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Textbook
1. General Insurance Concepts
2. Producer Roles and Receipt Types
3. Principles of Life Insurance
4. Underwriting
5. Term Life Insurance
6. Whole Life Insurance
7. Variable Insurance Products
8. Group Life Insurance
9. Life Insurance Provisions
10. Annuities
11. Taxation of Life Insurance Products
12. Qualified Retirement Plans
13. Health Insurance Basics
14. Required Policy Provisions
15. Optional Policy Provisions
16. Medical Expense Insurance
17. Group Health Insurance
18. The Affordable Care Act (ACA)
19. Disability Income Insurance
20. Accidental Death and Dismemberment Insurance
21. Long Term Care Insurance
22. Dental Insurance
23. Section 125 Plans and Limited Policies
24. Federal Government Programs
25. Medigap and Medicaid
26. Health Insurance Taxation
Wrapping Up
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Achievable Life & Health

Nebraska State Regulations & NAIC Insurance Law

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Licensing

Any individual applying for a Nebraska resident producer’s license must be at least 18 years old and must be a Nebraska resident before submitting an application.

Pre-licensing course and exam

Nebraska does not have specific pre-licensing requirements, but a resident applicant must pass the examinations for the lines of authority applied for (Neb. Rev. Stat. § 44-4053(1)).

Fingerprints/background check

The Director reviews an applicant’s background before issuing a license, and many states require applicants to submit fingerprints for a state and FBI criminal history check as part of the application.

Controlled business

Controlled business is insurance written on the producer’s own life, property or interests, or on those of the producer’s family, employer or a business the producer controls. A producer may insure themselves and their family, but a license exists to sell insurance to the public, so states generally restrict obtaining or using a license principally to write controlled business.

Non-resident license

A producer licensed in another state can obtain a Nebraska nonresident license without taking Nebraska’s examination. Under the NAIC’s Producer Licensing Model Act, which most states have adopted in some form, a nonresident receives the license if the person:

  • Is currently licensed as a resident, and in good standing, in the home state
  • Has applied (the home-state application or the Uniform Application) and paid the fees
  • Lives in a home state that grants nonresident licenses to residents of this state on the same basis (reciprocity)

Under the same model, a producer who moves to another state files a change of address, with certification from the new home state, within 30 days. A licensed producer who moves into a state applies for a resident license there within 90 days and does not repeat prelicensing education or the examination for lines already held.

Temporary license

Most states allow the insurance regulator to issue a temporary license, without an examination, when one is needed to keep an insurance business serviced. Typical cases are:

  • The surviving spouse or personal representative of a producer who dies or becomes disabled, to allow time to sell the business or train new people
  • A member or employee of a business entity producer, on the death or disability of its designated producer
  • The designee of a producer entering active military service

The regulator may limit what a temporary licensee may do and may require a licensed sponsor who takes responsibility for the temporary licensee’s acts.

The NAIC’s model act limits a temporary license to 180 days.

Military service

Under the NAIC’s model act, a producer who cannot meet license renewal requirements because of military service, or because of another extenuating circumstance such as a long-term medical disability, may request a waiver of those requirements and of any examination, fine or sanction for missing them.

Renewal and reinstatement

A producer license stays in effect only while the producer renews it on schedule: paying the renewal fee and completing continuing education by the due date.

Each state sets its own renewal cycle.

A producer who misses the deadline and lets the license lapse may be able to reinstate it without retaking the examination.

Under the NAIC’s model act, a lapsed license may be reinstated within 12 months of the renewal due date, for a penalty of double the unpaid renewal fee. Each state sets its own window and fee, and after the window closes the person must qualify for a new license.

Continuing education

All states, including Nebraska, have continuing education requirements that must be met to renew any major lines (life, health, property, liability) insurance license. Individuals licensed in Nebraska must complete continuing education before renewing their license. The number of hours required is set by state law and published by the state insurance department.

Notice of change of name or address

Under the NAIC’s model act, the licensee reports a change of address to the regulator within 30 days of the change.

The model also requires a producer to report to the regulator within 30 days any administrative action taken against the producer in another state or by another government agency, counted from the final disposition, and any criminal prosecution in any jurisdiction, counted from the initial pretrial hearing date. A producer who does business under any name other than their legal name must notify the regulator before using it.

Company regulations

An insurance company must be authorized by the Department of Insurance to conduct business in Nebraska. To receive a certificate of authority, the company applies to the Director and files its charter or articles of incorporation, financial statements showing that it meets the state’s capital and surplus requirements, and the other documents and fees the state requires.

Capital and surplus requirement

A company authorized to conduct insurance business in Nebraska must meet minimum corporate standards. The certificate of authority allows the insurer to conduct business in the state only if it maintains the minimum capital or permanent surplus required. In Nebraska, when a domestic stock insurer’s capital is impaired, the Department may, instead of proceeding immediately, require its shareholders to make good the impairment within a reasonable time not exceeding ninety days (Neb. Rev. Stat. § 44-120).

Medigap policies

To reduce confusion about the many types of Medicare supplement policies available, federal law requires national standardization of Medigap policies. Insurers must offer a limited number of standardized Medigap plans developed by the NAIC.

Currently, the available plans are A, B, C, D, F, G, K, L, M, and N. Plans E, H, I, and J have been eliminated. In addition, Plans C and F are not available to individuals who became newly eligible for Medicare on or after January 1, 2020.

Plan A includes the “core” benefits (Parts A and B co-payments, 365 additional days of hospitalization, and the first 3 pints of blood). Its core benefits also include the Part A hospice care coinsurance or copayment. If an insurer sells any Medigap policies in the state, it must offer Plan A.

A Buyer’s Guide and an Outline of Coverage are delivered at the time of application, before accepting any premium payment.

Duties of the Director of Insurance

The Nebraska Director of Insurance is a state executive position in Nebraska state government. The Director oversees the Department of Insurance, which regulates and examines all insurance companies and designated related operations in the state. The Director is appointed by the Governor.

The Director is responsible for establishing and enforcing regulations in the Nebraska insurance market in a manner that protects consumers and encourages economic development.

Those duties include:

  • Investigate all claims and complaints of legal violations relating to insurance.

  • If the Director finds that laws have been violated, the findings and supporting documents may be referred for criminal prosecution.

  • Monitor transactions of all companies, including domestic, foreign, and alien insurance companies.

  • Examine the financial condition of insurers; the NAIC’s model examination law calls for every insurer to be examined at least once every five years. Nebraska examines every domestic insurer at least once every five years (Neb. Rev. Stat. § 44-5904(1)).

  • Audit the books and records of any resident producer as frequently as necessary.

