When your insurer is slow to pay: deadlines and interest

Key rules

• Payment deadline: The insurer must pay within 40 days of receiving your claim notification.
• Late interest: A late insurer owes the legal interest rate plus 50 percent, rising to at least 20 percent a year from the second year.
• Disputed coverage: A reasonable dispute over coverage can excuse the insurer from paying interest.
• Time limit: Legal actions under a health insurance contract expire after five years.

How long the insurer has to pay

The insurer must pay within 40 days of receiving your claim notification. Keep proof of the date you sent it, such as an email with a receipt or a registered letter.

The insurer must also start the investigations needed to establish the loss without delay. It cannot sit on your file while it decides what to do.

The undisputed minimum

Even if the insurer is still working out the full amount, it must pay the undisputed minimum within 5 days of the final determination of the loss. This is the part it already owes based on the information it holds. Ask for it in writing if it is not paid.

When interest starts

If the insurer has not paid within three months of the event, for a reason that is not your fault, interest runs on the amount owed. The rate is the legal interest rate plus 50 percent. From the second year, the rate is at least 20 percent a year. Interest is counted from the date of the event.

When the insurer owes no interest

There is no interest if the insurer has a justified reason for not paying. Courts accept a reasonable dispute over whether the claim is covered as a justified reason. A weak or invented excuse does not count.

Health policies: money versus services

Interest applies clearly to money payments. If your policy provides services and the insurer should have covered costs you paid yourself, courts have applied interest to that reimbursement. Courts have been less willing to apply it to services in kind, such as a treatment you did not receive.

If it still is not paid

1. Write to the insurer, citing the date of your claim notification and asking for payment plus interest.
2. If it does not answer, complain to the insurer's customer service, then take the matter to the regulator or a lawyer.
3. Do not wait too long. The time limit for legal action is set out in the timeline below, and a court claim or a written demand can interrupt it.

Check the current legal interest rate with a lawyer or consumer office, because it is set each year.

Timeline and deadlines

• Insurer starts investigating the loss: Without delay after your claim notification

• Interest starts to run on the amount owed: If three months pass after the event without payment, for a reason not your fault

• Last date to take legal action: Five years from the date you could first act, usually the event or the refusal

Frequently asked questions

How much interest does a late insurer owe me?

A late insurer owes the legal interest rate plus 50 percent, and from the second year of delay the rate is at least 20 percent a year. Interest is counted from the date of the event. The legal rate is set each year in the Budget law.

Can my insurer avoid paying interest on a late health claim?

Yes, an insurer can avoid default interest if it had a justified cause for not paying, and courts accept a reasonable dispute over coverage as one. It applies clearly to reimbursement of costs the insurer should have covered. It is applied less readily to services in kind, such as treatment provided directly by the insurer.

How long do I have to take legal action over an unpaid health claim?

Legal actions under a health insurance contract expire after five years. The clock runs from the date you could first act, usually the event or the refusal. A court claim, a written demand to the insurer or the insurer acknowledging the debt restarts it.