How we can help with insurance complaints
We can help you with your life or health insurance complaint by:
- Answering questions about your complaint
- Telling you how to take your complaint to your company if you haven’t already done this
- Contacting your company on your behalf if you submitted a complaint to them and they haven’t responded within 90 days
- Reviewing your complaint if you are not happy with your insurance company’s final decision
Getting ready to submit a complaint for OLHI
Before you submit a complaint to us, take a few minutes to review these steps:
Step 1 – Get a Final Position Letter ?A Final Position Letter is a written decision made by the insurer that outlines its final position about a consumer claim.
All insurance companies have an internal complaints process. You must try to resolve your complaint directly with your insurance company and get a Final Position Letter from them.
Once you have received a Final Position Letter, you can submit your complaint to us.
Step 2 – OLHI confirms we can review your complaint ?We can review a complaint if the complaint involves one of our member companies and falls within OLHI’s mandate, and if you have a final position letter from your insurer.
There are some types of complaints that OLHI cannot review. We also can only start a review of your complaint if you have a Final Position Letter.
If you do have a Final Position Letter, we will contact you to gather more information and to get your written authorization to review your complaint.
Step 3 – OLHI reviews your complaint
If you have received a Final Position Letter, and your complaint is reviewable then an OLHI Complaints analyst will start a review.
The Complaints Analyst will look at all the information you and your insurance company provided, including your insurance policy. We may come back to you and your insurance company to request more information.
If we believe your complaint has merit, it goes to an OmbudService Officer.
Step 4 – OLHI investigates your complaint
If the OmbudService Officer agrees there is merit to your complaint, OLHI will make a non-binding settlement ?If our complaints process finds that a case has merit, we make a non-binding settlement recommendation that the consumer and the insurance company can choose to accept or not. recommendation to your insurer.
During an investigation, the OmbudService Officer may also ask you or your insurance company for more information.
Step 5 – Senior Adjudicative Officer Investigation
If your insurance company doesn’t accept our recommendation, OLHI’s Senior Adjudicative Officer may investigate the complaint and try to negotiate a settlement with the company.
How to submit a complaint
1. Make sure you have a Final Position Letter
2. Submit your complaint online
After we receive your complaint, we will send you an email asking for the Final Position Letter and additional information.
Types of complaints OLHI can’t review
OLHI cannot review some types of complaints, including:
- Complaints that aren’t about life or health insurance.
- Complaints about independent insurance advisors.
- Complaints about foreign life and health insurance.
- Complaints that are already underway in court, in a tribunal or with a mediator.
- Complaints that have already been decided by a court, tribunal or mediator.
- Complaints made by a business.
- Complaints from medical practitioners or professional services providers to collect payment from a life and health insurance company.
- Complaints related to an employee benefit plan the insurance company is only administering on behalf of the employer (known as an administrative services only plan).
We may also decline a complaint under these circumstances:
- The complaint is currently under investigation by a regulator.
- There is a more appropriate venue to address the complaint.
- Too many years passed before the complaint was submitted to OLHI.
Frequently asked questions
What is a final position letter?
A written decision made by the insurer that outlines its final position about a consumer claim is called a final position letter.
Is OLHI a consumer advocate?
Any recommendation we make is based on our impartial review of the relevant facts so that both sides know they are getting a fair, unbiased perspective.
What is a reviewable complaint?
We can review a complaint if:
- The complaint involves one of our member companies and falls within OLHI’s mandate.
- The consumer has received a final position letter from the insurer.
What does it cost to use your services?
All OLHI services are free of charge to consumers across Canada, in either English or French.
How does OLHI determine if a case has merit?
A complaint has merit if our complaints process finds that the insurer did not follow the terms of the consumer’s life or health insurance policy. We may also consider factors outside of a policy’s terms or conditions.
What can you do for me?
OLHI can mediate on your behalf with your insurance company. If you have a dispute with your insurance company and OLHI finds that your claim has merit, we can ask them to reconsider a decision.
Sometimes, this can result in a negotiated settlement agreeable to both sides.
Are OLHI’s recommendations binding?
No. We provide voluntary settlement recommendations which avoid costly, complex court proceedings.
What does non-binding mean?
“Non-binding” means that that the consumer and the insurance company can choose whether to accept our recommendation.
How do I submit a complaint?
If you have received a Final Position Letter from your insurance company, you can submit a complaint here.
After I complete my insurance company’s complaints process, will they tell you about me and my case so that you can help me?
No, you must submit your complaint to OLHI yourself.
What if my friend or relative contacts you about me and they ask you to call me?
If your friend or family member contacts us, we can’t take any action until we hear from you. You must submit your complaint, along with an authorization form.
If you want a representative to work with us on your behalf, you must advise us of this on your authorization form.
How long will it take to handle my complaint?
We make every effort to review the complaint and conclude the treatment of such within 120 days upon receipt.
Are there any circumstances where you cannot handle my complaint, even after I complete my company’s process?
OLHI is always available to discuss a complaint but we are unable to review some types.
Can I skip the Complaints Analyst step and have my complaint immediately dealt with by an OmbudService Officer?
Our complaints handling process has been specifically designed to handle your complaint in the quickest and most efficient way. Most complaints are capable of early resolution under the review of a Complaints Analyst. If the complaint has merit, it is then escalated to an OSO for review.
What if I am not satisfied with the outcome of my complaint?
If we find your complaint does not have merit or we are unable to settle the complaint, you have the right to pursue other remedies, such as legal action or a complaint to a local regulator.
Should I speak to my lawyer before making a complaint to OLHI?
You and the insurance company will be asked to sign an agreement suspending the limitation period while OLHI reviews your complaint.
However, in Quebec, it is not legally permissible to make such an agreement. You should speak with a lawyer if you have any questions about this or about how working with OLHI impacts your limitation period.
We do not provide legal advice. You are free to consult a lawyer anytime during our process, as long as you don’t start legal action. If you do, you must notify OLHI immediately, and we will withdraw from our process.
How can you be impartial and independent when OLHI is funded by life and health insurance companies?
In Canada and around the world, regulators and OmbudServices in the financial services sector are typically funded by the industries they cover, as opposed to the general taxpayer.
OLHI’s independence is safeguarded by ensuring that the insurance companies do not control our operations.
To ensure impartiality, our operations are overseen by the Canadian Council of Insurance Regulators (CCIR) as well as our independent Board of Directors.
Our budget is set by OLHI’s Board, based only on the recommendations of the independent directors.
Our CEO, who manages day-to-day operations, has no ties to the life and health insurance industry.