Dealing with insurance adjusters in Canada

Most people don’t meet an insurance adjuster when they’re prepared or when they’ve had time to think, but instead, it’s generally on a bad day when something has already gone wrong, such as after a car accident or other type of accident and they’re trying to keep things from getting worse.

A tree comes down. A car doesn’t stop in time. A pipe bursts while you’re out. And suddenly someone you’ve never spoken to before is asking detailed questions about your life, your home, your car and your choices. That’s the insurance adjuster.

An adjuster isn’t there to make things worse. But they also aren’t there just to make things easy, either. From how your relationship with one actually works in Canada to what options exist when something feels off, we’ll walk you through everything you need to know about dealing with insurance adjusters in Canada.

Disclaimer: This article is for general information only. It does not replace legal advice. If your insurance claim involves a serious dispute, allegations of bad faith or potential litigation, consider seeking professional help, such as hiring a personal injury lawyer, attorney or public adjuster, for complex claims or disputes.

What is an insurance adjuster?

An insurance adjuster, also known as a claims adjuster, doesn’t sell insurance and they don’t decide what coverage you should have purchased. Instead, they’re assigned to review your claim once you’ve reported a loss to your insurance company. While the policyholder (you) and the insurance company are the main parties involved in the claims process, the adjuster sits between them, applying the policy to the loss and assessing what the insurer is responsible for.

The process generally starts with the insurance adjuster investigating the loss, reviewing your policy coverage and determining the extent of the damage. Their role is to determine how the policy applies to the loss and help move things toward a fair settlement. In Canada, there are two main types of insurance adjusters you might encounter:

All adjusters must be licensed in the province or territory where they work. They act on behalf of the insurance company and prioritize the company’s interests over the policyholder’s interests.

What does an insurance adjuster actually do?

A lot of an adjuster’s work actually happens behind the scenes. First, they gather information such as photos, reports, statements and repair estimates and sometimes visit the site of the loss to evaluate the circumstances surrounding a claim. They may also interview witnesses or talk with experts to gather more information about a claim. They’re trying to understand not just what was damaged, but how the loss happened.

Second, they read over your policy closely. Insurance policies are contracts, which means that your insurance coverage depends on what is written in them and not on what feels reasonable or expected. Third, they estimate the value of the damage or loss based on your policy and the information in the file. The recommendations they make will influence the settlement you’re offered and the outcome often depends on how well things have been documented and communicated.

What happens within the first 48 hours?

The first couple of days after a loss are when most insurance claims take shape. This is when:

• Property damage is first documented

• Timelines are established

• Initial statements and reports are gathered

This is also when most people are dealing with cleanup, temporary fixes and making important decisions. By the time the claim progresses, much of what’s reviewed later will trace back to this early period. Most insurance policies in Canada generally expect losses to be reported fairly quickly and reviewed while the details are still intact. This is because any early information is often all there is for an adjuster to go off of later on.

Over time, details can start to fade. That’s why things like dates, descriptions and explanations are so important when they’re documented as soon as you can after the loss happens. In some cases, policies will also allow for a cash advance to cover additional living expenses or urgent repairs once the claim is underway.

Your responsibilities and rights under Canadian policies

Insurance policies are contracts, but most people don’t experience them that way until they have to deal with an adjuster. By then, the policy wording often matters a lot more than anyone would like.

From the adjuster’s side, claims are handled based on what’s in the file. That’s why questions can repeat and why follow-ups are common, especially if any of the details are unclear or the file moves between people. That’s also why decisions about your claim can sometimes feel impersonal. Decisions about coverage or payment are tied back to the policy wording and to whatever information has been documented at the time.

But that doesn’t mean the obligations only run one way. Insurers are expected to explain how decisions are reached, including the reasons for a partial payment, limitation or claim denial. When a claim is under review, policyholders are also entitled to updates on how the file is progressing and to have questions thoroughly addressed through the insurer’s claims process.

If a claim doesn’t resolve as expected, the adjuster is generally still your main point of contact, but the review process goes beyond them. Every insurance company has its own complaint process and there are also provincial and territorial regulators who oversee whether claims are handled in line with required standards.

How does communication with an adjuster help shape a claim?

