The insurer is the company with which you have an insurance
contract. It has agreed to compensate you if you suffer
damages to a risk that is covered under your contract. If your
claim is admissible, the insurer is obliged to return your
property to the state that it was in before the loss occurred,
according to the terms of your contract.
DAMAGE INSURANCE AGENT
If you purchased your contract directly from the insurer, it was
an agent employed by this insurer who advised you and sold
you the contract. Generally speaking, agents do not participate
in the claims settlement process.
DAMAGE INSURANCE BROKER
If you purchased your insurance contract through a broker, he is
the person who advised you and sold you your contract. When
a loss occurs, this professional can give you an overview of the
steps involved in making a claim, however it is the claims adjuster
in charge of your file who is responsible for guiding you through
the claims settlement process.
CLAIMS ADJUSTER MANDATED BY THE INSURER
The claims adjuster is the professional who the insurer has
mandated to settle your claim. He is responsible for
investigating the cause of the loss, determining whether this
loss is admissible under the terms of your insurance contract,
estimating the amount of damages and negotiating the
settlement with you. Whether he is employed by the insurer
or works for a claims adjusting firm (in which case he is called
an external or independent claims adjuster), his duties remain
the same. He is paid by your insurer.
The claims adjuster is the orchestra conductor of the claims
settlement process: he takes your statement, collects
additional information from third parties, sends you details
regarding the coverage your insurance contract provides,
explains to you the claim process and the expected timelines
and, together with you, he prepares the claim presented
to the insurer. He is the resource person to turn to if you have
any questions regarding your claim.
The claims adjuster is, at all times, the person ultimately in
charge of settling the claim, even though he may delegate
some of his work to service providers whose work he supervises.
CLAIMS ADJUSTER MANDATED BY THE CLAIMANT
You may, at your own cost, retain the services of a “public”
claims adjuster who will deal with your insurer and the
insurer’s claims adjuster on your behalf. He will be your main
representative and spokesperson with the insurer and will
negotiate on your behalf with the claims adjuster mandated
by the insurer. This professional will regularly report to you on
the status of your file, and help you to properly document your
claim and make informed decisions throughout the process.
The claims adjuster must provide you with a written contract
and allow you to choose between two methods of payment.
See details on page "Required documents".
Did you know?
Claims adjusters (mandated by the insurer or by you)—
just like damage insurance agents and brokers—are
professionals who are certified by the Autorité des
marchés financiers and overseen by the Chambre de
l’assurance de dommages (ChAD). They are obliged to
take at least 20 hours of professional development
every two years in order to maintain, and indeed
upgrade, their skills. They are bound by a code of
ethics and must comply with several Acts; the ChAD
ensures their professional practice compliance. Go to
chad.ca to read the Code of ethics of claims adjusters. You can verify that your claims adjuster is authorized
to carry on activities by checking the register of the
Autorité des marchés financiers.
DISASTER RESTORATION PROFESSIONAL
This service provider specializes in emergency work and the
clean-up that may be required in the wake of a loss to limit
damages and ensure that the situation does not deteriorate.
It is recommended that you call the insurer first, since it will
dispatch the disaster restoration professionals if necessary.
You may also contact a service provider directly. If the loss is
not covered under your insurance contract, you will have to
cover the costs yourself.
Did you know?
The cost of the work performed by the disaster
restoration professional is deducted from the total
compensation that you receive and is included in
the cost of repairing or replacing your property.
Carefully read our advice on page "Step by step: what to do when a loss occurs".
The appraiser is mandated by the claims adjuster to calculate
the amount of damages and estimate the cost of repairs,
including the cost of materials required to restore your
property to the state it was in before the loss occurred.
It is important to request a copy of the quote or the estimate
and discuss it with the claims adjuster. This document
specifies the work to be done and its cost. You have a say
regarding the proposed work and the choice of materials
(which must be of the same nature and quality as those that
were there at the time of the loss).
The contractor is the person or the company that carries out
the renovations after the loss. You can chose the contractor to
do the repairs or do them yourself. Insurers can also suggest
service providers with whom they already have a business
relationship. Confirm all terms and conditions of the various
options with your claims adjuster.
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