Complaints

Complaints

Have a concern? We’re here to help

At Gore Mutual, we want our customers to be completely satisfied with their insurance experience—whether it’s obtaining a policy through one of our trusted broker partners or settling a claim. We’re proud that we usually achieve this, however, if you have any concerns about your policy, claim, or service, we’re here to help.

Please follow the steps below to have your concern addressed.

To get started, please choose the option that best describes your concern:

Please note, if you are represented by a lawyer, they should write on your behalf or provide written authorization to communicate directly with you.

Claims Complaint Process

If your concern is related to a claim, here’s where to start:

Please note, if you are represented by a lawyer, they should write on your behalf or provide written authorization to communicate directly with you.

Step 1: Speak to your Claims representative

Your first point of contact should be the adjuster assigned to your claim. Please ensure you have your claim number, email, and phone number ready when you contact them.

Step 2: Escalate to a supervisor

If the adjuster is unable to resolve your concern, you can request that it be escalated to a supervisor. The supervisor will review your claim and concern and work towards a resolution.

Step 3: Escalate to a manager and Final Business Decision

If the supervisor is unable to resolve your concern, you can request that it be escalated to a manager. The manager will conduct a thorough review of your claim and work toward a resolution. If the manager is unable to resolve your concern, they will provide you with a written Final Business Decision.

Step 4: Reach out to our Ombudsman

If your concern remains unresolved after following these steps, and you have received a written Final Business Decision, you may escalate to the Ombudsman

The Ombudsman is responsible for:
  • Overseeing the Company’s complaint handling process
  • Ensuring customers’ complaints are addressed
  • Ensuring that the customer receives a letter outlining the Company’s final position, if the complaint cannot be resolved
  • Working with MICO or GIO, as applicable, to address any complaints that could not be resolved by us
  • Working with the FCAC for any complaints pertaining to loans, credit cards charges and other similar transactions that could not be resolved by us
It is important to note that the Ombudsman cannot:
  • Enter any 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.
  • Overturn business decisions related to your policy or claim

This means that the Ombudsman will be reviewing your concerns related to how your claim was handled, how your concerns were handled and escalated, and how you were treated.

When you contact the Ombudsman, please submit your complaint in writing and include:

  • A copy of the Final Business Decision provided by the manager
  • Your name, full address including postal code, email address, and policy number
  • The nature and summary of your concern
  • A description of your expectations and what resolution you are seeking

Please note that if Steps 1 to 3 have not been completed and you do not have a written Final Business Decision from the manager, you will be redirected back to the applicable Gore Mutual department.

Gore Mutual’s Ombudsman is:

Sonya Stark
Gore Mutual Insurance Company
252 Dundas Street North, Cambridge Ontario N1R 5T3
Email: ombudsman@goremutual.ca

Policy Complaint Process

If your concern is related to your policy, please follow these steps:

Step 1: Talk to your broker

Your independent insurance broker is your first point of contact. Brokers are your independent licensed representatives, authorized to handle your policy and address your concerns. They will escalate matters to Gore Mutual if required.

Step 2: Work with a Gore Mutual representative

If your broker cannot resolve your concern, they will contact a Gore Mutual representative on your behalf.

We can assist customers directly with:

  • Billing inquiries, such as credit card payments or explaining your bill.
  • Helping you find your broker or escalating issues to your broker.

Please note that all other inquiries, policy changes, or cancellations must be handled by your broker, as they are your authorized representative and licensed to do so.

Step 3: Ask your broker to escalate to a manager and provide a Final Business Decision

If the Gore Mutual representative is unable to resolve your concern, your broker can escalate the matter to a Gore Mutual manager, who will conduct a thorough review and work towards a resolution.

If the matter remains unresolved, the Gore Mutual manager will provide you (either directly or through your broker) with a written Final Business Decision.

Step 4: Contact the Ombudsman

If you remain unsatisfied after following these steps and have received a written Final Business Decision from the Gore manager, you may then escalate the matter directly to the Gore Mutual Ombudsman.

The Ombudsman is responsible for:
  • Overseeing the Company’s complaint handling process
  • Ensuring customers’ complaints are addressed
  • Ensuring that the customer receives a letter outlining the Company’s final position, if the complaint cannot be resolved
  • Working with MICO or GIO, as applicable, to address any complaints that could not be resolved by us
  • Working with the FCAC for any complaints pertaining to loans, credit cards charges and other similar transactions that could not be resolved by us
It is important to note that the Ombudsman cannot:
  • Enter into any 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.
  • Overturn business decisions related to your policy or claim

This means that the Ombudsman will be reviewing your concerns related to how your policy matter was handled, how your concerns were handled and escalated, and how you were treated.

