§ 10-304 Resolution of tribal dispute process.
A. Burden of Proof. The claimant bears the burden of proving, by a preponderance of the evidence, both that the claimant suffered a compensable injury and the fact and amount of compensation due in accordance with this chapter.
B. Determination. For claims being resolved directly by the Gaming Authority, the Gaming Authority Director of Customer Care shall analyze all relevant information and documentation in a fair and reasonable manner and will make a determination as follows:
1. If legal liability of the Gaming Authority is clearly not proper, the claim shall be rejected.
2. If legal liability of the Gaming Authority is proper and the claim is for an amount justly due, the claim shall be allowed and shall be promptly settled.
3. If legal liability of the Gaming Authority is proper but the claim is for an amount greater than is justly due, the claim shall either be rejected in full or the claim shall be allowed for the amount believed to be justly due and rejected for the remaining amount believed not to be justly due.
4. If legal liability of the Gaming Authority and the amount justly due are disputed, the claim may be rejected or may be negotiated. If the claimant accepts the amount offered to settle the claim, it must be a final resolution in settlement of the entire claim.
5. If the legal liability of the Gaming Authority may be proper, but the written notice of injury, formal written claim, or both, were not timely filed, the claimant may make a written request to the Director of Customer Care for permission to have his or her claim processed under the tribal dispute process. The request shall be presented within a reasonable time not to exceed one (1) year after the accrual of the cause of action. The request shall state the reason for the delay and shall include a copy of the proposed claim, if not already received. The request shall be granted where one (1) or more of the following is applicable:
a. The failure to present the written notice of injury or formal written claim was through mistake, inadvertence, surprise, or excusable neglect and the Gaming Authority was not prejudiced in its defense of the claim by the failure to present the claim within the time specified.
b. The claimant who sustained the alleged bodily injury, personal injury or property damage was a minor during the time specified in Section 10-303(A) through (C) for the presentation of the written notice of injury or formal written claim.
c. The person who sustained the alleged bodily injury, personal injury, property damage or loss was physically or mentally incapacitated during the time specified in Section 10-303(A) through (C) for the presentation of the written notice of injury or formal written claim and by reason of such disability failed to present it during such time.
d. The claimant who sustained the alleged bodily injury, personal injury or property damage died before the expiration of the time specified in Section 10-303(A) through (C) for the presentation of the written notice of injury or formal written claim.
If the Director of Customer Care or insurance carrier fails to act on a request for additional time to file the written notice of injury or formal written claim, the request will be deemed to have been denied on the forty-fifth day and the determination will become appealable as provided in Articles IV and V of this chapter.
C. The Director of Customer Care shall be authorized to enter into a binding settlement or render a final determination and issue an award of up to an amount determined in the guidelines, which shall be binding on the Gaming Authority. If the Director of Customer Care determines an appropriate award exceeds the amount in the guidelines, the Gaming Authority shall notify and seek approval by resolution from the Tribal Council for the proposed award.
D. The determination letter shall be sent to claimant at the address provided in the formal written claim or to an updated address provided by the claimant.
E. The determination letter shall include findings of fact and, if applicable, an explanation of the reasons why the claim or the amount requested was rejected in whole or in part. The determination letter will also include an explanation of the claimant’s right to appeal and provide prominent notice of all applicable deadlines the claimant must meet. (Res. 2021-22)