What should I do if I disagree with my insurer’s decision?

Ask questions

Compensation is always based on the terms of your contract. The first step is therefore to ask your questions to your claims adjuster to fully understand the insurer’s motives. For example, on what clause does he base his decision or how are the indemnities calculated? The role of the adjuster consists in particular of explaining the claim process to you and providing you with details regarding the protections included in your contract, the limitations, and exclusions.

Did you deal with a broker to purchase your insurance? Discuss your situation with him to see if he can help you resolve the impasse.

Explain and demonstrate your point of view

Discuss your disagreement with the adjuster and any additional information you need to provide for them to revise their position. You may need to obtain additional supporting documents to demonstrate your position. If your disagreement relates to:

  • The amount of compensation offered: it will be necessary to find comparables.
  • The report of a specialist appointed by the claims adjuster during his investigation: you may have to appoint another specialist, at your expense, to obtain a second opinion.

Negotiate a new settlement agreement

Present the new information to your adjuster, negotiate the proposed compensation, or request that they revise their position.

File a complaint with the insurer

If the situation is not resolved with the claims adjuster or his supervisor, you can file a complaint in writing with your insurer’s complaints handling department. Information about the complaints process can be found on most insurance company websites. If necessary, ask the claims adjuster who to address your complaint to.

Transfer of the file to the Autorité des marchés financiers

If the complaint is not resolved, you can then request the transfer of your file to the Autorité des marchés financiers. The organization will analyze the file and, depending on the situation, could offer you dispute resolution services between you and the insurer. For more information, 

Civil remedies

Insureds who consider themselves wronged in terms of damage insurance, in particular, if they wish to recover a sum of money, can always consult a lawyer to check what the possible remedies would be before the civil courts, if applicable.

Insureds with a claim of less than $15,000 can also file a small claims claim. Two memoranda for plaintiffs and defendants in the Small Claims Division of the Court of Québec are available for consultation.

File a complaint with the Chamber of Damage Insurance

Any insured who wonders about compliance with the ethical obligations of a damage insurance professional (agent, broker, or claims adjuster) can file a complaint with the Syndic’s Office of the Chambre de l’assurance de damage. However, filing a complaint with the Office of the syndic of the ChAD does not allow you to recover a sum of money that you believe has been wronged or to resolve a dispute with an insurer. See our Complaint section.

Leave a Reply