In Maryland, insurance companies and their agents or producers are regulated by the Maryland Insurance Administration (MIA). The Insurance Commissioner is required to enforce the insurance laws passed by the Maryland General Assembly. By law, all insurance companies are required to file their rates and policy forms with the MIA and other laws regulate insurance claim settlements, non-renewal or cancelation of a policy and insurance premium. If you have a problem with your insurance company or agent, you can file a complaint with the MIA and an investigator will determine whether your insurance company violated Maryland’s insurance laws. Violations are not found in most complaint matters and the law gives the complainant the opportunity to request an administrative hearing after receiving the investigator’s letter finding that there was no violation.

FAQ’s on ADMINISTRATIVE HEARINGS

1. What is an administrative hearing
   
2. How do I request an administrative hearing
   
3. Should I request an administrative hearing?
   
4. Who will decide the case
   
5. May I contact the ALJ or MIA about my case
   
6. Do I need an attorney or can I represent myself
   
7. Should I get an attorney to represent me at the administrative hearing
   
8. Can someone at PICD be my attorney
   
9. May I settle my case without a hearing
   
10. Can I get my complaint file from the MIA
    
11. How do I prepare for my hearing
    
12. Do I need permission to bring people who support my viewpoint?
    
13. How can I change the date for my hearing?
    
14. What will happen at my administrative hearing?
    
15. What is the “burden of proof”?
    
16. What happens if I fail to attend the hearing?
    
17. When will a decision be issued?
    
18. Will I win my case against the insurance company?
    
19. What if I disagree with the decision?

1. What is an administrative hearing?

If you receive a negative decision from the Maryland Insurance Administration (MIA) on your complaint, you may request a formal administrative hearing. Your hearings will either be held at the MIA or at the Office of Administrative Hearings (OAH). At your hearing, you can testify and present evidence supporting your complaint. You can also identify the relevant insurance laws to show that the insurance company violated Maryland law. The insurance company will likely have witnesses or documents to show that it did not violate the insurance laws. Approximately one month after the hearing, the MIA or OAH will issue a written decision that should include the hearing officer's findings of fact and a decision on whether the insurance company's actions constituted a violation of Maryland law. If the hearing is held at the MIA, the full text of all MIA hearing regulations can be found by clicking: COMAR 31.02.01.01 to 31.02.01.14 The OAH hearing procedures are found in the regulations for OAH, COMAR 28.02.01.01 to 28.02.01.27.

2. How do I request an administrative hearing?

Send a letter to the MIA explaining that you want a hearing. The letter must be received by the MIA no later than the 30th day following the date on the letter from MIA explaining the decision made on your complaint. Post-marking the request by the 30th day will not be considered a timely hearing request.

3. Should I request an administrative hearing?

Only you can decide whether to request a hearing on your insurance complaint. You may want to consider what written information or documents you have or could obtain to show that the insurance company violated the insurance laws when it acted or failed to act (e.g. denied coverage, sent a non-renewal notice).

4. Who will decide the case?

If your hearing is held at the MIA, a Deputy Insurance Commissioner or Associate Commissioner may be assigned to hear your case. If your hearing is held at OAH, an Administrative Law Judge (ALJ) will hear the case and issue either a final decision or a proposed decision. If the ALJ is directed by MIA to issue a proposed decision, the case is returned to MIA for a final decision. The ALJ is an attorney and an employee of the OAH, not an employee of the Maryland Insurance Administration. There are many ALJs employed by OAH and one will be appointed to conduct your hearing.

5. May I contact the ALJ or MIA about my case?

No, you should instead contact an OAH Docket Specialist if the case is scheduled to be heard at OAH. If the case will be held at MIA, you can contact the MIA Appeals Clerk. The phone numbers are: OAH, Maryland Insurance Administration Docket Specialist: 410-229-4265; MIA Main Phone Number: 410-468-2000.

6. Do I need an attorney or can I represent myself?

You are permitted to represent yourself. If you want someone to represent you, the person needs to be an attorney. Homeowners often represent themselves at an administrative hearing. The Insurance Company is generally represented by an attorney.

7. Should I get an attorney to represent me at the administrative hearing?

You must decide whether to get an attorney. You may want to consider the cost of legal representation, the complexity of the matter and what amount you may be able to obtain from the insurance company. Insurance policies have limits for the different coverages provided by the policy. For example, a typical limit for a single piece of jewelry is $1,500. Even if a ring is valued at $5,000, the most you could get from the insurance company may only be $1,500. By looking at the limits in your policy, you can identify the maximum amount your policy will pay for a loss.

8. Can someone at PICD be my attorney?

No, the People's Insurance Counsel Division (PICD) is not able to provide legal representation for individual homeowners.

9. May I settle my case without a hearing?

Parties are encouraged to settle their cases and the OAH offers two voluntary methods of alternative dispute resolution. The first way is to have your assigned ALJ work as a settlement judge on your case. In this capacity, the ALJ will assist the parties with settlement discussions as well as provide a realistic assessment of their case. The second option is to have the ALJ work as a mediator. In this capacity, the ALJ will discuss the case with the parties and work toward a resolution with an assessment. If you would like to take advantage of either of these alternative dispute resolution methods, please contact the docket specialist listed on your hearing notice as far in advance as possible. The ALJ who will help you with the settlement will not hear or discuss your case with the ALJ who may eventually be assigned to conduct your hearing. Your case will not be postponed due to your partaking in mediation or settlement discussions.

10. Can I get my complaint file from the MIA?

Yes, your request for a copy of the complaint investigation file should be made in writing and it may take a few weeks for the file to be ready. MIA will charge you for the copies.

