Important: When We Can Review Your Complaint
For OLHI to conduct a formal review:
- You must have a final position letter from your insurer
- Your complaint must involve a life and health insurance product
- Your insurer must be an OLHI participant
If you do not have a final position letter yet, we can still help by guiding you through your insurer’s process.
All insurance companies have an internal complaint process. Before OLHI can begin its complaint review process, you must first try to resolve your complaint directly with your insurer and obtain a final position letter, which is the insurer’s written decision in response to your complaint.
What to do:
- Contact your insurer and ask for its final position
- If you need help finding the right contact, see our insurer’s complaint contacts
OLHI’s Process
We will review review the insurer’s final position letter and assess whether your complaint falls within the scope of OLHI’s mandate. We may contact you to gather additional information.
If we are able to review your complaint, we will then request your written authorization to obtain the relevant documents from your insurer.
Once we confirm your complaint is reviewable:
- You will receive a formal acknowledgment confirming that your complaint has been accepted for review. Our objective is to complete our review within 120 days from the date of this acknowledgment.
- OLHI will obtain your complaint file from your insurer. You may also submit any additional documents in support of your complaint.
- An OLHI Complaints Analyst will contact you to:
- explain our review process,
- answer any questions, and
- give you an opportunity to share your perspective.
- The Analyst will review all relevant information provided by you and your insurer, including your insurance policy.
- We may ask you or your insurer for additional information, if needed.
What happens next:
If the Analyst believes your complaint has merit, one of the following may occur:
- Informal negotiation: the Analyst may attempt to resolve the issue directly with your insurer.
- Escalation to OSO: if informal negotiation does not resolve the matter, the complaint may be escalated to an OmbudService Officer (OSO) for an investigation, which we aim to complete in 45 days.
If the Analyst finds that your insurer’s position is reasonable:
The complaint will be closed, and we will provide you with our findings in writing, explaining why the insurer’s position is fair under the circumstances.
If the complaint is escalated and the OmbudService Officer (OSO) agrees that your complaint has merit:
- The OSO may negotiate directly with your insurer and/or make a non-binding settlement recommendation as part of our conciliation process.
- If the OSO determines that a recommendation is not appropriate, we will inform you in writing and explain the reasons.
- During the investigation, the OSO may request additional information from you or your insurer.
If your insurer does not accept the OSO’s recommendation:
OLHI’s Senior Adjudicative Officer may conduct a further investigation and attempt to negotiate a settlement with the insurer.
Types of Complaints OLHI Cannot Review
OLHI cannot review some types of complaints, including:
- Complaints related to an employee benefit plan the insurance company only administers on behalf of the employer – known as an Administrative Services Only (ASO) plan.
- Complaints that aren’t about Canadian life or health insurance products.
- Complaints about the conduct of independent insurance advisors.
- Complaints that are already underway in court, a tribunal, or with a mediator.
- Complaints that have already been decided by a court, tribunal, or mediator.
- Complaints made by a business.
- Complaints where the consumer already accepted a resolution offered by the insurer.
- Complaints from medical practitioners or professional services providers seeking payment from an insurance company.
We may also decline a complaint under certain circumstances, including:
- If the complaint is currently under investigation by a regulator.
- If there is a more appropriate venue to address the complaint.
- When too many years have passed before the complaint was submitted to OLHI.
For more details: