Your insurer accuses you of fraud: when to involve a lawyer

1. Identify the precise allegation

Start with the entire letter and its attachments. Does the allegation concern answers when you applied for insurance, or information supplied when claiming compensation? Record the question asked, your answer and the inaccuracy the insurer alleges. Explain whether an intermediary or another person helped transmit the information.

Kifid distinguishes intentional deception from an ordinary ambiguity or mistake. The surrounding circumstances therefore matter. Simply saying that you made a mistake does not provide the full explanation: describe what actually happened and identify the original records supporting that account. Do not present another person's assumption as something you personally witnessed.

2. Preserve the application and original claim records

Gather the application form, questionnaires, confirmations, policy and claim notification. Preserve photographs, invoices and earlier messages in their original form. A later explanation must be recognisable as later information. Do not alter a document to suggest that the revised version existed when you first applied or made your claim.

Create a timeline showing which information was available, when it became available and to whom you supplied it. Mark which allegation each document addresses. A disputed purchase receipt should remain distinct from a disputed answer on the application form. Ask your adviser how to obtain missing documents lawfully instead of reconstructing them as originals.

3. Separate the fraud finding from its consequences

An insurer may announce several measures in one letter. Make a separate entry for each: what was decided, what justification was given and what outcome you seek. Asking only for payment does not necessarily challenge investigation costs or cancellation of other policies.

Kifid explains that established intentional deception may have consequences for compensation and the insurance relationship. This does not mean that every possible measure is automatically justified in every case. Ask a lawyer to examine the policy, legal basis and circumstances for each measure individually. Resolving one part of the dispute may leave the remaining decisions in place unless the agreement expressly addresses them.

4. Treat registration as a separate issue

There are internal and external warning systems. Establish which register is involved, who made the entry and what period the decision specifies. Kifid describes a stricter threshold for external registration than a reasonable suspicion of guilt. An internal note is therefore not legally interchangeable with an external registration, even when both originate from the same investigation.

Keep the registration decision and describe the practical consequences it has caused. Whether there is a sufficient basis, whether registration is proportionate and whether its duration is justified are separate questions. Do not assume that the same duration applies to everyone or turn the outcome of one published decision into a general rule. The guide to the Extern Verwijzingsregister addresses access requests and the removal procedure separately.

5. Respond carefully to investigation requests

Read exactly what information the insurer requests and the stated deadline. Ignoring an investigation is not a general way to protect your position. Equally, avoid signing an account that you do not understand. Ask for clarification and discuss the appropriate response with your adviser, including whether you need assistance to understand a questionnaire or meeting record.

After an interview, keep the confirmation or report and identify any passages you believe are inaccurate. Submit corrections clearly and promptly, without silently replacing your earlier statement. Discuss who can support you at subsequent meetings and how additional evidence should enter the file.

6. Choose the complaint or proceedings route with advice

The AFM advises submitting a financial complaint to the firm in writing first. Specify the allegation and measures you dispute, the supporting records and the remedy you want. Keep proof of sending and the response. A report to the AFM can additionally inform supervision, but the AFM does not decide your individual insurance dispute or obtain compensation for you.

Check whether Kifid can handle this particular complaint and which rules apply. Ask about the consequences of a binding decision before choosing that route. A potential criminal matter requires separate attention to your position in that process. An internal complaint or Kifid case does not automatically cover every procedure arising from the same events.

If there is also an actual criminal suspicion of fraud, read about the separate criminal defence response. An internal insurance allegation is not automatically a criminal case.

7. Fictional example: a receipt does not match the claim

Suppose an insured person uploads a purchase document after a theft. The insurer concludes that the document does not match the claimed item and alleges fraud. The insured person says that the wrong file was selected during uploading. This disagreement calls for examination of the original notification, files and communications rather than an immediate assumption that either account is correct.

Useful preparation includes collecting the complete upload confirmation, original purchase records and correspondence in chronological order. A lawyer can then assess what supports the allegation and which explanation is relevant. This fictional example does not establish that the insured person is right, or that uploading an incorrect document can never contribute to a justified allegation.

8. Checklist for your insurance lawyer

Bring every measure and explain its practical impact, such as a new insurance application or a demand for payment. Ask for an initial assessment of the facts, urgency and available routes. Discuss the scope and cost of the engagement. Check possible legal expenses cover without assuming in advance that a lawyer or every aspect of the dispute will be reimbursed.

• The complete allegation, investigation report and response deadlines.
• Application, questionnaires, policy and original claim notification.
• Original supporting records, transmission or upload details and interview reports.
• Separate decisions on compensation, cancellation, costs and registration.
• Your previous responses, complaints and any criminal proceedings documents.