Here's what happens when you contact us with a benefit entitlement dispute or service complaint.

Step 1: Business Unit Review

The process starts as soon as you inform us of your complaint. At this point, your client service representative will ask you a number of questions - to make sure they fully understand your complaint, and any necessary background or context. You can expect to have a detailed conversation with the representative at this time.

Once you have shared this information, the client service representative will make a commitment to follow up with you within two business days. While the issue may not be resolved within 48 hours, you can expect a status update within the next two business days.

Depending on the nature of the complaint, the client service representative will either research the issue and work through the process with you directly, or they will escalate the issue to Step 2 in the process.

Our goal is to achieve an early resolution at the Business Unit Review level but if you are not satisfied that the business unit resolved your complaint, you may ask to have your matter escalated to Step 2 of the process.

Step 2: Client Services Review

This step in the process may be triggered for a number of reasons, for example:

  • If there are special circumstances to your case
  • If the issue requires a legal, actuarial, or full policy review
  • If the client service representative escalated the issue to Step 2
  • If you are not satisfied with the resolution proposed at Step 1

At this stage, the complaint is re-evaluated. The re-evaluation would be completed at the management level and, if necessary, assistance may be sought from outside legal, actuarial or policy consultants.

We commit to keeping you informed throughout our review of your case.

Depending on the nature of the complaint, the manager will either research the issue and work through the process with you directly, or they will escalate the issue to Step 3 in the process.

It is important for you to know that if you are not satisfied with the response from OPB at this stage, you can ask to have your matter escalated to Step 3 of the process.

Step 3: Senior Management Unit Review

This step in the process may be triggered for a number of reasons, for example:

  • If a settlement is being considered
  • If the manager escalated the issue to Step 3
  • If you are not satisfied with the resolution proposed at Step 2

At this stage in the process, the complaint is re-evaluated at the senior executive level. We commit to keeping you informed throughout our review of your case.

At this point, if you are not satisfied with the resolution proposed, you may have the following options: