Section 1373.20 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1373.20
. (a) If a plan uses arbitration to settle disputes with
enrollees or subscribers, and does not use a professional dispute
resolution organization independent of the plan that has a procedure
for a rapid selection, or default appointment, of neutral
arbitrators, the following requirements shall be met by the plan with
respect to the arbitration of the disputes and shall not be subject
to waiver:
(1) If the party seeking arbitration and the plan against which
arbitration is sought, in cases or disputes requiring a single
neutral arbitrator, are unable to select a neutral arbitrator within
30 days after service of a written demand requesting the designation,
it shall be conclusively presumed that the agreed method of
selection has failed and the method provided in Section 1281.6 of the
Code of Civil Procedure may be utilized.
(2) In cases or disputes in which the parties have agreed to use a
tripartite arbitration panel consisting of two party arbitrators and
one neutral arbitrator, and the party arbitrators are unable to
agree on the designation of a neutral arbitrator within 30 days after
service of a written demand requesting the designation, it shall be
conclusively presumed that the agreed method of selection has failed
and the method provided in Section 1281.6 of the Code of Civil
Procedure may be utilized.
(b) If a court reviewing a petition filed pursuant to Section
1373.19 or subdivision (a) finds that a party has engaged in dilatory
conduct intended to cause delay in proceeding under the arbitration
agreement, the court, by order, may award reasonable costs, including
attorney fees, incurred in connection with the filing of the
petition.
(c) If a plan uses arbitration to settle disputes with enrollees
or subscribers, the following requirements shall be met with respect
to extreme hardship cases:
(1) The plan contract shall contain a provision for the assumption
of all or a portion of an enrollee's or subscriber's share of the
fees and expenses of the neutral arbitrator in cases of extreme
hardship.
(2) The plan shall disclose this provision to subscribers in any
evidence of coverage issued or amended after August 1, 1997.
(3) The plan shall provide enrollees, upon request, with an
application for relief under this subdivision, or information on how
to obtain an application from the professional dispute resolution
organization that will administer the arbitration process. If the
plan uses a professional dispute resolution organization independent
of the plan, the provision for assumption of the arbitration fees in
cases of extreme hardship shall be established and administered by
the dispute resolution organization.
(4) Approval or denial of the application shall be determined by
either (A) a professional dispute resolution organization independent
of the plan if the plan uses a professional dispute resolution
organization, or (B) a neutral arbitrator who is not assigned to hear
the underlying dispute, who has been selected pursuant to paragraph
(1) of subdivision (a), and whose fees and expenses are paid for by
the plan.