Complaints report 2021 - 2022

Sectors we regulate

FSRA protects Ontarians by regulating the following sectors:

• auto insurance
• credit unions and caisses populaires
• financial planners and financial advisors
• health services providers (related to auto insurance)
• life and health insurance
• loan and trust companies
• pension plan administrators^[1]
• property and casualty insurance
• mortgage brokering

FSRA's complaints process

FSRA's Complaints and Risk Assessment Unit (CRAU) is the single point of contact for complaints regarding FSRA's regulated sectors, except pension plans. Consumer complaints provide a snapshot of how actual market outcomes are experienced by consumers when they use the services and products of our regulated sectors. By analyzing information provided by consumers and industry about the financial services marketplace, FSRA can assess whether the regulatory expectations contained in legislation regarding consumers have been met.

FSRA's regulated entities are required to have effective and transparent protocols to resolve complaints that are submitted directly to them. Where complaints cannot be resolved, a consumer after considering other avenues such as a third-party dispute resolution body,^[2] may elect to come to FSRA.

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When a complaint is submitted to FSRA, in most cases it is expected that a consumer would have received a final decision in writing from the person or entity with which they have a concern. That final decision should be part of the material included with the complaint submitted to FSRA. This allows FSRA to review a complaint quickly with an understanding of the position and available documents of both parties. It also ensures that our licensees are documenting complaints and making real attempts to evaluate and resolve complaints against them.

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For all complaints, FSRA sends an acknowledgement of receipt letter to the complainant, and a Compliance Officer in the CRAU is assigned to the complaint. The Compliance Officer assigned to the case reviews the allegations in the complaint and makes initial contact with the complainant to ensure a clear understanding of the allegations.

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During the review, the Compliance Officer will collect evidence from the complainant, licensee and if appropriate, other parties involved, to determine if the allegations in the complaint support a breach under the legislation, regulation and/or relevant codes of conduct.

Based on the allegations and evidence collected during the review, we will let the complainant know of the determination through a closing letter. Outcomes may include:

• a case was closed because the information provided was insufficient to render a decision
• A determination that FSRA is not the regulatory body with authority over the issue presented or the licensee who is the subject of the complaint. Staff will provide the complainant with appropriate options for alternative resolutions, if they wish to pursue their complaint.
• a decision that confirms that the information provided indicates the licensee was compliant
• In the case of non-compliance, the consumer is informed that the review is complete. Appropriate action will be taken with the subject of the complaint, such as issuing a warning letter.
• where more serious outcomes are suspected, complaints may be escalated to other areas of FSRA for consideration of other regulatory outcomes within Market Conduct or to FSRA's Legal and Enforcement (L&E) Department
• Contractual matters are reviewed to ensure that the licensee has carried out the terms of the contract in the stated and agreed upon way. Disagreements regarding contractual outcomes where adherence is not an issue, such as the amount of a total loss, or bodily injury settlement would not be within FSRA’s jurisdiction. However, in these cases we may provide alternatives to a consumer where such disputes may be continued.

During this fiscal year, the CRAU issued 110 Warning Letters to individuals or entities found in contravention of the legislation and the Acts we supervise to address this misconduct. Our office also published 15 public notices warning consumers about unlicensed activity and the risk of engaging in business with unlicensed individuals and entities.

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In cases where the outcome of our review includes an assessment that the licensee is compliant, but the practice or activity of the licensee has the potential for consumer harm, the CRAU educates the licensee and makes recommendations regarding improved consumer outcomes and compliance culture.

The CRAU reviews all complaints with the same level of due diligence regardless of the outcome. In addition to complaints made to FSRA by consumers, the CRAU also initiates reviews from information obtained from other sources, such as sanctions imposed by other regulators, government, media reports, and industry reports.

What happens to more serious cases?

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In cases of multiple or severe compliance infractions, the CRAU escalates the matter to our L&E Department for consideration of regulatory sanctions, such as non-renewal, cancellation, conditions on a license, suspension, revocation, or administrative monetary penalties. Personnel within Market Conduct may also receive escalations from CRAU for cases requiring license conditions or other penalties related to administrative contraventions.