  • Collect all fees associated with producers and insurers.

  • Determine and administer fines associated with violations for insurers and producers.

  • Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.

  • Approve documentation used by insurance companies, such as forms and rates.

Sidenote
Know this...

The Director does not have the authority to arrest, issue injunctions, or sentence jail time. The Director can start the process, but a law officer must make an arrest, and a judge or court of law must issue injunctions or sentence jail time.

In Nebraska, Fraud Prevention Division investigators who are certified law enforcement officers have the authority and power of a peace officer, including to search and arrest with or without a warrant (Neb. Rev. Stat. § 44-6606(2)(a)).

Suspend, revoke or non-renew

The Director has the authority to suspend, revoke, or refuse to renew a license for:

  • Providing false information on the application for an insurance license.

  • Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.

  • Being found guilty of a violation or the noncompliance of insurance regulations and laws…

  • Committing fraud while attempting to obtain an insurance license.

  • Improperly withholding, misappropriating or converting any money or property received in the course of doing insurance business.

  • Providing false information in reference to the terms and conditions of an insurance contract.

  • Having been convicted of a felony. Nebraska’s ground also covers a Class I, II or III misdemeanor (Neb. Rev. Stat. § 44-4059(1)(f)).

  • Having admitted or been found to have committed any insurance unfair trade practice or fraud.

  • Having engaged in activities of a fraudulent nature which allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.

  • Having had a prior insurance license revoked or suspended in a state other than Nebraska.

  • Using another person’s identity and forging their name on an insurance application.

  • Being found guilty of using unethical practices or cheating on an examination for an insurance license.

Cease and desist

If the Director finds that a producer has violated the state’s insurance laws, the Director may order the producer to cease and desist. A cease and desist order does not suspend or revoke the recipient’s registration, but it does require the recipient to stop or limit the activity addressed in the order.

Hearing and penalties

A person facing action by the Director is entitled to notice and an opportunity for a hearing, within time limits set by Nebraska law, and may ask a court to review the final order. In Nebraska the hearing comes first: the Director serves a statement of the charges and a notice of a hearing held at least ten days after service, and only if, after the hearing, a violation is found issues an order to cease and desist (Neb. Rev. Stat. §§ 44-1528(1), 44-1529).

A violation of the insurance laws can bring a civil penalty in addition to action against a license. State law sets the maximum, usually per violation and often with a cap on the total, and a higher tier commonly applies to a violation that was knowing or flagrant. Some violations are also crimes.

After a hearing finds an unfair trade practice, the Director of Insurance may order a penalty of up to $1,000 for each violation, not more than $30,000 in all, or, for a violation committed flagrantly in conscious disregard of the law, up to $15,000 for each violation and $150,000 in all (Neb. Rev. Stat. § 44-1529).

Unfair claims settlement practices

Under the NAIC’s model act, these practices are violations when committed flagrantly and in conscious disregard of the law, or often enough to indicate a general business practice.

  • Intentionally obstructing or delaying claim payment, or delaying a claims investigation, is a violation of regulation.

  • Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.

  • Failing to pay claims without conducting a thorough investigation is a violation of regulation.

  • Making settlement decisions based on information in an application that has been altered without the insured’s consent is a violation of regulation.

  • Denying a claim without conducting a thorough investigation.

  • Attempting to settle a claim for less than fair market value.

Policy forms

Insurers file their policy forms with the Director.

Depending on the line of insurance and the form, a state may require approval before a form is used, often with a period after which a filing that has not been acted on is deemed approved, or may allow the form to be used as soon as it is filed (“file and use”).

If a policy provision conflicts with Nebraska law, the policy is read as amended to conform to the law.

The interest rate an insurer may charge on a life insurance policy loan is also limited by state law.

Record maintenance

A producer keeps records of each transaction (the policies placed, the insureds, the premiums received and any changes) and makes them available for the Director’s inspection.

Nebraska’s Insurers Examination Act requires every company or person subject to it to keep market conduct records for five years after the transaction is completed (Neb. Rev. Stat. § 44-5905(2)(b)(i)(B)).

Fraudulent producer representation

An insurance producer who represents to the public that they are licensed to conduct insurance business in Nebraska, but has not passed the appropriate licensing examination, is in violation of regulation. This includes any means of public communication, such as advertisements, letterheads, circulars, business cards, and other methods of representation.

A producer found guilty of conducting business in Nebraska in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.

Misrepresentation

  • Misrepresentation is prohibited. This includes creating or distributing policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy.

  • Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.

  • Providing inaccurate or incomplete information for the purpose of inducing, or tending to induce, the lapse, exchange, conversion, forfeiture, or surrender of a policy is also a violation (twisting).

False advertising

In Nebraska, an act the Unfair Insurance Trade Practices Act lists, such as false advertising, defamation or misrepresentation, is an unfair trade practice when committed flagrantly and in conscious disregard of the Act, or with such frequency as to indicate a general business practice (Neb. Rev. Stat. § 44-1524).

Making, publishing or circulating an advertisement, announcement or statement about the business of insurance that is untrue, deceptive or misleading is an unfair trade practice under state law, based on the NAIC’s model act. The medium does not matter: the rule reaches newspapers, magazines, radio and television, and also notices, circulars, pamphlets, letters, posters and any other way of placing the statement before the public. The model act’s test is whether the statement is untrue, deceptive or misleading, not whether the person meant to deceive.

Defamation

Defamation of an insurer is an unfair trade practice under state law, based on the NAIC’s model act: making, publishing or circulating an oral or written statement that is false, or maliciously critical of or derogatory to the financial condition of an insurer, and that is calculated to injure that insurer or any other person engaged in the business of insurance. Nebraska’s statute reaches such a statement when it is calculated to injure the insurer itself (Neb. Rev. Stat. § 44-1525(3)). Spreading an untrue rumor that a competing insurer is about to fail is the classic example.

Boycott, coercion and intimidation

Entering into an agreement to commit, or by concerted action committing, any act of boycott, coercion or intimidation that results or tends to result in unreasonable restraint of, or monopoly in, the business of insurance is prohibited.

False financial statements

In Nebraska, knowingly filing with a public official, or knowingly making, publishing or circulating, a false material statement of fact about an insurer’s financial condition is an unfair trade practice (Neb. Rev. Stat. § 44-1525(5)), and so is making a false or fraudulent statement on or relative to an application for a policy to obtain a fee, commission, money or other benefit (Neb. Rev. Stat. § 44-1525(10)).

Illegal inducements

Offering anything of value not specified in the policy (money, a service, a favor or a gift) as an inducement to buy insurance is prohibited unless state law expressly allows it, and any agreement made as part of the sale must be written into the policy.

