Complaint Handling & Dispute Resolution Policy

Purpose
This policy aims to ensure the fair handling of complaints we receive from our clients. Our policy aims to provide our clients with a free, accessible, and easy-to-use complaints handling service, provide clients with details so they understand how we handle their complaints and manage complaints received, from receipt to resolution.

It also aims to contribute to the improvement of our services by enabling us to identify common causes of the complaints we receive and implement solutions to correct problematic situations.

We have prepared a summary of our policy for our clients. They can consult it on our website at optimainsuranceservices.ca  or obtain a copy by contacting us. This policy outlines how Optima Insurance Services Inc. receives, processes, and resolves complaints received from clients in a fair, transparent, and timely manner.

We handle each complaint objectively, taking into account the interests of the client who filed it, and we communicate with them in clear and simple language.

What we consider as a complaint
A complaint expresses a reproach, grievance or dissatisfaction, whether oral or written from or on behalf of a customer regarding the services or products we offer, and an expectation that we will take steps to address it and provide a final response to our customers.

The following are not considered complaints:

  • a request made for information or materials in respect of an offered product or service;
  • a request for access or rectification made in accordance with the Act respecting the protection of personal information in the private sector;
  • a claim for an indemnity or any other insurance claim;
  • a request for correction of an administrative error or mistake in calculation;
  • a comment or a remark about us.

However; we consider a request to correct an administrative error to be a complaint when it has other consequences for the client or several of our clients. For example, if it results in expenses that we must reimburse to the client(s).

Our Complaints Officer
Our Complaints Officer ensures the fair handling of complaints we receive and the adherence to and implementation of our policy within the firm, specifically to ensure that:

  • our management and staff are aware of and apply our Complaints Policy;
  • our clients can easily obtain information on how we handle complaints or on the handling of their complaints;
  • our staff carry out the necessary follow-up to ensure the proper handling of our clients’ complaints;
  • the person responsible for handling a complaint has the necessary skills to handle the complaint assigned to them;
  • each complaint is handled objectively and its handling takes into account the client’s interests.

Ways for our clients to submit complaints to us
Our clients can contact us through Webform, Email, Phone or Mail:

Our clients can file complaints through various channels most commonly but not limited to the following:

  • a client reaching the Optima customer service team via phone call;
  • a client reaching the Optima customer service team via email;
  • a client formally mailing written complaint to Optima;
  • a client reaching the insurer or financial institution that Optima represents and Optima subsequently notified by the insurer or financial institution for complaint resolution.

Complaint Handling Steps

Step 1: Complaint Assessment
When a customer expresses a grievance or dissatisfaction, we determine whether it constitutes a complaint. We consider all the information provided by the customer to assess whether they are indeed filing a complaint. If we are unsure, we contact them to explore the situation further and determine whether they are indeed filing a complaint. We are responsible for helping the customer formulate their complaint clearly, for example, by asking questions to understand the situation. We also ensure we understand their expectations of us in order to determine their expectations with respect to outcome.Each complaint is recorded in our complaints log upon receipt. We ensure that complaints are handled promptly and resolved as quickly as possible.

Step 2:  Complaint Acknowledgment
If we establish that it will take more than 20 days in order to resolve the complaint, we confirm receipt of the complaint to the client in writing within 10 days and inform them of their right to have their complaint reviewed by the Authority. We also provide them with the information necessary such as expected timeframe for our response, date of receipt, name and contact detail of the complaint handler and information on how to inquire further.

Some complaints resolved within 20 days of receipt. For such complaints, we are not required to provide the client with a written acknowledgment. For these cases we verbally inform the client that their complaint has been received and of their right to request that their file be transferred to the Authority (within 10 days).

Step 3: Complaint Documentation
We create a file for each complaint. We ensure that the complaint file is kept up to date by recording relevant documents and information as the complaint is processed.

The complaint file is kept for a period equivalent to that which we apply for retaining the client file and in accordance with our Privacy Policy and record retention regulations.

Step 4: Complaint Investigation
We analyze the complaint and investigate the complaint in a thorough, objective, and timely manner. We request additional information and/or documents if needed.

Step 5: Complaint Resolution

Simplified Processing of Certain Complaints
Some complaints resolved within 20 days of receipt through our simplified process. This applies to complaints for which we are able to offer clients a satisfactory solution within 20 days. We consider a complaint resolved to a client’s satisfaction when they accept the solution we propose to resolve their complaint or when the explanations we provide resolve the complaint.

Under this process, these complaints may be handled by a member of our customer service team. Furthermore, we are not required to provide the client with a written acknowledgment of receipt or a final written response. The person handling the complaint may do so verbally, for example, during a telephone call.

For each complaint, the person handling the complaint must provide the client with our response and the proposed solution to resolve their complaint (within 20 days).

These exchanges may be summarized in a document filed with the complaint or recorded in full within the complaint file. The complaint file may be placed in the client’s file, including the information used in processing and resolving the complaint.

Non Simplified Processing
If a complaint cannot be resolved within 20 days, a final written response will be sent within 60 days of the complaint’s receipt.

Extension of the deadline for providing our final response
However, the person analyzing the complaint may find that the process is longer or more complex than anticipated and determine that additional time is needed to continue the analysis. This additional time cannot exceed 30 days.

