Case Study

CASE

Fire damage insurance coverage

Burnt wooden walls house with charred roof burnt fire damaged interior details

Synopsis of Complaint:

The consumer had smoke damage to the contents of her home due to a fire. Her policy limit for contents was $100,000. A restoration company was sent by the insurance company to dispose of any goods that were unsalvageable and send any other goods that were able to be saved for cleaning.  The consumer did not consent for the contractor to remove any goods, nor was she given any other options for contractors. The consumer only realized that the contractor’s fees were being deducted from her contents limit when she was asked to complete an itemized proof of loss form provided by the insurer.

Review by GIO:

The Consumer Service Officer (CSO) contacted the consumer to get more information regarding the situation and what was completed by the restoration company.  Upon further investigation, the consumer advised that had she known the contractor’s fees were being deducted from the contents limit, she would have requested multiple quotes, and even offered to do some of the removal herself to save on the costs.  The CSO felt the claims adjuster should have given a more in-depth explanation to the consumer regarding the contents limit and that they should have proposed alternative solutions to the consumer that could have potentially lowered the amount that was paid for restoring and removing the damaged contents.

Resolution:

The CSO contacted the company’s Ombudsman and after review of the file, they decided to hold firm on their position of maintaining that the consumer’s content limits were reached. The file was moved to the mediation stage of GIO’s process, and a mediator was assigned to review and mediate the complaint between the insurance company and the consumer. At the mediation, the insurance company agreed to pay for further expenses incurred by the consumer of disposal and replacement of goods that were damaged in the fire.

GIO is an independent body set up to help Canadians find a fair resolution to disputes with insurance providers. GIO can provide advice on dealing with your insurance company as a first step. If you are not satisfied with the decision from your provider on your claim, GIO can help resolve your claim. 

If you’d like to submit a claim visit here.

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