States differ on promotional gifts. The NAIC’s model act lets producers and insurers give customers non-cash gifts, meals or charitable donations up to an amount the state considers reasonable, as long as the gift is not conditioned on buying or renewing a policy and is offered without unfair discrimination. Each state sets its own limit.

Unfair discrimination

Unfair discrimination is treating people or risks that present the same hazard differently. The NAIC’s model act, on which state unfair trade practices laws are based, prohibits:

  • Unfair discrimination between individuals of the same class and equal expectation of life in life insurance and annuity rates, dividends, benefits or terms
  • Unfair discrimination between individuals of the same class and essentially the same hazard in health insurance premiums, benefits or terms
  • Refusing, limiting or canceling coverage because of a person’s sex, marital status, race, religion or national origin
  • In property and casualty insurance, refusing or limiting coverage solely because of a risk’s geographic location, unless sound underwriting and actuarial principles justify it, or solely because the applicant or insured is physically or mentally impaired

Many states also expressly forbid refusing or limiting coverage solely because a person is blind or partially blind. Nebraska does: refusing or limiting coverage, or charging a different rate, solely because of blindness or partial blindness is unfair discrimination (210 NAC 35-003), and so is refusing or limiting coverage solely because of sex or marital status (Neb. Rev. Stat. § 44-1525(7)(e)).

Errors & omissions

Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties. E&O covers negligence and unintentional mistakes that cause financial harm to clients. It does not cover intentional misconduct, criminal acts, or regulatory fines.

Children covered as dependents

Under the Affordable Care Act, a plan that offers dependent coverage must make it available to an adult child until age 26, whether or not the child is married, a student or financially dependent on the parent.

State law generally requires a policy that covers dependents to cover a newborn from the moment of birth and an adopted child from placement, and may let the insurer require notice and any added premium within a set period to continue the child’s coverage. Policies also generally continue coverage past the age limit for a dependent child who cannot support themselves because of a mental or physical disability that began before that age.

Rebating

Nebraska licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance.

Sidenote
Know this...

To “solicit” or “negotiate” insurance implies that the person is licensed.

Sharing commission

The splitting or sharing of commissions with a licensed producer is allowed. Both parties must be licensed in the line of business in which the proposed commission is to be split. Under the NAIC’s model act, a commission may also be paid to an insurance agency, or to a person who does not sell, solicit or negotiate insurance.

Twisting

Providing false information or expressing derogatory ideas about the financial condition of a competitor company with the intent to lapse or surrender an existing policy is a violation of the law. Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information are prohibited.

Under the NAIC’s model act, twisting is a misrepresentation made to induce a policyholder to lapse, forfeit, surrender, exchange or convert a policy. A false or maliciously critical statement about a competing insurer’s finances, made to injure it, is defamation.

Unfair marketing practices

The Department of Insurance is responsible for establishing minimum standards for full and fair disclosure of policy content. The Department also requires standardization and simplification of the terms used to describe insurance coverage. Advertising may not involve the following:

  • Any statement or implication that policies are approved, or that the financial condition of a company is endorsed, by any government agency or by any independent group, individual, organization or society, unless that is the fact.

  • Any statements regarding advertising that are false or untrue in reference to the time frame in which claims are paid.

Gramm-Leach Bliley Act (GLBA)

This law repealed the parts of the Glass-Steagall Act of 1933 that kept commercial banks and securities firms apart, and allowed the consolidation of commercial banks, investment institutions and insurance companies. GLBA established a framework of responsibilities for federal and state regulators for these financial industries. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.

McCarran-Ferguson Act

Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level. Grants insurers a limited exemption from federal antitrust legislation. Since 2021 the exemption does not cover the business of health insurance, apart from narrow activities such as sharing historical loss data (15 U.S.C. § 1013(c)).

National Association of Insurance Commissioners (NAIC)

The U.S. standard-setting and regulatory support organization is created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Fair Credit Reporting Act

The Fair Credit Reporting Act (FCRA, 15 U.S.C. 1681) regulates consumer reporting agencies and the use of consumer reports, such as credit reports, MIB records and investigative reports, including in insurance underwriting.

  • When an insurer requests an investigative consumer report, it must disclose that to the consumer within 3 days of the request
  • When an insurer takes adverse action based on a consumer report, it must notify the consumer and identify the reporting agency. The consumer then has 60 days to request a free copy of the report and may dispute inaccurate information

Privacy Act of 1974

The federal Privacy Act of 1974 governs how federal agencies handle personal information. It does not apply to private insurers. An insurer’s use of an applicant’s personal information is governed by the FCRA, the Gramm-Leach-Bliley Act and state insurance privacy law.

In states that adopted the NAIC’s Insurance Information and Privacy Protection Model Act, an authorization to collect personal information signed with an application is valid for no more than 30 months for life, health or disability insurance and one year for property or casualty insurance.

Telemarketing

The National Do Not Call Registry is a list of telephone numbers whose owners do not want to receive telemarketing calls. Telemarketers may not call registered numbers without the person’s permission or an established business relationship, and unsolicited sales calls:

  • May be made only between 8 a.m. and 9 p.m. in the recipient’s local time
  • Must disclose the caller’s identity, the company the caller represents and that the purpose is a sale

CAN-SPAM

A commercial email must:

  • Be identified clearly as an advertisement
  • Carry accurate header information and a subject line that is not deceptive
  • Include the sender’s valid physical postal address
  • Offer a way to opt out, and the sender must honor an opt-out within 10 business days

Licensing

  • Minimum age: 18, must be Nebraska resident to apply
  • No specific pre-licensing course required, but must pass exam for lines of authority

Pre-licensing course and exam

  • Nebraska: no pre-licensing course requirement
  • Must pass exam for lines applied for (Neb. Rev. Stat. § 44-4053(1))

Fingerprints/background check

  • Director reviews background before licensing
  • Fingerprints often required for state/FBI criminal history check

Controlled business

  • Insurance written on producer’s own life/property/family/employer/controlled business
  • License intended for selling to public; states restrict license used mainly for controlled business

Non-resident license

  • Nonresident license granted without Nebraska exam if licensed/good standing in home state, applied + paid fees, and reciprocity exists
  • Change of address: file within 30 days with certification
  • Move to new state: apply for resident license within 90 days, no repeat of prelicensing/exam for held lines

Temporary license

  • Issued without exam to keep business serviced (e.g., death/disability of producer, military service)
  • Regulator may require licensed sponsor
  • Model act caps temporary license at 180 days

