Your insurer refuses, delays or underpays: refusals, loss adjuster reports, deadlines and the Ombudsman

In short

If your insurer disputes cover, it must give a reasoned answer to your claim within 3 months; if not, it automatically owes you €300, and after your reminder €300 per day may start to run (Insurance Act, art. 73/1).

A refusal is not always the last word: an unclear clause is read in your favour, and a minor breach that did not cause the loss is not enough for a full refusal.

If you agreed on part of the amount, the undisputed part must be paid within 30 days; late amounts in principle carry twice the legal interest rate.

Ask for the adjuster’s report in writing; if you dispute the amount you can appoint your own expert. Under a home policy the insurer pays that expert’s cost up front (an advance); in the end the side found to be wrong bears it.

The Insurance Ombudsman is free; a complete complaint suspends the limitation period. In 2025, 56% of the cases examined on the merits were resolved in the consumer’s favour.

You generally have 3 years to sue your insurer: put the date in your calendar now.

This guide follows the order of a dispute with an insurer: reading the refusal, checking the policy clause, the loss adjuster’s report, payment deadlines and interest, the Ombudsman and finally court. For questions specific to home damage, see our home damage guide.

My insurer refused my claim: does the letter actually give reasons?

The first step is to check whether the letter is a real decision and what it relies on.

For claims made from 1 October 2024, an insurer that disputes cover must give a reasoned answer to the points raised in your claim within three months (Insurance Act, art. 73/1 §2). Art. 111/1 lays down the same rule for property insurance and art. 145/3 for liability insurance. In compulsory motor liability insurance (RC auto), the same deadline applies to the other driver’s insurer (Motor Insurance Act 1989, art. 13-14).

The Act requires the answer to address the points raised in the claim (« aux éléments invoqués dans la demande »). A letter saying “your file is being examined” that does not address them does not meet this requirement. No decision on the notion has been published yet. For the similar rule in motor liability insurance (1989 Act, art. 14), the Advocate General at the Court of Cassation wrote that its purpose is to force the insurer to take a position and explain why it considers it must or must not pay, and that the answer may be positive or negative (Cass. 30.1.2020, C.18.0559.N, opinion of the Advocate General).
If the letter is short or vague, ask in writing for: the policy clause relied on (clause number and version of the general conditions), the adjuster’s report and other documents in the file, and which facts the insurer considers proven.
The insurer’s own requests for documents must be “reasonable and relevant” (art. 73/1 §7). Endless requests for documents cannot be used to stretch the deadline.
Send everything by registered letter or by email with a delivery receipt: dates will matter later.

Home fire insurance (simple risks) and life insurance have their own deadline rules; the €300 penalty does not apply to fire damage under a home policy (see “My file has been pending for months” below).

Is the policy clause really enough to justify a refusal?

The problem often lies in the clause itself or in how it is applied.

Clarity rule: clauses must be clear and precise; if in doubt, they are read in favour of the policyholder (Insurance Act, art. 23; Cass. 8.10.2021, C.21.0070.F).
Mandatory rules: the contract rules in the Act are generally mandatory; your policy cannot put you in a worse position than the law (art. 56). A clause saying “no cover if not reported within 8 days” cannot, on its own, justify a refusal.
Exclusion or forfeiture? An exclusion (exclusion) is different from losing your rights because you breached an obligation (déchéance). The court looks at what the clause does, not at its label: a clause penalising your conduct after the contract was concluded (for example, not following a security rule) is a forfeiture, and the insurer must prove the link between the breach and the loss (Mons Court of Appeal, 8.3.2016).
A general duty of care is not enough: your rights cannot be forfeited on the basis of a vaguely worded obligation such as “you did not take due care”; the expected precaution must be spelled out in the policy (Mons Court of Appeal, 8.9.2016).
Condition of cover or forfeiture? Courts can reach different results: the Liège Court of Appeal treated “doors must be locked with a key when you are away” as a condition of cover; the policyholder had to prove the door was locked with a key (17.12.2012). The same court treated a duty to fit an approved tracking system as a forfeiture; the insurer had to prove causation, but a high degree of likelihood was enough, and the insurer won that case (16.12.2020).
A mere reference to the general conditions: if the special conditions only refer to the general conditions, you may not be treated as aware of an exclusion in them; you must actually have known the terms or have had a real opportunity to read them (Cass. 15.2.2019, C.18.0401.N; 22.12.2022, C.22.0082.F). Ask when and how the general conditions were given to you.
The insurer must prove that the conditions of an exclusion are met.

