Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 28 (2002)

Page:   Index   Previous  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  Next

382

RUSH PRUDENTIAL HMO, INC. v. MORAN

Opinion of the Court

odds with the manifest congressional purpose to confine adjudication of disputes to the courts. It does not turn out to be this simple, however, and a closer look at the state law reveals a scheme significantly different from common arbitration as a way of construing and applying contract terms.

In the classic sense, arbitration occurs when "parties in dispute choose a judge to render a final and binding decision on the merits of the controversy and on the basis of proofs presented by the parties." 1 I. MacNeil, R. Speidel, & T. Stipanowich, Federal Arbitration Law 2.1.1 (1995) (internal quotation marks omitted); see also Uniform Arbitration Act 5, 7 U. L. A. 173 (1997) (discussing submission evidence and empowering arbitrator to "hear and determine the controversy upon the evidence produced"); Commercial Dispute Resolution Procedures of the American Arbitration Association ¶¶ R33-R35 (Sept. 2000) (discussing the taking of evidence). Arbitrators typically hold hearings at which parties may submit evidence and conduct cross-examinations, e. g., Uniform Arbitration Act 5, and are often invested with many powers over the dispute and the parties, including the power to subpoena witnesses and administer oaths, e. g., Federal Arbitration Act, 9 U. S. C. 7; 28 U. S. C. 653; Uniform Arbitration Act 7, 7 U. L. A., at 199; Cal. Civ. Proc. Code Ann. 1282.6, 1282.8 (West 1982).

Section 4-10 does resemble an arbitration provision, then, to the extent that the independent reviewer considers disputes about the meaning of the HMO contract 12 and receives "evidence" in the form of medical records, statements from

12 Nothing in the Act states that the reviewer should refer to the definitions of medical necessity contained in the contract, but the reviewer did, in this case, refer to that definition. Thus, we will assume that some degree of contract interpretation is required under the Act. Were no interpretation required, there would be a real question as to whether 4-10 is properly characterized as a species of mandated-benefit law of the type we approved in Metropolitan Life Ins. Co. v. Massachusetts, 471 U. S. 724 (1985).

Page:   Index   Previous  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  Next

Last modified: October 4, 2007