The Mutual Insurance Companies OmbudService (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.

Background

All federally regulated property and casualty insurance companies, i.e. insurers of cars, homes, farms and businesses, are required by law to have a procedure in place for addressing customer complaints and must designate an Ombudsman Liaison Officer within the company with whom the policyholder may discuss his/her concerns.

As well, legislation requires that these insurers be members of an independent organization which deals with complaints that cannot be resolved by their Ombudsman Liaison Officer. Mutual insurers have formed the Mutual Insurance Companies OmbudService whose role is to refer these complaints to independent mediators.

Customer Assistance

The dispute resolution process has been set up to address claims related and insurance coverage interpretation issues.

If you have a problem with respect to a claim related issue or if you have an insurance coverage interpretation issue, the first step is to contact your insurance company’s representative.

If the matter cannot be resolved to your satisfaction, the company representative will initiate the second step by putting you in contact with the insurer’s appointed Ombudsman Liaison Officer. The company’s Ombudsman Liaison Officer will review the situation with you and will subsequently send you a letter explaining the insurer’s final position on the issue.

If you are still not satisfied with your insurance company’s decision, you may proceed to the third step by asking the Mutual Insurance Companies OmbudService (MICO) to arrange a mediation session where an independent mediator will help both parties to work towards an acceptable solution.

Dispute Resolution

To start the mediation process, you must complete a Mediation Registration Form which you will obtain from your insurance company’s Ombudsman Liaison Officer or from MICO at 1-866-231-2602 or that you can complete on-line at www.MutualOmbudService.ca.

Upon receiving your request, if the preconditions have been met, MICO will ask the ADR Institute of Canada Inc., which MICO has contracted, to appoint a mediator to the case. The mediator will facilitate a 90-minute mediation session between you and your insurance company’s Ombudsman Liaison Officer or his/her representative. The cost of that 90-minute mediation session will be paid entirely by the insurance company.

During the mediation session, the mediator will try to bring the two parties to agree on a solution. After the mediation session, if you and the insurance company still disagree on all or some of the issues, the mediator will prepare a written report with recommendations that are not binding on either party. Should both parties wish to extend the mediation session beyond the mandatory 90 minutes, the additional cost will be divided between the policyholder and the insurer according to a joint decision by the two parties.

After the Mediation

If the mediator’s written report does not bring the two parties to agree on a solution, the policyholder may still proceed with legal actions. MICO will not help in this process.

Do I have to pay for the Mediator?

MICO does not charge for its services. The insurance company pays the mediator’s 90-minute mandated mediation session as well as for the travel and meeting expenses incurred by the mediator. However, the member is responsible for the costs he/she incurs to attend the mediation session.

Who can use MICO?

Any policyholder of a participating mutual insurance company may use the service. MICO deals with complaints about claims related matters or interpretation of policy coverage.

Some matters are beyond the scope of MICO: matters not submitted to the insurance company or that have not yet been considered by the insurer’s Ombudman 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.