If you have a complaint about your meal at a restaurant, you can ask your server to send it back to the kitchen. If you have a complaint about clothing you purchased from the Gap, you can return it for a refund.
If you have a complaint about your insurance company’s refusal to pay a settlement, a resolution is equally available as in the above scenarios, but the process is a bit more formalized. That’s where the Financial Services Commission of Ontario comes in (sometimes referred to as the Ontario Insurance Council).
Insurance is a heavily regulated industry, which can make dispute resolution both easier and more complex. The responsibilities of an insurance company are clearly defined, and plenty of free resources exist for resolving disputes.
It’s unlikely that a consumer would ever have to spend money on a lawyer to get fair treatment. However, like most regulated industries that resolve disputes primarily through government bodies, the steps to resolution can be a bit complicated and time-consuming. We hope this article will quickly answer any questions you might have.
Use an ombudservice before the Ontario Insurance Council
There is a service you should use to resolve your insurance issues before taking your case to the Ontario Insurance Council.
If you can’t resolve a dispute through the insurance company’s customer representatives, you may still find resolution within the company. All licensed insurers have an internal ombudsperson or liaison officer, and their role within the company is defined by the government. Customers can trust that their support is without bias towards the company.
Nevertheless, this isn’t the only ombudsperson available to customers. In Canada, the General Service OmbudService (GIO) can resolve disputes independently. They provide a free service that’s made available to insurance customers through any communication channel.
Whichever ombudservice you use, it’s important to provide as much information as possible, including the names of anyone you’ve spoken with, the emails or letters you’ve received, and, most importantly, a final position letter that you’ve requested from the company. The more information you provide the more quickly you will receive a fair resolution to your complaint.
Resolving your dispute through the Financial Services Commission of Ontario
The above solutions will resolve most complaints that a customer can have—but if they don’t, there are still more options.
The Financial Commission of Ontario (FSCO) will resolve any and all disputes through mediation, arbitration, appeals, and variations and revocations (more on these fun terms below!). The process isn’t quite so free from this point, so it’s worth exploring the above solutions before submitting an Insurance Business Activity Complaint Form (which you can download here).
The first step is mediation. The FSCO charges no administrative fees at this point, but it will be up to you to pay any personal expenses, including travel expenses or fees for producing medical documents.
Mediators are often very successful in working objectively with both parties to find a resolution. If no resolution is found, however, then you can apply for arbitration. The difference in this step is that whatever the arbitrator decides is legally binding This step also requires paying an administrative fee of $100, which is why it’s often best to find a resolution as early in the process as possible.
If, after all this, you’re still unhappy with the decision, you can appeal. The fee for appeals is $250, and your appeal will have to address a legal technicality in the arbitrator’s decision (it’s not simply to get a second opinion). Even after all this, the arbitrators decision could be reversed if new evidence or an indication that the decision was made in error surfaces later on, initiating a variation or revocation.
Insurance customers are well protected from any unfairness in how their insurance policy is handled. The Financial Services Commission of Ontario (or Ontario Insurance Council) has multiple mechanisms in place to protect insurance policy holders.
We are proud that aha insurance is based in Ontario, where we can develop insurance technologies for the modern age. We hope you’ll feel comfortable contacting our representatives with any questions or complaints, because we like to make sure all our customers are fairly treated and happy with our services.