What does an insurance adjuster do? (A Canadian guide to claims)

You’ve just had a car accident or maybe your basement flooded after a storm. You call your insurer and soon someone reaches out to meet you on-site, examine damage, review policies and help you navigate the claims process. That person is the insurance adjuster.

Insurance adjusters play a critical role behind-the-scenes when helping everyday Canadians recover after a loss has occurred. And their role is becoming even more important every year. Insured losses from wildfires, floods and hailstorms totalled $8.5 billion in 2024, almost three times higher than in 2023 and a staggering 12 times the annual average of $701 million recorded between 2001 and 2010 and that’s not even factoring in car accident claims. According to Reuters, this is putting strain on Canadian adjusters to fill a projected 10% to 20% staffing gap by 2029. In this guide, we’ll walk you through the entire claims journey from start to finish, outline what adjusters can and can’t do, what type of information you’ll be asked along the way and how to work with them after you’ve been in a collision.

Adjuster 101: roles and types

In Canada, an insurance claims adjuster is the person who steps in after something goes wrong, like a car accident. They’re there to manage your insurance claim by determining what happened, who’s legally responsible and what coverage applies before moving you toward repairs or a settlement. Read on to find out more:

What an insurance adjuster actually does

So, what exactly does an insurance adjuster do? Most of the time, adjusters will:

• Gather information, photos, documents and statements.

• Confirm insurance coverage, deductibles and coverage limits.

• Determine liability and fault where necessary.

• Assess vehicle damage or total-loss value.

• Coordinate the repair process, vehicle rentals, towing and settlement payments.

Beyond this, they also serve as your point of contact throughout the claims process. Whether you have questions or concerns, adjusters can help you find the answer you need to keep your file moving forward toward a resolution.

Types of insurance adjusters

In Canada, there are three main types of insurance adjusters. Here’s how they differ:

• Staff adjusters: Staff adjusters work directly for insurance companies. They handle claims on behalf of their employer and are typically assigned when an insured person files a claim through their insurer.

• Independent adjusters: Independent claims adjusters are hired by insurance companies but don’t work in-house. Instead, they work for independent adjusting firms that provide adjusting services.

• Public adjusters: Public adjusters, while more common in the U.S., also exist in Canada. These adjusters work on behalf of the policyholder, not the insurer, to help negotiate a better settlement.

While claims adjusters work on behalf of the insurance company, their role is to apply your insurance coverage fairly and consistently based on the evidence you provide. It doesn’t automatically mean they are there to deny your claim.

What claims adjusters are not

Insurance adjusters do not help with the following:

• They are not your legal counsel.

• They are not the repair shop.

• They are not law enforcement.

• They don’t always make the final decision.

Where adjusters fit in Canada’s systems

Because car insurance in Canada is provincially regulated, how claims are handled will vary by province or territory. That being said, an adjuster’s overarching role in the claims process will remain the same. Most provinces and territories in Canada operate under a private insurance framework, while others function under a public system (British Columbia, Saskatchewan and Manitoba) or a hybrid system (Quebec).

Ultimately, this system structure determines where motorists purchase insurance policies from. In a private system, drivers purchase coverage from private insurance companies, whereas drivers in a public system purchase insurance coverage directly from a government corporation like ICBC. Let's take a closer look:

No-fault auto insurance

You may have also heard of the term “no-fault insurance.” This doesn’t mean that drivers are never at fault for a collision. It means that for certain insurance policies, you’ll be dealing with your own insurers, regardless of who caused the car accident.

The policy commonly associated with no-fault insurance is known as direct compensation-property damage, which means all vehicle damage claims are handled through your own insurance company to ensure a speedy claims process. Note that not all provinces function under no-fault insurance.

First notice of loss (FNOL) and file setup

First notice of loss (FNOL) refers to the moment you report your car accident to your insurer, broker or an insurance claim call centre. Here's what you should know:

The insurance adjuster’s role at the FNOL

Your insurance adjuster:

• Opens your claim file.

• Confirms your current policy is still active.

• Provides you with a claims number.

• Explains the next steps and expected timelines for your claim.

Information that they will typically ask an insured person following a car accident:

Be prepared to give answers for the following questions:

• Date, time and location of the car accident.

