Key: (1) language to be deleted (2) new language
Laws of Minnesota 1984
CHAPTER 555-S.F.No. 1862
An act relating to insurance; regulating insurance
claims settlement; defining terms; prescribing
penalties; providing for the venue for certain
injunction proceedings; amending Minnesota Statutes
1982, sections 72A.20, subdivisions 11 and 12, and by
adding a subdivision; 72A.23, subdivision 1; and
72A.25, subdivision 2.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 1982, section 72A.20,
subdivision 11, is amended to read:
Subd. 11. [APPLICATION TO CERTAIN SECTIONS.] Violating any
provision of the following sections of this chapter not set
forth in subdivisions 1 to 10 15 shall constitute an unfair
method of competition and an unfair and deceptive act or
practice: section 72A.12, subdivisions 2, 3, and 4, section
72A.16, subdivision 2, sections 72A.03 and 72A.04, section
72A.08, subdivision 1 as modified by section 72A.08, subdivision
4, and section 65B.13.
Sec. 2. Minnesota Statutes 1982, section 72A.20,
subdivision 12, is amended to read:
Subd. 12. [UNFAIR SERVICE.] Causing or permitting with
such frequency to indicate a general business practice the
claims and complaints of insureds to be processed in an
unreasonable length of time, or in an unfair, deceptive, or
fraudulent manner, or in violation of such rules as the
commissioner of insurance shall make in the public interest to
insure the prompt, fair, and honest processing of such claims
and complaints, shall constitute an unfair method of competition
and an unfair and deceptive act or practice any unfair,
deceptive, or fraudulent act concerning any claim or complaint
of an insured or claimant including, but not limited to, the
following practices:
(1) misrepresenting pertinent facts or insurance policy
provisions relating to coverages at issue;
(2) failing to acknowledge and act reasonably promptly upon
communications with respect to claims arising under insurance
policies;
(3) failing to adopt and implement reasonable standards for
the prompt investigation of claims arising under insurance
policies;
(4) refusing to pay claims without conducting a reasonable
investigation based upon all available information;
(5) failing to affirm or deny coverage of claims within a
reasonable time after proof of loss statements have been
completed;
(6) not attempting in good faith to effectuate prompt,
fair, and equitable settlements of claims in which liability has
become reasonably clear;
(7) compelling insureds to institute litigation to recover
amounts due under an insurance policy by offering substantially
less than the amounts ultimately recovered in actions brought by
the insureds;
(8) attempting to settle a claim for less than the amount
to which a reasonable person would have believed he or she was
entitled by reference to written or printed advertising material
accompanying or made part of an application;
(9) attempting to settle claims on the basis of an
application which was altered without notice to, or knowledge or
consent of, the insured;
(10) making claims payments to insureds or beneficiaries
not accompanied by a statement setting forth the coverage under
which the payments are being made;
(11) making known to insureds or claimants a policy of
appealing from arbitration awards in favor of insureds or
claimants for the purpose of compelling them to accept
settlements or compromises less than the amount awarded in
arbitration;
(12) delaying the investigation or payment of claims by
requiring an insured, claimant, or the physician of either to
submit a preliminary claim report and then requiring the
subsequent submission of formal proof of loss forms, both of
which submissions contain substantially the same information;
(13) failing to promptly settle claims, where liability has
become reasonably clear, under one portion of the insurance
policy coverage in order to influence settlements under other
portions of the insurance policy coverage;
(14) failing to promptly provide a reasonable explanation
of the basis in the insurance policy in relation to the facts or
applicable law for denial of a claim or for the offer of a
compromise settlement.
Sec. 3. Minnesota Statutes 1982, section 72A.20, is
amended by adding a subdivision to read:
Subd. 12a. [CLAIMS SETTLEMENT.] (a) [ADMINISTRATIVE
ENFORCEMENT.] The commissioner may, in accordance with chapter
14, adopt rules to insure the prompt, fair, and honest
processing of claims and complaints. The commissioner may, in
accordance with sections 72A.22 to 72A.25, seek and impose
appropriate administrative remedies, including fines, for (1) a
violation of this subdivision or the rules adopted pusuant to
this subdivision; or (2) a violation of section 72A.20,
subdivision 12. The commissioner need not show a general
business practice in taking an administrative action for these
violations.
