Bill Text: MN SF1295 | 2013-2014 | 88th Legislature | Introduced
Bill Title: No-fault automobile insurance benefits, coverages, arbitration and health claims appeals and provider liens provisions modifications
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2013-03-11 - Referred to Commerce [SF1295 Detail]
Download: Minnesota-2013-SF1295-Introduced.html
1.2relating to insurance; regulating certain coverages; prohibiting certain exclusions;
1.3modifying no-fault benefits and coverages, arbitration and health claims appeals,
1.4and provider liens;amending Minnesota Statutes 2012, sections 65B.43,
1.5subdivision 5; 65B.44, subdivisions 2, 3, 4, 5, 6; 65B.47, subdivisions 4, 5;
1.665B.49, subdivision 3a; 65B.525, subdivision 1; 65B.54, subdivision 2, by
1.7adding subdivisions; 65B.56, subdivision 1; 72A.327; proposing coding for new
1.8law in Minnesota Statutes, chapter 60A.
1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.10 Section 1. [60A.0812] PROHIBITED EXCLUSION; CERTAIN PROPERTY
1.11AND CASUALTY POLICIES.
1.12An automobile insurance policy, personal excess liability policy, or personal
1.13umbrella policy must not contain an exclusion of, or limitation on, liability for damages
1.14for bodily injury solely because the injured person is a resident or member of the insured's
1.15household, or is related to the insured by blood or marriage.
1.16EFFECTIVE DATE.This section is effective January 1, 2014, and applies to
1.17policies issued, renewed, or continued on or after that date.
1.18 Sec. 2. Minnesota Statutes 2012, section 65B.43, subdivision 5, is amended to read:
1.19 Subd. 5. Insured. "Insured" means an insured under a plan of reparation security as
1.20provided by sections65B.41 to
65B.71 , including the named insured and the following
1.21persons not identified by name as an insured while (a) residing in the same household
1.22with the named insured and (b) not identified by name in any other contract for a plan of
1.23reparation security complying with sections65B.41 to
65B.71 as an insured:
1.24(1) a spouse,
2.1(2) other relative of a named insured, or
2.2(3) a minor in the custody of a named insured or of a relative residing in the same
2.3household with a named insured.
2.4A person resides in the same household with the named insured if that person's home
2.5is usually in the same family unit, even though temporarily living elsewhere.
2.6"Insured" does not include an assignment of benefits assignee.
2.7 Sec. 3. Minnesota Statutes 2012, section 65B.44, subdivision 2, is amended to read:
2.8 Subd. 2. Medical expense benefits. (a) Medical expense benefits shall reimburse
2.9all reasonable expenses for necessary:
2.10(1) medical, surgical, x-ray, optical, dental, chiropractic, and rehabilitative services,
2.11including prosthetic devices and medically prescribed equipment by a licensed physician;
2.12(2) prescription drugs;
2.13(3) ambulance and all other transportation expenses incurred in traveling to receive
2.14other covered medical expense benefits;
2.15(4) sign interpreting and language translation services, other than such services
2.16provided by a family member of the patient, related to the receipt of medical, surgical,
2.17x-ray, optical, dental, chiropractic, hospital, extended care, nursing, and rehabilitative
2.18services; and
2.19(5) hospital, extended care, and nursing services.
2.20(b) Hospital room and board benefits may be limited, except for intensive care
2.21facilities, to the regular daily semiprivate room rates customarily charged by the institution
2.22in which the recipient of benefits is confined.
2.23(c) Such benefits shall also include necessary remedial treatment and services
2.24recognized and permitted under the laws of this state for an injured person who relies
2.25upon spiritual means through prayer alone for healing in accordance with that person's
2.26religious beliefs.
2.27(d) Medical expense loss includes medical expenses accrued prior to the death of a
2.28person notwithstanding the fact that benefits are paid or payable to the decedent's survivors.
2.29(e) Medical expense benefits for rehabilitative services shall be subject to the
2.30provisions of section65B.45 .
2.31(f) Providers of goods and services for which a medical expense benefit claim is
2.32submitted shall notify the appropriate reparation obligor of the date the services were
2.33commenced or the goods were first provided within 30 days of determining the identity of
2.34the reparation obligor, but in any event not later than 60 days from the date services were
2.35commenced or goods were first provided.
3.1(g) Once the reparations obligor has been established, all bills must be submitted to
3.2the reparations obligor not later than 60 days from the date of service.
3.3 Sec. 4. Minnesota Statutes 2012, section 65B.44, subdivision 3, is amended to read:
3.4 Subd. 3. Disability and income loss benefits. (a) Disability and income loss
3.5benefits shall provide compensation for 85 percent of the injured person's loss of present
3.6and future gross income from inability to work proximately caused by the nonfatal
3.7injury subject to a maximum of$250 $500 per week. Loss of income includes the costs
3.8incurred by a self-employed person to hire substitute employees to perform tasks which
3.9are necessary to maintain the income of the injured person, which are normally performed
3.10by the injured person, and which cannot be performed because of the injury.
3.11(b) If the injured person is unemployed at the time of injury and is receiving or is
3.12eligible to receive unemployment benefits under chapter 268, but the injured person loses
3.13eligibility for those benefits because of inability to work caused by the injury, disability
3.14and income loss benefits shall provide compensation for the lost benefits in an amount
3.15equal to the unemployment benefits which otherwise would have been payable, subject to
3.16a maximum of$250 $500 per week.
