Maine policyholders at loggerheads with their delaying, denying and recalcitrant insurers may seek help in the claims process by filing a complaint with the Maine Bureau of Insurance.
An insurance complaint with the Maine Bureau of Insurance may be filed either through the mail or electronically. Policyholders filing their claims electronically can find electronic forms on the Department website. Electronic forms are available for Property & casualty, Health, Life, Annuity, Long Term Care, Disability, and Medicare Supplement.
If you choose to send an electronic form, the Bureau cannot guarantee the confidentiality of your complaint during electronic transmission. However, once received by the Bureau your file will be confidential.
The Bureau needs the following information to process a claim:
- Details. You will need to provide the details of what happened, who was involved, and why you think the company or agent is wrong. Explain whether you tried to resolve the problem and details of your efforts to resolve the problem.
- Relief. Tell the department what you want the insurance company to do.
- Documents. Attach copies (not originals) of applicable documents, such as letters, e-mail and other communications, such as notices from the insurance company, explanations of benefits and appeal decisions, between you and the insurance company or agent concerning your complaint; records explaining how claim payments were calculated; a copy of your insurance policy or certificate of coverage; Property loss forms, vehicle appraisals, police reports; and any additional information you feel might be pertinent to the complaint.
- Note: If filing on line, any paper copies listed above can be either sent by fax to (207) 624-8599 or mailed to Bureau of Insurance, 34 State House Station, Augusta, ME 04333. Make sure to include your name and the words “Consumer Complaint.” For help call (207) 624-8475 (in Maine toll free 1-800-300-5000).
For some types of complaints, you may be required to provide a signed release form to allow the Bureau to investigate your complaint. If this is the case, you will be contacted by a Bureau staff person who will provide you with the necessary form.
Policyholders who want to submit a complaint through the mail should print out and complete one of the printable forms available on the website note above. The signed complaint form authorizes the Bureau to investigate your complaint. If additional space is needed to provide claim information, use a separate sheet of paper. Once completed, detach the complaint form and mail to Bureau of Insurance, 34 State House Station, Augusta, ME 04333.
After your completed complaint is 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 summarizing your complaint and request a written response to the issues you raised.
By law, any person or company licensed in Maine must respond to the Bureau within 14 days, plus an additional three (3) days for mailing time. If the Bureau does not receive a timely response, a follow-up letter is sent by certified mail; however, the company may ask the Bureau for an extension if the response requires additional investigation.
The Bureau notes that the length of an investigation will vary; it may require follow-up letters and phone calls. The investigator will advise you of the outcome of the investigation, which usually takes a minimum of thirty days.
Please be aware the Bureau cannot force the company to satisfy you if no laws have been broken; act as your lawyer or give you legal advice; make medical judgments; or make liability decisions.
The Maine website contains the following practical consumer tips:
- Read your policy. Make sure that 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, make sure to get a referral from your Primary Care Provider. Contact your insurance company before you receive the referred services to verify that the company approved the referral.
- Take notes when you talk to the company; write down the date, time, and name of the person you talk to whenever you call with a question or a complaint about your policy or claim.
Should additional issues arise or if you need legal advice, please contact our attorneys.