No individual violation constitutes an unfair,
discriminatory, or unlawful practice in business, commerce, or
trade for purposes of section 8.31.
(b) [CONSTRUCTION.] The policy of the department of
commerce, in interpreting and enforcing this subdivision, will
be to take into consideration all pertinent facts and
circumstances in determining the severity and appropriateness of
the action to be taken in regard to any violation of this
subdivision.
The magnitude of the harm to the claimant or insured, and
any actions by the insured, claimant, or insurer that mitigate
or exacerbate the impact of the violation may be considered.
Actions of the claimant or insured which impeded the
insurer in processing or settling the claim, and actions of the
insurer which increased the detriment to the claimant or insured
may also be considered in determining the appropriate
administrative action to be taken.
(c) [DEFINITIONS.] For the purposes of this subdivision,
the following terms have the meanings given them.
(1) Adjuster or adjusters. "Adjuster" or "adjusters" is as
defined in Minnesota Statutes, section 72B.02.
(2) Agent. "Agent" means insurance agents or insurance
agencies licensed pursuant to Minnesota Statutes, section
60A.17, and representatives of these agents or agencies.
(3) Claim. "Claim" means a request or demand made with an
insurer for the payment of funds or the provision of services
under the terms of any policy, certificate, contract of
insurance, binder, or other contracts of temporary insurance.
The term does not include a claim under a health insurance
policy made by a participating provider with an insurer in
accordance with the participating provider's service agreement
with the insurer which has been filed with the commissioner of
commerce prior to its use.
(4) Claim settlement. "Claim settlement" means all
activities of an insurer related directly or indirectly to the
determination of the extent of liabilities due or potentially
due under coverages afforded by the policy, and which result in
claim payment, claim acceptance, compromise, or other
disposition.
(5) Claimant. "Claimant" means any individual,
corporation, association, partnership, or other legal entity
asserting a claim against any individual, corporation,
association, partnership, or other legal entity which is insured
under an insurance policy or insurance contract of an insurer.
(6) Complaint. "Complaint" means a communication primarily
expressing a grievance.
(7) Insurance policy. "Insurance policy" means any
evidence of coverage issued by an insurer including all
policies, contracts, certificates, riders, binders, and
endorsements which provide or describe coverage. The term
includes any contract issuing coverage under a self-insurance
plan, group self-insurance plan, or joint self-insurance
employee health plans.
(8) Insured. "Insured" means an individual, corporation,
association, partnership, or other legal entity asserting a
right to payment under their insurance policy or insurance
contract arising out of the occurrence of the contingency or
loss covered by the policy or contract. The term does not apply
to a person who acquires rights under a mortgage.
(9) Insurer. "Insurer" includes any individual,
corporation, association, partnership, reciprocal exchange,
Lloyds, fraternal benefits society, self-insurer, surplus line
insurer, self-insurance administrator, and nonprofit service
plans under the jurisdiction of the department of commerce.
(10) Investigation. "Investigation" means a reasonable
procedure adopted by an insurer to determine whether to accept
or reject a claim.
(11) Notification of claim. "Notification of claim" means
any communication to an insurer by a claimant or an insured
which reasonably apprises the insurer of a claim brought under
an insurance contract or policy issued by the insurer.
Notification of claim to an agent of the insurer is notice to
the insurer.
(12) Proof of loss. "Proof of loss" means the necessary
documentation required from the insured to establish entitlement
to payment under a policy.
(13) Self-insurance administrator. "Self-insurance
administrator" means any vendor of risk management services or
entities administering self-insurance plans, licensed pursuant
to Minnesota Statutes, section 60A.23, subdivision 8.
(14) Self-insured or self-insurer. "Self-insured" or
"self-insurer" means any entity authorized pursuant to Minnesota
Statutes, section 65B.48, subdivision 3; Minnesota Statutes,
chapter 62H; Minnesota Statutes, section 176.181, subdivision 2;
Laws of Minnesota 1983, chapter 290, section 171; Minnesota
Statutes, section 471.617; or Minnesota Statutes, section
471.981 and includes any entity which, for a fee, employs the
services of vendors of risk management services in the
administration of a self-insurance plan as defined by Minnesota
Statutes, 60A.23, subdivision 8, clause (2), subclauses (a) and
(d).
