The Top 9 Home Insurance Claims Adjuster Secret Tactics in Canada

By Arthur Dubois | Published on 15 Aug 2023

a house with a driveway and a lawn

Home insurance claims adjusters play a crucial role in the insurance industry. They assess home insurance claims and determine the appropriate compensation for policyholders. While their role is supposed to be fair and unbiased, there are some secret tactics claims adjusters often use to minimize payouts and protect the insurance company’s interests. This article will uncover these methods and provide strategies to protect yourself as a homeowner.

Understanding the Role of a Home Insurance Claim Adjuster

Before diving into the secret tactics, it is essential to understand the role of a home insurance claim adjuster. These professionals are responsible for investigating and assessing the damages claimed by policyholders. They work on behalf of insurance companies to determine the extent of the loss and the compensation the policyholder is entitled to receive. Claims adjusters are typically knowledgeable about insurance policies, construction, and pricing, enabling them to make informed decisions on the claim’s validity and value.

While claims adjusters are supposed to provide impartial assessments, their priority is often to minimize the insurance company’s financial burden. So, it’s essential to be aware of their tactics to achieve this.

The Importance of claims adjusters in Home Insurance

Claims adjusters act as a liaison between the insured homeowner and the insurance company. Their main objective is to investigate the claim, gather evidence, and determine the appropriate compensation. Without the expertise of claims adjusters, the home insurance industry would struggle to settle claims accurately and fairly.

However, it is important to recognize that claims adjusters work for the insurance company, which means their interests may not always align with yours as the policyholder. They focus on minimizing the insurance company’s liability and protecting its profits.

Claims adjusters have extensive knowledge of insurance policies and are well-versed in the intricacies of home construction and pricing. This expertise allows them to assess the damages accurately and determine the fair compensation that policyholders are entitled to receive. They use their training to evaluate the evidence presented by the policyholder and make informed decisions based on the terms and conditions of the insurance policy.

Furthermore, claims adjusters are skilled negotiators. They can analyze the evidence, negotiate with contractors and service providers, and ensure the policyholder receives the best possible settlement. Their expertise in the field allows them to identify any discrepancies or inconsistencies in the policyholder’s claim, ensuring that only valid and legitimate claims are approved.

How claims adjusters Work in Canada

In Canada, claims adjusters are to follow a strict code of ethics. Independent and public adjusters must be licensed, but adjusters working for insurance firms typically do not need licensing. They are required to act ethically and fairly when assessing home insurance claims. They should conduct thorough investigations, request supporting documentation, and provide detailed explanations for their decisions.

Claims adjusters in Canada are regulated and undergo rigorous training to ensure they have the necessary skills and knowledge to handle home insurance claims effectively. They must stay up-to-date with industry trends and regulations to provide accurate and fair assessments.

However, despite these regulations, some claims adjusters may resort to secret tactics to protect their employers’ bottom line. These tactics can be detrimental to policyholders already dealing with the stress and challenges of a home insurance claim.

Policyholders must be aware of these tactics and understand their rights. By being informed and prepared, policyholders can effectively navigate the claims process and ensure they receive the compensation they deserve.

Policyholders should document all communication with the claims adjuster, including phone calls, emails, and letters. This documentation can serve as evidence in case of any disputes or discrepancies. It is also essential to carefully review the terms and conditions of the insurance policy to understand the extent of coverage and the insurance company’s responsibilities.

Additionally, policyholders have the right to seek legal advice or hire a public adjuster to represent their interests. Public adjusters are independent professionals who work on behalf of the policyholder, ensuring that the policyholder’s rights are protected and that they receive a fair settlement.

Policyholders can confidently navigate the home insurance claims process and ensure they receive fair treatment by understanding the role of claims adjusters, being aware of their potential tactics, and taking proactive steps to protect their interests.

The Top 9 Secret Tactics Used by claims adjusters

Now, let’s delve into the top 9 secret tactics home insurance claims adjusters use in Canada and how they can impact your claim.