Military service

  • Producers unable to renew due to military service/extenuating circumstances may request waiver of requirements, exams, fines, sanctions

Renewal and reinstatement

  • Must renew on schedule: fee + continuing education
  • States set own renewal cycle
  • Model act: reinstate lapsed license within 12 months, penalty = double unpaid fee; after window, must requalify

Continuing education

  • Required for renewal of major lines (life, health, property, liability)
  • Hours set by state law/published by insurance department

Notice of change of name or address

  • Report address change within 30 days
  • Report administrative actions/criminal prosecutions within 30 days of final disposition/pretrial hearing
  • Must notify regulator before using assumed business name

Company regulations

  • Insurer must be authorized (certificate of authority) by Department of Insurance
  • Application includes charter, financial statements, capital/surplus proof, fees

Capital and surplus requirement

  • Insurer must maintain minimum capital/surplus to keep certificate of authority
  • Nebraska: impaired capital allows up to 90 days for shareholders to correct (Neb. Rev. Stat. § 44-120)

Medigap policies

  • Federally standardized plans: A, B, C, D, F, G, K, L, M, N (E, H, I, J eliminated)
  • Plans C & F unavailable to those newly eligible on/after Jan 1, 2020
  • Plan A = core benefits; must be offered if insurer sells any Medigap plans
  • Buyer’s Guide & Outline of Coverage given at application, before premium payment

Duties of the Director of Insurance

  • Appointed by Governor; oversees Department of Insurance
  • Investigates violations, examines insurers (domestic every 5 years per Neb. Rev. Stat. § 44-5904(1))
  • Audits producer records as needed, collects fees, issues fines, approves forms/rates
  • No authority to arrest, injunct, or sentence jail time (law enforcement/courts do that)
  • Nebraska Fraud Prevention Division investigators have peace officer authority (Neb. Rev. Stat. § 44-6606(2)(a))

Suspend, revoke or non-renew

  • Grounds: false application info, fraud, felony/misdemeanor conviction (Class I, II, III in NE), unfair trade practices, misappropriation of funds, prior license revocation elsewhere, exam cheating, identity forgery

Cease and desist

  • Ordered when producer violates insurance laws
  • Does not suspend/revoke license; only stops/limits specific activity

Hearing and penalties

  • Entitled to notice & hearing before license action; hearing held at least 10 days after service (Neb. Rev. Stat. §§ 44-1528(1), 44-1529)
  • Civil penalties: up to $1,000/violation, max $30,000; flagrant/knowing violations up to $15,000/violation, max $150,000

Unfair claims settlement practices

  • Violations include: delaying claims, failing to investigate, denying without investigation, settling below fair market value, using altered application info
  • Violation triggered if flagrant/knowing or frequent business practice

Policy forms

  • Insurers file forms with Director; may require approval or allow “file and use”
  • Conflicting policy provisions read as amended to match law
  • Life insurance policy loan interest rate capped by state law

Record maintenance

  • Producers keep transaction records, available for Director’s inspection
  • Nebraska requires market conduct records kept 5 years (Neb. Rev. Stat. § 44-5905(2)(b)(i)(B))

Fraudulent producer representation

  • Illegal to claim licensure without passing exam, via any public communication
  • Can result in suspension/revocation of other licenses held

Misrepresentation

  • Includes false policy illustrations/quotes, inaccurate comparisons
  • Twisting: inducing lapse/surrender via inaccurate info

False advertising

  • Untrue, deceptive, or misleading statements about insurance business = unfair trade practice
  • Applies across all media; intent to deceive not required (Neb. Rev. Stat. § 44-1524)

Defamation

  • False or maliciously critical statements about insurer’s financial condition, meant to injure
  • Nebraska statute targets harm to the insurer itself (Neb. Rev. Stat. § 44-1525(3))

Boycott, coercion and intimidation

  • Prohibited if resulting in unreasonable restraint or monopoly in insurance business

False financial statements

  • Knowingly filing/publishing false financial statements about insurer = violation (Neb. Rev. Stat. § 44-1525(5))
  • False statements on applications for personal gain also prohibited (§ 44-1525(10))

Illegal inducements

  • Offering unlisted value/gifts to induce purchase is prohibited unless expressly allowed
  • Model act permits reasonable non-cash gifts/donations if not conditioned on purchase

Unfair discrimination

  • Prohibits differing treatment of same-class/risk individuals in rates, benefits, terms
  • Cannot discriminate based on sex, marital status, race, religion, national origin
  • Property/casualty: cannot discriminate solely by geographic location or disability without actuarial basis
  • Nebraska bans discrimination based on blindness (210 NAC 35-003) and sex/marital status (§ 44-1525(7)(e))

Errors & omissions

  • E&O insurance = professional liability coverage for producers
  • Covers negligence/unintentional mistakes; excludes intentional/criminal acts and fines

Children covered as dependents

  • ACA: dependent coverage available until age 26
  • State law: newborns covered from birth, adopted children from placement
  • Disabled dependents may continue coverage past age limit if disability began before limit

Rebating

  • Prohibited: giving refunds/discounts/credits to induce insurance purchase
  • Soliciting/negotiating insurance implies licensure

Sharing commission

  • Allowed if both parties licensed in same line
  • Model act allows commission to agencies or non-selling persons

Twisting

  • Misrepresentation to induce lapse/surrender/exchange of policy
  • Related to defamation if statements are false/malicious about competitor

Unfair marketing practices

  • Dept. of Insurance sets disclosure/standardization requirements
  • Advertising cannot falsely imply government/organization endorsement
  • Cannot misstate claim payment timeframes

Gramm-Leach Bliley Act (GLBA)

  • Repealed key parts of Glass-Steagall; allows merging of banks, investment firms, insurers
  • Establishes regulatory framework across federal/state regulators

McCarran-Ferguson Act

  • 1945 law: insurance regulated at state level
  • Grants limited antitrust exemption; health insurance exemption removed since 2021 (15 U.S.C. § 1013(c))

National Association of Insurance Commissioners (NAIC)

  • Standard-setting body of state insurance regulators (50 states, DC, 5 territories)
  • Establishes standards, best practices, peer review, coordinated oversight

Fair Credit Reporting Act

  • Regulates consumer reporting agencies/reports used in underwriting
  • Investigative report request: disclose to consumer within 3 days
  • Adverse action: must notify consumer; consumer has 60 days to request free report/dispute

Privacy Act of 1974

  • Governs federal agencies’ handling of personal info; not applicable to private insurers
  • Insurer privacy governed by FCRA, GLBA, state law
  • NAIC model: authorization valid up to 30 months (life/health/disability) or 1 year (property/casualty)

Telemarketing

  • Do Not Call Registry protects listed phone numbers
  • Calls allowed only 8 a.m.–9 p.m. local time
  • Must disclose caller identity, company, and sales purpose

CAN-SPAM

  • Commercial emails must be labeled as ads, have accurate headers/subject lines
  • Must include sender’s physical address
  • Must provide opt-out, honored within 10 business days

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Nebraska State Regulations & NAIC Insurance Law

Licensing

Any individual applying for a Nebraska resident producer’s license must be at least 18 years old and must be a Nebraska resident before submitting an application.

