Life and health insurance

Here are your options if you have lost money because of an error, disagreement or possible misconduct relating to a life or health insurance product, such as a life insurance policy, a segregated fund, an annuity, a disability insurance policy, an employee health benefit plan or a travel insurance policy.

Step 1

Start with the insurance company

Start with the person or company you dealt with. Many insurance companies have internal processes for handling consumer complaints. Ask for a brochure or other written material explaining the process. Be sure to follow the steps suggested and ask for the final response in writing.

You can find more information about the complaint handling processes for provincially regulated insurance companies by contacting the appropriate provincial agency.

You can find a list of federally regulated insurance companies on the Office of the Superintendent of Financial Institutions website.

You can find more information about the complaint handling processes of federally regulated insurance companies on the Financial Consumer Agency of Canada website.

Step 2

Contact the company complaint officer

If you do not receive the information you need on how to make a complaint, contact the company’s complaint officer. Ask your representative or contact the insurance regulator in your province or territory for the name of your insurance company’s complaint officer. You can get contact information for insurance regulators from the Canadian Council of Insurance Regulators website.

If you are unable to resolve your complaint with your insurance company, the company complaint officer should provide you with the company’s final response in writing and information about the OmbudService for Life & Health Insurance, which is described below.

Step 3

Consider other options

Here are other options to consider if the insurance company does not respond to your complaint or you are not satisfied with the final response:

OmbudService for Life & Health Insurance (OLHI)

OLHI is a free, independent service for resolving life and health insurance disputes between participating insurance companies and their clients. You can find more information and a list of participating insurance companies on the OLHI website.

Regulatory action

You can contact the appropriate provincial or federal regulator. The regulator may be able to provide you with additional information, guidance or other assistance with resolving your complaint. A list of provincial and federal regulators can be found at the Canadian Council of Insurance Regulators web site.

If you live in Québec . . .

The Autorité des marchés financiers (AMF) offers a free mediation service for consumers who live in Québec and are not satisfied with the response from the insurance company’s internal complaint handling process. The AMF will review the complaint and may offer assistance to the consumer and insurance company in reaching a resolution. Participation in the service is voluntary and both the firm and consumer must consent to it. Consumers can pursue other options if an agreement cannot be reached. You can find more information about the AMF mediation service on the AMF website.

The AMF also has a compensation fund that pays compensation to eligible victims of fraud, fraudulent tactics or embezzlement by insurance firms or their representatives registered with the AMF to carry on professional activities in connection with the distribution of financial products and services. You can find more information about the AMF compensation fund on the AMFwebsite.

Legal action

You can take legal action through the courts to recover financial losses from a representative and/or insurance company for alleged misconduct. Each province and territory has a time limit for taking legal action.

You may want to consult a lawyer to get advice on your rights and options. Your provincial or territorial law society can help you find a lawyer. For a list of provincial and territorial law societies, visit the Federation of Law Societies of Canada website.

 

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Definitions

Segregated fund is an investment fund that is held within an insurance contract.

Annuity is an investment that pays a set monthly income for a set period of time. With an annuity, a lump sum is paid to the insurance company up front, and  income is then paid back each month over many years.

Representative includes advisers, dealers, financial consultants, investment advisers and counsellors, portfolio managers, insurance brokers and agents, insurance advisers and consultants, insurance representatives, securities dealers, wealth management advisers, mortgage brokers and agents.