(d) [STANDARDS FOR CLAIM FILING AND HANDLING.] The
following acts by an insurer, an adjuster, a self-insured, or a
self-insurance administrator constitute unfair settlement
practices:
(1) except for claims made under a health insurance policy,
after receiving notification of claim from an insured or a
claimant, failing to acknowledge receipt of the notification of
the claim within ten business days, and failing to promptly
provide all necessary claim forms and instructions to process
the claim, unless the claim is settled within ten business
days. The acknowledgment must include the telephone number of
the company representative who can assist the insured or the
claimant in providing information and assistance that is
reasonable so that the insured or claimant can comply with the
policy conditions and the insurer's reasonable requirements. If
an acknowledgment is made by means other than writing, an
appropriate notation of the acknowledgment must be made in the
claim file of the insurer and dated. An appropriate notation
must include at least the following information where the
acknowledgment is by telephone or oral contact:
(i) the telephone number called, if any;
(ii) the name of the person making the telephone call or
oral contact;
(iii) the name of the person who actually received the
telephone call or oral contact;
(iv) the time of the telephone call or oral contact; and
(v) the date of the telephone call or oral contact;
(2) failing to reply, within ten business days of receipt,
to all other communications about a claim from an insured or a
claimant that reasonably indicate a response is requested or
needed;
(3) unless provided otherwise by law or in the policy,
failing to complete its investigation and inform the insured or
claimant of acceptance or denial of a claim within 30 business
days after receipt of notification of claim unless the
investigation cannot be reasonably completed within that time.
In the event that the investigation cannot reasonably be
completed within that time, the insurer shall notify the insured
or claimant within the time period of the reasons why the
investigation is not complete and the expected date the
investigation will be complete. For claims made under a health
policy the notification of claim must be in writing;
(4) where evidence of suspected fraud is present, the
requirement to disclose their reasons for failure to complete
the investigation within the time period set forth in clause (3)
need not be specific. The insurer must make this evidence
available to the department of commerce if requested;
(5) failing to notify an insured who has made a
notification of claim of all available benefits or coverages
which he or she may be eligible to receive under the terms of a
policy and of the documentation which the insured must supply in
order to ascertain eligibility;
(6) unless otherwise provided by law or in the policy,
requiring an insured to give written notice of loss or proof of
loss within a specified time, and thereafter seeking to relieve
the insurer of its obligations if the time limit is not complied
with, unless the failure to comply with the time limit
prejudices the insurer's rights and then only if the insurer
gave prior notice to the insured of the potential prejudice;
(7) advising an insured or a claimant not to obtain the
services of an attorney or an adjuster, or representing that
payment will be delayed if an attorney or an adjuster is
retained by the insured or the claimant;
(8) failing to advise in writing an insured or claimant who
has filed a notification of claim known to be unresolved, and
who has not retained an attorney, of the expiration of a statute
of limitations at least 60 days prior to that expiration. For
the purposes of this clause, any claim on which the insurer has
received no communication from the insured or claimant for a
period of two years preceding the expiration of the applicable
statute of limitations shall not be considered to be known to be
unresolved and notice need not be sent pursuant to this clause;
(9) demanding information which would not affect the
settlement of the claim;
(10) unless expressly permitted by law or the policy,
refusing to settle a claim of an insured on the basis that the
responsibility should be assumed by others;
(11) failing, within 60 business days after receipt of a
properly executed proof of loss, to advise the insured of the
acceptance or denial of the claim by the insurer. No insurer
shall deny a claim on the grounds of a specific policy
provision, condition, or exclusion unless reference to the
provision, condition, or exclusion is included in the denial.
The denial must be given to the insured in writing with a copy
filed in the claim file;
(12) denying or reducing a claim on the basis of an
application which was altered or falsified by the agent or
insurer without the knowledge of the insured;
(13) failing to notify the insured of the existence of the
additional living expense coverage when an insured under a
homeowners policy sustains a loss by reason of a covered
occurrence and the damage to the dwelling is such that it is not
habitable;
(14) failing to inform an insured or a claimant that the
insurer will pay for an estimate of repair if the insurer
requested the estimate and the insured or claimant had
previously submitted two estimates of repair.
(e) [STANDARDS FOR FAIR SETTLEMENT OFFERS AND AGREEMENTS.]