Communication during an insurance claim isn’t really about how you sound. It’s about whether both sides are talking about the same thing. The person making the claim experiences it through phone calls, emails and quick conversations that are happening alongside everything else they’re dealing with. But adjusters can only rely on what’s written in the file. So, when those two versions of events no longer line up, confusion or tension tends to follow. If it feels like you’re being asked the same thing twice, it’s often because something wasn’t clear the first time, not because anyone’s questioning your honesty.

It’s also important to consider how you speak with an adjuster. Conversations that admit fault to the adjuster may negatively affect your claim. In some claims, adjusters may also request a recorded statement, which can influence how your claim is assessed later on, so it may be a good idea to consult an attorney beforehand.

How are settlements valued by adjusters?

Adjusters determine settlement values based on the policy and what information is available in the claim file. The insurance adjuster will investigate your claim and use inspections, estimates and third-party data to determine the claim amount.

Your insurance policy will define your coverage limits, exclusions and how value is measured. Property claims often revolve around repair estimates or replacement costs. With auto insurance claims, it tends to revolve around market value, whether repairs may cross certain thresholds and the vehicle’s condition before the loss.

After reviewing your claim, the adjuster will present a settlement offer. That number isn’t finalized until it’s discussed, but it reflects what’s been examined and documented up to that point. Sometimes, providing more information may change your settlement amount, but other times, the policy itself sets the limits.

How does the claims process tend to play out?

Early on, things can often move a lot faster than you’re prepared for. You report the loss, a file gets opened and some version of what happened gets written down before anyone’s had much time to sit with it.

But after that, things tend to slow down. Estimates start circulating. Someone might need to check your policy wording again. And the file might even sit untouched for a few days while one missing detail holds everything else up.

On a straightforward claim, that early review might be enough to get things moving toward an offer. On others, you may be asked to answer new questions or provide more information after the initial review is done and the file is looked at again with more context.

What does closing the claim look like?

Once a settlement is agreed to, things usually wrap up pretty quickly, though it can look a little different depending on how the claim is handled. Before reaching the final settlement, make sure to get any settlement terms in writing to avoid disputes later on. Here's what you should know:

Repairs

When repairs are involved, the direction of the claim may be decided early, but the file often stays open while the work is actually being done. This is because repairs can uncover additional damage and costs can shift during the process.

Cash settlement

If the insurer is paying out a cash amount, things usually wrap up once that amount is agreed to and the paperwork is signed.

Once the claim is officially closed, there isn’t much room to revisit anything. This means that if something was missed or handled incorrectly, it could be quite difficult and costly to reopen or revisit. If questions come up later, insurers generally look at the claim based on what was documented at the time it was closed and new information doesn’t always change that.

What happens when there’s a claim dispute?

Most claim disputes are handled within the insurer’s own review process, often moving from the adjuster to a supervisor or internal ombudsman. Here's what you should know:

General Insurance OmbudService (GIO)

Once an insurer has issued a final position, the General Insurance OmbudService (GIO) or Autorité des marchés financiers (AMF) for Quebec residents, can step in and review whether the claim was handled fairly.

Superintendent of Insurance

If a dispute isn’t resolved through those channels or if the insurer isn’t a member of GIO, the Insurance Bureau of Canada (IBC) points to provincial regulators, such as the Superintendent of Insurance or equivalent authority, as the next place to raise concerns. However, these regulators review insurer conduct rather than individual settlement amounts. Some of these regulators include:

When to seek legal help

If you find yourself facing significant pushback from the insurance adjuster or facing situations involving bad faith allegations, you may want to consider seeking legal counsel or an attorney. Insurance disputes can get complicated pretty quickly and professional guidance can help you figure out whether escalation is the best next step.

An experienced lawyer or attorney can help with gathering more evidence and negotiating with the insurance company. While it may seem like an added expense, their expertise can ultimately save you time and stress.

Learn more with BrokerLink

Claims are usually when people really see how their insurance works. Until then, it’s mostly just paperwork and assumptions. As insurance professionals, our BrokerLink advisors work with top insurance providers across Canada and can help walk through what your coverage actually means, what to expect during a car or home insurance claim and how it might affect things down the road.

You can reach us by phone, email or in person at any one of our locations throughout Canada. And if you’re looking for a free car, home or business insurance quote, we encourage you to take advantage of our free online quote tool that can provide you with a competitive quote in minutes.

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