Tactic 1: Procrastinating Or Not Responding Promptly

Your claims adjuster may not answer their calls or take a long time to return messages and emails. This can be frustrating as a policyholder, leaving you unwilling to pursue the matter. Some claims are time sensitive, so your adjuster’s lack of response could lead to your claim being delayed, denied or reduced. 

Tactic 2: Delaying the Claim Process

One common tactic claims adjusters employ is to prolong the claims process deliberately. They may request additional documentation or ask for repeated inspections, causing delays and frustration for policyholders. This tactic aims to wear down the homeowner, leading them to accept lower settlements or abandon their claims altogether.

For example, claims adjusters may request multiple rounds of inspections, even for minor damages, which can significantly extend the time it takes to settle a claim. They may also ask for excessive paperwork or documentation, creating unnecessary hurdles for homeowners to overcome. This deliberate delay tactic causes financial strain and adds emotional stress to an already challenging situation.

Tactic 3: Underestimating Home Damages

Another tactic used by claims adjusters is to underestimate the extent of the damages. They may downplay the seriousness of the loss or exclude certain damages from the claim, resulting in lower payouts for homeowners. Adjusters may rely on their own assessments rather than consulting independent experts, making minimizing the insurance company’s liability easier.

For instance, claims adjusters may argue that certain damages are unrelated to the claimed incident or were pre-existing, thereby reducing the compensation owed to homeowners. They may also undervalue the cost of repairs or replacement, leaving homeowners with insufficient funds to restore their properties to their pre-loss condition fully.

Tactic 4: Denying Claims Based on Technicalities

Claims adjusters are well-versed in insurance policy language, allowing them to capitalize on technicalities or ambiguities. They may deny claims based on minor policy violations or if you’ve filled out the claim incorrectly, even if the damages are valid. This tactic forces homeowners to navigate complex policy documents or seek legal assistance, adding unnecessary stress and expense to the claims process.

For example, claims adjusters may argue that the homeowner failed to provide timely notice of the loss or did not comply with specific policy requirements. They may exploit these technicalities to deny claims, leaving homeowners frustrated and unfairly treated. This tactic can create a sense of powerlessness and make it difficult for policyholders to assert their rights.

Tactic 5: Advising You Don’t Need a Lawyer

Claims adjusters may tell you that you don’t need to speak with a lawyer to handle your claim. They may present themselves as being on your side. In reality, while they are there to assist you, they represent the insurance company’s interests first.

If you have a large claim or feel that there are things you don’t understand, seeking legal advice may be in your best interests. Of course, you will pay a fee, but a lawyer can help you navigate your insurance policy’s technicalities to ensure you are treated fairly.

Tactic 6: Offering Quick, Low Settlements

Claims adjusters often offer quick, low settlements to homeowners, especially in the early stages of the claims process. They take advantage of the policyholder’s immediate financial needs and offer settlements far below the damages’ actual value. Many homeowners, desperate for funds, accept these inadequate settlements and are left with insufficient compensation to rebuild or repair their homes.

For instance, claims adjusters may present homeowners with settlement offers that only cover a fraction of the estimated repair costs. They may pressure homeowners to accept these offers by emphasizing the speed and convenience of a quick settlement. This tactic preys on the vulnerability and financial strain experienced by homeowners in the aftermath of a loss, leaving them at a significant disadvantage.

Tactic 7: Using Surveillance to Discredit Claims

Claims adjusters may resort to surveillance tactics to dispute the credibility of the homeowner’s claim. They hire investigators to monitor the claimant’s activities, looking for evidence contradicting the reported damages or injuries. This tactic aims to undermine the claimant’s credibility and weaken their position during negotiations or legal proceedings.

For example, claims adjusters may use video footage or photographs obtained through surveillance to challenge the severity of the claimed injuries or the extent of the damages. They may argue that the claimant’s activities in the surveillance footage contradict their reported limitations. This tactic can create a sense of invasion of privacy and further distress for homeowners already dealing with the aftermath of a loss.

