The Receivership Appeal Procedure For the Adjudication And Appeal Of Claim Decisions
Question:
If I am dissatisfied with the decision made on my claim, do I have a right to appeal that decision?
Answer:
Yes, in accordance with the applicable Receivership Appeal Procedure you may appeal claim decisions to the Deputy Receiver. Determinations of Appeal by the Deputy Receiver may, in turn, be appealable to the State Corporation Commission of the Commonwealth of Virginia (the "Commission"). The decisions of the Commission may then be appealable to the Virginia Supreme Court.
Question:
What is the procedure for appealing claim decisions?
Answer:
Effective January 29, 2003, the Third Directive of the Deputy Receiver Adopting Receivership Appeal Procedure adopted a receivership appeal procedure (the "Original RAP") for appeals or challenges of any decision made by the Deputy Receiver or Special Deputy Receiver with respect to claims against the Companies other than claims arising under contracts of insurance or insurance policies issued or assumed by ROA. Effective November 10, 2004, the Sixth Directive of Deputy Receiver Adopting Amended Receivership Appeal Procedure (the "Sixth Directive") amended the Original RAP (the "Amended RAP") to also apply to claims arising under policies or contracts of insurance issued or assumed by ROA ("Insurance Policy Claims"). The full Amended RAP can be seen at the Sixth Directive.
Question:
Is there a deadline for submitting an appeal to the Deputy Receiver?
Answer:
Yes. An appeal of a decision made by the Deputy Receiver or Special Deputy Receiver must be received by the Deputy Receiver within thirty (30) days following the Date of Decision. The Date of Decision is the date shown on the "Notice of Claim Determination" advising the claimant of the disposition of his or her claim; or, with respect to any non-claim matter, the day the Deputy Receiver announces his decision; or, with respect to any non-claim matter for which a decision is not announced, the date the decision is made. The date of receipt is very important; therefore you should use a method of delivery that will enable you to know when the appeal is actually received by the Deputy Receiver. If your appeal is not received within thirty (30) days of the Date of Decision, your right to appeal the decision will be waived and that decision will become final and non-appealable.
Question:
Which of the Original RAP or the Amended RAP applies to my claim?
Answer:
Except as to its application to Insurance Policy claims, the amendments to the Original RAP were not intended to be substantive. However, in the event of a conflict between the Original RAP and the Amended RAP, the Original RAP will apply to claims for which the Date of Decision is prior to November 10, 2004, the effective date of the Sixth Directive, while the Amended RAP will apply to claims for which the Date of Decision is on or after November 10, 2004.
Question:
What decisions are appealable under the Amended RAP (or, if applicable, the Original RAP)?
Answer:
A decision is appealable only if it concerns a specific claim against the Companies or it affects, or may affect, a financial interest, contract right, or legal entitlement of the person making the appeal.
Question:
Is there a specific procedure and/or form for appealing to the Deputy Receiver?
Answer:
The Deputy Receiver must receive a "Notice of Appeal" ("Appeal") that includes a narrative and supporting documentation as to why the particular decision is being appealed. The Appeal does not require a specific form. However, the first page of the submission should be clearly labeled "Notice of Appeal." The Appeal should include the Notice of Claim Determination (or if it is a non-claim matter, any available writing or documentation) a full and detailed explanation of your Appeal, including all grounds on which you are making the Appeal, and evidence that the Appeal was properly sworn (see Appendix 1–Jurat). Please note that any ground or basis not included in the Appeal will be deemed waived and may not be presented for the first time to the Commission, unless the Commission determines that consideration of the additional grounds are necessary to attain the ends of justice.
Question:
Where should I send my Appeal?
Answer:
Attn: Claims Department
The Reciprocal Group
Reciprocal of America
P.O. Box 85058
Richmond, VA 23285-5058
or
Attn: Claims Department
The Reciprocal Group
Reciprocal of America
4200 Innslake Drive
Glen Allen, VA 23060
Question:
How will I know the outcome of my appeal?
Answer:
The Deputy Receiver will send a written "Determination of Appeal" ("DOA") on or before thirty (30) days after receipt of your Appeal. However, the Deputy Receiver may send a written "Extension of Appeal" ("Extension") within thirty (30) days of receipt of your Appeal to notify you that he requires up to ninety (90) additional days to evaluate your Appeal. If the Deputy Receiver does not send you either a written DOA or an Extension notification within thirty (30) days following receipt of your Appeal, your Appeal will be deemed automatically rejected. You then have thirty (30) days within which to challenge the Deputy Receiver's decision.
Question:
If I am dissatisfied with the Deputy Receiver's determination (whether it be automatic rejection or a specific decision), how do I appeal to the Commission?
Answer:
You must file a "Petition for Review of Deputy Receiver's Determination of Appeal" ("Petition") (see Appendix 2–Petition Style). The Petition cannot include any grounds that were not submitted in the prior Appeal to the Deputy Receiver, unless the Commission determines that consideration of such grounds is necessary. Any finding, decision, judgment, or order by the Commission is considered a final judgment, order, or decree.
Question:
What is the deadline for filing a Petition?
Answer:
The Petition must be received by the Commission on or before the thirtieth (30th) day following the date shown on the DOA, or, if there is no written determination: the sixtieth (60th) day following the date on which the Deputy Receiver received your Appeal, or, if an Extension notification was provided to you, within thirty (30) days of the expiration of the Extension.
Question:
Where should I send the Petition and supporting documents?
Answer:
State Corporation Commission
Document Control Center
P.O. Box 2118
Richmond, VA 23218
Please note that any formal pleading or other
related document shall be considered filed with the Commission only upon
receipt of the original and required copies by the Clerk of the Commission
at the address above. Be sure to review the Commission's Rules of Practice
and Procedure available on its
web site, or contact the Clerk of the Commission, to
determine the number copies you should submit. The Deputy Receiver must also
be served with a copy of your Petition. Failure to file your Petition in the
manner described waives any further right to appeal and renders the Deputy
Receiver's DOA or other decision final.
Question:
What if I am dissatisfied with the outcome of my appeal to the Commission?
Answer:
You may pursue an appeal to the Supreme Court of Virginia.