Edmonton office helping Canadians settle insurance fights

An organization that handles disputes about workplace health benefits, disability and other insurance has opened an Edmonton office in hopes of raising its profile with Western Canadians.

The Toronto-based OmbudService for Life and Health Insurance assists customers of approximately four dozen member companies making up almost every firm in the Canadian industry, acting executive director Brigitte Kent said Thursday.

The group, started in 2002, received 2,632 complaint inquiries last year from people seeking a free, impartial review of concerns about companies’ claims, service, products, marketing and sales, and underwriting.

The vast majority wanted information, hadn’t completed their company’s internal appeal process or reached a resolution. Out of 337 cases that led to written complaints, 26 were ultimately referred for investigation and seven settled in favour of the customer.

Here’s an edited, condensed version of Kent’s conversation about the service.

Q: What does the OmbudService do?

A: We’re looking to see if there are grounds upon which we feel we can negotiate with the insurance companies. If there is, we negotiate to reach a settlement. Our recommendations are non-binding, but to date all the final recommendations we have made have been accepted by the insurers.

Q: Why is it needed?

A: Going to court is expensive and takes a very long time, whereas now the consumer has somewhere they can go where they can get an independent review of their complaint and it doesn’t cost them anything. We close most of our complaints within 120 days.

Insurance companies have to belong to a dispute resolution service of some sort under federal legislation. We are one of the choices.

Q: What are the most common types of complaints?

A: Disability and life insurance are the top two areas, then extended health and dental … (Generally) you’ve claimed a benefit and it’s been denied.

Q: The $2.2-million annual operating cost is paid by the industry. …read more

Source:: Edmonton Journal

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