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Gamata v. Allstate Insurance Co.4/28/1999
es not alter the statutory mandate that "billing/payment of medical expenses . . . [must] flow directly from . . . [Allstate] to . . . [Dr. Portner]." Id. The supreme court has recently confirmed that under the no-fault law, "the insured has a right to receive treatment of injuries, [while] the provider has a right to receive payment for treatment rendered." Government Employees Ins. Co. v. Hyman, No. 21697, slip op. at 13 (Haw. Mar. 18, 1999) (citations omitted). Any payments made by Plaintiff to Dr. Portner must, as a logical consequence, be returned to Plaintiff. Because Dr. Portner was the real party in interest with respect to the subject charges, we instruct that if he seeks reimbursement from Allstate, he shall be joined or substituted as a party plaintiff to this action, as the case may be, pursuant to District Court Rules of Civil Procedure Rule 17(a).
VII.
Plaintiff may also be a real party in interest. As previously stated, Plaintiff received treatment after his complaint was filed and apparently paid for the treatments himself. Plaintiff's status at the time of suit and of payment was thus factually distinguishable from the insured in Wilson, where the "admitted purpose in filing her lawsuit was to recover no-fault benefits against AIG [(Wilson's insurer)] on behalf of Dr. Robinson [(Wilson's provider)]." 89 Hawaii at 50, 968 P.2d at 652.
When an insurer denies no-fault benefits "on the basis that they are unreasonable and unnecessary, the value of medical expenses denied cannot be included as an `amount paid or accrued' for purposes of establishing the tort threshold." Id. (citing Ho v. Leftwich, 88 Hawaii 251, 259, 965 P.2d 793, 801 (1998)). The supreme court thus acknowledged that "an insured may be a real party in interest with respect to protecting his or her ability to sue in tort, which, in turn, is dependent upon the insured reaching the tort threshold." Id. (internal quotation marks omitted). Wilson's failure to articulate such a claim deprived "her the status of a real party in interest." Id. at 51, 968 P.2d at 653.
However, in light of the circumstances of this case, the issuance of Wilson during this appeal's pendency, and judicial economy, we believe it appropriate that on remand, Plaintiff be allowed, if he wishes, to amend his pleadings to assert that the denial jeopardized his right to assert tort liability. Such an amendment would secure him real party in interest status.
VIII.
We recognize that in many no-fault cases, treatment may be of a continuing nature and that disputes as to the necessity and reasonableness of expenses may periodically arise. That the no-fault law permits challenges at every stage of suggested treatment creates great potential for delay. Thus, independent of formal proceedings, we assume that relevant post-denial information regarding an insured's condition or treatment, such as in Plaintiff's case, may be submitted to the insured's insurer, such as Allstate, for its consideration. In Allstate's words, "an insurer den benefits at a time which is arguably too early." Submittal of post-denial information is not only prudent and practical, but in keeping with the law's resolve to promote the timely determination of benefits. We believe review of such information is required by that "legal duty, implied in a first[-party] . . . insurance contract [ ] that the insurer must act in good faith in dealing with its insured, and a breach of that duty of good faith gives rise to an independent tort cause of action." Best Place, Inc. v. Penn America Ins. Co., 82 Hawaii 120, 132, 920 P.2d 334, 446 (1996).
IX.
Thus, we vacate the March 5, 1998 oral order and the May
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