What should I do if I disagree with my insurer’s decision?
Occasionally, an insured disagrees with the insurer’s decision. If you do not agree with the amount of compensation the insurer has offered you, or with the insurer’s decision to not compensate you, here is what you can do.
First and foremost, be aware that you can always ask to speak to the claims adjuster’s supervisor, or to the head of claims to discuss the issue or request that your file be reviewed.
1. Ask questions
Compensation is always based on the clauses in your contract. The first step is therefore to ask the claims adjuster questions in order to clearly understand the insurer’s rationale. For instance, which clause is the insurer basing its decision on, or how is the compensation calculated? The claims adjuster’s role is to explain the claims process to you and give you detailed information on the coverage your contract provides, as well as its limits and exclusions.
Did you use a broker to purchase your insurance? Talk to her about your situation to see if she can help you resolve the issue.
2. Provide explanations and make a case for your viewpoint
Talk to your claims adjuster about your disagreement and the additional information you will need to give him to make him change his mind. You may have to provide additional supporting documents to prove your case. If your disagreement concerns:
- The amount of compensation offered: you will have to find comparables.
- The specialist’s report that the claims adjuster mandated during the course of his investigation: you may have to mandate another specialist, at your own cost, to get a second opinion.
3.Negotiate a new settlement
Show your claims adjuster new information, negotiate the compensation or ask that he review his position.
4.Complain to the insurer
If you cannot settle the situation with the claims adjuster or his supervisor, you may file a written complaint with your insurer’s complaints department. Information on the complaints procedure is available on the websites of most insurance companies. If need be, ask the claims adjuster to whom you should address your complaint.
5.Transfer the file to the Autorité des marchés financiers
If the complaint is still not resolved, you can ask to have your file transferred to the Autorité des marchés financiers. This organization will analyze the file and, depending on the situation, may offer services to help settle the dispute between you and the insurer. To find out more, go to the Authority’s website.
6. Go to court
Insureds who feel that they have been wronged in a situation involving damage insurance—in particular, if they wish to receive monetary compensation—may consult a lawyer to see whether or not recourse in civil court is an option.
Insureds whose claim is for less than $15,000 can also go to small claims court. Two information sheets for consumers are available from the Small Claims Division of the Court of Quebec: one for plaintiffs and the other for defendants.
File a complaint with the Chambre de l’assurance de dommages
Any insured who has concerns about whether a damage insurance professional (agent, broker or claims adjuster) is in compliance with his or her ethical obligations, may file a complaint with the Syndic’s Office of the Chambre de l’assurance de dommages. However, filing a complaint with the Syndic’s Office of the ChAD will not enable you to recover any money that you feel you are owed, nor will it enable you to settle a dispute with an insurer. Read the section on how to make a complaint.
The Claimant's Handbook
This guide will help you to keep track of all the steps, documents and information you need to settle your claim.