3.17(c) Compensation under this subdivision shall be reduced by any income from
3.18substitute work actually performed by the injured person or by income the injured person
3.19would have earned in available appropriate substitute work which the injured person was
3.20capable of performing but unreasonably failed to undertake.
3.21(d) For the purposes of this section "inability to work" means disability which
3.22prevents the injured person from engaging in any substantial gainful occupation or
3.23employment on a regular basis, for wage or profit, for which the injured person is or may
3.24by training become reasonably qualified. If the injured person returns to employment and
3.25is unable by reason of the injury to work continuously, compensation for lost income shall
3.26be reduced by the income received while the injured person is actually able to work. The
3.27weekly maximums may not be prorated to arrive at a daily maximum, even if the injured
3.28person does not incur loss of income for a full week.
3.29(e) For the purposes of this section, an injured person who is "unable by reason of
3.30the injury to work continuously" includes, but is not limited to, a person who misses time
3.31from work, including reasonable travel time, and loses income, vacation, or sick leave
3.32benefits, to obtain medical treatment for an injury arising out of the maintenance or use
3.33of a motor vehicle.
3.34 Sec. 5. Minnesota Statutes 2012, section 65B.44, subdivision 4, is amended to read:
4.1 Subd. 4. Funeral and burial expenses. Funeral and burial benefits shall be
4.2reasonable expenses not in excess of$2,000 $5,000, including expenses for cremation or
4.3delivery under the Darlene Luther Revised Uniform Anatomical Gift Act, chapter 525A.
4.4 Sec. 6. Minnesota Statutes 2012, section 65B.44, subdivision 5, is amended to read:
4.5 Subd. 5. Replacement service and loss. Replacement service loss benefits shall
4.6reimburse provide payment for all reasonable expenses reasonably incurred by or on
4.7behalf of the nonfatally injured person in obtaining usual and necessary substitute services
4.8in lieu of those that performed by a nonhousehold member, had the injured person not
4.9been injured, the injured person would have performed not for income but for direct
4.10personal benefit or for the benefit of the injured person's household; if the nonfatally
4.11injured person normally, as a full time responsibility, provides care and maintenance of a
4.12home with or without children, the benefit to be provided under this subdivision shall be
4.13the reasonable value of such care and maintenance or the reasonable expenses incurred in
4.14obtaining usual and necessary substitute care and maintenance of the home, whichever is
4.15greater. These benefits shall be subject to a maximum of $200 per week. All replacement
4.16services loss sustained on the date of injury and the first seven days thereafter is excluded
4.17in calculating replacement services loss.
4.18 Sec. 7. Minnesota Statutes 2012, section 65B.44, subdivision 6, is amended to read:
4.19 Subd. 6. Survivors economic loss benefits. Survivors economic loss benefits, in
4.20the event of death occurring within one year of the date of the accident, caused by and
4.21arising out of injuries received in the accident, are subject to a maximum of$200 $500
4.22per week and shall cover loss accruing after decedent's death of contributions of money
4.23or tangible things of economic value, not including services, that surviving dependents
4.24would have received from the decedent for their support during their dependency had the
4.25decedent not suffered the injury causing death.
4.26For the purposes of definition under sections65B.41 to
65B.71 , the following
4.27described persons shall be presumed to be dependents of a deceased person: (a) a wife
4.28is dependent on a husband with whom she lives at the time of his death; (b) a husband
4.29is dependent on a wife with whom he lives at the time of her death; (c) any child while
4.30under the age of 18 years, or while over that age but physically or mentally incapacitated
4.31from earning, is dependent on the parent with whom the child is living or from whom the
4.32child is receiving support regularly at the time of the death of such parent; or (d) an actual
4.33dependent who lives with the decedent at the time of the decedent's death. Questions of
5.1the existence and the extent of dependency shall be questions of fact, considering the
5.2support regularly received from the deceased.
5.3Payments shall be made to the dependent, except that benefits to a dependent who
5.4is a child or an incapacitated person may be paid to the dependent's surviving parent or
5.5guardian. Payments shall be terminated whenever the recipient ceases to maintain a status
5.6which if the decedent were alive would be that of dependency.
5.7 Sec. 8. Minnesota Statutes 2012, section 65B.47, subdivision 4, is amended to read:
5.8 Subd. 4. Other cases. In all other cases, the following priorities apply:
5.9(a) The security for payment of basic economic loss benefits applicable to injury to
5.10an insured is the security under which the injured person is an insured.
5.11(b) The security for payment of basic economic loss benefits applicable to injury
5.12to the driver or other occupant of an involved motor vehicle who is not an insured is
5.13the security covering that vehicle.
5.14(c) The security for payment of basic economic loss benefits applicable to injury
5.15to a person not otherwise covered who is not the driver or other occupant of an involved
5.16motor vehicle is the security covering any involved motor vehicle. An unoccupied parked
5.17vehicle is not an involved motor vehicle unless it was parked so as to cause unreasonable
5.18risk of injury.
5.19(d) The security for payment of basic economic loss benefits applicable to a person
5.20who is injured in or by a vehicle listed in section 168.012, subdivision 1, paragraph (a), is
5.21entitled to security under which the injured person is an insured.
5.22 Sec. 9. Minnesota Statutes 2012, section 65B.47, subdivision 5, is amended to read:
5.23 Subd. 5. Contribution. If two or more obligations to pay basic economic loss
5.24benefits are applicable to an injury under the priorities set out in this section, benefits are
5.25payable only once and the reparation obligor against whom a claim is assertedshall must
5.26 process and pay the claim as if wholly responsible, but the reparation obligor is thereafter
5.27entitled to recover contribution pro rata for the basic economic loss benefits paid and the
5.28costs of processing the claim. A reparation obligor failing to comply with this subdivision
5.29is liable for interest as prescribed in section 65B.54. Where contribution is sought among
5.30reparation obligors responsible under subdivision 4, clause (c), proration shall be based on
5.31the number of involved motor vehicles.
5.32 Sec. 10. Minnesota Statutes 2012, section 65B.49, subdivision 3a, is amended to read:
6.1 Subd. 3a. Uninsured and underinsured motorist coverages. (1) No plan of
6.2reparation security may be renewed, delivered or issued for delivery, or executed in this
6.3state with respect to any motor vehicle registered or principally garaged in this state
6.4unless separate uninsured and underinsured motorist coverages are provided therein. Each
6.5coverage, at a minimum, must provide limits of $25,000 because of injury to or the death
6.6of one person in any accident and $50,000 because of injury to or the death of two or more
6.7persons in any accident. In the case of injury to, or the death of, two or more persons in
6.8any accident, the amount available to any one person must not exceed the coverage limit
6.9provided for injury to, or the death of, one person in any accident.
6.10(2) Every owner of a motor vehicle registered or principally garaged in this state shall
6.11maintain uninsured and underinsured motorist coverages as provided in this subdivision.
6.12(3) No reparation obligor is required to provide limits of uninsured and underinsured
6.13motorist coverages in excess of the bodily injury liability limit provided by the applicable
6.14plan of reparation security.
6.15(4) No recovery shall be permitted under the uninsured and underinsured motorist
6.16coverages of this section for basic economic loss benefits paid or payable, or which would
6.17be payable but for any applicable deductible for policies of coverage above the minimum
6.18limits provided by this chapter.
6.19(5) If at the time of the accident the injured person is occupying a motor vehicle,
6.20the limit of liability for uninsured and underinsured motorist coverages available to the
6.21injured person is the limit specified for that motor vehicle. However, if the injured person
6.22is occupying a motor vehicle of which the injured person is not an insured, the injured
6.23person may be entitled to excess insurance protection afforded by a policy in which the
6.24injured party is otherwise insured. The excess insurance protection is limited to the extent
6.25of covered damages sustained, and further is available only to the extent by which the limit
6.26of liability for like coverage applicable to any one motor vehicle listed on the automobile
6.27insurance policy of which the injured person is an insured exceeds the limit of liability of
6.28the coverage available to the injured person from the occupied motor vehicle.
6.29If at the time of the accident the injured person is not occupying a motor vehicle or
6.30motorcycle, the injured person is entitled to select any one limit of liability for any one
6.31vehicle afforded by a policy under which the injured person is insured.
6.32(6) Regardless of the number of policies involved, vehicles involved, persons
6.33covered, claims made, vehicles or premiums shown on the policy, or premiums paid, in no
6.34event shall the limit of liability for uninsured and underinsured motorist coverages for two
6.35or more motor vehicles be added together to determine the limit of insurance coverage
6.36available to an injured person for any one accident.
7.1(7) The uninsured and underinsured motorist coverages required by this subdivision
7.2do not apply to bodily injury of the insured while occupying a motor vehicle owned by the
7.3insured, unless the occupied vehicle is an insured motor vehicle.
7.4(8) The uninsured and underinsured motorist coverages required by this subdivision
7.5do not apply to bodily injury of the insured while occupying a motorcycle owned by
7.6the insured.
7.7 Sec. 11. Minnesota Statutes 2012, section 65B.525, subdivision 1, is amended to read:
7.8 Subdivision 1. Mandatory submission to binding arbitration. (a) Except as
7.9otherwise provided in section72A.327 , the Supreme Court and the several courts of
7.10general trial jurisdiction of this state shall by rules of court or other constitutionally
7.11allowable device, provide for the mandatory submission to binding arbitration of all cases
7.12at issue where the claim at the commencement of arbitration is in an amount of $10,000
7.13or less against any insured's reparation obligor for no-fault benefits or comprehensive or
7.14collision damage coverage.
7.15(b) If assigned claims against a reparation obligor are submitted pursuant to this
7.16section, the aggregate amount of the claims is considered to be one claim for purposes of
7.17the jurisdictional dollar limitation in paragraph (a). Aggregated or consolidated claims in
7.18excess of $10,000 must be recovered in an action in district court.
7.19 Sec. 12. Minnesota Statutes 2012, section 65B.54, subdivision 2, is amended to read:
7.20 Subd. 2. Interest on overdue payments. Overdue payments shall bear simple
7.21interest at the rate of 15 percent per annum. Once an obligor has denied benefits from a
7.22specific provider, made a blanket denial of a type of benefits, or issued a general denial of
7.23benefits, interest is due on all overdue benefits within the scope of the denial, regardless
7.24of whether the insured or provider continues to provide ongoing proof of the fact and
7.25amount of each additional loss incurred.
7.26 Sec. 13. Minnesota Statutes 2012, section 65B.54, is amended by adding a subdivision
7.27to read:
7.28 Subd. 7. Wrongful provider liens. A licensed health care provider who makes,
7.29files, perfects, or records a wrongful lien against the property of an insured for unpaid
7.30medical expense benefits is liable to the insured for $1,000 or actual damages, whichever
7.31is greater, and for reasonable attorney fees and costs.
