{"product_id":"vragen-77134-zorgverzekering-weigert-aanvraag-tot-betalen-tandarts-ondanks-ongevallenverzekering","title":"Health insurance refuses request to pay dentist, despite accident insurance","description":"\u003ch4\u003e Questioner\u003c\/h4\u003e \nDear Sir\/Madam,\n\n My aunt is insured with Zilveren Kruis, where she has also had additional accident insurance (2 stars) for many years.\n\n After 4 months of back and forth “hassle” between the dentist and the insurance company, Zilveren Kruis, for a reason that is completely incomprehensible to us, has decided NOT to reimburse the dental costs after an unfortunate fall on the face on a hard concrete floor.\n\n Anyone who fell that hard would also have their teeth “pop” out of their mouth, they can’t deny that, can they?\n\n Because the 4 front teeth were knocked out in the accident, the dentist now wants to place a bridge...\n\n My aunt doesn't want a beauty treatment, she just wants to be able to talk, eat and laugh again!\n\n What does the insurance want now?? Because of the fall it is NECESSARY..... and this treatment costs more than € 4000\n\n She would have preferred to have had her own teeth too.....\n\n BUT, here it comes:\n \nAccording to Zilveren Kruis, they are NOT allowed to reimburse if a set of teeth looks better after repair than before due to a legal provision (??)...\n\n Is this correct???\n\n My aunt is 80 years old, still has all her own teeth (nothing is loose), brushes her teeth 3 times a day, she faithfully goes to the check-up and dental hygienist every six months, at the moment she only has some inflamed gums, but hey, what do they expect at her age.\n\n My aunt contacted Zilveren Kruis several times by telephone and was told the following:\n\n One employee told her, on December 17, 2020, by phone that she is insured for accidents up to € 10,000 and therefore she should not worry and others also seemed positive and hopeful and kept telling her that everything would be fine, but that they were just waiting for the dentist's quote...\n \nIn their rejection letter they write about slightly deteriorating gums (my aunt is 80 years old) and that this could possibly cause 1 or 2 teeth to become loose in the future.\n\n Her own dentist never spoke to her about this and it has absolutely nothing to do with her fall.\n\n My apologies for the very long introduction, I will now give you an explanation of the accident:\n\n On December 15, 2020, my aunt fell over a flower box outside her downstairs neighbor's house.\n\n She fell forward with her face “flat” on a hard concrete floor.\n\n She sustained the following injuries as a result of this fall:\n\n - broken wrist\n\n - bruised hand\n\n - broken jaw\n\n - face swollen and black and blue\n\n - broken glasses\n\n - 4 teeth at the front of the mouth have “popped out” due to the hard tooth (this is what the claim is about now)\n \nThe oral surgeon can confirm, as he also stated in a letter, that the broken jaw and the teeth that fell out of the front denture were clearly caused by the hard fall flat on the face on a concrete floor.\n\n Anyone (young or old) who fell that hard would also have their teeth “pop” out of their mouth, they can’t deny that, can they?\n\n We have already filed a written objection with Zilveren Kruis (with a letter similar to this one, in which more explanation is given about the accident, because they never asked my aunt).\n\n Can you advise me whether the insurance company is correct and indeed does NOT have to reimburse the treatment costs or can we do something to make it clear to the insurance company once again that the fall was an accident and that my aunt should receive compensation, for which she has had insurance all these years.\n \nWe look forward to hearing from you, because we do not want to leave it at that, an accident should be compensated (regardless of age?).\n\n Yours sincerely,\n\n Belinda van de Velde\n\n\u003ch4\u003e Lawyer\u003c\/h4\u003e\n\n Dear,\n\n What an annoying situation. First of all, everything depends on the policy. Furthermore, the question is how your insurance knew that the teeth looked worse before the fall than after the recovery. The insurance bears the burden of proof in this. Of course, the insurance wants to have to pay out as little as possible. This is unreasonable, given that you have been paying premiums for years. A judge is often on the side of a small party, but it mainly depends on the policy. If you would like to contact me (without obligation), I can advise you further on this.\n\n\u003ch4\u003e Questioner\u003c\/h4\u003e\n\n First of all, thank you very much for your response. The insurance company has asked the dentist for information about the past 5 years and apparently concluded that the teeth are better after repair than before....\n \nBut what I don't understand is that for anyone who loses their front teeth after such a hard fall, their teeth will never be the same again, whether you are young or old....\n\n What the insurance company is hiding behind is that they are NOT legally allowed to pay out if a set of teeth, after repair, becomes better than before.\n\n Is this allowed? And is it true that such a provision has been included in Dutch law???\n\n Ps: Is it possible that our question is not so publicly “displayed” on the website?\n\n I thought that questions are always treated confidentially?\n\n We would like to have our question off the public website, this is more private, otherwise I would have given my real name too\n\n not used\n\n Thank you in advance\n\n\u003ch4\u003e Lawyer\u003c\/h4\u003e\n\n Dear,\n\n You can contact me by phone, there is a phone number on my profile. You can call this so that we can discuss the matter further verbally.\n\n\u003ch4\u003e Lawyer\u003c\/h4\u003e\n\n You may also send me a personal message so that we can continue to correspond confidentially and non-publicly by email.\n\n","brand":"Rechtswinkel.nl","offers":[{"title":"Default Title","offer_id":55003027603805,"sku":"","price":0.0,"currency_code":"EUR","in_stock":true}],"url":"https:\/\/www.rechtswinkel.nl\/en\/products\/vragen-77134-zorgverzekering-weigert-aanvraag-tot-betalen-tandarts-ondanks-ongevallenverzekering","provider":"Rechtswinkel.nl","version":"1.0","type":"link"}