When an individual has vehicle insurance they feel confident. They believe that they have coverage for at least what the policy covers. What happens when a dispute takes place over this? There are times that insured individuals do not agree with the Insurance Company. At least, not when they are setting an amount to pay out on a claim.
Some feel that they are at the mercy of the Insurance Companies when it comes to claim pricing. There are rules and regulations that these Companies must follow. They all have their mandate when determining the payouts they will make. There are standards in this industry.
Insured individuals have the right to challenge the payout of a claim. If they feel that the claim is not valid, there are a few options to try and rectify the problem.
- 1 Steps to Challenge a Claim Pricing
- 2 Ask Questions
- 3 Review Your Policy Carefully
- 4 Speak to Your Broker
- 5 Speak to a Supervisor
- 6 Filing a Complaint
- 7 The FSCO for Ontario
- 8 Gather the Documentation
- 9 Contact the Ombuds Service
- 10 Do You Need a Lawyer?
- 11 Support
- 12 Complaints Officer
- 13 Mediation
- 14 Adjudication
- 15 The Final Step
- 16 Is it Worth It?
Steps to Challenge a Claim Pricing
How you can challenge, a claim pricing may vary according to the province in which the claim applies to. These are basic steps and may differ according to particular circumstances.
You are a client of the Insurance Company. As such, have the right to ask questions. It may be wise to begin by asking these directly to the claims adjuster. You can ask what criteria they used to reach their decision.
Review Your Policy Carefully
Many who buy vehicle insurance do not review their policies carefully. It is a mistake to do this. There could be something in the policy that explains why you claim is in the amount that it is.
Speak to Your Broker
Not everyone fully understands the legalities of their vehicle insurance. If you have an insurance broker, you can ask them to explain what you do not understand. They can contact the Insurance Company directly. If they want more information.
Speak to a Supervisor
The answers provided by the claims adjustor may not be sufficient. There are further options. An insured can ask to speak to a claims supervisor. If this does not solve the problem, then additional steps are available.
Filing a Complaint
There should be procedures in place for filing a complaint. The method for doing so will vary according to the province.
The FSCO for Ontario
Ontario has a governing body for insurance called the FSCO. It stands for Financial Services Commission of Ontario. Ontario has a government act that regulates Insurance providers in Ontario. If a person feels that their claim payment is not fair, they can bring this matter before the FSCO. There is a procedure that is in place to do this.
Attempts to settle the matter with the Insurance company is important. If this is not successful, then there is the option to proceed with FSCO.
Gather the Documentation
The Insurance company needs to issue a letter. It should come from their complaints division. The letter should outline the final decision of the Company. Also, it should contain information on who to contact. It is a contact if you wish to take the matter further. Most likely, it will be the name and contact information for the Ombuds service.
Contact the Ombuds Service
The next step is to write a letter to the specific Ombuds service. Its the one outlined in the letter received from the Insurance Company. The letter must contain the details. It should outline the circumstances. Also, the specific issues that the insured has with the claim payment.
There may be additional documents that are pertinent to the issue. These should be an attachment to the letter.
Do You Need a Lawyer?
The Ombuds service is there to assist Insured individuals. Any individual can use a lawyer to contact them if they choose to do so. However, this is not necessary.
Some individuals are overwhelmed with proceeding with a complaint to the omsbud services. In this case, they can ask someone of their choosing to assist them. This individual can write the required letter on behalf of the complainant. However, this person must include a note of authority. It should be from the Insured stipulating they agree to this person writing the letter. If authorization is not obtainable, an explanation as to why should be part of the letter.
The Ombuds service upon receipt of the letter of complaint will assign a complaints officer to the case. This individual will do a thorough review of all of the material they have received. They may do further investigations. The insured will receive notice of the complaint’s officers findings.
A mediation process might be necessary. The Manager of Complaints will make the decision regarding this. If this is an option, then the Insured will have the opportunity to choose from a list of mediators. The mediation process is a meeting between the insured, the mediator, and the Insurance Company. If an agreement is not reached then further steps could be necessary.
Adjudication may take place through the Senior Adjudicative Officer. The Insurance company is notified of this. The Insurer will have the chance to submit additional information to support their decision. The adjudication process is different than the mediation. There is no meeting of the parties involved. The Adjudicator will review all of the material. Then at its conclusion will prepare a report of the findings. It will include recommendations for resolving the issue.
The Final Step
The decisions reached by the Adjudicator are not binding on the Insurance Company. The Insurance Company may not comply with the recommendations. In this case, the insured would have to decide whether to take the matter to court. It may mean having to hire a lawyer.
Is it Worth It?
If it comes down to the end stage of having to take legal action, it requires some serious thought. Perhaps the amount disputed is substantial then it may be worth it. However, if not, then the money spent on legal action may supersede the amount in dispute.
For the most part, the Insurance Companies are reputable. They will not normally dispute a claim unless they have some substantial facts to back them up.