What is the mandate and role of MICO?
The Mutual Insurance Companies OmbudService (MICO) is a component of a dispute resolution process put in place by a number of federally regulated or federally supervised mutual insurance companies. MICO assists insurance companies and their members (policyholders, insured) resolve their differences related to claims and policy coverage when the insurer has not been able to solve the issue to the satisfaction of the policyholder. In such instances, the role of MICO is to ask the ADR Institute of Canada Inc. to appoint an independent mediator with the mandate to set up and facilitate a 90-minute mediation session.
What kind of issues will MICO address?
MICO’s mandate is limited to addressing claims issues as well as insurance coverage issues.
Specifically excluded from MICO’s role are issues related to:
- matters not submitted to the insurance company or that have not yet been considered by the insurer’s appointed Ombudsman Liaison Officer
- underwriting issues
- rating issues
- matters that are before the courts
- cases that have already been dealt with by MICO
What kind of information does MICO collect?
With the policyholder’s consent, MICO will collect personal information from the policyholder. MICO will collect contact information for the purpose of identifying the policyholder and being able to establish communications; will collect information to determine if the issue at stake falls within the type of issues for which the dispute resolution process has been put in place; and will collect other information to determine if the issue has been dealt with by the insurer’s Ombudsman Liaison Officer, or has already been dealt with by MICO or if the issue is now before the courts.
What role will the mediator play?
The mediator will organize a 90-minute mediation session at a date and location convenient for both parties. During the mediation session, he/she will try to get the parties to reach an agreement and will write a report summarizing the content of the agreement reached between the insurer and the policyholder. If the parties do not reach such an agreement during the session, the mediator’s written report will include a non-binding recommendation.
How and when should one make a complaint to MICO?
First, the policyholder must try to solve the issue directly with the insurance company’s representative. If the policyholder is unable to solve the issue with his/her contact person at the insurance company, the policyholder will be referred to the company’s Ombudsman Liaison Officer who will review the situation with the insured. After this review, the Ombudsman Liaison Officer must send a letter to the insured detailing the company’s final position.
If the policyholder is still unsatisfied with the insurer’s position, he/she can proceed to mediation - the step that involves MICO. To initiate this process, the insured must complete and sign a Mediation Registration Form made available by the insurer’s Ombudsman Liaison Officer, or by calling MICO at 1-866-231-2602 or (613) 789-9630 or by completing the Mediation Registration Form electronically on MICO’s Web Site at www.MutualOmbudService.ca, form which must then be printed, signed and mailed to MICO. Following reception of the completed form, MICO will ask the ADR Institute of Canada to appoint a mediator with experience in addressing insurance related issues. The appointed mediator will then set up and facilitate a 90-minute mediation session between the policyholder and the insurer.
If the policyholder and the insurance company reach an agreement, the mediator will write a report providing details of the agreement.
If, after the mediation session, the policyholder and the insurance company still disagree or fail to resolve all the issues, the mediator will prepare a written report including his/her recommendations. These recommendations are not binding on either party. If the written report does not bring the parties to agree on a solution, the policyholder still has access to the legal system. MICO will not help in this process.
Who is responsible for setting up the mediation session?
The mediator, after his/her appointment by the ADR Institute of Canada, will communicate with the policyholder and the insurer to determine a convenient date and location for the mediation session and will advise the two parties of the decision.
Who will pay for the mediation session and related costs?
First, MICO does not charge for its services. The cost for the mediator, i.e. the cost of the 90-minute mediation session, the travel expenses of the mediator and the rental of the facility for the meeting are paid for by the insurance company. However, the policyholder will pay for his/her expenses incurred to attend the mediation session.