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Appeal Procedures - Consumers
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At Facility Association, decisions are made in accordance
with the rules set out in the
Facility Association Rules and Rates Manual or the Plan of
Operation. On occasion,
consumers may request that a decision be arrived at or
revisited based on individual
circumstances.
In such instances, these are the steps to be taken:
- Contact your agent/broker and explain why you feel the
decision on your policy
should be different. Your agent/broker will review the
decision with the insurer
and let you know the outcome. It may be there is a
misunderstanding that can be cleared up at this point.
- If the decision remains unchanged, document the request
and include any
additional information or exhibits. Send a copy of your
documentation to your
insurer. (Your agent/broker can help with this.)
- If the situation is not resolved, request that your
insurer forward a copy of your
documentation to Facility Association Head Office. It will
be forwarded to the
appropriate Provincial Operating Committee for discussion
and resolution.
You will be advised of the decision. NOTE: A copy of your
documentation
will be provided to the Servicing Carrier.
NOTE: All appeals must adhere to these steps in the order
outlined.
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