If you are visiting this site, it will usually be because you or someone you know needs help understanding the insurance claim process as it relates to property loss claims or the dispute resolution process referenced as “Appraisal” in accordance with s. 128 of the Insurance Act of Ontario or a similar such Act in another Province.
Has your insurer rejected your Proof Of Loss (POL)? Are you considering the Appraisal process OR has your insurer demanded the amount of loss be determined by Appraisal in accordance with section 128 of the Insurance Act?
Once an insured with or without the help of an adjuster or lawyer submits a Proof Of Loss (POL) in accordance with Statutory Condition 6 of the policy and the POL is rejected or an offer of settlement made by the insurer that is unacceptable to the insured, either party may demand Appraisal in accordance with Statutory Condition 11 to determine the amount of loss. Each party must then appoint an appraiser if such a demand is made the respondent party shall appoint an individual to act as their appraiser within seven (7) clear days next. Quite often it will be the handling claims representative or adjuster for either party, but a fresh set of eyes is recommended.
An Appraiser is not defined in the Act. The only reference to the word is contained in what the Act states is NOT an adjuster! A person who is employed as an appraiser, engineer or another expert SOLEY for the purpose of giving expert advice or evidence. See 1. (f) under definition of an adjuster.
The inference Stat11 Inc. takes from this, is an appraiser as referenced is an individual, not a corporation, who gives advice or evidence. Quite like a real estate appraiser; an automobile appraiser who estimates loss or damage up against market value; a building or contents estimator/appraiser who estimates repair/replacement cost.
An appraiser under the Act whose duties are outlined in s. 128 of the Act is not a corporation. They are individuals each party appoints, vesting their interests and authority in the party selected, to determine the amount of loss or claim. Appraisers appointed in accordance with the Act may utilize the services of engineers and physical damage estimators/appraisers as witnesses, very often already retained by adjusters or claims representatives for both parties.
Refer to “Additional Information tab” for the selection process proposed by Glenn Gibson, ICD.D, CIP, FCIAA, FCLA, CFE, President & CEO, The GTG Group.
Most often an insurer will reject the POL merely stating they do not agree with the amount claimed. Seldom is the rejection accompanied by an offer of settlement or a clear outline of what portions of the claim submission they accept or reject.
Appraisers for both parties are then faced with working with information and documentation presented to them and in most cases, carry out further investigation to assist in their negotiations with the appraiser opposite.
The appraisers’ then meet, with or without witnesses, to clearly identify their differences in terms of scope of loss and amount claimed. If they can agree between themselves as to the amount of loss an award may be written, the appraisal completed.
Appraisers seldom reach agreement on all issues, usually scope of loss related matters a barrier to resolution. As a result, briefs are then prepared and exchanged between appraisers with copies delivered to the umpire for review. The umpire may attend the loss site at the invitation of either appraiser before briefs are exchanged or, based upon the review of briefs, recommend a site inspection worthwhile to appreciate the differing views of the scope of loss and amounts in dispute. After site meetings and exchange of briefs, the umpire will host a boardroom type meeting with the appraisers and their witnesses to determine the amount of loss. Once witnesses have been heard from both parties they will be excused. The two appraisers and the umpire will then determine the amount of loss by the line of coverage in dispute, two of three required to agree and an award be made in writing.
The award will be used to pay, or top-up payments owed by the insurer, identify recoverable depreciation and/or given to legal counsel should there be a question of entitlement to coverage.
There are differing views as to the role of an appraiser, the opinion of George and the operational policy of Stat 11 Inc. is that while an advocate for the insured, there is a duty to the process itself, the goal being that the amount of loss to be determined should be based on known information and documentation to both appraisers, shared with each other and an umpire.
As part of an agreement to act as appraiser the Insured(s) will be asked to authorize and direct the Appraiser and Umpire to destroy all notes, documents, information or research tendered to, received or obtained by the Appraiser or Umpire in conjunction with the Appraisal, and that they will not compel the Appraiser or Umpire to divulge or submit same to any person or court in any subsequent arbitral or judicial proceedings, save and except the Appraisal Agreement and the Appraisal Award.
The appraisal process is one of negotiation between members of the tribunal where differences may be aired for resolution between appraisers or determined before an umpire.
The appraisal fee charged by Stat11 Inc. is based on an hourly rate, plus disbursements, payable by the insured. A retainer deposit is paid for this service, waived along with the hourly rate if Stat11 Inc. has been retained as an adjuster for the insured, on contingency!
Note, licensed adjuster fees are HST exempt under the Excise Tax Act.
if George is unable to address your immediate need for an Appraiser, we belong to a referral network that may help.
If you wish to speak with George to discuss any of our services, you may reach him at 1-800-214-1348