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HOW TO MAKE A COMPLAINT TO AN INSURANCE OMBUDSMANAn Insurance Ombudsman is a final step for the informal resolution of
complaints about the business practices of insurance companies. The Insurance
Ombudsman assists consumers with written complaints about licensed insurance
companies operating in its jurisdiction.
What do I do when I have an insurance complaint?
Write a letter to your company representative, explaining your problem and how you think it may be resolved. Send the company any information which supports your complaint. Every company has a procedure to deal with complaints. This process is different at each company; your representative will give you details about the procedures. Someone from your insurance company may contact you to review your complaint and attempt to resolve it. Each company has appointed a person to act as a liaison to address consumer complaints. If you are unable to get all the information you need from your representative, you may want to contact your company's Ombudsman Liaison Officer. The Liaison Officer should also ensure that you receive a letter outlining the company's final position, if your complaint cannot be resolved.
You may write to the Insurance Ombudsman if you and your insurer cannot resolve the complaint. Describe your complaint and what you want the company to do about it. Be sure to outline the steps taken to resolve your complaint and include the letter from your insurance company. This should be done as soon as possible because it is easier to resolve complaints if they are dealt with early. It is not necessary to hire a lawyer, but if you have one, he or she should write to the Insurance Ombudsman on your behalf. Or, if you are writing on behalf of someone else, include a note signed by that person, stating that you are authorized to act for him or her in this matter. When it is not possible to obtain an authorization, you should explain the circumstances to the Insurance Ombudsman, in writing.
After receiving your letter, the Ombudsman will: review your complaint and promptly advise you about what can be done; give you the name and telephone number of the person in the Insurance Ombudsman's Office who will be looking into the complaint; and give the insurer an opportunity to respond to the complaint. After considering the complaint and any response, the Insurance Ombudsman may: attempt to resolve the complaint; or recommend that the Superintendent of Financial Services inquire into the complaint; or advise that your complaint should be dealt with by another organization. In such a case the Insurance Ombudsman will inform you of the situation and if you agree, refer the complaint to the organization.
The report is not binding on either party. If you wish to pursue the matter further, you may want to consider taking legal action against the insurer. What kind of complaints can the Insurance Ombudsman investigate? The Insurance Ombudsman can look into complaints about the business practices of insurers. Some examples of the types of insurance you may have complaints about are:
What kind of complaints can't be investigated? The Insurance Ombudsman may not inquire into a complaint that:
As a matter of practice, the Insurance Ombudsman will not inquire into complaints that:
Ombudsman information can be found through the following sites. See also Government | ||||||||||||||||||||||||||||||||||||
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