Maine policyholders in loggerheads with their delay, denial and recovering insurers can seek help in the claim process by filing a complaint with the Maine Bureau of Insurance.
An insurance claim by the Maine Bureau of Insurance may be filed either by post or electronically. Policyholders who submit their claims electronically can find electronic forms on the institution's website. Electronic forms are available for property and accidents, health, life, annuity, long-term care, disability and medicare supplements.
If you choose to send an electronic form, the Bureau cannot guarantee the confidentiality of your complaint during electronic transmission.
However, the Bureau needs the following information to process a claim:
- Details. You will need to give details of what happened, who was involved, and why you think the company or agent is wrong. Explain if you were trying to solve the problem and details of your efforts to solve the problem.
- Relief. Tell the department what you want the insurance company to do.
- Document. Attach copies (not originals) of current documents, eg. letters, e-mails and other communications, such as messages from the insurance company, explanations of benefits and appeal decisions between you and the insurance company or the representative of your complaint. register explaining how credit claims were calculated a copy of your insurance policy or insurance certificate Property loss form, vehicle reviews, police reports
- Note: If you submit online, any paper copies listed above may be sent either by fax to (207) 624-8599 or sent to the Insurance Agency, 34 State House Station, Augusta, ME 04333. Be sure to include your name and the words "Consumer Complaint." For help calling (207) 624-8475 (in Maine free of charge 1-800-300-5000).  For some types of complaints, you may be required to submit a signed form to have the Bureau investigate your complaint. If so, you will be contacted by a person with the Bureau who will provide you with the necessary form.
Policyholders who wish to file a complaint via the post must print and complete one of the printable forms available on the website note above. The signed application form allows the Bureau to investigate your complaint. If additional space is needed to provide claim information, use a separate paper. Once you have completed, remove the complaint form and mail to the Insurance Agency, 34 State House Station, Augusta, ME 04333.
Once your completed complaint has been received, it will be assigned to a Bureau Investigator who will contact you by mail at the beginning of the investigation. The Bureau will write to the insurance company which summarizes your complaint and request a written response to the questions you raised.
According to the law, all persons or companies licensed in Maine must respond to the Bureau within 14 days, plus an additional three) days for mailing out. If the Bureau does not receive a correct answer, a follow-up letter with a certified letter is sent. However, the company may ask the Agency for extension if the answer requires further investigation.
The Bureau notes that the investigation period will vary. It may require follow-up letters and phone calls. The investigator will advise you on the outcome of the investigation, which usually takes at least thirty days.
Please be aware that the Bureau cannot force the company to satisfy you if no laws have been breached. Act as your lawyer or give you legal advice making medical judgments or making decisions about liability.
The Maine website contains the following practical consumer tips:
- Read your policy. Make sure you understand your coverage and call your insurer or agent if you have any questions.
- Keep a file with all your insurance records.
- If your health plan requires referrals, be sure to get a referral from your Primary Caregiver. Contact your insurance company before you receive the specified services to verify that the company approved the referral.
- Take notes while talking to the company. Enter the date, time and name of the person you are talking to when you call with a question or complaint about your policy or claim.
If additional problems arise or if you need legal advice, please contact our lawyer. 19659021]