The Financial Services Commission of Ontario (FSCO) oversees the operation of a system that ensures all insurance complaints are dealt with professionally, speedily and subject to review by an independent body.

Often the fastest way for a consumer to resolve a complaint is to deal directly with the company where the problem first arose.

If your company is unable to resolve the complaint within a reasonable period of time, you have the right to have your complaint reviewed by a third party. Most insurance companies are members of an Ombuds Service under the Financial Services OmbudsNetwork.

Breaches of the Insurance Act

One of the key roles of the Licensing and Market Conduct Division at FSCO is to inquire into allegations of contraventions of legislative requirements.

Contact them at:

The Financial Services Commission of Ontario
Licensing & Market Conduct Division
Insurance Company Complaint
5160 Yonge Street
4th Floor, Box 85
Toronto, ON M2N 6L9

When writing to them, please set out the nature of the problem and include all relevant facts and documentation. You should also enclose a copy of any correspondence you have received from your insurance company which explains their position on your complaint.

Please note their office may not inquire into a complaint that:

• Has not been submitted to the insurance company and has not gone through the insurer’s complaint process; or
• Is being or has been dealt with by a court or an alternative dispute resolution process, or where the individual has a statutory right of appeal under the Insurance Act.

If you require additional information on how to file a complaint, please call them at (416) 250-7250 or toll free at 1-800-668-0128.

When your complaint is received, it will be replied to and handled as quickly as possible by FSCO's insurance area. They are committed to providing quality service in performing their regulatory responsibilities.

Tips for Resolving a Complaint

If you think there's a problem, ask for an explanation as soon as possible

Often, problems arise due to misunderstanding or miscommunication between individuals. If addressed early, they can easily get sorted out. However, if you are not satisfied with the response you receive make a formal complaint.

Be clear about the problem and what you would like to see happen

A formal complaint often requires that you put the information down in writing. You need to identify the problem, state why you think it's a problem and set out what you would like to happen. Put down the facts in a logical order and provide relevant documentation. Avoid unnecessary detail and repetition. Avoid bringing new issues forward while the complaint is going through the process. Often this confuses matters and results in unnecessary delays.

Ask for information

Know your rights about filing a complaint. Keep in mind that every company is required to have a complaint process that contains information on how to make a complaint, how long the process will take and the next steps if the complaint remains unresolved.

Keep a complaint file

Make copies of all correspondence and official documents you send to the company. Always send copies of official documents and keep the original for your file.

Keep records of conversations

If you phone a company or attend a meeting, keep a record of the date, the name of the person you spoke to and the main issues raised by both of you. If there is an action expected following a conversation, send a confirmation letter to the company. Be specific about the agreed action and the timelines.

How to File a Complaint

Step 1: Make your complaints to your insurance company

Every company has a procedure to deal with complaints. Your company representative will give you the necessary details about how to make a complaint.

Each company has also appointed a Consumer Complaint Officer to oversee the complaint process. If you are unable to get all the information you need from your representative about how to make a complaint, you may want to contact your Consumer Complaint Officer.

You can get the name of your insurance company's Complaint Officer by asking your insurance broker, or by call FSCO at (416) 250-7250 or toll-free at 1-800-668-0128, or by sending a fax to (416) 590-8480.

Step 2: If you are unable to resolve your complaint with your insurance company, request a letter from the company stating its final position on your complaint

The Consumer Complaint Officer should ensure that you receive a letter stating the company's final position and advising you of the name and details of the independent Ombuds Service that can review the complaint.

Step 3: Write to the independent Ombuds Service referred to in the company's final position letter

Your letter should describe your complaint and why you disagree with the company's position.

Ensure you enclose the insurance company's letter and all documentation relating to your complaint. This will assist the person assigned to review your complaint.

It is not necessary to hire a lawyer, but, if you have one, he or she may write the letter to the Ombuds Service on your behalf. If you are writing on behalf of someone else, include a note signed by that person, authorizing you to act for him or her. When it is not possible to obtain an authorization, explain the circumstances in writing.

Step 4: A complaint officer at the independent Ombuds Service will review your complaint

Upon receipt of your unresolved complaint, an officer will be assigned to handle your case. You will be advised about the process and what to expect. All unresolved complaints will be reviewed and a response provided.

Links to Ombuds Services

Canadian Life and Health Insurance OmbudService

Centre for the Financial Services OmbudsNetwork

General Insurance Ombudservice

Ombudsman for Banking Services and Investments

for more information, visit FSCO: www.fsco.gov.on.ca/