Loss adjust SUMMARY OF A LOSS ADJUSTMENT PROCESS
1. ADJUSTMENT OBJECT
The purpose of the adjustment process is basically to determine the loss occurrence, if it is covered by the contracted insurance coverage and, if applicable, the determination of the indemnification to be paid.
2. FORM TO PERFORM THE ADJUSTMENT
The adjustment could be directly performed by the Company or entrust it to an Insurance Adjuster. The decision should be communicated to the Insured within a three working day term counted from the date of the loss denouncement.
3. RIGHT OF OPPOSITION TO THE DIRECT ADJUSTMENT
In case of an adjustment directly made by the Company, the Insured or beneficiary could oppose to it, requiring by written the appointment of an Insurance Adjuster within a five working day term counted from the communication of the Company. The Company should designate an Adjuster in a three working days counted from said opposition.
4. INFORMATION TO THE INSURED OF THE MANAGEMENT TO BE PERFORMED AND BACKGROUNDS REQUEST
The Adjuster or the Company within the term of three working days after the initiation of the adjustment process, it should inform the Insured by written of its pertinent management to be performed by it and all the backgrounds required to adjust the loss.
5. ADJUSTMENT PRE-REPORT
When losses suggest problems and differences in relation to their causes, risk evaluation or coverage extension, the Adjuster will be entitled to - acting pursuant to Law or upon request of the Insured - issue an pre-report of adjustment about the coverage of the loss and the amount of the damages produced, which should be notified to the Interested Parties. The Insured or the Company could make written observations to the pre-report within a five working day term counted from the notification reception.
6. ADJUSTMENT TERM
Within the shortest term, not being entitled to exceed:
a. General Insurances: 90 running days from the denouncement date;
b. Motorized Vehicle Insurances: 60 running days from the denouncement date;
c. Haul or Heavy Damages Maritime Insurances: 180 running days from the denouncement date.
7. ADJUSTMENT TERM EXTENSION
The above stated terms could be extended in special cases, successively for equal periods, which should be informed to the Insured and the Superintendence, where this latter is entitled to void the extension, in qualified cases, and determine a term to deliver the Adjustment Report.
8. FINAL ADJUSTMENT REPORT
The final adjustment report should be addressed to the Insured and simultaneously to the Insurer, when pertinent, and it should necessarily contain the full transcription of articles 24 to 27 of the Regulation of Auxiliaries of the Insurance Commerce (Treasury S.D. N°863, of 1989, Official Gazette from April 5, 1990), related to the resolution of the refutations formulated and to the right of the Insured to apply the arbitration procedure considered in the Policy.
9.REFUTATION TO THE ADJUSTMENT REPORT
Upon reception of the Adjustment Report, the Company and the Insured will have a ten working day term to refute it. In the event of an adjustment directly made by the Company, this right will only be enforceable by the Insured. After refuting the Report, the Adjuster will have a five working day term to reply the refutation.
