Important disclaimer

This article is informational only and does not constitute legal advice. It explains common options under Maine law and points you to Maine resources. Consult a licensed Maine attorney to evaluate your specific case.

Detailed answer — step-by-step options

1. Confirm exactly what the insurer’s offer covers and why it’s low

Request a written breakdown of the insurer’s “top” offer if you do not already have one. Ask the insurer to explain line-by-line how they reached the figure: which medical bills they paid or denied, how they calculated lost wages, and what offsets (like prior payments, policy limits, or comparative fault) they applied. A clear explanation helps you identify weak points you can challenge.

2. Collect and organize documentation

Strengthen your position by assembling complete proof of losses:

• All medical records and itemized bills.
• A treating provider’s statement about required further care and prognosis.
• Pay stubs, tax returns, a letter from your employer, or payroll records showing lost wages and time missed from work.
• Receipts for out-of-pocket expenses (transportation, prescriptions, childcare).
• Communications with the insurer and any settlement offers in writing.

3. Challenge the insurer’s position

With your documentation in hand, you can:

• Send a reasoned demand letter outlining your damages and attaching supporting documents. State a clear settlement demand and deadline for response.
• Request a peer review or independent medical exam if the insurer disputes treatment necessity.
• Ask the insurer to detail how they calculated lost wages and provide the formula or policy provision they used.
• Point out calculation errors, omitted bills, or misapplied policy terms. Often carriers will revise offers when shown clear evidence.

4. Use alternative dispute resolution

If direct negotiation stalls, consider mediation or arbitration:

• Mediation uses a neutral mediator to help you and the insurer reach a voluntary settlement.
• Arbitration is binding if you and the insurer agreed to it under the policy. Review your insurance contract for mandatory arbitration clauses.

5. File a lawsuit

If negotiations and ADR fail, you can sue the responsible party (or the insurer if appropriate). A court can award damages for medical costs, lost wages, pain and suffering, and other losses. Be aware of deadlines to file; act promptly so you do not lose the right to sue. For general information about civil actions and filing in Maine courts, see the Maine Judicial Branch: https://www.courts.maine.gov/.

6. If the injury is work-related — workers’ compensation

If you were injured at work, your employer’s workers’ compensation system often covers medical care and wage replacement even if an insurer for a third party offers little. For information and to file a claim, contact the Maine Workers’ Compensation Board: https://www.maine.gov/wcb/.

7. File a complaint with the Maine Bureau of Insurance

If you suspect the insurer acted unfairly or violated consumer protections, file a complaint with the Maine Bureau of Insurance (Consumer Services). The Bureau can investigate insurer practices and may help obtain explanations or corrective action. Maine Bureau of Insurance consumer information: https://www.maine.gov/pfr/insurance/.

8. Consider an attorney — when and why

Hire a Maine attorney if:

• Your medical care and lost wages are substantial.
• The insurer refuses to pay clearly covered benefits.
• Your case involves complex liability facts or significant disputes (e.g., comparative fault, serious injuries).
• You face a hard deadline to file a lawsuit or an administrative claim.

An attorney can: evaluate damages, send a stronger demand, negotiate or litigate, obtain expert medical or vocational opinions, and protect your legal rights. To find a Maine attorney or a referral, see the Maine State Bar Association: https://www.mainebar.org/.

9. Small claims and other quicker options

If the unpaid medical bills and lost wages are modest, small claims court or simplified civil procedures may be faster and cheaper than full litigation. Check the Maine Judicial Branch site for small claims information and limits: https://www.courts.maine.gov/.

10. Keep an eye on timing and deadlines

Do not delay. Evidence fades, memories dim, and legal filing deadlines can bar claims. If in doubt, consult an attorney quickly to preserve rights.

Helpful hints — practical steps you can take right now

• Get every offer and denial in writing. Request a written explanation of benefits from the insurer.
• Organize medical records chronologically and keep originals of bills and receipts.
• Gather wage proof: pay stubs, employer letters stating hours missed and pay rates, and tax records if self-employed.
• Ask your treating provider for a clear letter describing treatment needed and expected future care and costs.
• Make a detailed log of time missed from work and why.
• Send a firm but professional demand letter before filing suit. A deadline for response improves leverage.
• Consider a single consultation with a Maine attorney — many offer free or low-cost initial meetings and can estimate case value and next steps.
• If you suspect bad faith insurance conduct (unreasonable delay or denial), document all communications and consider filing a complaint with the Maine Bureau of Insurance: https://www.maine.gov/pfr/insurance/consumer/complaint/.