Claim Disputes, Mistakes and Official Sources
Official sources for life and disability insurance in Canada: regulators, OLHI, Assuris and benefit portals
Where to verify life and disability insurance rules in Canada: provincial regulators, the AMF, OLHI complaints, Assuris protection, Service Canada, Retraite Québec and CRA.
To verify a rule, a figure or an advisor before you rely on it, go to the official source for that layer. Public benefits: Service Canada on canada.ca for EI sickness and CPP disability, and Retraite Québec for the QPP. Tax: the Canada Revenue Agency, and Revenu Québec for Quebec income tax. Insurers and advisors: your provincial insurance regulator, or the Autorité des marchés financiers (AMF) in Quebec, which also licenses advisors; federally incorporated insurers' solvency is supervised by OSFI. Complaints: the insurer's own process first, then the free OmbudService for Life and Health Insurance (OLHI) at olhi-oap.ca. If an insurer fails: Assuris, which every life and health insurer authorized in Canada must join. Appeals of public benefits: the Social Security Tribunal for CPP, the Employment Insurance Board of Appeal for EI since April 2026, and in Quebec the Tribunal administratif du Québec.
This guide is part of the overview of common life and disability insurance mistakes.
Who does what
| Body | Role | Use it to |
|---|---|---|
| Service Canada (canada.ca) | Administers EI and CPP | Check EI sickness rules, the 2026 maximum of $729 a week, CPP disability eligibility and amounts, apply and track claims |
| Retraite Québec | Administers the QPP | QPP disability pension rules, amounts and review requests |
| Canada Revenue Agency | Federal tax | Taxation of LTD, group life taxable benefits, disability tax credit, TFSA and RRSP rules |
| Revenu Québec | Quebec tax | Quebec taxable benefits on RL-1 slips |
| Provincial insurance regulators (e.g. FSRA in Ontario, BCFSA in British Columbia, Alberta Superintendent of Insurance, FCAA in Saskatchewan, Insurance Council of Manitoba for agents, FCNB in New Brunswick) | License agents and supervise insurer conduct | Check an advisor's licence; report misconduct |
| Autorité des marchés financiers (AMF) | Quebec regulator for insurers and representatives | Check the register of firms and representatives; complaints and dispute resolution |
| Chambre de la sécurité financière | Quebec self-regulatory body for representatives in insurance of persons | Professional conduct of Quebec advisors |
| Canadian Council of Insurance Regulators (CCIR) | National forum of regulators | Find your regulator; read fair treatment guidance |
| OSFI | Federal prudential supervisor | Information on federally regulated insurers |
| OLHI | Independent, free ombudservice for life and health insurance | Complaints after the insurer's final written position |
| Assuris | Policyholder protection if a member insurer fails | Check protection levels for death, income and cash value benefits |
| Social Security Tribunal | Appeals of CPP decisions; Appeal Division for EI | File a CPP appeal after reconsideration |
| Employment Insurance Board of Appeal | First-level EI appeals since April 1, 2026 | File an EI appeal after reconsideration |
| Financial Consumer Agency of Canada (FCAC) | Federal consumer agency | Plain-language guides; bank conduct for creditor insurance |
| CLHIA | Industry association | Consumer guides; industry guidelines |
How a complaint about an insurer moves
- Insurer's front line. Customer service or your advisor.
- Insurer's complaints officer or ombudsman. Ask for a final position in writing. Insurers must have a complaint process and tell you how it works.
- OLHI. Free, in English and French, across Canada including Quebec. OLHI aims to conclude most complaints within 120 days of acknowledging the written complaint. It can recommend that the insurer review its decision.
- Regulator. For conduct concerns. In Quebec, the AMF can examine the complaint and offer mediation.
- Court. Small claims for smaller amounts, or a lawsuit within the limitation period.
Steps 3 and 5 can overlap in time; do not let a complaint run past a limitation period. See what to do when an LTD claim is denied.
Assuris: what happens if your insurer fails
Assuris is a not-for-profit organization funded by its member companies. If a member insurer fails, Assuris works to transfer policies to a solvent insurer and protects policyholders up to set levels by type of benefit: death benefits, monthly income benefits such as disability income, health expense benefits, and cash values and accumulation amounts. As of October 2026, its website lists protection of $1,000,000 for death benefits and $5,000 a month for monthly income, among other levels. Check assuris.ca for the current levels and how they apply before relying on them for a large policy. Fraternal benefit societies may participate voluntarily, so confirm membership if your policy is with one.
Checking an advisor
- Outside Quebec, search the provincial regulator's or insurance council's licensee lookup for the advisor's name and licence class (life and accident and sickness).
- In Quebec, check the AMF's register of firms and individuals authorized to practise.
- Ask whether the advisor is captive (one insurer) or independent (several), and how they are paid; regulators expect disclosure of conflicts of interest.
Checking a benefit figure
Use only the government page for the current year. EI and CPP amounts change on January 1 each year. The figures used on this site, a $729 maximum weekly EI benefit and a $1,741.20 maximum monthly CPP disability benefit, are for 2026. QPP figures come from Retraite Québec.
A short glossary
| Term | Meaning |
|---|---|
| Final position letter | The insurer's last word through its internal process, needed before OLHI |
| Reconsideration | Mandatory first review of an EI or CPP decision by Service Canada |
| Non-evidence maximum | Group coverage available without medical questions |
| Elimination period | Waiting period before disability benefits begin |
| Contestable period | The first two years in which a policy can be voided for misrepresentation |
Frequently asked questions
Is OLHI the same as my insurer's ombudsman?
No. Many insurers have an internal ombudsman, which is part of the insurer's own process. OLHI is independent and comes after it.
Does OLHI handle CPP or EI complaints?
No. Public benefit decisions go to reconsideration and then the Social Security Tribunal (CPP) or the EI Board of Appeal (EI), or for QPP to Retraite Québec and the TAQ. The deadlines are set out in CPP disability and EI reconsiderations.
Who regulates group benefit plans?
The insurer is regulated provincially for market conduct. The employer's plan design is a contract between the employer and the insurer; employment standards and human rights law may also apply.
Can I check whether my insurer is solvent?
Federally regulated insurers report capital to OSFI, and public companies publish financial statements. For consumers, Assuris membership is the practical protection.
Sources
- OmbudService for Life and Health Insurance (OLHI) — free complaint service
- Assuris — policyholder protection levels
- Autorité des marchés financiers — Quebec register and complaints
- Canadian Council of Insurance Regulators — directory of provincial regulators
- Office of the Superintendent of Financial Institutions — federally regulated insurers
- Social Security Tribunal of Canada — CPP appeals and the Appeal Division
- Employment Insurance Board of Appeal — first-level EI appeals
- Government of Canada — EI, CPP and CRA
- Retraite Québec — QPP
