{"id":1307,"date":"2026-01-12T15:59:40","date_gmt":"2026-01-12T20:59:40","guid":{"rendered":"https:\/\/oap.wp.vortexdev.com\/?page_id=1307"},"modified":"2026-05-27T14:51:47","modified_gmt":"2026-05-27T18:51:47","slug":"our-process","status":"publish","type":"page","link":"https:\/\/oap.wp.vortexdev.com\/en\/complaints\/our-process\/","title":{"rendered":"Our process"},"content":{"rendered":"\n<div class=\"wp-block-media-text has-media-on-the-right is-stacked-on-mobile is-vertically-aligned-top\" style=\"grid-template-columns:auto 45%\"><div class=\"wp-block-media-text__content\">\n<h5 class=\"wp-block-heading\"><strong>Important: When We Can Review Your Complaint<\/strong><\/h5>\n\n\n\n<p>For OLHI to conduct a formal review: <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>You must have a <strong>final position letter<\/strong> from your insurer<\/li>\n\n\n\n<li>Your complaint must involve a <strong>life and health insurance product<\/strong><\/li>\n\n\n\n<li>Your insurer must be an <a href=\"https:\/\/oap.wp.vortexdev.com\/en\/about\/participating-companies-list\/\"><strong>OLHI participant<\/strong><\/a><\/li>\n<\/ul>\n\n\n\n<p>If you do not have a final position letter yet, we can still help by guiding you through your insurer&#8217;s process.<\/p>\n\n\n\n<p>All insurance companies have an internal complaint process. Before OLHI can begin its complaint review process, you must first&nbsp;try to resolve your complaint directly with your insurer&nbsp;and obtain a final position letter, which is the insurer\u2019s written decision in response to your complaint.<\/p>\n\n\n\n<p><strong>What to do:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Contact your insurer and ask for its final position<\/li>\n\n\n\n<li>If you need help finding the right contact, see our insurer&#8217;s complaint contacts<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/oap.wp.vortexdev.com\/en\/complaints\/insurer-complaint-contacts\/\">List of insurer complaint contacts<\/a><\/div>\n<\/div>\n<\/div><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" width=\"871\" height=\"1024\" src=\"https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/Mountains-871x1024.jpg\" alt=\"\" class=\"wp-image-2506 size-full\" srcset=\"https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/Mountains-871x1024.jpg 871w, https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/Mountains-255x300.jpg 255w, https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/Mountains-768x903.jpg 768w, https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/Mountains-1307x1536.jpg 1307w, https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/Mountains-1742x2048.jpg 1742w\" sizes=\"(max-width: 871px) 100vw, 871px\" \/><\/figure><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">OLHI&#8217;s Process<\/h2>\n\n\n<section class=\"block-accordions-group accordion-container aligndefault\">\n  \n<div id=\"step-1-olhi-determines-if-we-can-review-your-complaint\" class=\"accordion ac\">\n  <div class=\"accordion__accordion\">\n    <button class=\"accordion__header-row accordion-toggle ac-header ac-trigger\">\n      <p class=\"accordion__header__title\">        Step 1 &#8211; OLHI determines if we can review your complaint      <\/p>      <span class=\"accordion__header__icon\" role=\"presentation\">\n        <span class=\"plus\"><\/span>\n      <\/span>\n    <\/button>\n    <div class=\"accordion__sub-rows wysiwyg ac-panel\">\n      \n\n<p>We will review review the insurer&#8217;s final position letter and assess whether your complaint falls within the scope of OLHI&#8217;s mandate. We may contact you to gather additional information. <\/p>\n\n\n\n<p>If we are able to review your complaint, we will then request your written authorization to obtain the relevant documents from your insurer. <\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/oap.wp.vortexdev.com\/en\/olhi-authorization-form\/\">Consult our Authorization Form<\/a><\/div>\n<\/div>\n\n    <\/div>\n  <\/div>\n<\/div>\n\n\n<div id=\"step-2-olhi-reviews-your-complaint\" class=\"accordion ac\">\n  <div class=\"accordion__accordion\">\n    <button class=\"accordion__header-row accordion-toggle ac-header ac-trigger\">\n      <p class=\"accordion__header__title\">        Step 2 -OLHI reviews your complaint      <\/p>      <span class=\"accordion__header__icon\" role=\"presentation\">\n        <span class=\"plus\"><\/span>\n      <\/span>\n    <\/button>\n    <div class=\"accordion__sub-rows wysiwyg ac-panel\">\n      \n\n<p>Once we confirm your complaint is reviewable:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>You will receive a formal acknowledgment confirming that your complaint has been accepted for review. Our objective is to complete our review within 120 days from the date of this acknowledgment.<\/li>\n\n\n\n<li>OLHI will obtain your complaint file from your insurer. You may also submit any additional documents in support of your complaint.<\/li>\n\n\n\n<li>An OLHI Complaints Analyst will contact you to:\n<ul class=\"wp-block-list\">\n<li>explain our review process,<\/li>\n\n\n\n<li>answer any questions, and<\/li>\n\n\n\n<li>give you an opportunity to share your perspective. &nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The Analyst will review all relevant information provided by you and your insurer, including your insurance policy.