Pre-licensing course and exam

Nebraska does not have specific pre-licensing requirements, but a resident applicant must pass the examinations for the lines of authority applied for (Neb. Rev. Stat. § 44-4053(1)).

Fingerprints/background check

The Director reviews an applicant’s background before issuing a license, and many states require applicants to submit fingerprints for a state and FBI criminal history check as part of the application.

Controlled business

Controlled business is insurance written on the producer’s own life, property or interests, or on those of the producer’s family, employer or a business the producer controls. A producer may insure themselves and their family, but a license exists to sell insurance to the public, so states generally restrict obtaining or using a license principally to write controlled business.

Non-resident license

A producer licensed in another state can obtain a Nebraska nonresident license without taking Nebraska’s examination. Under the NAIC’s Producer Licensing Model Act, which most states have adopted in some form, a nonresident receives the license if the person:

  • Is currently licensed as a resident, and in good standing, in the home state
  • Has applied (the home-state application or the Uniform Application) and paid the fees
  • Lives in a home state that grants nonresident licenses to residents of this state on the same basis (reciprocity)

Under the same model, a producer who moves to another state files a change of address, with certification from the new home state, within 30 days. A licensed producer who moves into a state applies for a resident license there within 90 days and does not repeat prelicensing education or the examination for lines already held.

Temporary license

Most states allow the insurance regulator to issue a temporary license, without an examination, when one is needed to keep an insurance business serviced. Typical cases are:

  • The surviving spouse or personal representative of a producer who dies or becomes disabled, to allow time to sell the business or train new people
  • A member or employee of a business entity producer, on the death or disability of its designated producer
  • The designee of a producer entering active military service

The regulator may limit what a temporary licensee may do and may require a licensed sponsor who takes responsibility for the temporary licensee’s acts.

The NAIC’s model act limits a temporary license to 180 days.

Military service

Under the NAIC’s model act, a producer who cannot meet license renewal requirements because of military service, or because of another extenuating circumstance such as a long-term medical disability, may request a waiver of those requirements and of any examination, fine or sanction for missing them.

Renewal and reinstatement

A producer license stays in effect only while the producer renews it on schedule: paying the renewal fee and completing continuing education by the due date.

Each state sets its own renewal cycle.

A producer who misses the deadline and lets the license lapse may be able to reinstate it without retaking the examination.

Under the NAIC’s model act, a lapsed license may be reinstated within 12 months of the renewal due date, for a penalty of double the unpaid renewal fee. Each state sets its own window and fee, and after the window closes the person must qualify for a new license.

Continuing education

All states, including Nebraska, have continuing education requirements that must be met to renew any major lines (life, health, property, liability) insurance license. Individuals licensed in Nebraska must complete continuing education before renewing their license. The number of hours required is set by state law and published by the state insurance department.

Notice of change of name or address

Under the NAIC’s model act, the licensee reports a change of address to the regulator within 30 days of the change.

The model also requires a producer to report to the regulator within 30 days any administrative action taken against the producer in another state or by another government agency, counted from the final disposition, and any criminal prosecution in any jurisdiction, counted from the initial pretrial hearing date. A producer who does business under any name other than their legal name must notify the regulator before using it.

Company regulations

An insurance company must be authorized by the Department of Insurance to conduct business in Nebraska. To receive a certificate of authority, the company applies to the Director and files its charter or articles of incorporation, financial statements showing that it meets the state’s capital and surplus requirements, and the other documents and fees the state requires.

Capital and surplus requirement

A company authorized to conduct insurance business in Nebraska must meet minimum corporate standards. The certificate of authority allows the insurer to conduct business in the state only if it maintains the minimum capital or permanent surplus required. In Nebraska, when a domestic stock insurer’s capital is impaired, the Department may, instead of proceeding immediately, require its shareholders to make good the impairment within a reasonable time not exceeding ninety days (Neb. Rev. Stat. § 44-120).

Medigap policies

To reduce confusion about the many types of Medicare supplement policies available, federal law requires national standardization of Medigap policies. Insurers must offer a limited number of standardized Medigap plans developed by the NAIC.

Currently, the available plans are A, B, C, D, F, G, K, L, M, and N. Plans E, H, I, and J have been eliminated. In addition, Plans C and F are not available to individuals who became newly eligible for Medicare on or after January 1, 2020.

Plan A includes the “core” benefits (Parts A and B co-payments, 365 additional days of hospitalization, and the first 3 pints of blood). Its core benefits also include the Part A hospice care coinsurance or copayment. If an insurer sells any Medigap policies in the state, it must offer Plan A.

A Buyer’s Guide and an Outline of Coverage are delivered at the time of application, before accepting any premium payment.

Duties of the Director of Insurance

The Nebraska Director of Insurance is a state executive position in Nebraska state government. The Director oversees the Department of Insurance, which regulates and examines all insurance companies and designated related operations in the state. The Director is appointed by the Governor.

The Director is responsible for establishing and enforcing regulations in the Nebraska insurance market in a manner that protects consumers and encourages economic development.

Those duties include:

  • Investigate all claims and complaints of legal violations relating to insurance.

  • If the Director finds that laws have been violated, the findings and supporting documents may be referred for criminal prosecution.

  • Monitor transactions of all companies, including domestic, foreign, and alien insurance companies.

  • Examine the financial condition of insurers; the NAIC’s model examination law calls for every insurer to be examined at least once every five years. Nebraska examines every domestic insurer at least once every five years (Neb. Rev. Stat. § 44-5904(1)).

  • Audit the books and records of any resident producer as frequently as necessary.

  • Collect all fees associated with producers and insurers.

  • Determine and administer fines associated with violations for insurers and producers.

  • Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.

  • Approve documentation used by insurance companies, such as forms and rates.

Sidenote
Know this...

The Director does not have the authority to arrest, issue injunctions, or sentence jail time. The Director can start the process, but a law officer must make an arrest, and a judge or court of law must issue injunctions or sentence jail time.

In Nebraska, Fraud Prevention Division investigators who are certified law enforcement officers have the authority and power of a peace officer, including to search and arrest with or without a warrant (Neb. Rev. Stat. § 44-6606(2)(a)).

