Detailed Answer
This section explains, step by step, what typically happens after an insurance claim is submitted in Maine and what rights and options the claimant should expect. This explanation uses common Maine rules and practices and points to consumer resources and the Maine insurance statutes where appropriate. This is for educational purposes only and does not create an attorney-client relationship. It is not legal advice.
1. Acknowledgment and claim intake
After you submit a claim, the insurer normally acknowledges receipt and opens a file. An insurer will typically assign a claims representative or adjuster to the file and ask for basic documents: a claim form, photos, proof of loss, police reports (if applicable), and receipts. Keep copies of everything you send and note the date you reported the loss.
2. Investigation
The insurer investigates the loss. The adjuster may inspect the property, review medical records (for bodily-injury claims), interview witnesses, and request estimates. Cooperate, but avoid giving recorded statements about fault beyond factual details without checking your policy or consulting an attorney. Document all contacts—who you spoke with, the date, and what was discussed.
3. Coverage review and decision
The insurer evaluates whether the policy covers the loss. It may: (a) accept coverage and pay the claim, (b) offer a partial payment, or (c) deny coverage. If the insurer denies the claim or offers less than you expect, you should receive a written explanation referencing the policy provisions that support the insurer’s position.
Under Maine insurance law, insurers must follow rules about fair claim settlement practices. If you believe the insurer misrepresented the policy, intentionally delayed, or failed to promptly investigate, you can review Maine’s consumer protections and consider filing a complaint with the Maine Bureau of Insurance. See Maine’s insurance consumer pages at https://www.maine.gov/pfr/insurance/ and the statutory provisions governing unfair claim settlement practices at 24-A M.R.S.A. §2436.
4. Settlement and payment
If the claim is accepted, the insurer arranges payment. For property claims, this may be a check to you or a joint check with a mortgagee/interestholder. For medical or liability claims, payment may go directly to providers or to you, depending on policy language and prior payments. Read any settlement offer carefully before signing releases that might waive future claims.
5. Claim denial or dispute — next steps
If the insurer denies your claim or you disagree with the settlement amount, you can:
- Request a detailed written explanation of the denial.
- Provide additional documentation to support your position.
- Use any internal appeals process the insurer offers.
- Consider alternative dispute resolution methods in your policy (appraisal, mediation, or arbitration).
- File a complaint with the Maine Bureau of Insurance if you suspect unfair practices: https://www.maine.gov/pfr/insurance/.
- Consult an attorney experienced in insurance claims to evaluate possible breach-of-contract or bad-faith claims.
6. Deadlines and proof-of-loss
Insurance policies include specific deadlines for actions you must take, such as providing a proof of loss. These time limits vary by policy. To protect your rights, act promptly: meet proof-of-loss requirements, respond to reasonable requests from the insurer, and preserve evidence. If you miss a contractual deadline in your policy, you could jeopardize your claim.
7. Legal remedies and consumer complaints
If the insurer refuses payment without a reasonable basis or engages in unfair practices, you may have remedies under Maine law. You can file a consumer complaint with the Maine Bureau of Insurance and, where appropriate, pursue legal action for breach of contract or unfair settlement practices. For general guidance from the state consumer pages, see Maine Bureau of Insurance. For the statute addressing unfair claim settlement practices, see 24-A M.R.S.A. §2436.
What to keep in mind
Insurance claims involve both factual investigation and contract interpretation. The insurer evaluates what the policy covers, and that can lead to disputes. Acting quickly, keeping thorough records, and knowing your policy’s procedures will help you preserve options and protect your rights.
Helpful Hints
- Document everything: dates, names, phone numbers, emails, and copies of all documents you submit or receive.
- Photograph or video the damage promptly before repairs begin.
- Read your policy carefully. Note deadlines for proof-of-loss and any clauses about appraisal or arbitration.
- Get written estimates and keep receipts for emergency repairs and mitigation expenses.
- Don’t sign broad releases or settlement agreements without understanding their scope.
- If the insurer delays or denies unreasonably, file a complaint with the Maine Bureau of Insurance: https://www.maine.gov/pfr/insurance/.
- Consider consulting an attorney experienced with Maine insurance law if the claim is large, complex, or denied.
Disclaimer: This article explains general steps and common Maine practices and cites statutes and consumer resources for reference. It is educational only and not legal advice. For advice about a specific claim, consult a licensed Maine attorney or contact the Maine Bureau of Insurance.