Publication of a report on current industry practices for group disability claims

Insurance Organization

Québec City – The Autorité des marchés financiers (“AMF”) today published its Group disability insurance cross-sectional analysis report (pdf - 514 KB)This link will open in a new windowUpdated on March 14, 2019The Guideline sets out the AMF’s expectations for sound commercial practices, which are intended to ensure: FTC, which is a core component of the governance and corporate culture of insurers; that consumers have information allowing them to be properly informed and make enlightened decisions regarding a product, before, during and after the purchase of the product; that claims and complaints are examined diligently and settled fairly, using a procedure that is simple and accessible to claimants., which is based on an analysis of usual insurance industry practices in Québec relating to the handling of group disability insurance claims. Through this initiative, the AMF sought to develop a more detailed overall picture of those practices and ensure that they were adequate and resulted in the fair treatment of consumers (FTC).

The analysis did not reveal any systemic problems with the way group disability insurance was being managed. Some good practices were observed, while others will need to be upgraded by insurers in a continuous improvement environment.

The work relating to the analysis of commercial practices followed in handling group disability insurance claims began in April 2018. The AMF obtained the cooperation of the ten largest insurers in Québec, which account for close to 90% of the province’s group disability insurance market. It sent them requests for information and also conducted interviews with them.

The AMF determined that it was appropriate to further clarify expected FTC good practices by means of recommendations, some of which are inspired by good practices it observed among certain insurers.

The AMF will follow up with the insurers by obtaining action plans from them and ensuring the practical implementation of the proposed corrective actions. The insurers must provide the AMF with their action plans by June 30, 2019.

The AMF reminds the public that any claimant who is dissatisfied with the examination of or response to their claim can file a complaint with their insurer. If they are still not satisfied at the end of that process, they can request that their file be transferred to the AMF, which will examine the file and may, if it deems it appropriate and the parties agree, act as a conciliator or mediator.

The Autorité des marchés financiers is the regulatory and oversight body for Québec’s financial sector.

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