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For referrals to L&E, FSRA has a governance structure that ensures consistent risk criteria are applied to the escalation of the most serious files. Risk criteria include breaches of legislation causing consumer harm, repeated non-compliance or disregard for operating within the regulatory regime, or misconduct that FSRA has stated will be targeted for review as part of its business priorities. Sometimes complainants are asked to participate in the enforcement process by providing witness testimony; otherwise, FSRA does not communicate with complainants once the file is escalated for further investigation until such matter becomes public. For more information on FSRA's Enforcement Actions and when matters become public, please see our Transparent Communication of FSRA Enforcement Action Guidance.

FSRA's L&E Department issues Notices of Proposals (NOP) that contain allegations of serious conduct and a recommended outcome. Outcomes can include license refusals, suspensions, revocations, conditions, and recommended administrative monetary penalties. Licensees, or in some cases, applicants to become licensees, have 15 days to decide to have their matter heard before the Financial Services Tribunal (FST). FST is an independent, adjudicative body with exclusive jurisdiction to determine all questions of fact or law that arise in any proceeding before it. For those who do not proceed to a hearing, FSRA issues an Order to impose the terms outlined in the NOP.

The following complaints were escalated within Market Conduct to Regulatory Discipline Officers (RDOs) and to the L&E Department in Fiscal Year 2021/22:

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To learn more about complaints submitted against life agents, please see the 2020/21 Life Agent Reporting Form (LARF) Summary Report.

In summary, the complaints process facilitates the maintenance of high standards of conduct in the regulated sectors and protects individuals from consumer harm. When evidence shows that a licensee has not been compliant with the relevant legislation or regulations, appropriate enforcement action is taken based on specific case facts and circumstances of the conduct and may result in any of the following outcomes:

• best practice letter to educate
• warning letter
• administrative monetary penalty and/or fine
• compliance order
• posting of a public warning notice
• conditions attached to license such as enhanced supervision, limit on activities, etc
• suspension or revocation of a license that bans, permanently or for a specified period, from conducting business in the regulated sector
• other remedies or penalty deemed appropriate

The CRAU tracks these outcomes to understand whether or not licensees are meeting consumers' expectations. Where we find emerging risks, FSRA considers the impact and how it may influence future work planning. The information provided in the complaints enables the CRAU to identify trends and share information with other departments within the organization. Complaint trends impact proactive supervisory initiatives, inform rulemaking, and are considered when making legislative changes and releasing public awareness bulletins.

What complaints we do not handle

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FSRA's complaint handling does not include intervening in claims settlement amounts or assisting with recovering money lost through services offered by licensees. In the Insurance sector, consumers can have certain decisions regarding claims settlements reviewed by third-party dispute resolution bodies^[1] that Insurance companies must be members of. Otherwise, a civil court of law can decide on cases of negligence and/or contractual disputes and award judgments that make complainants whole. However, every complaint is reviewed to get to the point of understanding the appropriate outcome and communicating it to the consumer. Regardless of the outcome, complaint resolution assists us with monitoring conduct in our regulated sectors and understanding if further rules or guidance should be considered to keep pace with industry trends and continue to carry out FSRA's vision of financial safety, fairness, and choice for all Ontarians.

Fiscal year 2021/22 in review

Here is a sectoral breakdown of complaints that FSRA received and closed for fiscal year 2021/22:

The average time to complete a review of a complaint was 47 days, where 92% of our cases were closed within 120 days, and 98% were closed within 270 days.

Mortgage brokering

Auto insurance

Property and casualty insurance

Life and health insurance

Credit unions and caisses populaires

Health service providers

Loan and trust companies

Appendix: FSRA service standards - complaints

^[1] The Pensions Department handles Pension Plan complaints and the statistics are not included within this report
^[2] General Insurance Ombudservice (GIO) for P&C, Ombudservice for Life and Health Insurance (OLHI) for Life Companies
^[3] Must include relevant facts and details, supporting documents and final position letter from subject entity.