Calendar·Insurance·Claims Process
Working With Adjusters: Roles, Rights, and Friction Points
FACULTY OF INSURANCEClaims Process • ~50 min

How the insurance adjustment process works across Canada, who adjusters represent, what rights policyholders have throughout the process, and how to manage the friction points that derail legitimate claims.

Working With Adjusters: Roles, Rights, and Friction Points

Price
$149
Lessons
6
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What this course covers

01What Adjusters Do and Who They Work For: Independent, Staff, and Public Adjusters
02Your Rights in the Adjustment Process: What Provincial Insurance Legislation Guarantees
03Common Friction Points in the Adjustment Process: Delays, Scope Disputes, and Low Offers
04When to Push Back and How to Do It Without Damaging the Claim
05Escalation: When and How to Go Over the Adjuster's Head
06Working With Adjusters on Commercial Claims: Key Differences From Personal Lines

Scenario

A mid-sized food processing company in southwestern Ontario had maintained commercial property and business interruption coverage through a national insurer for 8 years without filing a significant claim. The policy, renewed annually with coverage limits adjusted to reflect the company's growing operations, included endorsements for equipment breakdown, spoilage, and extended business interruption tied to supply chain disruptions. The company employed approximately 120 workers across 2 shifts and supplied prepared food products to institutional clients including hospitals, schools, and long-term care facilities throughout the region.

In the 3rd week of operations following a scheduled equipment upgrade, a refrigeration system failure resulted in catastrophic spoilage of inventory valued by the company at approximately $340,000. The failure also damaged temperature-sensitive processing equipment and forced a production shutdown lasting 19 days while replacement parts were sourced and installed. During the shutdown, the company lost contracts with 2 institutional clients who could not wait for production to resume and required immediate alternative suppliers. The company's internal estimates placed total losses, including property damage, spoiled inventory, lost revenue, and contract penalties, at approximately $1.2 million.

The insurer assigned the claim to an independent adjusting firm rather than handling it through staff adjusters. The lead adjuster retained by the independent firm began the investigation within 5 business days of the loss notification, requesting extensive documentation including maintenance records for the refrigeration system, inventory logs, supplier contracts, and 3 years of financial statements to support the business interruption component. The company's risk manager, who had limited experience with commercial claims of this magnitude, found the documentation requests broader than anticipated and the timeline for responses shorter than seemed workable given the operational disruption the company was still managing.

Within 6 weeks of the loss, disagreements emerged on multiple fronts. The adjuster's preliminary assessment valued the spoiled inventory at $195,000 rather than the company's claimed $340,000, citing questions about the inventory valuation methodology and the condition of certain products prior to the refrigeration failure. The adjuster also questioned whether the lost institutional contracts fell within the policy's business interruption coverage or represented consequential losses beyond the policy's scope. Correspondence between the adjuster and the company's risk manager became increasingly formal, with each party citing policy language to support divergent interpretations.

The company retained a public adjuster to assist with documentation and presentation of the claim. The insurer's adjuster acknowledged the public adjuster's involvement but noted that the retention would not alter the insurer's coverage analysis. The claim remained unresolved, with the company facing ongoing financial pressure from the production disruption while navigating an adjustment process that had become adversarial in tone and uncertain in outcome.

More in this program

First Notice of Loss: What to Do in the First 72 Hours
~30 min · $79
Proof of Loss and Documentation Requirements
~30 min · $79
Appraisal and Dispute Resolution in Property Claims
~50 min · $149

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