Step-by-step guide to the insurance-claim process in Montana

Disclaimer: This article is for general information only and is not legal advice. It does not create an attorney-client relationship. For advice about your specific situation, consult a licensed Montana attorney or contact the Montana Commissioner of Securities and Insurance.

Detailed Answer — What typically happens after a claim is submitted

After you submit an insurance claim in Montana, the insurer begins a sequence of administrative and investigative steps. Below is a practical, step-by-step description of that process and important Montana-law considerations you should understand.

1. Acknowledgement and claim number

Most insurers will send an acknowledgement that they received your claim and provide a claim number. This may come by phone, email, or mail. Keep that number and the name of the person who handled the call.

2. Assignment to an adjuster

The insurer usually assigns a claims adjuster or examiner. That person coordinates the investigation, evaluates coverage and damage, and communicates with you or your representative.

3. Initial investigation

The adjuster will investigate the loss. For property claims this can include inspecting damage, taking photos, reviewing contractor estimates, and collecting police or fire reports. For auto claims the insurer may inspect the vehicle and get repair estimates. For liability claims, the insurer will review the reported facts, interview witnesses, and determine whether the policy covers the claim. Cooperate, provide requested documentation, and keep copies of everything you give the insurer.

4. Coverage analysis

The insurer must review your policy terms — coverage limits, exclusions, deductibles, and any endorsements — to decide what the policy covers. If the insurer determines the loss is covered, it will move toward payment or repair authorization. If coverage appears excluded or limited, the insurer should explain the basis for denial or partial payment.

5. Requests for additional information / proof of loss

The insurer may request a signed proof-of-loss form, estimates, receipts, medical records, or other documentation. Provide accurate and timely information; failure to cooperate can affect coverage or payment.

6. Repair estimates, mitigation, and payment options

You must generally mitigate (prevent further loss) and obtain repair estimates. The insurer may offer to pay the actual cash value, replacement cost, or the contractor’s invoice depending on your policy. Discuss whether repairs will be paid directly to you or to the contractor, and whether depreciation will be withheld until repairs are completed.

7. Claim decision: payment, partial payment, or denial

After investigation and coverage review, the insurer issues a decision: pay the claim, offer a partial payment, or deny the claim. If the insurer denies or limits coverage, you are entitled to a written explanation of the reason(s).

8. If you disagree: internal appeal and dispute resolution

If you disagree with the insurer’s decision, you can:

• Ask the insurer for a written explanation and the evidence it relied on.
• Submit additional documentation or a rebuttal letter.
• Use any contractual dispute-resolution method (mediation or appraisal clauses for property claims are common).

9. Regulatory complaint and bad-faith claims

If you believe the insurer is delaying unreasonably, misrepresenting policy provisions, or otherwise acting unfairly, you may file a complaint with the Montana insurance regulator. Montana’s insurance laws address unfair or deceptive trade practices by insurers. For general reference on Montana insurance law and statutes, see the Montana Code (Title 33 — Insurance): https://leg.mt.gov/bills/mca_toc/. To file a consumer complaint or get help contacting the insurer, see the Montana Commissioner of Securities and Insurance: https://csimt.gov/.

10. Litigation and deadlines

If internal appeals and regulatory complaints don’t resolve the dispute, a policyholder can consider filing a civil action. There are state statutes and procedural rules that affect timing and remedies. Because the applicable deadlines and legal theories (contract breach, bad faith, statutory violations) can be complicated, consult a Montana lawyer promptly if you think legal action may be necessary.

Montana-law considerations to keep in mind

• Montana’s insurance laws and administrative rules regulate insurer conduct and provide avenues for consumer complaints. The Montana Commissioner of Securities and Insurance can assist with complaints about delays, denials, or alleged unfair practices. See: https://csimt.gov/.
• Insurers typically must communicate reasons for denials or payments in writing. If you receive a denial, request the insurer’s full explanation and the documents it relied on.
• Contract language controls coverage. Policy limits, exclusions, conditions, and endorsements determine whether a loss is payable.
• Keep prompt, contemporaneous records of all communications, estimates, receipts, and mitigation steps. These documents are essential if you appeal or sue.

Helpful Hints

• Get the claim number and adjuster’s contact details immediately; record call dates, names, and summaries.
• Document the loss with photos and videos before repairs start, if safe to do so.
• Mitigate further damage (temporary repairs) and keep receipts; many policies require reasonable steps to limit loss.
• Provide clear, organized documentation: police/fire reports, receipts, contractor estimates, medical records, and correspondence.
• Ask for written explanations for any denial or partial payment. If facts or records were misunderstood, submit corrected or additional documentation.
• Review your policy’s appraisal, arbitration, or suit limitations so you don’t miss contractual deadlines.
• If the insurer appears to act unreasonably, contact the Montana Commissioner of Securities and Insurance for guidance or to file a complaint: https://csimt.gov/consumer/file-a-complaint/.
• Consider consulting a Montana attorney experienced in insurance disputes before signing releases or accepting a final settlement you think is insufficient.

Following these steps will help you navigate the claim process and preserve your rights under Montana law. If you need help interpreting your policy or deciding whether to pursue a dispute, speaking with a Montana-licensed attorney is the next best step.

Reminder: This information is educational only and not a substitute for legal advice.