A L T E R N A T I V E . D I S P U T E . R E S O L U T I O N

An Introduction to The Use Of Alternative Dispute Resolution to Resolve Insurance Disputes
Jay E. Grenig*

I. INTRODUCTION
 
Alternative dispute resolution describes the techniques or procedures for resolving disputes short of trial in the public courts. Alternatives to civil litigation are not a new phenomenon.1 However, in recent years the interest in alternative dispute resolution has increased.2 Non-judicial procedures may be superior in a variety of disputes.  They may be less expensive, faster, less intimidating, more sensitive to the disputants’ concerns, and more responsive to the underlying problems.

The first section of this article provides an introduction to alternative dispute resolution.  The second section discusses the Federal Arbitration Act3 and the McCarran-Ferguson Act.4 The third section examines the use of various alternative dispute resolution processes in addressing different types of insurance situations.
 

II. ALTERNATIVE DISPUTE RESOLUTION

A. Generally
There are a number of voluntary alternative dispute resolution methods available to facilitate the settlement of disputes or to adjudicate disputes if settlement cannot be reached.  These methods can be used separately or in combination, and their components can be modified and mixed to suit the circumstances of the particular case.
 
B. Negotiation
Negotiation normally should be considered the first step in attempting to resolve any dispute.5 It is probably the most frequently used method of dispute resolution.  Negotiation implies joint responsibility and authority for making certain decisions.  Parties to a dispute may utilize negotiation to solve their problems and disputes directly as between themselves, without the involvement of a third party.

The negotiation process is voluntary and non-binding.  In negotiation, two or more disputing parties meet together in good faith to identify and discuss the issues at hand, present facts and supporting data, arrive at mutual solutions, and abide by the outcome.  Negotiation continues as long as the parties are willing to exchange views on settlement.
 
C. Conciliation
Conciliation is the process in which a third party brings the disputing parties together so that the disputing parties can begin to discuss the issues.  It involves the adjustment and settlement of a dispute in a friendly, non-antagonistic manner.  Conciliation may be used in the courts before trial, with a view towards avoiding trial, and in labor disputes prior to arbitration.

Conciliation may be a particularly good choice when emotions are running high, or when ongoing relationships are involved and the parties’ inability or unwillingness to communicate is a major barrier to resolution.  Conciliation also may be inappropriate where one party has a clear legal entitlement or where the parties have unequal bargaining power or sophistication.

The term “conciliation” is frequently used interchangeably with “mediation.”6 However, conciliation generally refers to a process less structured than mediation.  In some forms of conciliation, a conciliator does not take active part in the process or settlement discussions, while a mediator may actively promote a mutually acceptable settlement.  The conciliator’s primary role is to reduce the parties’ inflammatory rhetoric and tension, open channels of communication, and arrange for formal negotiations.

Unlike a mediator, a conciliator sometimes is called upon to make non-binding recommendations or findings that often concern the factual or legal issues in dispute.  The conciliator also may recommend an appropriate resolution under the circumstances.7 The finding or recommendation is made to the parties jointly by the conciliator.
 
D. Mediation
Mediation introduces the assistance of a neutral third party -- the “mediator” -- in attempting to resolve the dispute.8 The mediator’s function is to assist the parties in their negotiations by helping the parties to define the issues, to overcome barriers to communication, and to explore alternative methods of resolving their dispute.9 Mediation enhances the parties’ ability to communicate with each other. The mediation process is voluntary; either party can reject further participation by the mediator at any time in the process.  The mediator has no authority to impose a settlement and does not render a binding decision.  A mediator can clarify the parties’ expectations by focusing their needs and interests, attempting to diffuse hostilities, and reducing the adverse impact of emotions.  The parties retain complete control over the process and make their own decisions about what solutions will work for them.

The mediator usually deals directly with the parties or their representatives.  The mediator endeavors to ensure that each party is evaluating his or her position realistically.  A mediator helps the parties appreciate the difference between the best alternative to a negotiated agreement and the worst alternative to a negotiated agreement.

A mediator can facilitate the resolution of a dispute by suggesting non-monetary benefits that cost the party providing the benefit less than the value of the benefit to the other.  A mediator also can help parties overcome perceptive differences.  By communicating directly with those persons having settlement authority, a mediator can reduce the risk of a conflict of interest between a party and its negotiating representatives.  To be most successful in this regard, a mediator should strive to appear fair and impartial.  Furthermore, the mediator should analyze the disputed issues and prioritize them in order to facilitate resolution of the dispute.

Some mediators favor party-generated settlement options and do not suggest settlement terms.  They see themselves primarily as facilitators, digging deep into the interests and feelings underlying the surface dispute.10 Other mediators will propose settlement options and attempt to persuade the parties to make concessions.  In some cases, the mediator may be asked to offer an assessment of the probable outcome of the case in order to facilitate the parties’ more realistic evaluation of their respective positions.

In evaluative mediation, the mediator decides what the case is worth and advises how it should be settled.  It can be effective in a situation where the neutral has tried many similar cases or otherwise knows the case well.
 
E. Appraisal

Appraisal involves the valuation or estimation of the value of property by disinterested persons of suitable qualifications.11 It uses expert opinion, rather than explicit market transactions, in order to ascertain the value of an asset or liability.  Appraisals usually relate to leases, real estate, losses and damages under insurance policies or purchase and sale agreements.  Appraisals involve questions of value, price, amounts, damages, and other similar areas of dispute.

The appraiser is selected or appointed by a competent authority to arrive at a just and true valuation of property.  Appraisers are selected for their special knowledge of the subject matter.  An appraisal may be conducted without formal hearings, and the appraiser is permitted to make his or her own investigation and to establish his or her own procedures.

The appraiser’s decision need not assume any particular form.  However, an appraisal award may be invalid if it is outside the scope of the issues submitted to the appraiser.  An appraisal made within the scope of the submission is not invalid because the appraiser was mistaken as to law or fact.12

Appraisal differs from arbitration in that an arbitration award is the judgment of a tribunal selected by the parties to determine matters actually in variance between them, whereas an appraisal settles the price or value of property or aclaim.13 In the appraisal, the appraiser is empowered only to settle the price or value of the property or claim in issue.

