WHEN A DISAGREEMENT ARISES
Disputes between consumers and their insurance companies can often be quickly and easily resolved. Problems sometimes arise over a simple misunderstanding.
GIO is here to help consumers work out issues they are having with their insurance companies before they become protracted or difficult to address.
WE ARE HERE TO HELP
Dispute resolution?
We are here to
help
WHO CAN USE GIO AND WHEN?
Any home, car or business insurance policy holder who has a concern, problem or dispute with a 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. GIO Consumer Service Officers can only review a case once the policy holder has received a final position letter from their insurance company.
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 (CSOs) will review a matter to determine if it falls within our mandate. For complaints outside of our mandate, our CSOs will review other options available to the consumer.
WHAT DOES IT COST?
All GIO services are free to consumers.
WHEN TO CALL US?
The first step of insurance resolution is to try to solve the issue directly with your insurance company.
GIO Consumer Service Officers are available to discuss your complaint and guide you through your insurance company’s complaint process but we cannot review a case before you have received a final position letter from your insurance company.
HOW IT WORKS
Our Process
If you have received a final response that you are not satisfied with, and your complaint is within our mandate, we can begin our independent review:
We will assign a Consumer Service Officer (CSO) to you. The Officer will discuss the situation with you and work with you to determine how your problem might be resolved. We may provide you with industry information to resolve and/or clarify your concerns, or we may redirect you 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.
If your insurer has provided you with a final position letter your CSO may assist by contacting your insurer’s Company Liaison Officer (CLO) or other company personnel to further discuss the unresolved concerns. If the resolution is not to your satisfaction, you may be able to proceed to GIO’s 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 our mediators are independent and experienced in mediating disputes with insurance companies. Once GIO receives all the necessary and relevant documents, 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 insurance 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 an agreement was reached.
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 suitable 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.
The Senior Adjudicative Officer’s conclusion and non-binding recommendation is the final stage of GIO’s services. 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.