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Ekelmans & Meijer ranked as leading firm in Chambers Europe

Ekelmans & Meijer ranked as leading firm in Chambers Europe 1000 700 Ekelmans Advocaten
Chambers Europe 2020
Leestijd: 2 minuten
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The leading international lawyers guide Chambers Europe has included Ekelmans & Meijer in the list of best Dutch law firms (leading firms) in the field of Insurance Law.

“Most firms have the required knowledge but this firm knows how to use it to our advantage.”

The leading international lawyers guide Chambers Europe has included Ekelmans & Meijer in the list of best Dutch law firms in the field of Insurance Law.

Chambers and Partners annually compares the performance of law firms in key areas of law in 53 European countries. For each country, the researchers determine which law firms and which individual lawyers are among the best in the country. They base this on extensive and independent research, in which clients also assess the services provided. This makes the results all the more valuable.

Leading firm in Insurance

We are therefore particularly proud that Ekelmans & Meijer is recognised by Chambers as a ‘leading firm’ in the field of Insurance Law.

Chambers recommends our firm and writes:

Renowned for its litigation expertise and has a long track record advising on high-profile cases before the Supreme Court. Has a broad liability practice, covering professional, D&O and general liability concerning construction, property damage and marine. Particularly well known for its expertise regarding healthcare insurance matters.

Clients value the team’s depth of knowledge and quality of advice, with one stating: “They always do their very best and are a pleasure to work with. Most firms have the required knowledge but this firm knows how to use it to our advantage.”

Another adds: “We enjoyed the personal approach. We felt like we knew what was going on, which gave us enough comfort during the process.”

An overview of the Chambers Europe 2020 ranking for Ekelmans & Meijer can also be found on the Chambers website.

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De Zorgverzekering (‘Health Insurance’) — the first clear overview of the law in Dutch healthcare

De Zorgverzekering (‘Health Insurance’) — the first clear overview of the law in Dutch healthcare 2560 1707 Ekelmans Advocaten
overzicht zorgverzekeringsrecht
Leestijd: 2 minuten
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Dutch health insurance and long-term healthcare are riddled with rules and customary practices, in which it is easy to lose your way.

But now the first edition of the book De Zorgverzekering (i.e.: healthcare insurance) has appeared.

Dutch health insurance and long-term healthcare are riddled with rules and customary practices, in which it is easy to lose your way. But now the first edition of the book De Zorgverzekering (i.e.: healthcare insurance) has appeared. In this book, Jan Ekelmans provides a picture of the health insurance scene and unpicks it layer by layer. Health insurers, healthcare providers, regulatory bodies, consumers and their advisors can use this book to help them make better, faster choices on what action to take.

Market worth 80 billion euros

Insured healthcare is a market with a turnover of 80 billion euros. Producing an overview of what happens in that market is quite a challenge, one that has been taken up by this book. It focuses on four topics: the various kinds of insurance (health insurance, insurance under the Long-Term Care Act and supplementary insurance); the legal relationship between the healthcare provider and the health insurer; privacy protection and possible breaches of privacy; and the audits and fraud investigations by health insurers, plus the consequences attached to the findings from these investigations.

Practical approach

The book has a practical approach; it devotes attention to different perspectives on decisions and includes examples from actual practice, future developments and sources for further information and application. It contains a wealth of facts and legal information that has never before been brought together in one place, ordered and made accessible in this way.

About the author

Jan Ekelmans is a lawyer and partner at Ekelmans & Meijer Advocaten. He is an authority in the field of insurance law in the Netherlands. Insurers ask him for advice on complex and politically sensitive matters. For a number of years Jan was a deputy justice at the Arnhem–Leeuwarden court of appeal and a member of the advisory committee that advises the Dutch Parliament and Government on civil procedural law. His extensive experience with insurance law enables him to provide a clear overview of health care insurance in the Netherlands.

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Unclear clauses in a bourse policy

Unclear clauses in a bourse policy 150 150 Ekelmans Advocaten
Leestijd: 3 minuten
Lesedauer: 3 Minuten
Reading time: 3 minutes
Expertise:

This article will discuss in which way an unclear clause in a bourse policy, concluded on the Dutch insurance bourse on the basis of co-insurance, should legally be determined. This is relevant because the insurer and the policyholder at the bourse usually do not discuss the policy wording, but rather use a wording that is often used at the bourse.

This topic is recently discussed in an opinion of the Procurator-General of the Dutch Supreme Court in a case in which Ekelmans represented the insurers in the Supreme Court trial.

Bourse policies

In the Netherlands, insurance is taken out either directly from an insurance company (on the basis of a company policy) or with the help of a broker through the Dutch insurance bourse (on the basis of a so called bourse policy). These different insurance products follow different rules whenever there is a dispute concerning the meaning of the policy wording at hand. Bourse policies are mainly taken out for grave and complex risks when coverage is not provided by just one insurer, but by multiple insurers. In the Netherlands this is often called co-insurance. An example might be the insurance of a big ship.

