INFORMATION FOR CONSUMERS ON GORE MUTUAL’S COMPLAINT HANDLING PROCESS AND THE ROLE OF OUR OMBUDSMAN LIAISON OFFICER
At Gore Mutual Insurance Company (“Gore Mutual”), we want our customers to be completely satisfied with their insurance purchase or claims settlement, and we can proudly say that we usually accomplish this. However, should you have any concerns about your policy, your claim, or our service, the following information will provide you with your next steps towards resolving your concern.
The first step in resolving a complaint is to contact your broker. Your independent insurance broker works for you; not Gore Mutual. Your broker can speak to us on your behalf to obtain a solution which is acceptable to you or help you contact a Gore Mutual representative who can best resolve your complaint.
02.Work with a
Gore Mutual representative
If contact with a Gore Mutual representative is necessary to resolve your complaint, the first inquiry should be directed to the person responsible for your policy or claim, as they are in the best position to help you.
If an agreement cannot be reached with the assigned Gore Mutual representative, your complaint will be escalated to the appropriate supervisor/manager, and further to the appropriate manager/director, if agreement can still not be reached.
03.Contact the Ombudsman
If following this escalation, an agreement cannot be reached to resolve the matter to your satisfaction, you may contact our Ombudsman Liaison Officer.
GORE MUTUAL OMBUDSMAN LIAISON OFFICER RESPONSIBILIES
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.
GORE MUTUAL’S OMBUDSMAN LIAISON OFFICER
Ombudsman Liaison Officer Gore Mutual Insurance Company PO Box 70 252 Dundas Street N, Cambridge, ON N1R 5T3
Submitting a Complaint
Please submit your complaint to the Ombudsman Liaison Officer 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.
INSURANCE OMBUDSMAN LIAISON OFFICER
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, you may then write to the Mutual Insurance Companies OmbudService, General Insurance OmbudService or Financial Consumer Agency of Canada.
MUTUAL INSURANCE COMPANIES OMBUDSERVICE (“MICO”)
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 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.
Mutual Insurance Companies OmbudService 311 McArthur Avenue, Suite 205, Ottawa, ON, K1L 6P1
GENERAL INSURANCE OMBUDSERVICE (“GIO”)
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 another insurance Ombudsman Liaison Officer you could contact if you reside anywhere in Canada 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.
General Insurance OmbudService
4711 Yonge Street, 10th Floor, Toronto, Ontario, M2N 6K8
FINANCIAL CONSUMER AGENCY OF CANADA (“FCAC”)
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.
Financial Consumer Agency of Canada
427 Laurier Avenue West, 6th Floor, Ottawa, ON, K1R 1B9
Additional information may be found at the Financial Services Regulatory Authority of Ontario website at www.fsrao.ca.