Detailed Answer

When you submit an insurance claim in North Dakota, the insurer begins a sequence of actions required by your policy and by state insurance regulation. The basic steps below explain what typically happens, why each step matters, and what you should do to protect your rights.

1. Acknowledgement and assignment

Most insurers will acknowledge receipt of your claim. The insurer usually assigns a claims adjuster or examiner who will be your primary contact. This person opens a claim file, records the date you reported the loss, and begins the investigation.

2. Investigation

The adjuster investigates to confirm coverage and value. Investigation activities commonly include:

• Reviewing your policy to determine covered losses and any limits, deductibles, or exclusions;
• Requesting documentation such as photos, police reports, medical records, estimates, and proof of ownership;
• Inspecting property damage (in-person or via photos/video);
• Interviewing involved parties or witnesses; and
• Consulting experts where needed (e.g., appraisers, medical reviewers).

3. Requests for information (proof of loss)

The insurer can request reasonable documentation to support your claim (often called a “proof of loss”). Provide requested documents promptly and keep copies. Failure to provide requested information can delay or be a basis for denial under the policy.

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

After investigation, the insurer will decide whether to pay the claim in full, make a partial payment, or deny it. When the insurer approves payment, it should explain how the amount was calculated (what was covered, deductible, depreciation, and any applicable policy limits).

5. Communication and explanation

If the insurer denies or partially pays a claim, it should provide a clear explanation of the reasons and point to the policy provisions relied upon. Under North Dakota insurance law and regulations, insurers must handle claims fairly and communicate reasons for adverse decisions. For general statutory and regulatory guidance, consult North Dakota Century Code, Title 26.1 (Insurance): https://www.legis.nd.gov/cencode/t26-1, and the North Dakota Insurance Department consumer resources: https://www.nd.gov/ndins/.

6. Appeals, appraisal, and dispute resolution

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

• Request a re-review or internal appeal with the insurer and submit any additional evidence;
• Use policy dispute procedures such as appraisal (often used in property/value disputes) if your policy contains an appraisal clause;
• Consider mediation or arbitration if the insurer and policy allow or require it; and
• File a complaint with the North Dakota Insurance Department and seek help from state regulators (see ND Insurance Department).

7. Legal remedies and bad faith

If the insurer wrongfully denies or unreasonably delays a valid claim, policyholders may have legal remedies through private lawsuits. North Dakota law regulates unfair claim settlement practices through its insurance statutes and regulations found in Title 26.1. If you believe the insurer acted in bad faith, consult an attorney to evaluate options. The Insurance Department can also accept consumer complaints and may investigate patterns of unfair practices: https://www.nd.gov/ndins/.

8. Payment, subrogation, and claim closure

If the insurer pays, they will issue payment (to you, to a provider, or jointly with a mortgagee/lienholder if applicable). In many cases, the insurer may reserve subrogation rights—meaning the insurer can pursue recovery from a responsible third party and may require you to cooperate. Once the insurer resolves coverage and payment and there are no outstanding issues, the claim closes.

Timing — what to expect

Timeframes vary by policy, claim type, and the complexity of the loss. Simple claims might resolve in days or weeks. Complex claims (major property losses, complicated liability, or medical claims) can take longer. Check your policy for notice and proof-of-loss deadlines and act promptly. If an insurer delays without adequate reason, contact the North Dakota Insurance Department for guidance: https://www.nd.gov/ndins/.

When to contact an attorney

Consider speaking to an attorney if:

• The insurer denies coverage and you believe it should pay;
• The insurer refuses to explain the basis for denial or calculation;
• The insurer delays unreasonably or stops communicating;
• The insurer’s actions raise questions of bad faith or unfair claims handling; or
• Significant money is at stake and you need help negotiating, preserving evidence, or pursuing litigation.

For questions about how North Dakota law applies to your claim, review Title 26.1 of the North Dakota Century Code: https://www.legis.nd.gov/cencode/t26-1, and consult the North Dakota Insurance Department: https://www.nd.gov/ndins/.

Disclaimer

This article is for general informational purposes only and is not legal advice. I am not a lawyer. If you need legal advice about a specific claim or dispute, consult a licensed attorney in North Dakota or contact the North Dakota Insurance Department for consumer assistance: https://www.nd.gov/ndins/.

Helpful Hints

• Read your insurance policy immediately. Know your limits, deductibles, and notice deadlines.
• Document everything: photos, receipts, repair estimates, medical records, names and contact details of witnesses, and a timeline of events.
• Respond quickly to reasonable requests for documentation, but keep copies of everything you send.
• Get written explanations for any denial or partial payment and ask the adjuster to point to the specific policy language relied on.
• If the loss is urgent (medical care or emergency repairs), tell the adjuster and follow up in writing to confirm any verbal approvals.
• Keep a written log of all phone calls and meetings with the insurer, including dates, times, and the names of people you spoke with.
• Before signing any release or full-and-final settlement, understand whether the payment closes your claim permanently.
• If you suspect unfair handling, contact the North Dakota Insurance Department for consumer help: https://www.nd.gov/ndins/.
• Consider consulting an attorney when coverage, large sums, or bad-faith concerns arise.