Claims
What Does an Insurance Broker Do During a Claim?
Short answer
During a claim, your broker helps you report the loss, explains what the policy covers and what the process will look like, provides the insurer's claims contacts, and follows up when the file stalls. The insurer's adjuster decides the claim, not the broker, but the broker can escalate internally with the insurer and point you to the independent complaint channels if needed.
Written by BrokerUnion Insurance Editorial Team · Reviewed by Muqit Aziz, Principal Broker, BrokerUnion Insurance Inc. (RIBO licensed) · Last reviewed
Key takeaways
- The adjuster, employed or appointed by the insurer, determines coverage and settlement, not the broker.
- A broker's value at claim time is reporting help, interpretation, follow-up and escalation.
- Report promptly. Late reporting can complicate a claim regardless of who you bought from.
- Document everything: photos, receipts, dates, names and file numbers.
- If a claim is denied or stalls, there is an escalation path: insurer complaint officer, then an independent ombudservice.
What to do in the first 24 hours
- Make sure people are safe and, if it is safe to do so, prevent further damage
- Call emergency services and obtain a report number where relevant
- Photograph the damage and the surrounding scene before cleanup
- Keep receipts for any emergency repairs or temporary accommodation
- Report the loss to the insurer or your broker as soon as practical
- Write down the claim number, adjuster name and contact details
What your broker does
- Confirms which policy and which coverage applies before you report
- Helps you report the claim and provides the insurer's claims contacts
- Explains deductibles, sub-limits and what documentation the adjuster will ask for
- Follows up when the file goes quiet
- Escalates within the insurer when a claim stalls or a decision is unclear
- Explains the independent complaint route if the matter remains unresolved
If a claim is denied or delayed
Ask the insurer for the reason in writing, with reference to the policy wording relied on. If you disagree, the insurer's internal complaints officer is the next step. If the complaint remains unresolved, the General Insurance OmbudService provides an independent review for home, auto and business claims in Canada, and the OmbudService for Life and Health Insurance handles life and health matters.
Who does what during a claim
| Role | Responsibility |
|---|---|
| You | Report promptly, mitigate further damage, document the loss, provide requested information |
| Your broker | Confirm coverage, help report, explain the process, follow up, escalate |
| Adjuster | Investigate, determine coverage under the policy, negotiate and settle |
| Insurer complaints officer | Review internal complaints about a claim decision or handling |
| Independent ombudservice | Review unresolved complaints after the insurer's internal process |
What to consider
- A broker cannot overturn an adjuster's coverage determination, and any brokerage promising that is overstating its role.
- Reporting to the insurer directly is always acceptable; tell your broker so they can track the file.
Authoritative sources
Where this information comes from
- What to do after a loss — Insurance Bureau of Canada. Reviewed August 7, 2026.
- Complaint resolution process — General Insurance OmbudService (GIO). Reviewed August 7, 2026.
- OmbudService for Life and Health Insurance — OLHI. Reviewed August 7, 2026.
- Consumer complaints — Financial Services Regulatory Authority of Ontario (FSRA). Reviewed August 7, 2026.
This page is educational and general in nature. Coverage, eligibility and pricing vary by insurer and by policy. The policy wording governs in all cases.
How BrokerUnion helps
- Your dedicated broker helps report the claim, explains the process and provides carrier contact information.
- We follow up with the insurer and support escalation when a claim stalls.
- Our complaints process and the independent escalation routes are published on the site.
FAQ
Frequently asked questions
Should I call my broker or the insurer first?
Either is acceptable. Many clients call their broker first to confirm coverage and deductibles before the claim is formally reported.
Will making a claim raise my premium?
It can, depending on the type of claim, fault determination and insurer rules. Your broker can explain the likely renewal impact before you decide on small losses.
Can my broker escalate a denied claim?
A broker can escalate within the insurer and ensure your position is documented, but the coverage decision belongs to the insurer. Independent ombudservices exist for unresolved disputes.