265 P.3d 470
Haw.2011Background
- This consolidated certiorari review concerns insureds Chung Mi Ahn and Kee Sun Kim challenging Liberty Mutual's denial of PIP benefits and the insurer's compliance with Hawaii law and policy shifts.
- Wilson v. AIG Hawaii Ins. Co. held insureds are not real parties in interest to pursue PIP payments to providers, limiting insureds’ ability to sue for provider unpaid bills.
- Gamata v. Allstate Ins. Co. and Dacanay v. Liberty Mut. Ins. Co. discussed real party in interest and fee/interest dynamics under PIP, reinforcing limits on insureds’ standing.
- Orthopedic Associates v. Hawaii Ins. & Guar. Co. highlighted insurer denials and coding disputes, prompting legislative response via Act 198 of 2006.
- Act 198 of 2006 amended HRS 431:10C-308.5(e) to address disputes over charges and fees and signaled legislative intent to permit challenges to fee disputes, not just denials, by insureds, providers, or claimants.
- The Insurance Commissioner’s Final Orders denying PIP benefits predate Act 198’s effective date, creating a retroactivity question central to whether Wilson remained controlling.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is Act 198 retroactive and does it govern pre-existing orders? | Insureds argue Act 198 clarifies real party in interest in all PIP disputes, retroactively affecting Wilson. | Act 198 is not retroactive; Wilson remains controlling for pre-Act denials. | Act 198 is not retrospective; Wilson remains controlling for pre-Act orders. |
| Does Act 198 overrule Wilson’s real party in interest rule in PIP disputes? | Act 198 expressly or by history grants insureds real party in interest status and may overrule Wilson. | Wilson governs real party status; Act 198 only addresses fee disputes. | Wilson is overruled; insureds are real parties in interest in PIP disputes, and Act 198 supports broader standing. |
| What is the scope of real party in interest after Act 198: denials and fee disputes? | Insureds may contest fee disputes and PIP denials as real parties in interest. | Real party status should be limited to fee disputes under Act 198; denials remain governed by prior law. | Insureds may be real parties in interest for fee disputes and PIP denials under Act 198. |
Key Cases Cited
- Wilson v. AIG Hawaii Ins. Co., 89 Hawaiʻi 45 (Haw. 1998) (insured not real party in interest to recover no-fault benefits for provider)
- Gamata v. Allstate Ins. Co., 90 Hawaiʻi 213 (Haw. App. 1999) (insurer denial of PIP benefits; impact of Wilson on payments to providers)
- Dacanay v. Liberty Mut. Ins. Co., 108 Hawaiʻi 393 (Haw. App. 2005) (real party in interest and fees in PIP context; administrative review considerations)
- Orthopedic Associates of Hawaii, Inc. v. Hawaii Ins. & Guar. Co., Ltd., 109 Hawaiʻi 185 (Haw. 2005) (down-coding issue; denials and notices under PIP)