When contacting the Ombudsman, please submit your complaint in writing and include:

  • A copy of the Final Business Decision provided by the Gore Mutual Manager and/or your broker
  • Your name, full address including postal code, email address, and policy number
  • The nature and summary of your concern
  • A description of your expectations and what resolution you are seeking

Please note that if Steps 1 to 3 have not been completed and you do not have a written Final Business Decision from the Gore Mutual manager, you will be redirected back to your broker.

Gore Mutual’s Ombudsman is:

Sonya Stark
Gore Mutual Insurance Company
252 Dundas Street North, Cambridge Ontario N1R 5T3
Email: ombudsman@goremutual.ca

We’re here to help

For any general inquiries regarding your insurance policy, payments, or claims, please refer to the chart below to find the right contact person.

Amend coverage on policy

Your insurance broker

Cancel policy

Your insurance broker

Change vehicle on policy

Your insurance broker

Know when settlement cheque will be sent

Your broker or our Claims team

Discuss/negotiate claim settlement offer

Your assigned claims adjuster

Understand rate increase

Your insurance broker

If you are unsure how to reach your broker, we can help by providing their contact information or contacting the broker on your behalf if necessary. Please visit our Claims page or call 1-844-974-GORE(4673).

Industry OmbudService/Regulator Assistance

Insurance OmbudsService

If after the independent review and response by Gore Mutual’s Ombudsman you remain unsatisfied and wish to file a formal complaint with the industry Ombudservice and/or regulators, upon your request, the Ombudsman will provide you with a Final Position Letter outlining Gore Mutual’s final position on how your claim or policy matter was handled, how your concerns were handled and escalated, and how you were treated.

Depending on the nature of your complaint, you may then contact the Mutual Insurance Companies OmbudService; the General Insurance OmbudService; or the Financial Consumer Agency of Canada. Provided below is more information on each of these organizations to help you determine who to contact.

Mutual Insurance Companies OmbudService (MICO)

MICO assists in the resolution of conflicts between policyholders and participating mutual insurance companies. If a complaint cannot be resolved with the help of the company’s Ombudsman, MICO may appoint an independent mediator with the objective of helping both parties work towards an acceptable resolution.

Contact MICO if you reside anywhere in Canada and your complaint is not related to a loan, line of credit, credit card payment, or disclosure matters. MICO handles complaints about claims related matters and policy coverage interpretation. MICO does not handle matters that have not been fully escalated by the insurance company in accordance with the insurance company’s escalation process; settlement procedures established by legislation; matters that have been or are currently before the courts; or previously addressed matters.

Please note, MICO requires that you provide them with a copy of the Final Position Letter provided to you by Gore Mutual’s Ombudsman in order for MICO to respond.

Contact MICO

1000 McGarry Terrace, Unit #M010, Ottawa, ON, K2J 7A8
Telephone: 613-505-5070 or 866-231-2602
Email: info@mutualombudservice.ca
Website: www.mutualombudservice.ca

General Insurance OmbudService (GIO)

GIO assists in the resolution of conflicts between policyholders and participating insurance companies. If a complaint cannot be resolved with the help of the company’s Ombudsman, GIO may assign a customer service officer with the objective of helping both parties work towards an acceptable resolution and include various alternatives including mediation and adjudication.

Contact GIO if you reside in Alberta or British Columbia and your claim is not related to a loan, line of credit, credit card payment, or disclosure matters. GIO handles complaints about claims related matters, policy coverage interpretation, and policy processing. 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, or matters that have been or are before the courts.

Please note, GIO requires that you provide them with a copy of the Final Position Letter provided to you by Gore Mutual’s Ombudsman in order for GIO to respond.

Contact GIO

4711 Yonge Street, 10th Floor, Toronto, Ontario, M2N 6K8
Telephone: 1-877-225-0446
Fax: 416-299-4261
www.giocanada.org

Financial Consumer Agency of Canada (FCAC)

FCAC assists in the resolution of conflicts between policyholders and federally regulated financial institutions, investigating complaints regarding possible violations of legal obligations that relate to breach of law, code of conduct, or public commitment.

Contact FCAC if your complaint involves a violation of legal obligations relating to a loan, line of credit, credit card payment, or disclosure matters. FCAC does not handle matters related to the pricing of products, the quality of service, loan and credit granting practices, billing errors or other general service issues.

Contact FCAC

427 Laurier Avenue West, 6th Floor, Ottawa, ON, K1R 1B9
Telephone: 1-866-461-3222
Fax: 1-866-814-2224
www.fcac.gc.ca
www.fsrao.ca