Claim of Dacanay v. Liberty Mutual Insurance Co.

120 P.3d 1128, 108 Haw. 393, 2005 Haw. App. LEXIS 45
CourtHawaii Intermediate Court of Appeals
DecidedFebruary 9, 2005
DocketNo. 25424
StatusPublished
Cited by2 cases

This text of 120 P.3d 1128 (Claim of Dacanay v. Liberty Mutual Insurance Co.) is published on Counsel Stack Legal Research, covering Hawaii Intermediate Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Claim of Dacanay v. Liberty Mutual Insurance Co., 120 P.3d 1128, 108 Haw. 393, 2005 Haw. App. LEXIS 45 (hawapp 2005).

Opinions

Opinion of the Court by

WATANABE, Acting C.J.

This secondary appeal by Respondent/Appellant-Appellant Liberty Mutual Insurance Co. (Liberty Mutual) stems from an administrative proceeding initiated by Claimant/Appellee-Appellee Flor Dacanay (Daca-nay) before Appellee-Appellee Insurance Commissioner for the State of Hawaii (the Commissioner),1 challenging Liberty Mutu[394]*394al’s refusal to pay several claims for personal injury protection (PIP) benefits submitted by health care providers who had treated Dacanay following an automobile accident. Liberty Mutual settled these claims, and on April 2, 2002, the Commissioner entered a Final Order awarding Dacanay $930.15 in attorney’s fees and costs (the Commissioner’s Final Order). Liberty Mutual appealed to the Circuit Court of the First Circuit (the circuit court). On October 7, 2002, the circuit court2 entered a Judgment in favor of Dacanay and the Commissioner and dismissed Liberty Mutual’s appeal. This timely appeal3 followed.

Liberty Mutual argues that: (1) in light of Wilson v. AIG Hawaii Ins. Co., 89 Hawai'i 45, 968 P.2d 647 (1998), and Gamata v. Allstate Ins. Co., 90 Hawai'i 213, 978 P.2d 179 (App.1999), Dacanay is not a real party in interest entitled to prosecute a claim for payment of the contested PIP benefits; and, therefore, (2) Dacanay is not entitled to an award of attorney’s fees and costs for prosecuting such a claim.

We conclude that: (1) Liberty Mutual waived any objections that it may have had to Dacana/s status as the real party in interest, and (2) the Commissioner did not abuse his discretion when he awarded attorney’s fees and costs to Dacanay.

BACKGROUND

On February 26, 2001, Dacanay was driving a 1991 Honda Accord insured under a motor vehicle policy issued by Liberty Mutual when the vehicle was rear-ended, resulting in $509.00 worth of damages to the vehicle’s bumper. Two hours later, Dacanay went to see her regular physician and was referred to Workstar Occupational Health Systems, where she was seen by Dr. Gilbert P. Hager (Dr. Hager).

Dr. Hager examined Dacanay, noted the areas of her discomfort, and ordered x-rays of her cervical spine and right shoulder, magnetic resonance imaging (MRI) of her right shoulder, and a bone scan of her body. Dr. Hager also referred Dacanay for an arthro-gram and for physical therapy. Dr. Hager continued to treat Dacanay for several weeks, including a period after Dacanay had returned to work one month after the accident. These initial medical costs do not appear to have been challenged by Liberty Mutual.

On May 23, 2001, Dr. Kent Davenport (Dr. Davenport) conducted an independent medical evaluation (IME) of Dacanay. In a report to Liberty Mutual following the IME, Dr. Davenport summarized his evaluation of Dacanay as follows:

[Dacanay] had no prior history of any neck or right shoulder problems before her motor vehicle accident of February 26, 2001. Following that accident she was evaluated for neck and right shoulder discomfort. She has normal range of motion with minimal discomfort at this time. There are no objective findings of any significant pathology. Her bone scan is normal. There is no radicular discomfort in either upper extremity. The MRI-arthrogram of her right shoulder is normal and I feel that she has minimal soft tissue strains which should resolve with her continued home exercise program. She is now three months following the minor motor vehicle accident and I believe she is in need of no further medical treatment.
I do not find that she has any significant permanent disability, nor does she have any limitations on her work at this time. I do not feel that she needs any further treatment except for a home exercise program which she is currently doing.

Thereafter, by standard denial-of-claim form letters addressed to Dacanay and dated June 11, 2001,4 June 22, 2001,5 and July 5, [395]*3952001,6 respectively, Liberty Mutual informed Dacanay that it was denying billing statements for six claims submitted by Dacanay’s health care providers, for the reason that

under the Hawaii Motor Vehicle Insurance Law ... [t]he independent medical exam dated May 23, 2001, by [Dr. Davenport], and [Dacanay’s] medical history and records do not support that the benefits claimed are appropriate, reasonable, necessary or causally related to the subject motor vehicle accident in accordance with [Hawaii Revised Statutes (HRS) § ] 431:10C-103.

(Internal underscoring omitted.) The denial letters informed Dacanay that she had the following options if she wished to contest the denials:

(1) You may request a review of any action on your claim for benefits by filing with the Automobile Insurance Commissioner (P.O. Box 3614, Honolulu, Hawaii 96811-3614) two copies of the Notice of Denial of your claim, your request for review and a statement in duplicate giving specific reasons for the request within 60 days after the date of denial of your claim.
(2) You may also submit this dispute to arbitration. If you decide to submit this claim to arbitration, please send the attached copy of this Denial Form with a request for arbitration to the clerk of the [c]ireuit [c]ourt where the accident occurred. The Administrative Judge shall, within 10 days of the date of filing the request for arbitration, appoint an arbitrator to hear and determine the claim. Any fee or cost of the arbitrator shall be borne equally by the parties unless allocated by the arbitrator. You may be allowed an award of reasonable sum for attorney’s fees. The arbitration shall be in accordance with and governed by the provisions of Chapter 668 HRS. An appeal may be taken from any judgment of an arbitrator to the [c]ircuit [c]ourt in manner provided for in Rule 72 of the Hawaii Rules of Civil Procedures [sic],
(3)You may bring court action against [Liberty Mutual]. In this event, you should contact your lawyer.

On July 19, 2001, Dacanay, through her counsel, sent a written letter to the Commissioner, requesting a consolidated hearing to contest Liberty Mutual’s denials of the six claims submitted by Daeanay’s health care providers. The Insurance Division of the Department of Commerce and Consumer Affairs (DCCA) docketed Dacanay’s challenges to the denials of the six claims as ATX-2001-77, ATX-2001-78, ATX-2001-79, ATX-2001-80, ATX-2001-81, and ATX-2001-82, and on August 1, 2001, a DCCA hearings officer issued a Notice of Status Conference and Order Regarding Prehearing Statements, informing the parties of a status conference scheduled for August 27, 2001 and directing them to file and serve on all other parties a written prehearing statement.

On August 22, 28, and 29, 2001, Liberty Mutual reached compromised settlements with the health care providers whose claims for payment had initially been denied. Upon payment of these settlement amounts, Daca-nay exhausted the PIP benefits limit under her policy with Liberty Mutual.

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Bluebook (online)
120 P.3d 1128, 108 Haw. 393, 2005 Haw. App. LEXIS 45, Counsel Stack Legal Research, https://law.counselstack.com/opinion/claim-of-dacanay-v-liberty-mutual-insurance-co-hawapp-2005.