Our help is free, prompt and impartial. We guide consumers through the complaints resolution process by:
- Answering questions about your complaint or your insurance policy
- Telling you how to contact your life or health insurance company with your complaint, if you haven’t already done this
- Helping you if 90 days have passed since you complained to your insurance company and you haven’t received a final decision from them
- Reviewing your complaint if you are not happy with your insurance company’s final decision
To maintain our position as fair and independent, we do not advocate for either the consumer or the insurance company. Any recommendation we make is based on our impartial review of all the relevant facts.
Our four-step complaints process:
Before bringing your complaint to us for a review, you must first try to resolve it directly with your insurance company. Find out how the insurance company’s process works. OLHI is always available to discuss your complaint and guide you through the company’s complaint process but we are unable to review a case before you’ve completed this process. Sometimes, we are unable to become involved: read more about when we can’t help.
OLHI can formally review your complaint any time after you’ve received your final position letter. If it’s been 90 days since you’ve complained to your insurance company and you haven’t received a final position letter, we can urge them to review your case.
To conduct our independent review, you must submit your complaint, along with an authorization form and all documentation related to your complaint. You can find out what kind of documentation is needed here. If you are not sure about what to send, please contact us.
Work with OLHI must be initiated by the consumer. For example, an insurance company will never tell us about you or your complaint. The company will tell you about OLHI – and it is always up to you whether you decide to contact us.
A Dispute Resolution Officer will collect all relevant information from you and the insurance company, and will speak with you about your complaint. We will then let you know if there is merit to your complaint. Many cases are resolved at this step.
If we find merit to your complaint, it is escalated to an OmbudService Officer (“OSO”). The OSO will work with you and your insurance company to try to reach a settlement.
If our OSO does not reach a settlement and there is a reason to further pursue your complaint, we will refer it to our Senior Adjudicative Officer (SAO). The SAO will interview you and the insurance company and then write a report with non-binding settlement recommendations. To date, all our SAO recommendations have been accepted by the insurance company.
When we can’t help:
OLHI is always available to discuss a complaint but we are unable to review some types. For example:
- 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. Nor can we help medical practitioners or professional services providers to collect payment from a life and health insurance company. We can only help individual consumers of life and health insurance products.
- Complaints where an employee benefit plan is not insured by an insurance company, but where the insurance company has been engaged to administer the claims on behalf of the employer (known as an administrative services only plan).
We may also decline a complaint under certain circumstances. For example:
- The complaint is currently under investigation by a regulator
- There is a more appropriate venue to address the dispute
- Many years have passed before the complaint was brought to us
If you have any questions about whether we can help, please contact us.