Personal Insurance Claims Process

When the unexpected occurs, whether it's a car accident, home fire, or a slip and fall, your personal insurance policy is there as your financial safety net. Personal insurance includes policies like home, auto, and liability coverage designed to protect your assets and interests, with the aim of limiting any potential out-of-pocket losses. That said, for your insurance to work as it is intended to do, it's essential that you know how and when to file a claim.

A common concern that many Canadians have is, "Will my insurance premium increase after I file a claim?" The truth is, it depends on the type of claim you're filing, your previous insurance history, and the specifics listed in your actual policies. Another worry you may have is waiting too long to file with your insurance company. Delaying a claim could lead to your claim being denied or to minimal compensation.

When should you file a claim?

Filing a claim with your insurance company is a decision you shouldn't take lightly. In some instances, where injuries or severe property damage occur, it's essential to file as soon as possible. In other scenarios, where damage or losses are minor, it may be more cost-effective to pay out of pocket to avoid an increase in your insurance premiums.

Insurance Providers

When filing a claim makes sense

Generally speaking, you should seek to file a claim with your insurance company when the loss or damage is:

1. Substantial

If the cost of repairs or replacements, whether it be to your personal belongings, vehicle, or parts of your home, costs more than your deductible amount.

2. Involves other people

If you injure someone or damage property that belongs to another person. For example, causing a motor vehicle accident involving injuries to the other driver you hit.

3. Covered by your insurance policy

Damage occurs as a result of a covered peril listed in your insurance policy. For example, fire, theft, or vandalism (under your auto insurance). Or a weather event, e.g windstorm, hail, rising water levels, or fire, under your home insurance policy.

4. Is time-sensitive

Some situations, like burst pipes or theft of your vehicle, require prompt insurance filing to avoid further losses.

When to avoid filing a claim

Not every incident needs to be dealt with through your insurance company. Common scenarios where you may think twice about filing an insurance claim include:

  • The cost of repairs or replacements is close to or well below your deductible amount.
  • The incident is minor in nature and can be handled out of pocket without any financial strain.
  • You've had multiple claims recently, which may lead to your insurance provider viewing you as a high-risk customer.

Examples

  • A minor scratch on the bumper of your car.
  • A small water leak in your bathroom caused minimal damage.

Pro Tip: Consult with your insurance broker first

If you're unsure whether to make a claim, we recommend speaking with an insurance broker like BrokerLink, who can help you:

  • Estimate the financial impact of filing vs. paying for damages out-of-pocket.
  • Clarify if the event is covered under your current policy.
  • Determine how your claim could affect your future insurance premiums.

Step-By-Step Guide: How to make a claim (by type of claim)

Understanding what to do and when to file your claim is crucial if you want to ensure a smooth process from start to finish, while guaranteeing you get fairly compensated for your losses. Below, we've outlined how to make a car insurance claim, a home insurance claim, and claims for incidents involving your liability:

Auto insurance claim process

Statistics Canada reports that car insurance claims are on the rise across the country, especially in urban areas, which can be attributed to high amounts of traffic congestion, along with the rising costs of repairs due to inflation. Whether it be a fender bender or serious damage to your car resulting from a multi-vehicle accident, here is an outline of the steps in your claim process:

Step 1: Ensure you and your passengers are safe

Motor vehicle accidents can be scary and overwhelming. If you've been involved in a car accident, the first thing you need to do is check yourself and your passengers for injuries. Once you've done so, you'll need to move your vehicle out of traffic if possible. This will ensure that traffic can move around you and prevent other collisions from happening.

Don't forget to turn your hazard lights on to warn others on the road that there has been an incident and to proceed with caution. Once this is done, you can step out of your vehicle when it is safe to do so.

Step 2: Call emergency services

If you, your passengers, or others involved have suffered injuries, you will need to call 911 immediately. Additionally, if there is extensive damage to your car or other vehicles involved, you may also be required by law to report the accident to authorities. For example, in Ontario, if the damage between the vehicles is over $2,000, police need to be notified.

The thresholds for calling law enforcement vary between provinces. Therefore, you need to understand what your provincial reporting laws are, so you are prepared.