Usually, a professional bourse broker assists the future policyholder. Therefore, the policy between the insured and the insurer is mainly formed through negotiations between the insurer and the intermediary bourse broker. In co-insurance, the policyholder concludes an individual agreement with each participating insurer, always for the percentage the concerning insurer has accepted the risk for.

Thus, the professional bourse broker, acting as an intermediary on behalf of the aspiring-policyholder, offers the insurable risk(s) to the bourse insurer. A distinctive feature of a bourse policy is that the policy is concluded within a circuit of professional bourse brokers and insurers and that the policy wording is concluded through negotiations between these professional bourse brokers and insurers.

Explanation of an unclear clause

Within this framework, it is important to understand how an unclear wording should be interpreted in the event of a conflict.

In the case Chubb/Dagenstead (2008) The Dutch Supreme Court ruled that for the interpretation of a policy wording concluded on the insurance bourse, the focus should particularly be on the phrasing of the clauses and related comments, in light of the policy wording as a whole.

Recently, Ekelmans has assisted insurers at the Dutch Supreme Court in such a dispute with the insured. The case concerned a policy wording that was concluded on the insurance bourse on the basis of co-insurance. The Procurator-General of the Dutch Supreme Court argued that – besides the phrasing of a clause – judges should specifically take note of:

  • the meaning of the used term(s) in common speech;
  • the meaning of the used term(s) in a specific setting, for example the meaning of the term(s) within the insurance bourse circles;
  • the purpose of the specific clause and the nature of the insurance;
  • the ‘plausibility of the legal consequences to which various text interpretations could lead’ in case the phrasing of the clause offers (too) little grip for the case.

Knowledge of the bourse broker

Furthermore, the (assumed) knowledge of the bourse broker who represented the insured can also affect the interpretation of the wording . The legal allocation of the (assumed) knowledge of the bourse broker regarding the meaning of the product or the clause to the insured is not only based on the fact that a bourse broker (as a representative of the policyholder) concludes the insurance agreement on behalf of the policyholder, but also on the fact that the policy conditions are (mainly) the outcome of negotiations within bourse circles. This implies that the (assumed) knowledge of the bourse broker on the matter at hand can be hold against the policyholder whenever interpretation of an unclear wording needs to be established in a Dutch court of law.

Bron: Insurance Law Global

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A step into the Dutch world of product liability: subrogation claims

A step into the Dutch world of product liability: subrogation claims 150 150 Ekelmans Advocaten
Leestijd: 5 minuten
Lesedauer: 5 Minuten
Reading time: 5 minutes
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The basis of liability in case of a defective product

In case of a defective product that causes damage, the liability of the producer can be based on:

Strict liability for defective products (art. 6:185 – 191. DCC). This regulation is the implementation of The European Product Liability Directive of June 1985.
General tort liability (article 6:162 DCC). This liability is a fault-based liability.
Contractual liability (article 6:74 DCC). If there is a breach of a contract, according to article 6:74 DCC, a party can be held liable for a defective product.

It is self-evident that the claim of the insurer against the producer based on subrogation cannot be based on contractual liability since the insurer and the producer do not have any contractual obligations against each other.

Furthermore, according to article 6:197 DCC, insurers who pay compensation in a product liability case, have no subrogated claim for indemnity against the producer under the Product Liability Directive. Consequently the only bases for liability of the producer in case of subrogation is the general tort liability.

General Tort Liability

General principles

The general principle of Dutch tort liability is contained in article 6:162 DCC. This basic tort rule is one of negligence. Under Dutch general tort law the plaintiff will have to prove all the elements of the claim, namely: the unlawful act, the damage, and the causal connection between those two. Furthermore, contrary strict liability, the insurer has to argue convincingly that the unlawful act is attributable to the producer.

Unlawful act and the notion of a defective product

According to art. 6:186 DCC a product is defective if it does not offer the safety which a person is entitled to expect, taking all circumstances into account, including the presentation of the product, the use to which it could reasonably be expected to be and the time it was put into circulation. The question is if a defective product is considered to be unlawful in the framework of 6:162 DCC.

The Dutch Supreme Court ruled that a product is defective under 6:162 DCC if it does not offer the safety a user is entitled to expect, given the circumstances of the case. Therefore, the Dutch Supreme Court uses a similar definition under general tort law as for a defective product under the Product Liability Directive.

In principle it is up to the plaintiff to proof that the product is defective, however, a reversal of this burden of proof is possible. The Dutch Supreme Court considered in the Leebeek/Vrumona landmark case that if a plaintiff proves that damages occurred while the product was being used in a normal fashion, that state of affairs would lead to the factual presumption that the damage must have been caused by a defect in the product. It is then up to the producer to rebut this presumption.

