Some disputes are easier to resolve than others.
Geo political ones are always dicey. So are the ones where a brother calls his sister a “stupid head,” just because she re-arranged a couple of pieces in his Ninja Turtle collection.
Thankfully, conflicts between you and your private-sector auto insurance company are more likely to fall into the “easy to resolve” category, because there are established and proven protocols in place for dispute resolution.
Whether the dispute is over the dollar value settlement of a total loss vehicle, how a vehicle is repaired, the extent of injury benefits, premium rates, and/or who gets designated as the “at fault” driver, there are avenues to have your case heard, before you ever need to consider the courts.
Since you enter a contract whenever you sign up for automobile insurance, contract law (and the legal system) is always available to settle the dispute. But, as everyone knows, the cost, complexity and length of this avenue generally makes it the conflict resolution avenue of last resort.
Talk is Cheap and the First Step
The conflict resolution avenue of first resort is to pick up the phone and call your broker/agent, insurance company representative or claims adjuster for a more detailed explanation of their decision.
Insurance policies are legal documents that specify the rights and responsibilities of each party, and it’s quite possible you are not intimately aware of the all the nuances of those rights and responsibilities. Maybe you didn’t read the policy cover to cover?
If a more detailed explanation doesn’t make the conflict go away, you’ll need to talk to someone else.
It’s always best to work it up the ladder,” says Peter Karageorgos, spokesperson for the Insurance Bureau of Canada, which represents the vast majority of Canada’s private insurers. So Karageorgos suggests the next step is to ask the next line supervisor or manager to get involved.
“If you can’t get a resolution through the claim staff, the adjuster, or that supervisor, then you could formally contact the company’s complaint officer,” says Karageorgos.
Complaint Officer/Company Ombudsperson
All federally and provincially licensed insurers are required by law to have a dispute resolution system in place, and a core component of that is a designated complaint officer. Sometimes this person is also known as the company’s Ombudsman, or the more PC-correct, Ombudsperson.
This company officer is obligated to listen to your complaint. After they have had some time to digest your complaint, they may adjust the company’s position, or not. If the adjustment is not satisfactory to you, or they don’t offer any adjustment, and you still want to peruse the matter, then you are entitled to receive from this officer, the company’s Final Position Letter.
With Final Position Letter in hand, you could then take your complaint to the provincial regulatory body that overseas the financial services sector in your province. In Ontario, for example, that would mean the Financial Services Commission of Ontario (FSCO). The IBC has links to all these regulatory bodies at the bottom of this page on its website — www.ibc.ca/en/consumer_protection/.
But another option at this point, with great potential to solve your conflict, is to contact the General Insurance OmbudService.
General Insurance OmbudService
“We assist consumers in their concerns, or complaints with the insurance company,” says Brian Maltman, executive director of General Insurance OmbudService (GIO). “Federally licensed companies and provincially licensed companies are required by law to belong to an independent organization that does this. We’re funded by the industry, but they don’t control us …We’re a non-profit, national, independent organization.”
Companies who belong to the GIO do about 95 percent of the private insurance business in Canada. Maltman says consumers are free to call them anytime they have a concern about insurance; even before they’ve contacted their insurance company’s complaint officer or ombudsperson.
“We leave no stone unturned for the consumer but we’re not advocates,” says Maltman. “If a complaint come to us that the internal ombudsman has not yet seen, they get a shot a resolving it. We’ll give the consumer all of the contact information to reach the ombudsman, and suggest they call or email them. In many cases, with the additional help from us, which could include some clarification and coaching, and having the internal ombudsman review it, that will be enough.”
But Maltman adds: “If there is no joy after that, they can come right back to us and talk about escalating it to the next step.”
Mediation not Arbitration
The next step is having the IGO contact your insurance company, for a discussion on how to solve the conflict. When the discussions prove fruitless, the IGO can move the conflict to the mediation phase. But chances are it won’t go there. Maltman says the IGO’s “batting average” for solving conflicts “pre-mediation phase” is over 99.5 percent.
The IGO fielded over 3,700 calls last year. Only seven involved cases that eventually headed for mediation.
Note also, that any IGO suggestion or mediation is not binding on either party. It’s all about finding a mutually agreeable solution to the disagreement.
Knowledge and Communication
IBC’s Karageorgos notes that when auto insurance-related disputes do end up in the courts, they typically concern personal injury cases, because their high dollar amounts can justify the legal expenses.
Other issues seem best settled by talking, and getting more information and/or clarification. Karageorgos says one major area of confusion is when insurance companies assess “fault” even when police officers at the scene don’t lay any charges: “Insurers use fault determination rules as outlined in the Insurance Act, whereas police would use the (respective) Highway Traffic Act, so there are two different pieces of legislation at play.”
And sometimes consumers don’t realize that their auto insurance company actually went above and beyond their obligations. “We love to get on those calls from customers,” says Maltman. “We get to tell them their insurance company did a great job. Sometime you need to hear that from an independent body … someone with no skin in the game.”
Public vs Provincial
Four provinces operate publicly owned insurance corporations: B.C., Saskatchewan, Manitoba and Quebec. For claim disputes with those corporations, consult their respective websites.