7.32For purposes of this subdivision, "wrongful lien" means a document that the health
7.33care provider knows, or has reason to know:
8.1(1) is groundless;
8.2(2) contains a material misstatement or false claim; or
8.3(3) attempts to preserve and enforce a legal interest or right in the insured's property
8.4when none is provided by law.
8.5 Sec. 14. Minnesota Statutes 2012, section 65B.54, is amended by adding a subdivision
8.6to read:
8.7 Subd. 8. Health care provider claims arbitration limited. A health care provider
8.8shall not submit any medical benefit claims to arbitration pursuant to section 65B.525 as
8.9an assignment of benefits assignee.
8.10 Sec. 15. Minnesota Statutes 2012, section 65B.56, subdivision 1, is amended to read:
8.11 Subdivision 1.Medical Physical examinations or evaluations and discovery of
8.12condition of claimant. Any person with respect to whose injury benefits are claimed
8.13under a plan of reparation security shall, upon request of the reparation obligor from
8.14whom recovery is sought, submit to a physical examination or evaluation by a physician or
8.15physicians licensed provider or other providers selected by the obligor as may reasonably
8.16be required. The person being examined is entitled upon request to have a nonmedical
8.17observer present at any examination done pursuant to this subdivision.
8.18The costs of any examinations requested by the obligor shall be borne entirely by
8.19the requesting obligor. Such examinations shall be conducted within the city, town, or
8.20statutory city of residence of the injured person. Examinations must not be conducted
8.21in hotel or motel facilities. If there is no qualifiedphysician examiner to conduct the
8.22examination within the city, town, or statutory city of residence of the injured person,
8.23then such examination shall be conducted at another place of the closest proximity to
8.24the injured person's residence. If the injured person has moved out of Minnesota, the
8.25examination may take place at the reparation obligor's expense in or near the last city of
8.26residence within Minnesota. Obligors are authorized to include reasonable provisions in
8.27policies for mental and physical examination of those injured persons.
8.28If requested by the person examined, a party causing an examination to be made
8.29shall deliver to the examinee a copy of every written report concerning the examination
8.30rendered by an examining physician to that person, at least one of which reports must set
8.31out in detail the findings and conclusions ofsuch examining physician the examiner.
8.32An injured person shall also do all things reasonably necessary to enable the obligor
8.33to obtain medical reports and other needed information to assist in determining the
8.34nature and extent of the injured person's injuries and loss, and the medical treatment
9.1received. If the claimant refuses to cooperate in responding to requests for examination
9.2and information as authorized by this section, evidence of such noncooperation shall be
9.3admissible in any suit or arbitration filed for damages for such personal injuries or for the
9.4benefits provided by sections65B.41 to
65B.71 .
9.5The provisions of this section apply before and after the commencement of suit.
9.6 Sec. 16. Minnesota Statutes 2012, section 72A.327, is amended to read:
9.772A.327 HEALTH CLAIMS; RIGHTS OF APPEAL.
9.8(a) An insured whose claim for medical benefits under chapter 65B is denied because
9.9the treatment or services for which the claim is made is claimed to be experimental,
9.10investigative, not medically necessary, or otherwise not generally accepted by licensed
9.11health care providers and for which the insured has financial responsibility in excess of
9.12applicable co-payments and deductibles may appeal the denial to the commissioner. For
9.13purposes of this section, "insured" does not include an assignment of benefits assignee.
9.14(b) This section does not apply to claims for health benefits which have been
9.15arbitrated under section65B.525, subdivision 1 .
9.16(c) A three-member panel shall review the denial of the claim and report to the
9.17commissioner. The commissioner shall establish a list of qualified individuals who are
9.18eligible to serve on the panel. In establishing the list, the commissioner shall consult with
9.19representatives of the contributing members as defined in section65B.01, subdivision 2 ,
9.20and professional societies. Each panel must include: one person with medical expertise as
9.21identified by the contributing members; one person with medical expertise as identified by
9.22the professional societies; and one public member. The commissioner, upon initiation of an
9.23arbitration, shall select from each list three potential arbitrators and shall notify the issuer
9.24and the claimant of the selection. Each party shall strike one of the potential arbitrators and
9.25an arbitrator shall be selected by the commissioner from the remaining names of potential
9.26arbitrators if more than one potential arbitrator is left. In the event of multiparty arbitration,
9.27the commissioner may increase the number of potential arbitrators and divide the strikes
9.28so as to afford an equal number of strikes to each adverse interest. If the selected arbitrator
9.29is unable or unwilling to serve for any reason, the commissioner may appoint an arbitrator,
9.30which will be subject to challenge only for cause. The party that denied the coverage has
9.31the burden of proving that the services or treatment are experimental, investigative, not
9.32medically necessary, or not generally accepted by licensed health care professionals. In
9.33determining whether the burden has been met, the panel may consider expert testimony,
9.34medical literature, and any other relevant sources. If the party fails to sustain its burden,
10.1the commissioner may order the immediate payment of the claim. All proceedings of the
10.2panel and any documents received or developed by the review process are nonpublic.
10.3(d) A person aggrieved by an order under this section may appeal the order. The
10.4appeal shall be pursuant to section65B.525 where appropriate, or to the district court
10.5for a trial de novo, in all other cases. In nonemergency situations, if the insurer has an
10.6internal grievance or appeal process, the insured must exhaust that process before the
10.7external appeal. In no event shall the internal grievance process exceed the time limits
10.8described in section72A.201, subdivision 4a .
10.9(e) If prior authorization is required before services or treatment can be rendered, an
10.10appeal of the denial of prior authorization may be made as provided in this section.
10.11(f) The commissioner shall adopt procedural rules for the conduct of appeals.
10.12(g) The permanent rulemaking authority granted in this section is effective June 2,
10.131989, regardless of the actual effective date of January 1, 1990.
10.14 Sec. 17. EFFECTIVE DATE; APPLICATION.
10.15Sections 2 to 16 are effective January 1, 2014, and apply to plans of reparation
10.16security issued or renewed on or after that date.
1.3modifying no-fault benefits and coverages, arbitration and health claims appeals,
1.4and provider liens;amending Minnesota Statutes 2012, sections 65B.43,
1.5subdivision 5; 65B.44, subdivisions 2, 3, 4, 5, 6; 65B.47, subdivisions 4, 5;
1.665B.49, subdivision 3a; 65B.525, subdivision 1; 65B.54, subdivision 2, by
1.7adding subdivisions; 65B.56, subdivision 1; 72A.327; proposing coding for new
1.8law in Minnesota Statutes, chapter 60A.
1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.10 Section 1. [60A.0812] PROHIBITED EXCLUSION; CERTAIN PROPERTY
1.11AND CASUALTY POLICIES.
1.12An automobile insurance policy, personal excess liability policy, or personal
1.13umbrella policy must not contain an exclusion of, or limitation on, liability for damages
1.14for bodily injury solely because the injured person is a resident or member of the insured's
1.15household, or is related to the insured by blood or marriage.
1.16EFFECTIVE DATE.This section is effective January 1, 2014, and applies to
1.17policies issued, renewed, or continued on or after that date.
1.18 Sec. 2. Minnesota Statutes 2012, section 65B.43, subdivision 5, is amended to read:
1.19 Subd. 5. Insured. "Insured" means an insured under a plan of reparation security as
1.20provided by sections
1.21persons not identified by name as an insured while (a) residing in the same household
1.22with the named insured and (b) not identified by name in any other contract for a plan of
1.23reparation security complying with sections
1.24(1) a spouse,
2.1(2) other relative of a named insured, or
2.2(3) a minor in the custody of a named insured or of a relative residing in the same
2.3household with a named insured.
2.4A person resides in the same household with the named insured if that person's home
2.5is usually in the same family unit, even though temporarily living elsewhere.
2.6"Insured" does not include an assignment of benefits assignee.
2.7 Sec. 3. Minnesota Statutes 2012, section 65B.44, subdivision 2, is amended to read:
2.8 Subd. 2. Medical expense benefits. (a) Medical expense benefits shall reimburse
2.9all reasonable expenses for necessary:
2.10(1) medical, surgical, x-ray, optical, dental, chiropractic, and rehabilitative services,
2.11including prosthetic devices and medically prescribed equipment by a licensed physician;
2.12(2) prescription drugs;
2.13(3) ambulance and all other transportation expenses incurred in traveling to receive
2.14other covered medical expense benefits;
2.15(4) sign interpreting and language translation services, other than such services
2.16provided by a family member of the patient, related to the receipt of medical, surgical,
2.17x-ray, optical, dental, chiropractic, hospital, extended care, nursing, and rehabilitative
2.18services; and
2.19(5) hospital, extended care, and nursing services.
2.20(b) Hospital room and board benefits may be limited, except for intensive care
2.21facilities, to the regular daily semiprivate room rates customarily charged by the institution
2.22in which the recipient of benefits is confined.
2.23(c) Such benefits shall also include necessary remedial treatment and services
2.24recognized and permitted under the laws of this state for an injured person who relies
2.25upon spiritual means through prayer alone for healing in accordance with that person's
2.26religious beliefs.
2.27(d) Medical expense loss includes medical expenses accrued prior to the death of a
2.28person notwithstanding the fact that benefits are paid or payable to the decedent's survivors.
2.29(e) Medical expense benefits for rehabilitative services shall be subject to the
2.30provisions of section
2.31(f) Providers of goods and services for which a medical expense benefit claim is
2.32submitted shall notify the appropriate reparation obligor of the date the services were
2.33commenced or the goods were first provided within 30 days of determining the identity of
2.34the reparation obligor, but in any event not later than 60 days from the date services were
2.35commenced or goods were first provided.
3.1(g) Once the reparations obligor has been established, all bills must be submitted to
3.2the reparations obligor not later than 60 days from the date of service.
3.3 Sec. 4. Minnesota Statutes 2012, section 65B.44, subdivision 3, is amended to read:
3.4 Subd. 3. Disability and income loss benefits. (a) Disability and income loss
3.5benefits shall provide compensation for 85 percent of the injured person's loss of present
3.6and future gross income from inability to work proximately caused by the nonfatal
3.7injury subject to a maximum of
3.8incurred by a self-employed person to hire substitute employees to perform tasks which
3.9are necessary to maintain the income of the injured person, which are normally performed
3.10by the injured person, and which cannot be performed because of the injury.
