|
KENTUCKY INSURANCE ARBITRATION
ASSOCIATION
Click here to go
home
Click here to return to
KENTUCKY INSURANCE ARBITRATION
ASSOCIATION
Kentucky Insurance Arbitration
Association
Plan of Operations:
Frequently Asked Questions
1. How can I
become an arbitrator?
Answer:
See Article 2. A, 2
& 3
2. Who is a
member of KIAA?
Answer:
See Article 3.A. & B.
3. What is the
Statute of Limitations for PIP arbitration?
Answer:
See Article 4. C. (also
see Article 4, G,2)
4. Is there an
offset (deductible) ?
Answer:
See Article 4. E. Page 4.
5. If there is
an offset, does it apply to each injured person?
Answer:
See Article 4. E.
6. What if the
BI limits are exhausted?
Answer:
See Article 4. F. 2. and
KRS 304.39-040 (4)
7. How soon
can arbitration be filed and what is the 60 days referring
to?
Answer:
See Article 4. G. 2.
8. What if the
other reparation obligor is a non-member?
Answer:
See Article 5. B.2.
(Notice: Sections are extracted from the)
KENTUCKY INSURANCE ARBITRATION ASSOCIATION PLAN OF OPERATION
Article 2. Board of
Directors
A. There shall be
a Board of Directors consisting of ten members who are
full-time employees of writers of automobile insurance in
Kentucky.
^Back To Top
2. Each member of
the Board of Directors shall designate qualified persons who
are employed full-time by his company in claims
administration and who are licensed adjusters in the
Commonwealth of Kentucky, who, upon approval of the
Executive Director of the Office of Insurance, may serve as
his alternate at any time for the purpose of claims
arbitration as specified in Article 5. The number of
Alternates designated by each member shall be determined by
the needs of the Association.
^Back To Top
3. Any member of
the Board may designate an alternate representative to serve
from time to time in place and instead of the actual
selected representative. Such alternate shall be licensed
adjusters in the Commonwealth of Kentucky. Any member
designating an alternate shall so notify the Chairman, the
Secretary of the Board and the Executive Director of the
Office of Insurance.
^Back To Top
Article 3. Membership
A. Insurance
Companies and Self Insurers, which are admitted and approved
as of July 1, 1975 to provide the kinds of Insurance
required by Chapter 304.Subtitle 39, of the Kentucky Revised
Statutes shall be members of the Association. Each Insurer
and self-insurer approved by the Executive Director of the
Office of Insurance after July 1, 1975, shall automatically
become members of this Association.
B. Other persons,
associations, organizations and agencies of government may
by written application and upon approval of the Board and
the Executive Director of the Office of Insurance become
members of this Association.
^Back To Top
Article 4. Operations
C. A claim may be
submitted to arbitration not later than two (2) years after
the injury or the death, or the last basic reparation
payment made by any reparation obligor, or the settlement or
expiration of the statute of limitations of a claim or
claims arising out of the same accident, occurrence, or
insured event, whichever later occurs.
^Back To Top
Article 4.
Operations
E. In order that
there be fair allocation of significant losses, while at the
same time eliminating the unnecessary costs in the handling
and shifting of insignificant losses, no member shall make
application for or be entitled to receive, and no
arbitration award shall be made for damages paid or payable
by the member reparations obligor as basic benefits for the
first $1,000. in the aggregate of loss so paid arising from
a single occurrence without regard to the number of persons
to whom basic or added reparations benefits were paid or
payable.
^Back To Top
Article 4.
Operations
F, 2: The
Executive Director of the Office of Insurance shall
determine, if the members cannot agree, the extent to which
an award shall be modified in order to protect a member with
multiple occurrence liabilities from paying more in the
aggregate than the extent of its liability coverage. Added:
Also see, KRS 304.39-040(4)
^Back To Top
Article 4.
Operations
^Back To Top
G, 2. An
applicant shall attach to its application a certification or
other evidence of having requested reimbursement at least 60
days prior to such application and that such request has
been ignored or denied.
Article 5. Arbitration
^Back To Top
B, 2. Arbitration
of controversies between members of the Association who,
collectively, are not signatory members may be submitted
with the common consent of all controverting insurers.
Kentucky Insurance Arbitration Association
Click
here to return to top
Click here to return to
KENTUCKY INSURANCE ARBITRATION
ASSOCIATION Frequently Asked
Questions: Arbitration Rules
1. What if
accident happens outside of Kentucky?
Answer:
See General: rule 1.
