Brokers & Agents - Appeals Process

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, brokers may request that a decision be arrived at or revisited based on individual circumstances.

In such instances, these are the steps to be taken:

For appeals involving individual insurance policies:

1. Discuss the situation with the Underwriter at your Servicing Carrier.

2. If the decision remains unchanged, document the request using the appeal form () including any additional information or exhibits to substantiate the appeal and send a copy of the documentation to your Servicing Carrier who will forward it to Facility Association along with the facts they know about the situation. Facility Association will forward to the Provincial Operating Committee Chairperson in your jurisdiction for discussion and resolution.

   The Provincial Operating committees consist of two Servicing Carrier Members, two broker members, and two non-Servicing Carrier members.

   You will be advised of the decision.

3. If you are not satisfied with the decision of the Operating Committee you can appeal to the Facility Association Board of Directors or the Governance & Human Resources Committee, depending on the nature of the appeal. If you decide to proceed on that basis, advise your Servicing Carrier, who will instruct Facility Association to forward the completed appeal form with the Operating Committee decision to the appropriate body.

   You will be advised of the decision.

For appeals not involving individual insurance policies, but a rule in general:

1. Speak to the Manager at your Servicing Carrier.

2. If the issue remains unresolved, document your request and send a copy of the documentation to the Facility Association who will refer the case to the Rates and Rules Committee for discussion and resolution. You will be advised of the decision.

NOTE: All appeals must adhere to these steps in the order outlined.