In addition to providing the legislative framework for the regulation of insurance
companies and agents operating in Saskatchewan,
The Saskatchewan Insurance
Act describes the responsibilities, obligations, and powers of the
Superintendent of Insurance. One of the responsibilities of the Superintendent is to
investigate consumer complaints.
The Superintendent has delegated authority over agents and adjusters to the
General Insurance Council,
the Life Insurance Council
and the Hail Insurance Council
. The councils
are responsible for:
establishing bylaws;
conducting investigations and handling complaints; and
conducting hearings on agent and adjuster licensing and disciplinary matters.
The Superintendent hears appeals from decisions of the
councils regarding agent and adjuster licensing and disciplinary matters.
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Filing a Complaint
Before filing a complaint, attempt to resolve the matter with the insurance
company or agent, agency or adjuster.
To register a complaint against an insurance company, please complete an
Insurance Complaint Form
and return it to the address provided on the form.
Complaints about a particular licensed agent, agency, or adjuster, should be directed
to the Insurance Councils of Saskatchewan.
You should be aware that laws set out limitation periods for starting court action. You
may wish to consult a lawyer regarding any limitation periods that may be applicable.
For complaint inquiries or further information, please contact our office at
(306) 787-6700.
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Disability Complaints
In cases of disability complaints, it is the Superintendent’s role to assess the
process used by the insurance company in the review of the claim for disability benefits
to ensure that the complainant has received fair and reasonable treatment. It is not up to
the Superintendent to make a determination regarding the sufficiency of medical
information.
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Loss of or Damage to Property
For claims involving loss of or damage to property, it is not the Superintendent’s
role to make a determination regarding the value of the loss or damage. The appraisal
process is a process that can be used when there is a disagreement between the insured and
the insurer about the value of the property insured, the property saved, or the amount of
the loss. For more information regarding the appraisal process see section 108 and
statutory condition 15 of subsection 286(1) of The Saskatchewan Insurance
Act.
For information regarding compulsory automobile insurance, vehicle and driver licenses,
and Personal Auto Injury Insurance - Tort and No Fault Coverage see
Saskatchewan Government Insurance (SGI).
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Entities Not Regulated
by the Superintendent of Insurance
A. Crown Corporations and Government
Departments/Agencies
B. Exempt from The Saskatchewan Insurance Act
Group Medical Services (GMS), Medical Services Incorporated
(MSI) and Saskatchewan Blue Cross®
are not licensed as insurance companies under The Saskatchewan Insurance
Act. Both
GMS and MSI are non-profit corporations governed by private acts known as The Group
Medical Services Act, 1999 and The Medical Services Incorporated Act,
respectively, in which exemptions from The Saskatchewan Insurance
Act have been provided. As these companies are exempt from The Saskatchewan Insurance
Act, the Superintendent has no authority to investigate inquiries or
complaints against them.
Should your concern relate to GMS, consider:
- contacting the company directly using the phone number and address provided in the plan
documents; and
- consulting with your lawyer regarding any remedies that you may have, as well as any
time limitations which may affect your claim.
Should your concern relate to MSI or Saskatchewan Blue Cross®, consider:
- the appeal procedure described in the MSI plan documents; and
- consulting with your lawyer regarding any remedies that you may have, as well as time
limitations which may affect your claim.
C. Self-Funded Disability Plans
A self-funded plan, also known as a self-insured plan, is a form of group insurance in
which your employer sets aside funds and employee contributions each month to pay health
coverage claims submitted by plan participants. A self-funded plan may hire an insurance
company or a third-party administrator to coordinate providers and handle claims and
paperwork. In the case of a self-funded plan, the employer, not the insurance company,
assumes the financial risk and is financially responsible for paying claims made by
insured group members.
Saskatchewan Government
Employees Union (SGEU) and Saskatchewan Association of
Health Organizations (SAHO) have self-funded plans in which the insurance companies
are hired for a fee to administer the health benefit plan and
settle claims, but not guarantee payments because the plan is uninsured. Should
your concern pertain to either SGEU or SAHO, consider:
- the appeal procedure outlined in the SGEU/SAHO plan documents; and
consulting with your lawyer regarding any remedies that you may have, as well as any
time limitations which may affect your claim.
To find out if your plan is self-funded, please contact
your plan administrator directly.