(If two Kentucky residents are involved in an automobile
accident outside of Kentucky, the panel can hear those
controversies.)
2. May a
reparation obligor arbitrate with a general liability or
farmers comprehensive liability carrier?
Answer:
See
General: Rule 4.
(No)
3. What if a
company wants to defer the hearing?
Answer:
See General: Rule 8, 9
and 10.
4. What if the
court or another forum has rendered a decision?
Answer:
See General: Rule
11.
(Liability is res judica)
5. What are
the filing fee amounts?
Answer:
See Filing Fees: Rule 1, 2
6. How do I
file for arbitration?
Answer:
See Procedure:
Rules 1 and 2
7. How do I
respond to arbitration?
Answer:
See
Procedure: Rule 3
8. What is the
time limit for the respondent to reply?
Answer:
See Procedure:
Rule 4
9. How is a
counterclaim made?
Answer:
See
Procedure: Rule 5, (Must also pay a filing fee)
10. After the
hearing is set how long do I have to submit additional
evidence?
Answer:
See
Hearing and Evidence: Rule 3.
11. Can either
party request a continuance?
Answer:
See Hearing
and Evidence: Rule 4.
12. Who may
attend a hearing?
Answer:
See Hearing and Evidence: Rule 8 and 9
13. What
documentation should be submitted?
Answer:
See
Hearing and Evidence: Rule 13
14. How is an
appeal made?
Answer:
See
Decisions: Rule 2
(and Article 5,B, 3 of the Plan of Operations) (Note there
is no provision for an appeal in the Plan or Rules.)
(Notice: The following sections are extracted from the)
KENTUCKY INSURANCE ARBITRATION ASSOCIATION
AUTOMOBILE ACCIDENT REPARATIONS
ARBITRATION RULES
GENERAL
1. The
Arbitration Plan of Operation & Rules shall be applicable to
accidents, insured events of losses under the jurisdiction of the
Kentucky Motor Vehicle Reparation Act giving subrogation recovery
rights to reparation obligors for payments or benefits paid to
insureds or third parties under such statute.
^Back To Top
4. The
Arbitration Plan of Operation is applicable to controversies
involving reparation obligors and persons having the rights and
obligations of a reparation obligor. The interests of other persons
may not be arbitrated under the Plan. The fact that other persons
may be insureds of reparation obligors does not alter this rule.
^Back To Top
8.
The hearing of a matter pending before the arbitration panel
under this Plan will be deferred when a reparation obligor provides
written notice of the existence of pending claims or suits arising
out of the same accident, occurrence or insured event, and further
specifically request a deferment in writing. Otherwise the matter
will proceed to a hearing and the controverting parties will be
deemed to have waived any right they may have had to deferment. The
decision of the arbitrator(s) shall be deemed conclusive between the
controverting parties as to the issues of liability and damages with
respect to the claims heard, and it will not, except as provided in
Article 4F of the Plan of Operations, be subject to or affected by
any prior court decision, unless the claims had been asserted and
adjudicated in the action by way of intervention as provided in
KRS 304-39-070(3), or by any subsequent court decision which
directly or indirectly involves the same claims.
^Back To Top
9. A party may at any time challenge
deferment by providing notice in writing. Upon a determination by
the Arbitration Panel that good cause for deferment does not or no
longer exists, the Association’s Panel Secretary shall schedule a
hearing in accordance with these Rules.
10. Deferment of a hearing under Rule
8, generally, does not relieve a respondent reparation obligor
from the obligation to file its written answer asserting therein any
affirmative defense once the subject case has been removed from a
deferred status. All parties have the responsibility to determine
correct current addresses, when requesting deferment removal.
^Back To Top
11. Where there are
companion claims arising out of the same accident each of which
would be, or is subject to this Plan, only one filing is necessary
to determine the issue of liability as to the drivers of the
respective vehicles. A decision on the issue is res judicata on the
liability issue in all companion matters involving the same
reparation obligors under this Plan, except as to special defenses
arising in companion claim or suit.
^Back To Top
FILING FEES
1. The Board of Directors of the Association shall prescribe filing
fees, which shall be no less than $25.00. An Applicant or Respondent
who requests a hearing by a panel of three members shall pay a
filing fee of $100.00.
^Back To Top
2. The obligation for the prescribed
filing fee is incurred upon filing by the Applicant and by the
Respondent who files a counterclaim. The filing fee shall be made
payable to Kentucky Insurance Arbitration Association. The Secretary
of the Arbitration Panel shall not accept a case for arbitration
unless and until the filing fee is paid. Filing fees paid to the
Association shall not be refunded.
