I had an interesting discussion recently with someone who was involved in what was classed as a single vehicle accident. She agreed that I could tell her story but she didn't want her full name to be published. While driving properly on the highway, Mary was cut off by a garbage truck making a sudden lane change in order to reach an exit. In a split second she had to choose between hitting the truck or the guard rail. Mary chose the guard rail. Fortunately for her, others who observed the accident stopped the truck and when the police arrived, the driver admitted that he hadn't noticed her car when he changed lanes. The driver was charged. Her vehicle was a total loss.
It was not until she reported the accident to her insurance company that Mary's problems really began. As Mary hadn't hit the truck, the adjuster classified the accident as single vehicle – at fault. Since she didn't have collision coverage, Mary was told that she would not be compensated for the damage to her vehicle. It didn't seem to matter that there were witnesses to the accident, a police report and charges against the other driver. The adjuster remained adamant.
Mary was not prepared to take no for an answer. It took over two months, but finally the insurance company agreed that the claim fell under direct compensation and paid her. Mary is still not particularly happy with the outcome and she believes that as a long time insured, she should have received better treatment. She can't understand why it was such a struggle to get her insurance company to investigate. She was surprised when I told her that the insurance company has a right, but not the obligation to investigate any accident.
In fact, single vehicle accidents are rarely investigated unless there are injuries or there is a suspicion of a policy breach. It is easier and faster to treat these claims as at fault collisions, rather than to determine if there was another reason for the accident. For example in Ontario, a common cause of single vehicle accidents is snow or black ice and while the driver is usually at fault, there are court decisions that state that under certain circumstances, the driver may not be responsible at all. The insurance company however has no obligation to undertake an investigation just to prove that their insured is not at fault. Instead, they can arrive at a fault determination just as the adjuster did in Mary's case, by choosing to disregard that other helpful information may be available.
So how do you become a Mary and assert your rights if you think that your insurance company made the wrong decision in your accident? Mary did this by documenting everything in writing. She was persistent but polite and she always kept her focus on how the accident happened. She was able to resolve her complaint directly with a senior manager but when this appears to be unlikely, there are alternative options available.
The Financial Services Commission of Ontario offers tips for resolving insurance disputes on their website at www.fsco.com. Here are four steps that they describe:
1) If you disagree with your company, you should refer your complaint to the company's Consumer Complaint Officer.
2) If you can't resolve the complaint, ask for a final position letter. The letter should also identify the independent ombudsman who can review your complaint.
3) Write to the ombudsman explaining the reason for your complaint.
4) Your complaint will be reviewed and responded to.
The process for contacting the ombudsman is also described on the FSCO site. You can use their helpful links to access the General Insurance Ombudsman site or you can call GIO at their toll free number at 1-877-225-0466. If they accept your complaint, GIO will arrange a 90 minute mediation between you and your insurance company, at no cost to you except for your own expenses. In Ontario, GIO does not involve itself in disputes concerning settlement procedures established by legislation, insurance product pricing or business decisions. Alberta currently is the only province that has established a procedure for premium dispute resolution.
A mediator attempts to get the parties to resolve their differences through compromise, which means that there is no admission of right or wrong on either side. It is important to remember that if the dispute is over your fault assessment, a little compromise on your part can still result in a full premium increase. The GIO process is not binding and you always retain the option to sue your insurance company if you are not satisfied with the outcome.
I have not yet heard from anyone who has had their claim mediated by GIO and I would be interested in hearing from any reader who has. Did you find the process to be impartial and fair? Was it helpful?
Susan Saksida, CIP is an insurance consultant who has held senior positions within the insurance companies and brokers. She is currently conducting research into the root cause of consumer misunderstanding of the insurance industry. If you have an auto accident related story please email this to insurancecompliancematters@rogers.com .
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