Unless express provision is made for a hearing, the method of determining the facts in an appraisal is left to the appraiser.14 The decision may be made without notice to the parties and without a hearing, unless such notice or hearing is required by an express provision in the agreement between the parties.15 In addition, the appraisal may be made upon such principles as the appraiser sees fit to adopt, or upon such evidence as the appraiser chooses to receive.  Appraisers are not required to take an oath and are not obliged to provide formal notice or to hear evidence.  They usually proceed by ex parte investigation, so long as the parties are given an opportunity to furnish information and explanation regarding the matters in issue.16

An appraisal resolves only the specific issues of actual value or loss or damages.  All other issues are reserved for determination in a more complete and formal hearing on the merits.17 Generally, a dissatisfied party who participates in the selection of an independent appraiser has no greater right to challenge the appraiser’s valuations than that party would have to attack an arbitrator’s award. However, notwithstanding that the award may be fair on its face, a court may consider the method by which the appraiser reached his or her decision.18 Where the evidence shows that the appraisal was the result of fraud, corruption, dishonesty or bad faith, a court is justified in overturning the appraiser’s determination, even though the appraiser was selected by agreement between the parties.19

It should also be noted that a court is without power to enter a judgment upon an appraisal report as if it were an arbitration award. The proper remedy is to commence an action involving a complete and formal trial on the merits.20
 
F. Arbitration
Arbitration is a method for dispute resolution in which the parties submit their dispute to an impartial person selected by the parties.21 The parties may use a single arbitrator to hear a dispute or they may use an arbitration board or panel.  The arbitrator makes a decision following a hearing.  In binding arbitration (usually referred to simply as “arbitration”), the arbitrator’s decision is final and binding on the parties.

The arbitrator hears evidence from each side and renders a decision that is normally binding on the parties, as noted above.  The procedure is less formal than a judicial trial.  Unless the parties agree to the contrary, the arbitrator is not bound to follow the law.  Instead, the arbitrator may base the decision on business custom and practice, technical insight, or broad principles of equity and justice.  Once confirmed, an arbitrator’s award is enforceable in the same manner as a court judgment.22

The process in non-binding arbitration is the same as binding arbitration, except that the arbitrator’s decision is advisory only.  If the parties do not accept the decision, the advisory decision may be used as an aid to resolve the dispute through negotiation or other means.23 Incentive arbitration is a form of non-binding arbitration in which the parties agree to the imposition of a penalty on the party who rejects the arbitrator’s advisory decision and pursues its claim in court, if that party does not improve its position by some percentage or formula.  The penalties may include payment of attorney fees in the litigation or payment of the full cost of arbitration.

Compulsory arbitration results when a statute or administrative rule or regulation requires certain types of disputes to be submitted to arbitration.  In voluntary or contractual arbitration, the parties mutually agree that an issue may be submitted to arbitration.  The parties either contractually agree to submit future disputes to arbitration or they agree to submit an existing dispute to arbitration.
 
G. Mediation-Arbitration
Mediation-arbitration, sometimes referred to as “med-arb,” is a mixed process that begins as mediation and ends with arbitration if the mediation is unsuccessful.24 Mediation-arbitration is used most commonly in labor-management disputes.  It is supported by the theory that, under the threat of arbitration, the participants will try harder to achieve voluntary settlement of the dispute. 

Mediation-arbitration involves a two-step process.  First, a neutral third party mediates the dispute with the parties in an attempt to reach a voluntary settlement. Subsequently, if the participants remain at impasse, the neutral renders a binding decision on the unresolved issues following an arbitration hearing.  Mediation-arbitration is particularly effective when the participants are of relatively equal bargaining experience; the efficiency of a combined procedure outweighs the inhibiting effect of the mediator’s anticipated role change.25

The arbitrator may be the person who conducts the mediation or the parties may select one person to mediate and another person to arbitrate.  A person who acts as mediator and then as arbitrator is known as the mediator-arbitrator.  Some contend that using the same person to mediate and to arbitrate is advantageous because the neutral has more leverage in the mediation process -- the parties know a solution will be imposed upon them if they do not arrive at one of their own.  Others assert that mediation-arbitration compromises the integrity of the mediation process and the arbitrator’s neutrality.  The neutral may have received confidential information relevant to the merits of the dispute in the course of mediation before deciding the arbitration.

Because of this concern about the integrity of the process, some agreements provide for one person to mediate and a different person to arbitrate. However, this remedy is more costly and time consuming than using the same person as both mediator and arbitrator.  In addition, it does not allow for further attempts to mediate once the process reaches arbitration.26 However, the use of different persons as the mediator and the arbitrator is appropriate if the parties are concerned about the perceived bias of the mediator-arbitrator.27
 
H. Mini Trials
The mini trial is not a trial, per se.  It is a structured dispute-resolution method in which senior executives of the parties involved in a legal dispute meet in the presence of a neutral advisor. After hearing presentations on the merits of each side, these representatives attempt to formulate a voluntary settlement.28 The mini trial is a form of facilitated negotiation and includes elements of negotiation and adversarial case presentation.

The mini trial was developed in the corporate setting.  Mini trials are usually employed to resolve disputes that would otherwise involve lengthy litigation.  The senior executives selected to participate by the parties should hold no direct involvement in the dispute, lest they feel a need to defend past actions.  The more senior the management representatives, the greater the range of options available for a constructive solution.

The parties should agree in writing that the mini trial proceedings are confidential and that no written or oral statement made by any participant can be used as evidence or an admission in other proceedings.  The fees and expenses of the neutral advisor are borne equally by the parties.  Each party normally is responsible for its own costs, including legal fees, incurred by participation in the mini trial.  In their written agreement, the parties may alter the allocation of fees and expenses.
 
I. Early Neutral Evaluation
Early neutral evaluation is a court-annexed settlement program used to assist the parties in developing an approach to the litigation that focuses on key issues and necessary discovery.29 The parties may hire, or the court may appoint, a neutral evaluator (such as an attorney), who is highly experienced with the subject to conduct a review of the matter in dispute. 

The evaluator appraises the merits of the dispute and makes suggestions for conducting discovery and obtaining legal rulings to resolve the case efficiently.  The evaluator helps the parties identify areas of agreement, assess the strengths and weaknesses of their arguments and their evidence, and devise a plan for sharing important information and conducting key discovery.  The neutral evaluator’s report may also aid the parties in reaching a settlement.  If the case does not settle, the report remains confidential.  The evaluator then helps the parties to simplify and adapt the case for more expeditious handling in trial.


III. FEDERAL LAW

Traditionally, courts refused to enforce agreements to arbitrate.30 The Federal Arbitration Act of 192531 (also referred to as the United States Arbitration Act)32 changed the common law rule.  It made a written agreement to arbitrate specifically enforceable in the federal courts, so long as the agreement is connected with a maritime transaction or evidences a transaction involving foreign or interstate commerce.33 By adopting the Act, Congress intended to create a new body of federal substantive law affecting the validity and interpretation of arbitration agreements.  It also sought to exercise its full range of constitutional power under the commerce clause in order to make the Act as widely effective as possible.34 The Act applies in state courts as well as in federal courts.35

The purpose of the Act is to relieve congestion in the courts and to provide parties with an alternative method for dispute resolution that would be more efficient and less costly than litigation.36 It recognizes a strong public policy favoring arbitration of maritime and commercial disputes.37 The Act intends for the courts to enforce arbitration agreements into which parties have entered[38] and to place such agreements upon the same footing as other contracts.39 All doubts as to arbitrability under the Act are construed in favor of the liberal policy of promoting arbitration.40

Section 4 of the Act, allowing a party to petition the district court for an order compelling arbitration, does not create independent federal jurisdiction.41  In order to establish federal jurisdiction, the party seeking to compel arbitration must demonstrate that, if there were no agreement to arbitrate, a federal court would have jurisdiction “of the subject matter of a suit arising out of the controversy between the parties.”42 

However, Section 4 has been interpreted to mean that a federal court has subject matter jurisdiction over an action to compel or stay arbitration merely because the underlying claim raises a federal question.  A petition under Section 4 must be brought in state court unless some other basis of federal jurisdiction exists, such as diversity of citizenship or assertion of an admiralty claim.43

The Act applies to contracts “evidencing a transaction involving [interstate] commerce.”44 The Federal Arbitration Act is the only federal statute using the phrase “involving” to represent an interstate commerce relationship.45 Since the enactment of the Act, federal and state courts have differed as to when a transaction “involves” interstate commerce to such an extent that the Act applies.46

In Allied-Bruce Terminix Companies, Inc. v. Dobson,47 the United States Supreme Court held that the words, “involving commerce,” as used in the Act, are the functional equivalent of “affecting commerce,” signaling Congress’ intent to exercise its commerce power to the full.  The Court rejected the “contemplation of the parties” standard, which provides that the Act applies only if the parties contemplated substantial interstate activity.  The Supreme Court applied a “commerce in fact” standard, noting that the transaction must have involved interstate commerce, even if the parties did not conútemúplate an interstate commerce connection.48

The United States Supreme Court added further clarification in Prima Paint Corp. v. Flood & Conklin Manufacturing Co.,49 declaring that the Federal Arbitration Act “is based upon and confined to the incontestable federal foundations of ‘control over interstate commerce and over admiralty.’”50 The Court rejected the argument that the transactions involving commerce covered by the Act are limited to contracts between merchants for the interstate shipment of goods.  Acknowledging that the Act articulates substantive law, the Court determined that the Act applied in diversity cases because Congress had intended that result.  The Court explained, “Congress may prescribe how federal courts are to conduct themselves with respect to subject matter of which Congress plainly has power to legislate.”51

In Southland Corp. v. Keating,52 the United States Supreme Court addressed an additional question about whether the Act preempts conflicting state anti-arbitration law, or whether state courts could apply their own anti-arbitration statutes in pending cases, thereby reaching results different from those reached in similar federal diversity cases.  Declaring that Congress would not have wanted state and federal courts to reach different outcomes about the validity of arbitration in similar cases, the Court concluded that the Federal Arbitration Act preempts state law and is applicable in both state and federal courts.53

Furthermore, although traditional state law contract defenses, such as fraud, duress or unconscionability, may apply to invalidate arbitration agreements without contravening the Act, a court may not invalidate arbitration agreements under state laws applicable only to arbitration provisions.54 In Doctor’s Associates, Inc., v. Casarotto, franchisees brought an action in state court against a franchisor and its agent involving a dispute under a standard form franchise agreement.  The state trial court stayed the action pending arbitration, and the franchisees appealed.  The Montana Supreme Court reversed, finding that the arbitration clause was unenforceable under a state statute that conditioned enforceability of arbitration agreements on compliance with a special notice requirement not otherwise applicable to contracts generally.55

The United States Supreme Court held that Montana’s special notice requirement was preempted by the Federal Arbitration Act.56 The Court explained that, by enacting Section 2 of the Federal Arbitration Act, Congress precluded states from singling out arbitration provisions for suspect status, requiring instead that such provisions maintain the same status as other contracts.57 The Court affirmed that the Montana provision directly conflicted with Section 2 of the Act because the Montana law conditioned the enforceability of arbitration agreements on compliance with a special notice requirement not applicable to contracts generally.58

The Federal Arbitration Act does not mandate arbitration of all claims.  Without an agreement to arbitrate, the Act does not apply, and the parties are then entitled to a judicial remedy.59 Since arbitration arises through contract, parties are essentially free to define for themselves what questions may be arbitrated, the remedies an arbitrator may afford, and the extent to which the decision must conform to general principles of law.60 However, it has been held that arbitrators are without authority to decide constitutional issues irrespective of the contractual language.61

The McCarran-Ferguson Act62 exempts certain insurance practices from federal law (including the Federal Arbitration Act),63 and makes state law supreme.64 An agreement between an insurer and an insured to arbitrate claims arising out of insurance coverage should be considered as involving the “business of insurance,” as that term is used in the Act.65 However, there are few cases holding that the arbitration of claims is or is not the business of insurance.66

There is little case law on the applicability of the Federal Arbitration Act to individual insurance contracts.67 In addition, much of the insurance business is exempt from otherwise applicable federal law under the McCarran-FergusonAct.68 In United States v. South-Eastern Underwriters Association,69 the United States Supreme Court determined that, even if an individual insurance contract could be seen as “local” rather than “interstate” commerce, the broader business of insurance nonetheless was interstate commerce.70