Suspend, revoke or non-renew

The Director has the authority to suspend, revoke, or refuse to renew a license for:

  • Providing false information on the application for an insurance license.

  • Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.

  • Being found guilty of a violation or the noncompliance of insurance regulations and laws…

  • Committing fraud while attempting to obtain an insurance license.

  • Improperly withholding, misappropriating or converting any money or property received in the course of doing insurance business.

  • Providing false information in reference to the terms and conditions of an insurance contract.

  • Having been convicted of a felony. Nebraska’s ground also covers a Class I, II or III misdemeanor (Neb. Rev. Stat. § 44-4059(1)(f)).

  • Having admitted or been found to have committed any insurance unfair trade practice or fraud.

  • Having engaged in activities of a fraudulent nature which allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.

  • Having had a prior insurance license revoked or suspended in a state other than Nebraska.

  • Using another person’s identity and forging their name on an insurance application.

  • Being found guilty of using unethical practices or cheating on an examination for an insurance license.

Cease and desist

If the Director finds that a producer has violated the state’s insurance laws, the Director may order the producer to cease and desist. A cease and desist order does not suspend or revoke the recipient’s registration, but it does require the recipient to stop or limit the activity addressed in the order.

Hearing and penalties

A person facing action by the Director is entitled to notice and an opportunity for a hearing, within time limits set by Nebraska law, and may ask a court to review the final order. In Nebraska the hearing comes first: the Director serves a statement of the charges and a notice of a hearing held at least ten days after service, and only if, after the hearing, a violation is found issues an order to cease and desist (Neb. Rev. Stat. §§ 44-1528(1), 44-1529).

A violation of the insurance laws can bring a civil penalty in addition to action against a license. State law sets the maximum, usually per violation and often with a cap on the total, and a higher tier commonly applies to a violation that was knowing or flagrant. Some violations are also crimes.

After a hearing finds an unfair trade practice, the Director of Insurance may order a penalty of up to $1,000 for each violation, not more than $30,000 in all, or, for a violation committed flagrantly in conscious disregard of the law, up to $15,000 for each violation and $150,000 in all (Neb. Rev. Stat. § 44-1529).

Unfair claims settlement practices

Under the NAIC’s model act, these practices are violations when committed flagrantly and in conscious disregard of the law, or often enough to indicate a general business practice.

  • Intentionally obstructing or delaying claim payment, or delaying a claims investigation, is a violation of regulation.

  • Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.

  • Failing to pay claims without conducting a thorough investigation is a violation of regulation.

  • Making settlement decisions based on information in an application that has been altered without the insured’s consent is a violation of regulation.

  • Denying a claim without conducting a thorough investigation.

  • Attempting to settle a claim for less than fair market value.

Policy forms

Insurers file their policy forms with the Director.

Depending on the line of insurance and the form, a state may require approval before a form is used, often with a period after which a filing that has not been acted on is deemed approved, or may allow the form to be used as soon as it is filed (“file and use”).

If a policy provision conflicts with Nebraska law, the policy is read as amended to conform to the law.

The interest rate an insurer may charge on a life insurance policy loan is also limited by state law.

Record maintenance

A producer keeps records of each transaction (the policies placed, the insureds, the premiums received and any changes) and makes them available for the Director’s inspection.

Nebraska’s Insurers Examination Act requires every company or person subject to it to keep market conduct records for five years after the transaction is completed (Neb. Rev. Stat. § 44-5905(2)(b)(i)(B)).

Fraudulent producer representation

An insurance producer who represents to the public that they are licensed to conduct insurance business in Nebraska, but has not passed the appropriate licensing examination, is in violation of regulation. This includes any means of public communication, such as advertisements, letterheads, circulars, business cards, and other methods of representation.

A producer found guilty of conducting business in Nebraska in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.

Misrepresentation

  • Misrepresentation is prohibited. This includes creating or distributing policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy.

  • Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.

  • Providing inaccurate or incomplete information for the purpose of inducing, or tending to induce, the lapse, exchange, conversion, forfeiture, or surrender of a policy is also a violation (twisting).

False advertising

In Nebraska, an act the Unfair Insurance Trade Practices Act lists, such as false advertising, defamation or misrepresentation, is an unfair trade practice when committed flagrantly and in conscious disregard of the Act, or with such frequency as to indicate a general business practice (Neb. Rev. Stat. § 44-1524).

Making, publishing or circulating an advertisement, announcement or statement about the business of insurance that is untrue, deceptive or misleading is an unfair trade practice under state law, based on the NAIC’s model act. The medium does not matter: the rule reaches newspapers, magazines, radio and television, and also notices, circulars, pamphlets, letters, posters and any other way of placing the statement before the public. The model act’s test is whether the statement is untrue, deceptive or misleading, not whether the person meant to deceive.

Defamation

Defamation of an insurer is an unfair trade practice under state law, based on the NAIC’s model act: making, publishing or circulating an oral or written statement that is false, or maliciously critical of or derogatory to the financial condition of an insurer, and that is calculated to injure that insurer or any other person engaged in the business of insurance. Nebraska’s statute reaches such a statement when it is calculated to injure the insurer itself (Neb. Rev. Stat. § 44-1525(3)). Spreading an untrue rumor that a competing insurer is about to fail is the classic example.

Boycott, coercion and intimidation

Entering into an agreement to commit, or by concerted action committing, any act of boycott, coercion or intimidation that results or tends to result in unreasonable restraint of, or monopoly in, the business of insurance is prohibited.

False financial statements

In Nebraska, knowingly filing with a public official, or knowingly making, publishing or circulating, a false material statement of fact about an insurer’s financial condition is an unfair trade practice (Neb. Rev. Stat. § 44-1525(5)), and so is making a false or fraudulent statement on or relative to an application for a policy to obtain a fee, commission, money or other benefit (Neb. Rev. Stat. § 44-1525(10)).

Illegal inducements

Offering anything of value not specified in the policy (money, a service, a favor or a gift) as an inducement to buy insurance is prohibited unless state law expressly allows it, and any agreement made as part of the sale must be written into the policy.

States differ on promotional gifts. The NAIC’s model act lets producers and insurers give customers non-cash gifts, meals or charitable donations up to an amount the state considers reasonable, as long as the gift is not conditioned on buying or renewing a policy and is offered without unfair discrimination. Each state sets its own limit.

