§ 12-113 Dispute resolution.
A. Step One: Informal Process. In the event of any disagreement or dispute arising from a written decision, a claimant must request a review of such written decision at the Administrator level, subject to the following requirements:
1. Written appeals must be submitted to the Administrator within thirty (30) days of the written decision. Failure to timely file a written appeal shall render the written decision final and binding, and shall constitute a waiver to any subsequent appeals or dispute resolution processes set forth under this chapter.
2. Upon receipt of a timely written appeal, the Administrator shall respond within ninety (90) days in writing via certified mail or email as to whether the written decision being appealed shall be upheld, amended, or overturned and provide the justification for said determination. If the Administrator does not respond within ninety (90) days, the written decision shall be deemed upheld by the Administrator and an aggrieved claimant may proceed to Step Two below.
3. Where Step One appeals are based on a dispute regarding medical evidence or medical treatment, an independent medical examination shall be allowed; provided, however, that no prior independent medical examination had previously taken place in review of the claim in question; and further provided, that a failure by a claimant to submit to such an examination will render the Administrator’s written decision final and binding.
B. Step Two: Final Arbitration. If a claimant exhausts Step One above and continues to disagree with recommendation of the Administrator, or if the Administrator fails to respond to a timely request within ninety (90) days, the claimant may request a final arbitration. Such a request must be made in writing, stating with specificity all grounds supporting the request, including without limitation, all documents, witness statements and other evidence claimant intends to use to support the claim at arbitration, within thirty (30) days of the Administrator’s response under Step One above, or thirty (30) days from the ninety-first day should the Administrator fail to respond within ninety (90) days of the submission of a request for review where a timely written request has been made. Failure to make a timely written request for arbitration under this section for any reason, and/or failure to include all supporting evidence, will forever bar further appellate remedy under Step Two and will render the Administrator’s written decision final and binding. Where a timely request for arbitration is made pursuant to this section, an independent arbitrator appointed by the Administrator shall be selected, and an arbitration hearing shall be scheduled within sixty (60) days of the request.
1. The arbitrator shall:
a. Be bound by this chapter, and any other applicable tribal laws, civil procedures, regulations, and practices, but may at his or her discretion look to California law or other workers’ compensation law as a nonbinding source of reference or information. The arbitrator shall not have jurisdiction to issue any awards for damages other than those specifically and explicitly available under Section 12-111. This limitation on the arbitrator’s jurisdiction deprives the arbitrator of jurisdiction to award, among other remedies, punitive damages, treble damages, fines or penalties, attorneys’ fees, costs, and equitable relief.
b. Take all action necessary to ensure an equitable, orderly, and expeditious review.
c. Regulate all aspects of the arbitration hearing including, but not limited to, applicable oaths and affirmations, admissibility of evidence, and admissibility of expert or lay witness testimony.
2. Any evidence that either party (claimant or the casino) wishes to submit and have considered at the arbitration hearing must be submitted as true copies thereof to the opposing parties no later than fifteen (15) days prior to the date of the arbitration hearing; provided, however, that the claimant may not present evidence that was not included in his or her arbitration request, as provided in this subsection (B).
3. Both parties agree to abide by the arbitrator’s findings. Except as specifically expressed in Section 12-118, nothing shall be deemed or interpreted as (a) a waiver of the casino’s sovereign immunity, nor as (b) consent of the casino to enforcement of this provision by any other court, forum, or venue.
4. Cost of Arbitration. The parties shall bear their own costs, including attorney’s fees, in the arbitration. Initially, the casino shall pay the arbitrator’s fees, but if the casino is the prevailing party in arbitration, the arbitrator may award up to fifty percent (50%) of his or her fees and costs to the casino.
5. Limitations on Arbitration Award. Notwithstanding the limited waiver of sovereign immunity of the casino, as expressly set forth in Section 12-118, neither the arbitrator nor the Tribal Court shall have authority or jurisdiction to order execution against any assets or revenues of the casino except: (a) what is provided for under a valid policy of workers’ compensation insurance, but only up to the available limit therein; (b) funds specifically set aside or designated by the casino for payment of such compensation and/or workers’ compensation benefits; or (c) any other proceeds of any applicable insurance policies. In no instance shall any enforcement of any kind whatsoever be allowed against any assets of the casino other than the limited assets of the casino specified in this subsection. (Res. 2022-44 (Exh. A))