Detailed Answer

1. Immediate Acknowledgement and Claim Intake

After you submit a claim, most insurers send an acknowledgement (by mail, email, or phone). This confirms the insurer received your claim and gives a claim number and a contact person (an adjuster). Keep that claim number and any receipt. The insurer will usually request basic documents such as a police report, photos, receipts, or a proof-of-loss form.

2. Assignment to an Adjuster and Initial Contact

An adjuster (company employee or independent contractor) contacts you to gather facts. Expect questions about how the loss occurred, who was involved, and the extent of damage or injury. Be accurate but avoid speculation. If you don’t understand a question or request, ask for clarification in writing.

3. Investigation

The insurer will investigate coverage and liability. That can include: inspecting damaged property; interviewing claimants, witnesses, or other drivers; obtaining repair or medical estimates; and reviewing your policy language. The insurer must act in good faith while investigating.

4. Reservation of Rights and Requests for Proof

If the insurer is unsure whether your policy covers the loss, it may send a reservation-of-rights letter. This tells you the insurer will investigate but may later deny coverage. The insurer can also ask for a sworn proof of loss or additional documentation—provide reasonable documentation promptly.

5. Coverage Decision: Acceptance, Partial Payment, or Denial

After investigation, the insurer will take one of these actions: approve and pay the claim (in whole or in part), make a settlement offer, or deny the claim. If the insurer decides coverage applies, it should explain what it will pay and why. If the insurer denies the claim, it must state the reasons for denial.

6. Repair, Replacement, or Settlement

For property claims, you may be offered actual cash value (ACV) or replacement cost depending on policy terms. For bodily-injury claims, you may be offered a settlement to resolve medical bills, lost wages, and other damages. Read any release or settlement carefully—signing typically gives up future claims tied to that loss.

7. Dispute, Appeal, or File a Complaint

If you disagree with the insurer’s decision or the amount offered, you can:

• Request a written explanation of the denial or the method used to calculate payments.
• Provide more evidence (estimates, medical records, receipts) and ask for reevaluation.
• Negotiate a settlement through the adjuster or through a public adjuster or attorney.
• File a complaint with Oregon’s Division of Financial Regulation (DFR) if you suspect unfair treatment.

8. Timing and Deadlines

Oregon law and policy terms set timing expectations for insurers, though the exact deadlines depend on the policy and the nature of the claim. If you believe an insurer is unreasonably delaying, contact the insurer in writing and consider filing a complaint with Oregon’s Division of Financial Regulation. For statutory guidance, see Oregon’s insurance code (ORS chapter 746): https://www.oregonlegislature.gov/bills_laws/ors/ors746.html.

9. When to Consult an Attorney

Consider talking with an attorney if:

• Your claim has been denied and you believe it should be covered under your policy.
• The insurer is delaying payment unreasonably or you suspect a bad-faith practice.
• The settlement offer is much lower than reasonable estimates of your losses.
• There are complicated liability or coverage issues (e.g., disputed fault, multiple policies).

You do not need an attorney to make a claim, but an attorney can explain complex coverage issues and negotiate on your behalf.

10. How to File a Complaint with Oregon Regulators

If you have an unresolved dispute or suspect unfair treatment by an insurer, you can contact Oregon’s Division of Financial Regulation, which handles consumer complaints and enforces insurance laws. See their consumer pages here: https://dfr.oregon.gov/. The DFR website explains how to file a complaint and what information you will need.

Important note: This summary provides general guidance about procedures common after a claim is submitted. Your policy language controls coverage and many details. For statutory provisions governing insurer conduct and unfair claim practices, review Oregon’s insurance code: ORS chapter 746.

Helpful Hints

• Keep a dedicated folder (paper or digital) with all claim documents, photos, emails, receipts, and notes of phone calls (date, time, who you spoke with, summary).
• Record the claim number and adjuster’s name and contact info immediately after filing.
• Respond to reasonable document requests quickly. Delay can slow your claim or give the insurer grounds to deny payment.
• Never sign a broad release or settlement without understanding what you are giving up. Ask for the release in writing and, if needed, get legal advice before signing.
• Get at least two independent repair or replacement estimates when possible to compare with the insurer’s estimate.
• Ask the insurer for a written explanation of how they calculated any payment or why they denied coverage.
• If you suspect bad faith or an unfair settlement practice, contact Oregon’s Division of Financial Regulation: https://dfr.oregon.gov/.
• If medical treatment is required, keep complete medical records and itemized bills; these are often key to bodily-injury claims.