The Players: Who does What?
To follow up on the work, here is a list of all those involved in settling your claim.
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.
The claims adjuster is the resource person to turn to for all questions regarding your claim.
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.
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.