3.11(b) If the injured person is unemployed at the time of injury and is receiving or is
3.12eligible to receive unemployment benefits under chapter 268, but the injured person loses
3.13eligibility for those benefits because of inability to work caused by the injury, disability
3.14and income loss benefits shall provide compensation for the lost benefits in an amount
3.15equal to the unemployment benefits which otherwise would have been payable, subject to
3.16a maximum of
3.17(c) Compensation under this subdivision shall be reduced by any income from
3.18substitute work actually performed by the injured person or by income the injured person
3.19would have earned in available appropriate substitute work which the injured person was
3.20capable of performing but unreasonably failed to undertake.
3.21(d) For the purposes of this section "inability to work" means disability which
3.22prevents the injured person from engaging in any substantial gainful occupation or
3.23employment on a regular basis, for wage or profit, for which the injured person is or may
3.24by training become reasonably qualified. If the injured person returns to employment and
3.25is unable by reason of the injury to work continuously, compensation for lost income shall
3.26be reduced by the income received while the injured person is actually able to work. The
3.27weekly maximums may not be prorated to arrive at a daily maximum, even if the injured
3.28person does not incur loss of income for a full week.
3.29(e) For the purposes of this section, an injured person who is "unable by reason of
3.30the injury to work continuously" includes, but is not limited to, a person who misses time
3.31from work, including reasonable travel time, and loses income, vacation, or sick leave
3.32benefits, to obtain medical treatment for an injury arising out of the maintenance or use
3.33of a motor vehicle.
3.34 Sec. 5. Minnesota Statutes 2012, section 65B.44, subdivision 4, is amended to read:
4.1 Subd. 4. Funeral and burial expenses. Funeral and burial benefits shall be
4.2reasonable expenses not in excess of
4.3delivery under the Darlene Luther Revised Uniform Anatomical Gift Act, chapter 525A.
4.4 Sec. 6. Minnesota Statutes 2012, section 65B.44, subdivision 5, is amended to read:
4.5 Subd. 5. Replacement service and loss. Replacement service loss benefits shall
4.6
4.7behalf of the nonfatally injured person in obtaining usual and necessary substitute services
4.8
4.9been injured, the injured person would have performed not for income but for direct
4.10personal benefit or for the benefit of the injured person's household
4.11
4.12
4.13
4.14
4.15
4.16services loss sustained on the date of injury and the first seven days thereafter is excluded
4.17in calculating replacement services loss.
4.18 Sec. 7. Minnesota Statutes 2012, section 65B.44, subdivision 6, is amended to read:
4.19 Subd. 6. Survivors economic loss benefits. Survivors economic loss benefits, in
4.20the event of death occurring within one year of the date of the accident, caused by and
4.21arising out of injuries received in the accident, are subject to a maximum of
4.22per week and shall cover loss accruing after decedent's death of contributions of money
4.23or tangible things of economic value, not including services, that surviving dependents
4.24would have received from the decedent for their support during their dependency had the
4.25decedent not suffered the injury causing death.
4.26For the purposes of definition under sections
4.27described persons shall be presumed to be dependents of a deceased person: (a) a wife
4.28is dependent on a husband with whom she lives at the time of his death; (b) a husband
4.29is dependent on a wife with whom he lives at the time of her death; (c) any child while
4.30under the age of 18 years, or while over that age but physically or mentally incapacitated
4.31from earning, is dependent on the parent with whom the child is living or from whom the
4.32child is receiving support regularly at the time of the death of such parent; or (d) an actual
4.33dependent who lives with the decedent at the time of the decedent's death. Questions of
5.1the existence and the extent of dependency shall be questions of fact, considering the
5.2support regularly received from the deceased.
5.3Payments shall be made to the dependent, except that benefits to a dependent who
5.4is a child or an incapacitated person may be paid to the dependent's surviving parent or
5.5guardian. Payments shall be terminated whenever the recipient ceases to maintain a status
5.6which if the decedent were alive would be that of dependency.
5.7 Sec. 8. Minnesota Statutes 2012, section 65B.47, subdivision 4, is amended to read:
5.8 Subd. 4. Other cases. In all other cases, the following priorities apply:
5.9(a) The security for payment of basic economic loss benefits applicable to injury to
5.10an insured is the security under which the injured person is an insured.
5.11(b) The security for payment of basic economic loss benefits applicable to injury
5.12to the driver or other occupant of an involved motor vehicle who is not an insured is
5.13the security covering that vehicle.
5.14(c) The security for payment of basic economic loss benefits applicable to injury
5.15to a person not otherwise covered who is not the driver or other occupant of an involved
5.16motor vehicle is the security covering any involved motor vehicle. An unoccupied parked
5.17vehicle is not an involved motor vehicle unless it was parked so as to cause unreasonable
5.18risk of injury.
5.19(d) The security for payment of basic economic loss benefits applicable to a person
5.20who is injured in or by a vehicle listed in section 168.012, subdivision 1, paragraph (a), is
5.21entitled to security under which the injured person is an insured.
5.22 Sec. 9. Minnesota Statutes 2012, section 65B.47, subdivision 5, is amended to read:
5.23 Subd. 5. Contribution. If two or more obligations to pay basic economic loss
5.24benefits are applicable to an injury under the priorities set out in this section, benefits are
5.25payable only once and the reparation obligor against whom a claim is asserted
5.26 process and pay the claim as if wholly responsible, but the reparation obligor is thereafter
5.27entitled to recover contribution pro rata for the basic economic loss benefits paid and the
5.28costs of processing the claim. A reparation obligor failing to comply with this subdivision
5.29is liable for interest as prescribed in section 65B.54. Where contribution is sought among
5.30reparation obligors responsible under subdivision 4, clause (c), proration shall be based on
5.31the number of involved motor vehicles.
