In re: Request for Payment of, Lawinski, M.D. v. Saiki

Opinion

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Electronically Filed Supreme Court SCWC-XX-XXXXXXX 29-JUL-2026 09:15 AM Dkt. 28 OPA

IN THE SUPREME COURT OF THE STATE OF HAWAIʻI

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In the Matter of the Request for Payment of, CHRISTOPHER LAWINSKI, M.D., as Provider for Sean Tilton, Petitioner/Appellant-Provider-Appellant,

vs.

SCOTT SAIKI, INSURANCE COMMISSIONER, DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS, STATE OF HAWAIʻI, Respondent/Appellee-Appellee,

and

UNITED SERVICES AUTOMOBILE ASSOCIATION, Respondent/Appellee-Respondent-Appellee.

SCWC-XX-XXXXXXX

CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS (CAAP-XX-XXXXXXX; CASE NO. 3CCV-XX-XXXXXXX)

JULY 29, 2026

DEVENS, C.J., McKENNA, EDDINS, AND GINOZA, JJ., AND CIRCUIT JUDGE CHAR, ASSIGNED BY REASON OF VACANCY

OPINION OF THE COURT BY EDDINS, J.

I.

Sean Tilton was hurt in a car crash. He saw Dr.

Christopher Lawinski, who treated his neck and shoulder injuries *** FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND PACIFIC REPORTER ***

with low level laser therapy. Lawinski billed Tilton’s no-fault

insurer, United Services Automobile Association (USAA), for the

treatment. USAA contested the claims.

Lawinski says the law required full payment.

Hawaiʻi law requires no-fault insurers to pay personal

injury protection (PIP) benefits for car-crash injuries. See

Hawaiʻi Revised Statutes (HRS) § 431:10C-304 (2019).

Two conditions govern whether a treatment qualifies. It

must be appropriate, reasonable, and necessarily incurred

because of the accident. And it must be “substantially

comparable to the requirements for prepaid health care plans.”

HRS § 431:10C-103.5(a) (2019).

Lawinski satisfied the first condition. Not the second.

That ends his claim. Because Lawinski offered no evidence

that the laser therapy is substantially comparable to what

prepaid health plans cover, it was not a covered PIP benefit.

The Intermediate Court of Appeals (ICA) got there too. It

properly determined payment was not required. But its reasoning

is another matter. The ICA read the second condition as

ambiguous. It is not.

The legislature defined “substantially comparable” in the

very next statute, HRS § 431:10C-103.6 (2019). A phrase the

legislature has defined is not ambiguous. Definitions remove

doubt. The ICA’s reading inverts that.

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II.

A. The Treatment and the Claim

On June 26, 2017, Tilton was injured in a motor vehicle

collision. Lawinski, who practices naturopathic and holistic

medicine, prescribed massage and low level laser therapy (LLLT).

He treated Tilton with LLLT six times. Lawinski billed each

fifteen-minute session at $75 under Current Procedural

Terminology (CPT) code 97039, an unlisted modality with no

preset reimbursement rate.

USAA reimbursed Lawinski $7.17 per session. It recoded the

claims to CPT code 97026 for infrared therapy, which it

explained “better reflects the services rendered.” By

Lawinski’s own account, infrared treatment is “completely

different scientifically” from LLLT.

B. The Administrative Proceedings

Lawinski requested review of the denials. The matter went

to the Office of Administrative Hearings. USAA moved to

dismiss. It argued that Lawinski had not shown LLLT was the

sort of treatment PIP benefits cover. The hearings officer

granted the motion. The Insurance Commissioner adopted the

decision.

On appeal, the circuit court reversed. Dismissal without a

merits hearing, the court held, was “unauthorized by statute or

rule.” It remanded.

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On remand, a new hearings officer held a merits hearing on

February 7, 2022. Lawinski called Steven Shanks, the president

of the company that makes the laser device. Shanks walked

through how the device obtained FDA clearance and testified that

LLLT relieves back pain. But Shanks conceded he had “no idea”

whether any prepaid health care plan in Hawaiʻi covers LLLT.

Lawinski testified too. He claimed insurers other than prepaid

plans had paid him for LLLT, and that the treatment was

necessary for Tilton’s injuries. He also acknowledged that no

prepaid plan had ever covered his LLLT. He had never billed

one.