Step 3: Gather evidence

Once you've contacted police (if applicable), you can go ahead and exchange your information with the other drivers involved. Make sure to get a picture of their licence plate, insurance information, and driver's licence. Other evidence you'll want to document with photos and videos includes:

  • Damage to the vehicles involved.
  • The surrounding area, including road conditions, traffic lights, and signs.
  • Any injuries you may have sustained.
  • Eyewitness statements and contact information, if available.
  • If you have contact authorities, make sure to ask for a copy of the police report, as you will need to provide this to your insurance company.

Step 4: Contact your insurance company

Once you've received medical attention and are safely at home, you'll need to contact your insurance company. You can either file your claim online or contact them directly over the phone.

During this time, you'll be asked by your insurance company to provide information about what happened. For example, were you in an accident with another vehicle, an object, or did something else occur? They'll also ask for other information about who was involved, where the incident occurred, and more. So, make sure you're prepared to give as much detail as possible.

Afterwards, your insurance agent will provide you with a claim number. In a couple of days, you'll then receive either an email, letter, or phone call from your assigned adjuster, who will be handling the remainder of your claim moving forward.

Step 5: Speak with your adjuster & get an estimate for repairs

An adjuster will assess damages and determine liability for the accident that occurred. During this time, you may be required to use an approved body shop from a provided list or choose your own. Once a body shop has been chosen, you can go ahead and book an appointment with the body shop to have your recreational vehicle inspected for damage.

Now that you have an estimate, you can submit this information to your insurance company, along with other documents requested by your adjuster. Your adjuster will then review the information you've provided and either deny or approve your claim.

Step 6: Get compensated for your losses

Once the approval has been put through, your claims advisor will provide you with compensation so you can get your car repaired. Afterwards, you'll sign a release form that confirms you can no longer seek compensation from your insurance company for your losses.

Note that depending on which party is assigned fault by your insurance company, you may experience a car insurance premium increase. However, if you have accident forgiveness insurance and have never been at fault for a collision prior, you can use this insurance coverage to avoid a rate increase.

Home insurance claim process

Home insurance claims can involve a variety of issues, from natural disasters to theft, fires, and more. Canada's rising climate conditions are resulting in more frequent and severe property damage for homeowners across the country. In 2023, insured losses from severe weather occurrences totalled $3.1 billion, while house insurance rates increased by 7.8% in 2024.

With more frequent flooding, wildfires, and windstorms affecting residential areas, filing claims efficiently has never been more important. If you experience an incident involving your property, here are the steps in your claim process:

Step 1: Prevent further damage

The first thing after any incident on your property is damage control, which means preventing further damage from happening to your home. For example, shutting off the main water supply if you're experiencing a burst pipe, boarding up a broken or shattered window, or removing personal belongings from water-damaged areas to prevent mould and further losses.

Step 2: Document the damage

Providing accurate and thorough documentation to your insurance company when filing a claim under your home insurance policy is essential if you want to be compensated fairly. To do so, take numerous, clear photos and videos of all affected areas in your home, including close-up and further back to show the extent of the damage.

Next, create a detailed list of any damaged or destroyed items, including the name of the item, its estimated value, and the date you purchased it, if you can remember. If you still have the receipts for these items, include them in the list.

Step 3: Contact 911 (If Necessary)

If the insurance claim involves theft, vandalism, fire, or injuries, you'll need to contact local authorities immediately to report what happened. Again, you'll want to get a copy of the police or fire report to submit to your insurance company during your claims process.

The report serves as an official record of the incident, which your insurer may use to corroborate your loss. Make sure to request a copy of the report or the report's reference number so that you can forward it to your insurance company. Without a report, you run the risk of having your claim denied for a lack of evidence. 

Step 4: Notify your insurance company

Next, contact your insurance company over the phone or online to make a claim. Many home insurance policies have strict reporting timelines following a loss, so don't delay informing them.

When you contact your insurance company, the insurance agent will look over your insurance coverage and ask you questions as you submit your claim. This includes what happened, where it happened, and more. Make sure to be as detailed and honest as possible. At the end of your call, your agent will give you a claim number and inform you that your adjuster will be in contact with you at a later date.

Step 5: Schedule a visit with your adjuster

Once you've been assigned an adjuster, they will ask you to provide them with the required documentation for them to review. This includes the photos and videos you took, along with your detailed inventory list, receipts, and other information they may request.