Unfair discrimination

Unfair discrimination is treating people or risks that present the same hazard differently. The NAIC’s model act, on which state unfair trade practices laws are based, prohibits:

  • Unfair discrimination between individuals of the same class and equal expectation of life in life insurance and annuity rates, dividends, benefits or terms
  • Unfair discrimination between individuals of the same class and essentially the same hazard in health insurance premiums, benefits or terms
  • Refusing, limiting or canceling coverage because of a person’s sex, marital status, race, religion or national origin
  • In property and casualty insurance, refusing or limiting coverage solely because of a risk’s geographic location, unless sound underwriting and actuarial principles justify it, or solely because the applicant or insured is physically or mentally impaired

Many states also expressly forbid refusing or limiting coverage solely because a person is blind or partially blind. Nebraska does: refusing or limiting coverage, or charging a different rate, solely because of blindness or partial blindness is unfair discrimination (210 NAC 35-003), and so is refusing or limiting coverage solely because of sex or marital status (Neb. Rev. Stat. § 44-1525(7)(e)).

Errors & omissions

Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties. E&O covers negligence and unintentional mistakes that cause financial harm to clients. It does not cover intentional misconduct, criminal acts, or regulatory fines.

Children covered as dependents

Under the Affordable Care Act, a plan that offers dependent coverage must make it available to an adult child until age 26, whether or not the child is married, a student or financially dependent on the parent.

State law generally requires a policy that covers dependents to cover a newborn from the moment of birth and an adopted child from placement, and may let the insurer require notice and any added premium within a set period to continue the child’s coverage. Policies also generally continue coverage past the age limit for a dependent child who cannot support themselves because of a mental or physical disability that began before that age.

Rebating

Nebraska licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance.

Sidenote
Know this...

To “solicit” or “negotiate” insurance implies that the person is licensed.

Sharing commission

The splitting or sharing of commissions with a licensed producer is allowed. Both parties must be licensed in the line of business in which the proposed commission is to be split. Under the NAIC’s model act, a commission may also be paid to an insurance agency, or to a person who does not sell, solicit or negotiate insurance.

Twisting

Providing false information or expressing derogatory ideas about the financial condition of a competitor company with the intent to lapse or surrender an existing policy is a violation of the law. Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information are prohibited.

Under the NAIC’s model act, twisting is a misrepresentation made to induce a policyholder to lapse, forfeit, surrender, exchange or convert a policy. A false or maliciously critical statement about a competing insurer’s finances, made to injure it, is defamation.

Unfair marketing practices

The Department of Insurance is responsible for establishing minimum standards for full and fair disclosure of policy content. The Department also requires standardization and simplification of the terms used to describe insurance coverage. Advertising may not involve the following:

  • Any statement or implication that policies are approved, or that the financial condition of a company is endorsed, by any government agency or by any independent group, individual, organization or society, unless that is the fact.

  • Any statements regarding advertising that are false or untrue in reference to the time frame in which claims are paid.

Gramm-Leach Bliley Act (GLBA)

This law repealed the parts of the Glass-Steagall Act of 1933 that kept commercial banks and securities firms apart, and allowed the consolidation of commercial banks, investment institutions and insurance companies. GLBA established a framework of responsibilities for federal and state regulators for these financial industries. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.

McCarran-Ferguson Act

Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level. Grants insurers a limited exemption from federal antitrust legislation. Since 2021 the exemption does not cover the business of health insurance, apart from narrow activities such as sharing historical loss data (15 U.S.C. § 1013(c)).

National Association of Insurance Commissioners (NAIC)

The U.S. standard-setting and regulatory support organization is created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Fair Credit Reporting Act

The Fair Credit Reporting Act (FCRA, 15 U.S.C. 1681) regulates consumer reporting agencies and the use of consumer reports, such as credit reports, MIB records and investigative reports, including in insurance underwriting.

  • When an insurer requests an investigative consumer report, it must disclose that to the consumer within 3 days of the request
  • When an insurer takes adverse action based on a consumer report, it must notify the consumer and identify the reporting agency. The consumer then has 60 days to request a free copy of the report and may dispute inaccurate information

Privacy Act of 1974

The federal Privacy Act of 1974 governs how federal agencies handle personal information. It does not apply to private insurers. An insurer’s use of an applicant’s personal information is governed by the FCRA, the Gramm-Leach-Bliley Act and state insurance privacy law.

In states that adopted the NAIC’s Insurance Information and Privacy Protection Model Act, an authorization to collect personal information signed with an application is valid for no more than 30 months for life, health or disability insurance and one year for property or casualty insurance.

Telemarketing

The National Do Not Call Registry is a list of telephone numbers whose owners do not want to receive telemarketing calls. Telemarketers may not call registered numbers without the person’s permission or an established business relationship, and unsolicited sales calls:

  • May be made only between 8 a.m. and 9 p.m. in the recipient’s local time
  • Must disclose the caller’s identity, the company the caller represents and that the purpose is a sale

CAN-SPAM

A commercial email must:

  • Be identified clearly as an advertisement
  • Carry accurate header information and a subject line that is not deceptive
  • Include the sender’s valid physical postal address
  • Offer a way to opt out, and the sender must honor an opt-out within 10 business days
Key points

Licensing

  • Minimum age: 18, must be Nebraska resident to apply
  • No specific pre-licensing course required, but must pass exam for lines of authority

Pre-licensing course and exam

  • Nebraska: no pre-licensing course requirement
  • Must pass exam for lines applied for (Neb. Rev. Stat. § 44-4053(1))

Fingerprints/background check

  • Director reviews background before licensing
  • Fingerprints often required for state/FBI criminal history check

Controlled business

  • Insurance written on producer’s own life/property/family/employer/controlled business
  • License intended for selling to public; states restrict license used mainly for controlled business

Non-resident license

  • Nonresident license granted without Nebraska exam if licensed/good standing in home state, applied + paid fees, and reciprocity exists
  • Change of address: file within 30 days with certification
  • Move to new state: apply for resident license within 90 days, no repeat of prelicensing/exam for held lines

Temporary license

  • Issued without exam to keep business serviced (e.g., death/disability of producer, military service)
  • Regulator may require licensed sponsor
  • Model act caps temporary license at 180 days

Military service

  • Producers unable to renew due to military service/extenuating circumstances may request waiver of requirements, exams, fines, sanctions

Renewal and reinstatement

  • Must renew on schedule: fee + continuing education
  • States set own renewal cycle
  • Model act: reinstate lapsed license within 12 months, penalty = double unpaid fee; after window, must requalify

Continuing education

  • Required for renewal of major lines (life, health, property, liability)
  • Hours set by state law/published by insurance department

Notice of change of name or address

  • Report address change within 30 days
  • Report administrative actions/criminal prosecutions within 30 days of final disposition/pretrial hearing
  • Must notify regulator before using assumed business name

