HF 3535

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to insurance; automobile; requiring that 
  1.3             automobile insurance medical benefits not be 
  1.4             discontinued except as determined by a neutral health 
  1.5             care professional; amending Minnesota Statutes 1998, 
  1.6             sections 65B.525, subdivision 1; and 72A.201, 
  1.7             subdivision 8; proposing coding for new law in 
  1.8             Minnesota Statutes, chapter 65B; repealing Minnesota 
  1.9             Statutes 1998, section 72A.327. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 1998, section 65B.525, 
  1.12  subdivision 1, is amended to read: 
  1.13     Subdivision 1.  Except as otherwise provided in section 
  1.14  72A.327, The supreme court and the several courts of general 
  1.15  trial jurisdiction of this state shall by rules of court or 
  1.16  other constitutionally allowable device, provide for the 
  1.17  mandatory submission to binding arbitration of all cases at 
  1.18  issue where the claim at the commencement of arbitration is in 
  1.19  an amount of $10,000 or less against any insured's reparation 
  1.20  obligor for no-fault benefits or comprehensive or collision 
  1.21  damage coverage. 
  1.22     Sec. 2.  [65B.526] [AUTOMOBILE INSURANCE; MEDICAL CLAIM 
  1.23  DENIAL.] 
  1.24     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.25  section, the following terms have the meanings given them.  
  1.26     (a) "Claimant" means a claimant as defined in section 
  1.27  72A.201, subdivision 3, clause (5). 
  2.1      (b) "Health professional" means any person licensed or 
  2.2   certified to provide health care services to natural persons. 
  2.3      Subd. 2.  [SECOND MEDICAL EVALUATION.] No reparation 
  2.4   obligor shall terminate benefits or deny a claim by an insured 
  2.5   or other eligible claimant for medical benefits under this 
  2.6   chapter on the basis of a medical evaluation by a health 
  2.7   professional selected by the reparation obligor unless: 
  2.8      (1) the reparation obligor allows the insured or other 
  2.9   eligible claimant the option of obtaining a second medical 
  2.10  evaluation by a health professional from the roster established 
  2.11  pursuant to subdivision 3; and 
  2.12     (2) if the option is exercised, the medical evaluation is 
  2.13  consistent with the initial evaluation obtained by the 
  2.14  reparation obligor. 
  2.15     If the option is not exercised, the reparation obligor may 
  2.16  terminate benefits or deny the claim.  The cost of this 
  2.17  evaluation must be borne by the reparation obligor at a rate at 
  2.18  least equal to the rate the reparation obligor has customarily 
  2.19  paid for similar medical evaluations.  The medical evaluation 
  2.20  required in this subdivision must be performed by a health 
  2.21  professional qualified to evaluate the injury that is the 
  2.22  subject of the claim and who has a license and specialty 
  2.23  designation specified by the reparation obligor.  When a 
  2.24  reparation obligor requests that the insured or other eligible 
  2.25  claimant submit to a medical evaluation, the reparation obligor 
  2.26  must provide a written notice of the rights of the insured or 
  2.27  other eligible claimant under this section. 
  2.28     Subd. 3.  [HEALTH PROFESSIONAL ROSTER.] The commissioner of 
  2.29  commerce shall develop and maintain a roster of health 
  2.30  professionals.  Every health professional is eligible to be 
  2.31  placed on the roster.  Health professionals on the roster must 
  2.32  agree not to treat the insured or other eligible claimant after 
  2.33  the evaluation for the injury that is the subject of the claim, 
  2.34  except as permitted by the commissioner.  The commissioner shall 
  2.35  select from the roster the health professional who is to provide 
  2.36  the medical examination.  This selection must be made by a 
  3.1   random procedure based upon subpools within the roster.  The 
  3.2   subpools must be based upon geographic location of the health 
  3.3   professional's office or offices and upon the licensure or 
  3.4   designated specialty of the health professional.  The 
  3.5   commissioner shall establish a procedure ensuring that medical 
  3.6   evaluations are normally completed within 30 days of receipt by 
  3.7   the commissioner of a request from the reparation obligor.  The 
  3.8   health professional must submit the medical evaluation report 
  3.9   within 15 days of the completion of the evaluation.  The 
  3.10  reparation obligor, if requested by the person examined, shall 
  3.11  provide a copy of the medical evaluation report to the person 
  3.12  examined within ten business days of receiving the request or 
  3.13  receiving the report, whichever is later. 