Can a minor breach of the rules lead to a full refusal?

Belgian law favours a proportionate sanction.

If you breached an obligation (lock, alarm, paperwork), the insurer can refuse only if there is a causal link between the breach and the loss (Insurance Act, art. 65). According to the Court of Cassation, this applies not only to gross negligence but also to ordinary negligence in breach of a sufficiently specific obligation (Cass. 10.3.2025, C.24.0343.F).
For late notification, the insurer may only reduce payment by the harm it actually suffered; a full refusal requires an intention to deceive (art. 74, 76). Missing an 8-day deadline in the policy does not by itself forfeit your rights (Brussels Court of Appeal, 26.2.2010).
An unintentional misstatement when taking out the policy leaves the contract in force; at most, the payout is reduced proportionally (art. 60).
“You have another insurance policy” is not in itself a ground for refusal (art. 99).

Proof in theft claims: you bear the burden of proving the theft, but you should be believed if your account is plausible and nothing casts doubt on it (Mons Court of Appeal, 21.4.2016). Do not exaggerate the loss: a deliberately inflated claim can cost you the entire cover, including the genuine part (art. 76 §2; Liège Court of Appeal, 2021/RG/262). State clearly when the value of an item without an invoice is an estimate.

Some of the appeal court rulings cited in this section date from the former Act of 25 June 1992 on non-marine insurance contracts; the same principles are retained in the 2014 Insurance Act (art. 65, 74, 76).

Short answer: ask for the report in writing, challenge the amount with reasons and, if needed, appoint your own expert. An answer that the report is an “internal document” does not have to be accepted in every case.

Your right to see the report. There are several grounds:

The expertise record: since 1 July 2025, in fire (home) insurance, after every on-site expertise or expertise involving your own expert, the insurer’s expert draws up a record setting the amount (procès-verbal d’expertise) and a copy is given to you; the insurer bases its offer on that record (Insurance Act, art. 121/1 §5). This rule applies to fire insurance only: the Act of 3.5.2024 inserted it into the fire insurance section of the Act (art. 115-122); according to its justification it applies to on-site expertises and expertises involving the insured’s expert in fire insurance, and no record is required if the insurer did not appoint an expert (Chamber document DOC 55 3856/002, amendment no. 32). The general rule for other property insurance such as comprehensive motor cover (art. 111/1) provides for no such record; there, rely on the grounds below. Under the code of conduct of the insurers’ association Assuralia and the experts’ association Gebcai, in force on the same date, the expert must explain to the policyholder how the amount was determined [Official: minister’s written answer to Parliament].
Personal data: the information about you in the claim file and the report is personal data; you have the right to a copy of it (GDPR, art. 15). According to the EU Court of Justice, a “copy” may include a faithful reproduction of documents or extracts of documents where needed to understand the data (C-487/21, 4.5.2023). Opinions and assessments about a person are also that person’s personal data (EU Court of Justice, Nowak, C-434/16, 20.12.2017); relying on that principle, the Belgian Data Protection Authority recognised a right of access to the data in an independent expert’s evaluation report (decision 41/2020, an employment case). The limit is the rights and freedoms of others (GDPR art. 15(4)): third parties’ information may be redacted, but this does not justify refusing the whole report. We found no Belgian decision specifically on insurers’ adjuster reports; address your request, headed “GDPR art. 15”, to the insurer’s data protection officer (DPO), and if there is no answer within one month you can complain to the Data Protection Authority (GDPR art. 12(3), 77).
Duty to cooperate on evidence: in court, the parties must cooperate in producing evidence (Civil Code Book 8, art. 8.4); a court may draw conclusions against an insurer that withholds a document.
The Ombudsman has criticised the lack of transparency of adjusters’ conclusions in its annual reports, and notes that treating reports as “confidential” in files with several insurers delays agreement (2023 and 2025 reports).

Challenging the assessment and a counter-expert. Under a home (simple-risk fire) policy, if you dispute the amount you appoint your own expert; if the two experts disagree, they choose a third and decide by majority. The insurer pays the costs of your expert and of the third expert up front (an advance), and the side found to be wrong ultimately bears them (art. 121 §2 2°). The expertise must be completed within 90 days of you notifying the appointment of your expert. The same mechanism exists for other property insurance (art. 111/1 §3). The Ombudsman notes that this cost rule is often ignored in practice (2025). Some policies also cover expert fees according to a scale; check your policy.