Culpability

Contrary to strict liability, it is not sufficient that a defective product leads to liability of the producer under general tort law. The unlawful act (defective product) must also be attributable to the defendant. The Dutch Supreme Court has never accepted strict liability for defective products based on general tort law, however as set out above the burden of proof with respect to fault has more or less been shifted to the defendant. Whether or not the subrogated insurers also have the benefit of a shifted burden of proof with respect to fault is still an unsettled issue.

In the case Du Pont/Hermans the Dutch Supreme Court decided:
”Due to the nature of the unlawful act, the question whether the producer was at fault, can only be answered in the light of the circumstances to be stated by the producer.”

In the Rockwool case the Supreme Court defined the duty of care of a producer:
“Generally a producer will have to take all measures reasonably required, as a prudent manufacturer, to prevent damage caused by the product which is marketed. The producer of a new product, or a product that has been altered, has a duty to ascertain which effects the product has when used for foreseeable purposes.’’

Apart from this, The Dutch Association of Insurers (‘’Verbond van Verzekeraars’’) has imposed a restriction on this principle. If the insurer is a member of the Dutch Association of Insurers, the insurer is bound by the Regulation Subrogated Fire Insurers 2014 (‘’Bedrijfsregeling Brandregres 2014’’). Article 2 of this regulation states that the right of subrogation against non-individuals (companies) can only be exercised “if the liability is related to a negligent act” (‘’onzorgvuldig handelen’’).

There is much debat about the interpretation of the concept ‘’negligent act’’. In my opinion, the most obvious explanation is that there must be a culpable action. This explanation is also in line with the explanatory notes of the Regulation.

So the question of culpability under general tort law is answered on the basis of the circumstances invoked by the producer. If the insurer is a member of the Dutch Association of Insurers, the Regulation plays an important role in this since the definition of culpability is restricted by this regulation.

Causal connection

According to 6:162 DCC the plaintiff will have to prove causal connection between the unlawful act and the damages suffered.

However, also in the field of causation the courts have come to the aid of plaintiffs. A new rule on the burden of proof has gained momentum in recent years. It states that in case a wrongful act consists of a breach of a safety standard and the purpose of this standard is to prevent damages as suffered, the courts will consider the causal link established, unless the producer can prove that abiding by the safety standard would not have prevented the damage from occurring.

Recoverable damage

The rules of compensation are laid down in art. 6:95-110 DCC. There are no specific rules limiting compensation according to the type of injury in products liability cases based on general tort law. This means that not only physical harm and damage to property is recoverable under Dutch law, but also pure economic loss.

A successful appeal to general tort law

In the context of product liability, a subrogated insurer cannot rely on strict liability or contractual liability. Therefore, the only bases for liability of the producer in case of subrogation is the general tort liability.

For a successful appeal to general tort law, the insurer has to prove the unlawful act, the culpability, the damage and the causal connection between the unlawful act and the damage. The Supreme Court uses the definition of defective product from the Product Liability Directive to answer the question whether or not an act is unlawful in the context of 6:162 DCC.

The disadvantage of the general tort liability regulation is that – contrary to strict liability – not only the unlawful act, damage and causal connection must be proven, but the unlawful act must also be attributable to the defendant. If the claiming subrogated insurer is bound by the regulations of the Dutch Associaton of Insurers, the requirement is even higher and requires a negligent act.

This makes the threshold for a successful claim for damages on the basis of general tort law higher than for a claim based on strict liability. This threshold can be nuanced due the fact that the court has the authority to order a reversal of the burden of proof. Whether or not the insurer will have the benefit of this shifted burden of proof is an unsettled issue though.

Bron: Insurance Law Global

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Abdi Youssuf: the most driven mentor

Abdi Youssuf: the most driven mentor 1900 1357 Ekelmans Advocaten
Abdi Youssuf-Ekelmans Advocaten
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We are proud of Abdi! “The most driven mentor” is how he was described by the jury tasked with selecting the mentor of the year.

And our best wishes to Annemieke Hazelhoff, who won the ‘best mentor of the year award’.

Abdi, a lawyer specialized in insurance law at Ekelmans & Meijer, acts as a mentor to young lawyers (trainees) during the first three years of their career.

Our firm attaches a high priority to coaching and training for our young lawyers. An excellent mentor makes an important contribution to this. We see the nomination of Abdi as recognition of his qualities. And not only is Abdi a great mentor and fantastic person to work with, he is also an outstanding lawyer with a successful practice!

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Beware of the Cyber Security Act!