&nbsp;<\/li>\n\n\n\n<li>We may ask you or your insurer for additional information, if needed.<\/li>\n<\/ul>\n\n\n\n<h6 class=\"wp-block-heading\">What happens next:<\/h6>\n\n\n\n<p>If the Analyst believes <strong>your complaint has merit<\/strong>, one of the following may occur:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Informal negotiation: the Analyst may attempt to resolve the issue directly with your insurer.<\/li>\n\n\n\n<li>Escalation to OSO: if informal negotiation does not resolve the matter, the complaint may be escalated to an OmbudService Officer (OSO) for an investigation, which we aim to complete in 45 days.<\/li>\n<\/ul>\n\n\n\n<p>If the Analyst finds that <strong>your insurer&#8217;s position is reasonable:<\/strong><\/p>\n\n\n\n<p>The complaint will be closed, and we will provide you with our findings in writing, explaining why the insurer\u2019s position is fair under the circumstances.<\/p>\n\n    <\/div>\n  <\/div>\n<\/div>\n\n\n<div id=\"step-3-ombudservice-officer-investigation\" class=\"accordion ac\">\n  <div class=\"accordion__accordion\">\n    <button class=\"accordion__header-row accordion-toggle ac-header ac-trigger\">\n      <p class=\"accordion__header__title\">        Step 3 &#8211; OmbudService Officer investigation      <\/p>      <span class=\"accordion__header__icon\" role=\"presentation\">\n        <span class=\"plus\"><\/span>\n      <\/span>\n    <\/button>\n    <div class=\"accordion__sub-rows wysiwyg ac-panel\">\n      \n\n<p>If the complaint is escalated and the OmbudService Officer (OSO) agrees that your complaint has merit:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The OSO may negotiate directly with your insurer and\/or make a non-binding settlement&nbsp;recommendation as part of our conciliation process.<\/li>\n\n\n\n<li>If the OSO determines that a recommendation is not appropriate, we will inform you in writing and explain the reasons.<\/li>\n\n\n\n<li>During the investigation, the OSO may request additional information from you or your insurer.<\/li>\n<\/ul>\n\n    <\/div>\n  <\/div>\n<\/div>\n\n\n<div id=\"step-4-senior-adjudicative-officer-investigation\" class=\"accordion ac\">\n  <div class=\"accordion__accordion\">\n    <button class=\"accordion__header-row accordion-toggle ac-header ac-trigger\">\n      <p class=\"accordion__header__title\">        Step 4 &#8211; Senior Adjudicative Officer Investigation      <\/p>      <span class=\"accordion__header__icon\" role=\"presentation\">\n        <span class=\"plus\"><\/span>\n      <\/span>\n    <\/button>\n    <div class=\"accordion__sub-rows wysiwyg ac-panel\">\n      \n\n<p>If your insurer does not accept the OSO\u2019s recommendation:<\/p>\n\n\n\n<p>OLHI&#8217;s Senior Adjudicative Officer may conduct a further investigation and attempt to negotiate a settlement with&nbsp;the insurer.<\/p>\n\n    <\/div>\n  <\/div>\n<\/div>\n\n<\/section>\n\n\n\n<h2 class=\"wp-block-heading\">Types of Complaints OLHI Cannot Review<\/h2>\n\n\n\n<p>OLHI cannot review some types of complaints, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Complaints related to an employee benefit plan the insurance company only administers on behalf of the employer &#8211; known as an Administrative Services Only (ASO) plan.<\/li>\n\n\n\n<li>Complaints that aren\u2019t about Canadian life or health insurance products.<\/li>\n\n\n\n<li>Complaints about the conduct of independent insurance advisors.<\/li>\n\n\n\n<li>Complaints that are already underway in court, a tribunal, or with a mediator.<\/li>\n\n\n\n<li>Complaints that have already been decided by a court, tribunal, or mediator.<\/li>\n\n\n\n<li>Complaints made by a business.<\/li>\n\n\n\n<li>Complaints where the consumer already accepted a resolution offered by the insurer.<\/li>\n\n\n\n<li>Complaints from medical practitioners or professional services providers seeking payment from an insurance company.<\/li>\n<\/ul>\n\n\n\n<p>We may also decline a complaint under certain circumstances, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If the complaint is currently under investigation by a regulator.<\/li>\n\n\n\n<li>If there is a more appropriate venue to address the complaint.<\/li>\n\n\n\n<li>When too many years have passed before the complaint was submitted to OLHI.<\/li>\n<\/ul>\n\n\n\n<p>For more details:<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/oap.wp.vortexdev.com\/wp-content\/uploads\/2026\/05\/OLHI_TermsOfReference.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Consult our Terms of Reference<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>OLHI&#8217;s Process Types of Complaints OLHI Cannot Review OLHI cannot review some types of complaints, including: We may also decline&hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1258,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1307","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1307","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/comments?post=1307"}],"version-history":[{"count":8,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1307\/revisions"}],"predecessor-version":[{"id":2713,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1307\/revisions\/2713"}],"up":[{"embeddable":true,"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/pages\/1258"}],"wp:attachment":[{"href":"https:\/\/oap.wp.vortexdev.com\/en\/wp-json\/wp\/v2\/media?parent=1307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}