When hiring an expert (from 1.7.2025): your expert must tell you in writing beforehand the total price (hourly rate or a percentage of the loss) and the scope of the assignment. An offer from an expert who turns up uninvited after the loss can only be accepted at least one day later, and you cannot accept the insurer’s offer before a cooling-off period of at least 5 working days (art. 121/1 §3, §4, §6).

The insurer won’t even pay the amount it accepted, saying “other items are still disputed”

Short answer: it must pay the undisputed part. Whichever article applies, the law points the same way:

Home (simple-risk fire): the undisputed part established jointly is paid within 30 days of the agreement (art. 121 §2 2°). Rehousing and other immediate costs are paid within 15 days of you sending proof of the costs (art. 121 §2 1°).
Other property insurance: 30 days from the agreement (art. 111/1 §3).
Other lines (general rule): the jointly established undisputed part is paid within 30 days of being determined (art. 73/1 §4, §6).

Interest. An amount not paid in time automatically carries twice the legal interest rate (art. 121 §7, 111/1 §5, 73/1 §6). The civil legal interest rate is 4.5% in 2025 and 2026, so twice that is 9%. No interest runs if the insurer proves the delay is not attributable to it or its agents. According to the Court of Cassation, the art. 121 §7 penalty applies where the delay results from the insurer’s fault or negligence; a refusal made in good faith that later proves wrong may not trigger it (Cass. 9.9.2022, C.21.0461.N). Under the former Act, courts also applied double interest to late fire payouts (Liège Court of Appeal, 4.10.2010; 14.1.2013).

Advances and receipts. An advance offer may never contain a “full and final settlement” (quittance pour solde) wording, even a partial one (art. 73/1 §5, 111/1 §7). If the document you sign when receiving a partial payment contains such wording, ask for it to be removed before signing.

“We won’t pay until the investigation is over.” Where there is a presumption of intentional conduct the insurer may suspend payment, but the suspicion must rest on serious elements concerning you; mere suspicion is not enough (Mons Court of Appeal, 21.2.2017). On 1.10.2024 the Act removed “theft” from the suspension grounds in art. 121 §3. However, the Royal Decree of 24.12.1992, art. 9 §1 5° a), still allows the insurer, for perils other than fire, to reserve the right to obtain a copy of the criminal file in case of theft. Even then, the request must be made within 30 days of closing the expertise, payment must follow within 30 days of the insurer learning the outcome of the file, and the rule does not apply if you yourself are prosecuted.

Steps: ask for written confirmation of the agreed amount; once 30 days have passed, send a registered formal notice; calculate the interest item by item and claim it separately.

My file has been pending for months and I’m only told it is “being examined”: have the deadlines passed?

Short answer: very probably. Which deadline applies depends on the type of insurance and the date of the claim.

Insurance	Deadline	Sanction
General rule (legal expenses, health, accident, income protection, etc.)	Reasoned answer within 3 months if cover is disputed (art. 73/1 §2)	€300 automatically; if no reply within 11 days of a reminder, €300 per day
Property insurance (own-damage motor, theft, all risks)	3-month reasoned answer; expertise 90 days; payment 30 days (art. 111/1)	€300 + €300 per day; twice the legal interest for late payment
Home, simple-risk fire	Expertise within 90 days of notification; payment within 30 days of closing the expertise (art. 121 §2)	Twice the legal interest (art. 121 §7). The €300 penalty does not apply to fire damage (art. 121 §8, last sentence). For water, storm or theft under the same policy, applying art. 111/1 is arguable; no decision yet
Liability insurance (the other party’s insurer)	Reasoned offer or reasoned answer within 3 months (art. 145/2, 145/3)	Legal interest, or €300 + €300 per day

Date of the claim: art. 73/1, 111/1 and 145/1-145/5 apply to claims made from 1.10.2024. In RC auto, the new rule applies to accidents after 12.4.2024; before that, the penalty was €250 per day (not indexed).
€300 and the reminder: once the 3 months have passed, send a reminder by registered letter or equivalent. The 11 days start on the third working day after sending; if there is no reply, the daily amount runs from the day the reminder was sent and stops the day after the reasoned answer is received. The amounts are indexed every year; the calculated 2026 value is about €309 (no official notice has been published, so treat it as a minimum). These amounts require no proof of loss and are not deducted from the main indemnity.
Suspension: the deadline is suspended only if the insurer notifies in writing an obstacle beyond its control and that of its agents (art. 73/1 §8; 111/1 §4). A delay by its own adjuster does not count. A mere refusal of cover does not stop the home expertise either (Cass. 9.9.2022).
Damages for delay: beyond these, specific losses caused by the delay (e.g. rent, loan interest) can also be claimed under general law, if proven.