The following acts by an insurer, an adjuster, a self-insured,
or a self-insurance administrator constitute unfair settlement
practices:
(1) making any partial or final payment, settlement, or
offer of settlement, which does not include an explanation of
what the payment, settlement, or offer of settlement is for;
(2) making an offer to an insured of partial or total
settlement of one part of a claim contingent upon agreement to
settle another part of the claim;
(3) refusing to pay one or more elements of a claim by an
insured for which there is no good faith dispute;
(4) threatening cancellation, rescission, or nonrenewal of
a policy as an inducement to settlement of a claim;
(5) failing to issue payment for any amount finally agreed
upon in settlement of all or part of any claim within five
business days from the receipt of the agreement by the insurer
or from the date of the performance by the claimant of any
conditions set by such agreement, whichever is later;
(6) failing to inform the insured of the policy provision
or provisions under which payment is made;
(7) settling or attempting to settle a claim or part of a
claim with an insured under actual cash value provisions for
less than the value of the property immediately preceding the
loss, including all applicable taxes and license fees. In no
case may an insurer be required to pay an amount greater than
the amount of insurance;
(8) except where limited by policy provisions, settling or
offering to settle a claim or part of a claim with an insured
under replacement value provisions for less than the sum
necessary to replace the damaged item with one of like kind and
quality, including all applicable taxes, license, and transfer
fees;
(9) reducing or attempting to reduce for depreciation any
settlement or any offer of settlement for items not adversely
affected by age, use, or obsolescence;
(10) reducing or attempting to reduce for betterment any
settlement or any offer of settlement unless the resale value of
the item has increased over the preloss value by the repair of
the damage.
(f) [STANDARDS FOR AUTOMOBILE INSURANCE CLAIMS HANDLING,
SETTLEMENT OFFERS, AND AGREEMENTS.] In addition to the acts
specified in paragraphs (d), (e), (g), (h), and (i), the
following acts by an insurer, adjuster, or a self-insured or
self-insurance administrator constitute unfair settlement
practices:
(1) if an automobile insurance policy provides for the
adjustment and settlement of an automobile total loss on the
basis of actual cash value or replacement with like kind and
quality and the insured is not an automobile dealer, failing to
offer one of the following methods of settlement:
(a) comparable and available replacement automobile, with
all applicable taxes, license fees, at least pro rata for the
unexpired term of the replaced automobile's license, and other
fees incident to the transfer or evidence of ownership of the
automobile paid, at no cost to the insured other than the
deductible amount as provided in the policy;
(b) a cash settlement based upon the actual cost of
purchase of a comparable automobile, including all applicable
taxes, license fees, at least pro rata for the unexpired term of
the replaced automobile's license, and other fees incident to
transfer of evidence of ownership, less the deductible amount as
provided in the policy. The costs must be determined by:
(i) the cost of a comparable automobile, adjusted for
mileage, condition, and options, in the local market area of the
insured, if such an automobile is available in that area; or
(ii) one of two or more quotations obtained from two or
more qualified sources located within the local market area when
a comparable automobile is not available in the local market
area. The insured shall be provided the information contained
in all quotations prior to settlement; or
(iii) any settlement or offer of settlement which deviates
from the procedure above must be documented and justified in
detail. The basis for the settlement or offer of settlement
must be explained to the insured;
(2) if an automobile insurance policy provides for the
adjustment and settlement of an automobile partial loss on the
basis of repair or replacement with like kind and quality and
the insured is not an automobile dealer, failing to offer one of
the following methods of settlement:
(a) to assume all costs, including reasonable towing costs,
for the satisfactory repair of the motor vehicle. Satisfactory
repair includes repair of both obvious and hidden damage as
caused by the claim incident. This assumption of cost may be
reduced by applicable policy provision; or
(b) to offer a cash settlement sufficient to pay for
satisfactory repair of the vehicle. Satisfactory repair
includes repair of obvious and hidden damage caused by the claim
