Detailed Answer

This overview explains what typically happens after you submit an insurance claim in Vermont, what the insurer is likely to do, and what rights and options you have. This is educational information only and not legal advice.

1. Claim intake and acknowledgement

After you submit a claim (by phone, online, or in writing), the insurer generally records the claim, assigns a claim number, and assigns a claims adjuster or examiner. Most companies send an acknowledgement (by email or mail) that includes the claim number and a contact person. Keep that notice and the claim number; you will need it for all future communications.

2. Investigation

The insurer performs an investigation to determine the facts and whether your policy covers the loss. Typical steps include:

• Contacting you for a recorded or written statement and for supporting documents (photos, receipts, police reports, medical records).
• Inspecting the damaged property or reviewing medical records.
• Requesting estimates or using company-approved vendors for repairs or medical evaluations.
• Checking the policy wording and prior communications to determine coverage and limits.

3. Requests for proof and the proof‑of‑loss

Insurers commonly request proof of loss—documents that verify the loss amount and your right to payment. Provide requested documentation promptly and keep copies. If you fail to provide reasonably requested proof, the company may delay or deny payment.

4. Coverage decision — acceptance, partial payment, or denial

Once the insurer completes its investigation, it will take one of these actions:

• Accept the claim and pay the covered amount (less any deductible).
• Pay part of the claim if some items are covered and others are not, or if the insurer disputes the value.
• Deny the claim in whole or in part and explain the reasons in writing.

If the insurer denies or limits a claim, it generally must provide the reasons for denial and point to the relevant policy language or facts supporting the decision.

5. Repair, replacement, or medical payments

If the claim is accepted, payment may be made directly to you or to a repair vendor. For property claims, the insurer may offer a vendor network or let you pick a repair shop. For bodily-injury claims, insurers often pay medical providers or reimburse you for covered medical expenses.

6. Settlement offers and releases

When an insurer offers to settle, read any release carefully before signing. A full release typically ends your right to pursue that claim further. If you have questions about the settlement amount or the release language, consider getting an independent estimate or legal advice before accepting.

7. If the insurer delays, disputes, or denies payment

If you believe the insurer unreasonably delayed, undervalued, or wrongfully denied the claim, steps you can take include:

• Request a written explanation of the denial or the basis for any disputed amount.
• Provide any additional documentation the insurer requests in a timely way.
• Use any internal appeal or complaint process the insurer provides.
• File a consumer complaint with the Vermont Department of Financial Regulation (DFR) if you think the carrier acted unfairly. Vermont DFR consumer information and complaint forms are available at: https://dfr.vermont.gov/consumer/insurance and to file a complaint: https://dfr.vermont.gov/consumer/file-complaint.
• Consider appraisal (for many property claims) or other contract remedies if your policy includes them.
• Consult an attorney experienced in insurance claims if the dispute is significant or complex.

8. Timelines and “reasonable” handling under Vermont law

Vermont’s insurance statutes and regulations set rules about unfair claim settlement practices and require insurers to handle claims in good faith. These laws generally require prompt and reasonable investigation and timely communication with claimants. The Vermont insurance laws are found in Title 8 of the Vermont Statutes. You can review the insurance statutes at: https://legislature.vermont.gov/statutes/title/08. For consumer guidance and enforcement resources, see the Vermont DFR consumer pages linked above.

9. Practical documents to keep and prepare

To help your claim move smoothly, keep organized records:

• Your policy and declarations page.
• All claim-related correspondence and emails.
• Photographs and videos of damage.
• Receipts, invoices, and estimates.
• Police or incident reports, medical records, and witness contact info.
• Notes of phone calls: date, time, person spoken to, and a short summary.

10. When to talk to an attorney

Consider seeking attorney advice if:

• Your claim is large compared with policy limits.
• The insurer denies coverage but you believe the facts fall within your policy.
• The insurer offers a settlement you think is unreasonably low.
• You face complicated liability or multiple parties are involved.

Key takeaways

• After you file, expect acknowledgement, investigation, and a decision based on policy language and evidence.
• Provide prompt, complete documentation and keep careful records.
• If the insurer delays or denies, you have appeal options, and you may file a complaint with the Vermont Department of Financial Regulation: https://dfr.vermont.gov/consumer/insurance.
• Consult counsel for significant or unresolved disputes.

Disclaimer: This article is for informational purposes only and is not legal advice. It does not create an attorney-client relationship. For legal advice about your particular situation, consult a licensed attorney.

Helpful Hints

• Photograph damage immediately and date-stamp photos on your phone or in file names.
• Back up all documents and correspondence in a dedicated folder (digital and physical).
• When speaking with an adjuster, be factual and avoid admitting fault; if unsure, limit to describing what happened.
• Don’t sign a full release or final settlement until you understand what it closes and you have received promised funds.
• If you get an offer you don’t understand, ask the insurer to send the offer and denial or reservation of rights in writing.
• If the insurer requests a recorded statement and you’re worried about liability, consider consulting an attorney first—especially for serious injury claims.
• Use the Vermont DFR consumer pages to check company complaint histories and to file a complaint if needed: https://dfr.vermont.gov/consumer/insurance.