Some courts have upheld the application of the Federal Arbitration Act to reinsurance agreements.71 Only a few cases involving individual insurance policies have arisen under the Federal Arbitration Act.  Hart v. Orion Insurance Co.72 involved a disability insurance policy.  The insurance company had sought and obtained a court order compelling arbitration.  The insured appealed, asserting that the arbitration agreement was unenforceable.  On appeal to the Tenth Circuit, the court held that the Federal Arbitration Act applies whenever interstate commerce is involved. Such involvement existed in this case by virtue of an interstate delivery of the insurance policy.73

Congress passed the McCarran-Ferguson Act74 in response to South-Eastern Underwriters.75 The Act is intended to exempt the insurance industry from most federal antitrust laws and to return to the states some of their regulatory authority prior to South-Eastern Underwriters.  How much authority Congress intended to return to the states is still unclear.76

In the McCarran-Ferguson Act, Congress ceded to the states the primary responsibility for regulating the insurance business and it provided an exemption, under certain circumstances, from application of federal law.77 In order to establish that an activity is exempt from a particular federal law, three conditions must be met:  (1) the federal law in question does not specifically relate to the business of insurance; (2) the activity in question is the “business of insurance;”78 and (3) the application of federal law would invalidate, impair or supersede state regulation of the activity.79

Since the Federal Arbitration Act does not specifically relate to the business of insurance,80 the first criterion is readily satisfied in cases involving the Federal Arbitration Act and insurance disputes.  Most controversies regarding application of the McCarran-Ferguson Act involve the second and third criteria.81

In determining whether a particular practice is part of the “business of insurance,” one court has suggested that the following three factors should be considered:

  1. Whether the practice has the effect of transferring or spreading a policyholder’s risk;
  2. Whether the practice is an integral part of the policy relationship between the insurer and the insured; and
  3. Whether the practice is limited to entities within the insurance industry.82


IV. APPLICATION OF ALTERNATIVE DISPUTE

Resolution to Insurance Claims

A. Personal Injury Claims
Many personal injury claims are suitable for alternative dispute resolution.
83 If utilized properly and with the right type of claim, alternative dispute resolution can be important in securing the just, speedy, and inexpensive determination of a claim.  Mediation can be used to resolve personal injury claims.84 Mediated personal injury claims generally have three characteristics:85

  1. the claimant typically is inexperienced in resolving personal injury disputes;86
  2. the negotiations usually only involve the distribution of funds from one party to the other, and
  3. the issue being mediated is largely subjective.

Liability is typically stipulated by the parties before entering an agreement to mediate a personal injury claim.87 In addition, the issue of who pays for any alleged damages is usually established before mediation. Thus, the defendant frequently is not present at the mediation session.  The plaintiff, the plaintiff’s attorney, the defendant’s attorney and an adjuster from the defendant’s insurer will focus on the issue of damages.

Because the mediation involves a claimant who is probably involved in a single lawsuit necessitating evaluation, while the insurance representative may have handled hundreds of similar cases, the mediator is challenged to bring some balance to the playing field.  For this reason, it may benefit the plaintiff to be represented by a lawyer.

The distributive nature of personal injury disputes requires the mediator to determine how to facilitate give-and-take when the claim involves only how much the defendant will pay and how much the claimant will accept.  The subjective nature of the personal injury dispute involves the claimant’s pain and suffering.  The mediator is challenged to find suitable criteria that will help the parties place an acceptable value on pain and suffering.

The mediation session usually begins with a joint session at which both parties provide a brief overview of their issues and arguments.88 The mediator may then caucus separately with each party to discuss each side’s concerns.  At the mediation session, the plaintiff may present a settlement package, including all medical records and billings as well as other records of special damages to provide the mediator with access to the records as the case is being discussed.  It is important for the mediator to establish communication and rapport as soon as possible.89 Although distributive interests constitute a large segment of personal injury mediation, the mediator should help the parties identify the other interests involved.90 These interests may include the desire for an admission of fault or an apology.

An unresolved issue of liability often precludes the use of mediation and requires the use of bindingarbitration.91 Cases involving substantial medical expenses with no objective findings of injury, and cases involving minor impacts, are often more suitable to arbitration because the defendant is sometimes reluctant to accept the claim or the extent of the claim.92

Initially, the parties enter into a written arbitration agreement, establishing the procedural rules, rules for conduct of the hearing, powers of the arbitrator, enforceability of the award, method of selecting the arbitrator, and any other terms and conditions to arbitration.93 At the arbitration hearing, the parties present material evidence and cross-examine opposing witnesses.94

Under the rules of the American Arbitration Association, insurers or claimants start the process by sending the following information to the nearest AAA office:

The names and addresses of the insurer, the claimant, and their representatives, along with the telephone numbers of the parties;

  • The insurer’s claim number;
  • A brief description of the claim and the amount involved, and
  • Any additional information that will assist the AAA in arranging to have the case submitted to arbitration.

Upon receipt of this information, the AAA writes the other party to explain the program, enclosing a submission form and a copy of the procedures.95 Within ten days of that letter, an AAA administrator telephones the party to explain the program further and to answer any questions.  Once the parties have agreed to submit a case to arbitration, they are asked to complete a submission agreement.  By that form, they are given the option of selecting mediation or arbitration.  The AAA appoints an arbitrator from its panel of neutrals.  Following appointment of the arbitrator, the AAA telephones the parties’ representatives and the arbitrator in order to schedule a convenient date and time for the hearing.96

The arbitrator looks to the following documents to ensure that the authority granted is not exceeded and that all issues submitted are answered:

  • The Insurance Endorsement.  The insurance contract states the amount of coverage, the issues to be arbitrated, the conditions precedent to recovery, and the time limits within which the insured must make a claim.
  • The Demand for Arbitration.  Most arbitration cases are initiated when one party demands arbitration.  The demand will describe the issue, how much money is sought, and the applicable policy limits.
  • The Submission to Dispute Resolution.  Particularly where the insurance policy lacks a pre-dispute arbitration clause, the parties will articulate the issues and the amount involved in a submission statement.
  • The Answering Statement.  The respondent to a demand for arbitration may file an answering statement containing the respondent’s view of the issue.
  • The Arbitration Rules.  The arbitration rules provide a basis for the arbitrator’s rulings and describe the applicable procedures.

