Insurance Arbitration FAQ’s
Insurance Arbitration Association FAQ
KRS 304.39-290: All reparation obligors shall be and remain members of the association as a condition of their authority to transact business in the Commonwealth. Other persons, associations, organizations and agencies of government may by written application and upon approval of the Board and the Kentucky Department of Insurance become members.
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 Operation: 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.)
In order for a case involving a non-member to be heard the non-member must agree to arbitration. The KIAA application asks the question: Do you accept arbitration?
KIAA Article 4C: A claim may be submitted to arbitration not later than two (2) years after the last basic reparation payment made by any reparation obligor, or two (2) years after the settlement of the last bodily injury claim arising out of the same accident; or if there is no settlement, two (2) years after the expiration of the statute of limitations of the last bodily injury claim arising out of the same accident, whichever later occurs.
Filings should be submitted via the online PIP Arbitration System. The only exception to this is if a panel of three is requested. The Application, Contentions Form and an Amended Application are available in PDF format on the Plan website.
An arbitration proceeding is commenced by a reparation obligor filing an Arbitration Application and supporting documentation with the Association once at least 60 days have passed and the Respondent has either not responded to or denied the Applicant’s request for reimbursement. The filing should be completed and supports should be uploaded to the online PIP Arbitration System eliminating the need for documentation to be mailed.
The non-refundable filing fee is $35.00 and must be submitted before the application for arbitration will be processed. If a panel of three is requested, the filing fee is $100.
The Respondent may choose to but is not required to respond; however, the lack of a response will not delay the scheduling of a hearing. If the Respondent elects not to respond after proper notice has been given, the case will proceed and the Arbitrator will make a decision based on the information submitted by the Applicant. The Respondent may respond by entering their allegations, contentions, and uploading supporting documentation to the online PIP Arbitration System.
The respondent has thirty days after the applicant’s filing to file an answer. If a respondent fails to submit an answer within thirty days, it is presumed that the applicant’s claim has been denied and the case is ready for a hearing on the issues. Failure to file an answer will not 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.
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. Original documents are not required and electronic or duplicate copies, properly authenticated where necessary, will be acceptable. Additional evidence deemed necessary, by the arbitrator, to reach a determination of the dispute shall be produced by the parties.
If two Kentucky residents are involved in an automobile accident outside of Kentucky, or if both parties are under the jurisdiction of the Kentucky Motor Vehicle Reparations Act, the KIAA can hear the arbitration.
No. KRS 304.39-290 established the KIAA to provide a mechanism for the reimbursement, among reparation obligors of losses paid as basic or added reparation benefits and is applicable to controversies involving reparation obligors and persons having the rights and obligations of a reparation obligor.
A hearing 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 specifically requests a deferment in writing. Otherwise the matter will proceed to a hearing and the parties will be deemed to have waived any right they may have had to deferment. A party may at any time challenge deferment by providing notice in writing and 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.
Deferment of a hearing 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.
Yes. Companion physical damage and/or medical payments claims may be heard when submitted with the PIP subrogation claim; however, the Respondent must agree to arbitration of the companion claim otherwise the Arbitrator will issue a decision concerning only the PIP damages claimed.
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.
The Respondent shall select in the PIP Arbitration System the option to file a counterclaim. A filing fee must be submitted in order for the counterclaim application to be processed. 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.
The Applicant and Respondent(s) shall be notified by the Association of the time and place of a scheduled hearing at least 15 days in advance of the hearing date. Notice of hearing is sent by certified mail, return receipt requested or by priority mail with proof of delivery, to any respondent that has not filed a written answer. If a written response is not received by the Plan at least 7 days prior to the hearing it will not be considered. Additional documentation by either party must be submitted at least 7 days prior to the hearing.
Decisions shall be complied with as soon as practicable. Any unwarranted delay on the part of the parties concerned should be reported to the Association’s Arbitration Panel Secretary by the prevailing party.
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 $1000 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/ (Plan of Operation, Article 4E)
If there are multiple injured parties and the BI limits are paid in full for any one party, the $1000 offset is absorbed within those limits which are unrecoverable and the remaining amount of PIP is due in full.
When rendering decisions, the $1000 offset is taken first. Any comparative negligence would then be applied.
Example 1 (no comparative negligence):
- Aggregate loss is $9,000
- Less offset – $1000
- Net loss $8,000
Example 2 (comparative negligence is applied):
- Aggregate loss is $9,000
- Less offset – $1,000
- Net loss $8,000
- Less 30%
- Negligence – 2,400 (net loss multiplied by the negligence)
- Award is: $5,600 (net loss minus negligence)
The Insurance Commissioner, Kentucky Department 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.
Requests for continuances must be received 10 days prior to the scheduled hearing and may be granted at the sole discretion of the Panel Secretary for good cause shown.
Upon 10 days’ notice to the adverse party and the Association witnesses may be present at an Arbitration Hearing. Upon 10 days notice to the adverse party and the Association parties may be represented at an arbitration hearing by any member of their staffs, an adjuster or by attorneys.