Hawaii Providers Network, Inc. v. AIG Hawaii Insurance Co.

98 P.3d 233, 105 Haw. 362
CourtHawaii Supreme Court
DecidedOctober 5, 2004
Docket23790
StatusPublished
Cited by13 cases

This text of 98 P.3d 233 (Hawaii Providers Network, Inc. v. AIG Hawaii Insurance Co.) is published on Counsel Stack Legal Research, covering Hawaii Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hawaii Providers Network, Inc. v. AIG Hawaii Insurance Co., 98 P.3d 233, 105 Haw. 362 (haw 2004).

Opinion

Opinion of the Court by

ACOBA, J.

We hold that Hawai'i Revised Statutes (HRS) § 431:10C-308.5 (1993) which referred to the worker compensation treatment schedules adopted by the director (director) of the Department of Labor and Industrial Relations (DLIR) in the Hawai'i Administrative Rules (HAR) as the schedules governing the amount of payments to providers of no-fault benefits under motor vehicle insurance policies must be construed as having generally incorporated the worker compensation fee schedules as they may have been adopted and amended from time to time. Accordingly, after the director repealed HAR Title 12, chapter 13, referred to in HRS § 431:100-308.5(a), and adopted in 1996, HAR Title 12, chapter 15, the latter became the fee schedule governing payments to no-fault benefit providers under HRS § 431:100-308.5.

Because the September 12, 2000 judgment of the first circuit court (the court) 1 granting summary judgment in favor of Defendants-Appellees insurance companies 2 and against Plaintiff-Appellant Hawaii Providers Network (HPN) was consistent with the foregoing, we affirm the said judgment.

I.

In 1992, the Legislature amended the motor vehicle insurance law. These amendments were generally enacted “with the intent of reducing and stabilizing the soaring cost of motor vehicle insurance in this State.” Sen. Conf. Comm. Rep. No. 161, in 1992 Senate Journal, at 825. In this regard, the existing workers’ compensation fee schedule was adopted as the payment fee schedule applicable to medical and rehabilitative services provided as no-fault benefits, HRS § 431:10C-103(10)(A), 3 for persons injured in *365 automobile accidents. This provision which was part of Act 128 (1992 Session Laws of Hawai'i) became effective on January 1, 1993 as HRS § 431:10C-308.5(a) and (b). 4 It stated in relevant part that:

(a) As used in this article, the term “workers’ compensation schedules” means the schedules adopted and as may be amended by the director of labor and industrial relations for workers’ compensation cases under chapter 386, establishing fees and frequency of treatment guidelines and contained in sections 12-18-30, 12-13-35, 12-13-38, 12-13-39, 12-18-45, 12-13-85 through 92, and 12-13-94, Hawaii administrative rules. References in the workers’ compensation schedules to “the employer”, “the director”, and “the industrial injury”, shall be respectively construed as references to “the insurer”, “the commissioner”, and “the injury covered by no-fault benefits” for purposes of this article.
(b) Effective January 1, 1993, the charges and frequency of treatment for services specified in section 431:100-103(10)(A)(i) and (ii), except for emergency services provided within seventy-two hours following a motor vehicle accident resulting in injury, shall not exceed the charges and frequency of treatment permissible under the workers’ compensation schedules, except as provided in section 431:10C-308.6.... The [insurance] commissioner may adopt administrative rules relating to fees or frequency of treatment for injuries covered by no-fault benefits. If adopted, these administrative mies shall prevail to the extent that they are inconsistent with the workers’ compensation schedules.

(Emphases added.) The legislative intent was to “[e]stablish[ ] a medical fee schedule which limits charges and frequency of medical services and treatment [for purposes of no-fault coverage] by adopting, by reference, the workers’ compensation fee schedule and guidelines.” Sen. Conf. Comm. Rep. No. 161, in 1992 Senate Journal, at 826 (emphasis added). The Legislature also indicated that “[m]edical cost containment ... will be accomplished by adoption of a fee schedule modeled on the workers’ compensation medical fee schedule.” Hse. Stand. Comm. Rep. No. 1271-92, in 1992 House Journal, at 1391. At that time the workers’ compensation fee schedule was contained in HAR Title 12, chapter 13. Therefore, pursuant to HRS § 431:10C-308.5, the workers’ compensation fee schedule in Title 12, chapter 13 was adopted and made effective for no-fault purposes as of January 1,1993. 5

Subsequently, the Insurance Commissioner (the commissioner) promulgated new administrative rules consistent with HRS § 431:100-308.5 under Title 16, chapter 23, “Motor Vehicle Insurance Law,” HAR. HAR § 16-23-115 (1993) 6 which became effective *366 on June 1, 1993, adopted the fee schedule contained in HAR Title 12, chapter 13 for no-fault purposes.

In 1995, the Legislature amended the workers’ compensation laws to provide that charges for medical and rehabilitative services rendered to recipients of workers’ compensation benefits shall not exceed 110% of the fees set by the federal government’s Medicare schedule. This provision was section 7 of Act 234 (1995 Session Laws of Hawaii) and is codified as HRS § 386-21(c). HRS § 386-21(c) (Supp.1995) provides in relevant part:

(c) As of June 29, 1995, and for each succeeding fiscal year thereafter, the charges shall not exceed one hundred ten percent of fees prescribed in the Medicare Resource Based Relative Value Scale system applicable to Hawaii as prepared by the United States Department of Health and Human Services, except as provided in this subsection.

(Emphases added).

Following the adoption of Act 234, the commissioner issued a memorandum dated August 7,1995 addressed to “All Motor Vehicle Insurers Licensed in Hawaii” regarding the “Medicare Fee Schedule Applicable to No-Fault Claims”. This memorandum stated that

In Section 7 of Act 234-, the Workers’ Compensation Medical Fee Schedule contained in Title 12, Chapter 13, HAR, ... was replaced by the Medicare Fee Schedule. More specifically, the Act mandates that charges for medical care, services, and supplies shall not exceed one hundred ten percent of fees prescribed in the Medical Resource Based Relative Value Scale system as prepared by the United Stated Department of Health and Human Services (Medicare Fee Schedule).

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Bluebook (online)
98 P.3d 233, 105 Haw. 362, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hawaii-providers-network-inc-v-aig-hawaii-insurance-co-haw-2004.