After both sides have had an equal opportunity to present all of their evidence and arguments, the arbitrator declares the hearing closed.  The arbitrator usually has thirty days from the close of the hearing within which to render an award.
 
B. Mass Torts And Class Actions

Unlike settlements of ordinary tort litigation, mass tort and class action settlements can create a monetary pool covering numerous claims.97 The settlements frequently are funded by multiple defendants.  Alternative dispute resolution may be effective in resolving disputes involving such settlements.

Alternative dispute resolution procedures may include negotiation, mediation or arbitration, or a combination of these.98 In one class action settlement, the parties agreed that class members would submit their claims to a claim-review process, which included the right to appeal to a mediator/arbitrator selected from an American Arbitration Association roster.99 Initially, a claims determination is made by a claim review team appointed by the defendant. If a class member is dissatisfied with the claim-review team’s decision, the class member subsequently may obtain de novo review of the claim by an independent mediator/arbitrator.

Mediation may be appropriate in resolving mass torts, including defective products, defective drugs, and environmental exposure actions.100 Mediation offers a solution to the myriad problems associated with trying a mass tort case by opening communications between the parties.  The parties should evaluate a case for mediation early in deliberations, before the parties harden their positions or expend unnecessary funds on discovery and pretrial motions.

C. Catastrophe-Related Disputes

Every catastrophe, such as earthquake, hurricane, hailstorm, flood or other event, presents innumerable difficulties when establishing the amount of the loss. Appropriate alternative dispute resolution mechanisms in such situations include appraisal,101 arbitration,102 and mediation.103

Appraisal is a suitable method for determining values.104 Homeowner policies frequently provide that each party selects an appraiser.  The policies require that the appraisers be competent and disinterested or independent.  Categories of persons challenged for lack of impartiality include public adjusters who formerly represented the insured on other matters, and accountants who serve to advise the insured.105 The two appraisers select an impartial umpire.106 Objections to the competence or interest of the appraisers or umpire should be made promptly or they may be deemed waived.107

The procedures used during appraisals are dependent upon the appraisers’ discretion. Hearings can be requested and testimony received together with evidentiary exhibits.  The appraisers should secure all evidence necessary for a complete review and resolution of the issues.  This may include a site inspection and reports by experts.108

The proceedings are concluded by a written appraisal award signed by the appraisers and the umpire.  If the appraisers fail to agree on the value of the property and the amount of the loss, they submit their differences to the umpire.  A determination adopted by any two is binding on the parties.109 An appraisal conducted pursuant to an insurance contract is binding upon the parties to the contract.  However, challenges may lie regarding:110

  • The qualifications or interest of the appraisers or umpire;111
  • Bad faith, fraud or mistake;112
  • The failure of an insurer to abide by the appraisal process and pay the award.113

D. Uninsured and Underinsured Motorist Disputes

One of the most common forms of insurance arbitration agreements is the arbitration agreement in uninsured or underinsured motorist coverage of automobile insurance policies.114 Uninsured motorist insurance provides coverage to the insured for injuries caused by the owner or operator of an uninsured, or sometimes underinsured, motor vehicle.  The amount owed by the insurer to its insured is determined by an existing right to recover damages for the injury from the uninsured or underinsured motorist.

If the insured sues the uninsured third-party directly, obtains a judgment and then collects that judgment from the insured’s insurance company, the company effectively is made an insurer of the third-party.  However, in that situation the insurance company has no ability to control the litigation or demand cooperation from the uninsured motorist.  If the insured sues the insured’s insurance company directly, the company runs the risk that juries will treat it unfairly.

In order to avoid this problem, the standard automobile insurance policy attempts to prevent suit by the insured against the third-party, either by prohibiting such actions explicitly or by providing that the insurance company will not be bound by a judgment obtained without its permission in such an action.  The standard policy also includes provision for compulsory and binding arbitration at the election of either the company or the insured.  Most states permit or require that uninsured motorist claims be resolved by arbitration.  However, when such a requirement is imposed by the legislature as a matter of binding arbitration, the uninsured motorist may sometimes challenge the loss of a right to jury trial.115

According to the California Supreme Court, a trial court has authority to consolidate an uninsured motorist arbitration proceeding between an insurer and the insured with the insured’s pending action against third-parties for all purposes, including trial.  Such consolidation ostensibly avoids conflicting rulings on a common issue of law or fact.116 

Few court decisions have considered whether the Federal Arbitration Act117 applies to arbitrations under uninsured motorist clauses.  In Preziose v. Lumbermen’s Mutual Casualty Co.,118 the Vermont Supreme Court held that the Federal Arbitration Act applied to an uninsured motorist dispute.  The court explained that enforcement of the arbitration clause in the insurance policy did not invalidate, impair or supersede the Vermont Arbitration Act or its uninsured motorist statute.  Accordingly, it concluded that the McCarran-Ferguson Act119 did not bar application of the Federal Arbitration Act to the dispute.  The court observed that there was no provision in Vermont law requiring a jury trial in uninsured motorist disputes.

A clause within an insurance policy providing that the damage award will be binding only if it does not exceed the minimum limit for bodily injury liability specified by law is often characterized as an “escape hatch”120 or “escape”121 clause.  This language is commonplace in automobile insurance policies.

A number of courts have addressed the validity of the “escape” clause, sometimes holding that the clause is void as against public policy.122 The Minnesota Supreme Court found the provision contrary to public policy and articulated its rationale as follows:

The policy’s arbitration provision, instead of providing a speedy, informal, and relatively inexpensive procedure for resolving controversies between the parties--the raison d’etre of arbitration--instead substantially thwarts those policy goals.  By permitting resort to the court system for a trial de novo notwithstanding the absence of any claimed impropriety in the arbitration process itself, by fostering multiple hearings in multiple forums, by increasing the costs to the contracting parties, and, by unnecessarily, and without real cause, extending the time consumed in resolving the controversy it likewise operates to defeat goals designed to promote judicial economy and respect for the judicial system.123

Other relevant jurisdictions have concluded there is no violation of public policy and subsequently enforced these “escape hatch” provisions.124 The New Mexico Supreme Court offered its rationale for upholding an “escape” clause as follows:

