Policyholder Resources
Useful Information
Consumer Complaint Resolution Process for Ontario
Complaints Handling and the Appointed Ombudsman
Updated September, 2024
Policy
At Optimum Insurance Company, we make customer service our priority. Occasionally, an issue will arise where you may not be completely satisfied with the service you have received. To ensure the fair, diligent, and free processing of complaints, we have the following procedure in place to deal with these situations.
What is a complaint?
A complaint means the expression, from a client, of at least one of the following elements, which persists after being considered and processed in the normal course of business:
- A reproach against Optimum Insurance Company;
- The reporting of actual or potential harm that a client has suffered or may suffer; or
- A request for corrective action.
Step 1 : Contact your insurance broker
If you are dissatisfied with a service or product from Optimum Insurance Company, you must first contact your insurance broker. If you make an inquiry, a request, or wish to file a complaint, you will be encouraged to contact your insurance broker. Your insurance broker works on your behalf and represents your interests. He offers independent advice and considers the importance of insurance when it comes to your financial security. If your insurance broker is unable to find a satisfactory solution to resolve the dispute or if the complaint relates to your insurance broker or our claims department, you may proceed to the following step and contact the Complaints Officer.
Step 2 : File a complaint
If you are still not satisfied with the responses or information obtained in the previous step, you may file a complaint to the Complaints Officer. We recommend that all formal complaints be submitted in writing from the outset. The Complaints Officer can be contacted by mail, phone, or email at the following addresses and contact details:
Quebec
Complaints Officer
Optimum Société d'Assurance inc.
425, de Maisonneuve West boulevard, suite 1500
Montreal, Quebec H3A 3G5
Telephone : 514 288-8725
Email: [email protected]
Ontario, Manitoba and Saskatchewan
Complaints Officer
Optimum Insurance Company Inc.
147, Mclntyre Street West
North Bay, Ontario P1B 2Y5
Telephone : 1-800-461-6110
Email: [email protected]
The complaint must include your name, your policy number, the name of the person against whom an allegation is made, and detail all the information (facts, dates, and times) including the nature of the complaint, the steps taken before filing the complaint, and expectations regarding the complaint filing. The written version of the complaint must be dated and signed.
The Complaints Officer shall record your complaint in the complaint register. A file is created for each complaint recorded in the register. Only those responsible for processing complaint files will have access to the register and the associated files via our systems.
Upon receipt of the complaint, the Complaints Officer will acknowledge receipt accompanied by a written notice within a reasonable period, namely within five (5) business days following its receipt.
The processing of the complaint must be carried out in a reasonable period, namely within ten (10) business days following the receipt of all necessary information for its processing. If the Complaints Officer is unable to meet this deadline, he will inform you of the reason for the delay and the expected decision date.
Following the examination of the complaint, the Complaints Officer will send you a written and reasoned final response.
However, there are situations where the Complaints Officer is not able to resolve the complaint, such as
- Unavailability of insurance coverage;
- Dispute resolution procedures imposed by law or other regulatory powers;
- Any issues that have already been brought before or are currently before the courts.
In such cases, the response from the Complaints Officer will reflect this.
Step 3 : Escalate the file to an external organization
If you are not satisfied with the resolution of your file or its processing, you can request the transmission of your complaint file to one of the following relevant organizations:
Autorité des marchés financiers (AMF): regarding questions in Quebec, the AMF is the body mandated by the Government of Quebec to regulate Quebec’s financial markets and assist consumers of financial products and services. This body can recommend conciliation or mediation if the concerned parties agree to it. 1-877-525-0337 | www.lautorite.qc.ca
Financial Services Regulatory Authority of Ontario (FSRA): regarding questions in Ontario, FSRA is the agency of the Government of Ontario that protects the rights of consumers by promoting high standards of business conduct and transparency. 1-800-668-0128 | https://www.fsrao.ca/
Use of the masculine gender to designate individuals in this document serves only to simplify the text and applies to both women and men. Unless the context in which a particular word is used clearly indicates otherwise, words in the singular include the plural and vice versa.
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