Three real-life cases of how to act with diligence and avoid negligence

Publication date: August 4, 2025

Targeted audiences

Claims adjuster Damage insurance agent Damage Insurance Broker

Category

Actual case

Topics

Auto insurance Commercial-lines insurance Home insurance Policy renewals

Appropriate follow-up when handling a claim, complete and clear notes in the file, adequate analysis of needs, and advice tailored to the client – these are examples of diligent actions by conscientious certified professionals.

Unfortunately, sometimes professionals lack care, application, or accuracy in fulfilling their obligations. This is called negligence. In fact, in 2024, nearly 40% of the total number of reasons¹ why clients most often complained against a certified professional were related to negligence.

One thing is certain: it is possible to overcome these shortcomings and improve the services provided to clients. To help you reflect on and ultimately improve your professional practice, here are three real-life cases involving potential negligence, along with the best practices to adopt.

The three stories presented here are inspired² by ethical investigations that conducted in 2024 by the Syndic’s Office whose files were closed³ for one of the following reasons:

The complaint was unfounded
An administrative measure was imposed – typically a behavior or good practice to be implemented preventively, aimed at improving professional conduct

^{1 Grouped into different categories, the grounds of complaint represent the main reasons why professionals were most frequently reported to the Syndic’s Office by clients.}

^{2 All identifying information about insured persons or certified professionals has been removed or altered. The purpose of this article is purely preventive and aims to provide ethical guidance in recurring industry situations.}

^{3 Over the past 10 years, an average of 8% of investigations have resulted in a formal complaint to the ChAD Disciplinary Committee.}

Does the client want protection or not?

The Story

A client wants to insure a secondary home that is about to be built. He contacts a damage insurance agent to obtain a quote. The agent offers coverage in case of theft of materials and tools during construction. Unsure, the client tells the agent he needs to do some checks before deciding.

The quote is then sent to the client without the proposed coverage. The client informs the agent that he will get back to her to finalize the contract and make a decision regarding the theft protection.

The Shortcoming

A few days later, the client emails the agent with the construction start date and asks her to call him back to finalize the contract.

Without contacting the client again, the agent issues the policy.

A theft occurs on the construction site. During the claim process, the client learns that the theft protection was not included and that his claim is not admissible.

The Best Practice

During the quoting phase, the agent provided the client with sound advice regarding their needs for the construction of the building. However, she should have called the client back to confirm his final decision before issuing the contract.

The contractual undertaking (formal condition): unexplained and misunderstood

The Story

An entrepreneur renews his insurance contract through his broker to cover the company’s trucks.

The insurer adds a formal condition to the contract: the client must install an anti-theft or tracking system on each of his vehicles.

The Shortcoming

The broker sends the contract to the client without explaining the scope of the formal condition.

Later, one of the trucks is stolen. The claim is denied because the client did not comply with the formal condition.

The Best Practice

Ethics are closely tied to good customer service. A broker’s added value lies in explaining the insurance contract. In this case, the broker should have ensured that the client understood the nature of the formal condition imposed by the insurer and the consequences of non-compliance.

A Claim in due form

The Story

An insured is involved in a car accident. The vehicle is a total loss.

The Shortcoming

The insured files a complaint against the claims adjuster, alleging negligence in explaining the claim process and delays in handling the file.

The Best Practice

The Syndic’s Office concluded that the claims adjuster acted diligently, for the following reasons:

He provided clear explanations, including that the vehicle was insured under Chapter A only, and that the insurer reserved the right to deny compensation if the claim was inadmissible. He needed the police report to identify the third party involved, which was essential to confirm the insured’s non-liability and proceed with the claim.
Delays were due to the time it took to obtain the police report.
The claims adjuster maintained regular follow-ups with the client to inform her of required documents, claim status, and insurer decisions.
The client file was well documented, allowing the Syndic’s Office to verify the facts effectively.

In short: even if the client disagreed with the outcome, the claims adjuster acted properly and professionally.

The translation of this article was done using AI but was reviewed by humans.