Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 60 - UNFAIR PROPERTY AND CASUALTY SETTLEMENT PRACTICES RULE › Section 210-60-008 - Standards for prompt, fair and equitable settlements applicable to all insurers

Current through June 17, 2024
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.