44-393. Mandatory Reporting of Suspected Fraud (Insurance Companies and Producers)

INSURANCE 
ARTICLE 66 
INSURANCE FRAUD

44-6601. Act, how cited. 

44-6602. Purpose of act. 

44-6603. Terms, defined. 

44-6604. Fraudulent insurance acts; enumerated. 

44-6605. Immunity from civil liability. 

44-6606. Insurance Fraud Prevention Division; powers and duties; public inspection, limitations; fee. 

44-6607. Civil penalty; costs; section, how construed. 

44-6608. Act, how construed. 

CRIMES AND PUNISHMENTS 
ARTICLE 6 
OFFENSES INVOLVING FRAUD

28-631. Crimes and Punishments

Purpose

The purpose of the Insurance Fraud Act is to confront the problem of insurance fraud in Nebraska by:

• Detecting insurance fraud
• Developing fraud prevention programs
• Investigating complaints of suspicious insurance activity
• Seeking prosecution of individuals committing insurance fraud
• Obtaining restitution of fraudulently obtained benefits

The ultimate goal is to reduce the amount of premium dollars used to pay fraudulent claims.

Immunity

The Insurance Fraud Act also provides immunity from civil liability to any person or entity that reports suspected insurance fraud, without malice, fraudulent intent, or bad faith. The Insurance Fraud Act also provides insurer to insurer immunity. Insurance companies are immune from civil liability when they communicate amongst themselves regarding suspicious claims and insurance activity. This benefits not only insurance companies, but law enforcement as well. Sharing of information avoids the duplication of efforts. §44-6605

Insurance Fraud Violations (Criminal Prosecution)

The Insurance Fraud Act sets forth 12 separate acts which constitute insurance fraud. These 12 violations are set forth in the insurance code Neb.Rev.Stat. §44-6604 and repeated in the criminal code, Neb.Rev.Stat. §28-631.

1. Claims Fraud
2. Aid and Abetting Claims Fraud
3. False Statement to Insurer (death/disability)
4. False Statement to Insurer (contract, agreement, or instrument)
5. Conversion of Premiums
6. Embezzlement from Insurer
7. Issuing or Possessing Fake Policies, Certificates, Identification Cards, Binders
8. Filing False Documents with the Nebraska Department of Insurance
9. Removes, Alters, Diverts, or Destroys Records of an Insurer or Agent
10. Worker's Compensation Premium Avoidance
11. Discount Medical Plan Operation
12. Discount Medical Plan Fee Collection Failure to Provide Benefits

The Insurance Fraud Act follows the same grading of offenses as theft.    Any violation under $500 is a misdemeanor and any violation $500 or greater is a felony.  §28-631(2)(a)

Kimberly P. Church, SCLA, CIFI, AHFI
Fraud Division Chief
Telephone: 402.471.4999  402.471.8334 
E-mail: Kimberly.Church@nebraska.gov

John McGahan
Fraud Investigator
Telephone: 402.471.1842
E-mail::  John.McGahan@nebraska.gov

Connie C. Drake 
Administrative Assistant 
Telephone: 402.471.8336 
E-mail::  Connie.Drake@nebraska.gov

Division E-mail: DOI.FraudPrevention@Nebraska.gov 
Facsimile: 402.742.8313

At the request of the Nebraska Workers' Compensation Court, the Nebraska Department of Insurance has drafted and approved a mandatory amendatory endorsement for attachment to policies providing specific and/or aggregate excess workers' compensation insurance for entities approved as self-insurers in the State of Nebraska. With policy information inserted, this endorsement should be attached to every specific and/or aggregate excess workers' compensation policy issued to an entity approved as a self-insurer in the State of Nebraska.

It is our intent not to approve any provisions in conflict with this endorsement. In addition, so-called "deductible endorsements" (of any form) and retrospective rating will not be approved to be used for excess workers' compensation policies issued to an entity approved as a self-insurer in the State of Nebraska. These actions reflect the policies of the Workers' Compensation Court for approved workers' compensation self-insured employers.

The Nebraska Department of Insurance is affiliating with State Based Systems (SBS), a National Association of Insurance Commissioners business partner. As of July 16, 2012, SBS will be maintaining the Nebraska Department of Insurance's Producer and Company Licensing database. The links below will connect you with the SBS Company and Producer Lookup. Report Generator will allow you to create mailing lists based on specific criteria at a small cost.