If you are like most people, insurance is something you struggle to understand. We can assure you that you are not alone. A lot of the calls we receive at the General Insurance OmbudService (GIO) are calls from consumers who are looking for information about the insurance claims process and what happens after you suffer a loss.

The Insurance Bureau of Canada lays out the steps in understanding the claims process as follows:

Insurance Claims Basics

Been in a collision? Has your home been burglarized? Was your business impacted by a cyber-attack? You’ll want to get things back to normal as quickly as possible.

We hope you’ll never have to file an insurance claim, but if you do, here’s what you should know.

• Record all details about the event. Make a complete list of damaged, destroyed, or stolen items. Take photos and detailed notes.
• Call your insurance representative as soon as you can.
• Carefully review the terms and conditions in your insurance policy to confirm:
  • If the specific loss or event is covered
  • Any exclusions, losses, or events that aren’t covered
  • Any deductibles, coverage limits, replacement values, and terms and conditions
  • Any time limits surrounding when you must report or submit a claim
• Decide what to do next. You may want to pay for damage instead of filing a claim. For example:
  • If the deductible you must pay is equal to, or less than, the total repair cost
  • If you have a claims-free discount and the cost to repair the damage is lower than the cost of the damages.
• If you choose to file claim, complete all required forms and provide all required documentation to your insurance representative and/or company.
• Discuss with your insurer if you can use a supplier of your choice to repair property damage.

Are all Claims the Same?

While they have similar steps for filing an insurance claim, auto, home, and business claims have specific requirements and procedures.

Understand what you’re responsible for and how to make the claims process smoother, whether you’ve been in a collision or suffered damage to your home or business.

• How to file an auto insurance claim
• How to file a home insurance claim
• How to file a business insurance claim

What to expect from your insurer

Insurance is a legally binding contract between a policy holder (you, the consumer) and the policy provider (your insurance company).

When you file an insurance claim, your insurance representative will:

• Review your policy and the circumstances with you
• Assign an insurance adjuster to examine the claim – including the loss situation – and determine the eligibility and coverage limits of the claim in accordance with your policy
• Ask for additional information such as police reports, photos, home inventory lists etc., to help process your claim
• Inform you of what is and is not covered based on your policy

It’s important to remember your insurance representative is a resource for you to rely on, and they will answer your questions throughout the entire claims process

What if I have a dispute about my claim?

Things don’t always go as planned and it’s important to know that you have options when filing a complaint. Start by getting more information from your insurer and consider contacting the company’s Ombudsperson. Search for your insurance company’s complaint escalation process here.

If you have completed the complaints escalation process with your insurer and you are still unsatisfied, you can contact us here.