incident, and includes reasonable towing costs;
(3) regardless of whether the loss was total or partial, in
the event that a damaged vehicle of an insured cannot be safely
driven, failing to exercise the right to inspect automobile
damage prior to repair within five business days following
receipt of notification of claim. In other cases the inspection
must be made in 15 days;
(4) regardless of whether the loss was total or partial,
requiring unreasonable travel of a claimant or insured to
inspect a replacement automobile, to obtain a repair estimate,
to allow an insurer to inspect a repair estimate, to allow an
insurer to inspect repairs made pursuant to policy requirements,
or to have the automobile repaired;
(5) regardless of whether the loss was total or partial, if
loss of use coverage exists under the insurance policy, failing
to notify an insured at the time of the insurer's
acknowledgement of claim, or sooner if inquiry is made, of the
fact of the coverage, including the policy terms and conditions
affecting the coverage and the manner in which the insured can
apply for this coverage;
(6) regardless of whether the loss was total or partial,
failing to include the insured's deductible in the insurer's
demands under its subrogation rights. Subrogation recovery must
be shared at least on a proportionate basis with the insured,
unless the deductible amount has been otherwise recovered by the
insured. No deduction for expenses may be made from the
deductible recovery unless an attorney is retained to collect
the recovery, in which case deduction may be made only for a pro
rata share of the cost of retaining the attorney;
(7) requiring as a condition of payment of a claim that
repairs to any damaged vehicle must be made by a particular
contractor or repair shop;
(8) where liability is reasonably clear, failing to inform
the claimant in an automobile property damage liability claim
that he or she may have a claim for loss of use of the vehicle;
(9) failing to make a good faith assignment of comparative
negligence percentages in ascertaining the issue of liability;
(10) failing to pay any interest required by statute on
overdue payment for an automobile personal injury protection
claim;
(11) if an automobile insurance policy contains either or
both of the time limitation provisions as permitted by Minnesota
Statutes, section 65B.55, subdivisions 1 and 2, failing to
notify the insured in writing of those limitations at least 60
days prior to the expiration of that time limitation;
(12) if an insurer chooses to have an insured examined as
permitted by Minnesota Statutes, section 65B.56, subdivision 1,
failing to notify the insured of all of his or her rights and
obligations under that statute, including the right to request,
in writing, and to receive a copy of the report of the
examination.
(g) [STANDARDS FOR RELEASES.] The following acts by an
insurer, adjuster, or self-insured or self-insurance
administrator constitute unfair settlement practices:
(1) requesting or requiring an insured or a claimant to
sign a release that extends beyond the subject matter that gave
rise to the claim payment;
(2) issuing a check or draft in payment of a claim that
contains any language or provision that implies or states that
acceptance of the check or draft constitutes a final settlement
or release of any or all future obligations arising out of the
loss.
(h) [STANDARDS FOR CLAIM DENIAL.] The following acts by an
insurer, adjuster, or self-insured, or self-insurance
administrator constitute unfair settlement practices:
(1) denying a claim or any element of a claim on the
grounds of a specific policy provision, condition, or exclusion,
without informing the insured of the policy provision,
condition, or exclusion on which the denial is based;
(2) denying a claim without having made a reasonable
investigation of the claim;
(3) denying a liability claim because the insured has
requested that the claim be denied;
(4) denying a liability claim because the insured has
failed or refused to report the claim, unless an independent
evaluation of available information indicates there is no
liability;
(5) denying a claim without including the following
information:
(i) the basis for the denial;
(ii) the name, address, and telephone number of the
insurer's claim service office or the claim representative of
the insurer to whom the insured or claimant may take any
questions or complaints about the denial; and
(iii) the claim number and the policy number of the insured;
(6) denying a claim because the insured or claimant failed
to exhibit the damaged property unless:
(i) the insurer, within a reasonable time period, made a
written demand upon the insured or claimant to exhibit the
property; and
(ii) the demand was reasonable under the circumstances in
which it was made.
