There is no required Demand for Arbitration form.  If you want, a letter to Kaiser Permanente is sufficient.  Please note that it is necessary to have the words “Demand for Arbitration.”  Rules 7 and Rule 8 in our Rules for Kaiser Permanente Member Arbitrations provide additional information in preparing your Demand.  They are set out below:

7.  Contents of the Demand for Arbitration

The Demand for Arbitration shall include the basis of the claim against the Respondent(s); the amount of damages the Claimant(s) seeks in the Arbitration; the name, address and telephone number of the Claimant(s) and their attorney, if any; and the name of all Respondent(s).  Claimant(s) shall include all claims against Respondent(s) that are based on the same incident, transaction, or related circumstances in the Demand for Arbitration.

8.  Serving Demand for Arbitration

a.  In Northern California, Kaiser Foundation Health Plan, Inc. (“Health Plan”), Kaiser Permanente Insurance Corporation (“KPIC”), Kaiser Foundation Hospitals, and/or The Permanente Medical Group, Inc. shall be served with a Demand for Arbitration by mailing the Demand for Arbitration addressed to that Respondent(s) in care of:

Kaiser Foundation Health Plan, Inc.
Legal Department
P.O. Box 12916
Oakland, CA  94604

or

Kaiser Foundation Health Plan, Inc.
Legal Department 
1950 Franklin Street, 17th Floor
Oakland, CA  94604

Service on that Respondent shall be deemed completed when received.

b.  In Southern California, Health Plan, Kaiser Foundation Hospitals, and/or Southern California Permanente Medical Group, shall be served with a Demand for Arbitration by mailing the Demand for Arbitration to that Respondent(s) in care of:

Kaiser Foundation Health Plan, Inc.
Legal Department
393 East Walnut Street
Pasadena, CA  91188

Service on that Respondent shall be deemed completed when received.

c.  All other Respondent(s), including individuals, must be served as required by the California Code of Civil Procedure for a civil action.

d.  All Respondent(s) served with a Demand for Arbitration in the manner described above shall be Parties to the Arbitration.  The Arbitrator shall have jurisdiction only over Respondent(s) actually served.  If Claimant(s) serves any Respondent(s) other than an organization affiliated with Kaiser Permanente, the Claimant(s) shall serve a proof of service of that Respondent(s) on the Independent Administrator.

e.  Where an order to arbitrate has been entered, the underlying court complaint constitutes the Demand for Arbitration and the entry of the order constitutes its service.

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