Jou v. Hamada

201 P.3d 614, 120 Haw. 101
CourtHawaii Intermediate Court of Appeals
DecidedMarch 5, 2009
Docket27491, 27539
StatusPublished
Cited by5 cases

This text of 201 P.3d 614 (Jou v. Hamada) 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
Jou v. Hamada, 201 P.3d 614, 120 Haw. 101 (hawapp 2009).

Opinion

Opinion of the Court by

NAKAMURA, J.

Under the provisions of Hawaii Revised Statutes (HRS) §§ 386-73 (Supp.2007) and 386-87 (1993) of the Hawaii workers’ compensation law, the parties to a decision by the Director of the Department of Labor and Industrial Relations (the Director) have the right to appeal the Director’s decision to the Labor and Industrial Relations Appeals Board (LIRAB). The Director has promulgated a rule, Hawaii Administrative Rules (HAR) § 12-15-94(d), prohibiting any appeal of the Director’s decisions in billing disputes between employers and medical service providers in workers’ compensation cases. HAR § 12-15-94(d) authorizes the Director to resolve such billing disputes without a hearing and provides that “[t]he decision of the [Director is final and not appealable.”

The question presented in these consolidated appeals 2 is whether the Director was authorized to promulgate a rule prohibiting any appeal of the Director’s decisions in billing disputes between employers and medical service providers. We conclude that the Director’s no-appeal rule is inconsistent with the statutory right granted to parties to appeal the Director’s decisions under HRS §§ 386-73 and 386-87.

We hold that: 1) the provision prohibiting appeal of the Director’s decisions in HAR § 12-15-94(d) is invalid as beyond the Director’s rulemaking power; 2) Provider-Appellant Emerson M.F. Jou, M.D., (Dr. Jou) is entitled to a declaratory judgment that the no-appeal provision of HAR § 12-15-94(d) is invalid; 3) the Circuit Court of the First Circuit (circuit court) 3 erred in dismissing Dr. Jou’s claims for declaratory relief; and 4) although Dr. Jou cannot pursue the merits of his appeals of the Director’s decisions before the circuit court, he is entitled to file appeals of the Director’s decisions with the LIRAB.

BACKGROUND

Dr. Jou is a licensed medical doctor who specializes in physiatry—the diagnosis and treatment of disease by physical methods, including massage, manipulation, exercise, heat, and water. In the two eases underlying these consolidated appeals, Civil No. 05-1-0375 and Civil No. 05-1-1079, Dr. Jou treated patients that had sustained work-related injuries. Respondent-Appellee Argonaut Insurance Company (Argonaut) was the workers’ compensation insurance carrier for the patient’s employer in Civil No. 05-1-0375, and Respondent-Appellee Marriott Claim Services Corporation (Marriott) was the workers’ compensation insurance adjuster for the patient’s employer in Civil No. 05-1-1079.

Dr. Jou billed Argonaut and Marriott for his treatments, which included massage therapy performed by licensed massage therapists employed by Dr. Jou. Argonaut and Marriott initially denied payment for the massage therapy on the ground that Dr. Jou did not have a massage establishment (“MAE”) license. 4 Dr. Jou responded that as *105 a licensed physician, he did not need an MAE license.

In each case, the billing dispute remained at a standstill for several years. In November 2004, Dr. Jou filed a request for a hearing before the Director on the denials of reimbursement by Argonaut and Marriott. The Director instructed the parties to negotiate and attempt to resolve the billing dispute pursuant to HAR § 12-15-94. 5 Dr. Jou wrote to Argonaut and Marriott and demanded payment of the full amount of the disputed bills plus interest. Argonaut agreed to pay the outstanding bill of $293.33, which was for services rendered by Dr. Jou’s massage-therapist employees. Marriott agreed to pay $2,217.85 for the services rendered by the massage-therapist employees, which comprised the lion’s share of the outstanding bill, *106 but refused to pay for two office visits claimed by Dr. Jou. 6 Both Argonaut and Marriott rejected Dr. Jou’s demand for payment of interest.

After obtaining position statements from the parties, the Director issued decisions in both eases. 7 The Director resolved the dispute over the fees billed by Dr. Jou for the two office visits in favor of Dr. Jou and ordered Marriott to pay for those visits. The Director denied Dr. Jou’s request that Argonaut and Marriott be required to pay interest. HAR § 12—15—94(c) provides that after accepting liability, an employer shall pay all charges billed within sixty days of receipt “except for items where there is a reasonable disagreement,” and that if an “undisputed billing” remains unpaid for more than sixty days, the amount owed “shall be increased by one per cent per month of the outstanding balance.” In Dr. Jou’s dispute with Marriott, the Director found that “there was a reasonable disagreement over Dr. Jou’s fees” and therefore ruled that the employer was not liable for the assessment of one per cent per month for late payment of the disputed fees. In Dr. Jou’s dispute with Argonaut, the Director initially issued a decision finding that the “employer’s earlier denial of payment for lack of an MAE license [was] a reasonable dispute of fees.” The Director subsequently issued an amended decision which deleted this finding and simply ruled that “with the employer’s payment of the disputed fees ... employer shall not be liable for an assessment of one per cent per month simple interest.”

Dr. Jou appealed the Director’s decisions to the circuit court pursuant to HRS § 91-14 (1993 & Supp.2007) 8 and Hawai'i Rules of Civil Procedure (HRCP) Rule 72 (2005). 9 Appellees-Appellees the Administrator of the Disability Compensation Division (DCD) of the Department of Labor and Industrial Relations (DLIR) and the Director (collectively referred to herein as the “DLIR Appellees”) were Appellees in both Civil No. 05-1-0375 and Civil No. 05-1-1079. Argonaut was the Respondent-Appellee in Civil No. 05-1-0375 *107 and Marriott the Respondent-Appellee in Civil No. 05-1-1079. In his notices of appeal and statements of the case to the circuit court, Dr. Jou raised numerous claims, including that the DLIR was biased in favor of insurance companies, that the Director’s decisions were made upon unlawful procedure, and that the Director’s decisions violated various constitutional and statutory provisions.

In his notice of appeal to the circuit court in Civil No. 05-1-1079, Dr. Jou requested that the circuit court “treat this filing as an action for declaratory judgment that the rules relating to billing disputes, are unconstitutional or invalid pursuant to HRS § 91-7.” 10 In his statement of the case accompanying that notice of appeal, Dr. Jou alleged, among other things, that “HAR § 12-15-94 violates statutes relating to pre-judgment interest and

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Cite This Page — Counsel Stack

Bluebook (online)
201 P.3d 614, 120 Haw. 101, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jou-v-hamada-hawapp-2009.