For the reasons discussed more fully herein, we vacate that portion
of the trial court's June 25, 2004 final judgment dismissing PMC's
counterclaim and
remand this case for further proceedings consistent with this opinion.
I. BACKGROUND
The facts of this case are relatively simple and largely uncontroverted. PMC is a medical clinic which, at the times relevant hereto, was licensed to provide medical services to patients. Between 1996 and 1998, PMC submitted to AIG (1) treatment plans to be rendered to persons insured by AIG who were injured in automobile accidents for pre-approval, pursuant to HRS § 431:10C-308.6(d) (1993) (3) and (2) billings for services rendered. With respect to the billings, AIG paid some in full, partially paid others, and made no payment on a number of others. It is the latter two categories, where AIG made either no payment or only partial payment, that are the subject of PMC's counterclaim in this case.AIG timely challenged PMC's treatment plans for services that PMC had already rendered and billed, which AIG paid in full. AIG also challenged treatment plans that had been submitted by PMC for pre-approval, pursuant to HRS § 431:10C-308.6(a). (4) Upon receipt of AIG's challenges, the DCCA forwarded the disputes to independent peer review organizations (PROs). During the pendency of the PRO review, PMC apparently proceeded with the proposed treatment plans and billed AIG for those services. Notwithstanding the fact that the PRO-process was ongoing, AIG paid the bills submitted by PMC. (5)
Thereafter, the PROs determined that the treatment plans and proposed treatment plans submitted for various claimants were inappropriate and/or unreasonable. Armed with the PROs' reports, AIG (1) notified PMC, in writing, of the PROs' findings and (2) requested reimbursement of the amounts it had paid for the inappropriate or unreasonable treatments. PMC did not respond to AIG's request but instead sought a hearing with the DCCA on a number of the PROs' reports, including reports pertaining to claimants Cecilia Birch, Victoria Hart, and Wendy Van Houten [hereinafter, the DCCA Hearing Claimants], which are the subject of this appeal.
On October 24, 1997, AIG filed a complaint against PMC, asserting two claims for relief: (1) reimbursement of $62,884.36 in no-fault benefits paid to PMC for treatments that were found to be inappropriate and/or unreasonable by the independent PROs, pursuant to HRS § 431:10C-308.6(j) (1993), quoted infra, (Count I); and (2) unfair and deceptive business practices, based upon PMC's submission of duplicative and/or "unbundled" (6) billings to AIG, in violation of HRS §§ 480-2 and 480-13 (1993) (Count II). A stipulation to dismiss Count II without prejudice was filed on December 30, 1999.
On January 26, 1998, PMC filed a counterclaim, asserting that AIG failed to provide the written denial notice required by HRS § 431:10C-304(3)(B) on a number of its billings. Consequently, PMC maintained that AIG owed it a total principal amount of $413,059.88, plus statutorily mandated interest, penalties, and attorneys' fees.On August 6, 2001, the case was tried, without a jury, before the Honorable Gary W.B. Chang. The evidence admitted at trial revealed, inter alia, that: (1) AIG failed to pay 6,539 bills submitted by PMC; (2) for each of these bills, AIG did not: (a) pay the bill in full; (b) issue a denial for the unpaid portions; or (c) request further information; and (3) for each of these bills, AIG either (a) made no payment or (b) paid the undisputed portion of the bill and offered to respond to any of PMC's questions as to the disputed amounts. At the conclusion of the trial, the parties presented oral argument, and the court requested the parties to submit reply posttrial memoranda, including proposed findings of facts (FOFs) and COLs.