Additionally, you'll need to schedule a visit with your adjuster to come to your home and review the damage. The adjuster is responsible for determining the cause and value of the damage that occurred and for estimating the cost of replacing or repairing it. In some circumstances, insurers collaborate with preferred vendors who may repair the damages. But most of the time, you have the option of choosing your own contractor to perform the needed repairs. 

Step 6: Review your settlement offer

Once your adjuster has reviewed your claim, your insurance company will offer a settlement amount. The amount depends on your type of policy:

  • Actual cash value: Compensates you based on the depreciated value of your belongings or structure.
  • Replacement cost value: The cost to replace your home or items without factoring in depreciation.

If you don't agree with the settlement value your insurance company has offered, you can dispute the claim with your adjuster until you reach an agreement. They may ask you to submit additional supporting documents to reconsider.

Step 7: Finalize your repairs or replacements

If your claim is approved and you accept the settlement, you can move forward with repairs or replace your damaged items. Some insurance companies will pay you directly, whereas others will pay contractors or suppliers. If you're making payments up front, keep all receipts and submit them for a refund.

Personal liability claim

Liability insurance protects your financial interest in the event you are held legally responsible for injuring someone or damaging their property. When it comes to personal insurance, this typically means someone is hurt on your property or claims that your negligence caused them harm. For example, a guest might slip on an icy walkway you forgot to salt, or your dog might bite a neighbour. This can also occur in a business claims scenario where someone is injured on your business property.

Liability claims can be expensive, from legal fees to medical bills, repairs, and other costs that may arise over time. Luckily, most auto insurance and home insurance policies include coverage for liability claims. Should a claim be filed against you, here's how you would submit your claim:

Step 1: Ensure safety and medical assistance

The first thing you need to do when an incident occurs that could lead to a liability claim is ensure that those involved are safe. If someone is injured, call for medical assistance immediately.

Because liability claims also cover medical expenses, you'll want to ensure that you get a copy of their medical records for when you submit your claim with your provider. Even if the injury seems minor, it’s best to have it assessed by a medical professional and documented correctly. If emergency services do respond to the scene, ensure that you keep copies of any reports or assessments they have made.

Step 2: Avoid admitting fault

After the incident involving your liability has occurred, you'll want to avoid making statements that prove you are liable. For example, "I'm so sorry, this is all my fault." While this may be polite, it could be used against you later in your claims process and lead to more out-of-pocket expenses.

Instead, try to remain calm, gather their information, and let medical emergency personnel do their jobs.

Step 3: Document the incident thoroughly

Ensuring you have the right documentation following a liability incident is one of the best ways to defend yourself during a claim. Take photos of the scene, including any hazards like icy pathways, broken or uneven pavement, the surrounding environment, and other relevant evidence.

Additionally, record the day, time, and weather conditions. If there are witnesses to the incident, make sure to get their names and contact information. Don't forget to get a copy of the accident report to submit to your claims advisor.

Step 4: Contact Your insurance company

When an incident involving your liability occurs, you'll want to contact your insurance provider for your claims service by phone or online immediately, even if you aren't sure whether a lawsuit can be filed against you. If you are unsure how to proceed or are confused about your insurance coverage, speak with a broker; they can help clarify any confusion you have before you contact your claims centre.

Remember, waiting too long may work negatively in your favour.

Step 5: Cooperate throughout the investigation

Once you file your claim online or over the phone, your insurance company will investigate to determine who is at fault, what coverage you have, and the damages that occurred.

They may contact you and ask that you submit your documentation or record a statement from you. It’s important to cooperate and provide honest information about the incident. You'll also be advised by your claims advisor of your policy limits, which can be used to pay for damages and legal fees. 

Step 6: Allow your insurer to handle communications

From here on out, your insurance company will hire a defence lawyer who will represent you in court. Don't communicate with the other parties involved unless your lawyer tells you to. Trust that your legal team is there to handle your negotiations, settlement discussions, and courtroom proceedings on your behalf.

Step 7: Understand how this may affect your insurance

Whether or not your liability claim increases your premiums depends on what happened. However, frequent liability claims could show your insurance provider that you're a higher risk to insure, which could lead to expensive premiums.

