Detailed Answer

This section explains, in plain language, the typical steps that follow after you submit an insurance claim in Michigan, what the insurer must do, what you should expect, and what remedies are available if problems arise. This is educational information only and not legal advice.

1. Claim acknowledgement and claim number

After you submit a claim (by phone, online, or through an agent), the insurer usually confirms receipt and gives you a claim number. Keep that number. Use it on all correspondence and notes. The acknowledgment may include the name of an assigned claims adjuster and a timeline for next steps.

2. Assignment of an adjuster and initial contact

An adjuster or examiner will contact you to gather details. Expect questions about the facts, policy information, injured parties, witnesses, police or repair records, and any immediate need for emergency payments (for example, temporary vehicle rental or emergency medical expenses under a no‑fault policy). Answer truthfully and provide requested documents promptly.

3. Investigation and documentation

The insurer will investigate to verify coverage, the facts, and the amount of loss. That investigation can include:

• Reviewing the policy language to confirm what is covered.
• Requesting records: repair estimates, medical records, receipts, photos, police reports, proof of loss, and written statements.
• Inspecting damaged property or arranging for estimates.
• Interviewing claimants, witnesses, and sometimes third parties.

Provide clear records and cooperate, but do not sign away rights without understanding the consequences.

4. Coverage decision (approval, partial payment, or denial)

Once the insurer finishes its investigation it will make a coverage decision:

• Approval: The insurer agrees the loss is covered and will issue payment or direct repair/benefits per policy terms.
• Partial payment: The insurer pays some benefits but denies others (for example, approves medical treatment but disputes certain charges).
• Denial: The insurer concludes the loss is not covered, a policy condition was not met, or fraud or late reporting prevents coverage.

If the insurer denies or partially denies a claim, it should state the reason in writing. Keep that denial letter and any explanation of benefits.

5. Payment, repair, or benefits delivery

If the claim is approved, the insurer will arrange payment. For property or auto damage this may be a check to you or directly to a repair shop. For personal injury or medical benefits (including Michigan no‑fault benefits), the insurer may pay providers or reimburse you according to policy rules and applicable state law.

6. Follow-up and reopened claims

If new information emerges (additional medical bills, delayed symptoms, additional damage), you can reopen or supplement the claim. Report such changes promptly with supporting records.

7. Dispute resolution options in Michigan

If you disagree with the insurer’s decision, you have several options:

• Ask the insurer for a written explanation and re-evaluation. Request that they identify the specific policy provisions and facts relied on.
• File an internal appeal or dispute through the company’s review process.
• Contact the Michigan Department of Insurance and Financial Services (DIFS) for guidance or to file a consumer complaint: https://www.michigan.gov/difs
• Pursue private litigation. If you believe the insurer acted unlawfully—such as unfair claim practices or breach of contract—you may have a legal claim. Statutes and case law affect deadlines and remedies; consult an attorney promptly or check the Michigan Legislature site for statutes: https://www.legislature.mi.gov

Timing: how long will the process take?

Timing varies by claim type and complexity. Simple claims may resolve in days or weeks. Complex liability, injury, or coverage disputes can take months. Insurers generally must act within a reasonable time; if you feel the insurer is unreasonably delaying, document communications and contact DIFS for assistance.

Common reasons insurers delay or deny claims

• Incomplete or late documentation.
• Questions about whether the policy covers the loss.
• Disputes over cause or responsibility (liability).
• Suspected fraud or misrepresentation.
• Policy exclusions, limits, or lapsed/insufficient coverage.

When to consider an attorney

Consider speaking with an attorney if:

• The insurer denies coverage but you believe the policy covers the loss.
• The insurer unreasonably delays payment or investigation.
• You face large unreimbursed medical bills or significant property loss.
• You receive a low-ball settlement offer that doesn’t cover ongoing losses.
• There are disputes about liability or you are threatened with litigation.

Michigan-specific resources and laws

Michigan consumers can get help from the Michigan Department of Insurance and Financial Services (DIFS): https://www.michigan.gov/difs. For statutory language and deadlines that may affect your claim (for example, Michigan’s no‑fault automobile insurance provisions or provisions of the Insurance Code), search the Michigan Compiled Laws at the Michigan Legislature website: https://www.legislature.mi.gov. If you plan litigation, an attorney can point to the precise statutes and case law that apply to your situation.

Disclaimer

This content is for educational purposes only and does not constitute legal advice. Laws change, and each claim depends on specific facts and policy terms. Consult a licensed Michigan attorney for advice tailored to your situation.

Helpful Hints

• Document everything: dates, names, claim number, phone calls, and copies of all documents you submit or receive.
• Keep originals of police reports, medical records, repair estimates, receipts, and photographs.
• Provide information promptly. Delays in providing requested records can slow or jeopardize a claim.
• Ask for written explanations for denials or partial payments, and save them.
• Check your policy for deadlines, coverage limits, and required notice provisions.
• If you disagree, use the insurer’s internal appeal process first, then contact DIFS if needed: https://www.michigan.gov/difs.
• Before signing settlement releases, have an attorney review them—releases can waive important rights.
• If you need help locating a Michigan attorney, consider referrals from DIFS, local bar associations, or trusted referral services.