
- Investigation costs must be reasonable in relation to the fraud
- Excessive claims are not permitted
- Personal circumstances must be considered
Prescription periods
- Standard: 5 years from discovery
- Maximum: 20 years from the fraud
- Period stops upon claim
Undue benefit
- Only what was actually paid unduly can be recovered
- Legitimate partial benefit remains in place
Defense against recovery
You can dispute the recovery on several grounds:
Dispute fraud determination
- Was there really intent to deceive?
- Is the evidence lawfully obtained?
- Is there sufficient evidence?
Dispute amount
- Are the investigation costs reasonable?
- Are there parts that were legitimate?
- Is the calculation correct?
Invoke personal circumstances
- Financial situation
- Ability to pay
- Disproportionate consequences
Payment arrangement
If you cannot pay at once:
- Request a payment arrangement with the insurer
- Propose a realistic repayment schedule
- Document your financial situation
- With debt: request referral to debt assistance
Recovery procedure
Extrajudicial phase
- Claim letter from insurer
- Opportunity to respond
- Negotiation about amount and payment
Judicial phase
- Summons to court
- Opportunity to mount defense
- Judgment with possible payment arrangement
Frequently asked questions about recovery after fraud
Must I also pay investigation costs?
Only if they are reasonable and proportionate. Excessive investigation costs (e.g., €10,000 for minor fraud) can be disputed.
Can the insurer also recover from my partner?
Only if your partner was also involved in the fraud or if there is community of property and the debt falls into the community.
What if I cannot pay?
Request a payment arrangement or seek debt assistance. An insurer cannot collect more than you can afford.
How long can the insurer still claim?
Up to 5 years after discovering the fraud. After that, the claim is time-barred, unless the period has been interrupted.
May the insurer offset against another claim?
Yes, if you have another claim with the same insurer, they may offset the recovery against that claim.
Where can I get help with recovery by insurer in Utrecht?
A lawyer or legal advisor can help you dispute the recovery or make a payment arrangement. Contact us for advice in Utrecht.