Our legislature has not expressed its intent that an arbitration award should be final in cases in which the parties have provided to the contrary by contract; the [Uniform Arbitration Act] is supportive of the parties’ right to contract for arbitration.  Further, this Court has consistently held that “parties to an insuring agreement may contract for and agree upon any mutually acceptable terms and provisions.”  . . . Although contractual terms and provisions will not be enforced if they contradict “our public policy, as manifest in positive law,” . . . we are unable to find that this provision is repugnant to public policy.  As evidenced by the unambiguous terms of the contract between Bruch and CNA, the parties agreed to settle by arbitration controversies arising under the uninsured motorist clause only if the award was less than the minimum limit for bodily injury liability required by law.  As CNA admits, it would be bound by the decision of the arbitrators to award less than that amount and would not be entitled to a trial de novo.  We strongly encourage final settlement by arbitration; however, Bruch and CNA mutually accepted the applicable term of the insurance contract.125

In cases administered by the American Arbitration Association, the injured person can initiate the claim by serving a demand for arbitration on the insurance company with copies to the nearest AAA office.126 The injured individual may designate the place of hearing.  If the insurance carrier objects to the location, the AAA will determine the location of the hearing.

Uninsured motorist hearings tend to be brief and informal, affording each side the opportunity to present its case through the testimony of witnesses and the presentation of exhibits.  A written award must be signed by the arbitrator within thirty days after the hearing is declared closed.  It is not customary for the arbitrator to explain the reasoning behind the award.127

E. No-Fault Disputes

Unlike arbitration of uninsured motorist claims, which is based solely upon the agreement of the insurer and the insured to arbitrate any disputes, no-fault arbitration is afforded by state statutes.128 No-fault arbitration awards usually contain detailed options.129 New York has special provisions for the arbitration of no-fault motor vehicle claims administered by the American Arbitration Association.  The New York no-fault arbitration system has its own unique review procedure.  Under the New York procedure, awards can be appealed to a master arbitrator.  Grounds for review include:

  • statutory grounds for vacating an award contained in New York arbitration law, except failure to follow procedures contained in the New York arbitration law;
  • the award required an insurer to pay amounts in excess of policy limits;
  • the award in an expedited case was incorrect;
  • an attorney fee awarded by the hearing arbitrator did not accord with the fee schedule;
  • an AAA award was “inconsistent and irreconcilable” with a Health Service arbitration award involving the same injuries.130

F. Reinsurance Disputes

Many reinsurance agreements include arbitration clauses providing that any dispute relating to the agreement will be resolved by disinterested insurance or reinsurance executives who must resolve disputes in accord with industry custom and practice.131 A representative arbitration clause provides:
 
If any dispute shall arise between the reinsured and the re insurer with reference to the interpretation of this contract or their rights with respect to any transaction involved, the dispute shall be referred to three arbitrators. . . .  [The] arbitrators shall consider this contract an honorable engagement rather than merely a legal obligation; they are relieved of all judicial formalities and may abstain from following the strict rules of law.  The decision of a majority of the arbitrators shall be final and binding on both the reinsured and the reinsurer.
132

At times, the interplay between the McCarran-Ferguson Act133 and the Federal Arbitration Act creates issues unique to the insurance and reinsurance industries.134 Some courts have interpreted their state’s legislative framework for handling insolvent insurers and reinsures as vesting exclusive jurisdiction in the state court responsible to oversee the liquidation or rehabilitation.  Using the rationale expressed by these courts, the McCarran-Ferguson Act bars application of the Federal Arbitration Act and enforcement of arbitration provisions.135 Other courts have enforced arbitration agreements in reinsurance contracts, either compelling liquidators or rehabilitators to arbitrate, or enforcing demands by liquidators to arbitrate.136

Federal courts have applied the Federal Arbitration Act to reinsurance disputes.137 In Hamilton Life Insurance Co. v. Republic National Life Insurance Co.,138 the Second Circuit Court of Appeals held that the defendant was bound to arbitrate a reinsurance dispute under the Federal Arbitration Act.139 However, some federal courts have relied on the McCarran-Ferguson Act to uphold state statutes or doctrines that do not permit insurance or reinsurance agreements to include arbitration provisions.140

Parties to a reinsurance relationship commonly have entered into several different reinsurance agreements, typically covering different risks or different time periods.141 Absent the consent of the parties, a court may not order the arbitrations consolidated.142 This could create a problem of multiple arbitration proceedings between the same parties.143

G. Title Insurance Disputes

Many title insurance policy forms contain arbitration provisions.  Under a clause used by the American Land Title Association (ALTA), arbitration can be requested at the option of either the insured or the insurer when the amount of insurance is $1,000,000 or less.  If the amount of insurance is more than $1,000,000, arbitration can be invoked only if both the insured and the insurer agree.

The ATLA arbitration clause provides that arbitrable matters may include any controversy or claim between the insurer and the insured arising out of or relating to the policy, any service of the insured in connection with its issuance, or the breach of a policy provision or other obligation.  The law of the jurisdiction in which the real property is located applies to the arbitration.  Arbitrations under the ATLA clause are conducted by the American Arbitration Association under its Title Insurance Arbitration rules.

H. Environmental Insurance Disputes

Increasingly, state and federal courts are establishing mandatory settlement programs using mediation to resolve environmental insurance coverage disputes.  Similarly, parties themselves are suggesting mediation in order to quickly resolve environmental disputes.  Arbitration also may be utilized in resolving environmental disputes.

A variety of environmental insurance issues can be submitted to arbitration.  For example, it may be necessary to determine which of a policyholder’s insurance policies responds to a covered loss.144 Another issue involves the question whether the term “damages,” as used in the insurance policy, covers clean-up or response costs that are sought pursuant to the Comprehensive Environmental Response, Compensation and Liability Act of 1980145 or similar statutes.146

It may be necessary to determine whether the insured expected or intended the bodily injury or property damage for which coverage is sought.  There would be no insurance coverage if the conduct was expected or intended, since coverage is based upon the happening of an “occurrence” that requires the harm be neither expected nor intended from the standpoint of the insured.147 Commercial general liability policies contain a number of pollution exclusions.  Alternative dispute resolution may be used to determine whether an exclusion applies.148

When the parties wish to have some control over the process and the outcome, mediation149 is the appropriate method of alternative dispute resolution.  Arbitration150 may be appropriate when factual or damage related issues are the major focus of dispute and legal issues hold minor importance.151 On the other hand, a minitrial152 may be appropriate in complex cases, where a formal hearing is necessary to present their cases properly, but the parties wish to retain control of the outcome.

