Complaint Investigation & Disciplinary Process

The Council has obtained its authority through delegation by the Superintendent of Insurance in the province. The establishment of the Insurance Council of Manitoba is outlined in Regulation 227/91. Council may investigate a complaint that involves an insurance agent, broker or adjuster or the distribution of insurance by an intermediary, and has the authority to take disciplinary action with respect to a licence holder or a former licence holder. Council may also make application to the Court of King’s Bench for a compliance order for violation of a provision of The Insurance Act of Manitoba or its regulations which involves issues within its delegated authority. The majority of complaints investigated involve current licence holders (“licensees”).

Complaints can be generated from different sources including a member of the public, another licence holder, a public domain, or an external regulator (e.g. Superintendent of Insurance). Council can initiate an investigation (e.g. misrepresentation on an application or renewal, holding out, failure to maintain errors and omissions insurance, unlicensed activity) and complaints from anonymous sources may be considered. Complaints from outside sources must be made in writing and should be on the complaint form located on the Council website.

Upon receipt of a complaint, the first step is to determine whether or not the issues fall within the mandate of the Council. The allegations are considered with respect to whether they could constitute a violation of The Insurance Act of Manitoba, its Regulations, Licensing Rules and/or the applicable Code of Conduct.

When it has been determined that the complaint is within the Council’s mandate, the investigator will commence investigation of the complaint.

The investigator will contact the licensee to outline the issues of concern and request a written response to the allegations from the licensee within a specified timeframe. The Insurance Council of Manitoba is not obligated to provide a copy of the complaint or disclose the source of the complaint at this time.

While no two investigations are the same, the investigator might obtain written statements, conduct interviews, conduct on-site inspections, and obtain documentary evidence.

The investigation may also include contact with:

• the complaining party for additional information or documentation, 
• insurers for policy and documentary evidence,
• the licensee’s employer or sponsor
• other regulatory bodies, and 
• any others who may have information relevant to the complaint.

The response to the allegations should be considered seriously by the licensee, keeping in mind that disciplinary action is a potential outcome of the process. Complete co-operation is required and is in the best interest of the licensee. Written responses should be sent directly to the investigator, not through another party, such as an insurance company or sponsor. The licensee should provide a full and complete written response to the investigator including all information and documentation to support why the allegations are unfounded, or if the allegations are true, to provide any mitigating factors. Copies of emails, letters, meeting notes, recorded phone conversations, or policies are examples of items that may be useful supporting documents.

The response to Council should provide an explanation to all questions relating to the allegations or any other issue that has arisen during the course of the investigation. A complete response avoids delays in the process and ensures that the licensee has a fair opportunity to present his position before the industry Council deliberates on the investigation findings.

As Council has the authority to request full participation of the licensee through The Insurance Act and the applicable Code of Conduct, failing to respond to Council within the specified timeframe can by itself be reason for disciplinary action, regardless of other violations. Where there are extenuating circumstances, extensions may be granted to ensure that the written response is full and complete.

Upon completion of the investigation, the investigator submits a written report and evidence to the appropriate Council (i.e. Life, General (including Adjusters)) for its review in determining whether regulatory violations have occurred. Council also considers the history of the licensee, aggravating circumstances and mitigating circumstances in its review.

Council consists of individuals with industry experience and members of the public. Council members are appointed by the Minister and serve term positions.

If Council determines that there was no substantiated evidence of violation of The Insurance Act of Manitoba, its Regulations, Licensing Rules, or the applicable Code of Conduct, the complaint is closed. The party making the complaint and the licensee are informed in writing of the result of the review.

Where Council determines that minor infractions have occurred but formal disciplinary action is not warranted, a letter of caution may be issued to the licensee. This letter may include recommendations to improve the licensee’s practices in order to avoid future complaints. Letters of caution are retained on file, and may be considered if future complaints of a similar nature are received. The party making the complaint is advised in writing that a letter of caution has been issued.

Where Council determines that the complaint was unsubstantiated or sends a letter of caution, public disclosure is not required. Information concerning the investigation does not appear on Council’s website or in the Council Report.

If Council determines that a violation of The Insurance Act of Manitoba, its Regulations, Licensing Rules, or the applicable Code of Conduct has occurred, they may issue an intended disciplinary decision (the “Intended Decision”). The person subject to discipline is notified in writing and receives an Intended Decision which outlines:

• The allegations and supporting evidence
• Specific regulatory or code violations
• Proposed disciplinary actions (e.g., fines, licence suspension or cancellation, conditions or required education.)

The person subject to discipline may accept the Intended Decision or request a Show-Cause Hearing. If a hearing is requested, the person subject to discipline will be provided with a copy of the evidence reviewed by Council in making is determination.

After the final decision is issued, the person subject to discipline may appeal to the Insurance Agents’ and Adjusters’ Licensing Appeal Board.

Once the decision is final, the complainant is notified in writing. Disciplinary actions are publicly disclosed on ICM’s website and in the Canadian Insurance Regulators Disciplinary Actions database.

If a person subject to discipline disagrees with Council’s Intended Decision, they may request a Show-Cause Hearing to explain why the decision should not proceed. Although all relevant information should have been provided during the investigation, this hearing allows the person subject to discipline to submit additional evidence or testimony.

A written notice is sent with the hearing’s time, date, and location. The evidence Council relied on is only provided if a hearing is requested.

During the hearing:

• The person subject to discipline presents their case, including witnesses and supporting documents.
• Council does not present new evidence.
• Hearings are held privately (in camera), under sworn or affirmed testimony, and recorded by a court reporter.
• Legal counsel represents ICM; the person subject to discipline may also have legal representation and witnesses.
• Witnesses testify one at a time and may not attend until their testimony is complete.
• Council and legal counsel may ask questions.

After the hearing, Council deliberates and may enforce, revise, or reverse its Intended Decision. Additional costs may apply.

The person subject to discipline may appeal the final decision to the Insurance Agents’ and Adjusters’ Licensing Appeal Board, or accept it and waive the right to appeal.

Once the decision is final, the complainant is notified in writing. Disciplinary actions are publicly disclosed on ICM’s website and in the Canadian Insurance Regulators Disciplinary Actions database.

The person subject to discipline may request an appeal before the Insurance Agents’ and Adjusters’ Licensing Appeal Board, an independent body appointed by the Lieutenant Governor in Council.

To initiate an appeal, a written request must be sent directly to the Appeal Board. Both parties must submit their evidence and witness lists at least two weeks before the hearing.

The appeal is a new hearing (trial de novo), where both sides present sworn or affirmed testimony. ICM is represented by legal counsel, and the individual may also have legal representation.

During the hearing:

• Both parties give opening statements.
• Council presents its case, including alleged violations and supporting evidence.
• The person subject to discipline responds with their own evidence and witnesses.
• Board members and Council’s lawyer may ask questions.
• Closing statements are provided by both parties.

After the hearing, the Appeal Board deliberates and may uphold, overturn, or modify Council’s decision—including increasing disciplinary actions or costs. The final decision is communicated in writing to both parties and the complainant.

The person subject to discipline must comply with the Appeal Board’s decision. Failure to do so may result in the suspension of their licence. Final disciplinary actions are publicly disclosed on ICM’s website and in the Canadian Insurance Regulators Disciplinary Actions database.