Beware of the Cyber Security Act! 1920 1280 Ekelmans Advocaten
cybersecuritywet
Leestijd: 4 minuten
Lesedauer: 4 Minuten
Reading time: 4 minutes
Expertise:

The Network and Information Systems Security Act (Wbni) is applicable in the Netherlands. The act is also known as the Cyber Security Act. The directive applies to operators of essential services and providers of digital services. This directive may also apply to your organisation.

Since 9 November 2018, the Network and Information Systems Security Act (in dutch: “Wet beveiliging network – en informatiesystemen”) has been applicable in the Netherlands, also known as the Cyber Security Act. This Act is the Dutch translation of the European Cyber Security Directive (EU Network and Information Security Directive 2016/1148). Each Member State is mandatory to have its own translation of the directive. The directive applies to operators of essential services and providers of digital services. This directive may also apply to your organization. In this article the operators of essential services and digital service providers are explained first and then the duty of care arising from the European Cyber Security Directive will be discussed.

When are you a operator of essential services or a provider of digital services?

Essential service operators include organizations in the energy, financial and transport sectors. The digital service providers includes for example cloud services, search engines and online market places, also known as “DSPs”. However, not every party that offers a digital service is automatically covered by the European Cyber Security Directive. For example, social media and web shops also offer digital services, but do not necessarily have to comply with the European Cyber Security Directive. Required is that the organization must have a head office or representation in the Netherlands. In addition, more than 50 employees must be employed within the organization or there must be a balance sheet total or an annual turnover of more than 10 million euros. Small and micro-enterprises therefore do not fall under the scope of the European Cyber Security Directive.

The failure or disruption of operators of essential services or digital service providers can lead to major social disruption. The European Cyber Security Directive therefore includes a duty of care for security measures.

The duty of care

The duty of care means that operators of essential services and the digital service providers must take appropriate organizational and technical measures to manage security risks and to reduce the consequences of incidents. In the GDPR (art. 24) we also have such an arrangement for the processing of personal data. However, the European Cyber Security Directive specifically focuses on digital security and includes the operators of essential services and the digital service providers in the broad sense.

The European Cyber Security Directive works out five aspects that operators of essential services and the digital service providers must take into account. This elaboration is based on art. 2 Implementing Regulation (EU) 2019/151 and consists – in brief – of taking the following measures:

First of all, the network and information systems must be adequately secured. In addition, organizations must be able to demonstrate that they take measures in the event of incidents. This could include processes for reporting incidents and for identifying shortcomings and weaknesses in the system. Provision must also be made for measures to properly maintain or restore business continuity and services after an incident. These measures include the establishment and use of contingency plans. It is also relevant that regular checks are made to ensure that the measures in question work properly and are therefore periodically tested. Finally, international standards must be taken into account in all of this.

All these measures aim to ensure that operators of essential services and the digital service providers comply with the principle of duty of care as set out in the European Cyber Security Directive: “taking appropriate measures to prevent incidents and, if incidents do occur, the consequences thereof so as much as possible “.

The duty of care in practice

The European Cyber Security Directive mainly indicates what needs to be done, but not how the implementation of this duty of care should subsequently be given shape.

Operators of essential services and the digital service providers must complete the implementation of the duty of care and the measures themselves, whereby each Member State needs to have a supervisory body (the Telecom Agency in the Netherlands) to supervise and take enforcement action if needed. However, because the duty of care and the measures are lacking, it is to be expected that organizations have many uncertainty about this. This could result in a failure to fulfill their duty of care.

Recommendation therefore deserves legal advice in applying the duty of care arising from the European Cyber Security Directive as correctly as possible in practice. It is important thereby that a balance is found in complying with the duty of care and respecting the commercial interests of companies and the privacy of natural persons. Creating a security protocol with a concrete step-by-step plan/checklist could be an example of this. However, due to the diversity of organizations that fall within the scope of the European Cyber Security Directive, this is a matter of customization.

What does this mean for the insurer?

The imposition of a specific duty of care on one hand, but the absence of specific standards on the other hand, makes the operators of essential services and the digital service providers vulnerable not only to the regulator but also to (possible) claims.

This increases the risk of an insurer that insures operators of essential services and the digital service providers. For insurance companies it is therefore advisable to take this into account in the underwriting processes regarding these operators and providers. For example this can be done by checking whether protocols and step-by-step plans to meet the duty of care are present within the organization. It is also advisable to oblige insured operators of essential services and digital service providers to inform the insurer of any changes to this duty of care within the organization.

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When are you entitled to immaterial compensation under Dutch law?

When are you entitled to immaterial compensation under Dutch law? 1000 465 Ekelmans Advocaten
immaterial compensation
Leestijd: 4 minuten
Lesedauer: 4 Minuten
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The Dutch Supreme Court ruled on immaterial compensation. This time in a case involving a detainee who was placed under a too strict detention regime by the Dutch government.