In its September 7, 2001 memorandum, PMC summarized and reasserted its contention that AIG must strictly and literally comply with Section (3)(B). It maintained that AIG's noncompliance rendered the subject bills due and owing, with penalties and interest in accordance with HRS §§ 431:10C-304(4) and (6), and 431:10C-117(b) and (c) (1993). (7)
On the same day, AIG filed its memorandum, arguing that it is obligated to issue a denial under the subject statute or seek peer review only when benefits to a claimant are denied or when a treatment plan is challenged. AIG contended that the appropriate billing dispute resolution mechanism required payment of the undisputed amount and negotiation as to the remainder, as provided in HAR § 16-23-120 and the 2000 amendments to HRS §§ 431:10C-304(6) and 431:10C-308.5 (Supp. 2004). (8) AIG further maintained that all of PMC's bills were not properly certified as required by HAR § 16-23-116. With respect to specific claimants, AIG asserted that: (1) their respective no-fault benefits had been exhausted (specifically, for claimants Rossano Bunao, Melba Sagisi, Garibaldi Guhit, Melanie Kusaka, Zi Hang Ruan, Vannessa Rumph, and Luzviminda Velasco [hereinafter, collectively, the PIP Limit Claimants]); (2) their claims had been ruled upon by the DCCA (specifically, for the DCCA Hearing Claimants); and (3) a medical examination had determined that the treatment rendered was not related to the particular motor vehicle accident (specifically, for claimant Derrick Domingcil).
On September 21, 2001 and September 24, 2001, AIG and PMC submitted their respective proposed FOFs and COLs. Thereafter, on April 20, 2004, the trial court entered its FOFs and COLs, essentially adopting AIG's proposal and adding only a reference to prejudgment interest that stated, "the amount thereof to be determined by motion and notice." The trial court's FOFs appear to address solely AIG's affirmative claims and make no mention of PMC's counterclaim.
As discussed more fully infra, the trial court essentially concluded that: (1) PMC's failure to properly certify any of its billings submitted to AIG provided "an independent basis for an insurer's rejection of the bill," COL No. 39; (2) AIG's compliance with HAR § 16-23-120, i.e., paying the undisputed portion of the bill and negotiating the remainder, relieved it of its obligation to issue denial notices under HRS § 431:10C-304(3)(B); (3) with respect to the PIP Limit Claimants, AIG's obligation to pay no-fault benefits ended upon the exhaustion of their policy benefits; (4) with respect to the DCCA Hearing Claimants, AIG was not required to pay PMC for treatments that the DCCA determined to be inappropriate and/or unreasonable; and (5) AIG had no obligation to pay PMC for Domingcil's treatment that was found to be unrelated to his June 7, 1997 accident.
On June 25, 2004, the trial court entered judgment in favor of AIG and against PMC in the amount of $62,884.36, plus prejudgment interest, and dismissed PMC's counterclaim with prejudice. PMC timely filed its notice of appeal on August 27, 2004. (9)
II. STANDARDS OF REVIEW
A. Conclusions of Law
We review the trial court's COLs de novo under the right/wrong standard. Janra Enterprises, Inc. v. City & County of Honolulu, 107 Hawai‘i 314, 319, 113 P.3d 190, 195 (2005) (citation omitted); Leslie v. Estate of Tavares, 91 Hawai‘i 394, 399, 984 P.2d 1220, 1225 (1999) (citation omitted). Under this standard, this court must examine the facts and answer the pertinent question of law without being required to give any weight or deference to the trial court's answer to it. Robert's Hawai‘i Sch. Bus, Inc. v. Laupahoehoe Transp. Co., Inc., 91 Hawai‘i 224, 239, 982 P.2d 853, 868 (1999) (citation omitted). "Thus, a [COL] is not binding upon the appellate court and is freely reviewable for its correctness." Fujimoto v. Au, 95 Hawai‘i 116, 137, 19 P.3d 699, 720 (2001) (citations and internal quotation marks omitted). A COL that is supported by the trial court's FOFs and that reflects an application of the correct rule of law will not be overturned. Robert's Hawai‘i Sch. Bus, 91 Hawai‘i at 239, 982 P.2d at 868 (citation omitted).
B. Statutory Interpretation
"The standard of review for statutory construction is well-established. The interpretation of a statute is a question of law which this court reviews de novo. Where the language of the statute is plain and unambiguous, our only duty is to give effect to its plain and obvious meaning." Liberty Mut. Fire Ins. Co. v. Dennison, 108 Hawai‘i 380, 384, 120 P.3d 1115, 1119 (2005) (quoting Labrador v. Liberty Mut. Group, 103 Hawai‘i 206, 211, 81 P.3d 386, 391 (2003)) (internal quotation marks omitted).