About one in four complaints to the Ombudsman concerns delays and unreachability, so you can complain about an unanswered file, not only after a refusal. In its 2025 report, the Ombudsman writes that the payment deadlines in art. 121 are “not applied rigorously”.

How should I write to the insurer’s complaints service?

Most insurers have a complaints service (service des plaintes / klachtendienst), and the Ombudsman expects you to write there first. Write a short, factual letter:

what happened and when you made your claim,
why you disagree with the refusal or the delay,
which rule you rely on (e.g. 3-month reasoned answer, causal link, undisputed part),
what you want (payment, reasons, a copy of the report, a new review) and by when.

If you have a broker, ask them for support too.

When and how do I go to the Insurance Ombudsman?

The Insurance Ombudsman (Ombudsman des Assurances / Ombudsman van de Verzekeringen) is the free, out-of-court complaints scheme provided for by law for disputes between insurers or intermediaries and their customers (Insurance Act, art. 322). It is a non-profit association; its supervisory board includes the FSMA, the Economy ministry and consumer representatives. There is no fixed waiting period: you can complain once you have written to the company and not received a satisfactory answer.

2025 figures: 9,429 requests (the highest since 2013); of the 4,409 cases examined on the merits, 2,171 were resolved in the consumer’s favour (56%); companies closed 9 files against the Ombudsman’s opinion; average handling time 88 days. Favourable outcome rates: vehicle 59%, fire/home 57%, life 61%, health 55%, legal expenses 57%, general liability 40%.

How to complain

Write to the company first (previous section). In 2025, a third of requests received directly were first redirected to the company’s complaints service.
Complain in writing: online form, post or email. Telephone complaints are not accepted.
You may write in French, Dutch, German or English; the reply comes in French or Dutch. Complaints in Turkish are not accepted; a short, clear text in English or French is enough.
A complete complaint: identity and address, the company or intermediary, the policy or claim number, a short description and documents. If medical information is needed, a signed consent form is added.
You may also complain through a broker, lawyer or family member; a representative outside the family (other than a lawyer or broker) needs a power of attorney.

What happens next? Admissibility is assessed within 3 weeks; the company is given 1 month to respond and must answer requests for information. The outcome is communicated within 90 days (at most 180 days for complex files). During this time the limitation period and the insurer’s collection procedures are suspended (art. 322 §2/2). You can withdraw your complaint at any time.

What it can and cannot do. It examines your file, asks the company for explanations, checks whether the insurer took your arguments into account, mediates and proposes a solution. It does not decide who caused an accident, cannot sanction the company (supervision lies with the FSMA and the National Bank), and does not handle work accident disputes (Fedris is competent), contracts governed by foreign law, disputes between professionals or cases already in court. It does not act directly on adjusters; it addresses the insurer that appointed them. The opinion is not binding, but companies very rarely go against it.

If you have legal expenses insurance and that insurer wants to handle the dispute amicably, the Ombudsman expects you to use that cover first. For a dispute with your legal expenses insurer itself, you can go to the Ombudsman directly.

A good complaint: describe the facts in date order in 5 to 10 lines; attach the refusal or delay letter, the policy, the general conditions, the adjuster’s report and the correspondence; state what you want and the rule you rely on; record the filing date.

If the Ombudsman does not settle it: legal expenses cover and the deadline to sue

You may have legal expenses insurance (protection juridique / rechtsbijstand) in your car policy, home policy or a standalone policy. In court or administrative proceedings you choose your own lawyer (Insurance Act, art. 156). If the insurer says your case “has no chance”, you can invoke the objectivity clause (art. 157). See our legal expenses guide.

You have 3 years from the day you learned of the event to sue your own insurer (at most 5 years from the event; art. 88 §1). This 5-year maximum can also be interrupted and suspended (Cass. 23.4.2026, C.25.0066.N). A timely claim notification interrupts the period until the insurer communicates its decision clearly and in writing (art. 89 §3); a late notification does not (Cass. 13.3.2026, C.25.0020.F). A direct action against the other party’s insurer must be brought within 5 years (art. 88 §2). The safe approach is to diarise the deadline without counting on any interruption or suspension; see our Deadlines guide.

Checklist

You can search case law on similar refusal grounds by topic on our Decision Search page.

Sources

This guide is general information, not legal advice. Current as of 09.10.2026.