What to Consider When Disputing an Insurance Claim

It is not easy to deal with large insurance companies. Often, you walk away with more questions than answers. Complex policies can often leave insured persons wondering about the extent of their coverage and unable to know what they qualify for. 

Insurance is a necessary (even if undesirable) aspect of life. With it, you can protect yourself and your family if something happens to you or a loved one. Nevertheless, insurance companies can withhold payouts even to contributors who never miss a payment and pay punctually. Such an experience can be shocking when you need support the most. 

Below are the four steps you should consider when attempting to resolve a dispute with your insurance company:

1. Compile all the facts.

• Insurance policies can be challenging to follow. Even though the policy (i.e., the contract) details all the parties’ rights and responsibilities, it is nonetheless possible that miscommunications will arise. Consult your insurance representative, agent or broker to clarify your particular issue or concern.
• Contact the IBC Consumer Information Centre (CIC) to get answers to your questions on coverage, proceeding with a complaint and policy wording.

 

2) Contact your insurance company’s ombudsperson or Complaint Liaison Officer or Ombudsperson.

• There is a complain-resolution procedure that licensed insurers follow, and there is a specific person in charge of applying this procedure. The provincial regulator is the body that regulates this role.
• If you decide to submit a complaint via this procedure, describe your complaint plainly and state the resolution that you expect. Ensure that all your documents are easily accessible, that you account for all the people with whom you spoke about the complaint and that you describe what you discussed explicitly. Furthermore, ensure to afford the Ombudsperson or Complaint Liaison Officer enough time to respond to your complaint and to investigate.

 

3) Contact the General Insurance OmbudsService (GIO).

• Suppose you are unsatisfied with the progress (or lack thereof) concerning your insurance company’s complaint procedure. In that case, you can ask for a Final Position Letter and reach out to the GIO, which is a neutral, consumer-dispute resolver. It aims to help insured people and their insurance companies resolve their disputes on claims issues.

 

4) Escalate it to the provincial or federal level.

• If your insurance company is not a member of the GIO or if the GIO cannot resolve the dispute, you can escalate the matter by contacting your province’s financial consumer agency. You can also escalate it to the federal level by contacting the Financial Consumer Agency of Canada.

If you encounter issues with claiming compensation from your insurance company, call McNally Gervan of Ottawa, at 613-238-1424. Our knowledge of and experience in the insurance industry makes us dependable, personal injury lawyers whom you can trust to advocate on your behalf. We will take care of the heavy lifting and take the burden off you so that you can receive what you deserve.