III. DISCUSSION
Inasmuch as PMC delineates its points of error into five categories (i.e., (1) certification; (2) billing disputes; (3) exhaustion of benefits; (4) preclusion by the DCCA hearing; and (5) Domingcil's unrelated claim) -- the first two of which deal with HRS § 431:10C-304, -- we group the trial court's COLs accordingly and discuss each category in turn.
A. Certification under HAR § 16-23-116
With respect to certification, the trial court's COLs provided:
40. Insurers have no obligation whatsoever to process an uncertified bill. HAR § 16-23-116.
41. The insurer may reject the uncertified bill. This rejection need not be accompanied by any partial payment, nor by the issuance of any formal denial, and requires no further action by the insurer. HAR § 16-23-116.
HAR § 16-23-116, entitled "Certification by physicians and non-physicians," provides:
Each physician shall certify on the bill or charges that the charges are in accordance with this chapter. Any service performed by a non-physician shall be similarly certified.
(Emphases added.) The above administrative rule, which has been in effect since 1993, is intended to ensure that all bills submitted for payment are properly calculated in accordance with the mandatory fee schedules referred to in HRS § 431:10C-308.5 (1993) because the rule was expressly adopted to implement HRS § 431:10C-308.5. See HAR § 16-23-116 (citing history of the promulgated rule, including "Imp. HRS § 431:10C-308.5"). Section 431:10C-308.5, entitled "Limitations on charges," provides in relevant part:
(a) As used in this article, the term "workers' compensation schedules" means the schedules adopted . . . establishing fees and frequency of treatment guidelines[.]
(b) [T]he charges and frequency of treatment for services specified in section 431:10C-103(10)(A)(i) and (ii)[(1993) (10)] . . . shall not exceed the charges and frequency of treatment permissible under the worker's compensation schedules, except as provided in section 431:10C-308.6[, which governs charges and treatment in excess of fee schedules or treatment guidelines.]
PMC specifically contends that all of its bills were, in fact, certified, and, even assuming arguendo the bills were uncertified, such failure did not excuse AIG from complying with the subject statute. The record, however, does not support PMC's contention. Nowhere on PMC's bills does the mandated certification "that the charges are in accordance with this chapter[, i.e., HRS § 431:10C-308.5,]" appear. (11) HAR § 16-23-116 (emphasis added). Therefore, the trial court properly concluded that "[n]one of the bills submitted by [PMC] . . . were properly certified in accordance with HAR Section 16-23-116." COL No. 37. Accordingly, COL Nos. 19, 24, and 37 are correct.Nonetheless, we cannot agree with the trial court that PMC's failure to certify its bills allowed AIG to ignore the requirement of HRS § 431:10C-304(3)(B). As more fully discussed in Section III.B., infra, HRS § 431:10C-304(3)(B) essentially requires an insurer to notify the claimant, in writing, of a denial of benefits and the reasons therefor. HAR § 16-23-116, as previously indicated, requires that the providers include a certification on the billings submitted to insurers for payment. The rule, however, does not indicate -- either expressly or impliedly -- that a provider's noncompliance with the certification requirement relieves an insurer of its obligations under Section (3)(B). Indeed, the certification administrative rule was adopted to implement HRS § 431:10C-308.5 and not Section (3)(B). See HAR § 16-23-116.
AIG argues that the trial court correctly concluded that "[v]iolation of HAR § 16-23-116 provides an independent basis for an insurer's rejection of the bill without any further action required on the part of the insurer." COL No. 39. In support of its position, AIG relies upon an Insurance Commissioner's decision in GEICO v. DCCA, Ins-DR-2000-1 (Sept. 18, 2000). First, we note that the GEICO decision was issued after the instant billing dispute. Second, an Insurance Commission's decision is not binding on this court. And, third, we fail to comprehend how GEICO supports AIG's position. AIG specifically quotes the following from GEICO as indicating that an insurer need not issue a formal denial or take any further action when a provider presents an uncertified bill:
Finally, in instances where the provider has failed to certify that the amount charged is in accordance with HAR Title 16, Chapter 23, (as required by HAR § 16-23-116), the insurer may reject the uncertified bill. This rejection need not be accompanied by any partial payment, nor by the issuance of any formal denial, and required no further action by the insurer . . . .
