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In re Claim of Hoffacker12/17/2002
WATANABE, ACTING C.J., LIM, AND FOLEY, JJ.
This secondary appeal by Claimant-Appellant Melvin Hoffacker (Hoffacker) challenges the Final Judgment entered by the Circuit Court of the First Circuit (the circuit court) on May 8, 2001, affirming the Final Order of Respondent-Appellee Wayne C. Metcalf, III, Insurance Commissioner, Department of Commerce and Consumer Affairs (DCCA), State of Hawaii (the Commissioner), dated August 4, 2000, that in turn, upheld the denial by Respondent-Appellee State Farm Mutual Automobile Insurance Company (State Farm) of no-fault motor vehicle insurance benefits to Hoffacker.
The primary issue we have been asked to decide is whether the circuit court correctly concluded that Hoffacker had the burden of proving, by a preponderance of the evidence, that State Farm's denial of benefits to him was improper.
We affirm.
BACKGROUND
The facts of this case are summarized in the circuit court's Findings of Fact, Conclusions of Law and Order, filed on April 24, 2001.
Hoffacker was involved in a motor vehicle accident on March 6, 1998, while operating a motor vehicle insured under a no-fault policy issued by State Farm. Following the accident, Hoffacker, who had a history of pre-accident injuries, was treated by Dr. Thomas H. Sakoda (Dr. Sakoda), who diagnosed Hoffacker as suffering from cervical and lumbar disk syndrome. State Farm extended no-fault benefits to Hoffacker for the treatments rendered.
Following his subsequent examinations of Hoffacker, Dr. Sakoda reported that Hoffacker "looks all right[,]" "is in no significant distress[,]" and "moves easily." State Farm thereafter requested that Hoffacker submit to an independent medical examination (IME). Dr. Mark Gabr (Dr. Gabr), a neurologist, conducted the IME on May 7, 1999 and issued a report, opining:
There is clear evidence from the history of a pre-existing somatoform disorder, and there is also clear evidence, by MRI, of pre-existing degenerative disc disease in the cervical and lumbar spines. None of these factors are related to the 3/06/98 accident. There is no convincing history that the claimant's condition was aggravated by the subject accident. There are a number of signs of inorganic pain behavior on physical examination.
Subjective complaints are secondary to [Hoffacker's] underlying pain syndrome and could represent malingering. I can detect no objective findings on examination.
Dr. Gabr further wrote, "there is no condition or injury that I believe was caused by the subject accident. Thus, in my opinion, [Hoffacker] has remained at a pre-injury status and has reached maximum medical improvement." Based on the IME report, State Farm issued denials for no-fault benefits to Hoffacker on July 7, 1999 and July 16, 1999, for disability from June 11, 1999 to August 1, 1999 and for services from March 12, 1999 to April 14, 1999, respectively.
Hoffacker then requested administrative hearings before DCCA's Insurance Division for review of each of the two denials. The hearings for both denials were consolidated by stipulation, and an administrative hearing was held on April 27, 2000. On May 25, 2000, the hearings officer issued the Hearings Officer's Findings of Fact, Conclusions of Law and Recommended Order, recommending that the Commissioner "find and conclude that [Hoffacker] has failed to establish by a preponderance of the evidence that [State Farm's] denials were improper, and that the denials should therefore be affirmed." The hearings officer specifically concluded, in part:
In order to prevail, [Hoffacker] has the burden of producing credible evidence and of establ
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