Health insurance deductible after an accident: how can you recover it from the liable party?

1. Why do you receive a bill when someone else is liable?

Your health insurance determines which medical care is covered and which portion you must pay yourself. Liability concerns who must ultimately bear the financial consequences of the accident. A correctly calculated deductible bill and a valid compensation claim can therefore exist alongside each other. The bill is not automatically incorrect merely because the other party has admitted liability.

Ask your health insurer for an explanation if you do not understand the calculation. Separately, ask the liable party to reimburse the accident-related amount that you actually have to bear yourself. Keep the two sets of correspondence clearly distinguishable. Otherwise, your health insurer may think you are only disputing the policy calculation, while the other party thinks your healthcare costs have already been fully settled. ONVZ explicitly describes this distinction in its information about healthcare costs after an accident.

2. Which deductible may be involved?

For adults, the mandatory deductible in 2026 is €385 per calendar year. You may also have agreed to a voluntary deductible. A statutory co-payment is a separate expense again. These terms must not be used interchangeably in your schedule of losses. Furthermore, not every treatment is subject to the deductible; GP care is a familiar example of an exception. See the current explanation from Zorginstituut Nederland.

Do not therefore include the maximum annual amount in your claim without checking it. Use the statement showing the amount actually charged to you. List any voluntary deductible separately and include the relevant policy details. Choosing a higher deductible does not, in itself, determine the extent of the other party's obligation to compensate you.

3. There must first be a legal basis for liability

An accident involving another person does not automatically mean that they must reimburse your costs. In an ordinary claim based on an unlawful act, relevant factors include the conduct complained of, whether it is attributable to that person, and its connection with the loss. Article 6:162 of the Dutch Civil Code provides the general legal basis. Depending on the circumstances, a special liability rule may apply.

You should therefore also retain evidence of the incident: an accident report form, photographs, witnesses' contact details and correspondence about liability. A bill proves an expense, but does not by itself prove who is legally responsible for it. If your claim is rejected, ask which element is disputed. Is the dispute about how the accident happened, liability, the connection with the treatment, or only the amount? A targeted response is more effective than submitting the same total amount again.

4. Substantiate the amount caused by the accident

The central practical question is how much additional deductible you have to bear because of this accident. The fact that a healthcare bill was received after the accident is not always sufficient to establish this. A bill may relate to a different treatment. Your deductible may also have been used up in full before the accident occurred. In that case, subsequent treatment may not create any additional deductible expense.

A substantive counterargument from the other party may be that you would have had to pay the same annual amount for other healthcare even without the accident. This calls for an examination of the specific claims and how the year unfolds, rather than automatic rejection. Show which costs have been attributed to the accident and which other healthcare costs are relevant. If there is a dispute, obtain an assessment of which comparison is legally appropriate. Identify a future bill that remains uncertain as an item reserved for later consideration, rather than as a payment already established.

5. Check the treatment period and the billing details

A hospital bill often contains a diagnosis-treatment combination, known in the Netherlands as a dbc: a package of care for a particular treatment. As a result, not every procedure corresponds to a separate bill. The Dutch Healthcare Authority (NZa) explains this billing system. If anything is unclear, ask which treatment and period the bill relates to.

For hospital care, the start date of a dbc sub-trajectory may determine the calendar year against which the deductible is charged. The date on which you receive the bill is therefore not a reliable basis for your schedule of losses. A follow-up trajectory may raise further questions about the relevant year. Ask your health insurer to explain this in writing. Do not apply these hospital billing rules to other types of healthcare without checking. Also retain any subsequent corrections: a refund or recalculation may change your remaining loss.

6. Recovery by your health insurer does not automatically include your deductible

When an indemnity insurer compensates a loss, the corresponding compensation claim may pass to it by subrogation. This transfer is linked to the compensation paid. The deductible you bear yourself therefore requires separate attention. Article 7:962 of the Dutch Civil Code provides the statutory basis.

Ask specifically whether your health insurer or claims representative is including your personal expenses, and on what basis. A statement that the insurer is 'investigating recovery' is not sufficiently clear. ONVZ, for example, states that its ordinary recovery of healthcare costs it has paid does not include the deductible, while separate recovery assistance may also be available. Services and conditions vary. Agree who will submit your deductible bill, who will receive the response, and who will check that the payment actually reaches your bank account.

7. Submit a claim that can be verified

Prepare a short covering message stating the accident date, the case reference and the basis on which you are holding the other party liable. Then attach an itemised statement. For each item, state the healthcare provider, the relevant period, the amount charged to you and any reimbursement already received. Identify the documents that support the connection with the accident.

Ask for a reasoned position if an item is rejected. A response stating that 'the medical costs have already been paid' does not explain what has happened to your deductible. Provide the specific information needed and ask about the appropriate assessment procedure for sensitive medical documents. A complete medical file is not automatically required for every small expense claim. Record what you have provided and retain a copy of your own schedule of losses.

• Keep the accident notification and the position taken on liability.
• Download the itemised statement of the deductible actually charged.
• Link the relevant healthcare bills to the accident.
• Separate deductibles, co-payments and other personal expenses.
• Check who is actually handling your personal losses.
• Update the statement promptly with payments and corrections.

8. Fictional example: two case files, one forgotten expense

Fictional example: Eva is hit by a vehicle in March 2026. The other party admits full liability. Her health insurer charges her a €385 mandatory deductible for accident-related hospital care. Eva had not used any of her deductible that year, has no voluntary deductible and receives no relevant correction later. Her health insurer pays for the remaining covered hospital care.

The health insurer tells her that it is recovering the costs it has paid. Eva asks in writing whether her €385 is also being claimed. It turns out that it is not. She therefore submits this personal expense, together with the itemised statement, to the person handling her personal injury claim. The example assumes that the costs and the causal connection are established. The amount therefore does not follow solely from the admission of liability: the deductible bill must also be substantiated.

9. Exceptions: contributory fault and insufficient funds available for recovery

An accepted item of loss is not reimbursed in full in every case. Contributory fault can affect the obligation to compensate. Special protective rules may apply to road accidents involving cyclists and pedestrians. You should therefore not transfer a percentage from the settlement between insurers to your own claim. The reverse reasoning can also lead to an incorrect outcome.

A dispute may also arise when the liable party has insufficient assets available to satisfy the claim or an insurance limit is relevant. Article 7:962(2) of the Dutch Civil Code protects your right to compensation in relation to the way your own insurer exercises the claim transferred to it. That protection does not create additional assets. If a shortfall appears likely, ask for the recovery actions to be coordinated and obtain legal advice about the allocation. Do not accept a proposal solely because the insurer wants to close its own file.

10. Finalise the matter only once your personal expenses have been included

Before agreeing to a final settlement, check whether the deductible for the relevant treatment periods is known and whether any further bills or corrections are expected. Explicitly identify outstanding items. Any reservation must be sufficiently clear and reflect what the parties actually agree. Do not assume that a general message about ongoing treatment automatically keeps all financial consequences open.

If you have doubts about the deductible calculation, first ask your health insurer for an explanation and, if necessary, a correction. If the other party disputes liability or compensation, address that dispute in your substantiated response. In a larger personal injury case, it is sensible to have the same claims representative handle this expense. Ask in advance about the scope of the engagement and the costs. Do not let necessary monitoring of deadlines depend on the completion of your health insurer's recovery case.