(Emphases added.) AIG, however, conveniently omitted the remainder of the last sentence, which states, "beyond notifying the provider of the fact and reason for the rejection." Thus, even if this court were to give any weight or deference to the Insurance Commissioner's decision in GEICO, it seems, in our view, to be contrary to AIG's position.Based on the foregoing, coupled with the discussion in Section III.B., infra, we hold that the trial court's COL Nos. 39 through 42 are wrong, including its conclusion that PMC's "failure to certify that the amounts charged . . . prohibits [PMC] from seeking any of the amounts set forth in its counterclaim." COL No. 53.
B. Billing Disputes
With respect to billing disputes, the trial court's COLs provided:
49. Where the insurer has accepted the treatment or service as legitimate and the only disagreement is over the correct amount to be paid for that benefit, the issuance of a formal denial of benefits is not required under the provision of HRS § 431:10C-304(3)(B).
PMC contends that AIG failed to fulfill its obligation under HRS § 431:10C-304(3)(B) to provide written notice of its complete or partial denial of PMC's billings for treatment rendered to its insureds. At the time PMC's claim arose, Section (3)(B) provided:
(B) Subject to section 431:10C-308.6, relating to peer review, if the insurer elects to deny a claim for benefits in whole or in part, the insurer shall within thirty days notify the claimant in writing of the denial and the reasons for the denial. The denial notice shall be prepared and mailed by the insurer in triplicate copies and be in format approved by the commissioner. In the case of benefits for services specified in section 431:10C-103(10)(A)(i) and (ii), the insurer shall also mail a copy of the denial to the provider.
(Emphases added.) AIG, however, argues that it was not obligated to issue a formal written denial where the sole dispute was over the amounts to be paid for PIP benefits and "that [such] simple bill[ing] disputes [should] be resolved by payment of the undisputed amount and negotiation as to the remainder," pursuant to HAR § 16-23-120, quoted infra, and the new HRS § 431:10C-308.5(e), see supra note 7. HAR § 16-23-120, entitled "Dispute regarding charges," states in pertinent part:(a) In the event of a dispute between the provider and the insurer over the amount of a charge or the correct fee and procedure code to be used pursuant to exhibit A to the workers' compensation schedules, the insurer shall pay all charges not in dispute and shall negotiate in good faith with the provider on the disputed charges. Such disputes shall not be filed with the commissioner for submission to peer review.
(b) If the provider and the insurer cannot resolve the dispute, either party may make a request to the commissioner for a hearing.
(Emphases added.)During the pendency of this appeal, this court, in a published opinion in Orthopedic Associates of Hawai‘i, Inc. v. Hawai‘i Ins. & Guar. Co., Ltd., No. 24634 (Haw. Dec. 7, 2005) [hereinafter, Orthopedic], decided the precise questions presented in the instant case: (1) whether insurers are required to issue formal written notices of denial for partial payment of medical bills pursuant to HRS § 431:10C-304(3)(B); (2) whether HAR § 16-23-120 applies to the subject billing disputes; and (3) whether the subsequent legislative amendments resulting in the promulgation of the new HRS § 431:10C-308.5(3) are applicable to the billing disputes. The answers to those questions are controlling here.
In Orthopedic, we first noted that "an insurer's obligation to pay no-fault benefits is set forth in HRS § 431:10C-304(3)(A), which provides that '[p]ayment of no-fault benefits shall be made within thirty days after the insurer has received reasonable proof of the fact and amount of benefits accrued, and demand for payment thereof.'" Slip op. at 18 (quoting HRS § 431:10C-304(3)(A)) (emphasis in original) (footnote omitted). Stated differently, "an insurer shall pay no-fault benefits within thirty days of receipt of a provider's billing statement showing 'the fact,' i.e., the treatment services, and 'the amount of benefits,' i.e., the charges or cost of treatment services." Id. at 18-19. We stated that:
Section (3)(B) . . . does not limit an insurer's obligation to provide notice only when the insurer elects to deny a claim for treatment services. In reading the first and second sentences of Section (3)(B), it is clear that "a claim for benefits" includes both treatment services and the charges attendant thereto. The first sentence of Section (3)(B) indicates that any denial of "a claim for benefits," either in whole or in part, requires the issuance of a denial notice to the claimant. The second sentence states: "In the case of benefits for services . . . the insurer shall also mail a copy of the denial to the provider." In other words, if an insurer elects to deny a claim for treatment services and/or cost, in whole or in part, it must notify the claimant; if the denial involves treatment services, the insurer -- in addition to notifying the claimant -- must also notify the provider of the denial. If we were to limit the phrase "claims for benefits" as used in the first sentence of Section (3)(B) to treatment services only, . . . the second sentence would be rendered superfluous.
