Make a Complaint
View all 'Make a Complaint'Definition of a complaint
Complaints are generally expressed in writing through correspondence, e-mail, fax or other form that allows a complaint to be kept on file. Where a consumer makes a complaint by phone or in person and the complaint is handled and examined by the person responsible for the examination of complaints and designated as such in the organisation’s policy, the complaint must be documented so that it can be kept on file.
A Reportable Complaint means any reproach or dissatisfaction expressed either in writing or verbally, in respect of a service or product offered by Lloyd’s Underwriters related to a policy or claim issued by Lloyd’s Underwriters Canada that could not be resolved immediately, nor a plan agreed with the party to resolve the matter at initial contact, to the satisfaction of the party voicing the concern.
Reportable complaints will follow the tier one/tier two processes.
The Market must apply judgment when determining if a complaint is reportable. In a case when it is unclear or there is doubt, the complaint must be treated as a reportable complaint.
Definition of a complainant
A consumer means all current and prospective customers of insurance products.
Application of Lloyd’s procedure and local complaint regulations
Federal - The Office of the Superintendent of Financial Institutions (OSFI) regulates and supervises all banks and federally incorporated or registered trust and loan companies in Canada, as well as insurance companies.
All federally regulated financial institutions are required by the Insurance Companies Act to have dedicated procedures as well as personnel in place to deal with consumer complaints.
The Insurance Companies Act S.C. 1991, c. 47 is the primary legislation governing all federally incorporated or registered insurance companies in Canada.
Reporting of complaints is not specifically addressed in all jurisdictions other than a general requirement that insurers have a duty to furnish the superintendent on his request for full information.
Tier one and tier two complaints
A tier one complaint is a complaint that can be addressed within 20 days by the Lloyd’s Market (for example, Coverholders, Third Party Claims Administrators, and managing agents).
A tier two complaint is a complaint that has been escalated to the Complaints Management Office. The Complaints Management Office means the Lloyd’s Canada, Chief Regulatory & Compliance Officer (CRCO) who is the designated Complaints Manager/Ombudsman. The CRCO delegates the handling and response of a tier two complaint to the Lloyd’s Complaints Department in Canada (LCD).
Process
Receiving Complaints
Complaints related to a Canadian policy or claim should be sent to the Lloyd’s Canada Service Desk at info@lloyds.ca immediately.
Complaints can be initiated by a complainant either by mail, phone, or email.
If the complaint is received verbally, the complainant will be encouraged to provide a written complaint. However, if they are unable to do so, the complaint will be summarized in writing by the service desk team. A copy of the complaint summary will be sent back to the complainant either by email or mail.
All complaints are acknowledged within two business days by the Lloyd’s Canada Service Desk of the complaint being received by them.
In the event that a complaint is received through a regulatory body, this will initiate the Complaint process. As well, there may be an obligation to respond to the regulatory body which will be done by the Lloyd’s Canada Service Desk.
Coverholders must ensure they notify their managing agents of the complaint directly.
The complaint received date to be used by managing agents is the data the complaint was received by Lloyd’s Canada Service Desk.
Assessing and Assigning Complaints
Complaints will be assigned for a tier one review assuming that the concerns can be addressed within 20 Calendar Days by the Market Participant.
Complaints of a serious nature (allegations of fraud, material misrepresentation, or misconduct) may be escalated directly to a tier two review. The CRCO may also, at their discretion, select complaints to review personally, (instead of the LCD team) which are deemed as exceptions.
Where there is an obligation to respond to the regulatory body, the response will be managed by the CRCO.
Analysis and Response Tier One
Tier one complaints are reviewed and responded to by the applicable Market participant (Coverholder, TPA, managing agent), within 20 calendar days.
Tier One response letters, regardless of the resolution, must contain the internal and external escalation wording.
Escalation to Tier Two
After a tier one review, should a complainant remain unsatisfied, the complainant may request a review of their concerns by the Complaint’s Manager.
As well, some claimants may escalate directly to tier two review if the circumstances require.
When requested, the Service Desk will escalate the complaint to the Lloyd’s Complaints Department (“LCD”) who may delegate this complaint to Lloyd’s Complaints team in the UK. The CRCO may review tier two complaints personally when a regulatory authority or Industry Ombudsman is involved, or at the discretion of the CRCO as they see needed.
Tier two responses must be issued within 56 days of original receipt. Response letters must contain the external escalation wording.