(i) [STANDARDS FOR COMMUNICATIONS WITH THE DEPARTMENT.] In
addition to the acts specified elsewhere in this section, the
following acts by an insurer, adjuster, or a self-insured or
self-insurance administrator constitute unfair settlement
practices:
(1) failure to respond, within 15 working days after
receipt of an inquiry from the commissioner, about a claim, to
the commissioner;
(2) failure, upon request by the commissioner, to make
specific claim files available to the commissioner;
(3) failure to include in the claim file all written
communications and transactions emanating from, or received by,
the insurer, as well as all notes and work papers relating to
the claim. All written communications and notes referring to
verbal communications must be dated by the insurer;
(4) failure to submit to the commissioner, when requested,
any summary of complaint data reasonably required;
(5) failure to compile and maintain a file on all
complaints. If the complaint deals with a loss, the file must
contain adequate information so as to permit easy retrieval of
the entire file. If the complaint alleges that the company, or
agent of the company, or any agent producing business written by
the company is engaged in any unfair, false, misleading,
dishonest, fraudulent, untrustworthy, coercive, or financially
irresponsible practice, or has violated any insurance law or
rule, the file must indicate what investigation or action was
taken by the company. The complaint file must be maintained for
at least four years after the date of the complaint.
(j) [SCOPE.] This subdivision does not apply to workers'
compensation insurance. Nothing in this subdivision abrogates
any policy provisions.
Sec. 4. Minnesota Statutes 1982, section 72A.23,
subdivision 1, is amended to read:
Subdivision 1. [DETERMINATION BY COMMISSIONER; FINDINGS.]
Whenever it appears to the commissioner that any person has
engaged or is about to engage in any act or practice
constituting a violation of this chapter or any rule or order
hereunder:
(a) He may issue and cause to be served upon the person an
order requiring the person to cease and desist from violations
of section 72A.19 or 72A.20. The order must be calculated to
give reasonable notice of the rights of the person to request a
hearing thereon and must state the reasons for the entry of the
order. A hearing must be held not later than seven days after
the request for the hearing is received by the commissioner
after which and within 20 days of the date of the hearing the
commissioner shall issue a further order vacating the cease and
desist order or making it permanent as the facts require. If no
hearing is requested within 30 days of service of the order, the
order will become final and will remain in effect until it is
modified or vacated by the commissioner. All hearings must be
conducted in accordance with the provisions of chapter 14. If
the person to whom a cease and desist order is issued fails to
appear at the hearing after being duly notified, the person
shall be deemed in default, and the proceeding may be determined
against him upon consideration of the cease and desist order,
the allegations of which may be deemed to be true. The
commissioner may adopt rules of procedure concerning all
proceedings conducted pursuant to this subdivision; and
(b) If, after a hearing, as provided in section 72A.22, the
commissioner shall determine that the method of competition or
the act or practice in question is defined in section 72A.20 or
any rules adopted pursuant to section 72A.19 or 72A.20, and that
the person complained of has engaged in that method of
competition, act, or practice, in violation of sections 72A.17
to 72A.32 he shall reduce his findings to writing and shall
issue and cause to be served upon the person charged with the
violation an order requiring him to cease and desist from
engaging in that method of competition, act or practice, and may
impose a civil penalty of not more than $2,000 for each
offense. If the commissioner determines that an insurer has
engaged in an act or practice defined in section 72A.20,
subdivision 13, the cease and desist order may also require the
insurer to write or renew the homeowner's insurance coverage
sought by the insured or prospective insured for a specified
period of up to three years without cancellation or nonrenewal
by the insurer for a reason not specified in section 65A.01;
after the specified period expires, cancellation or nonrenewal
of the coverage may be made only as permitted by law.
Sec. 5. Minnesota Statutes 1982, section 72A.25,
subdivision 2, is amended to read:
Subd. 2. [APPLICATION FOR INJUNCTION.] If the report
charges a violation of sections 72A.17 to 72A.32 and if the
method of competition, act, or practice charged by him has not
been discontinued, the commissioner may, through the attorney
general, at any time after 20 days after the service of the
report, cause a petition to be filed in the district court
within the district wherein the person against whom the charges
were made resides, or that wherein he has his principal place of
business of Ramsey County, to enjoin and restrain that person
from engaging in the method, act, or practice charged. A
transcript of the proceedings before the commissioner, including
all evidence taken and the report and findings, shall be filed
with the petition. Upon the filing of the petition and
transcript the court shall have jurisdiction of the proceedings
and shall have power to make and enter appropriate orders in
connection therewith and to issue such writs as are ancillary to
its jurisdiction or necessary in its judgment to prevent injury
to the public pendente lite.
Sec. 6. [EFFECTIVE DATE.]
Sections 1 to 5 are effective the day following final
enactment.
Approved April 25, 1984
Official Publication of the State of Minnesota
Revisor of Statutes