Tactic 8: Leading You to Make Statements They Can Use Against You

Your claims adjuster may record your conversations and will keep track of all correspondence. They may ask questions that lead you to say things that could suggest you were negligent or responsible for the damage. Sometimes, they may ask you to sign statements that could negatively impact your claim. Generally, it’s best not to offer too much information and be aware of how your comments could affect your claim.

Tactic 9: Using Intimidation Tactics

Sadly, some claims adjusters resort to intimidation tactics to dissuade homeowners from pursuing their claims. They may use aggressive language, threats, or harassment to pressure policyholders into accepting lower settlements or dropping their claims altogether. This unjust behaviour can leave homeowners feeling helpless and discouraged.

For instance, claims adjusters may employ aggressive negotiation tactics, making homeowners feel overwhelmed and coerced into accepting unfair settlements. They may threaten legal action or imply that the claimant’s credibility will be undermined if they pursue their claim further. This intimidation tactic creates a power imbalance and can cause significant emotional distress for homeowners seeking fair compensation for their losses.

How to Protect Yourself from These Tactics

While claims adjusters’ secret tactics may seem overwhelming, there are proactive steps you can take to protect yourself as a homeowner. Being knowledgeable and prepared, you can confidently navigate the home insurance claims process.

Understanding Your Policy

The first step is to understand your home insurance policy thoroughly. Familiarize yourself with the coverage limits, exclusions, and conditions affecting your claim. By knowing your rights and entitlements, you can confidently assert your position during claims negotiations.

Having The Right Insurance Policy For Your Needs

After carefully reviewing your policy, you might find it doesn’t offer the proper coverage. You can talk to a broker or agent to determine what types of home insurance would best suit your needs. It’s best to compare home insurance policies and prices to make sure you get the right coverage at the best price.

Documenting Everything

Documenting the damages and the claims process is crucial in strengthening your case. Take extensive photos and videos of the affected areas, keep a detailed record of all correspondence with the insurance company and claim adjuster, and gather any supporting documentation such as repair estimates or medical reports. This evidence will provide undeniable proof of the damages and expenses incurred.

Hiring a Public Adjuster

If you find the claims process overwhelming or believe you are being unfairly treated, consider hiring a public adjuster. Public adjusters are independent professionals who work on behalf of the policyholder to maximize their claim settlement. They have the expertise to navigate the complexities of the claims process and negotiate with claims adjusters on your behalf. While public adjusters typically charge a percentage of your settlement, they can significantly increase the compensation you receive, making their services worthwhile in some instances.

If you need a public adjuster, you can search for one the Canadian Independent Adjuster’ Association website. However, before hiring an independent adjuster, make sure they are licensed in your province and that they offer public adjusting services, as many independent adjuster’s firms focus on serving insurance companies and don’t provide their services to the public. Here is a table to help you find a public adjuster in Canada’s most populous provinces: 

ProvincesProvincial RegulatorsPublic Adjusting Firms
OntarioFinancial Services Regulatory Authority of Ontario (FSRA)NFA, Queen Adjusters
QuebecAutorité des marchés financiers (AMF)Roy, Morissette & Associés
British ColumbiaInsurance Council of British ColumbiaGreenspan Adjusters International
AlbertaAlberta Insurance CouncilT&L Adjusters
ManitobaInsurance Council of ManitobaWheat City Claims Services

The Bottom Line

By familiarizing yourself with these secret tactics and implementing proactive measures, you can level the playing field and protect your interests as a homeowner. Don’t let claims adjusters undermine your claim. Stand up for your rights and ensure you receive the fair and just compensation you deserve.

Arthur Dubois is a personal finance writer at Hardbacon. Since relocating to Canada, he has successfully built his credit score from scratch and begun investing in the stock market. In addition to his work at Hardbacon, Arthur has contributed to Metro newspaper and several other publications