In March this year, the Supreme Court ruled (again) on this question and this time in a case involving a detainee who was placed under a too strict detention regime by the Dutch government. It was already legally established that the state had acted unlawfully. But does that also mean that there is a right to compensation for immaterial damage claimed by the detainee?

This article discusses how compensation for immaterial damage is regulated by Dutch law and what kind of development you see at the Supreme Court.

The case

In 2013, the claimant was sentenced to life imprisonment. During his pre-trial detention, the claimant was placed in the so-called “Extra Secure Institution” (ESI). After the claimant objected to this at the Council for the Administration of Criminal Justice and Protection of Juveniles, it considered that his stay there was unjustified. He was then transferred to another institution.

For this unjustified stay (of 350 days) the State paid a fixed compensation based on the ground of fairness of €1.375,00. However, the detainee believed he was entitled to higher compensation. He claimed he had suffered immaterial damage and that he had been affected in his person by the unlawful stay. He had never felt safe there. This was due to the many physical examinations and the intimate, body searches. He also had experienced his stay as social isolation.

Mental injury

Under Dutch law, one can only claim compensation for immaterial damage if the law provides for this. This because of the legislator’s idea that a claim is only justified in serious cases. One of the legal bases can be found in Article 6:106 of the Dutch Civil Code, paragraph 1, sub b. According to that article, a right to compensation is foreseen if the injured person (i) has sustained a physical injury, (ii) has been compromised in his honor or good name or (iii) has been affected otherwise in his person.

In this case, there was no physical injury nor a compromising in his honor or good name, so the question here is whether or not the detainee had been affected otherwise in his person.

The Supreme Court already judged on this topic in other cases a few times earlier. According to the Supreme Court in 2002, it is not enough to speak of personal harm when there has been more or less strong mental discomfort or feeling hurt. The starting principle is that the existence of mental injury is established in court, which in general will only be the case if there is a disease recognized in psychiatry. A year later, the Supreme Court considers that in any case, the injured party must provide sufficient and specific information that shows that psychological damage has occurred in connection with the circumstances of the case, which requires that the existence of mental injury be established by objective standards.

Almost ten years later, in 2012, the Supreme Court ruled that an exception can be made to the principle that mental injury must be established in court, in connection with the serious severity of the violation of standards and the consequences thereof for the injured party.

Consequences for the injured party

Both the court of the first instance and the appeal court rejected the view of the claimant. The Court of Appeal considers if the exception to the principle that there must be mental injury occurred here. But in this case – according to the court – there were no grounds for accepting such an exception since the claimant had not furnished sufficient facts about the consequences that the stay in the ESI had for him.

Immaterial compensation for violation of a fundamental right?

In the appeal in cassation, the claimant complains, among other things, that there has been a violation of a fundamental right and that the Court of Appeal has misunderstood that in the event of a violation of certain rights, it must be assumed that immaterial harm has been suffered. After all, the unlawful deprivation of liberty is a serious (fundamental) violation of his privacy.

The Supreme Court does not agree with that. First, the Supreme Court repeats its earlier judgments. The Supreme Court then rules that when someone takes the position that he has been affected in his person, he must substantiate that with specific facts. However, the nature and seriousness of the violation of standards may – where appropriate – mean that the adverse consequences for the injured person are so obvious that an impairment in his person can be assumed.

However, impairment in his person as referred to in art. 6: 106 (1) (b) of the Dutch Civil Code, can not be assumed with only a violation of a fundamental right. Even then, there must be sufficient certainty about the consequences of that violation. Therefore, the above-mentioned complaint is unsuccessful.

In addition, the Supreme Court finds the Court of Appeal’s opinion that the claimant’s consequences of the breach of standards have not been established legally, not incomprehensible. The claimant must, therefore, be satisfied with the compensation of € 1.375,00.

Bron: Insurance Law Global

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The Obstacle Criterion

The Obstacle Criterion 150 150 Ekelmans Advocaten
Leestijd: 4 minuten
Lesedauer: 4 Minuten
Reading time: 4 minutes
Expertise:

Dutch healthcare insurers provide three types of insurance. Under the in-kind contracted care policy, the insurer reimburses the provided care received by contracted care providers.

The insured can however still receive health care from non-contracted care providers, but –in that case – under Dutch law – the insurer does not have to reimburse all the costs. The Dutch Supreme Court recently issued an important ruling on this matter.

In-kind-contracted care policies

Generally, Dutch healthcare insurers provide three types of insurance: in-kind contracted care policies, restitution non- contracted care policies and the combined policy.

Under the in-kind care policy, the insurer reimburses the care received by the insured provided by a care provider that the insurer has a contract with. The insured are not entitled to reimbursement of the costs of the care provided, but to the care itself.

The restitution non-contracted care policies on the other hand, reimburse the costs of care given by the insured’s care provider of his/her own choice. These policies are usually more expensive.

