Compensation in Exceptional Circumstances and the Obligations of Certified Professionals
In Québec, claims adjustment expertise is reserved for holders of a claims adjuster certificate issued by the Autorité des marchés financiers (the “Authority”), with a few exceptions. One of these exceptions applies to major weather events, or “special circumstances,” which are occurring more frequently. For example, during torrential rain, ice storms or extreme winds, claims multiply, causing significant damage and stress for insured individuals. During these peak periods, claim requests increase sharply, creating heavy workloads for claims adjusters.
Under the Act Respecting the Distribution of Financial Products and Services (“the Act”), as amended by Bill 16 on various measures mainly relating to the financial sector, the Autorité has the power to expand the workforce authorized to act as claims adjusters during special circumstances, under conditions it determines (“authorized persons”). These activation conditions were recently published on its website.
What role can members of the Chambre de l’assurance play in this context, and what are their obligations? This article focuses on the obligations of damage insurance agents and brokers, as well as claims adjusters, once a permission is activated. This information complements the Autorité’s web page, which also outlines the activation conditions and firms’ responsibilities.
Agents and Brokers: Your Obligations When Permission Is Granted
When a permission is activated, the Authority may authorize damage insurance agents or brokers to handle claims under the conditions it sets. Other individuals may also be authorized to act as claims adjusters, without being supervised by the Chambre de l’assurance.
The Chambre emphasizes the conditions set by the Authority, which specify that an insurance agent or broker may perform claims adjustment activities during the permission period if:
- Their certificate issued by the Authority is valid at the time the permission is activated.
- They have held their certificate and practised for at least 24 months (consecutive or not) during the 36 months preceding the activation.
Under these conditions, the agent or broker may handle claims for the entire duration of the permission—six months, with no possibility of extension. This period begins when the Authority activates the permission and ends on the date indicated in the notice published on its website.
During this period, an agent or broker authorized to act as a claims adjuster must:
- Work in Canada.
- Continue to comply with their own code of ethics and with the code of ethics for claims adjusters.
- Comply with all other regulations applicable to claims adjustment activities in Québec.
Claims files:
- Are assigned by the firm to the agent or broker handling the claim.
- Are associated with a claims adjuster who must be ready to take over at any time.
- Do not need to be related to the event that triggered the permission.
- Have no maximum claim value for authorized persons.
If you are an agent or broker who wishes to help when permission is activated, here are three good practices:
- Know and apply the ethical obligations of claims adjusters.
- Maintain excellent record‑keeping and clear notes to ensure smooth file transfer when needed.
- Handle files within the limits of your knowledge and accept only those for which you are qualified and competent.
Claims Adjusters: Your Obligations During the Permission Period
1. Obligations Relating to Authorized Persons (including agents and brokers)
Under the conditions set by the Authority, the firm must associate each claims file with a claims adjuster as soon as it is assigned to an authorized person. The claims adjuster must be able to take over the file at any time, including when the permission expires, if the file is not completed.
If multiple files are assigned to the same authorized person, they may be associated with different claims adjusters.
Good practice : When a claims adjuster takes over a file previously handled by an authorized person, they should review the entire file, including all tasks completed and steps taken since it was opened.
2. Obligations Relating to Telephone Employees (non‑certified)
During the permission period, telephone employees are authorized to handle claims valued up to $30,000, instead of the usual $7,500 limit provided under section 10 of the Act.
At all times, the claims adjuster’s supervision obligations toward non‑certified employees remain applicable, including requirements related to supervisor qualification, full responsibility for files, file review and communications with clients..
The Chambre reminds claims adjusters supervising non‑certified employees that these workers play a key role in the industry and in protecting the public. Rigorous supervision ensures the application of good practices, thereby supporting the protection of claimants.
The translation of this article was done using AI but was reviewed by humans.