It's always a good idea to look over your liability limits each year to ensure you're sufficiently protected. Many Canadians have $1 million in personal liability insurance; you can purchase limits up to $2 million for added peace of mind. Assess your risk tolerance and purchase coverage that meets your unique needs and vulnerabilities. 

After you file your claim online or over the phone: What happens next?

So you've made a claim, what happens next? Here's a closer look:

How adjusters review your case

Once you make a claim, a claims advisor's job is to review the information you've provided, such as witness statements, videos, photos, reports, and more. They also make sure that the accident or loss that happened falls within your policy.

Expected timelines

Depending on the severity of your claim, your timeline can vary. For example, if your vehicle was damaged because you drove into a pole or you experienced auto glass breakage, your process will be fairly straightforward and swift.

In contrast, if your vehicle was damaged, numerous members of your family were injured, and more than one other car was involved, this can slow down the claims process as the claims advisor needs to review all the evidence, determine fault, and speak to several parties.

Tips to avoid delays

To avoid delays:

  • Respond promptly to all requests.
  • Submit detailed documents.
  • Follow up with any questions you may have.
  • Double-check that the information you submit is accurate and honest.

What to do if you disagree with the decision

If your claim is denied or the settlement amount is lower than what you were expecting, you can submit a formal request to have your claim reviewed. If the issue remains unresolved, you can contact the General Insurance Ombudsman Service (GIO) or seek legal advice.

Common mistakes to avoid when filing a claim

There are numerous mistakes Canadians can make when claiming with their insurance company, including:

  • Not reporting in time: One of the most common and avoidable mistakes is waiting too long to file your claim. Delaying could mean your claim is denied, even if what happened would have been covered otherwise.
  • Submitting incomplete documents: Providing insufficient documentation can lead to delays or reduce your payouts. Be thorough when submitting your claim.
  • Providing inaccurate information: It’s crucial to be truthful when communicating with your adjuster. Exaggerating, omitting important facts, and changing your story could be flagged by your insurer as potential fraud.
  • Not preventing further damage to your car or home: After an incident, you're expected to take actions to prevent further damage. Failing to do so can affect the results of your claim.

Understanding your insurance coverage

Understanding whether your insurance policy provides coverage for damages or losses is essential before you make a claim, and it will determine whether you can file with your provider in the first place.

How to read your policy

The first page of your insurance is called the declaration page. This page outlines the type of coverage you have, your policy limits, deductibles, any additional endorsements, and when your policy expires.

Understand your exclusions and limits

Not all losses or damages are covered by your insurance plan. The exclusions portion of your policy will specifically outline what is not covered, whereas your limits portion will detail how much your insurer will pay you if you make a claim.

For example, if you file a car insurance claim and a lawsuit is filed against you by another driver for damages, and your liability limit is $1 million, your provider will cover costs up to $1 million, which can be used for repairs, medical bills, legal fees, and other associated expenses.

Endorsements and optional coverage

Endorsements, or riders, are optional additions to your policy that enhance your coverage. Common endorsements include overland water, sewer backup, identity theft protection, collision coverage, comprehensive coverage, and more.

How BrokerLink can help

At BrokerLink, we help Canadians find affordable insurance coverage. Whether you need car insurance for your recreational vehicle, personal group insurance, house insurance, or other types of protection, know that our experienced brokers have got you covered:

Questions about your insurance claim? We're here to walk you through the process, answer your questions, and ensure you feel confident before contacting your provider.

FAQs

Can I withdraw my insurance claim?

Yes, if you would no longer like to pursue your personal insurance claim, you can do so. Make sure you do it as early as possible to ensure the cancellation is approved. Note that if your claim involves your liability, you cannot withdraw your claim.

Why are auto insurance claims denied?

Auto insurance claims are often denied by insurance companies because the terms of the insurance plan were violated, the policyholder was not honest with their insurance provider, the policyholder failed to provide enough evidence, or the claim involves criminal activities.

How can I prevent a claim under my homeowner's insurance?

As a homeowner, it's your responsibility to take care of your property to prevent claims from occurring. To prevent a claim, ensure your HVAC systems are maintained yearly, clear your gutters and downspouts to prevent flooding around your property, ensure all plumbing and electrical systems are up-to-date, and install security cameras and alarms.