C111 Chapter 6 Advanced Loss Adjusting


  1. The insured may feel vulnerable or traumatized. The insured may display strange and unpredictable behaviour. Pg. 02
  2. A conflict of interest may arise if the adjuster has a stake in the business or the same adjuster (company) represents two opposing claimants. Pg. 03
  3. A loss adjuster may need to hire an expert to deal with separate issues and be prepared to explain how each claim will be handled and what kind of information is required for each. Pg. 03
  4. Questions to be answered for good faith test:
    • Did the loss adjuster or insurer act promptly?
    • Did the loss adjuster or insurer act competently?
    • Was the loss investigated thoroughly? Pg. 05
  5. All claims file information is available to the insured. If uncorrected criticism is included in the file, the insured will have greater evidence for liable against the adjuster/insurer (bad faith). Pg.07
  6. Statutory conditions. Pg. 09
  7. Insured statement, witness statements, Fire/police reports/statements, expert reports, financial information/history. Pg. 10

    • replacement to occur with due diligence and dispatch;
    • replacement to take place on the same site or an adjacent site;
    • settlement on a replacement cost basis to occur once the replacement has been effected by the insured;
    • if the insured fails to comply with the terms and conditions of the replacement cost endorsement then the basis of settlement reverts to the original policy terms. Pg. 10-11
  9. The value of a property is based on the income produced by the property. Pg. 12
  10. An appraisal can expedite a claims process when the value of the claim is in dispute. Pg. 12
  11. The appraisal clause can be invoked by either party to contract. Pg. 12

    • umpire controls the appraisal process; asks for all documentation (narrative)
    • umpire will hear arguments from both sides, and will usually allow controlled debate on the issues;
    • it is up to the umpire to limit the discussions to the area the appraisal concerns. Pg. 13-14
  13. Building code and repair violations as well as permits and original plans/documents. Pg. 14
  14. Privacy’s officer role is to protect personal information collected by the organization. Pg. 15
  15. Incendiary, accidental and unknown. Pg. 23
  16. Statements should be taken as soon after incident as possible so that recollection does not fade. Pg. 18
  17. Policy or statute conditions. Pg. 22
  18. An insurer can recoup some losses from a fraudulent insured by becoming the mortgagee and selling the property when the insured defaults. Pg. 20
  19. Ask for an order of restitution or launch civil action against insured. Pg.20
  20. The insurer must show the insured what is deficient in the proof of loss and ask the insured to rectify the situation. Pg. 21
  21. There are several stages:
    • pre-test interview;
    • collection of data;
    • analysis of the data
  22. Public adjusters represent the insured’s interest with their insurer when a loss has occurred. Pg. 25