Property Insurance Claims FAQ’s

All policyholders are required to report a claim as soon as a loss occurs. You will need to provide brief details about the loss and contact information to assist the company in handling your loss.

You can contact our claims department by phoning 1-800-565-5441 at any time.

When you report a loss, a claim file is opened and an adjuster may be assigned to handle your claim. An adjuster is a person who deals with claim assessments and assists policyholders to determine if coverage applies and to what extent the company can help.

An appointed adjuster will generally make contact with you the same day a loss is reported.

Adjusters will gather information about the loss which may include personal visits, photographs and statements from you and other witnesses.

Once it is determined that a loss is insured under the policy the adjuster will review estimates and valuations to assist by advising how much can be paid under the policy in specific circumstances.

An adjuster’s goal is to settle covered claims with insureds on a basis that is fair to both the client and the company.

The adjuster will receive and forward relevant claim information to the company for consideration.

PEI Mutual policies consist of a Coverage Summary, a policy booklet or wording and any applicable endorsements or forms. All of these documents make up your policy. They are an agreement or a contract between you and PEI Mutual. The coverage summary outlines who is insured, the effective dates and the specific coverage that has been purchased by you. The policy booklet or wording and endorsements lay out the coverage terms and conditions.

First, the lost or damaged item must be insured. If the item is insured we move on to the next step. If it is not an insured item, the policy will not respond.

Next, the item under consideration must be damaged by an insured peril or cause of loss. If the insured item was damaged by an insured peril we move on to the next step. If the damage was not caused by an insured peril, the policy will not respond.

Next, it must be determined if any policy conditions would affect coverage. If no policy conditions affect coverage then we move on to the next step. The policy may not intend to provide coverage in specific circumstances and in these cases the policy will not respond.

Finally, there may be limits that affect the amount of payment. These may be the limits of insurance or the deductible that you purchased. There may also be specific limits of coverage in the policy that apply to a loss.

At PEI Mutual we consider that your home is your castle. You will decide what work is done, when and by who. The adjuster’s role is to advise how much can be paid under your policy depending on the decisions you make.

When you need the help of a contractor and you do not have a specific one in mind an adjuster may suggest a few contractors who you may contact. Selection of the contractor is the choice of the insured or property owner. We do not recommend or require that you use a specific contractor.

Contractors will be directed by you and you will be responsible for payment to them.

The adjuster can assist you, and in turn your contractor, by advising what can be paid under the policy and under what circumstances.

The adjuster can assist you by arranging payment for a contractors completed work. For larger claims that can take longer to settle, interim payments can usually be arranged to assist you and your contractor.

All policyholders are responsible to minimize any insured damage. Coverage is provided for reasonable costs of temporary repairs required to prevent further damage immediately after an insured loss.

If you must complete emergency repairs before an adjuster can attend it is beneficial to you and the company to take pictures of the damage. A picture can tell a thousand words! In addition, you will need to save any damaged items for the adjuster to view.

A Proof of Loss Form is a specific claim form that can help you meet the minimum claim filing requirements. These forms are available at any time on request.

The company can also provide you with Schedule of Loss forms to help itemize your loss and claim.

When agreed, the adjuster can assist you in completing and filing these forms for consideration by the company.

It is the insureds responsibility to “prove their claim”. This means that the insured must establish that the claim is covered and that amounts claimed are covered under the policy. Often, the adjuster will help with advice in presenting a claim, but the responsibility is with the insured.

Insurers must be able to rely on the honesty of all policyholders. Careful and accurate presentation of claims is advised at all times. Misstatements by a policyholder can have the effect of voiding an entire claim even where portions of the claim are otherwise valid and insured.

Some examples of misstatements are: claims for undamaged items, exaggerated valuations and claims for deliberate damage. These types of claims affect all policyholders at PEI Mutual.

Claims discussions and negotiations will take place between the named insureds and the adjuster or company representative. It may be the decision of the insured and the company to involve other parties in the claims process.

For insured’s property, all policies allow for the lesser of: the cost to repair, the actual cash value or the limit of insurance. If repair is a reasonable option, this cost will be the basis of settlement. Actual Cash Value means the actual value of similar used goods. Some policies limit payment to the Actual Cash Value.

Some policies (check with your adjuster) include coverage for replacement cost payments. Under these policies when replacement is made, promptly with property of like kind and quality the actual replacement costs may be claimed. Otherwise settlement will be based on Actual Cash Value.

If you have replacement cost coverage you are entitled to replace the item with like kind and quality. On approval of the adjuster you can apply the replacement cost of the item you lost to your purchase. You will be responsible for the additional cost of upgrade.

Obsolescence or wear and tear are not proper issues for an insurance policy, so matching is not a factor in claims settlements.

We find that many of our policyholders are resourceful and are often interested in doing some work themselves. The policy is not a source of profit for the insured but we can make allowances to compensate in these instances.

These allowances will be dealt with directly between the adjuster and insured.

The company endeavors to pay claims as quickly as possible. When a claim is covered and the presentation is in order, payment is usually made without delay. While we often make claims settlements seem easy, claims representatives must ensure that proper claims settlement processes are followed.

In the case of larger claims that will take longer to settle your adjuster can help you arrange interim payments when warranted.

All claims are added to a policyholder’s history and their history can affect premium. We have discounts for residential claims free clients and surcharges for clients that may make several claims. At PEI Mutual, we have very forgiving policies for clients who have had the misfortune of a loss.

If you want to know whether a particular claim will affect your premium please contact our claims department.

Short answer, No. It is important for the company to keep a record of all reports but it will not count as a claim.

Claim cheques are made in the policyholder’s names for their protection unless we receive direction otherwise.

When a claim is made for contractor’s work often the contractor’s name will be added on the cheque.

If your claim involves payment for an item that is subject to mortgage or lien the lender will be added on the cheque.

Cheques must be endorsed or signed by all payees.

Damaged property is to be kept until an adjuster approves disposal. Damaged property is part of the information needed to assess your claim.

We suggest in urgent situations that damaged property be set aside, but not disposed of, so that it may be viewed by the adjuster.

Once a claim is paid the company is entitled to retain and sell any salvaged property.

Notice: All policyholders are required to notify their insurer as soon as a loss occurs.

Presentation of a claim by an insured must be made as soon as is reasonably practicable.

Payment: While we endeavor to pay claims quickly, once a proof of loss is filed by an insured all insurers must pay covered claims within 60 days.

Limitation: Property damage claims are treated as barred if not settled within one year after the loss.

It can take time to assess a claim so it is always recommended that claims be presented as early as possible. After all, the sooner you present your claim, the sooner you can receive payment. Lengthy delays in presentation of claims can put your coverage in jeopardy.

Straightforward smaller claims can be settled in weeks if not days.

More complex claims requiring time for repairs can take a few months or just weeks to settle.

If you have lost your home to fire typically it can take 1 to 2 months to resettle your household temporarily and plan for your repairs. It can take another 3 to 4 months for repair or rebuild of your home. Resettling your home and final payments can usually be completed within 8 months.