  3.14     Subd. 4.  [NONAPPLICATION.] This section does not apply if 
  3.15  the reparation obligor's initial medical evaluation is performed 
  3.16  by a health professional from the roster established pursuant to 
  3.17  subdivision 3 and selected by the commissioner using the 
  3.18  procedure set forth in subdivision 3. 
  3.19     Subd. 5.  [ARBITRATION REMEDY PRESERVED.] After completion 
  3.20  of the procedure required by this section, either party may 
  3.21  pursue its rights under section 65B.525. 
  3.22     Sec. 3.  Minnesota Statutes 1998, section 72A.201, 
  3.23  subdivision 8, is amended to read: 
  3.24     Subd. 8.  [STANDARDS FOR CLAIM DENIAL.] The following acts 
  3.25  by an insurer, adjuster, or self-insured, or self-insurance 
  3.26  administrator constitute unfair settlement practices:  
  3.27     (1) denying a claim or any element of a claim on the 
  3.28  grounds of a specific policy provision, condition, or exclusion, 
  3.29  without informing the insured of the policy provision, 
  3.30  condition, or exclusion on which the denial is based; 
  3.31     (2) denying a claim without having made a reasonable 
  3.32  investigation of the claim; 
  3.33     (3) denying a liability claim because the insured has 
  3.34  requested that the claim be denied; 
  3.35     (4) denying a liability claim because the insured has 
  3.36  failed or refused to report the claim, unless an independent 
  4.1   evaluation of available information indicates there is no 
  4.2   liability; 
  4.3      (5) denying a claim without including the following 
  4.4   information:  
  4.5      (i) the basis for the denial; 
  4.6      (ii) the name, address, and telephone number of the 
  4.7   insurer's claim service office or the claim representative of 
  4.8   the insurer to whom the insured or claimant may take any 
  4.9   questions or complaints about the denial; 
  4.10     (iii) the claim number and the policy number of the 
  4.11  insured; and 
  4.12     (iv) if the denied claim is a fire claim, the insured's 
  4.13  right to file with the department of commerce a complaint 
  4.14  regarding the denial, and the address and telephone number of 
  4.15  the department of commerce; 
  4.16     (6) denying a claim because the insured or claimant failed 
  4.17  to exhibit the damaged property unless:  
  4.18     (i) the insurer, within a reasonable time period, made a 
  4.19  written demand upon the insured or claimant to exhibit the 
  4.20  property; and 
  4.21     (ii) the demand was reasonable under the circumstances in 
  4.22  which it was made; 
  4.23     (7) denying a claim by an insured or claimant based on the 
  4.24  evaluation of a chemical dependency claim reviewer selected by 
  4.25  the insurer unless the reviewer meets the qualifications 
  4.26  specified under subdivision 8a.  An insurer that selects 
  4.27  chemical dependency reviewers to conduct claim evaluations must 
  4.28  annually file with the commissioner of commerce a report 
  4.29  containing the specific evaluation standards and criteria used 
  4.30  in these evaluations.  The report must be filed at the same time 
  4.31  its annual statement is submitted under section 60A.13.  The 
  4.32  report must also include the number of evaluations performed on 
  4.33  behalf of the insurer during the reporting period, the types of 
  4.34  evaluations performed, the results, the number of appeals of 
  4.35  denials based on these evaluations, the results of these 
  4.36  appeals, and the number of complaints filed in a court of 
  5.1   competent jurisdiction; and 
  5.2      (8) failing to comply with section 65B.526. 
  5.3      Sec. 4.  [REPEALER.] 
  5.4      Minnesota Statutes 1998, section 72A.327, is repealed. 
  5.5      Sec. 5.  [EFFECTIVE DATE.] 
  5.6      Sections 1 to 4 are effective January 1, 2001.