Fraud

Insurance Fraud Prevention Division

Mission: The mission of the Insurance Fraud Prevention Division is to confront the problem of insurance fraud in Nebraska by prevention, investigation, and prosecution of fraudulent insurance acts in an effort to reduce the amount of premium dollars used to pay fraudulent claims.

The Insurance Fraud Prevention Division is a certified law enforcement division whose duties and responsibilities are to conduct investigations independent of, or in conjunction with, law enforcement agencies when the Division has cause to believe that an act of insurance fraud has been, or is currently being, committed. The Division works in cooperation with law enforcement agencies, prosecuting attorneys, and the insurance industry to investigate and prosecute violations of the Nebraska Insurance Fraud Act (Neb.Rev.Stat. §44-6601 - 44-6608). The Division also undertakes independent studies to determine the extent of fraudulent insurance activity in Nebraska. The Division also provides anti-fraud training to the insurance industry, law enforcement agencies, and civic organizations.

Definition: Insurance fraud is any deliberate deception committed against or by an insurance company, insurance agent, or consumer for the purpose of unjustified financial gain. This occurs during the process of buying, using, selling and underwriting insurance.

 

Nebraska Department of Insurance 
Insurance Fraud Prevention Division

1526 K Street, Suite 200
Lincoln, NE 68509-5087

 

Telephone:402-471-2201
Facsimile: 402-742-8313
Email: DOI.FraudPrevention@Nebraska.gov

 

Excess Workers' Compensation Requirements

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.

Company and Producer Search

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.

 

Prompt Pay Problem Report Form for Health Care Professionals

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Pre-Need Complaint Questionnaire

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Fraudulent Claim Referral Form and Procedures

If a matter involves any type of insurance fraud, fraudulent insurance act, insurance-related theft scheme, or a violation of the Nebraska Insurance Fraud Act, which carries criminal penalties, the matter should be referred to the Insurance Fraud Prevention Division for review.

Fraudulent Claim Referral Form

 


 

Referral Procedure for Consumers

  1. Download a Fraudulent Claim Referral (above) or contact the Insurance Fraud Prevention Division via telephone, letter, facsimile, e-mail or visit our office;
  2. Supply any documents or evidence which support beliefs that a claim may be fraudulent or a violation of the Nebraska Insurance Fraud Act has occurred.

Referral Procedure for Insurance Companies

  1. Electronic referrals can be submitted using the National Insurance Crime Bureau (NICB), for member companies, or the National Association of Insurance Commissioners (NAIC) online reporting forms; or
  2. Download a Fraudulent Claim Referral (above) and submit to the Insurance Fraud Prevention Division or contact the Division directly.

All original documents, along with the postmarked envelopes in which they were received, should be retained in the company's file. In some cases, it may be necessary for an investigator of the Insurance Fraud Prevention Division to have access to the entire claim file. In these instances, an official request either in writing or by telephone will be made by the Division to the appropriate company representative for the entire file.

Department of Insurance Investigator badge
 

NEBRASKA DEPARTMENT OF INSURANCE

INSURANCE FRAUD PREVENTION DIVISION
1526 K St, Suite 200,
Lincoln, NE, 68508

Policyholder Help

The Insurance Complaint Division provides the public with insurance information and assistance and examines consumer complaints.  

File an online complaint:  

ONLINE COMPLAINT FORM    FORMA DE QUEJA EN LINEA 

Please read our Filing An Insurance Complaint brochure for additional information.

Downloadable Complaint Form 

Before filing a complaint:

Important: If you did not live in Nebraska when you purchased the policy, please contact the state in which you lived at the time of purchase.

View a map of Insurance Departments

  • Contact your insurance company and request an explanation.
  • Make sure you have provided all information requested by the company.
  • If you are concerned about the handling of a health insurance claim, ask what appeal and external review procedures are available to you. (Appealing a Health Plan Decision)

If you are not satisfied with the company’s response to your concerns, you may consider filing a complaint.  Be prepared to summarize your complaint, so people who are not familiar with your issue will be able to understand.

What the Nebraska Department of Insurance cannot do:

  • Order the company to pay your claim or refund premium
  • Decide who was at fault in an accident
  • Act as a court of law or provide legal advice
  • Recommend an agent, company, or products
  • Identify an insurance company with whom a particular person may hold a policy
  • Establish the facts surrounding a claim (for example: who is being truthful when there are conflicting reports of a situation)
  • Determine the cause of loss, the value of a claim, the amount owed to you, or act as your adjuster
  • Address issues the Department can’t legally enforce

How filing a complaint with the Nebraska Department of insurance can help:

  • A complaint provides a fresh objective evaluation by individuals with the insurance expertise and usually prompts a new review at the insurance entity
  • The process allows an opportunity to provide additional understanding and documentation if it was missing
  • Complaints allow the Department of Insurance to evaluate whether an insurance company has complied with Nebraska law

For assistance with other entities not regulated by the Department, please refer to the following list of resources:

After you file a complaint:

  • Once received, your complaint will be assigned to an Insurance Complaint Examiner who will send you an acknowledgment letter with a case tracking ID number.  Please reference this tracking ID number for all case inquiries with the Insurance Complaint Division.
  • We will send a copy of your complaint to the company and/or agent and request a detailed explanation.
  • Companies and agents are allowed 15 business days to respond to the Department’s request for information. Some examinations may take longer depending on complexity.
  • After reviewing the company/agent response, the examiner will advise you of the case outcome.

Pre-Need Complaint Questionnaire
Use this form if your complaint concerns the handling of a pre-need trust. A pre-need trust is the purchasing of burial or funeral merchandise (casket, vault, monument, etc.) or services prior to the time of death.

 

 

Contact Insurance Complaint Division:

Phone: 877-564-7323 (toll-free in Nebraska) or 402-471-0888 Fax:402-471-4610

Email Address: doi.insurancecomplaints@nebraska.gov

Mailing Address:

Nebraska Department of Insurance

P.O. Box 95087

Lincoln, NE 68509-5087