Claim for disability insurance and incapacity for work

Questioner

I have been on sick leave for 19 months as a job seeker at the UWV. I took out disability insurance with my savings mortgage in 1994. I am entitled to this if I have been continuously incapacitated for work for 52 weeks and am 45% or more incapacitated for work on that day. When can I claim AOV insurance or from what moment is someone incapacitated for work?

Lawyer

It is not possible to determine unambiguously when there is a question of incapacity for work, because many insurers use different definitions. Often, reference is made to the model policy conditions 2004/2005, which states: 'incapacity for work only exists if, in relation to illness or accident, there are objectively medically verifiable disorders that limit the insured person's functioning'. You can claim AOV if your illness is medically diagnosed.

Questioner

- The insurer itself indicates that it will wait until the WIA assessment (after 2 years) and then pay out the disability % retroactively for 1 year. - The volunteer at the legal aid clinic thinks that if one is on sick leave, this is not considered incapacity for work and therefore no claim can be made on the AOV. - In its report, the UWV states: Client is unfit to perform his work, as referred to in Article 19 of the Sickness Benefits Act. - The labor expert concludes that the client cannot earn more than 65% of the standard wage. This is seen by a lawyer as 35% incapacitated?! The question is whether it makes sense to write to the insurer to determine what the percentage of incapacity for work is in the 2nd year of the Sickness Benefits Act, or do I have no chance anyway and must I wait for the official WIA assessment?

Lawyer

With the substantiation of the occupational expert and the report of the UWV in hand, I would like to advise you to write to the insurer stating that there is indeed a loss of work (35%). If the insurance company does not want to comply with this, you can ask the insurer to appoint an expert or doctor to prove the opposite. If they do not want to comply, I advise you to first file a complaint with the insurer. You should consider whether you want to initiate the procedure with the insurer, now that you will probably be called up for a WIA assessment in a few months.