The hearings officer ruled for USAA. The statute required

two things: a treatment had to be appropriate, reasonable, and

necessarily incurred from the accident, and it had to be

substantially comparable to the requirements for prepaid health

care plans. Lawinski, the hearings officer found, “did not

submit any evidence that LLLT treatment is reimbursed by prepaid

health care plans.” So LLLT was not compensable as a PIP

benefit. The Commissioner adopted the decision as final. See

HRS § 431:10C-212(c) (2019).

C. The Appeals

The circuit court affirmed. It held the statute

unambiguous and statutory interpretation unnecessary. Lawinski,

the court found, “failed to present any evidence establishing

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that LLLT therapy [is] substantially comparable to the

requirement[s] for prepaid health care plans.”

The ICA affirmed by summary disposition order, but on

different reasoning. It held that HRS § 431:10C-103.5(a) is

ambiguous. The ICA found “doubt and uncertainty” in the phrase

“substantially comparable to the requirements for prepaid health

care plans.” That doubt, it said, was “readily resolved” by the

definition in the next statute, HRS § 431:10C-103.6. Applying

that definition, the ICA agreed that LLLT was not substantially

comparable to prepaid plan coverage and so was not a PIP

benefit.

Lawinski applied for cert. He argued that legislative

history showed an intent for “generous” benefits covering every

“reasonable” treatment. He raised fifteen questions. We

accepted review on two: whether the courts and the Commissioner

erred (1) in deciding that LLLT was not a PIP benefit under HRS

§ 431:10C-103.5(a), and (2) on the ambiguity of the statute and

the need for statutory interpretation. See Hawaiʻi Rules of

Appellate Procedure Rule 40.1(i) (this court “may limit the

question on review”).

USAA and the Hawaiʻi Insurance Commissioner defend the ICA’s

result. Lawinski filed no reply.

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III.

This is a secondary appeal. We review the Commissioner’s

decision under HRS § 91-14(g) (2012 & Supp. 2016). Allstate

Ins. Co. v. Schmidt, 104 Hawaiʻi 261, 264, 88 P.3d 196, 199

(2004). Statutory interpretation is a question of law we decide

de novo. Rosehill Trustee of the Linda K. Rosehill Revocable

Tr. dated August 29, 1989 v. State, 155 Hawaiʻi 41, 49, 556 P.3d

387, 395 (2024).

A. The Statute is Unambiguous, and it Imposes Two Conditions

The text controls. An insurer must pay PIP benefits for

accident injuries. See HRS § 431:10C-304. The statute defines

those benefits:

Personal injury protection benefits, with respect to any accidental harm, means all appropriate and reasonable treatment and expenses necessarily incurred as a result of the accidental harm and which are substantially comparable to the requirements for prepaid health care plans[.]

HRS § 431:10C-103.5(a).

The conjunction does the work. A treatment must be

appropriate, reasonable, and necessary. And it must be

substantially comparable to the requirements for prepaid health

care plans.

The ICA stumbled at this phrase. It called “substantially

comparable to the requirements for prepaid health care plans”

ambiguous. But it resolved the doubt it found by reading the

very next statute – the one that defines the phrase.

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A phrase the legislature has defined is not ambiguous. The

definition is the meaning.

Our cases confirm this. When asked whether a statutory

word is unclear, we look first to whether the statute defines

it. See, e.g., State v. Ontai, 84 Hawaiʻi 56, 60, 929 P.2d 69,

73 (1996) (resolving the meaning of “enterprise” by turning to

the statutory definition). Where the legislature provides a

definition, we follow it.

Whole chapters of our code place their definitions up

front, apart from the operative provisions. See, e.g., HRS

§§ 205A-1 (2017), 386-1 (2015 & Supp. 2017), 521-8 (2018), 707-

700 (2014 & Supp. 2016). Definitional sections exist to remove

doubt, not to manufacture it.

The ICA’s reasoning inverts that arrangement. Under it, a

defined term stays murky until the court consults the definition

that clears it up — an approach that would make every defined

term ambiguous and every definition section a fresh source of

uncertainty. Left standing, that move would not stay confined

to PIP. We decline to let it travel.

The phrase is clear. The next statute unpacks

“substantially comparable”:

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The benefits provided under section 431:10C-103.5 shall be substantially comparable to the requirements for prepaid health care plans, as provided in chapter 393 and rules of the department of labor and industrial relations, pertaining to the Prepaid Health Care Act. The reference to the Prepaid Health Care Act is only for purposes of describing the coverages and exclusions[.]