EDR scheme and eligibility
General Insurance OmbudService (GIO)
The General Insurance Ombudsman Service is an independent organisation, created in 2002, with the sole purpose of helping Canadian consumers resolve disputes or concerns with their home, auto or business insurers.
The GIO deals with complaints relating to home, automobile, commercial and accident and sickness for any federally licensed company in Canada that is a member of the GIO.
For Québec clients, as well as contacting GIO, they may also refer their complaint to:
Autorité des marches financiers (AMF):
The AMF is the body mandated by the government of Québec to regulate the province’s financial markets and provide assistance to consumers of financial products and services.
https://www.lautorite.qc.ca/en/
Local Regulatory Reporting Requirements
The provincial regulators regulate market conduct and the licensing and supervision of insurance intermediaries, such as agents, brokers and adjusters.
The Canadian Council of Insurance Regulators (CCIR) represent the provincial/territorial insurance regulatory authorities. It is an inter-jurisdictional association of insurance regulators. The mandate of the CCIR is to facilitate and promote an efficient and effective insurance regulatory system in Canada to serve the public interest. They work together to develop solutions to common regulatory issues.
Through the CCIR Annual Statement, insurers are required to file information related to their governance, practices and policies with respect to the fair treatment of consumers.
Insurers are required to complete/file Annual Statement by May 1.
The Insurance Companies Act of Canada requires licensed insurers to have a complaints procedure and join an independent organization to mediate complaints that have not been resolved to the satisfaction of the consumer through the insurer’s own internal procedures. To comply with these requirements, Lloyd’s is a member of the General Insurance OmbudService (GIO). In this regard, every Lloyd’s underwriting member carrying on Canadian business and every managing agent acting on their behalf is required to conform to and abide by GIO standards. The GIO is the dispute resolution body for all Canadian jurisdictions, with the exception of Québec.
The Financial Consumer Agency of Canada supervises all federally regulated financial institutions, which includes federally regulated insurance companies, for compliance with federal consumer protection laws, including the requirement to have a complaint-handling process in place. FCAC does not resolve individual complaints.
If you have a problem with a financial product or service, you may file a complaint with:
Lloyd’s Underwriters
Attention: Complaints Officer:
Royal Bank Plaza South Tower
200 Bay Street, Suite 2930, P.O. Box 51
Toronto, ON
M5J 2J2
Tel: 1-877-455-6937
E-mail: info@lloyds.ca
If you are not satisfied with how your complaint has been handled, you can escalate the complaint to the following third-party complaints body:
General Insurance OmbudService (GIO): assists in the resolution of conflicts between insurance customers and their insurance companies.
The GIO can be reached at:
Toll free number: 1-877-225-0446
Website: http://www.giocanada.org/
Québec complainants:
Autorité des marchés financiers (AMF):
Toll Free: 1-877-525- 0337
Québec: (418) 525-0337
Montréal: (514) 395-0311
Website: www.lautorite.qc.ca
If you want to know your rights or need information about Lloyd’s Underwriters complaint-handling process, you may contact FCAC by online form, mail, or telephone. FCAC uses information from consumer enquiries to support its mandate.
Website: www.canada.ca/fcac
Online form: https://www.canada.ca/en/financial-consumer-agency/corporate/contactus.html
Phone:
For service in English: 1-866-461-FCAC (3222)
For service in French: 1-866-461-ACFC (2232)
For calls from outside Canada: 613-960-4666
Teletypewriter (TTY): 1-866-914-6097 / 613-947-7771
Video Relay Service:
FCAC welcomes Video Relay Service (VRS) calls. You do not need to authorize the relay service operator to communicate with FCAC. Visit(https://srvcanadavrs.ca/en/ to learn more.
Mailing address:
Financial Consumer Agency of Canada
427 Laurier Avenue West, 5th Floor
Ottawa (Ontario)
K1R 7Y2
Further information on FCAC is available on Crystal, refer to Processing and Servicing of Risks and Complaints.
The OmbudService for Life & Health Insurance (OLHI) is an independent complaint resolution and information service for consumers of Canadian life and health insurance. It includes resolving insurance complaints about disability, employee benefits, travel, and investment products such as annuities and segregated funds. OLHI’s operations are overseen by the Canadian Council of Insurance Regulators (CCIR), as well as their independent Board of Directors.
Lloyd’s Complaint Notice
The Lloyd’s Underwriters’ Policyholders’ Complaint Protocol for Canada is LSW 1542F and is published on the Lloyd’s Wordings repository in English and French. It is also referenced in the Pre-contractual notification and Insurance documents sections of Crystal.