Section 210-61-008 - Standards for prompt, fair and equitable settlements008.01 When a claim is denied, written notice of denial shall be sent to the claimant within fifteen (15) days of the determination. No insurer shall deny a claim, or portion thereof, on the grounds of a specific policy provision, condition or exclusion unless reference to such provision, condition, or exclusion is included in the denial. The denial must be given in writing, with reasonable and accurate explanation. The claim file of the insurer shall contain documentation of the denial as required by Section 004.008.02 If a claim remains unresolved for fifteen (15) days from the date proof of loss is received, the insurer shall provide the insured a reasonable written explanation for delay. If the investigation remains incomplete, the insurer shall, thirty (30) days from the date of initial notification the claim is unresolved and every thirty (30) days thereafter, send to the insured a reasonable written explanation setting forth the reasons additional time is needed for investigation.008.03 The insurer shall affirm or deny liability on claims within a reasonable time and shall tender payment within fifteen (15) days of affirmation of liability, if the amount of the claim is determined and not in dispute. In claims where multiple coverages are involved or portions of the claim are in dispute, payments to a known payee which are not in dispute should be tendered within fifteen (15) days after receipt by the insurer of settlement information if such payment would terminate the insurer's known liability under that individual coverage or portion of the claim which was not in dispute. This is notwithstanding the existence of disputes as to other portions of coverage.008.04 With each claim payment, the insurer shall provide to the insured an Explanation of Benefits that shall include, if applicable, the name of the provider or services covered, amount charged, dates of service, and a reasonable explanation of the computation of benefits.008.05 An insurer may not impose a penalty upon any insured for noncompliance with insurer requirements for pre-certification and/or concurrent review unless such penalty is specifically and clearly set forth in the policy.008.06 No insurer shall deny a claim upon information obtained in a telephone conversation or personal interview with any source unless the telephone conversation or personal interview is documented in the claim file.008.07 Insurers offering cash settlements of first party long-term disability income claims, except in cases where there is a bona fide dispute as to the coverage for, or amount of, the disability, shall develop a present value calculation of future benefits (with probability corrections for mortality and morbidity) utilizing contingencies such as mortality, morbidity, and interest rates assumptions, etc. appropriate to the risk. A copy of the amount so calculated shall be given to and attested to by the insured at settlement time.008.08 If, after an insurer rejects a claim or portion thereof, the claimant objects to such rejection and the rejection is maintained, the insurer shall notify the claimant in writing that he or she may have the matter reviewed by the Nebraska Department of Insurance, and the insurer shall provide the claimant with the Department's address and phone number.210 Neb. Admin. Code, ch. 61, § 008