The Civil Code of Quebec provides a general obligation for the insured to always cooperate with his insurer, particularly during the post-loss investigation. This often means that the insured must repeatedly explain the circumstances surrounding the loss : the initial call notifying the loss, the police report, the version given to the claims adjuster representing the insurer and, if required, in the insurer’s subsequent demands.

What if these different statements contain small differences? Does this automatically mean that your insurer can refuse to compensate you for the loss that occurred, due to a lack of cooperation?

First, rest assured that the answer to this question is no. From a legal point of view there is a significant difference between false statements and deceitful representations.

Distinguishing the false from the deceits

Indeed, it is only when the insured makes deceitful representations that the insurer is justified in denying cover, whereas simple false statements do not lead to the loss of the right to compensation. What is the difference?

Case law shows that not everything that is false is necessarily deceitful. In order to be qualified as a deceitful representation, the insured must have the intention to fool the insurer, with the aim of obtaining the insurance indemnity in fraud of the latter’s rights.

Courts have held that an omission, a simple exaggeration, a lack of accuracy, a mistake, or the failure to answer exactly the same thing to repeated questions in deferred interrogatories may indeed represent false declarations, without however being a deceitful representation.

For example, if the time at which you declare becoming aware of the loss changes from one version to another, in the absence of an intention to fool the insurer, these are insufficient contradictions to justify the refusal of compensation.

On the contrary, pure and simple inventions regarding the circumstances of the loss, the origin or value of the goods affected, made in the purpose of collecting the insurance indemnity and increasing the amount paid by the insurer, are deceitful representations sufficient to forfeit the right to indemnity. 

It belongs to the insurer to prove clear malicious intent on the part of the insured and the denial of compensation cannot be based on mere suspicion. In the absence of such proof and despite certain contradictions, the insurer is obliged to compensate the insured for the loss suffered.

Focus on transparency

It is important to remember that the insured is legally bound to always act honestly and in good faith. He is obliged to inform the insurer of everything he knows about the circumstances of the loss and the extent of the damage suffered, as well as to provide all the documents requested for the investigation. In short, transparency is the key: full and frank declarations eliminate grey areas.

If the claim is a major financial issue for you, if you feel that the investigation is getting out of hand, if you realize that there are differences in your statements that are causing you concern, or if you simply need help with the long and complicated process of the insurer’s investigation : CONTACT US.