How does ABN AMRO Insurance determine permanent disability after an accident?

After an accident has been reported, the claims department reviews the claim. If this is necessary to determine permanent disability, medical advice is requested from the Personal Injury department of NN Group. NN Group is the insurance group that ABN AMRO Insurance is part of.

The insured person receives a questionnaire. Based on the answers, we assess whether additional medical information is needed. If medical information is required, ABN AMRO Insurance will request it from the treating doctor or therapist. This is only done with the insured person's permission through a signed consent form.

Once the medical information has been received, the medical adviser of ABN AMRO Insurance assesses whether the degree of permanent disability can be determined. If so, the adviser also determines the extent of the permanent disability.

The degree of permanent disability is determined when medical specialists no longer expect any further improvement in the person's condition. This must be done within the assessment period stated in the policy conditions. In most cases, this period is two years after the accident.

ABN AMRO Insurance uses the AMA Guides to determine permanent disability. These guidelines were developed by the American Medical Association (AMA), a professional association of medical practitioners. 

The AMA Guides are widely accepted in both medical and insurance practice and are used to:

• assess permanent impairments;
• determine a percentage of loss of function for the whole body.

This is done by objectively assessing the degree of permanent physical loss of function resulting from an injury. The AMA Guides assign percentage values to almost all limbs, senses and organs of the body. Based on these percentages, the full or partial loss of function of a body part can be converted into a percentage of loss of function of the body as a whole.

1. A 45-year-old man collides with another skier during a skiing holiday. As a result, he suffers permanent problems with his right knee. The insured amount stated on his policy schedule is €50,000. After one year and six months, his doctor determines that the knee will not recover any further. Based on the AMA Guides, the medical adviser concludes that there is a 25% loss of function of the right leg. According to the same guidelines, this is equal to a 10% loss of function of the body as a whole. The insurer adopts this percentage and calculates the benefit. Ten percent of €50,000 equals €5,000.
2. A 29-year-old woman falls from a jetty during a sailing holiday. Her arm becomes trapped between a boat and the jetty, causing a serious injury. As a result of the accident, she can no longer use her arm. The insured amount for permanent disability is €100,000. According to the AMA Guides, a complete loss of function of an arm is equivalent to 60% permanent disability of the body as a whole. She therefore receives a benefit of €60,000.
3. A car driver suffers a glass injury in a traffic accident that results in the amputation of part of his little finger. The driver has accident passenger insurance that covers permanent disability. The insured amount is €20,000. Based on the level of the amputation, the AMA Guides indicate an 80% permanent disability of the little finger. According to the same guidelines, this is equal to a 4% permanent disability of the body as a whole. The benefit therefore amounts to 4% of €20,000, which is €800.