Insurance providers largely in sync with OLHI on complaints

OmbudService for Life & Health Insurance reports that providers agree with its recommendations 80% of the time

For an organisation where dealing with complaints is its bread and butter, the OmbudService for Life & Health Insurance didn’t have much in the way of negative comments at its 2016 AGM.

Instead, the OLHI reported strong performance over the past year, with a view to increasing standards even further in 2017. Chair of the OLHI, Dr. Janice MacKinnon, identified having a broader public profile and increased visibility outside central Canada as a key goal.

To that end, the complaint resolution service has invested in a new case management system and website, which MacKinnon stated was a real “game-changer.”

In the OLHI’s annual report, data showed that public contacts in fiscal 2015/16 reached 86,000, which matched historic levels. Complaint investigations meanwhile increased by 27.6% over the period – double the number of two years previous.
Andrea Zviedris is communications manager at the OLHI and outlines how the OmbudService goes about its work in resolving disputes in the life and health insurance industry.
“A public contact is any consumer who reaches out to us through the web site, on the phone, or in writing to get information about our complaints or information services,” she says. “One of our priorities is to raise awareness of OLHI. The higher contacts over the past couple of years show we are making progress.”
As the service acting as middleman between insurance providers and disgruntled policyholders, complaints are the lifeblood of the OLHI. In that respect, the past year provided plenty of work for its employees, with complaint investigations increasing by 27.6%.
“The most common complaint is about a declined claim,” says Zviedris. “Disability and life claims made up a combined 82% of all the complaints at the investigation stage.”

After the investigation comes the settlement process, which in 2015/16 saw decisions in favour of the consumer climbing to 80%.

Zviedris explains the OLHI’s role whenever a provider and policyholder cannot come to an agreement themselves. “If we believe there is merit to the complaint, we negotiate with the insurance company to try to reach a better solution. In 80 per cent of these cases, the insurance company agrees with us and pays the consumer quickly.

The recommendations by the OLHI are non-binding for the providers, but as Zviedris explains, the industry’s major players tend to be quite open to the OmbudService’s point of view.

“An insurance company is not obligated to agree with OLHI’s recommendation,” she says. “However, to date insurers have accepted every final non-binding recommendation we have made.

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