5.32 Sec. 10. Minnesota Statutes 2012, section 65B.49, subdivision 3a, is amended to read:
6.1 Subd. 3a. Uninsured and underinsured motorist coverages. (1) No plan of
6.2reparation security may be renewed, delivered or issued for delivery, or executed in this
6.3state with respect to any motor vehicle registered or principally garaged in this state
6.4unless separate uninsured and underinsured motorist coverages are provided therein. Each
6.5coverage, at a minimum, must provide limits of $25,000 because of injury to or the death
6.6of one person in any accident and $50,000 because of injury to or the death of two or more
6.7persons in any accident. In the case of injury to, or the death of, two or more persons in
6.8any accident, the amount available to any one person must not exceed the coverage limit
6.9provided for injury to, or the death of, one person in any accident.
6.10(2) Every owner of a motor vehicle registered or principally garaged in this state shall
6.11maintain uninsured and underinsured motorist coverages as provided in this subdivision.
6.12(3) No reparation obligor is required to provide limits of uninsured and underinsured
6.13motorist coverages in excess of the bodily injury liability limit provided by the applicable
6.14plan of reparation security.
6.15(4) No recovery shall be permitted under the uninsured and underinsured motorist
6.16coverages of this section for basic economic loss benefits paid or payable, or which would
6.17be payable but for any applicable deductible for policies of coverage above the minimum
6.18limits provided by this chapter.
6.19(5) If at the time of the accident the injured person is occupying a motor vehicle,
6.20the limit of liability for uninsured and underinsured motorist coverages available to the
6.21injured person is the limit specified for that motor vehicle. However, if the injured person
6.22is occupying a motor vehicle of which the injured person is not an insured, the injured
6.23person may be entitled to excess insurance protection afforded by a policy in which the
6.24injured party is otherwise insured. The excess insurance protection is limited to the extent
6.25of covered damages sustained, and further is available only to the extent by which the limit
6.26of liability for like coverage applicable to any one motor vehicle listed on the automobile
6.27insurance policy of which the injured person is an insured exceeds the limit of liability of
6.28the coverage available to the injured person from the occupied motor vehicle.
6.29If at the time of the accident the injured person is not occupying a motor vehicle or
6.30motorcycle, the injured person is entitled to select any one limit of liability for any one
6.31vehicle afforded by a policy under which the injured person is insured.
6.32(6) Regardless of the number of policies involved, vehicles involved, persons
6.33covered, claims made, vehicles or premiums shown on the policy, or premiums paid, in no
6.34event shall the limit of liability for uninsured and underinsured motorist coverages for two
6.35or more motor vehicles be added together to determine the limit of insurance coverage
6.36available to an injured person for any one accident.
7.1(7) The uninsured and underinsured motorist coverages required by this subdivision
7.2do not apply to bodily injury of the insured while occupying a motor vehicle owned by the
7.3insured, unless the occupied vehicle is an insured motor vehicle.
7.4(8) The uninsured and underinsured motorist coverages required by this subdivision
7.5do not apply to bodily injury of the insured while occupying a motorcycle owned by
7.6the insured.
7.7 Sec. 11. Minnesota Statutes 2012, section 65B.525, subdivision 1, is amended to read:
7.8 Subdivision 1. Mandatory submission to binding arbitration. (a) Except as
7.9otherwise provided in section
7.10general trial jurisdiction of this state shall by rules of court or other constitutionally
7.11allowable device, provide for the mandatory submission to binding arbitration of all cases
7.12at issue where the claim at the commencement of arbitration is in an amount of $10,000
7.13or less against any insured's reparation obligor for no-fault benefits or comprehensive or
7.14collision damage coverage.
7.15(b) If assigned claims against a reparation obligor are submitted pursuant to this
7.16section, the aggregate amount of the claims is considered to be one claim for purposes of
7.17the jurisdictional dollar limitation in paragraph (a). Aggregated or consolidated claims in
7.18excess of $10,000 must be recovered in an action in district court.
7.19 Sec. 12. Minnesota Statutes 2012, section 65B.54, subdivision 2, is amended to read:
7.20 Subd. 2. Interest on overdue payments. Overdue payments shall bear simple
7.21interest at the rate of 15 percent per annum. Once an obligor has denied benefits from a
7.22specific provider, made a blanket denial of a type of benefits, or issued a general denial of
7.23benefits, interest is due on all overdue benefits within the scope of the denial, regardless
7.24of whether the insured or provider continues to provide ongoing proof of the fact and
7.25amount of each additional loss incurred.
7.26 Sec. 13. Minnesota Statutes 2012, section 65B.54, is amended by adding a subdivision
7.27to read:
7.28 Subd. 7. Wrongful provider liens. A licensed health care provider who makes,
7.29files, perfects, or records a wrongful lien against the property of an insured for unpaid
7.30medical expense benefits is liable to the insured for $1,000 or actual damages, whichever
7.31is greater, and for reasonable attorney fees and costs.
7.32For purposes of this subdivision, "wrongful lien" means a document that the health
7.33care provider knows, or has reason to know:
8.1(1) is groundless;
8.2(2) contains a material misstatement or false claim; or
8.3(3) attempts to preserve and enforce a legal interest or right in the insured's property
8.4when none is provided by law.
