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Llanes v. Daso9/19/2000
that the no-fault statute allows the insurer to issue blanket denials of continuing services or treatment). To the extent that it did so, our holding in Wilson does not apply. Wilson merely holds that insureds are not real parties in interest with respect to disputes regarding payment for services already rendered; it does not deny insureds status as real parties in interest with respect to disputes regarding the continuation of treatment. Cf. Government Employees Ins. Co. v. Hyman, 90 Hawaii 1, 7, 975 P.2d 211, 217 (1999) (" he insured has a right to receive treatment of injuries, and the provider has a right to receive payment for treatment rendered." (citations omitted)). Accordingly, we hold that Llanes was a real party in interest entitled to challenge AIG's prospective denial of no-fault benefits and that the district court erred in ruling against Llanes based on Wilson.
The district court awarded Dr. Daso $8,269.02 for chiropractic services provided, evidently finding that those services were reasonable and appropriate. However, in ruling against Llanes based on Wilson, the court did not address the question whether further chiropractic treatment was reasonable and appropriate. We thus vacate the district court's judgment and remand for further proceedings consistent with this opinion.
Llanes also argues that the district court erred by awarding AIG fees and costs. HRS § 431:10C-211(d) (1993) provides in relevant part:
An insurer or self-insurer may be allowed an award of a reasonable sum as attorney's fees based upon actual time expended, and all reasonable costs of suit for its defense against a person making claim against the insurer or self-insurer, within the discretion of the court upon judicial proceeding . . . where the claim is determined to be fraudulent or frivolous.
We have held that the district court erred in ruling against Llanes on the grounds stated. This necessarily forecloses an award of attorney's fees to AIG under HRS § 431-10C-211(d) based on a finding that Llanes' claim was fraudulent or frivolous. We thus reverse the district court's award of fees and costs to AIG.
III. CONCLUSION
Based on the foregoing, we vacate the judgment of the district court and remand for further proceedings consistent with this opinion.
CONCURRING OPINION OF ACOBA, J.
I concur, but emphasize that in my view an insurer's prospective denial of future benefits does not necessarily deprive an insured of later status as a real party in interest.
In Government Employees Ins. Co. v. Dang, 89 Hawaii 8, 967 P.2d 1066 (1998), this court held that Hawaii Revised Statutes § 431:10C-308.6(c) and (d) (1993) did not preclude an insurer from bringing a blanket challenge to prospective treatment of a no-fault insured and sustained such a challenge. Id. at 15-16, 967 P.2d at 1073-74. In doing so, it departed from a contrary interpretation of these statutory provisions by prior insurance commissioners. Id. at 15, 967 P.2d at 1073. Dang did leave for future determination the effect to be given "a treatment plan based upon the exacerbation of an injury after . . . determin[ation that] future treatment is unreasonable or inappropriate." Id. at 16 n.3, 967 P.2d at 1074 n.3.
When Dang allowed insurers to deny prospective treatment as a means "to reduce and stabilize the cost of motor vehicle insurance," id. at 15-16, 967 P.2d at 1073-74, it shifted to insureds the burden of pursuing insurance coverage and benefits in continuing treatment situations. The issue of "exacerbation of an injury" aside, it is not inconceivable that an insured may decide to continue with medical treatment after future no-faul
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