OMBUDSPERSON AND COMPLAINT HANDLING

If you believe that Ontario's Insurance Act or regulations have been violated by your insurance company, agent or adjuster, you may request that Financial Services Commission of Ontario (FSCO) review the matter.

Dispute Resolution

1

Contact your Broker

Your insurance broker works for you; not Gore Mutual. They can speak on your behalf to obtain a solution which is acceptable to you or connect you with a Gore Mutual representative.

2

Speak to a Manager

Concerns are solved faster when you speak directly to the person responsible for your business. First inquiries will be directed to the manager who is in the best position to help you.

3

Contact the Ombudsman Liaison Officer

If an agreement cannot be reached within 15 days, your complaint should be escalated to our Ombudsman Liaison Officer. See below for details.

Ombudsman Liaison officer

Contact Information

Susan Walton

Gore Mutual Insurance Company PO Box 70 252 Dundas Street N, Cambridge, ON N1R 5T3

1-800-265-8600 ext. 2496

1-800-601-9773

ombudsman@goremutual.ca

Submitting a Complaint

Plase submit complaint in writing. Your letter should include:

  • Your name, address and policy number

  • A phone number you can be reached during normal business hours

  • The nature of the dispute

  • A description of your expectations and what you want Gore Mutual to do

Lawyers and Agents

If a lawyer for the matter in dispute represents you, he or she should write to the Ombudsman Liaison Officer. Alternatively, Gore Mutual should receive written authorization from your lawyer to deal directly with you to resolve your complaint. If you are writing on behalf of someone else, Gore Mutual must receive a notarized note signed by that person stating that you are authorized to act for him or her in this matter.

Liaison officer responsibilities

The Ombudsman Liaison Officer is responsible for:

  • Overseeing our complaint handing process;

  • Ensuring your complaint is addressed;

  • Ensuring that you receive a letter outlining our final position if your complaint cannot be resolved;

  • Working with the Mutual Insurance Companies OmbudService to address any complaints that could not be resolved by us; and

  • Working with the Financial Consumer Agency of Canada for any complaints pertaining to loans, credit card charges and other similar transactions that could not be resolved by us.

The Ombudsman Liaison Officer cannot:

  • Enter into the investigation, negotiation or settlement of an insurance claim.

  • Inquire into matters that are being, will be, or have been dealt with by a court or a dispute resolution process.

Further resources

If we are unable to resolve the matter to your satisfaction, our Ombudsman Liaison Officer will ensure that you receive a letter outlining Gore Mutual’s final position. Depending on the nature of your complaint and your residential location, you may then write to the resources below.

Mutual Insurance Companies OmbudService (Outside AB & BC)

MICO assists in the resolution of conflicts between policyholders (customers, insured) and participating property and casualty mutual insurance companies. When a dispute arises between the insurer and the policyholder and the issue cannot be solved with the help of the company’s Ombudsman Liaison Officer, an independent mediator is appointed with the objective of helping both parties work towards an acceptable solution. MICO is the insurance Ombudsman Liaison Officer you should contact if you reside anywhere in Canada except Alberta and British Columbia and if your claim is not about a loan, line of credit, credit card payment or disclosure matters. MICO deals with complaints about claims related matters or interpretation of policy coverage. MICO does not handle matters that have not been submitted to the insurance company or that have not been yet considered by the insurer’s Ombudsman Liaison Officer; settlement procedures established by legislation; matters that have been, or are currently, before the courts; and cases that have already been dealt with by MICO.

Contact MICO

Mutual Insurance Companies OmbudService 311 McArthur Avenue, Suite 205, Ottawa, ON, K1L 6P1

1-866-231-2602

613-789-7665

info@mutualombudservice.ca

www.mutualombudservice.ca

General Insurance OmbudService (AB & BC)

GIO assists in the resolution of conflicts between policyholders (customers, insured) and participating insurance companies. When a dispute arises between the insurer and the policyholder and the issue cannot be solved with the help of the company’s Ombudsman Liaison Officer, a customer service officer will be assigned to assist with various alternatives including mediation and adjudication. GIO is the insurance Ombudsman Liaison Officer you should contact if you reside in Alberta or British Columbia and if your claim is not about a loan, line of credit, credit card payment or disclosure matters. GIO deals with complaints about claims related matters or interpretation of policy coverage, policy processing and handling. GIO does not handle matters relating to the cost of insurance and rates, availability of insurance; dispute settlement procedures as required by law or designated regulatory authorities; and matters that have been or are before the courts.

Contact GIO

General Insurance OmbudService 10 Milner Business Court, Suite 701, Toronto, ON M1B 3C6

1-877-225-0446

416-299-4261

www.giocanada.org

Financial Consumer Agency of Canada

FCAC assists in the resolution of conflicts between policyholders (customers, insured) and federally regulated financial institutions. FCAC investigates complaints regarding possible violations of legal obligations that relate to breach of law, code of conduct or public commitment. FCAC is the agency you should contact if your claim is about a violation of legal obligation relating to a loan, line of credit, credit card payment or disclosure matters. FCAC does not handle complaints involving: the pricing of products; the quality of service; loan and credit granting practices; billing errors or other general service issues.

Contact FCAC

Financial Consumer Agency of Canada 427 Laurier Avenue West, 6th Floor, Ottawa, ON, K1R 1B9

1-866-461-3222

1-866-814-2224

www.fcac.gc.ca

Additional information

Additional information may be found at the Financial Services Commission of Ontario website at www.ontarioinsurance.com.