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The
appeals procedure is simple and informal. No special forms are required,
although one is available for your use on this website. View a sample form (You will need Adobe
Acrobat Reader to view this form. Click here
to download it.)
There
is no need to hire an attorney. The Office of the Ombudsman has
the responsibility of assisting Homeowners in filing appeals. A
simple letter asking for a review of the claim will suffice. You
should include a brief explanation of why you believe the denial
of benefits was not proper. Include any documentation such as repair
bills, photographs, copies of insurance claim documents, water bills,
etc. that will support your position. Most appeals can be resolved
by the Office of the Ombudsman. If not, the Ombudsman will present
your appeal to the Appeals Committee as described below. It should
be understood that while the Ombudsman may assist individuals, he
is not an advocate for the individual Homeowner, but represents
and protects the interests of the members of the Class as a whole.
The
Appeals procedure described below is found in the Settlement Agreement
at Exhibit A, Section VII
Claimants whose claims are denied or who are dissatisfied with the relief
offered by the CPRC shall have the right to appeal through the following
process, which per the Terms of Settlement shall be the exclusive
appeals process.
Click to view issues which are considered appealable
issues.
Click to view Filing Deadline Issues.
Click to view issues which are considered
non-appealable issues.
A claimant wishing to appeal the decision of a representative of the CPRC
shall do so, in writing, within sixty (60) days of said decision,
stating his or her reason for the dissatisfaction with the adjustment
of the claim and including copies of any supporting documentation.
Appeals shall be considered by an Appeal Committee appointed by the Board
of Directors from among the employees of the CPRC. While the Appeals
Committee may include employees with claim handling duties, any
such employee shall not participate in the consideration of an appeal
with respect to a claim that was adjusted under his or her personal
authority.
Claims that cannot be resolved by the appeals process shall be submitted
to binding arbitration, conducted in the manner determined to be
appropriate by the Board of Directors, in the state in which the
property is located.
The fee of the arbitrators and other costs of arbitration shall be paid
75% by the CPRC and 25% by the claimant.
Each party shall bear his own attorneys fees and related expenses.
Click to view Frequently Asked Questions on
Appeals
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