Lastly, there is the combined policy, which is a combination of the aforementioned policies.

The in-kind-contracted care policy is central to this article.

Reimbursement for non-contracted care

As mentioned before, the insured with an in-kind contracted care policy is entitled to healthcare. To meet the obligation to provide care under these policies, insurers enter into agreements with care providers about the care or service to be provided and the price to be charged for it. This way insurers try to achieve savings on healthcare costs.

The insured can however still receive health care from non-contracted care providers. In accordance with article 13 of the Dutch Health Insurance Act insurers must give the insured reimbursement for non-contracted care. The insurers determine the amount of this reimbursement, as long as the reimbursement isn’t so low that it constitutes an obstacle for the insured to turn to a non-contracted health care provider of his/her choosing.

The court of appeal held that a general reimbursement of 75-80% of the market rates was regarded as a widely accepted practice standard of how low a reimbursement may be to not constitute an obstacle to be free in the choice of a care provider.[1] This judgment of the Court of Appeal has been upheld by the Dutch Supreme Court in2014.[2]

Despite that, a non-contracted healthcare provider tried his luck again and brought a case all the way before the highest Dutch Court. On June 7th 2019, The Dutch Supreme Court ruled on the matter.

Dutch Supreme Court Judgment on obstacle criterion

In this case, the insurer reimbursed 75% of the market rates for the healthcare provided by this particular healthcare provider. The healthcare provider, however, argued that this system was not fair. He maintained the opinion that the insurer was acting in breach of the ‘obstacle criterion’ enclosed in article 13 of the Dutch Health Insurance Act. Also, he took the position that the ‘obstacle criterion’ precludes a generic discount. Therefore, the healthcare provider was of the opinion that the insurer was only entitled to deduct a small amount for the extra administrative acts they had to carry out as a result of not having a contract with this healthcare provider.

The Dutch Supreme Court considers that article 13 of the Dutch Health Insurance Act speaks in general terms of “a reimbursement to be determined by the health insurer”. Furthermore, the explanatory memorandum of that act shows – according to the Dutch Supreme Court -that the health insurer has a great deal of freedom to determine the amount of the reimbursement as long as they do not act contrary to the “obstacle criterion’ and as long as they use the same method of calculation for each insured person who requires the same form of care or service.

Therefore, the Dutch Supreme Court rules that neither the explanatory memorandum of the Dutch Health Insurance Act nor the text in article 13 of the Act support the view that a health insurer may only reduce the reimbursement for non-contracted care by the (average) extra (administrative) costs they had to carry out because of the absence of a contract with the concerned health provider. According to the Dutch Supreme Court the latter view would also undermine the legislators’ desired system of Dutch in-kind care policies that differentiate between contracted and non-contracted care. Accepting the view of the healthcare provider would mean that even with the use of non-contracted care there would still be a right to an almost complete reimbursement, which was not the intention of the legislator.

According to the Dutch Supreme Court the complaint that the ‘obstacle criterion’ generally opposes a generic discount can also not be supported by the explanatory memorandum of the Dutch Health Insurance Act. Whether and to what extent the ‘obstacle criterion’ precludes a generic discount in certain cases can only be determined on the basis of concrete facts and circumstances.[3]

Reimbursement of 75% not (necessarily) an obstacle

This ruling of the Dutch Supreme Court is in line with the previous case law. Therefore, the health insurer is (still) entitled to determinate how much they reimburse under an in-kind contracted care policy in case of health care provided by non-contracted healthcare providers as long as they do not act contrary to the ‘obstacle criterion’. A general Reimbursement of 75% of the market rates on its own, is considered not to be an obstacle for the freedom of choice of a care provider.

[1] Court of Appeal Den Bosch, July 9th 2013, ECLI:NL:GHSHE:2013:2971.
[2] Dutch Supreme Court July 7th 2014, ECLI:NLHR:2014:1646.
[3] Dutch Supreme Court June 7th 2019, ECLI:NL:HR:2019:853.

Bron: Insurance Law Global

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CAR coverage for inherent defects and its limits

CAR coverage for inherent defects and its limits 2560 1920 Ekelmans Advocaten
Man repairing collapsed ceiling. Ceiling panels damaged huge hole in roof from rainwater leakage.Water damaged ceiling .
Leestijd: 5 minuten
Lesedauer: 5 Minuten
Reading time: 5 minutes
Expertise:

In principle, Dutch CAR policies explicitly provide coverage for inherent defects of the built object. However, the central notion of material damage in Dutch CAR policies provides a concealed limit to CAR coverage for inherent defects. Case law shows that in cases of inherent defects, there is a fine line between coverage and no coverage.

Central notions in CAR policies: material damage and inclusion of inherent defects

In the Netherlands, the central notion in the description of coverage of a Construction All Risk (CAR) policy is material damage. Without material damage there is no coverage under the CAR policy.

