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Maine.gov > PFR Home > Insurance Regulation > Consumer Complaint Form

STATE OF MAINE
PROPERTY & CASUALTY DIVISION CONSUMER COMPLAINT FORM


Please note: Although it is most unlikely that you will experience any problems using this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may send an email to: Thomas.R.Michaud@maine.gov.


Important information about filing a complaint

In response to your request for our assistance, please complete this Consumer Complaint Form and return it to this office. The form authorizes the Bureau to investigate the matter on your behalf; and provides us the basic information we need to investigate your complaint. The form may be submitted either electronically or by mail. If you choose to send the electronic form, the Bureau cannot guarantee the confidentiality of your complaint during electronic transmission. Once received by the Bureau your file will be confidential, except that a copy will be provided to the company, agent, or other insurance entity against whom your complaint is made.

PHOTOCOPIES of any correspondence, insurance policies, or other documentation related to your insurance problem (property loss forms, vehicle appraisals, police reports, of all correspondence concerning your complaint and a copy of that portion of your policy relating to your concern, etc.) may be necessary in order for the Division to act upon your complaint.

Your complaint will be assigned to a Claims Examiner who will contact you by mail at the beginning of their investigation and will advise you of their conclusions once the investigation has been completed. This usually takes a minimum of thirty days.

Please note the Bureau does not have the authority to order the payment of monetary judgments, although in some instances we can order restitution for violations of the Insurance Code. There are some disputes that are more appropriately handled by the courts. However, we are often able to help and we will make every effort to see that the insurance companies are complying with Maine Insurance laws.


(PLEASE CHECK ALL THAT APPLY)








Complainant Information










Insurance Information











Consumer Authorization

I hereby authorize that any hospital, physician, other health care provider, person, or company regulated by the Maine Bureau of Insurance may provide the Bureau with any medical information or records needed by the Bureau to investigate my complaint. I specifically authorize release of information about mental health and substance abuse treatment as needed to investigate this complaint. This authorization remains in effect until I revoke it in writing.




Details of Complaint

 

Last Updated: October 1, 2008