OmbudService for Life & Health Insurance Canada: How to File a Complaint

If your Canadian life insurance, health insurance, disability, or critical illness claim has been denied and your insurer's internal appeal process has failed you, the OmbudService for Life & Health Insurance (OLHI) is your next step. The OLHI is Canada's independent, not-for-profit dispute resolution service for life and health insurance complaints.

This guide explains what the OLHI is, who can use it, how the process works, and what outcomes it can deliver.

What Is the OLHI?

The OmbudService for Life & Health Insurance (OLHI) — formerly known as the OmbudService for Life & Health Insurance — was established by the Canadian life and health insurance industry to provide consumers with an independent review of disputes. It is:

• Free for consumers
• Independent of the insurance industry
• Available across Canada (English and French)
• Operated under its own governing structure, separate from any insurer

The OLHI was created to provide an accessible alternative to expensive litigation for consumers with unresolved insurance disputes.

What Types of Disputes Can the OLHI Handle?

The OLHI handles disputes arising from individual (not group) life and health insurance policies, including:

• Life insurance claims — denial of death benefits, policy rescission, non-disclosure disputes
• Critical illness insurance — denied CI benefits, definition disputes
• Disability insurance (individual policies) — denied long-term disability, definition of disability disputes
• Health and dental insurance (individual policies) — denied benefits, coverage disputes
• Accident and sickness insurance — denied claims

Important limitations:

• The OLHI handles individual policies — group insurance plans (employer-sponsored benefits) are generally handled by the Group Insurance OmbudService (GIO)
• The OLHI does not handle property and casualty insurance (car, home) — those go to the General Insurance OmbudService (GIO) or provincial regulators

Before You Can Go to the OLHI

You must exhaust the insurer's internal complaint process before the OLHI will accept your complaint. This means:

1. Submitting a formal written complaint to the insurer's customer relations or appeals department
2. Receiving a final written response from the insurer
3. Being unsatisfied with that response

Most Canadian insurers are required to respond to complaints within 60 days. If you have not received a response within this period, the OLHI will generally accept your complaint.

Step-by-Step: How to File an OLHI Complaint

Step 1: Exhaust Internal Appeals

Make sure you have:

• Submitted a formal complaint in writing to your insurer
• Received a final written response (or waited 60 days without one)

Step 2: Gather Your Documents

Collect:

• Your policy documents and certificate of insurance
• All correspondence with the insurer, including the denial letter and any appeal response
• Medical records, specialist reports, and other supporting evidence
• The insurer's final response letter

Step 3: Submit Your OLHI Complaint

Go to olhi.ca and complete the online intake form. You can also:

• Call: 1-888-295-8112 (toll-free)
• Write: 401 Bay Street, Suite 1507, Toronto, ON M5H 2Y4

When submitting, explain:

• What your policy covers
• What happened (the denial or other complaint)
• What you believe the insurer did wrong
• What outcome you are seeking

Step 4: OLHI Review and Investigation

The OLHI assigns your complaint to a case analyst who:

• Requests information and documents from both you and the insurer
• Reviews all evidence
• Assesses the complaint against the policy terms, applicable law, and industry standards

The OLHI then issues a written recommendation.

Step 5: Recommendation and Follow-Up

The OLHI's recommendation is not legally binding — but member insurers (which include all major Canadian life and health insurers) are expected to implement recommendations. The OLHI publishes statistics on insurer compliance.

If the insurer accepts the recommendation in your favour, your dispute is resolved. If the insurer does not accept the recommendation, the OLHI may refer the matter to the appropriate provincial regulator.

What Outcomes Can the OLHI Recommend?

The OLHI can recommend that the insurer:

• Pay the denied claim in full or in part
• Reconsider its decision with new evidence
• Reinstate a cancelled or rescinded policy
• Provide clarification or an apology
• Pay reasonable compensation for financial loss

The OLHI cannot award punitive damages or compensation for non-financial harm.

Provincial Regulators: Your Parallel Option

In addition to the OLHI, you can file a complaint with your provincial insurance regulator at any time:

• Ontario: FSRA — fsrao.ca
• Quebec: AMF — lautorite.qc.ca
• British Columbia: BCFSA — bcfsa.ca
• Alberta: AIC — alberta.ca/insurance-council

Provincial regulators investigate market conduct issues and can take action against insurers who are systematically mishandling claims.

Fight Back With ClaimBack

ClaimBack helps Canadians prepare OLHI-ready complaint submissions with professional documentation, evidence frameworks, and insurer-specific arguments for life, health, disability, and critical illness disputes.

Start your OLHI complaint preparation with ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• Internal vs External Insurance Appeal: What's the Difference?
• How to Use the Insurance Ombudsman