New York No-Fault Arbitration Rules
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Agreement of PartiesThe following New York No-Fault Arbitration Rules shall apply whenever parties sign a document that states they will abide by them. Parties may modify any provision, in writing, by mutual agreement. Agreements sent to parties must be signed and received by The Jansen Group within seven days of the date sent or The Jansen Group will have the right to cancel the agreement. These rules and any amendment hereto shall bind the parties except for any such provision that may be inconsistent with applicable law or when modified in writing by the parties.
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Agreement to BoundThe Parties agree that the arbitrator's decision is final and binding. The parties agree that the same dates of services/issues in dispute arising out of the same Denial of Benefits already determined, may not be again litigated in Court or re-arbitrated in another alternative dispute forum. They further agree to be bound by the New York No-Fault Regulations, No. 68 11 NYCRR 65, and any subsequently issued revised No-Fault Regulations, promulgated by the New York State Superintendent of Insurance, along with the Insurance Law, Section 5100, et al, controlling court decisions and the Superintendent of Insurance issues Advisory Opinions.
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Arbitration FeesEach party to the Arbitration shall be invoiced in accordance to The Jansen Group fee schedule provided to the parties.
Selection of ArbitratorUnless applicable law or the agreement of the parties provides otherwise, the dispute shall be decided by one arbitrator. We maintain a panel of highly experienced neutrals, from which we will assign the arbitrator on a rotating basis.
Qualifications of ArbitratorNo person shall serve as an arbitrator in any case in which that person has any financial or personal interest. The arbitrator shall disclose any circumstances likely to create a presumption of bias that might disqualify her/him as an impartial arbitrator. If for any reason as appointed arbitrator should be unable to perform the duties of the office, The Jansen Group shall appoint a replacement from among those panel neutrals to assume the role as arbitrator.
Hearing Date, Time and LocationThe Jansen Group shall schedule the date and time of the arbitration hearing subject to any other mutually agreed date and time submitted by the parties. All arbitration hearings will be scheduled to be heard in The Jansen Group's Jericho, New York Office.
RepresentationAny party may be represented by counsel or other authorized representative.
Stenographic RecordAny party wishing a stenographic record shall make arrangements directly with a stenographer and shall notify the other party, in writing, of such arrangements in advance of the hearing. The requesting party or parties shall pay the cost of the record if such transcript is agreed by the parties to be, or determined by the arbitrator to be the official record of the proceeding, it must be made available to the arbitrator and to the other party for inspection at a time and place determined by the arbitrator.
InterpretersAny party wishing an interpreter shall make arrangements directly with the interpreter and shall assume the costs of such service.
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Postponements, cancellation or settlement prior to hearing The arbitrator may, for good cause, postpone the hearing upon the request of a party or upon the arbitrator's own initiative. The arbitrator shall grant such postponement when all of the parties agree thereto. Any party requesting the postponement shall pay a processing fee to The Jansen Group according to the terms of their fee schedule.
OathsBefore proceeding with the arbitration phase of the hearing (if necessary). the arbitrator may take an oath of office and, if required by law, shall do so. The arbitrator may require witnesses to testify under oath administered by any duty qualified person and, if required by law or requested by either party, shall do so.
Arbitration in the Absence of a Party or CounselUnless the law provides the contrary, the arbitration may proceed in the absence of any party of counsel whom, after due notice, fails to be present or fails to obtain an adjournment. An award shall not be made solely on the default of party. The arbitrator shall require the party who is present to submit such evidence as is deemed necessary for the making of an award. The arbitrator will review and consider any evidence submitted previously by the absent party.
Arbitration HearingThe hearing may be conducted by the arbitrator in manner that permits a fair presentation of the case by the parties.