I. Marine Insurance Disputes

Alternative dispute resolution likewise can be effective in resolving marine insurance disputes.  In particular, arbitration may be appropriate because it is relatively efficient and affords the opportunity to utilize an arbitrator with expertise in marine insurance matters. Arbitration has been used to resolve such marine insurance disputes as whether an insured should contribute, in general average, to the insurer’s costs of salvaging the insured’s boat which sunk because the insured’s uninsured fish net and other fishing equipment were salvaged in the same operation that had raised the boat.153

A contract of protection and indemnity insurance covering a vessel between an American insured and a foreign insurer is a maritime contract.  The Federal Arbitration Act154 requires enforcement when a maritime contract has an arbitration clause, despite the McCarran-Ferguson Act.155 The court in Triton Lines explained that the McCarran-Ferguson Act was inapplicable because a disputed claim is not the “business of insurance.”

J. Force-Placed Insurance Disputes

Force-placed insurance programs protect a lender’s interest in collateral from loss or damage.  They are commonly used by lending institutions which finance automobile purchases.156 Under a force-placed insurance program, a borrower is required to maintain insurance on the collateral supporting the loan and to provide the lender with the right to “force-place” insurance on the collateral, should the borrower allow the insurance coverage to lapse.

In recent years, consumer finance suits have attacked the validity of charges imposed on borrowers by force-placed insurance programs.  Alternative dispute resolution may be appropriate in resolving “force-placed” disputes.  Arbitration, in particular, can provide swift settlement of claims and enhance customer relations.157

 

IV. CONCLUSION

Society does not and should not rely exclusively on the courts for resolving disputes.  Other non-judicial procedures may be superior when addressing a variety of disputes.  These non-judicial mechanisms may be less expensive, faster, less intimidating, more sensitive to the disputants’ concerns, and more responsive to the underlying problems.

Alternative dispute resolution can provide an efficient and economical procedure for resolving insurance disputes.  In that regard, alternative dispute resolution complements the judicial system.  As the cost of litigation rises and courts become increasingly congested, private litigants turn to alternative dispute resolution with greater frequency to manage unavoidable disputes.  Alternative dispute resolution may be appropriate particularly where the parties desire privacy, limited discovery, jury avoidance, preservation of relations, or reduction of costs.



ENDNOTE

* This article is adapted from Jay Grenig, Alternative Dispute Resolution With Forms (2d ed. 1997) published by West Group. BACK

