Parksville Insurance
Service Ltd.
Telephone: (250) 248-5784 Fax:
(250) 248-5502
WHO DOES WHAT IN THE
CLAIMS PROCESS
After you have notified
your agent that you have experienced a loss, the agent will:
1) Check the records to
ensure that the policy is in force.
2) Check that the policy
provides coverage for the loss being reported.
3) Discuss with you the
policy deductible, claims free discount, and general ramifications of the claim
against the policy.
4) Follow progress of the
loss settlement and assist the insured, adjuster and insurer in any way that
might be necessary.
5) Maintain minimal loss
records i.e. photocopies of Proof of Loss, Receipts etc.
6) The agent/broker is not
authorized to make financial commitments on behalf of the insurance company.
The appropriate employee of
the insurer directs the investigation and approves the settlement of the
claim. They will make the decision
whether to adjust the claim over the telephone or hire a local adjuster. They also will:
1) Ensure that the
investigation of the loss occurs as soon as it is established that the policy
will respond to the loss being reported
2) Open a claim file with
the appropriate reserves to ensure that the insurer’s liabilities are correctly
tabulated and reported to the government.
3) Monitor the
investigation. Call for additional
information i.e. police report, fire department report, appraisals etc.
4) Supply the insured with
a blank Proof of Loss form to enable the insured to comply with his
obligation under the policy.
5) Give, where appropriate,
written notice of intention to repair.
6) Authorize settlement and
pay the loss within the allotted time.
This is legally 60 days from receipt of the Proof of Loss form, however, it is generally sooner.
The person appointed to
investigate the loss is known as the adjuster.
This may be an employee of the insurer or an independent business
person. In either event the duties are similar. They will:
1) Confirm his authority to
handle the claim with the insurer.
2) Check the policy’s coverage
to establish exclusions and any other information that would be relevant to the
loss.
3) Interview the insured,
possibly visit the scene of the loss, arrange the appraisal of the damage, and
make contact with any other parties involved.
4) Provide a preliminary
report with estimates of the damage to allow the insurer to establish reserves
and set up a file.
5) Carry out the
instructions of the insurer. An
independent adjuster can make recommendations to insurers regarding payments
but is not authorized to make commitment on behalf of the insurer.
When you have experienced a
loss, you will need to do your part to ensure that the claim is processed as
smoothly as possible.
1) Report the loss to the
policy or fire department immediately.
Make sure that you keep track of the number assigned to your case.
2) Ensure the risk is
secure against future loss (i.e. board-up broken windows, cordon-off dangerous
property.
3) Report claim to agent as
soon as possible. The agent will require
case numbers and an initial list of what is being claimed.
4) Begin making a more
detailed list of what is being claimed.
5) Co-operate with insurer
and adjuster in investigation by providing appraisals, statements, witnesses
etc.
6) Complete Proof of Loss
Form. The adjuster will let you know if
this needs to be notarized or can be witnessed by your agent. YOUR CLAIM CANNOT BE PROCESSED WITHOUT
THIS FORM BEING COMPLETED.
ON THE SCHEDULE OF
LOSS:
Column 0 Number items for easy reference.
Column 1 Give description of items being
claimed (make/model, serial no.)
Column 2 Advise where you acquired
items. If the item was a gift, advise
from whom.
Column 3 Note when item was acquired. Be as accurate as you can.
Column 4 Give original purchase
price. Again, if it was a gift, please
indicate as such.
Column 5 This column is most
important. Please indicate current cost
to
replace the lost or destroyed article with one of like kind
and
quality.
The rest of the
columns are up to the insurer. Send the
forms back to the insurer with any supporting proof of purchase documentation you
have. Since the insurer needs the
original documents it is useful to bring the Proof of Loss and supporting
documentation into the agency where we will photocopy it for your records and
for your file. This will allow both of
us to have a reference copy in future discussions with the insurer.
TIP: If you have had a “break and enter”, it is
possible that you did not notify the policy of everything you have noticed
missing since their visit. Keep them
advised of any changes to your property list.
7) Documenting your loss-
it is your responsibility to show that you own the items being claimed. Theft and fire claims present a particular
challenge in that the stolen/destroyed items are no longer in your possession
and can therefore be easily overlooked.
While we and your insurers recognize that
listing and describing every stolen/destroyed item is a difficult task, we rely
on your best efforts to provide accurate, detailed descriptions.
The
following points may assist you…
Choose a place to keep notes about the loss and
all receipts for expenses
and/or items replaced. A file, folder or notebook will serve you
quite well.
·
Look
in your videos and/or photo albums, if they are still available, for shots that
show some of your personal belongings.
This will not only help to describe articles, but may assist you in
identifying articles which were previously overlooked in the assessment of your
loss.
·
Physically
or mentally go through each room, one at a time, and examine the walls, floors,
closets, drawers, cupboards, counters and the like, for missing items. Make notes as you do so.
·
If
you claim is a theft claim, commonly stolen items such as CDs can be difficult
to itemize, however, you may be able to reasonably estimate the number of
missing items by the vacant spaces left in your racks. You will, however, be required to provide CD
titles and artists for your insurers.
·
Simply
listing bulk items is not sufficient (ie. 30 CDs or $1,000
worth of jewelry). The list must be
detailed.
·
Provide
proof of purchase, when possible (ie. Receipt, Visa, M/C
or department store statement).
Refer to owners’ manuals, warranty cards or
packaging, when possible, for make, model or serial number information.