Insurance and Risk Management (IRM) has a complaint process available to the public.
A complaint is an expression of dissatisfaction related to a City of Toronto program, service, staff member or the City’s insurance adjusters, ClaimsPro; where a customer believes that the City or its staff has not provided a service experience to the customer’s satisfaction at the point of service delivery, and a response or resolution is explicitly or implicitly expected.
Note: The complaint process is not intended to deal with the outcome of your claim (e.g. a denial or settlement amount). The insurance claims process involves you (the claimant) and the ClaimsPro insurance adjuster assigned to act on behalf of the City’s liability insurance policy. If your claim has been denied, your remedy is to seek independent legal advice.
As noted under Insurance Claims above, the City’s insurance adjuster pays only when the City is legally liable which is determined by them considering your proof of claim.
The City’s insurance adjuster’s assessment of your claim is final and it can only be reviewed by them if you can provide additional relevant evidence to support your claim which was not considered by the adjuster originally.
A Complaint can be about one or more of the following:
- Timeliness of Service
- Quality of Service
- Agents (City’s Insurance Adjusters, ClaimsPro)
- Access to Service
A complaint process involves the steps below.
1. Customer Initiates Contact
A complaint may be made in a number of ways:
- Verbal complaints are made by telephone to our General Inquiry line at 416-397-4212.
- Written complaints may be made by filling in a complaint form and submitting it by mail, fax or e-mail:Corporate Finance Division
Insurance & Risk Management – Claims Complaint
5th Floor, East Tower, City Hall
100 Queen Street West, Toronto, ON, M5H 2N2
Your complaint should include the following:
- Contact details of the complainant
- Summary of the complaint (details, location, staff involved, resolution requested, enclosures, date complaint submitted)
- Type of the complaint
- Desired outcome
We will endeavour to resolve your complaint within 14 days of receipt.
2. Informal Resolution
Complaints will be resolved informally where possible.
3. Taking Your Complaint
If your complaint cannot be resolved informally, it will be recorded and tracked from initial receipt through the entire process until the complaint is resolved. You will be provided with a tracking number.
4. In-Take Assessment
Staff will determine that the complaint is with the correct division, and:
- Confirm the complaint is not an enquiry, feedback, a suggestion, or a comment;
- Check to see if there are any previous complaints from this complainant or about the issue(s) concerned;
- If necessary, contact the complainant to clarify the complaint and capture any missing required details;
- Categorize and prioritize the complaint; and
- Ensure complaint information is complete for the investigation.
Staff will outline the steps that will be taken to settle the matter and the estimated investigation duration.
5. Assessment Review
Staff will determine what has happened and identify appropriate action to resolve the complaint (if possible) and summarize findings. If the complainant is not satisfied, staff will escalate the complaint to their immediate supervisor. If necessary, the complaint will be escalated to the Manager.
Internal review of complaints may not always result in resolution, and a complainant may seek external review. External review can take a number of forms:
- External investigation agencies – There are a number of accountability/complaint bodies that receive and investigate complaints from the public and public sector agencies about the conduct of agencies (e.g., the Office of the Ombudsman at the City of Toronto).
- Alternative dispute resolution – A professional mediator, through a formal face-to-face process of discussion, helps the parties to clarify issues and reach a solution agreeable to both sides.
- Other appeal mechanisms – Where rights of appeal to outside tribunals or other legal remedies exist, dissatisfied complainants should be advised of these avenues of redress after all others have been exhausted.
If the resolution is accepted by the complainant, the complaint is closed.