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Gamata v. Allstate Insurance Co.4/28/1999
t, Allstate urged that only evidence retrospective of November 12 was "relevant."
The court did not expressly state whether it found Allstate's denial affected all future no-fault benefits or was effective only with respect to the proposed treatment plans rejected in the November 12 letter. But whatever the case may be, as Allstate admitted at trial, a denial of future benefits may "arguably [be made] too early." Such a concession seems hardly disputable. We agree and conclude, then, that evidence of Plaintiff's post-denial treatment and condition was relevant because it would have a tendency to make the claimed prematurity of the denial more probable or less probable than it would be without such evidence. See HRE Rule 401 (1993).
VI.
As previously noted, Plaintiff was entitled to sue Allstate for denial of treatment ostensibly covered under the definition of no- fault benefits. However, after the action was filed, Plaintiff underwent the MRI and the nerve root injection, and apparently at some point, paid Dr. Portner for those treatments. In Wilson, the Hawaii Supreme Court held that the insured's provider and not the insured is the real party in interest in an action against the no-fault insurer for payment of a provider's unpaid bill.
A.
The supreme court examined HRS § 431:10C-304(1)(A) and (B) in Wilson, and determined that " plain reading of [those provisions] reveals that an insurer is only obligated to make direct payment to the insured for wage loss, expenses incurred as a result of accidental harm, funeral services, and attorney's fees and costs." Wilson, 89 Hawaii at 49, 968 P.2d at 651. Thus, the supreme court concluded that " he statute does not confer upon the insured the right to receive payment of medical benefits on behalf of his or her provider." Id. Instead, "the statute designates billing/payment of medical expenses to flow directly from the insurer to the provider." Id. (citing HRS § 431:10C-304(1)(B)). As a result, the supreme court explained "that the provider, not the insured, is entitled to pursue payment from the insurer for the cost of unreimbursed medical services to the insured." Id. at 50, 968 P.2d at 652. The supreme court held, then, "as a matter of law, the insured plays no role in the billing/payment process for medical services. Any dispute relating to the payment of medical services is strictly between the insurer and the provider." Id. at 49, 968 P.2d at 651.
B.
Accordingly, the fact that Plaintiff paid Dr. Portner did not confer real party in interest status on Plaintiff with respect to the doctor's previously unpaid bill. Under the Wilson rationale, Dr. Portner was the "party" with an interest in payment for the services under the treatment plans; only Dr. Portner, not Plaintiff, was "entitled to pursue payment from the insurer for the cost of unreimbursed medical services to the insured." Id. at 50, 968 P.2d at 652.
The supreme court further pointed out that HRS § 431:10C- 308.5(e) specifically prohibits a provider, such as Dr. Portner, from directly billing or collecting from the insured for services rendered:
"The provider of services described in section 431:10C-103(10)(A)(i) and (ii) shall not bill the insured directly for those services but shall bill the insurer for a determination of the amount payable. The provider shall not bill or otherwise attempt to collect from the insured the difference between the provider's full charge and the amount paid by the insurer."
Id. at 49, 968 P.2d at 651 (quoting HRS § 431:10C-308.5(e)) (emphasis added). The fact that Dr. Portner was paid, in apparent contravention of HRS § 431:10C-308.5(e), do
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