(A) Claim Accrual and Notice.
(1) Claims brought under this article shall be deemed to accrue on the date when the injury is sustained.
(2) A person seeking monetary damages against the Tribe based upon a claim for bodily injury, personal injury, or property damage must submit a written notice of such claim to the Claims Administrator. (A person seeking monetary damages against the Tribe based upon a claim for bodily injury, personal jury, or property damage must submit a written notice of such claim to the Claims Administrator within one hundred eighty (180) days of the date the injury accrues.)
(B) Notice Requirement. Upon receipt of the claimant’s notice in accordance with subsection (A)(2) of this section, the Claim Administrator shall provide notice by personal service or certified mail, return receipt requested, of the following:
(1) That the claimant is required within one hundred eighty (180) days of receipt of the notice in this subsection (B) to bring and/or amend his/her claim.
(2) Claimant shall be informed that failure to exhaust the Tribal dispute process will result in the claimant’s forfeiture of further rights to pursue a claim under this article.
(3) Claimant shall be notified that if he/she is dissatisfied with the resolution under the Tribal dispute process, he/she is entitled to arbitrate his/her claim de novo before a retired judge in accordance with the JAMS comprehensive arbitration process, as set forth in KTC 6.10.420.
(4) Claimant shall be notified that, where a claim for money damages is sought, arbitration must be filed within thirty (30) days of the issuance of the Claim Administrator’s determination under the Tribal dispute process.
(C) Claim Commencement.
(1) Claimant must file a written claim presenting all material facts relating to the alleged incident and injury. This written claim must be received by the Claims Administrator no later than one hundred eighty (180) calendar days from claimant’s receipt of the notice in subsection (B) of this section. This time limit is jurisdictional and shall be strictly construed to preclude late-filed claims.
(2) The written claim must present all material facts relating to the alleged incident and injury. At a minimum, the written claim must contain the following:
(a) The name, mailing address, and telephone number of the claimant and same contact information for the claimant’s legal counsel, if any.
(b) The date, location, and a detailed account of the alleged incident or occurrence that gave rise to the claim.
(c) The identity or description of all persons, including but not limited to witnesses, involved in the incident or occurrence that gave rise to the claim.
(d) A detailed description of the alleged damage or injury suffered by the claimant.
(e) The specific amount of compensation sought by the claimant as of the date of the presentation of the claim, including the estimated amount of any prospective injury, damage, or loss, together with the basis of computation and documentation to support or justify the amount sought.
(f) All supporting documentary evidence and written witness statements on which the claimant intends to rely.
(g) The claim must be signed by the claimant under penalty of perjury. If the claimant is unable to sign the claim because of physical or mental incapacity, or because the claimant is deceased, the claim must be signed under penalty of perjury by claimant’s authorized representative.
(3) A written claim submitted under subsection (C)(1) of this section must be submitted to the following address:
Rain Rock Casino
777 Casino Way
Yreka, CA 96097
(4) The failure of the claimant to provide the information required by this section may be grounds for denial of the claim.
(5) The claimant bears the burden of proving, by a preponderance of the evidence, that claimant incurred a compensable injury.
(D) Certification or Rejection of Claims.
(1) Within thirty (30) calendar days of the receipt of a claim under subsection (C)(1) of this section, the Claims Administrator shall determine whether:
(a) The claim was received within one hundred eighty (180) calendar days of the claimant’s receipt of the notice in subsection (B) of this section;
(b) The claim as presented complies with the content requirements described in subsection (C)(2) of this section and is signed under penalty of perjury;
(c) The incident or occurrence alleged by the claim occurred on the premises of the Tribe’s gaming facility or in connection with the Tribe’s gaming operation;
(d) The alleged injury or damage may have been the proximate result of a negligent or wrongful act or omission of any officer, employee, or agent of the Tribe, or such act or omission may have been a contributing cause of the alleged injury or damage; and
(e) The claim seeks a remedy created by and available under this article.
(2) If a claim meets all of the requirements as set forth in this article, the Claims Administrator shall certify the claim and send to claimant a written “Certification of Claim.”
(3) A determination under subsection (D)(2) of this section shall be made solely for the purpose of determining whether to certify the claim for further proceedings, and shall not constitute a determination of the merits of the claim.
(4) In the event the Claims Administrator determines that a timely filed claim contains incomplete information or is missing any of the items required by subsection (C)(2) of this section, the Claims Administrator shall notify claimant in writing that the claim is incomplete and shall identify the information and any documentation that claimant must provide in order to present a complete claim. Claimant shall be given at least twenty (20) business days from the date notification is mailed to provide the requested information.
(5) If the Claims Administrator does not receive the requested information within the time provided, or if the claim for other reasons does not comply with the requirements of this article, the claim will be considered forfeited for failure to comply with the Tribal dispute process.
(E) Processing of a Claim.
(1) Upon certification of a claim, the Claims Administrator shall undertake an investigation of the claim in conjunction with the gaming facility’s insurance carrier.
(2) The Claims Administrator and insurance investigators may, in their discretion, request additional information from claimant. In addition, the Claims Administrator may request claimant and witnesses to appear before it and to provide recorded testimony under oath administered by an authorized notary public as to facts underlying the claim. The failure of claimant to provide additional information requested by the Claims Administrator or failure of claimant to appear before the Claims Administrator and to give recorded testimony when requested may result in forfeiture of the claim for failure to comply with the Tribal dispute process.
(F) Claim Resolution.
(1) After conclusion of an investigation, if a claim has been determined to have merit, the Tribe’s insurance carrier may attempt to settle with the claimant.
(2) If the Claims Administrator determines a claim is valid but the Tribe’s insurance carrier is unable to reach agreement with the claimant regarding the amount of any award, the Claims Administrator shall issue a written decision describing all grounds for that decision, including the amount of its proposed award. The Claims Administrator shall inform the claimant of his/her option to accept the award as a full and final settlement of the claim or to reject the proposed award and arbitrate the claim de novo before a JAMS arbitrator in a JAMS comprehensive arbitration.