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Office of the Revisor of Statutes

72A.201 REGULATION OF CLAIMS PRACTICES.
    Subdivision 1. Administrative enforcement. The commissioner may, in accordance
with chapter 14, adopt rules to ensure 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 section
or the rules adopted pursuant to this section; 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.
    Subd. 2. Construction. The policy of the Department of Commerce, in interpreting and
enforcing this section, 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 section.
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.
    Subd. 3. Definitions. For the purposes of this section, the following terms have the meanings
given them.
(1) Adjuster or adjusters. "Adjuster" or "adjusters" is as defined in section 72B.02.
(2) Agent. "Agent" means insurance agents or insurance agencies licensed pursuant to
sections 60K.30 to 60K.56, 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
section 60A.23, subdivision 8.
(14) Self-insured or self-insurer. "Self-insured" or "self-insurer" means any entity
authorized pursuant to section 65B.48, subdivision 3; chapter 62H; section 176.181, subdivision
2
; Laws of Minnesota 1983, chapter 290, section 171; section 471.617; or 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 section 60A.23, subdivision 8, clause
(2), subclauses (a) and (d).
    Subd. 4. 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)(i) unless provided otherwise by clause (ii) or (iii), other 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;
(ii) for claims submitted under a health policy, the insurer must comply with all of the
requirements of section 62Q.75;
(iii) for claims submitted under a health policy that are accepted, the insurer must notify
the insured or claimant no less than semiannually of the disposition of claims of the insured or
claimant. For purposes of this clause, acceptance of a claim means that there is no additional
financial liability for the insured or claimant, either because there is a flat co-payment amount
specified in the health plan or because there is no co-payment, deductible, or coinsurance owed;
(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 the insured 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.
    Subd. 4a. Standards for preauthorization approval. If a policy of accident and sickness
insurance or a subscriber contract requires preauthorization approval for any nonemergency
services or benefits, the decision to approve or disapprove the requested services or benefits must
be processed in accordance with section 62M.07.
    Subd. 5. 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) notwithstanding any inconsistent provision of section 65A.01, subdivision 3, 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.
    Subd. 6. Standards for automobile insurance claims handling, settlement offers, and
agreements. In addition to the acts specified in subdivisions 4, 5, 7, 8, and 9, 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 acknowledgment 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, except that when an insurer is recovering directly from an
uninsured third party by means of installments, the insured must receive the full deductible share
as soon as that amount is collected and before any part of the total recovery is applied to any other
use. 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. An insured is not bound by any settlement of its insurer's
subrogation claim with respect to the deductible amount, unless the insured receives, as a result of
the subrogation settlement, the full amount of the deductible. Recovery by the insurer and receipt
by the insured of less than all of the insured's deductible amount does not affect the insured's
rights to recover any unreimbursed portion of the deductible from parties liable for the loss;
(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 or that parts, other than window glass, must
be replaced with parts other than original equipment parts or engaging in any act or practice of
intimidation, coercion, threat, incentive, or inducement for or against an insured to use a particular
contractor or repair shop. Consumer benefits included within preferred vendor programs must
not be considered an incentive or inducement. At the time a claim is reported, the insurer must
provide the following advisory to the insured or claimant:
"You have the legal right to choose a repair shop to fix your vehicle. Your policy will cover
the reasonable costs of repairing your vehicle to its pre-accident condition no matter where you
have repairs made. Have you selected a repair shop or would you like a referral?"
After an insured has indicated that the insured has selected a repair shop, the insurer must
cease all efforts to influence the insured's or claimant's choice of repair shop;
(8) where liability is reasonably clear, failing to inform the claimant in an automobile
property damage liability claim that the claimant 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 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 section 65B.56,
subdivision 1
, failing to notify the insured of all of the insured's rights and obligations under
that statute, including the right to request, in writing, and to receive a copy of the report of the
examination;
(13) failing to provide, to an insured who has submitted a claim for benefits described in
section 65B.44, a complete copy of the insurer's claim file on the insured, excluding internal
company memoranda, all materials that relate to any insurance fraud investigation, materials that
constitute attorney work-product or that qualify for the attorney-client privilege, and medical
reviews that are subject to section 145.64, within ten business days of receiving a written request
from the insured. The insurer may charge the insured a reasonable copying fee. This clause
supersedes any inconsistent provisions of sections 72A.49 to 72A.505;
(14) if an automobile policy provides for the adjustment or settlement of an automobile loss
due to damaged window glass, failing to provide payment to the insured's chosen vendor based on
a competitive price that is fair and reasonable within the local industry at large.