If, for example, it comes to light during the building period that the balconies in an apartment building would collapse in case of heavy load, the damage resulting from the necessary replacements of those balconies is not covered under CAR insurance. If the lacking strength of the balconies has led to cracks in the balconies, however, the cracks would be regarded as material damage. As a result, the cracks and all damage resulting from them would be covered under CAR insurance.

In terms of CAR coverage in the Netherlands, it is not relevant whether or not the cracks are the result of an inherent defect. As long as one can point to any material damage as a result of the inherent defect that has occurred during the building period, the defect and all damage resulting from the defect is covered under CAR insurance. However, there are exceptions to said principle. The notion of material damage in CAR policies includes a concealed exclusion of coverage for a certain group of inherent defects.

Concealed exclusion for objects which were damaged from the beginning

The idea is that the requirement of material damage cannot be met if an object has never been flawless, i.e. if the object was damaged from the beginning. This idea is regularly seen in Dutch case law and Dutch legal literature. The underlying reasoning is that an object which has never been flawless cannot be (materially) damaged as it was never a proper object in the first place. This idea has developed into a central tenet in Dutch CAR cover cases.

The question then arises: when can an object be qualified as being damaged from the beginning? How do we make a distinction between an object with an inherent defect and an object which was damaged from the beginning? Is it not that every object with an inherent defect can be regarded as an object which was damaged from the beginning?

Case law from 2018

In general, Dutch courts set high requirements in CAR cover cases for the argument of insurers that the object in question has never been flawless. Such is understandable given the aforementioned fact that CAR policies – explicitly – provide coverage for inherent defects.

Two decisions by lower courts given last year show that there is a fine line between coverage and no coverage in cases of inherent defects.

In the first case[1], a coating layer had been applied onto an ice skating track. After two weeks the layer showed blisters. Research showed that the coating layer had been applied too thick, as a result of which the solvent in the coating layer had not been able to evaporate causing blisters on the coating layer. The CAR insurer took the position that the coating layer had never been flawless and denied coverage for the damaged coating layer and all damage resulting from it. In assessing the question whether the coating layer had been materially damaged, the court considered that the deciding factor is whether the coating layer had been flawless at the time it was applied onto the track. The court specified that if the coating layer met all characteristics and requirements to become a coating layer without any defects at the time it was applied, the blisters on the coating layer could be regarded as material damage. The court considered that correct application is a precondition for a coating layer to become a flawless one. As the coating layer in question had not been applied correctly there was never a moment in time at which the coating layer had been flawless. Thus, the court concluded that there was no material damage, resulting in the claim not being covered under CAR insurance.

In the second case[2], the result was different. In this case, several welds had been applied to steel structures creating so-called skid beams, used in offshore industry. After application, the welds were examined by ultrasonic testing to ensure the absence of flaws. After two skid beams had been approved for delivery, they were examined again by ultrasonic testing after they had been delivered to their purchaser. During the second examination, indications were found for the presence of flaws. The skid beams were cut open and ruptures were found. They were repaired swiftly given the time pressure of the whole project. Insurers did not get the chance to observe the ruptures themselves. During the proceedings, insurers queried the results of the ultrasonic testing by pointing to the unreliability of the method and argued that the welds had never been flawless. Furthermore, insurers pointed to the fact that the flaws had been the result of a design fault combined with faults made during welding. According to insurers, the chosen method of welding could never have led to proper welds. The court assumed on the basis of the statements given by the experts who performed the ultrasonic testing that the welds had ruptured after they had been flawless. The court also found that CAR policies providing coverage for all damage no matter what cause, also provide coverage for design faults if the object does not show any flaws at first, as a result of good workmanship, but only at a later stage. Based on these considerations, the court granted the insured’s claim for coverage.

Conclusion

It can be difficult to divide between covered and uncovered claims in cases of inherent defects. Taking into consideration the aforementioned case law, it seems that as long as the insured can point to a moment in time at which the built object has been flawless, there is coverage under CAR insurance. This can be a quite difficult and very factual discussion.

Material damage as a result of design faults seems to be covered most of the time. Material damage as a result of faults during the construction phase can also be covered, but more often the aforementioned exception seems to apply. Especially faults which occur during the making of a specific component run the risk of falling outside the scope of CAR coverage.

[1] Judgment of the Rotterdam court of 7 November 2018, ECLI:NL:RBROT:2018:9314.
[2] Judgment of the Amsterdam court of 11 July 2018, ECLI:NL:RBAMS:2018:6603.

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Another EU regulation regarding privacy? Yes!

Another EU regulation regarding privacy? Yes! 1920 1280 Ekelmans Advocaten
EU regulation privacy
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While quite some organisations are investing in personal data protection and privacy measures to attain the General Data Protection Regulation (GDPR) compliance and others are still in de stage of GDPR awareness, another EU Regulation requires our attention: the new Regulation of the European Parliament and of the Council concerning the respect for private life and the protection of personal data in electronic communications (ePrivacy Regulation).

