Coverage Dispute Procedure

Originally Adopted by MVRMA Board: April 15, 1991

Amended by MVRMA Board:	May 20, 1991
	December 20, 1993
	June 16, 2008

Purpose

On occasion a question may arise as to whether the insurance afforded by the Miami Valley Risk Management Association (MVRMA) may cover a specific claim or lawsuit, valued within the Association's self-insured retention (SIR), against a member municipality. In such situations, the interests of the Association may be at odds with those of the municipality. In order to minimize the effect of this problem, the members of MVRMA agree to handle any such disputes in accordance with the following procedure.

Procedure

1.         The MVRMA Executive Director, after consultation with the Claims Manager, corporate counsel or coverage attorney, and the member city, may determine that a claim or lawsuit is not covered under the insurance afforded by the Association.  If such an occasion should arise, the Executive Director shall notify the member city in writing of his decision and the basis of his decision.

2.         If the member city disputes the Executive Director’s decision, it shall, within fourteen (14) calendar days of the receipt of the Executive Director’s decision, submit a memorandum to the Executive Director setting forth its opinion as to the existence of coverage.  The Executive Director shall then review the city's opinion and either reverse or affirm his prior decision within fourteen (14) calendar days from the date of receipt of the city's memorandum.  If the Executive Director affirms his prior decision, the city may request that the coverage issue be submitted to the Board of Trustees in accordance with Article IX of the Amended Agreement and Bylaws of Miami Valley Risk Management Association, Inc.  Such request shall be made within thirty (30) calendar days from the date of receipt of the Executive Director’s final decision. 

3.         When there is a request that the coverage issue be submitted to the Board of Trustees, all applicable policies, investigative material pertaining to the claim and all position papers shall be submitted to the Executive Director who shall then distribute all such material to the Board of Trustees.  Upon request, the member city may request the opportunity to make an oral presentation to the board.  If the member city does make such a request, the Executive Director shall have the opportunity to make an oral presentation to the Board of Trustees as well.

In its discretion, the Board of Trustees may employ as an advisor, an attorney who has particular expertise in the field of insurance law who has not, nor has anyone with whom that person has been associated in the practice of law within five years, provided legal services to the member city or the Association.

4.         The Board of Trustees shall be requested to decide the issues in dispute.  It shall provide both parties with a written decision within thirty (30) calendar days of the matter being submitted to it.  Neither party shall have any ex parte communications with any members of the Board of Trustees regarding the issue in dispute and all contacts with the Board of Trustees in regard to the issue in dispute shall be in writing with a copy of the communication being given to the other party. The decision of the Board of Trustees of the Association shall be final in the absence of a clear abuse of its discretion.  However, the Association may, in its sole discretion, institute legal proceedings to further resolve the issue by final judicial determination.

5.         While the coverage issue is being resolved, MVRMA shall investigate, adjust and defend the claim or lawsuit which generated the coverage dispute and shall keep the involved city fully informed.

If, during the coverage dispute, the Association proposes to settle any pending claim or suit, it may do so in accordance with Article XIV of the Amended Agreement and Bylaws of Miami Valley Risk Management Association, Inc.  If, during the course of the coverage dispute, the member city believes it would be prudent to settle the pending claim or lawsuit, it may do so at its own expense after giving notice to the Association.  The settlement of any such claim or lawsuit shall not affect the resolution of any coverage dispute unless both parties agree.  If the coverage dispute is decided in favor of the party which paid the claim or settled the lawsuit, that party shall be reimbursed by the other party for the amount paid to the claimant, including legal expenses.