Nebraska Administrative Code
Topic - INSURANCE, DEPARTMENT OF
Title 210 - NEBRASKA DEPARTMENT OF INSURANCE
Chapter 60 - UNFAIR PROPERTY AND CASUALTY SETTLEMENT PRACTICES RULE
Section 210-60-011 - Standards for overpayment recovery applicable to all insurers
Universal Citation: 210 NE Admin Rules and Regs ch 60 ยง 011
Current through March 20, 2024
011.01 No insurer shall withhold any portion of any benefit payable or request any refund, on the basis that the sum withheld or the refund requested is an adjustment or correction of an overpayment made on a prior claim arising under the same policy unless:
011.01(A) The insurer has
within its files clear, documented evidence of an overpayment and written
authorization from the claimant permitting such withholding procedure,
or
011.01(B) The insurer has within
its files clear, documented evidence that:
011.01(B)(1) The overpayment was clearly
erroneous under the provisions of the policy. If the overpayment is the subject
of a reasonable dispute as to facts, this procedure may not be used;
and
011.01(B)(2) The error which
resulted in the overpayment is not a mistake of law; and
011.01(B)(3) The insurer has notified the
claimant within six (6) months of the date of the error, except that in
instances of error prompted by representations or nondisclosures of claimants,
the insurer notifies the claimant within fifteen (15) days after the date that
clear, documented evidence of discovery of such error is included in its file;
and
011.01(B)(4) Such notice states
clearly the nature of the error, the amount of the overpayment, and the three
year limitation as provided in subsection
011.01(C).
011.01(C) An insurer may use the
procedure set forth in subsection
011.01(B)provided
that the claim used to adjust the first overpayment is made no later than three
years after the date of the error.
011.02 For the purpose of Section 011, the date of the error shall be the day on which the draft for benefits is issued.
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