Id. at 20-21 (some emphases and some ellipsis in original) (some emphasis and ellipsis added) (citation omitted). Accordingly, this court concluded that the plain and unambiguous language of Section (3)(B) requires an insurer to provide written notice of its denial where the denial -- whether in whole or in part -- relates to the treatment service and/or the charges therefor. Id. at 22-23.With respect to HAR § 16-23-120, we stated:
Under HAR § 16-23-120, disputes relating to "the amount of a charge or the correct fee and procedure code" need not "be filed with the [Insurance] Commissioner for submission to [p]eer [r]eview." Rather, it authorizes insurers to make partial payment of charges "not in dispute" and negotiate with the providers on "the disputed charges." The peer review exemption, however, clearly conflicts with the plain language of HRS § 431:10C-304(3)(B) in existence before the repeal of the peer review statute. Prior to the repeal, an insurer's denial of benefits, in whole or in part, was "[s]ubject to section 431:10C-308.6, relating to peer review." HRS § 431:10C-304(3)(B). Inasmuch as HAR § 16-23-120 exempts insurers from the peer review procedure for controversies relating to treatment services and/or the costs attendant thereto, we hold that HAR § 16-23-120 contravenes the express requirement of Section (3)(B) and is therefore void and unenforceable to this limited extent.
Id. at 24-25. The court in Orthopedic recognized that, as a result of the January 1, 1998 repeal of the peer review statute, the phrase "[s]ubject to section 431:10C-308.6, relating to peer review" was deleted from Section (3)(B) as part of the 2000 amendments to HRS § 431:10C-304, thus removing the conflict between the administrative rule and the subject statute. We emphasized, however, that "nothing in HAR § 16-23-120 . . . relieves the insurers of their obligation to provide the written notice required by HRS § 431:10C-304(3)(B) when the insurer wishes to challenge, in whole or in part, a bill for medical treatment[.]" Id. at 25. We, therefore, held that, to the extent that HAR § 16-23-120 was consistent with the subject statute after January 1, 1998, the insurers remained obligated to provide formal denial notices of a claim for benefits in accordance with Section (3)(B). Id. at 25-26.Therefore, consistent with our decision in Orthopedic, we hold that the trial court's COL Nos. 2, 5, 20, 23, 48-50, and 52 are incorrect to the extent they relieve and/or provide support for relieving AIG of its obligation to comply with the subject statute.
C. Exhaustion of Benefits
The court's conclusions with respect to the exhaustion of benefits is as follows:
HRS § 431:10C-301(a) (1993) outlines the basic no-fault policy requirement and provides in pertinent part:
At trial, Carol Himalaya-Fidele, a senior claim representative of AIG, testified that she had reviewed the information concerning the no-fault/PIP policy as it related to the PIP Limit Claimants. Himalaya-Fidele prepared a two-page summary sheet showing: (1) the claimant's names; (2) the date of the motor vehicle accident; (3) the no-fault/PIP policy limits; (4) the amount of benefits paid; (5) the amount of benefits that was available for payment of medical benefits; and (6) the status of the policy, i.e., whether such policy limit was exhausted. On direct examination by AIG's counsel, Himalaya-Fidele explained her summary sheet in more detail:
| CLAIMANT'S NAMES | MVA | CLAIM # | POL. LIMIT | BENEFITS PD. | BAL. OF $ | STATUS |
| Bunao, Rossano | 04/28/95 | 95004706 | 20,000.00 | 20,000.00 | EXHAUSTED | |
| Sagisi, Melba | 08/26/95 | 95009788 | 20,000.00 | 20,000.00 | EXHAUSTED | |
| Guhit, Garibaldi | 10/28/97 | 97013974 | 20,000.00 | 10,624.33 | 9,375.67 | EXHAUSTED |
| Kusaka, Melanie | 06/26/99 | 99008483 | 10,000.00 | 10,000.00 | EXHAUSTED | |
| Ruan, Zi Hang | 12/31/95 | 96000002 | 20,000.00 | 13,393.19 | 6,606.81 | EXHAUSTED |
