A consumer had a not-at-fault accident and their vehicle was declared reparable. The consumer used a non-preferred body shop, and a labour charge rate was applied in accordance with the shop’s fees.
The insurer took the position that this charge was not approved, which resulted in the consumer owing some additional funds.
The consumer stated that they had dealt with the insurer on 5 separate occasions and they were not advised that the labour charge rate was unapproved.
The consumer contacted GIO for assistance after receiving a Final Position Letter from their insurer, which maintained the decision to pay only the labour charge rate when a preferred body shop was used.
The Consumer Service Officer (CSO) reviewed the consumer’s Final Position Letter and the supporting documentation of their claim.
The CSO discovered that the consumer’s supporting documentation included an approval by the insurer to pay the labour charge rate in this case.
Once provided with this information, the insurer determined that this information had been overlooked and agreed to pay the outstanding funds owed for the repair.
The consumer was very grateful for GIO’s assistance and this outcome redeemed her confidence in her insurer.
A consumer travelled to Florida on a personal trip, where she was admitted to the hospital for a serious illness. She was released from the hospital one day before her return flight to Canada.
She was required to provide negative results from a COVID-19 PCR test before her flight home, but the hospital was unable to perform one.
As a result, her test results were not available for 72 hours and she missed her flight. The insurer denied the consumer coverage for the cost of the new return ticket.
The Consumer Service Officer (CSO) reviewed the consumer’s Final Position Letter from their insurer, as well as their insurance policy and communications with the insurer.
The CSO wrote to the Complaint Liaison Officer asking for them to change their position since the delay in receiving COVID-19 test results was not caused by the consumer. Upon further review of the file, the insurer agreed to pay the consumer’s claim.
The consumer was involved in an accident in a roundabout and the insurance company assessed that the consumer was at fault. The consumer escalated the case, as they believed the insurance company had misinterpreted the rules of the roundabout. The insurance company maintained that the consumer was at fault as they were not yielding to the right-of-way, in accordance with the signage at the roundabout when the collision occurred.
The Consumer Service Officer (CSO) asked the consumer to provide a photo of the signage and reviewed the rules of the roundabout.
The CSO contacted the insurance company and provided the photo of the signage and the rules of the roundabout. The other vehicle involved in the collision had failed to follow the right-of-way when the accident occurred.
The insurance company was satisfied that the consumer had yielded to right-of-way and exited properly in accordance with the signage. The record was amended to show that the consumer was not at fault in this accident.
The consumer was in a car accident that involved wildlife. Their insurance company denied their claim as their coverage did not include accidents involving wildlife.
A month after the consumer had added insurance to their vehicle, they had contacted their insurance agent to add physical damage coverage. The consumer had opted for collision only as they assumed that wildlife strikes would be covered under this insurance policy.
The Consumer Service Officer (CSO) sought clarification from the insurance company based on the statement provided by the consumer.
The CSO requested a transcript of the conversation between the consumer and the insurance company during the consumer’s purchase of their insurance policy. The consumer was not informed of the various scenarios that would be covered, as it’s not common practice to sell stand-alone collision coverage.
GIO’s Informal Conciliation aided in the resolution of the consumer’s complaint. The insurance company agreed to pay the loss under the collision coverage.
Note: A revised edition of the Alberta Standard Automobile Policy SPF #1 now clarifies a live undomesticated animal strike is covered under comprehensive coverage.
The consumer had full coverage on their vehicle, until the insurance company realised that the consumer had repaired damages to their vehicle themselves from a previous accident. The consumer had used payment from the insurance company to finish the repairs. As a result, the insurance company revoked the consumer’s coverage and requested full documentation of the completed repairs from the previous damage, which the consumer did not provide. Without the required documents, the insurance company could not reinstate the full coverage but failed to notify the consumer of this action.
During this time, the vehicle was involved in another collision and the consumer assumed that the vehicle was insured, leading to a dispute. After several months, the insurance company agreed that coverage should have been added to the vehicle and agreed to handle the claim. The consumer wanted to take a settlement and complete the repairs himself, as he had done previously. The insurance company insisted the vehicle was a total loss and needed to be disclosed as such. Meanwhile, the vehicle was in a storage facility that the insurance company did not approve of and was incurring storage fees. The consumer also requested for a rental vehicle to use while his vehicle was awaiting repair. The insurance company refused to pay for the storage charges or the rental.
The Consumer Service Officer (CSO) contacted the consumer to get more information on the delays and why he required a rental. The consumer discussed his prior claim experience and felt insurance company set a precedent by allowing him to repair a previously damaged vehicle without needing the repairs to be disclosed. The consumer ultimately decided to accept the insurance company’s settlement for the vehicle, but the dispute about the storage charges and rental request needed to be resolved.
The CSO contacted the company’s Ombudsman and said that the rental was needed because the consumer’s vehicle was not drivable. The consumer should have been entitled to a rental from the date of the accident as he carried rental coverage on his insurance. The Ombudsman agreed to reimburse the consumer for the rental cost.
The insurance company also agreed to reimburse the consumer 50% of the storage fee, as the insurance company had not asked where the vehicle was located and did not request approval from the consumer to move the vehicle to a storage facility during the dispute. The consumer agreed to this offer.
The consumer had smoke damage to the contents of her home due to a fire. Her policy limit for contents was $100,000. A restoration company was sent by the insurance company to dispose of any goods that were unsalvageable and send any other goods that were able to be saved for cleaning. The consumer did not consent for the contractor to remove any goods, nor was she given any other options for contractors. The consumer only realized that the contractor’s fees were being deducted from her contents limit when she was asked to complete an itemized proof of loss form provided by the insurer.