The following reasons may justify extending the deadline:

  • circumstances beyond our control delay the processing of the complaint, for example, when the analysis of the complaint requires the receipt of documents from a third party;
  • exceptional circumstances may arise that justify extending the complaint review period. For example, if we see a significant increase in the volume of complaints following a natural disaster.

In this case, the person reviewing the complaint will notify the client in writing no later than the date on which the response was originally scheduled to be provided

Types of response
We may provide three types of response:

  • we offer to grant the customer’s request;
  • we propose a solution that partially addresses the customer’s request or differs from it: we attempt to find common ground;
  • we reject the customer’s complaint: if, after analysis, we conclude that the complaint is unfounded or that no resolution is possible.

Our response explains to the client how we analyzed their complaint and what led to our response and the proposed solution. We remind them of their right to have their complaint reviewed by the Authority.

Sending our response does not end our communications with the client, and we continue to respond if they contact us, particularly to answer their questions, follow up on their comments, or allow them to submit new facts relevant to the processing of their complaint.

Evaluation of the Offer and Complaint Settlement
When we propose a solution to resolve a client’s complaint, we allow them a reasonable amount of time to evaluate our offer. This timeframe must take into account the complexity of the case and allow the client, if they wish, to obtain the advice they need to accept our offer, reject it, or submit a counter-offer.

When we reach an agreement with the client to settle their complaint, we have 30 days to implement the agreement. We may agree to a different timeframe, provided it is in their best interest.

We never require the complainant to withdraw any other complaint they have filed with us. Furthermore, the conditions accompanying the offer are never intended to prevent the client from:

  • having their case reviewed by the Authority;
  • contacting the Authority, or the Canadian Investment Regulatory Organization,

Review of the complaint by the authority (AMF)
The client has the right to request a review of their complaint by the Authority if they are dissatisfied with how we handle their complaint or with the response we provided.

The client may request that we transfer their complaint file to the Authority or contact the Authority directly. In all cases, we ensure that we forward the file to the Authority within a maximum of 15 days of receiving the request.

Official Contact Person
The official contact person is the individual we designate to interact with the Authority (Responsible Officer). This person is responsible for monitoring the processing of a complaint or during the Authority’s review of a complaint file. They are also the Authority’s point of contact when it requests our participation in a conciliation or mediation process.

Record Keeping
We maintain a Complaint Register.

We record all complaints received in a register as soon as they are received. Occasionally, a complaint may not be recorded in our register on the day it is received. This is particularly the case if we receive the complaint outside of our business hours. We make sure to record it as soon as possible.

We record in the register the information that allows our management to be informed of the complaints we receive and the follow-up we take.

Complaint resolutions are documented and retained for a minimum of seven years. We ensure that our register is kept up to date.

Complaint Assignment
Complaints are handled by our Complaints Officer or assigned to a person under their supervision such as customer service managers.

When handled by the Complaints Officer or a person acting under their supervision, that person provides the client with a final written response within the timeframes stipulated in our policy.

Some complaints may be handled by one of our representatives or administrative staff. This person may process the complaint according to our simplified procedure. When the complaint cannot be resolved to the customer’s satisfaction through this process, the complaints officer or someone under their supervision will take over to finalize the resolution and provide the customer with a final written response.

If we find that the complaint cannot be resolved to the customer’s satisfaction within 20 days, we will inform the customer by means of a written notice which will be communicated to them before the expiry of this period.

We consider several factors when determining who will handle a complaint, including:

  • the complexity of the complaint;
  • the skills of the person handling the complaint, including their knowledge, training, and professional experience;
  • the workload of the person handling the complaint.

In all cases, we ensure that this person handles each complaint in accordance with our Complaints Handling Policy and that they have access to all the information necessary to process it.

Reporting and Monitoring
Complaints are reported to insurers and provincial regulators as mandated. We analyze complaint trends to identify systemic issues and improve service delivery.

We provide our management with a monthly overview of the complaints we have received. We communicate to our management:

  • the number of complaints received and processed, as well as our responses to these complaints;
  • the common causes of the complaints processed and the problematic situations that are revealed;
  • difficulties related to the implementation, dissemination, and compliance with the policy.

Training
All employees handling complaints receive regular training on complaint handling procedures, client communication, and regulatory requirements.

Our Responsibilities

Our Representatives and Employees
Any representative or employee of the firm who receives a complaint must forward it without delay to the individuals responsible for handling complaints. They must cooperate in the handling of any complaint and provide the documents or information necessary for processing the complaint.

Our Staff Assigned to Handling Complaints
The person responsible for handling the complaint must not do so if they are unable to handle it objectively. They must ensure they have the necessary skills or knowledge to handle the complaint and, if necessary, seek support from individuals who can assist them in ensuring the complaint is processed. They collect information or documents necessary to analyze the complaint. If necessary, they contact the client to obtain clarification on the situation giving rise to the complaint or on the client’s expectations.

Our Responsibility and That of Our Management
We ensure that our policy is known to all our staff and that everyone is informed of their responsibilities. For example, we provide all staff members with a copy of our policy upon their arrival and inform them of any changes to our policy or our complaint handling procedures. This policy is also placed on our firm’s intranet for employees to access.

We develop the procedures and implement the processes necessary to handle the complaints we receive and ensure that our complaint handling staff are trained. We appoint a complaints officer after ensuring they have the necessary skills to fulfill their responsibilities. We ensure that our staff and management collaborate in handling complaints.

Review of Policy
This policy is reviewed annually or upon any major regulatory or operational change. We always implement measures to improve our processes.