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Evidence The arbitrator shall be the judge of the relevance and materiality of the evidence offered and conformity to legal rules of evidence shall not be necessary. Parties may submit expert reports, affidavits, medical records, financial statements, tax returns. witness statements, and other documents and reports in lieu of calling live witnesses to testify at the hearing. The parties are permitted to call live witnesses. Parties agree to submit all exhibits, documentation, and lists of witnesses to be used in the arbitration directly to the arbitrator, and to the opposing party. The exhibits, documentation and witness lists must be postmarked (if sent by mail), delivered to a courier (if sent b messenger or overnight delivery), or transmitted (if sent by email or facsimile) no later than seven (7) days prior to the established arbitration hearing date. Pursuant to State Statutes, deadlines are subject to arbitrator's rights.
Closing of HearingThe arbitrator shall specifically inquire of all parties whether they have any further proofs to offer or witnesses to be heard in accordance with the Arbitration Agreement. The arbitrator shall declare the hearing closed upon determination that there are no further presentations.
Arbitration AwardThe arbitration award shall be in writing and shall be signed by the arbitrator. The arbitrator shall render the award promptly and, unless otherwise agreed by the parties or specified by law, no later than fourteen days from the date of closing the hearing, or, if oral hearings have been waived, from the date of transmitting the final statements and proofs to the arbitrator.
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Extensions of Time The parties may modify any period of time by mutual written agreement. The Jansen Group may, for good cause, extend any period of time for making the award. The case manager shall notify the parties of any such extension and its reason therefore.
Serving of Notice(a) Each party shall be deemed to have consented that any papers, notices, or process necessary or proper for the initiation or continuation of any arbitration under these rules, for any court action in connection therewith; or for the entry of judgment on any award made under these rules may be served upon such party by mail addressed to such party or its attorney at the last known address or by personal service, in or outside the state where the arbitration is to be held, provided that reasonable opportunity to be heard with regard thereto has been granted to such party. (b) To facilitate communication between the parties and The Jansen Group, the parties agree that communications received from each other or The Jansen Group via facsimile machine, telex, telegram, or other written forms of electronic communication are valid and proper notice under these rules. (c) Parties agree that the arbitration agreement may be executed in one or more counterparts, all of which taken together shall constitute one instrument and facsimile copies of signatures are as valid and enforceable as original signatures.
Scope of AwardThe parties agree that any decision rendered by the arbitrator is conclusive only as to the matters being adjudicated in said arbitration, pertaining to the parties present. The decision of the arbitrator is not res judicial nor will it have collateral estoppel effect as to the same or similar issues in companion claims or actions arising out of the incident, which is subject of said arbitration. Any award is subject to Master Arbitration Procedures under section 5106(b) of the Insurance Law.
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Consent Award At any point during the arbitration process or the Master Arbitration process, upon request of the parties, the arbitrator will issue a consent award memorializing the agreement and/or settlement terms between or among the parties.
Delivery of Award to PartiesParties shall accept as legal delivery of the award the placing of the award or a true copy thereof in the mail addressed to such party or its attorney at the last known address, personal service of the award, or the filing of the award in any other manner that may be permitted by law.
Modification of Decision/AwardA modification to a decision/award may be requesteded in writing by any party, and the arbitrator may modify a decision/award, for the correction of a typographical or mathematical miscalculation contained within the decision/award.
Applications to Court and Exclusions of Liability(a) No judicial proceeding by a party relating to the subject matter of the arbitration shall be deemed a waiver of the party's right to arbitrate. (b) Neither The Jansen Group nor any arbitrator in a proceeding under these rules is a necessary party in judicial proceedings relating to the arbitration or mediation. (c) Parties to these rules shall be deemed to have consented that judgment upon the arbitration award may be entered in any federal or state court having jurisdiction thereof. (d) Neither The Jansen Group nor any arbitrator shall be liable to any party for any act or omission in connection with any arbitration conducted under these rules.
Interpretation and Application of RulesThe arbitrator shall interpret and apply these rules insofar as they relate to the arbitrator's powers and duties.