8.5 Sec. 14. Minnesota Statutes 2012, section 65B.54, is amended by adding a subdivision
8.6to read:
8.7 Subd. 8. Health care provider claims arbitration limited. A health care provider
8.8shall not submit any medical benefit claims to arbitration pursuant to section 65B.525 as
8.9an assignment of benefits assignee.
8.10 Sec. 15. Minnesota Statutes 2012, section 65B.56, subdivision 1, is amended to read:
8.11 Subdivision 1.
8.12condition of claimant. Any person with respect to whose injury benefits are claimed
8.13under a plan of reparation security shall, upon request of the reparation obligor from
8.14whom recovery is sought, submit to a physical examination or evaluation by a physician or
8.15
8.16be required. The person being examined is entitled upon request to have a nonmedical
8.17observer present at any examination done pursuant to this subdivision.
8.18The costs of any examinations requested by the obligor shall be borne entirely by
8.19the requesting obligor. Such examinations shall be conducted within the city, town, or
8.20statutory city of residence of the injured person. Examinations must not be conducted
8.21in hotel or motel facilities. If there is no qualified
8.22examination within the city, town, or statutory city of residence of the injured person,
8.23then such examination shall be conducted at another place of the closest proximity to
8.24the injured person's residence. If the injured person has moved out of Minnesota, the
8.25examination may take place at the reparation obligor's expense in or near the last city of
8.26residence within Minnesota. Obligors are authorized to include reasonable provisions in
8.27policies for mental and physical examination of those injured persons.
8.28If requested by the person examined, a party causing an examination to be made
8.29shall deliver to the examinee a copy of every written report concerning the examination
8.30rendered by an examining physician to that person, at least one of which reports must set
8.31out in detail the findings and conclusions of
8.32An injured person shall also do all things reasonably necessary to enable the obligor
8.33to obtain medical reports and other needed information to assist in determining the
8.34nature and extent of the injured person's injuries and loss, and the medical treatment
9.1received. If the claimant refuses to cooperate in responding to requests for examination
9.2and information as authorized by this section, evidence of such noncooperation shall be
9.3admissible in any suit or arbitration filed for damages for such personal injuries or for the
9.4benefits provided by sections
9.5The provisions of this section apply before and after the commencement of suit.
9.6 Sec. 16. Minnesota Statutes 2012, section 72A.327, is amended to read:
9.772A.327 HEALTH CLAIMS; RIGHTS OF APPEAL.
9.8(a) An insured whose claim for medical benefits under chapter 65B is denied because
9.9the treatment or services for which the claim is made is claimed to be experimental,
9.10investigative, not medically necessary, or otherwise not generally accepted by licensed
9.11health care providers and for which the insured has financial responsibility in excess of
9.12applicable co-payments and deductibles may appeal the denial to the commissioner. For
9.13purposes of this section, "insured" does not include an assignment of benefits assignee.
9.14(b) This section does not apply to claims for health benefits which have been
9.15arbitrated under section
9.16(c) A three-member panel shall review the denial of the claim and report to the
9.17commissioner. The commissioner shall establish a list of qualified individuals who are
9.18eligible to serve on the panel. In establishing the list, the commissioner shall consult with
9.19representatives of the contributing members as defined in section
9.20and professional societies. Each panel must include: one person with medical expertise as
9.21identified by the contributing members; one person with medical expertise as identified by
9.22the professional societies; and one public member. The commissioner, upon initiation of an
9.23arbitration, shall select from each list three potential arbitrators and shall notify the issuer
9.24and the claimant of the selection. Each party shall strike one of the potential arbitrators and
9.25an arbitrator shall be selected by the commissioner from the remaining names of potential
9.26arbitrators if more than one potential arbitrator is left. In the event of multiparty arbitration,
9.27the commissioner may increase the number of potential arbitrators and divide the strikes
9.28so as to afford an equal number of strikes to each adverse interest. If the selected arbitrator
9.29is unable or unwilling to serve for any reason, the commissioner may appoint an arbitrator,
9.30which will be subject to challenge only for cause. The party that denied the coverage has
9.31the burden of proving that the services or treatment are experimental, investigative, not
9.32medically necessary, or not generally accepted by licensed health care professionals. In
9.33determining whether the burden has been met, the panel may consider expert testimony,
9.34medical literature, and any other relevant sources. If the party fails to sustain its burden,
10.1the commissioner may order the immediate payment of the claim. All proceedings of the
10.2panel and any documents received or developed by the review process are nonpublic.
10.3(d) A person aggrieved by an order under this section may appeal the order. The
10.4appeal shall be pursuant to section
10.5for a trial de novo, in all other cases. In nonemergency situations, if the insurer has an
10.6internal grievance or appeal process, the insured must exhaust that process before the
10.7external appeal. In no event shall the internal grievance process exceed the time limits
10.8described in section
10.9(e) If prior authorization is required before services or treatment can be rendered, an
10.10appeal of the denial of prior authorization may be made as provided in this section.
10.11(f) The commissioner shall adopt procedural rules for the conduct of appeals.
10.12
10.13
10.14 Sec. 17. EFFECTIVE DATE; APPLICATION.
10.15Sections 2 to 16 are effective January 1, 2014, and apply to plans of reparation
10.16security issued or renewed on or after that date.