11. How do I prepare for my hearing?

Prepare by focusing on what you need to prove. You will need to prove that the action or inaction of the insurance company violated a Maryland insurance law. Review the insurance laws and the hearing rules. (See Essential Information for homeowners with disputes with their insurance company.) Prepare to bring with you any witnesses or documents that will support your case. For example, in the case of a claim denial or insufficient claim payment, you may want to have a document showing the cost of repair work performed by a contractor who repaired your home. You will need the original document, plus three copies (one for you, one that may be referred to by a witness, one for the ALJ or MIA hearing officer, and one for the other party).

12. Do I need permission to bring people who support my viewpoint?

For each person you wish to testify at the hearing, you should submit a written request for a subpoena. You will need the full name and full address of each person you wish to subpoena. You must specifically describe any documents (books, papers, etc.) you wish to subpoena. For each subpoena requested, you will need to provide the requestor’s name, address, and telephone number.

For hearings held at the MIA:
Submit the written request to MIA. If the request is made 15 or fewer days before the scheduled hearing date, the requestor must arrange to have the subpoena served by a person who is not a party to the case and who is at least 18 years old. The person serving the subpoena must prepare an Affidavit stating that service was made and the Affidavit must be filed with MIA. For the full text of the regulation summarized here, click on the MIA hearing regulations in the first FAQ to find COMAR 31.02.01.06.

For hearings held at OAH:
Submit the written request to the Clerk’s Office at the OAH. For the full text of the regulation summarized here, click on: COMAR 28.02.01.14. Subpoenas must be made at least 10 (ten) days before the scheduled hearing. Each subpoena costs $5.00 and the requestor must specify the method of service for the subpoena from the three choices below:

• Personal delivery by an individual 18 years or older who is not a party to the proceeding. The requestor is responsible for all necessary arrangements.
• Certified Mail to the person at the address listed in the subpoena request. The requestor is responsible for the cost of the certified mail.
• Regular Mail if mailed by the OAH.

To confirm the total cost of your request, please contact the docket specialist listed on your hearing notice. Please include all necessary checks with your requests made payable to the “Maryland State Treasurer”.

13. How can I change the date for my hearing?

For hearings held at the MIA:
At least 15 days before the hearing date, you may submit a written request for a postponement. The MIA will decide whether to grant the request. If the postponement request is made fewer than 15 days before the hearing, the postponement will not be allowed unless it is for good cause. Documentation showing the need for the postponement should be provided with the request. For the full text of the MIA regulation on postponements, click on the MIA hearing regulations in the first FAQ to find COMAR 31.02.01.09.

For hearings held at OAH:
Five days or more before the hearing date, you may request a postponement, in writing if you cannot attend your hearing. You also need to send a copy of your request to the other party(ies) at the same time you send it to the OAH. In your request, you need to establish good cause for your inability to attend your hearing with supporting documentation. For example, if you have a health-related reason, provide a doctor’s note confirming your reason. If you have vacation plans, you must provide proof of your plans. Emergency postponement requests can be made by telephone. For more information on postponements, please click on: COMAR 28.02.01.16. Additional information is also available at http://www.oah.state.md.us/postponement.asp.

14. What will happen at my administrative hearing?

The hearing will begin with a brief introduction to the hearing procedures. Each party will be allowed to make opening statements and then witnesses may be called. Each party has the right to examine his or her own witness and the opposing party will then have the right to cross-examine that witness. Documents or other evidence may be presented through witnesses. Decisions will be made on whether each item of evidence will be admitted. After each party has had a chance to present their witnesses, the party that bears the burden of proof may have the right to present rebuttal evidence. At the end of the hearing, each party may present a closing argument.

15. What is the “burden of proof”?

The “burden of proof” is the responsibility to prove the disputed charge or allegation. The party who filed the complaint bears this burden and will present his or her case first. If this party fails to prove his or her case, this party will lose the case. The ALJ or the MIA hearing officer establishes who bears the burden of proof at the beginning of the hearing.

16. What happens if I fail to attend the hearing?

The ALJ or MIA hearing officer may proceed with the hearing in the party’s absence or issue a default order against the absent party. (For the OAH regulation on this topic, click on COMAR 28.02.01.23. For the full text of the MIA regulation, click on the MIA hearing regulations in the first FAQ to find COMAR 31.02.01.10.)

17. When will a decision be issued?

The ALJ or the MIA hearing officer issues a decision on the hearing within 30 days of the hearing date.

18. Will I win my case against the insurance company?

It is impossible to know the outcome of a future hearing. Homeowners who bring documents or have witnesses that support their viewpoint have a better chance than those that come to the hearing without documents or other proof.

19. What if I disagree with the decision?

A request for rehearing can be submitted in writing to the Insurance Commissioner if the hearing was held at the MIA. If the hearing was held at OAH and the ALJ issued a proposed decision, a request for rehearing can be submitted to the Insurance Commissioner. (For the full text of the regulation, click on the MIA hearing regulations in the first FAQ to find COMAR 31.02.01.13.) If the ALJ issued a final decision, the ALJ can revise the decision if there is fraud, a mistake or an irregularity. Requests must be submitted to the ALJ. (See COMAR 28.02.01.27.)
Alternatively, a decision against the person who filed the complaint can be appealed to the Maryland Circuit Court by filing a petition for judicial review within 30 days of the date of the decision or order. The insurance law allowing review by a court is found at section 2-215 of the Insurance Article.

For more questions and answers relating to administrative hearings, please visit the Office of Administrative Hearings website at: http://www.oah.state.md.us/faq.asp

Maryland Attorney General’s Office
People’s Insurance Counsel Division
200 St. Paul Street
Baltimore, Maryland, 21202
410-576-6432
1 (888) 743-0023
email: PIC@oag.state.md.us