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Government Employees Insurance Co. v. Hyman3/18/1999
MOON, C.J., KLEIN, LEVINSON, NAKAYAMA, AND RAMIL, JJ.
Respondent-appellant-appellant Government Employees Insurance Company (GEICO) appeals the first circuit court's order and judgment affirming the final order of appellee-appellee Wayne C. Metcalf, III, Insurance Commissioner of the State of Hawaii (insurance commissioner) granting summary judgment in favor of provider- appellee-appellee Robert A. Hyman, M.D (Dr. Hyman) and denying GEICO's cross-motion for summary judgment. On appeal, GEICO argues that the circuit court erred in ruling that: 1) Dr. Hyman had standing to contest GEICO's denial of no-fault benefits based on the 1992 amendment to Hawaii Revised Statutes (HRS) § 431:10C-212(a); and 2) Dr. Hyman was entitled to attorney's fees and costs under HRS § 431:10C-211(a) (1993) as a "person" bringing a no-fault claim. Revisiting the agency's original decision in this case, the insurance commissioner now joins GEICO in asserting that the 1992 amendment to § 431:10C-212(a) does not apply in the present case and thus requests this court to reverse the decisions of the circuit court and the agency. Because the arguments of GEICO and the insurance commissioner lack merit, we affirm the judgment of the circuit court.
I. BACKGROUND
On January 7, 1989, Daniel Ream, insured under a GEICO no- fault insurance policy, was injured in a motor vehicle accident. Ream subsequently received various health care treatments from Dr. Hyman. Dr. Hyman submitted to GEICO several treatment plans dated July 16, 1994, August 1, 1994, and August 24, 1994. GEICO challenged the plans, and the insurance commissioner referred the challenges to Richard Greenfield, M.D. for peer review evaluation. Dr. Greenfield determined Dr. Hyman's proposed treatment plans to be inappropriate and unreasonable. On February 16, 1995, GEICO, based on Dr. Greenfield's evaluation, issued a denial of no-fault insurance benefits to Ream.
Dr. Hyman sought administrative review of GEICO's denial of benefits pursuant to HRS § 431:10C-212(a) (1993). On October 11, 1996, Dr. Hyman filed a motion for summary judgment. In his motion, Dr. Hyman argued that 1) GEICO's denial was invalid under this court's opinion in Richard v. Metcalf, 82 Hawaii 249, 921 P.2d 169 (1996), insofar as it applied peer review procedures to the treatment of injuries sustained in a motor vehicle accident occurring before January 1, 1993, the effective date of the 1992 amendments to the Hawaii no-fault law that instituted the peer review system; and 2) Dr. Hyman had standing to contest GEICO's denial of benefits because Richard's ruling against the retroactivity of the 1992 amendments did not apply to the amendment to HRS § 431:10C- 212(a), see supra note 3, granting a provider standing to contest a denial of no-fault benefits. GEICO filed a memorandum in opposition to Dr. Hyman's motion on October 25, 1996, arguing that Richard precluded the application of any of the 1992 amendments to previously arising claims and that, thus, Dr. Hyman had no standing to contest GEICO's denial of benefits. After hearing oral argument on the motion, Hearings Officer Richard A. Marshall issued an order stating that he would treat GEICO's memorandum in opposition as a cross-motion for summary judgment and allow further written briefing accordingly.
On March 5, 1997, the hearings officer issued his findings of fact, Conclusions of law, and recommended order granting Dr. Hyman's summary judgment motion and denying GEICO's cross-motion. Pursuant to Richard, the hearings officer invalidated GEICO's denial of benefits as improperly based on a peer review evaluation. The hearings officer further ruled that Richard did not preclude a provider from contestin
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