The Consumer Service Officer (CSO) contacted the consumer to get more information regarding the situation and what was completed by the restoration company. Upon further investigation, the consumer advised that had she known the contractor’s fees were being deducted from the contents limit, she would have requested multiple quotes, and even offered to do some of the removal herself to save on the costs. The CSO felt the claims adjuster should have given a more in-depth explanation to the consumer regarding the contents limit and that they should have proposed alternative solutions to the consumer that could have potentially lowered the amount that was paid for restoring and removing the damaged contents.
The CSO contacted the company’s Ombudsman and after review of the file, they decided to hold firm on their position of maintaining that the consumer’s content limits were reached. The file was moved to the mediation stage of GIO’s process, and a mediator was assigned to review and mediate the complaint between the insurance company and the consumer. At the mediation, the insurance company agreed to pay for further expenses incurred by the consumer of disposal and replacement of goods that were damaged in the fire.
Consumer’s son borrowed the family vehicle and was involved in an accident. The consumer put in a claim, which was denied due to misrepresentation. Consumer contacted GIO for assistance after receiving a final position letter from his insurer maintaining the decision to deny his claim.
The insurer had determined that the consumer had not advised that his son was fully licensed, preventing the insurer to properly assess and rate the risk. The misrepresentation also resulted in the consumer receiving a notice of policy cancellation.
The consumer explained that he disclosed the driving status of his son to his agent but unfortunately there was nothing noted in the agent’s file regarding this. The agent had since left the company.
The Consumer Service Officer (CSO) handling the file asked the consumer to review all of his records (emails, text) to see if there was anything recorded in writing. The consumer had not thought to look for this information and was not sure he would find anything as many months had gone by.A few days later the consumer shared an e-mail with the CSO showing that his agent was aware of his son’s license status.
The CSO contacted the company Ombudsman and shared the new information. The insurer agreed to postpone the cancellation of the policy until the matter was further reviewed. In the end, the insurer was satisfied that there was a miscommunication and honored the consumer’s claim and maintained the policy in force.
Insured relied on a quote in which she provided information regarding her upcoming trip of a lifetime. Deposits for air, a cruise and half the cost of her Wedding Planner were paid when she contacted a travel agent regarding coverage.
Fast forward and, like many, her dream trip was cancelled due to Covid-19. She received her deposits back for her airfare and cruise however upon submitting a claim for the wedding planner costs, her claim was denied. The Insurer advised that this was not a covered expenditure.
The claim was paid. The couple were then able to live “happily ever after!”
Insured purchased a new mountain bike. Upon stopping on his drive home, he noticed his bike was no longer in the car rack. He contacted the police and filed a report.Looking for protection security coverage off his credit card for newly acquired items, he reported the claim to his Insurance provider.
The claim was denied based on his report to the police that the bike had fallen off while driving. With no bike, the insurer was unable to assess damages.
The Insured approached the GIO for an independent review. He stated his bike could have been stolen as the bike rack straps were slashed.
Claim denial maintained.
There was an auto collision and the issue in dispute was reimbursement for the total cost of the tow expenses and rental expenses.
The consumer had his vehicle towed 3 times to accommodate removal from the accident scene to the collision reporting center and then to a body shop. The insured did not advise the insurer ahead of time of the 3 tows and proceeded to forward a bill for the cost of 3 tows for a total of $1,211.50. The insurer felt the cost was excessive and felt they could have negotiated a better price. They paid $1,011.50 based on what they felt they would have paid if given the opportunity to negotiate the cost. This left the consumer out of pocket $200.00.
The insurer has a program where they offer the policyholder $20 per day if they choose not to take a rental vehicle. The consumer initially took a rental but ultimately decided he did not need the rental so returned it and requested reimbursement for the remaining time he was entitled to the rental. The insurer refused to pay this amount as he had taken a rental, so the offer was no longer available since he did not choose it from the start. The amount requested was $140.00.
The insurer reviewed their position and decided to settle with the client.
Claim made for a broken security camera system for which he has “equipment breakdown insurance” under a commercial policy. Upon reporting the loss, he was told he has a $1000 deductible.
Consumer had previously spoken with his agent prior to the renewal to discuss if there were any changes to his deductible or water coverage other than premium and was told no.
On the prior term, he had a $500 deductible, but the insurer maintained the $1000 deductible.
Once GIO reviewed the Final Position Letter and relevant documents, it was noted on the prior term’s renewal documents that there was reference to “important information” “change to your coverage” where it listed changes to the deductible, co-insurance and/or limits. The deductible did not change. However, the current term did not reference the same notification and the deductible was increased.
GIO was in contact with the insurer for informal conciliation. Their practice is not to show policy changes on the cover page of renewals. They state the onus is on the client to review their coverages on renewal. This consumer relied on his conversation with his agent.
The agent does not remember speaking with the consumer about the deductible, only the rate increase.
The insurer contacted GIO and, given the deductible was not clear to the consumer, their claims department agreed to reduce the deductible to $500 for this claim.
Consumer was appreciative for GIO’s assistance as he was not able to resolve on his own.
General Insurance OmbudServiceService de conciliation en assurance de dommages
4711 Yonge Street, 10th floorToronto, ON M2N 6K8Tel 1-877-225-0446Fax 416-299-4261
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