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.
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.
This is not what an appraiser appointed under s.128 of the Insurance Act is!
The inference George takes from this is an appraiser, as referenced, is not an individual or a corporation, who gives advice or evidence similar to that of 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 interest and authority in the appointed individual 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.
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 scope and 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 likely 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.
In order to maintain the efficiency of the process as intended by the policy and to avoid the necessity of litigation or judicial review, the parties may wish to consider clarifying the powers of the appraisal team by way of a written agreement signed by the parties authorizing the tribunal to make determinations that include scope of loss, replacement cost and actual cash value.
As part of an agreement to act as appraiser, the party retaining George will be asked to authorize and direct George and STAT11 Inc. to destroy all notes, documents, information or research tendered to or received by in in conjunction with the Appraisal, and that they will not compel George to divulge or submit same to any person or court in any subsequent arbitral or judicial proceedings, save and except his Retainer Agreement and the Appraisal Award.
George flows income and expenses through STAT11 Inc., his fee based on an hourly rate plus office expense, disbursements, mileage and HST. Long distance travel charged on a flat rate basis.
Call George at 1-800-214-1348 x 701 to discuss!
4-1550 Kingston Road
Box 1412, Pickering
Ontario L1V 6W9