Maine Claims Dispute & Statutory Guide
Maine operates an At-Fault automobile insurance framework under Title 24-A of the Maine Revised Statutes (M.R.S.). Under 24-A M.R.S. § 2902-D, every auto liability policy must include at least $2,000 in Medical Payments (MedPay) coverage. Motor vehicle liability is governed by modified comparative fault with a 50% bar under 14 M.R.S. § 156, and hospitals enforce statutory liens under 10 M.R.S. § 3411.
Statutory Framework & Jurisdiction
At-Fault / Traditional Tort (Mandatory $2,000 MedPay Requirement & Maine Hospital Lien Act)
Maine is an at-fault tort liability state that mandates first-party Medical Payments (MedPay) coverage on all automobile liability policies. Under 24-A M.R.S. § 2902-D, insurers must provide at least $2,000 per person in MedPay coverage for reasonable and necessary medical and funeral expenses incurred within 1 year of the accident. Liability is governed by modified comparative negligence under 14 M.R.S. § 156. Maine enforces a 6-year statute of limitations for personal injury tort claims under 14 M.R.S. § 752. Hospitals protect unpaid inpatient and outpatient accounts by filing statutory liens in the county registry of deeds pursuant to 10 M.R.S. § 3411.
PIP / MedPay Coverage & Medical Fee Rules
mandatory Med Pay Requirement
Under 24-A M.R.S. § 2902-D, every motor vehicle liability policy issued in Maine must provide at least $2,000 in MedPay coverage per person (with higher optional limits available), paying medical and funeral expenses incurred within 1 year of the collision
made Whole Doctrine
Under Maine common law, an automobile insurer's right of subrogation for MedPay benefits is subordinate to the Made-Whole doctrine, preventing recovery from a third-party settlement until the injured insured's total damages are satisfied
assignment Of Benefits
Healthcare providers routinely obtain patient assignments of MedPay benefits for direct claims submission to automobile insurers
Official Medical Fee Schedule & Reimbursement Standards
name
Reasonable and Customary Fee Standard
rules
Maine does not enforce a statutory fee schedule table for motor vehicle accident medical bills outside of workers' compensation. Providers bill standard reasonable and customary charges prevailing in the local medical community for comparable care.
cpt Basis
CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims
Preauthorization & Decision Point Review
requirement
Preauthorization is not required by statute for emergency trauma stabilization or initial acute management. Elective surgical interventions and prolonged physical therapy regimens are evaluated under insurer medical necessity guidelines.
carrier Examinations
Under standard auto policy terms, insurers may request medical records or independent physician reviews to evaluate causal relationship to the motor vehicle collision.
Administrative Appeals & Dispute Mechanism
prompt Payment Statute
Under 24-A M.R.S. § 2436, claims for benefits under an insurance policy must be paid within 30 calendar days after receiving complete proof of loss. Claims not paid within 30 days accrue statutory interest at the rate of 1.5% per month, plus reasonable attorney fees.
hospital Lien Act
Under 10 M.R.S. § 3411 et seq., every hospital in Maine has a statutory lien upon personal injury tort claims, settlements, and judgments for the reasonable value of hospital services. To perfect the lien, the hospital must file notice with the registry of deeds in the county where the hospital is located, and serve written notice on the patient and liability insurer prior to distribution of proceeds.
dispute Forum
Maine Superior Court (or District Court for claims within jurisdictional limits) for civil recovery actions.
Critical Statutory & Dispute Deadlines
| Dispute Phase / Trigger Event | Statutory Timeline / Deadline |
|---|---|
| Accident Notice | Notice to insurer as soon as reasonably practicable |
| MedPay Treatment Window | Expenses incurred within 1 year from accident date (24-A M.R.S. § 2902-D) |
| Clean Claim Payment Window | 30 calendar days from receipt of complete proof of loss (24-A M.R.S. § 2436) |
| Registry of Deeds Lien Filing | Must be filed with county registry of deeds prior to settlement payment (10 M.R.S. § 3412) |
| Statute of Limitations | 6 years from accident date for personal injury tort claims (14 M.R.S. § 752); 6 years for written contracts |
Required Evidentiary Filing Checklist
- ✓Maine MedPay Claim Application Form
- ✓Executed Assignment of Benefits (AOB) and medical records authorization
- ✓Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS codes and ICD-10 diagnostic coding
- ✓Contemporaneous medical records, emergency intake documentation, operative reports, and imaging findings
- ✓Recorded Notice of Hospital Lien with county registry of deeds recording stamp (10 M.R.S. § 3412)
- ✓Insurer Explanation of Benefits (EOB) or written explanation of claim determination
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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