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.