The Insurance Complaints Division of the Nebraska Department of Insurance investigates policyholder complaints against insurance companies and insurance agents. If you have an insurance-related concern and you file a complaint, the Insurance Complaints Division will investigate the matter.
What the Insurance Complaints Division (ICD) Can Do
ICD works to assist policyholders and promote compliance with Nebraska insurance laws.
- The division facilitates communication between policyholders and insurance companies or agents.
- Complaints are investigated to ensure the proper handling of insurance transactions by agents or insurance carriers doing business in Nebraska.
- Through the complaint process, policyholders may learn whether additional information or documentation is needed to support a claim or substantiate a loss.
- If an insurer's handling of a matter appears consistent with policy language, the division will help explain the benefits provided under the insurance policy.
- Documentation provided by consumers and insurers or agents is reviewed to verify compliance with Nebraska insurance laws.
- If evidence of a violation is found, the matter is referred to the Department's Legal Division for further review.
- Complaint data is entered into the Department's electronic tracking system. If a problem appears to be recurring, the Department may recommend changes to how an insurer conducts business.
- When appropriate, findings may be referred to the Department's Market Conduct Division for further examination
What the Insurance Complaints Division Cannot Do
The Nebraska Department of Insurance is an administrative agency and not a court of law. Because of this, there are limits to the authority of ICD.
The division cannot:
- Decide questions of fact or provide legal advice or legal representation.
- Order an insurance company to pay a claim or issue a premium refund.
- Determine the value of property or the extent of damages.
- Establish fault or negligence in an auto accident.
- Resolve billing disputes with medical providers.
ICD personnel are not medical professionals. If a complaint involves whether a treatment is medically necessary or considered experimental or investigative, policyholders should contact their insurer to learn about available internal appeal or external review options.
For more information on health insurance appeals, visit doi.nebraska.gov and select the tile labeled "Appeal a Denied Health Insurance Claim".
Jurisdictional Limitations
Certain complaints fall outside the authority of ICD.
- If a complaint involves life or health insurance coverage purchased in another state, or an auto accident that occurred in another state, policyholders must contact the insurance regulator in that state for assistance.
- ICD has limited, if any, jurisdiction over employer self-insured health plans.
- A jurisdiction map with links to insurance departments across the US is available through the National Association of Insurance Commissioners (NAIC).
How to File an Insurance Complaint
File a Complaint
Policyholders may file a complaint electronically on our complaints form page.
If internet access is not available, consumers may call the toll-free Consumer Hotline at 1-877-564-7323 to request that a paper complaint form be mailed to them.
All relevant sections of the complaint form should be completed to allow the insurance company to identify the complainant as policyholder or claimant.
Summarize Your Problem
When submitting a complain, provide a clear, concise, and complete summary of the issue. The explanation should allow individuals unfamiliar with the situation to understand the concern.
Complaint Review Process
Once a complaint is received:
- The complaint is entered into the Department's complain database.
- The policyholder is sent an email or letter confirming receipt.
- The correspondence includes a tracking identification number and the name of the insurance investigator assigned to the case.
As a note, the investigator assigned to your case will not call unless something is unclear.
The investigator will:
- Forward a copy of the complaint and supporting documents to the insurance company and/or insurance agent.
- Request information necessary to address the policyholder's concerns.
Insurance companies and agents have 15 working days from the receipt of the complaint to respond to the Department's request for information.
ICD attempts to complete its review within one month. Complex cases or those requiring additional information may take longer.
When the review is complete:
- The policyholder receives a copy of the response.
- A summary of the Division's findings is provided.
Additional Assistance
If you have questions about filing a complaint or need assistance accessing complaint forms, please visit the Insurance Complaint Division's "File a Complaint" page.
