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, you must first try to resolve it directly with your insurance company; OLHI does not start complaints with an insurance company on your behalf. Find out how the insurance company’s process works. OLHI is always available to discuss a complaint but we are unable to review some types. Read more about when we can’t help.
OLHI can 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 .
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, medical practitioner or professional services provider to collect payment from a life and health insurance company. We can only help consumers
- Complaints where an employee benefit plan is not provided by an insurance company. Instead, benefits are provided by an employer who decides how and when to pay the claims – not the insurance company.
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.