ombudservice – OLHI – Free, impartial help with your life & health insurance complaints

Our Ombudsman is head of the OmbudService for Life and Health Insurance (OLHI). OLHI offers an alternative dispute resolution public service that is free, bilingual, independent and impartial to Canadians with life and health insurance.

Sounds great so far, right? But what is an ombudsman or an ombudservice? How does alternative dispute resolution (ADR) work?

More importantly, how can an ombudsman or ADR help you?

Ombudsman: A brief history

More than 200 years ago, Sweden appointed the first Ombudsman to resolve complex problems when the King was away. The term “ombudsman” originates from “ombuds” (umboðsmaðr), which means “proxy agent” or “representative” in Old Norse.

Today, there are ombudservice offices for governments, organizations, and financial institutions across the globe.


Did You Know?

Over 100 countries are members of the International Ombudsman Institute.


What does an Ombudsman do?

An ombudsman can review complaints from the public about government, organizations, or financial institutions. An ombudsman’s goal is to help both sides come to a resolution via mutual agreement.

A mediator helping a consumer and an insurance company representative come to an agreement.
An ombudsman’s goal is to help both sides come to a resolution via mutual agreement.

Canadian life and health insurance consumers can submit a complaint to us if they feel dissatisfied with their insurer’s final position on a policy.

If your complaint is reviewable, we can review your policy outcome. If it has merit, OLHI can offer a non-binding recommendation to your insurance company.


Note: an Ombudsman is impartial.

An ombudsman is impartial, so they don’t represent the consumer or the organization, which in the case of OLHI, helps build confidence in Canada’s life and health insurance sector.


According to the International Network of Financial Services Ombudsman Schemes, the hallmark of an ombudsman is a “free, independent, impartial, fair, timely, efficient and informal alternative dispute resolution process.” 

Alternative Dispute Resolution in a nutshell

At its core, Alternative Dispute Resolution (ADR) is about finding fair resolutions to disputes outside the courts.

In other words, say you have a complaint with your life or health insurance provider, ADR may help solve your problem without expensive, lengthy, and adversarial litigation.

Benefits of Alternative Dispute Resolution (ADR)

Consider the benefits of ADR; you may thank yourself later. Alternative Dispute Resolution is:

  • Confidential—ombudservices have strict privacy policies and cannot share your information with anyone
  • Far more flexible than court proceedings
  • More cost-effective than litigation—it’s a free service to the public
  • Can offer resolution faster than litigation
  • Applicable over multiple jurisdictions (e.g., provinces, countries) at once, thereby evading a substantial time commitment to several lawsuits

How can an Ombudsman help me?

The OmbudService for Life and Health Insurance (OLHI) provides an impartial, independent, bilingual, and free ADR public service to the 29 million Canadians with life and health insurance.

Our public service can also guide consumers through the complaints process and answer their questions. We can also help them find lost policies or policies of deceased loved ones.

Mr. and Mrs. H. applied for life insurance and were approved. When her husband died several months later, Mrs. H. claimed the benefits under the policy. The insurance company denied the claim for failing to disclose information about Mr. H.’s health.

Mrs. H. brought her final position letter to OLHI. She explained to our Dispute Resolution Officer (DRO) that a nurse had come to their home on behalf of the insurance company to collect blood and urine samples and fill out a questionnaire. During their conversation, Mr. H. told her about his high iron levels and his visits to a hematologist. The nurse noted “blood work normal” in her report despite his disclosure. Mrs. H. and her husband gathered the high iron was not important since the nurse did not take it into account, nor did the insurance company analyze his blood for this.

After his review of the information from Mrs. H. and the insurance company, the DRO recommended an OmbudService Officer (OSO) investigate further.

The OSO discovered that the company had not contacted the nurse to find out more about her visit with Mr. and Mrs. H. He recommended Mrs. H. contact this nurse, to see if she could validate their conversation. The nurse was unable to recall the specifics of their meeting.

While Mr. H.’s medical records showed he had been diagnosed with a blood condition, it was not disclosed in his insurance application. However, Mr. H. had signed this application, along with the report that the nurse prepared, confirming that all information provided was accurate. For this reason, the OSO recommended that there was no reason to further pursue this complaint.

Disclaimer: Names, places and facts have been modified in order to protect the privacy of the parties involved. This case study is for illustration purposes only. Each complaint OLHI reviews contains different facts and contract wording may vary. As a result, the application of the principles expressed here may lead to different results in different cases.

OLHI held its annual general meeting and released its annual report for 2016/17, reporting on a year of record numbers and renewed priorities.

Highlights:

  • Complaint volumes increase by 23.2% across Canada, marking a historic high
  • Increase in complaints from Quebec (+36.2%), Prairie provinces (+25.6%) and British Columbia (+ 24.4%)
  • Public contacts exceed 87,000
  • Edmonton office established as a part of western expansion strategy

Read the news release.

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