210 Neb. Admin. Code, ch. 60, § 008

Current through September 17, 2024
Section 210-60-008 - Standards for prompt, fair and equitable settlements applicable to all insurers
008.01 Within fifteen (15) days after receipt by the insurer of settlement information or a properly executed proof of loss, the claimant shall be advised of the acceptance or denial of the claim by the insurer. No insurer shall deny a claim on the grounds of a specific policy provision, condition or exclusion unless reference to such provision, condition, or exclusion is included in the denial. The denial must be given to the claimant in writing and the claim file of the insurer shall contain documentation of the denial.
008.02 If the insurer needs more time to determine whether a claim should be accepted or denied, it shall so notify the claimant within fifteen (15) days after receipt of settlement information or the proof of loss, giving the reasons more time is needed. If the investigation remains incomplete, the insurer shall, thirty (30) days from the initial notification and every thirty (30) days thereafter, send to the claimant a letter setting forth the reasons additional time is needed for investigation. This subsection shall not apply to claims in litigation.
008.03 Where there is a reasonable basis supported by specific information available for review by the Director of Insurance for suspecting that the claimant has fraudulently caused or contributed to the loss, the insurer is relieved from the requirements of subsections 008.01 to 008.02; provided, however, that the claimant shall be advised of the acceptance or denial of the claim by the insurer within a reasonable time for full investigation after receipt by the insurer of settlement information or a properly executed proof of loss.
008.04 In cases where there is no dispute as to coverage as to one or more portions of the insurance policy and where liability has become reasonably clear, the insurer shall offer to claimants, within fifteen (15) days of receipt of settlement information, amounts within policy limits which are fair and reasonable as shown by the insurer's completed investigation. The insurer shall tender payment within fifteen (15) days of claimant's acceptance. Payment shall be made for any such portion of the insurance policy notwithstanding the existence of disputes as to other portions of the insurance policy coverage where such payment can be made without prejudice to any interested party.
008.05 Insurers shall not fail to settle first party claims on the basis that responsibility for payment should be assumed by others, except as may otherwise be provided by policy provisions.
008.06 Insurers shall not assign a percentage of negligence to a claimant for the purpose of reducing a settlement, when there exists no reasonable evidence upon which the assigned percentage of negligence could be based.
008.07 No insurer shall request or require any insured to submit to a polygraph examination or examination under oath, unless authorized under the applicable insurance contract and not prohibited by state law.
008.08 If the insurer denies a claim or portion thereof, and the claimant objects to such denial, the insurer shall notify the claimant in writing that he or she may have the matter reviewed by the Nebraska Department of Insurance, and the insurer shall provide the claimant with the Department's current address and phone number.

210 Neb. Admin. Code, ch. 60, § 008