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Minnesota Legislature

Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

  

                         Laws of Minnesota 1991 

                        CHAPTER 115-H.F.No. 525 
           An act relating to insurance; regulating claim denial; 
          requiring chemical dependency claim reviewers to meet 
          certain qualifications; requiring insurers to file an 
          annual report on evaluations with the commissioner of 
          commerce; amending Minnesota Statutes 1990, section 
          72A.201, subdivision 8, and by adding a subdivision. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1990, section 72A.201, 
subdivision 8, is amended to read: 
    Subd. 8.  [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.; 
     (7) denying a claim by an insured or claimant based on the 
evaluation of a chemical dependency claim reviewer selected by 
the insurer unless the reviewer meets the qualifications 
specified under subdivision 8a.  An insurer that selects 
chemical dependency reviewers to conduct claim evaluations must 
annually file with the commissioner of commerce a report 
containing the specific evaluation standards and criteria used 
in these evaluations.  The report must also include the number 
of evaluations performed on behalf of the insurer during the 
reporting period, the types of evaluations performed, the 
results, the number of appeals of denials based on these 
evaluations, the results of these appeals, and the number of 
complaints filed in a court of competent jurisdiction. 
     Sec. 2.  Minnesota Statutes 1990, section 72A.201, is 
amended by adding a subdivision to read: 
    Subd. 8a.  [CHEMICAL DEPENDENCY CLAIM REVIEWER 
QUALIFICATIONS.] (a) The personnel file of a chemical dependency 
claim reviewer must include documentation of the individual's 
competency in the following areas: 
    (1) knowledge of chemical abuse and dependency; 
    (2) chemical use assessment, including client interviewing 
and screening; 
    (3) case management, including treatment planning, general 
knowledge of social services, and appropriate referrals, and 
record keeping, reporting requirements, and confidentiality 
rules and regulations that apply to chemical dependency clients; 
and 
    (4) individual and group counseling, including crisis 
intervention. 
    (b) The insurer may accept one of the following as adequate 
documentation that a chemical dependency claim reviewer is 
competent in the areas required under paragraph (a): 
    (1) the individual has at least a baccalaureate degree with 
a major or concentration in social work, nursing, sociology, 
human services, or psychology, is a licensed registered nurse, 
or is a licensed physician; has successfully completed 30 hours 
of classroom instruction in each of the areas identified in 
paragraph (a), clauses (1) and (2); and has successfully 
completed 480 hours of supervised experience as a chemical 
dependency counselor, either as a student or as an employee; or 
    (2) the individual has documented the successful completion 
of the following: 
    (i) 60 hours of classroom training in the subject area 
identified in paragraph (a), clause (1); 
    (ii) 30 hours of classroom training in the subject area 
identified in paragraph (a), clause (2); 
    (iii) 160 hours of classroom training in the subject areas 
identified in paragraph (a), clauses (3) and (4); and 
    (iv) completion of 480 hours of supervised experience as a 
chemical dependency counselor, either as a student or as an 
employee; or 
    (3) the individual is certified by the Institute for 
Chemical Dependency Professionals of Minnesota, Inc., as a 
chemical dependency counselor or as a chemical dependency 
counselor reciprocal, through the evaluation process established 
by the Certification Reciprocity Consortium Alcohol and Other 
Drug Abuse, Inc., and published in the Case Presentation Method 
Trainer's Manual, copyright 1986; 
    (4) the individual successfully completed three years of 
supervised work experience as a chemical dependency counselor 
before January 1, 1988; or 
    (5) the individual is a licensed physician, who has 480 
hours of experience in a licensed chemical dependency program. 
    After January 1, 1993, chemical dependency counselors must 
document that they meet the requirements of clause (1), (2), or 
(3) in order to comply with this paragraph. 
    Presented to the governor May 16, 1991 
    Signed by the governor May 19, 1991, 5:32 p.m.