Disputes over entitlement to or exclusions from first-party benefits may be resolved by which method?

• A. Mediation only
• B. Arbitration or lawsuit
• C. Criminal court proceedings
• D. Administrative hearing with no appeal

Answer: (B)

When a dispute concerns whether someone is entitled to first-party benefits or whether certain benefits should be excluded, the binding ways to resolve it are arbitration or a civil lawsuit. Arbitration provides a neutral, enforceable ruling on entitlement or exclusions, which the parties generally must accept if the agreement or statute requires arbitration. If arbitration isn’t used or available, bringing the dispute to a civil court action lets a judge determine eligibility and any exclusions under the law, with the full procedural protections and potential appellate review.

Mediation, while helpful for settlement, does not by itself produce a binding determination of entitlement. Administrative hearings without a right to appeal typically won’t yield a final, enforceable resolution in this context, and criminal court proceedings aren’t appropriate for civil benefit disputes.