Case Study

CASE

Clarifying Policy Terms

Synopsis of Complaint:

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.

Review by GIO:

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.

Resolution:

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.

GIO is an independent body set up to help Canadians find a fair resolution to disputes with insurance providers. GIO can provide advice on dealing with your insurance company as a first step. If you are not satisfied with the decision from your provider on your claim, GIO can help resolve your claim. 

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