• Names and contact information of all involved parties.

• Photos and videos of the property damage and surrounding areas.

• Police report number (if applicable).

• Medical records.

• Accident witness contact information.

Coverage analysis: deductibles, limits and endorsements

Once your insurance claim has been opened, your insurance adjuster will review your car insurance policies in detail, including the declaration page, endorsements, exclusions and provincial regulations. They’ll confirm:

• Deductible amounts (if filing an insurance claim under collision or comprehensive)

• The insured person’s coverage limits.

• Endorsements (rental coverage, depreciation waiver, accident forgiveness).

• Direct compensation - property damage rules (if applicable).

Depending on the circumstances of your collision, your insurance claim may only be partially covered due to the specific deductibles, limits and exclusions of your car insurance plan. If your coverage has been denied or limited, you have the right to ask your insurance adjuster to explain why.

Liability claims investigations

When fault is present in a collision, claims examiners will investigate liability using several sources and documents:

• Driver statements.

• Statements from witnesses (sometimes they will interview witnesses).

• Photos and dash cam footage.

• Police reports.

• Vehicle damage and point of impact.

In Ontario, fault is determined using standardized Fault Determination Rules, which means fault can be shared between drivers in certain scenarios.

Assessments for damaged property: repairs vs. total loss

When your vehicle suffers damage as a result of a collision, the damage is typically assessed through:

• Photos that have been submitted to the insurance company by the driver or repair shop.

• An estimate for damages by the auto body shop.

• Inspected damage conducted by a field adjuster or appraiser.

If additional damage is found while repairs are being conducted, an additional estimate may be reviewed. Read on to learn more:

Repairs or total loss?

If the cost to repair your vehicle is more than its estimated value, your claims adjuster may deem your car a total loss. In that case, your settlement amount will be based on an actual cash value (ACV) framework, which considers depreciation, unless you have a replacement cost value (RCV) policy or a waiver of depreciation endorsement added to your plan.

Injury benefits and required documents

If you suffer a bodily injury in a collision, a separate insurance adjuster from your insurance company’s claims department may oversee the injury portion of your claim. Therefore, they may request:

• Medical records or treatment plans.

• Employee wage.

• Receipts for medications and rehabilitation.

• Accident benefits forms.

Remember that injuries following a collision may not be immediately apparent. Even if you are in a minor collision, seeking medical attention early on is always recommended.

Communication, negotiation and settlements

During your insurance claims journey, your claims adjuster is responsible for explaining decisions in your settlement, authorizing payments and communicating next steps. Depending on the circumstances of your claim, you may not agree with the recommended settlement amount offered. For example, in a total loss scenario or when injury benefits are involved. In this case, you have the option of negotiating your settlement amount until an agreement is reached. Remember to keep an open dialogue with your claims adjuster. Communicate respectfully and remain patient during the process.

Special adjuster roles

Depending on the extent of your collision, specialized adjusters may be involved:

• SIU (special investigations unit) adjusters who review potential cases of fraud.

• Desk adjusters who manage claims files remotely.

• Field adjusters/appraisers who inspect property damage in person.

Quick-fire claim examiner myths

Here's what you should know regarding myths surrounding insurance adjusters:

Myth: “An insurance adjuster’s job is to deny claims.”

• Reality: Claims adjusters use critical thinking, applying policy terms and evidence to reach a fair settlement.

Myth: “Police reports always decide who’s at fault.”

• Reality: Police reports are helpful, but don’t always determine liability.

Myth: “You have to use your insurance company’s repair shop.”

• Reality: It depends on the insurance company.

Myth: “Your first total-loss offer is final.”

• Reality: You can review comparable settlement amounts, ask questions and negotiate with your insurance claims adjuster.

Contact BrokerLink today

To learn more about what insurance adjusters do and how they fit into the claims process, reach out to BrokerLink. Our licensed brokers have the experience to guide you through the often confusing steps of filing a claim. We’ll help you determine whether it makes sense to file, walk you through your coverage, and explain how a claim could affect your premiums down the road. You can reach us by phone, email, or in person at any one of our locations throughout Canada.

Call Us 1-866-724-2372