Master ArbitrationMaster Arbitration under section 5106(b) of the Insurance Law
(a) Ground For Review. An award by an arbitrator rendered pursuant to section 5106(b) of the Insurance Law and section 65-4.4 or section 65-4.5 of the No-Fault Regulations, may be vacated or modified solely by appeal to a master arbitrator, and only upon one or more of the following grounds:
(1) any ground for vacating or modifying an award enumerated in Article 75 of the Civil Practice Law and Rules, except the ground enumerated in CPLR subparagraph 7511(b)(1)(iv).
(2) that the award required the insurer to pay amounts in excess of the policy limitations for any element of first party benefits; provided that, as a condition precedent to review by a master arbitrator, the insurer shall pay all other amounts set forth in the award which will not be the subject of an appeal, as provided for in section 65-4.4 or section 65-4.5 of the No-Fault Regulations.
(3) that the award required the insurer to pay amounts in excess of the policy limitations for any element of additional first party benefits; provided that, as a condition precedent to review by a master arbitrator, the insurer shall pay all other amounts set forth in the award which will not be the subject of an appeal, as provided for in section 65-4.4 or section 65-4.5 of the No-Fault Regulations.
(4) that an award rendered in an arbitration under section 65-4.4 or section 65-4.5 of the No-Fault Regulations, was incorrect as a matter of law.
(5) that the attorney's fee awarded by an arbitrator below was not rendered in accordance with the limitations prescribed in section 65-4.6 of the No-Fault Regulations; provided that, as a condition precedent to review by a Master Arbitrator, the insurer shall pay all other amounts set forth in the award which not be the subject of the appeal, as provided for in section 65-4.4 or section 65-4.5 of the No-Fault Regulations.
Master Arbitration ProceduresA Request for Master Arbitration must be filed within 21 days of receipt of the arbitrator award. The request must be in writing, and opposing party(ies) must be provided with a copy of the request and the decision at the time of the filing. The request must be sent via Certified Mailing to The Jansen Group and to the opposing party(ies). The appropriate fee must accompany the filing (see fee schedule).
Upon receiving the filing, The Jansen Group will assign the case to a Master Arbitrator in accordance with the panel rotation process.
The Case Administrator will then arrange a conference call between the Master Arbitrator and the parties. During this call, the Master Arbitrator, with input from the parties, will determine a schedule for the submission of the arbitration briefs and supporting materials, determine if there will be a live hearing, and establish any other deadlines necessary for the completion of the review.
The parties may modify any period of time by mutual written agreement. The Master Arbitrator may for good cause extend any period of time for making the award. The Master Arbitrator shall notify the parties of any such extension and its reason therefore.
The Master Arbitrator shall render a decision with 14 days of receiving the parties' briefs and supporting materials.
Unless the law provides to the contrary, the Master Arbitration may proceed in the absence of any party or counsel whom, after due notice, fails to be present or fails to obtain an adjournment. An award shall not be made solely on the default of party. The arbitrator shall require the party who is present to submit such evidence as is deemed necessary for the making of an award.
Failure by the Master Arbitrator to comply with the Master Arbitration deadlines will not void the underlying decision/award.
The parties agree that any award/decision rendered by the Master Arbitrator is final and binding with the exception of the following.
- Court Review pursuant to an Article 75 proceeding.
- Or if the award is $5000 or greater, not including interest and/or attorney fees, either party may, in lieu of an Article 75 proceeding, institute a court action to adjudicate the dispute de novo.
Any party who initiates an Article 75 proceeding or an action to adjudicate a dispute de novo shall follow the applicable CPLR Article 75 procedures. If the party initiating such action is an insurer, payment of all amounts set forth in the Master Arbitration decision/award which will not be subjects of judicial action or review shall be made prior to the initiation of an Article 75 proceeding.
Modification of decision/award is allowed pursuant to The Jansen Group New York No-Fault Arbitration Rules
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