Where facts establish that a different rate in a specific geographic area actually served by the
vendor is required by that market, that geographic area must be considered. This clause does not
prohibit an insurer from recommending a vendor to the insured or from agreeing with a vendor to
perform work at an agreed-upon price, provided, however, that before recommending a vendor,
the insurer shall offer its insured the opportunity to choose the vendor. If the insurer recommends
a vendor, the insurer must also provide the following advisory:
"Minnesota law gives you the right to go to any glass vendor you choose, and prohibits
me from pressuring you to choose a particular vendor.";
(15) requiring that the repair or replacement of motor vehicle glass and related products and
services be made in a particular place or shop or by a particular entity, or by otherwise limiting the
ability of the insured to select the place, shop, or entity to repair or replace the motor vehicle glass
and related products and services; or
(16) engaging in any act or practice of intimidation, coercion, threat, incentive, or inducement
for or against an insured to use a particular company or location to provide the motor vehicle
glass repair or replacement services or products. For purposes of this section, a warranty shall
not be considered an inducement or incentive.
    Subd. 7. 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.
    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;
(iii) the claim number and the policy number of the insured; and
(iv) if the denied claim is a fire claim, the insured's right to file with the Department of
Commerce a complaint regarding the denial, and the address and telephone number of the
Department of Commerce;
(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 be filed at the
same time its annual statement is submitted under section 60A.13. 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.
    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.
    Subd. 9. Standards for communications with department. In addition to the acts specified
elsewhere in this section and section 72A.20, 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.
For purposes of clause (1) the term insurer includes an agent of the insurer. The insurer must
have been sent a copy of any communication to an agent to be held in violation of this provision.
    Subd. 10. Scope. This section does not apply to workers' compensation insurance. Nothing
in this section abrogates any policy provisions.
    Subd. 11. Disclosure mandatory. An insurer must disclose the coverage and limits of an
insurance policy within 30 days after the information is requested in writing by a claimant.
    Subd. 12. Prejudgment interest. If a judgment is entered against an insured, the principal
amount of which is within the applicable policy limits, the insurer is responsible for their insured's
share of the costs, disbursements, and prejudgment interest, as determined under section 549.09,
included in the judgment even if the total amount of the judgment is in excess of the applicable
policy limits.
    Subd. 13. Improper claim of discount. (a) No insurer or community integrated service
network shall intentionally provide a health care provider with an explanation of benefits or
similar document claiming a right to a discounted fee, price, or other charge, when the insurer
or community integrated service network does not have an agreement with the provider for the
discount with respect to the patient involved.
(b) The insurer or community integrated service network may, notwithstanding paragraph
(a), claim the right to a discount based upon a discount agreement between the health care
provider and another entity, but only if:
(1) that agreement expressly permitted the entity to assign its right to receive the discount;
(2) an assignment to the insurer or community integrated service network of the right
to receive the discount complies with any relevant requirements for assignments contained in
the discount agreement; and
(3) the insurer or community integrated service network has complied with any relevant
requirements contained in the assignment.
(c) When an explanation of benefits or similar document claims a discount permitted under
paragraph (b), it shall prominently state that the discount claimed is based upon an assignment
and shall state the name of the entity from whom the assignment was received. This paragraph
does not apply if the entity that issues the explanation of benefits or similar document has a
provider agreement with the provider.
(d) No insurer or community integrated service network that has entered into an agreement
with a health care provider that involves discounted fees, prices, or other charges shall disclose
the discounts to another entity, with the knowledge or expectation that the disclosure will result in
claims for discounts prohibited under paragraphs (a) and (b).
History: 1984 c 555 s 3; 1987 c 64 s 1; 1989 c 193 s 1; 1989 c 260 s 21-23; 1991 c 115
s 1,2; 1991 c 131 s 2; 1991 c 207 s 7; 1992 c 413 s 1; 1992 c 524 s 2; 1992 c 564 art 1 s 47;
art 3 s 27; 1994 c 485 s 56,65; 1995 c 234 art 7 s 27; 1997 c 77 s 4; 1997 c 225 art 2 s 62;
1999 c 239 s 41; 2000 c 342 s 1; 2001 c 117 art 2 s 17; 2002 c 283 s 1; 2005 c 77 s 5; 2005 c
140 s 1; 2006 c 255 s 60