Verzekering

Nieuwe advocaat: Elieske Kallenberg

Nieuwe advocaat: Elieske Kallenberg 150 150 Ekelmans Advocaten
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Elieske maakt deel uit van de sectie Verzekering en Aansprakelijkheid en houdt zich bezig met uiteenlopende verzekeringsrechtelijke kwesties.

Opleiding

Elieske heeft gestudeerd aan de Universiteit Leiden. Daar behaalde zij in 2017 haar bachelorsdiploma. In 2019 rondde zij de master Civiel recht cum laude af. Tijdens haar bachelor studeerde zij een semester aan de University of East Anglia in Norwich, Verenigd Koninkrijk.

Werkervaring

In augustus 2019 is Elieske beëdigd als advocaat. Tijdens haar studie heeft zij verschillende stages gelopen in de advocatuur en bij de Rechtbank Amsterdam. Daarnaast was Elieske onder meer actief als commissielid bij de faculteitsvereniging en als bestuurslid bij het Augustijns Theater. In 2018 heeft zij de theaterstichting Henk Speelt opgericht, een muziektheatercollectief in Leiden. Eerder behaalde Elieske haar propedeuse musicaltheater aan de Fontys Hogeschool voor de Kunsten.

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Architect/constructeur en aannemer/bouwer in gelijke mate aansprakelijk

Architect/constructeur en aannemer/bouwer in gelijke mate aansprakelijk 2560 1709 Ekelmans Advocaten
Architect constructeur aannemer bouwer
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Een nieuw te bouwen school is voorzien van een stalen draagconstructie met betonnen vloeren. Onderdeel van het werk is een uitkraging van twee verdiepingen hoog, die gedragen wordt door vier stalen vakwerkspanten met diagonalen en boutverbindingen. Tijdens de bouw (ver)zakt deze uitkraging.

Onderzoek leert dat ‘slip in de boutverbindingen’ in de genoemde vakwerkspanten de oorzaak van de zakking is. De aannemer verhelpt de (ver)zakking/doorbuiging door de uitkraging op te vijzelen en de
boutverbindingen aan te passen. De procedure gaat over de vraag wie deze kosten moet dragen.

Klik hieronder voor de uitspraak van Raad van Arbitrage voor de Bouw  19-7-2018, No. 35772/36.020 rond dit geschil en de gastnoot die Frank Schaaf hierbij heeft geschreven.

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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
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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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Nieuwe advocaat: Lieske de Vos

Nieuwe advocaat: Lieske de Vos 150 150 Ekelmans Advocaten
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Lieske is werkzaam bij Ekelmans & Meijer op de sectie Verzekering en Aansprakelijkheid en staat verzekeraars bij in uiteenlopende aansprakelijkheidskwesties.

Lieske heeft haar bachelor rechtsgeleerdheid behaald in 2017 aan de Universiteit van Utrecht. Ze volgde tijdens haar bachelor zowel het toga- als het notariële traject. Gedurende haar bachelor nam zij deel aan het honours programme (Utrecht Law College). In 2018 rondde Lieske de master ‘Privaatrechtelijke Rechtpraktijk’ met goed gevolg af.

Gedurende haar studie heeft Lieske verschillende stages gelopen bij grote advocatenkantoren. Ook vervulde zij de rol van voorzitter binnen het bestuur van de notariële studievereniging Vevanos. Na het behalen van haar master trad Lieske in dienst bij de Universiteit Utrecht als Docent Privaatrecht. Naast deze werkzaamheden zet Lieske zich in als bestuurslid van de Stichting Home of Hope.

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The Obstacle Criterion

The Obstacle Criterion 150 150 Ekelmans Advocaten
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Reading time: 4 minutes

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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Ekelmans & Meijer joins ILG expert-conference Cyber and Privacy in London

Ekelmans & Meijer joins ILG expert-conference Cyber and Privacy in London 1000 465 Ekelmans Advocaten
ILG Conference London
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On 27 March 2019 insures from all over the world will come together in the Lloyd’s Building in London to be updated by international experts about the key issues regarding Cyber and Privacy in relation to the insurance sector.

This conference is organized by Insurance Law Global, an international network of insurance law firms that offers insurers top level law support for their international activities. Ekelmans & Meijer is a member of ILG.

Would you like to know more about ILG and what this international network can do for you? Please contact Frank Schaaf, partner Insurance at Ekelmans & Meijer.

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Jan Ekelmans lecturer at the University of Amsterdam

Jan Ekelmans lecturer at the University of Amsterdam 1900 1357 Ekelmans Advocaten
Jan Ekelmans-Ekelmans Advocaten
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Jan Ekelmans, partner Insurance at Ekelmans & Meijer, will be the lecturer on the subject Evidence in the course Insurance law at the University of Amsterdam. This course combines in depth academic knowledge with practical solutions and is meant for professionals who address insurance issues in their daily work and want to deepen their knowledge.

All lecturers of the course are specialists. They have extensive academic and practical experience. Almost all of them obtained a Phd. Jan Ekelmans obtained his Phd on a thesis on obtaining information from physical and digital documents for the purpose of civil proceedings. Those who successfully follow the course will become certified insurance lawyers (CIL) or Certified Insurance Law Expert (CILE).

Jan Ekelmans: “I am delighted to be part of this course. All lecturers are well experienced and offer participants a course of high standards. Sharing knowledge with professionals and learning from each other is very rewarding. I look forward to the course starting in September 2019.”

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CAR coverage for inherent defects and its limits

CAR coverage for inherent defects and its limits 2560 1920 Ekelmans Advocaten
CAR coverage
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Introduction

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.

Bron: Insurance Law Global

Verdeling van schade

Verdeling van schade 2560 1687 Ekelmans Advocaten
Verdeling van schade
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Deze uitspraak van appel-arbiters is interessant vanwege de wijze waarop zij omgaan met de gezamenlijke betrokkenheid van de adviseur (architect) en de aannemer, in hun relatie tot de vorderingen tot schadevergoeding van de opdrachtgevers in verband met diverse problemen in het werk.

Klik hieronder voor de uitspraak van Raad van Arbitrage voor de Bouw  4-6-2018, No. 72.113 rond dit geschil en de gastnoot die Frank Schaaf hierbij heeft geschreven.

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Instorten Morandibrug bij Genua: de vraag naar oorzaak en schuld

Instorten Morandibrug bij Genua: de vraag naar oorzaak en schuld 2560 1707 Ekelmans Advocaten
Instorten Morandibrug
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Frank Schaaf en Marieke van der Keur belichten in dit artikel, gepubliceerd in de Beursbengel 2019 / nr. 881, hoe deze situatie er onder Nederlandse recht uit zou zien.

De Morandibrug bij Genua werd gebouwd tussen 1963 en 1967. Al vijftig jaar lang vormde zij de toegangsweg naar de stad. Miljoenen toeristen reden over ‘La Superba’ met de auto over de A10-snelweg de stad in. Op dinsdag 14 augustus 2018 stortte de brug in. De schade is enorm. Toen ongeveer 200 meter aan wegdek instortte, vielen voertuigen ruim 80 meter de diepte in en kwamen deels in de Polcevera-rivier terecht, en deels op huizen en fabrieken onder de brug. Er zijn tientallen doden gevallen en tien gewonden werden in het ziekenhuis opgenomen. Een paar honderd mensen raakten dakloos. Direct na de ramp rees de vraag naar de oorzaak én naar wie verantwoordelijk kan worden gehouden voor de schade. Hoe ziet de situatie er onder Nederlandse recht uit?

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