| Rumph, Vannessa | 03/24/97 | 97003371 | 20,000.00 | 20,000.00 | EXHAUSTED | |
| Velasco, Luzviminda | 09/11/97 | 97010723 | 20,000.00 | 10,000.00 | 10,000.00 | EXHAUSTED |
At trial, PMC's counsel cross-examined Himalaya-Fidele on her summary sheet, taking as an example claimant Mercedes Arrocena, who is not a disputed claimant in this appeal. The summary sheet reveals the following information as to Arrocena:
| CLAIMANT'S NAMES | MVA | CLAIM # | POL. LIMIT | BENEFITS PD. | BAL. OF $ | STATUS |
| Arrocena, Mercedes | 09/08/95 | 95009892 | 20,000.00 | 14,223.91 | 5,776.06 | 10 & 10 *EXH |
We emphasize, however, that the exhaustion of no-fault/PIP policy limits does not exempt AIG from complying with the notice requirements of Section (3)(B). Although HRS § 431:10C-304(1) makes clear that the insurer's obligation to pay no-fault benefits extends only to "an amount equal to the no-fault benefits," Section (3)(B), as discussed supra, expressly mandates that, "if the insurer elects to deny a claim for benefits in whole or in part, [i.e., treatment services and/or the costs of those treatments,] the insurer shall within thirty days notify the claimant in writing of the denial and the reasons for the denial. . . . In the case of benefits for services [], the insurer shall also mail a copy of the denial to the provider." (Emphases added.)
When asked about AIG's procedure regarding a policy that has been exhausted, Himalaya-Fidele testified that "[w]e send out an exhaust letter to the claimant and CC the providers." However, Himalaya-Fidele did not indicate whether AIG had, in fact, done so in the instant case, and the record does not reveal whether such letters were issued. We, therefore, remand this case for a determination whether AIG met its obligation to provide written notice to all of the PIP Limit Claimants and/or PMC.D. Preclusion by the DCCA Hearing
The trial court's conclusions regarding the DCCA hearings provided:
34. Based on the DCCA Orders/Rulings, AIG [] does not owe any of the claims for reimbursement for Cecilia Birch, Victoria Hart, [and] Wendy Van Houten.
PMC argues that its appeals of the treatment plan denials, "whether those appeals were dismissed, heard on the merits, or withdrawn, are of no consequence in this proceeding[,]" because the DCCA's dismissal of PMC's appeal did not prevent it from seeking recovery of the unpaid bills in connection with these same treatments. We disagree. First, once the DCCA affirmed the PROs' determination that treatment plans were inappropriate and/or unreasonable, the billing related to those services became irrelevant. See HRS § 431:10C-308.6(j) (stating that provider shall not collect payment for services determined by PRO as not appropriate or reasonable).
Second, upon the DCCA's dismissal of PMC's appeal of the adverse PRO findings, PMC's remedy was to take a secondary appeal from the DCCA's final order, pursuant to HRS § 431:10C-212 (1993). Section 431:10C-212 provides in pertinent part:
In light of: (1) the PROs' reports indicating that the treatments rendered to the DCCA Hearing Claimants were inappropriate and/or unreasonable; (2) the DCCA's dismissal of PMC's appeal on these PROs' reports; and (3) HRS § 431:10C-308.6(j) mandating that "[i]f a [PRO] determines that a provider has provided treatment . . . services that are not appropriate or reasonable . . ., the provider shall not collect payment for the inappropriate or unreasonable treatment" (emphases added), the trial court's COL Nos. 34 and 35 are correct.
E. Domingcil's Unrelated Claim
Lastly, with respect to Domingcil, the trial court concluded that:
32. AIG [] was not obligated to make any payments to [PMC] for treatment rendered to [] Domingcil, whose treatment was found not to be related to his June 7, 1997 accident.
33. [PMC] is not entitled to seek recovery from AIG [] for services rendered to [] Domingcil. [sic] for a total of $15,519.92.
