WHAT YOU NEED TO KNOW
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.
Have you been appointed as an Appraiser for either the insurer or insured and in search of an Umpire who fits the needs of the claim or loss?
There is considerable articles and case law addressing appraisal and an umpire's role. An appraisal is not a mediation nor is it an arbitration. Visitors to this site are encouraged to conduct their own research. George R. Milnes has been an appraiser for both insurers and numerous times for insureds
Please refer to “Additional Information tab” for the selection process proposed by Glenn Gibson, ICD.D, CIP, FCIAA, FCLA, CFE, President & CEO, The GTG Group.
The following is George’s opinion of what both parties (appraisers) should be looking for in the selection of an umpire in accordance with s. 128 of the Insurance Act of Ontario and similar statutes in other Provinces having similar Statutes. Once an umpire is selected and willing to act, they can only be replaced in cases of sickness, death, conflict of interest or bias.
Appointed appraisers should determine the amount of loss between themselves if possible. Only when that fails should matters in dispute be addressed before an umpire, BUT, the Insurance Act requires the appraisers select an umpire within fifteen (15) days after both have been appointed. It's, therefore, necessary they begin the umpire selection process as soon as they are appointed, most often before they meet.
Unfortunately, it has become common practice for insurers to just return a Proof Of Loss (POL) within sixty (60) days of receiving it, stating the amount(s) claimed is not acceptable. Seldom do they make an offer of settlement or advise what is acceptable or unacceptable. This responsibility then falls to appointed appraisers.
A further problem facing appraisers is matching qualifications and experience of an umpire to the loss and issues in dispute. The more knowledgeable the appraiser with regards to the scope of loss as it pertains to the insured peril for which the claim for loss or damage has been made and coverage provided under the policy, the better the match of umpires to the disputes that may come before them. If the insurer has failed to identify the issues in dispute triggering the appraisal the more difficult this task may be. Consultation with the handling adjuster, claims representative or legal counsel if they have been appointed helps. Unfortunately, appraisers for the insurer quite often take direction from insurers as to their choice of umpire candidates. This is against the spirit of the Act, both parties having vested their interest and authority in the appointment of their appraiser. Only the appraisers should be involved in the selection process of an umpire.
Once an umpire is selected and agrees to act, time will be given for appraisers to meet. Tentative dates may be decided to for a site inspection, exchange of briefs and a meeting with appraisers and their witnesses. If they can determine the amount of loss between themselves AND an Award is made in writing, signed by both, the appraisal is completed. If not the date to exchange briefs and with the umpire will take place. Keep in-mind dates may be adjusted based on the availability of witnesses and tribunal members. Either appraiser may request the umpire attend the loss site where visual differences in scope of loss may be viewed before or after briefs are submitted.
The umpire will review briefs. Since it is the insured’s claim submission that has triggered the appraisal the umpire will first look to see what was not acceptable to the insurer and look for supporting opinions and documents to support each appraisers view. Best evidence is what will sway the umpire to one appraiser's opinion or the other.
George has had a career genuinely balanced for the role of an umpire. He has employed as a claims representative, an insurance adjuster for insurers and insureds, a building and contents estimator, general contractor, project manager, and Realtor. He was a police officer in his early career and a certified fraud examiner, later on, still holding the designation, CFE – Retired.
Having worked both sides of the fence so to speak, adjusters, appraisers, and umpires who have had dealings with him in the past will attest to George's ethical nature, knowledge of physical damage claims as they relate to scope and policy coverages. As an umpire he will be unbiased, fair and just!
While a unanimous appraisal award is always desired, George will review the evidence before the tribunal in briefs, ask questions of witnesses and appraisers to see if any categories or line item in dispute can be resolved, but at the end of that process George may agree with one of the appraisers or present his own opinion as to amount of loss and see if one or both appraisers agree.
An award will be made in writing when the appraisal is completed.
Keep in mind the appraisal tribunal is limited in its mandate to address only the amount of loss, not an entitlement to coverage.
As part of George R. Milnes’ retainer agreement to act as umpire, the Parties and their Appraisers will be asked to authorize and direct the umpire to destroy all notes, documents, information or research tendered to, received or obtained by the Umpire in conjunction with the Appraisal, and that they will not compel the Umpire to divulge or submit same to any person or court in any subsequent arbitral or judicial proceedings, save and except this Appraisal Agreement and the Appraisal Award.
The fee charged by Stat11 Inc. is based on an hourly rate plus disbursements shared equally by both parties.
Note, licensed adjuster fees are HST exempt under the Excise Tax Act.
if George is unable to address your immediate need for an Umpire, he belongs to a referral network that may help.
If you wish to speak with George to discuss any of our services, you may reach him