1998 Minnesota 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.01 to 
 60K.18, 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) 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 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 communicated to the 
 insured or the insured's health care provider within ten 
 business days of the preauthorization request provided that all 
 information reasonably necessary to make a decision on the 
 request has been made available to the insurer. 

    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; 

    (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 assume all reasonable costs sufficient to pay the 
 insured's chosen vendor for the repair or replacement of 
 comparable window glass.  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; 

    (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 
 recordkeeping, 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 the 
 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). 

    HIST: 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