Company regulations

  • Insurer must be authorized (certificate of authority) by Department of Insurance
  • Application includes charter, financial statements, capital/surplus proof, fees

Capital and surplus requirement

  • Insurer must maintain minimum capital/surplus to keep certificate of authority
  • Nebraska: impaired capital allows up to 90 days for shareholders to correct (Neb. Rev. Stat. § 44-120)

Medigap policies

  • Federally standardized plans: A, B, C, D, F, G, K, L, M, N (E, H, I, J eliminated)
  • Plans C & F unavailable to those newly eligible on/after Jan 1, 2020
  • Plan A = core benefits; must be offered if insurer sells any Medigap plans
  • Buyer’s Guide & Outline of Coverage given at application, before premium payment

Duties of the Director of Insurance

  • Appointed by Governor; oversees Department of Insurance
  • Investigates violations, examines insurers (domestic every 5 years per Neb. Rev. Stat. § 44-5904(1))
  • Audits producer records as needed, collects fees, issues fines, approves forms/rates
  • No authority to arrest, injunct, or sentence jail time (law enforcement/courts do that)
  • Nebraska Fraud Prevention Division investigators have peace officer authority (Neb. Rev. Stat. § 44-6606(2)(a))

Suspend, revoke or non-renew

  • Grounds: false application info, fraud, felony/misdemeanor conviction (Class I, II, III in NE), unfair trade practices, misappropriation of funds, prior license revocation elsewhere, exam cheating, identity forgery

Cease and desist

  • Ordered when producer violates insurance laws
  • Does not suspend/revoke license; only stops/limits specific activity

Hearing and penalties

  • Entitled to notice & hearing before license action; hearing held at least 10 days after service (Neb. Rev. Stat. §§ 44-1528(1), 44-1529)
  • Civil penalties: up to $1,000/violation, max $30,000; flagrant/knowing violations up to $15,000/violation, max $150,000

Unfair claims settlement practices

  • Violations include: delaying claims, failing to investigate, denying without investigation, settling below fair market value, using altered application info
  • Violation triggered if flagrant/knowing or frequent business practice

Policy forms

  • Insurers file forms with Director; may require approval or allow “file and use”
  • Conflicting policy provisions read as amended to match law
  • Life insurance policy loan interest rate capped by state law

Record maintenance

  • Producers keep transaction records, available for Director’s inspection
  • Nebraska requires market conduct records kept 5 years (Neb. Rev. Stat. § 44-5905(2)(b)(i)(B))

Fraudulent producer representation

  • Illegal to claim licensure without passing exam, via any public communication
  • Can result in suspension/revocation of other licenses held

Misrepresentation

  • Includes false policy illustrations/quotes, inaccurate comparisons
  • Twisting: inducing lapse/surrender via inaccurate info

False advertising

  • Untrue, deceptive, or misleading statements about insurance business = unfair trade practice
  • Applies across all media; intent to deceive not required (Neb. Rev. Stat. § 44-1524)

Defamation

  • False or maliciously critical statements about insurer’s financial condition, meant to injure
  • Nebraska statute targets harm to the insurer itself (Neb. Rev. Stat. § 44-1525(3))

Boycott, coercion and intimidation

  • Prohibited if resulting in unreasonable restraint or monopoly in insurance business

False financial statements

  • Knowingly filing/publishing false financial statements about insurer = violation (Neb. Rev. Stat. § 44-1525(5))
  • False statements on applications for personal gain also prohibited (§ 44-1525(10))

Illegal inducements

  • Offering unlisted value/gifts to induce purchase is prohibited unless expressly allowed
  • Model act permits reasonable non-cash gifts/donations if not conditioned on purchase

Unfair discrimination

  • Prohibits differing treatment of same-class/risk individuals in rates, benefits, terms
  • Cannot discriminate based on sex, marital status, race, religion, national origin
  • Property/casualty: cannot discriminate solely by geographic location or disability without actuarial basis
  • Nebraska bans discrimination based on blindness (210 NAC 35-003) and sex/marital status (§ 44-1525(7)(e))

Errors & omissions

  • E&O insurance = professional liability coverage for producers
  • Covers negligence/unintentional mistakes; excludes intentional/criminal acts and fines

Children covered as dependents

  • ACA: dependent coverage available until age 26
  • State law: newborns covered from birth, adopted children from placement
  • Disabled dependents may continue coverage past age limit if disability began before limit

Rebating

  • Prohibited: giving refunds/discounts/credits to induce insurance purchase
  • Soliciting/negotiating insurance implies licensure

Sharing commission

  • Allowed if both parties licensed in same line
  • Model act allows commission to agencies or non-selling persons

Twisting

  • Misrepresentation to induce lapse/surrender/exchange of policy
  • Related to defamation if statements are false/malicious about competitor

Unfair marketing practices

  • Dept. of Insurance sets disclosure/standardization requirements
  • Advertising cannot falsely imply government/organization endorsement
  • Cannot misstate claim payment timeframes

Gramm-Leach Bliley Act (GLBA)

  • Repealed key parts of Glass-Steagall; allows merging of banks, investment firms, insurers
  • Establishes regulatory framework across federal/state regulators

McCarran-Ferguson Act

  • 1945 law: insurance regulated at state level
  • Grants limited antitrust exemption; health insurance exemption removed since 2021 (15 U.S.C. § 1013(c))

National Association of Insurance Commissioners (NAIC)

  • Standard-setting body of state insurance regulators (50 states, DC, 5 territories)
  • Establishes standards, best practices, peer review, coordinated oversight

Fair Credit Reporting Act

  • Regulates consumer reporting agencies/reports used in underwriting
  • Investigative report request: disclose to consumer within 3 days
  • Adverse action: must notify consumer; consumer has 60 days to request free report/dispute

Privacy Act of 1974

  • Governs federal agencies’ handling of personal info; not applicable to private insurers
  • Insurer privacy governed by FCRA, GLBA, state law
  • NAIC model: authorization valid up to 30 months (life/health/disability) or 1 year (property/casualty)

Telemarketing

  • Do Not Call Registry protects listed phone numbers
  • Calls allowed only 8 a.m.–9 p.m. local time
  • Must disclose caller identity, company, and sales purpose

CAN-SPAM

  • Commercial emails must be labeled as ads, have accurate headers/subject lines
  • Must include sender’s physical address
  • Must provide opt-out, honored within 10 business days

Related readings

  • Producer Roles and Receipt Types
  • Underwriting
  • Term Life Insurance
  • Variable Insurance Products
  • Group Life Insurance