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Gamata v. Allstate Insurance Co.4/28/1999
t nerve root block injection" (the nerve root injection) and was to be administered during the same time period.
In a letter dated November 12, 1997, Allstate acknowledged receipt of the two plans but "advised that [it would] no longer accept [Dr. Portner's] treatment plans for [Plaintiff] as the IME disclosed that [Plaintiff's] current complaints are not attributable to the . . . accident[.]"
Plaintiff filed his complaint against Allstate on November 18, 1997. The complaint alleged Plaintiff had suffered personal injuries in the accident, and that Allstate's denial "violat[ed its] statutory and contractual duties to provide no-fault benefits [under HRS ยง 431:10C-303(a)] to or on behalf of Plaintiff[.]"
Despite Allstate's rejection of the treatment plans, the MRI was performed on December 19, 1997, and Dr. Portner performed the nerve root injection on November 21, 1997. According to the record, the amount outstanding on Plaintiff's account with Dr. Portner following these two treatments was $1,658.80. In a court memorandum filed subsequent to trial, Plaintiff represented that he had paid Dr. Portner for these medical services; however, the record does not indicate exactly when or how much Plaintiff paid the doctor. See infra p.15.
II.
A.
The case was tried on February 26 and March 5, 1998. In his trial memorandum, Plaintiff contended that the issues presented to the court were whether "(1) Plaintiff's injuries were a result of the March 28, 1997 accident, and (2) the treatment prescribed by . . . [Dr.] Portner . . . was reasonable, appropriate and necessary."
Allstate's trial memorandum presented three theories of defense: (1) "Plaintiff's condition at the time of the denial was not and is not attributable to the subject accident"[;] (2) the court should not consider evidence "available to the parties subsequent to Allstate's denial of treatment on October 13, 1997, Allstate's letter to [Dr. Portner] on November 12, 1997, and/or the filing of the omplaint"[;] and (3) "if the court finds that Plaintiff's condition was attributable to the subject accident," it should apply the "recovery standard" as opposed to the "pain management standard."
In support of its second defense theory, Allstate cited to several Hawaii Insurance Commissioner rulings which concluded that review of an insurer's no-fault denial is retrospective only as of the date of the denial. In support of its third defense theory, Allstate argued that the no-fault law did not authorize treatment that was "merely for comfort and pain management[.]" Allstate cited to a first circuit court order entered on February 3, 1997 in AIG Hawaii Ins. Co. v. Yucoco, Civil No. 96-2393-06 (the Yucoco order). While Allstate's trial memorandum does not supply a ready definition of the distinction between a recovery and a pain management standard, the Yucoco order, attached as an exhibit to it's trial memorandum, explained that "a person's entitlement to no-fault benefits . . . should be determined by whether or not the treatment contributes to the recovery process[.]"
B.
On the first day of trial, Allstate orally moved in limine to exclude "any evidence" of matters which "occurred subsequent" to October 13, 1997 as "irrelevant" and requested that the court "focus . . . on the information available to Allstate at the time it issued the denial."
In response, Plaintiff contended that Dr. Portner's post- denial treatment was relevant to whether Plaintiff's "injuries [were] related to his accident" and "Dr. Portner's treatment was, in fact, reasonable." Responding similarly to Allstate's third theory, Plaintiff maintained
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