Insurance Law

When an insurance claim is refused, delayed or disputed

A refusal letter does not always explain everything needed to assess a claim. The policy wording, the event, the information provided to the insurer and the reason for its decision all matter.

ZL Attorneys advises on insurance agreements and disputes, including home, motor, health, liability, pension and life insurance matters. Our insurance work connects with contract law, personal injury and litigation, depending on the problem you need to resolve.

Start with the policy and the written decision

We review the policy schedule, applicable terms, endorsements and the insurer's explanation. The important questions may include whether the event is covered, whether an exclusion applies, how the loss was assessed and whether a notification or other policy requirement is disputed.

An insurer's liability to pay and the amount of the loss are separate questions. A repair estimate or medical bill may help establish the amount, but it does not by itself determine coverage. Equally, the fact that an exclusion is mentioned does not finish the legal analysis: its wording and the facts must be examined.

Complaining to the insurer and the CBCS

For complaints concerning a supervised institution, the Centrale Bank van Curaçao en Sint Maarten (CBCS) says to complain to the institution first, preferably in writing. Its guidance explains escalation where handling is unsatisfactory or no response is received within two weeks.

The CBCS does not decide the merits of an individual payment dispute or act as a mediator. A regulatory complaint and a legal claim therefore serve different purposes. Follow the CBCS complaint procedure and keep copies of the original complaint and responses.

We can help frame the disputed issues, assess the response and consider negotiation or court action. Do not assume that a complaint process protects every contractual or legal deadline; ask for the dates to be checked separately.

What to prepare for a claim assessment

• The complete policy, schedule and any later changes or renewal documents.
• Proof of relevant premium payments and the claim reference.
• Your notification of the event and subsequent communications.
• The insurer's refusal, reservation of rights or settlement offer.
• Photographs, reports, estimates, invoices and other evidence of the loss.
• A short timeline and details of any urgent repair, medical or business need.

Keep originals and unedited copies. If evidence may change during repairs, discuss how to document it before work proceeds. For an initial enquiry, describe the issue briefly; arrange a suitable way to share medical, financial or other sensitive records after contact.

Reviewing insurance agreements before a dispute

For businesses, a policy review can focus on the insured activities, limits, exclusions, deductibles, notification requirements and the relationship with customer or supplier contracts. For individuals, it may focus on whether the wording addresses the risk they expected to insure.

We advise on policy and agreement wording. The appropriate cover and commercial terms also require discussion with the insurer or insurance adviser.

Questions clients ask

Can the regulator order my insurer to pay?

The CBCS complaint route is not a substitute for resolving the individual claim. Its published guidance distinguishes supervision from deciding or mediating a private dispute. We can assess the available legal route alongside a complaint.

Should I accept a settlement offer?

Check what the payment resolves, whether it includes a full release and whether future or disputed losses remain. Have the offer and supporting calculation reviewed before signing if the consequences are unclear.

Can you help when someone claims against my business?

Tell the insurer promptly in accordance with the policy and retain the demand and relevant evidence. We can assess the liability dispute and the coverage questions together. Bring any instructions already received from the insurer.

Discuss your insurance matter

Contact ZL Attorneys with the type of insurance, the insurer's decision and any stated deadline. We will discuss the documents needed to assess your position and the scope of the proposed assistance.