HRS § 431:10C-103.6(a).

To decide whether a treatment is a PIP benefit, we ask

whether it is substantially comparable to what prepaid health

care plans cover, as set by HRS chapter 393 and the Department

of Labor and Industrial Relations rules. Id. Those

requirements are not frozen; chapter 393 ties them to the plan

with the largest number of subscribers in the State, a benchmark

that can shift from year to year. See HRS § 393-7(a) (2015).

Because the words are clear, we do not consult legislative

history. See Courbat v. Dahana Ranch, Inc., 111 Hawaiʻi 254,

261, 141 P.3d 427, 434 (2006) (legislative history is available

when statutory language is ambiguous). That ends Lawinski’s

pitch for a “generous” reading covering every reasonable

treatment.

Even if we did consult the legislative history, it would

cut against Lawinski. Before 1997, the statute covered “[a]ll

appropriate and reasonable expenses necessarily incurred” for

medical and related services, with no comparability clause.

1997 Haw. Sess. Laws Act 251, § 13 at 523. The 1997 amendment

added the “substantially comparable” language, expressly

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“[t]ying ‘personal injury protection benefits’ to prepaid health

coverages[.]” S. Stand. Comm. Rep. No. 932, in 1997 Senate

Journal, at 1255-56. The aim was to rein in costs, not expand

coverage. See State Farm Mut. Auto. Ins. Co. v. Gepaya, 103

Hawaiʻi 142, 148, 80 P.3d 321, 327 (2003). Lawinski reads a

narrowing amendment as a broadening one. That’s backwards.

The hearings officer had it right. A treatment is a PIP

benefit only if it satisfies both conditions. Meeting the first

is not enough.

B. Lawinski Offered No Proof on the Second Condition

Lawinski staked his case on the first condition. He

gathered testimony and studies to show that LLLT is effective,

appropriate, and necessary. And he leaned on the FDA’s

clearance of the device. Take all of that as given. None of it

speaks to the comparability requirement. Whether the treatment

works tells us nothing about what prepaid health care plans

cover.

Lawinski had the burden on both conditions. To recover, he

had to show under the second condition that LLLT was

substantially comparable to the requirements for prepaid health

care plans. He did not meet his burden on the record he made.

His own expert had “no idea” whether any prepaid plan in Hawaiʻi

covers the therapy. And Lawinski admitted he had never billed a

prepaid plan for it. As the hearings officer put it, he “did

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not submit any evidence that LLLT treatment is reimbursed by

prepaid health care plans.” No proof, no recovery.

Lawinski’s authorities do not rescue him. He relies on

Richard v. Metcalf, 82 Hawaiʻi 249, 921 P.2d 169 (1996), and

Gamata v. Allstate Ins. Co., 90 Hawaiʻi 213, 978 P.2d 179 (1999),

for the proposition that a treatment qualifies once it is

appropriate, reasonable, and necessary. But both cases

construed the pre-1997 statute. That law contained no

comparability clause. See Gamata, 90 Hawaiʻi at 221-22 n.18, 978

P.2d at 187-88 n.18 (noting that the definition of “personal

injury protection benefits” was later moved and narrowed).

Those cases describe a statute the legislature has since

changed. The second condition controls. And Lawinski did not

meet it.

Lawinski had to prove comparability. He didn’t.

IV.

Lawinski may be right that LLLT relieved his patient’s

pain. But that answers only one of the statute’s two questions.

On the second - whether the treatment is substantially

comparable to the requirements for prepaid health care plans –

Lawinski showed nothing.

HRS § 431:10C-103.5(a) is unambiguous.

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We affirm the ICA’s March 17, 2026 Judgment on Appeal,

upholding the circuit court and the Commissioner.

Leslie K. Iczkovitz /s/ Vladimir P. Devens (on the briefs) for petitioner /s/ Sabrina S. McKenna

Christopher J.I. Leong, /s/ Todd W. Eddins Christopher T. Han, and John E. Cole (on the briefs) /s/ Lisa M. Ginoza for respondent Scott Saiki, Insurance Commissioner, /s/ Stephanie R.S. Char Department of Commerce and Consumer Affairs, State of Hawaiʻi

Gregory K. Markam and Keith K. Kato (on the briefs) for respondent United Services Automobile Association