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Dang v. State11/19/1998
be appropriate or reasonable." Therefore, if a provider ignores the challenge or denial of proposed treatment and provides the treatment, he or she will be unable to collect payment. Reading the plain language of Subsection 308.6(c), the legislature also allowed an insurer's challenge to continuing treatment or services at any time. Therefore, an insurer may challenge a proposed treatment plan for injuries received in a particular accident as a part of continuing treatment or services if the insured has already received treatment or services for injuries emanating from the same accident.
Reading Section 308.6 in its entirety, in addition to recognizing its legislative history, it seems absurd and illogical that the legislature wanted "to reduce and stabilize the cost of motor vehicle insurance" and yet, at the same time, intended for insurers to expend money challenging and denying each and every treatment plan for the same nature of treatment when a PRO has determined that future treatment of that same nature, or future treatment of any nature, is unreasonable or inappropriate. See Jumila, 87 Hawaii at 9, 950 P.2d at 1209; Arceo, 84 Hawaii at 19, 928 P.2d at 861. Even the hearings officer in Pecson noted that there are a "few exceptions" to the general prohibition against blanket denials. MVI-94-254-C, at 13-14. We hold that one exception arises when a PRO determines that future treatment of any nature is unreasonable or inappropriate.
Here, GEICO challenged the treatment plan within five days of its mailing and forwarded the challenge to a PRO, pursuant to HRS § 431:10C-308.6(d). Because GEICO submitted the challenge pursuant to HRS § 431:10C-308.6(c), this does not negate the fact that it was challenged in a timely manner for its reasonableness and appropriateness.
Furthermore, the hearings officer focused upon the technicalities of GEICO's challenge. Unlike Pecson, the instant PRO report determined that any future treatment, other than self-directed exercises, would be unreasonable. Thus, GEICO properly denied the proposed treatment plan based upon the PRO report and properly denied all future treatment for injuries emanating from the same accident.
IV. CONCLUSION
Based upon the foregoing, we reverse the Insurance Commissioner's final order dated May 15, 1996 and the circuit court's order and final judgment dated September 22, 1997. We hold that GEICO properly challenged the proposed treatment plan as "continuing services or treatment" and properly denied future services and treatment based upon the PRO report that stated any future treatment and services, with the exception of self-directed home exercises, was unreasonable.
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