^Back To Top
PROCEDURE
1. An arbitration
proceeding is commenced by a reparation obligor filing an
“Arbitration Notice” (three copies) with the Association’s
Arbitration Panel Secretary. At the same time a copy of the
“Arbitration Notice” and supporting documentation is to be submitted
by the applicant directly to the respondent. If there is more than
one respondent reparation obligor in a case the Applicant shall so
indicate on the original and all copies of the “Arbitration Notice”
and send a copy thereof to each respondent reparation obligor and a
copy to the Secretary. In the event an “Arbitration Notice”
(application) is obsolete, not one prescribed by the Board of
Directors or incomplete, the reparations obligor has 30 days from
date of notice by the Association to correct the deficiency,
^Back To Top
2. Notice by applicants shall set forth
the following information:
a) Names of applicant and respondent
reparation obligors together with names and addresses of persons
having supervision of the case in controversy.
b) Name and address of respondent
reparation obligor’s insured.
c) Claim file numbers of applicant and
respondent, if known.
d) Date and place of alleged accident,
loss or other insured events.
e) Amount of reparation obligors claim
payment.
f) Certification that settlement efforts
have been unsuccessful.
g) Brief statement of allegation solely
as to the issue in controversy.
h) Signature of applicant’s
representative and date signed.
^Back To Top
3. Answers filed
by respondent shall be made on Association Form as received from
Applicant. One copy to Secretary and one copy to Applicant with a
copy of all supporting documents.
a) Supplement, if and as necessary, the
information furnished by applicant as to respondent company’s name,
address, name of insured, file number or kind of policy coverage.
b) Whether there is an objection to
arbitration. If so, the grounds on which the objection is based
should be fully stated.
c) Brief statement of allegations as to
the issue in controversy.
d) Personal Representation will not be
allowed when an answer has not been filed as required above.
e) Signature of respondent’s
representative and date signed.
^Back To Top
4. The respondent has
thirty days after the applicant’s filing in which to file a
written answer. If a respondent fails to submit its answer within
thirty days after an applicant files, it is presumed that the
applicant’s claim has been denied and the case is ready for hearing
on the issues. Failure to file an answer will not operate to delay
the arbitration hearing. However, if affirmative defenses are
available to the respondent, and are not asserted by answer prior to
notice of hearing, the applicant, on request, will be entitled to an
adjournment to investigate such affirmative defenses.
^Back To Top
5.
The procedure set
out in the preceding paragraphs of this section is also
applicable to counterclaims. The “Arbitration Notice” should clearly
indicate that it is submitted as a counterclaim and the original
arbitration case to which it pertains shall be plainly identified.
Unless a counterclaim is filed by a respondent and heard with the
original arbitration case, the respondent with the counterclaim is
thereafter precluded from pursuing its claim against the adverse
reparation obligor.
^Back To Top
HEARING AND EVIDENCE
3.
The
controverting parties shall be notified by the Association’s
Arbitration Panel Secretary of the time and place of a scheduled
hearing at least 15 days in advance of the hearing date. Notice of
hearing shall be sent by certified mail, return receipt requested or
by priority mail with proof of delivery, to any respondent which has
not filed a written answer. If a written response is not received by
the Plan 7 days Prior to the hearing it will not be considered.
Additional documentation by either party must be submitted 7 days
prior to the hearing.
^Back To Top
4.
Requests for
continuances must be received 10 days prior to the scheduled
hearing. Continuances may be granted at the sole discretion of the
secretary for good cause shown.
^Back To Top
8. Upon 10
days notice to the adverse party and the Association’s Panel
Secretary, witnesses may be present at an Arbitration Hearing.
^Back To Top
9. Upon 10 days notice to the adverse
party and the Association’s Panel Secretary, parties may be
represented at an arbitration hearing by any member of their staffs,
an adjuster or by attorneys.
^Back To Top
13. Documents
which will be considered as evidence include but are not limited
to the following: Statements (handwritten or transcribed
recordings), police reports, photographs, coroner’s reports, medical
reports; and any other investigative material.
^Back To Top
DECISIONS
1. Decisions of
the Arbitrators are final (except as otherwise provided in the
Plan. (Note: The following is extracted from Article 5, B, 3 of the
Plan of Operations: Any member of the Association who makes
application for arbitration and any Respondent who agrees to
arbitration under this article shall be deemed to have consented to
be bound by the decision of the arbitration panel. A decision of an
Arbitrator or Arbitration Panel is final and binding with no right
of rehearing or appeal.)
^Back To Top
|
