What does your organization do?
The OmbudService for Life & Health Insurance (OLHI) is a free, impartial dispute resolution and information service for consumers of Canadian life and health insurance products. Last year, our organization received around 2,500 complaints from consumers, primarily relating to disability, life and extended health care, and dental insurance claims.
How does OLHI help if I have an insurance complaint?
Most insurance claims are paid out without incident. But sometimes, they're denied. Many people believe that if their insurer denies their claim, they have no other option but to simply accept the denial or pursue costly court proceedings. In fact, there is an alternative.
"To date, all OLHI's final settlement recommendations in favour of the consumer have been accepted by insurers."
OLHI can help in two ways: first, by advising Canadians on how to take next steps with their insurers. And second, by independently reviewing a complaint after an insurer has issued its final position letter.
What steps are involved in the complaints process?
If you have a complaint, you must first try to resolve the issue with your insurance company. Each insurer has a formal process for handling complaints and you will need to follow their required steps.
If you aren't satisfied with the insurance company's final decision, you can bring your complaint to OLHI and one of our Dispute Resolution Officers will assess whether the complaint has merit.
13,000 Number of information requests received by OmbudService last year
In the event of an insurance complaint, the OmbudService works with consumers and insurers to reach non-binding recommendations. . Istockphoto.com
If they don't think the case has merit, Officers routinely advise consumers of their option to pursue legal action, although they can't provide legal advice. On the other hand, if the complaint has merit, an OmbudService Officer will be assigned to your case and will try to reach a settlement. The Officer will work with you and your insurance company to try to reach a voluntary resolution of the complaint.
If the complaint isn't settled at this stage in the process, it may be escalated for final review by a Senior Adjudicative Officer, who interviews the parties and issues a written report with non-binding recommendations.
The case studies we've included on our website provide a general overview of the types of complaints we receive and the outcomes from our process.
What happens when OLHI makes a recommendation?
The OmbudService carefully considers each case and clearly outlines the reasoning behind a recommendation. Recommendations are non-binding, which means that you and the insurance company are not required to accept them.
Do non-binding recommendations work?
Absolutely. To date, all OLHI's final settlement recommendations in favour of the consumer have been accepted by insurers. Non-binding works for us because we have the support of the industry when we make recommendations.
The non-binding process is inexpensive, fast and fair – and, in most cases, avoids the lengthy complexity of court proceedings. A binding OmbudService process, on the other hand, would duplicate the court system and, to be fair to all parties, it would have to build in additional steps, such as appeals. This would undermine our fundamental objective: to provide a quick and effective dispute resolution process.
Finally, in a voluntary and non-binding system like ours, when the insurer agrees to pay, consumers are paid quickly and there are no collection issues as there may be in court.
How independent is OLHI?
OLHI does not report to insurers and it is not a consumer advocate. This lets OLHI maintain its impartial position. The OmbudService is led by an independent Board of Directors, of which the majority do not have ties to the life and health insurance industry, and the Board is never involved in complaints cases.
The Canadian Council of Insurance Regulators oversees OLHI's operations to ensure we meet their standards to protect the public interest, which includes independence from stakeholders such as insurers.
Does OLHI only provide dispute resolution services?
While dispute resolution is OLHI's core business, we also provide information services as a part of our commitment to help Canadians become more financially literate. Last year we received over 13,000 information requests -- for things like what types of insurance are available and where they can be found. OLHI's Insurance Finder is a useful resource that helps consumers find the information they need.
This content was produced by Randall Anthony Communications, in partnership with The Globe and Mail's advertising department. The Globe's editorial department was not involved in its creation.