This ePrivacy Regulation should have entered into force at the same time as the GDPR. Although the Regulation has been delayed, it should be adopted at least sometime in 2020. The Introduction of the GDPR has caused a lot of turmoil so let us reflect on the consequences as a result of the introduction of this new ePrivacy Regulation.

Key points

The scope of the new ePrivacy Regulation would apply to any business that provides any form of online communication service, uses online tracking technologies, or engages in electronic direct marketing. The key points of the ePrivacy Regulation includes:

  • New players: privacy rules will in the future also apply to new players providing electronic communications services such as WhatsApp, Facebook Messenger and Skype. This will ensure that these popular services guarantee the same level of confidentiality of communications as traditional telecoms operators.
  • Stronger rules: all people and businesses in the EU will enjoy the same level of protection of their electronic communications through this directly applicable regulation. Businesses will also benefit from one single set of rules across the EU.
  • Communications content and metadata: privacy is guaranteed for communications content and metadata, e.g. time of a call and location. Metadata have a high privacy component and is to be anonymised or deleted if users did not give their consent, unless the data is needed for billing.
  • New business opportunities: once consent is given for communications data – content and/or metadata – to be processed, traditional telecoms operators will have more opportunities to provide additional services and to develop their businesses. For example, they could produce heat maps indicating the presence of individuals; these could help public authorities and transport companies when developing new infrastructure projects.
  • Simpler rules on cookies: the cookie provision, which has resulted in an overload of consent requests for internet users, will be streamlined. The new rule will be more user-friendly as browser settings will provide for an easy way to accept or refuse tracking cookies and other identifiers. The proposal also clarifies that no consent is needed for non-privacy intrusive cookies improving internet experience (e.g. to remember shopping cart history) or cookies used by a website to count the number of visitors.
  • Protection against spam: this proposal bans unsolicited electronic communications by emails, SMS and automated calling machines. Depending on national law people will either be protected by default or be able to use a do-not-call list to not receive marketing phone calls. Marketing callers will need to display their phone number or use a special pre-fix that indicates a marketing call.
  • More effective enforcement: the enforcement of the confidentiality rules in the Regulation will be the responsibility of data protection authorities, already in charge of the rules under the General Data Protection Regulation.

EU’s existing ePrivacy legal framework

The Regulation aims to be an update of the EU’s existing ePrivacy legal framework, more specifically the EU ePrivacy Directive which goes back to 2002 and was revised in 2009. However, important technological and economic developments took place in the market since the last revision of the ePrivacy Directive in 2009. Consumers and businesses increasingly rely on new internet-based services enabling inter-personal communication such as Voice over IP, instant messaging and web-based email services, instead of traditional communication services. These Over-the-Top communication services (OTTs) are in general not subject to the current Union electronic communication framework, including the ePrivacy Directive, resulting in a void of protection of communications conveyed though new services. The ePrivacy Regulation is lex specialis to the GDPR and will particularise and complement it as regards electronic communication data. All matters concerning the processing of personal data not specifically addressed by the ePrivacy Regulation will be covered by the GDPR.

Important is also the fact that the update is in the form of a Regulation instead of a Directive. This means that the new ePrivacy Regulation is self-executing and becomes legally binding across the EU, whereas the ePrivacy Directive required local regulations for implementation. The reason for choosing a Regulation instead of a Directive is in order to ensure consistency with the GDPR and legal certainty for users and business alike by avoiding divergent interpretation in the Member States. As mentioned before, the ePrivacy Directive is part of the regulatory framework for electronic communication. In 2016, the European Commission adopted the proposal for a Directive establishing the European Electronic Communications Code (EECC), which revises the framework. The new ePrivacy Regulation will not be an integral part of the EECC but it partially relies on definitions provided therein. In addition, the EECC complements the Regulation by ensuring the security of electronic communication services.

The new ePrivacy Regulation and the Insurance Industry

The big question is whether this new ePrivacy Regulation will cause as much turmoil for the insured and the insurer as with implementation of the GDPR. The proposal now lies with the Council of Ministers of the European Union. When the EU member states will agree on the proposal, then it is expected that long-term negotiations with the European Parliament will follow so we should not anticipate things. However it is safe to prudently say it is expected that this will not be the case. The ePrivacy Regulation will be in line with the GDPR so the biggest impact in terms of implementing the requirements have already been. Regarding the particular subjects which the ePrivacy Regulation regulates and that are not mentioned – or at least not that wide – in the GDPR, some changes as reflected will be required. Assuming however that the privacy policy of Insurers will generally be compliant, it is expected that the required adjustments will be limited to a minimum.

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