If someone suffers permanent injury as a result of an accident or medical error, their care needs can be extensive. A wheelchair, help at home, nursing care: sometimes for years, sometimes for life. How can these care needs be met? And who pays for them? In the Netherlands, there are two routes: public care legislation and civil liability law. What are the relevant differences between these two care routes when it comes to making a choice? Does the person in need of care have freedom of choice in this regard, and what are the consequences of that choice? These questions are central to the PhD research of Melissa de Groot, PhD candidate at Erasmus School of Law.
On December 19 2025, De Groot defended her thesis: ‘Compensation for costs of care: on the relationship between civil compensation for costs of care and public care provisions’. She was supervised by Siewert Lindenbergh, Advocate General at the Supreme Court of the Netherlands and Professor of Civil Law at Erasmus School of Law, and Harriët Schelhaas, Dean and Professor of Private Law at Erasmus School of Law.
Two routes to care
Everyone in the Netherlands is entitled to care provisions under the public care legislation: the Health Insurance Act, the Long-Term Care Act (Wlz), the Social Support Act 2015 (Wmo) and the Youth Act. However, if the injury was caused by someone else, such as a motorist, a doctor or an employer, a second route may also be available, namely a claim for compensation under civil law. This allows the person in need of care to recover reasonable care costs from the liable party.
Why this topic? The human aspect of this topic immediately appealed to De Groot. “This concerns people who sometimes have extensive and long-term care needs. It is essential that they know what options are available to them, which best suit their situation, and that their care needs are adequately met,” explains the PhD candidate.
Until now, these two routes, embedded in different areas of law, public law and private law, have mainly been studied separately. This presents a challenging legal puzzle at the intersection of civil liability law and social security law. A legal-dogmatic analysis of their interrelationship was still lacking. This PhD research fills that gap.
Cuts to public care make the choice of a care pathway more urgent
The research touches on a current social debate. Public care in the Netherlands is under increasing pressure. An ageing population, staff shortages and rising costs are leading to political discussions about limiting the level of public care. For instance, the coalition intends to remove domestic help as a bespoke provision from the Social Support Act (Wmo) by 2029. If the standard of public care falls but the standard under civil law remains the same, the gap between the two routes may widen. Whether civil law will ultimately follow the trend of a declining public standard is an open question which the PhD candidate identifies as an area for further research.
The research is also relevant from a practical perspective. Just before the defence, the 2025 Compensation for Costs of Care Recommendation was published, a practical guide for the personal injury sector that provides guidance on complex care need cases. De Groot contributed to the development of this recommendation and has published on the subject.
Freedom and limits
The central question is: ‘How does a civil law claim for compensation for care costs relate to a claim for public care provisions in cases where the two overlap?’ The main conclusion is that, in principle, the person in need of care has the freedom to choose: the public route alone, the civil route alone, or a combination of both. But that freedom has its limits. Once the person in need of care has made use of one route, the other is thereby restricted. In this way, the system prevents someone from being compensated twice for the same care need.
A concrete example illustrates this. Suppose someone needs a wheelchair following an accident. That person can choose to obtain a wheelchair through the Social Support Act (Wmo) or to recover the costs of a privately purchased wheelchair from the liable party. If that person opts for the Wmo wheelchair, the option to recover the costs of a privately purchased wheelchair from the liable party is forfeited. However, the local authority may still recover the costs of the wheelchair provided from the liable party. Nevertheless, for the person in need for care the civil law route remains open for other care costs. The reverse is largely true as well: anyone whose costs are reimbursed under liability law is generally no longer entitled to a comparable public provision. An exception applies to provisions under the Long-Term Care Act (Wlz). Civil compensation received may, however, affect the level of the personal contribution for the Long-Term Care Act (Wlz), which is income- and asset-dependent.
Which route is the most suitable?
In addition to mapping out the mutual influences, De Groot also studied which differences between the two routes are relevant to the choice. And there are indeed differences: in the conditions for entitlement to care, in the form and scope of that entitlement and in the duration and funding thereof.
For instance, civil liability law has relatively high thresholds. There must be a liable party, there must be a causal link between the injury and the event causing the damage, and the injury must also not have been caused by the fault of the person in need of care. Public care laws do not impose such requirements; the cause of the injury is irrelevant. Furthermore, the criteria for the scope of care entitlement differ between the two routes. The level of care needed, therefore, need not be the same.
The differences between the two care pathways identified by De Groot can assist legal practitioners in making a well-considered decision in a specific case. Ultimately, the key question is which pathway best serves the interests of the person in need of care, namely that their care needs are adequately met. '“Living together means looking after one another.”'
- PhD student
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The entire PhD thesis can be found here (in Dutch).
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