1 See, e.g., Warren Burger, Isn’t There a Better Way?, Annual Report on the State of the Judiciary (1982);  Frank Sander, Varieties of Dispute Processing, 70 F.R.D. 79 (1976). BACK
2 For a discussion of the historical development of alternatives to formal adjudication, see Jerold S. Auerbach, Justice Without Law? (1983). BACK
3 9 U.S.C. § 1 et seq. BACK
4 15 U.S.C. §§ 1011-1015. BACK
5 See generally Gerald Williams, Legal Negotiation  & Settlement (1983). BACK
6 See Steven J. Burton, Combining Conciliation With Arbitration of International Commercial Disputes, 18 Hastings Int’l & Comp. L. Rev. 637, 638 (1995) (“conciliation” is often called “mediation” in the United States). BACK
7 Michael B. Shane, The Difference Between Mediation and Conciliation, 50 Disp. Resol. J. 31 (July 1995).  See Erik Langeland, The Viability of Conciliation in International Disputes Resolution, 50 Disp. Resol. J. 34 (July 1995) (conciliation differs from mediation: in conciliation the neutral evaluates the dispute and then strives to construct a just resolution that is proposed to the parties for their approval or rejection, while in mediation the mediator’s role is to facilitate resolution of the conflict by the parties, not to suggest solutions). BACK
8
For a detailed discussion of medication, see Jay E. Grenig, Alternative Dispute Resolution With Forms (2d ed. 1997) (“Grenig”), ch. 7. BACK
9 See generally Kimberlee Kovach, Mediation: Principles and Practice (1994); Robert Coulson, Professional Mediation of Civil Disputes (1984). BACK
10 Richard C. Reuben, The Lawyer Turns Peacemaker, ABA J. 55, 59 (August 1996). BACK
11 See also Grenig, supra note 8, § 13.21 (use of appraisal in insurance disputes). BACK
12 Cf. Jordan Marsh Co. v. Beth Israel Hosp., 118 N.E.2d 79 (Mass. 1954). BACK
13 Franks v. Franks, 1 N.E.2d 14 (Mass. 1936).  But see Cal. Code of Civ. Proc. § 1280(a) (agreements for “valuation and appraisal of property and similar proceedings” are treated as agreements for arbitration). BACK
14 Sorrells & Co. v. Ancona Co., 145 N.E. 564 (Mass. 1924). BACK
15 See Harmon v. Schwartz, 242 A. 2d 490 (Md. 1968). BACK
16 See City of Omaha v. Omaha Water Co., 218 U.S. 180 (1910) (appraisers not rigidly required to confine themselves either to matters within their own knowledge or those submitted to them formally in presence of parties). BACK
17 In re Delmar Box Co., 309 N.Y. 60, 127 N.E.2d 808 (1955). BACK
18 Dimson v. Elghanayan, 19 N.Y.2d 316, 280 N.Y.S.2d 97, 227 N.E.2d 10 (1967). BACK
19 Nelson v. Maiorana, 478 N.E.2d 945 (Mass. 1985).  See Helzel v. Superior Court of Alameda County, 123 Cal. App. 3d 652, 176 Cal. Rptr. 740 (1981). BACK
20 Hollander v. Kessler, 14 N.Y.2d 646, 249 N.Y.S.2d 431, 198 N.E.2d 600, aff’d, 15 N.Y.2d 586, 255 N.Y.S.2d 257, 203 N.E.2d 646 (1964). BACK
21 For a more detailed discussion of arbitration, see Grenig, supra note 8, chs. 3-6. BACK
22 See id., §§ 6.1-6.29. BACK
23 See id., § 2.56 (discussion of fact-finding). BACK
24 See generally Sherry Landry, Med-Arb: Mediation with a Bite and an Effective ADR Model, 63 Def. Couns. J. 263 (1996). BACK
25 Jay Folberg & Alison Taylor, Mediation: A Comprehensive Guide to Resolving Conficts Without Litigation 268 (1984). BACK
26 See Bartel Bartel, Comment, Med-Arb as a Distinct Method of Dispute Resolution: History, Analysis, and Potential, 27 Willamette L. Rev. 661, 666 (1991). BACK
27 But see Dean G. Pruitt, Solutions Not Winners: Community Mediators Help Neighbors, Families and Ex-lovers Solve Their Problems Without Going to Court, Psychol. Today Dec. 1987, at 58 (study revealed that, when different persons used as mediator and arbitrator, participants were less creative and mediators appeared less interested in sessions). BACK
28 See Grenig, supra  note 8, ch. 8 (detailed discussion of minitrials). BACK
29 For a discussion of court-annexed dispute resolution, see id., ch. 18. BACK
30 See discussion of common law arbitration in Grenig, supra note 8, § 3.4.  See Volt Info. Sci., Inc. v. Board of Trustees of Leland Stanford Jr. Univ., 489 U.S. 468, 474 (1989).  See generally Jones, Historical Development of Commercial Arbitration in the United States, 12 Minn. L. Rev. 240, 240-62 (1928) (discussing history of judicial approach to arbitration provisions). BACK
31 9 U.S.C. §§ 1-301.  See generally Charles Alan Wright et al., Federal Practice and Procedure: Jurisdiction § 3569 (2d ed. 1984). BACK
32 See, e.g., Southland Corp. v. Keating, 465 U.S. 1 (1984). BACK
33 9 U.S.C. § 2.  See Wright, supra note 31.  See also Allied-Bruce Terminix Cos. v. Dobson, 513 U.S. 265 (1995); Moses H. Cone Mem. Hosp. v. Mercury Const. Corp., 460 U.S. 1 (1983); Dean Witter Reynolds, Inc. v. Byrd, 470 U.S. 213, 220 (1985), on remand, 760 F.2d 238 (9th Cir. 1985) (when Congress passed the Arbitration Act in 1925 it was “motivated, first and foremost,” by a desire to change this anti-arbitration rule); Bernhardt v. Polygraphic Co. of Am., 350 U.S. 198, 201-02 (1956) (Act applicable only when agreement involves a maritime transaction or interstate or foreign commerce). BACK
34 Allied-Bruce Terminix Cos. v. Dobson, 513 U.S. 265 (1995); Mittendorf v. Stone Lumber Co., 874 F. Supp. 292 (D. Or. 1994); Associated Metals & Mins. Corp. v. The Steamship Mihalis Angelos, 234 F. Supp. 236 (S.D.N.Y.1964). BACK
35 See discussion of preemption in Grenig, supra note 8, § 3.24.  See Allied-Bruce Terminix Cos. v. Dobson, 513 U.S. 265 (1995); Southland Corp. v. Keating, 465 U.S. 1, 15-16 (1984). BACK
36 Scherk v. Alberto-Culver Co., 417 U.S. 506, reh’g denied, 419 U.S. 885 (1974); Wilko v. Swan, 346 U.S. 427 (1953). BACK
37 Gilmer v. Interstate/Johnson Lane Corp., 500 U.S. 20 (1991); Perry v. Thomas, 482 U.S. 483 (1987), on remand, 246 Cal. Rptr. 156 (Cal. Ct. App. 1988). BACK
38 Dean Witter Reynolds, Inc. v. Byrd, 470 U.S. 213, 220 (1985). BACK
39 Volt Info. Sci., Inc. v. Board of Trustees of Leland Stanford Jr. Univ., 489 U.S. 468, 474 (1989). BACK
40 AT&T Techs., Inc. v. Communications Workers of Am., 475 U.S. 643 (1986). BACK
41 Moses H. Cone Mem. Hosp. v. Mercury Constr. Corp., 460 U.S. 1, 25 n.32 (1983); Gibraltar, P.R., Inc. v. Otoki Group, Inc., 104 F.3d 616 (4th Cir. 1997) (dispute over ownership of trademarks did not present federal question but was merely a contract dispute). BACK
42 9 U.S.C. § 4; Gibraltar, P.R., Inc. v. Otoki Group, Inc., 104 F.3d 616, 618 (4th Cir. 1997). BACK
43 Westmoreland Capital Corp. v. Findlay, 100 F.3d 263, 268 (2d Cir.1996) (federal courts do not have subject matter jurisdiction over action to compel or stay arbitration, even when petition raises a statute of limitations defense and underlying claim involves federal question).  See Prudential-Bache Sec., Inc. v. Fitch, 966 F.2d 981, 986-88 (5th Cir. 1992) (federal securities law claims in underlying state court dispute could not provide required independent basis for federal jurisdiction in separate federal action seeking to compel arbitration of dispute under Federal Arbitration Act). BACK
44 9 U.S.C. § 2.  See generally Isham R. Jones, III, Note, The Federal Arbitration Act and Section 2’s “Involving Commerce" Requirement: The Final Step Towards Complete Federal Preemption Over State Law and Policy, 1995 J. Disp. Resol. 327. BACK
45 Allied-Bruce Terminix Cos. v. Dobson, 513 U.S. 265 (1995). BACK
46 Scott R. Swier, Note, The Tenuous Tale of the Terrible Termites: The Federal Arbitration Act and the Court’s Decision to Interpret Section Two in the Broadest Possible Manner:  Allied-Bruce Terminix Companies, Inc. v. Dobson, 41 S. D. L. Rev. 131, 133 (1996). BACK
47 513 U.S. 265 (1995). BACK
48 Allied-Bruce Terminix Cos. v. Dobson, 513 U.S. 265 (1995) (Court recognized “multi-state nature” of defendant and fact that termite-treating and house-repairing material used by defendant came from outside forum state). BACK
49 388 U.S. 395. BACK
50 388 U.S. at 405 (quoting H.R.Rep. No. 96, 68th Cong., 1st Sess., 1 (1924)). BACK
51 Prima Paint Corp. v. Flood & Conklin Mfg. Co., 388 U.S. 395, 405 (1967). BACK