Understanding insurance dispute resolution
Let’s say you’ve made a claim on your home insurance after a tree fell on your roof during a storm. The contractor has come and gone but you’re not happy.
What do you do?
The Insurance Bureau of Canada (IBC) offers this advice on addressing an insurance dispute:
1) First, talk to the contractor. They may be willing to rectify any deficient work and make things right. Many insurers guarantee the quality of work done by their preferred contractors. If you are using your insurer’s contractor, and speaking to the contractor doesn’t rectify the problem, your next step is to speak to the adjuster assigned by your insurer to outline your concerns. Each insurer has an internal escalation process to address these types of issues. In extreme circumstances, you may want to refer to your province’s formal dispute resolution process.
Next steps
IBC says if you have a complaint about your insurer or insurance professional, there are a number of actions you can take to be sure you’re heard and that your issue is resolved.
1) Speak with your insurance representative Ask your broker, company representative or claims adjuster for an explanation. Insurance policies are legal contracts that specify the rights and responsibilities of both parties. Sometimes, misunderstandings can occur. If you have further questions that your representative or adjuster are unable to answer, ask to speak with the claim supervisor or manager.
IBC says you can also contact their Consumer Information Centre or call 1-844-227-5422. Their staff are experienced and can answer general insurance questions about:
- policy wordings and coverage
- how insurance companies handle claims
- buying, renewing or updating insurance coverage
- how to proceed with a complaint
Keep in mind, the Consumer Information Centre is unable to provide legal advice.
2) Contact your insurance ombudsman All licensed insurers have their own internal dispute resolution process. Ask your insurance representative for their company’s ombudsman’s contact information. When you make a complaint:
- clearly state your concern and expectations
- have all pertinent information and documentation available
- allow time for your insurer to investigate and answer your complaint
- make sure you keep a record of the people you talked to and what was said
3) Contact the General Insurance OmbudService (GIO)
Inquiries can also be directed to the General Insurance OmbudService (GIO) at 1-877-225-0446. If your matter is not resolved with your insurer’s complaints liaison officer, request a final position letter and contact GIO.
The GIO is an independent consumer dispute resolution system for the insurance industry. Its members include most federally licensed and several provincially incorporated insurers. GIO helps resolve differences about claims-related matters and interpretation of policy coverage in a fair, independent and impartial environment.
To find out if your insurer is a member look here.
4) Contact a federal, provincial or territorial Superintendent of Insurance
If your dispute is not resolved by GIO or your insurer is not a member of GIO, get in touch with a Superintendent of Insurance in your province.
The provincial and territorial insurance regulators are:
- Alberta, Superintendent of Insurance
- British Columbia, Financial Services Authority
- Manitoba, Financial Institutions Regulations Branch
- New Brunswick, Financial and Consumer Services Commission
- Nova Scotia, Office of the Superintendent of Insurance
- Newfoundland, Superintendent of Insurance
- Northwest Territories, Superintendent of Insurance
- Nunavut, Office of Superintendent of Insurance
- Ontario, Financial Services Regulatory Authority (FSRA)
- Prince Edward Island
- Québec, Autorité des marchés financiers
- Saskatchewan, Insurance Councils of Saskatchewan
- Yukon, Office of the Superintendent of Insurance
Federal Government of Canada
Part of the role of the Financial Consumer Agency of Canada (FCAC) is to ensure that financial institutions have a complaint-handling process. If you have difficulty finding out about your institution’s complaint-handling process or if you’re experiencing delays, contact FCAC. Keep in mind that the FCAC does not provide redress or compensation and cannot get involved in individual disputes.
Learn more about filing a complaint with FCAC or call 1-866-461-3222.
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