Tips for resolving a complaint

(Source:  Canadian Council of Insurance Regulators)

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

Often, problems arise due to misunderstanding or miscommunication between individuals.

If addressed early, many problems 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 in the future

A formal complaint often requires that you make a complaint 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 information and copies of documents.

Avoid unnecessary detail and repetition. If new issues arise while the complaint is going through the process, it helps to reduce confusion and delays if you submit a new complaint for the new issue.

Ask for information when necessary

Know your rights about filing a complaint.

Keep in mind that all insurance companies are required to have a complaint process that includes providing information on:

  • how to make a complaint
  • how long the process will take
  • next steps if the complaint remains unresolved

This process must include a company ombudsperson (please refer to the following list, which is maintained by the Superintendent of Insurance):

The process must also include membership in an independent ombudservice, which is an independent organization that helps consumers resolve disputes or concerns with their insurance company. These services are free of charge, and help address consumer concerns about claims, interpretation of policy coverage, and policy processing and handling. They will mediate between insureds and insurers, but do not have the ability to order settlement of a claim or provide a legal opinion about policy coverage.

For general insurance, such as home, automobile and commercial insurance, contact the General Insurance OmbudService:

Toll free: 1-877-225-0446
Website: www.giocanada.org

For travel, life, accident and sickness, and other private health insurance, contact the OmbudService for Health and Life Insurance:

Toll free: 1-888-295-8112
Website: www.olhi.ca

Keep a complaint file

Make copies of all correspondence and official documents you send to the company.

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.

Form instructions

Trouble opening PDF forms?

Fillable forms do not open on some mobile devices and web browsers. If the form doesn't open or you see a "please wait" message, follow these steps to complete and save fillable forms from the Alberta Superintendent of Insurance:

  1. Right-click on the form link and select "Save Target As" or "Save Link As", and save the form to your computer.
  2. Launch Adobe Reader.
  3. Open the PDF from within Adobe Reader. You can now fill and save your form.

To submit your forms

Please follow the directions on the form for submission instructions. If you have any questions, contact the Alberta Superintendent of Insurance.

Getting your insurance claim settled

Know your options

There are a variety of steps you can take to resolve an outstanding insurance claim with your insurance provider. When issues, concerns, and disagreements arise, the following options are available.

Option 1: Dealing with your insurer

Contact your adjuster, review what is delaying the settlement of the claim, and come to an agreement on a plan to get the claim back on track.

If settlement of the claim cannot be agreed upon with the adjuster, contact the adjuster’s claims supervisor or manager.

If the claim is still not settled, contact your insurer’s complaint liaison officer or ombudsperson. In Alberta, all insurers are required to have an ombudsperson. Please refer to the following list, which is maintained by the Superintendent of Insurance:

Option 2: the Dispute Resolution Process

When you cannot reach an agreement about the following issues, they must be determined using the Dispute Resolution Process set out in section 519 of the Insurance Act (the Act).

  • value of the insured property
  • value of the property saved
  • nature and extent of the repairs or replacements required
  • amount of the loss or damage

The dispute resolution process must be used in settling the amount of a loss with your own insurer. Your insurer must send you a copy of section 519 of the Act within 10 days of determining that there is a dispute in respect to the amount of a loss.

Alternatively, as an insured, you can initiate the dispute resolution process in respect to the amount of a loss at any time, using the following process:

  • You must file a proof of loss form with the insurer and make a written request to start the dispute resolution process. A proof of loss form is available from your adjuster.
  • Within 7 days, you and your insurer must each appoint, at your own cost, someone to represent your interests. Neither party can represent themselves, and neither can appoint employees.
  • There is no requirement to appoint an appraiser to represent you. You may appoint anyone of your own choosing, although it is highly recommended you appoint a representative with expertise in the subject matter being disputed.
  • If the 2 representatives cannot agree on the amount of the loss, they will appoint an umpire to assist in establishing the amount of the loss.
  • If the representatives cannot agree on an umpire, they can apply to Alberta’s Superintendent of Insurance to select one. See the documents below:
  • The umpire will issue a written decision based on information provided by the representatives.
  • The outcome of the dispute resolution process is final and binding for both the insured and the insurer on the issue of the amount of the loss.
  • It is important to note that the dispute resolution cannot be used to resolve contractual disagreements, such as whether there is coverage under the policy. The interpretation of what is covered by your policy is a matter for the courts to decide.

Option 3: Contact an independent Insurance OmbudService

There are independent organizations that help consumers resolve disputes or concerns with their insurance company.  These services are free of charge, and help address consumer concerns about claims, interpretation of policy coverage, and policy processing and handling. They will mediate between insureds and insurers, but do not have the ability to order settlement of a claim or provide a legal opinion about policy coverage.

For general insurance, such as home, automobile and commercial insurance, contact the General Insurance OmbudService:

Toll free: 1-877-225-0446
Website: www.giocanada.org

For travel, life, accident and sickness, and other private health insurance, contact the OmbudService for Health and Life Insurance:

Toll free: 1-888-295-8112
Website: www.olhi.ca

Option 4: Legal advice

In instances where settlement cannot be achieved through the above listed options, it may be beneficial to review the matter with legal counsel in order to best protect your own interests.

For information on finding a lawyer, contact the Law Society of Alberta.

Insurance conduct complaints

Complaints about whether you've been treated fairly by your insurance agent, broker, adjuster or insurance company

Alberta Treasury Board and Finance and the Alberta Insurance Council work together to ensure that consumers are protected, and that insurance companies, insurance adjusters and insurance agents or brokers operate at the highest standards.

Please note that these offices do not formally arbitrate or settle claims.

Concerns about the market conduct or licensing of an agent, broker or an independent adjuster

Concerns about the market conduct of an insurance company

Sign up for updates

Subscribe to get our insurance publications by email

 

Contact

If you have trouble opening fillable PDF forms

See the form instructions.

To connect with the Office of the Alberta Superintendent of Insurance

Hours: 8:15 am to 4:30 pm (open Monday to Friday, closed statutory holidays)
Phone: 780-643-2237
Toll free: 310-0000 before the phone number (in Alberta)
Fax: 780-420-0752
Email: tbf.insurance@gov.ab.ca

Address

Alberta Superintendent of Insurance
Alberta Treasury Board and Finance
Financial Sector Regulation and Policy
402 Terrace Building
9515 107 Street
Edmonton, Alberta  T5K 2C3