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How The Process Works

WHEN A DISAGREEMENT ARISES

Disagreements between insurance companies and their customers can often be quickly and easily resolved. Problems often arise over a simple misunderstanding.

The GIO provides services across Canada to consumers to work out problems they are having with their insurance companies before they become protracted or difficult to address.

WHO CAN USE GIO AND WHEN?

Any home, car or business insurance policyholder who has a concern, problem or dispute with their General Insurance OmbudService (GIO) member company can use our service. The types of consumer complaints that GIO generally deals with include claims, interpretation of policy coverage, policy processing and handling.

Some matters are beyond the scope of GIO services. These include:

  • The cost of insurance and rates. (In Alberta only, GIO assists policyholders in resolving complaints about auto premiums in accordance with provincial legislation);
  • Availability of insurance;
  • Dispute settlement procedures as required by law or designated regulatory authorities;
  • Matters that have been, or are, before the courts.

GIO’s experienced Consumer Service Officers will review a matter to determine if the company acted appropriately, verify those situations where GIO’s dispute resolution services do not apply and discuss other options available to the consumer. Your GIO representatives will guide you through the options and will on occasion follow up with your insurance company to address preliminary issues or questions concerning the complaint.

WHAT DOES IT COST?

There are no costs charged to you for GIO’s efforts, including
its Mediation (or Senior Adjudication – where applicable) that we arrange for you.

STEP ONE – CONSUMER ASSISTANCE

If you have a problem, your first step is to contact GIO. We will assign a Consumer Service Officer (CSO) to you. After discussing the situation with you, the Officer will work with you to determine how your problem might be resolved. Industry information may be provided to resolve and/or clarify your concerns, or you may be redirected by the CSO to complete your insurer’s internal complaint process. Your insurance company will respond to your complaint and, if necessary, provide a final position letter indicating their position of the complaint. If you still need help, our CSO may proceed to informal conciliation.

STEP TWO – INFORMAL CONCILIATION

If your insurer has provided you with a final position letter, if required your CSO may assist by contacting your insurer’s CLO or other company personnel to further discuss the unresolved concerns. If resolution is not obtained to your satisfaction, you may be able to proceed to GIO’s Mediation.

STEP THREE – MEDIATION

At this stage, GIO’s Manager of Complaints will determine if the option of Mediation is possible. If your complaint proceeds to Mediation, our CSO will help you select a mediator. All of our mediators are independent and experienced in mediating disputes with insurance companies. Once all necessary and relevant documents have been received by GIO, the mediator will facilitate a two-hour non-binding session between you and a representative of your insurance company.

During this session, the mediator will act as a neutral third party to help you and the company representative resolve issues through discussion in an informal and confidential environment. At the conclusion, the mediator will prepare a report for GIO outlining whether or not an agreement was reached.

SENIOR ADJUDICATION

If a Mediation has taken place and has not resulted in an agreement, the Manager of Complaints may at this point determine if Senior Adjudication is appropriate. If your complaint is deemed favourable for further consideration under GIO’s process, our CSO will send a letter to the company informing them of the next phase and giving them an opportunity to submit any further written documentation in support of their position. The CSO will prepare the file and transfer it to GIO’s Senior Adjudicative Officer (SAO). The CSO will make sure that the SAO has all necessary material and is fully informed of all aspects of the complaint.

The SAO may wish to speak to you or the company representative for clarity. Neither you nor the company representative appear before the Senior Adjudicative Officer. The SAO will independently review the case and deliver a report containing a non-binding recommendation on how the matter should be resolved.

AFTER SENIOR ADJUDICATION

The conclusion reached and the delivery of the non-binding recommendation from the Senior Adjudicative Officer conclude the services offered by GIO. If you or your insurance company do not accept the non-binding recommendation, then you may wish to consider legal action. None of the services provided by GIO will affect your legal rights or the rights of your insurance company. Any further action you may wish to take is up to you.

OUR GOAL

GIO’s services provide consumers with an alternative solution to the courts. The primary objective is to resolve disputes efficiently and equitably. It is our hope that this process will also increase the confidence and satisfaction of insurance consumers by encouraging them to participate in the dispute resolution process with their insurance company. Finding a mutually agreeable solution in a confidential, non-confrontational, and cost-effective manner is a benefit to all participants.

To see GIO’s full Terms of Reference for Dispute Resolution, click here (PDF File)