PMC maintains that, although "at some point prior to the services and bills at issue, AIG made a determination that [Domingcil] was not entitled to benefits and had issued a denial[,]" "the denial of past billings it received from PMC does not excuse AIG from its obligation to comply with [Section (3)(B)] with respect to future billings for [Domingcil]." (Emphases added.)PMC fails to present any facts with regard to this claim by citation to the record in support of its contention that AIG did not comply with HRS § 431:10C-304(3)(B) on the future billings for services rendered to Domingcil. Int'l Bhd. of Elec. Workers, Local 1357 v. Hawaiian Tel. Co., 68 Haw. 316, 333, 713 P.2d 943, 956 (1986) ("[A]n appellate court is not required to sift through a voluminous record for documentation of a party's contentions."). Nor does PMC make any discernible argument or cite to any authority with respect to its position. Accordingly, insofar as PMC did not comply with HRAP Rule 28(b)(7) (2004) to provide "citations to . . . parts of the record relied on," we need not address this argument. HRAP Rule 28(b)(7); Citicorp Mortgage, Inc. v. Bartolome, 94 Hawai‘i 422, 433, 16 P.3d 827, 838 (App. 2000) ("An appellate court does not have to address matters for which the appellant has failed to present discernable argument."); Norton v. Admin. Dir. of the Court, 80 Hawai‘i 197, 200, 908 P.2d 545, 548 (1995) (disregarding a particular contention for lack of a "discernible argument in support of that position, in violation of [HRAP] Rule 28(b)(7)").
IV. CONCLUSION
Based on the foregoing, we vacate that part of the First Circuit Court's June 25, 2004 final judgment dismissing PMC's counterclaim and remand this case to the circuit court for further proceedings consistent with this opinion.
DATED: Honolulu, Hawai‘i, January 9, 2006.
1. On June 19, 1997, the legislature enacted wide-ranging amendments to the no-fault law, HRS chapter 413:10C, that included the universal replacement of the term "no fault" with the term "personal injury protection," effective January 1, 1998. See 1997 Haw. Sess. L. Act 251.
2. Robert Hyman, M.D. was also a defendant. However, during trial, at the close of AIG's case, Dr. Hyman moved to dismiss AIG's claims against him, pursuant to Rule 52(c) of the Hawai‘i Rules of Civil Procedure, because "all of the evidence offered by [AIG], including all of the documentary evidence, states a claim or, if at all, it's only as to [PMC], and there's no evidence whatsoever [of] the claim as to Dr. Hyman personally[.]" AIG did not object and the motion was granted. The trial court entered an order dismissing all claims against Dr. Hyman on October 4, 2001.
3. HRS § 431:10C-308.6 was
repealed
effective January 1, 1998. At the relevant times herein, section
431:10C-308.6(d) provided in pertinent part:
A provider may request
prior approval from the insurer for treatment exceeding the workers'
compensation schedules or treatment guidelines. The request
shall
include a treatment plan with a time schedule of measurable objectives
and an estimate of the total cost of services. The insurer shall
respond to such a request
within five working days of mailing of the request, giving
authorization or stating in writing the reasons for refusal to the
provider and the insured. Any such
refusal shall be filed concurrently for submission to the peer review
organization. Failure by the insurer to respond within five working
days shall constitute
approval of the treatment.
(Emphasis added.) "'[W]orkers' compensation schedules'" means the schedules adopted . . ., establishing fees and frequency of treatment guidelines[.]" HRS § 431:10C-308.5(a) (1993).
4. HRS § 431:10C-308.6(a) provided in relevant part:
5. At trial, Carol Himalaya-Fidele, a senior claim representative of AIG, testified that, "[i]f we challenge a treatment plan, any bills that come in within that plan had to be paid." HRS § 431:10C-308.6(h) stated that:
6. In its complaint, AIG defined "unbundling" as the willful and/or intentional submission "on a continuous basis . . . billing for services that were included in other billing statements."
7. HRS § 431:10C-304(4) states:
(c) Any person, in the capacity of a licensed or unlicensed motor vehicle insurer . . ., who knowingly violates any provision of this article shall be assessed a civil penalty of not less than $3,000 and not to exceed $10,000 for each violation.
8. In May 2000, HRS §§ 431:10C-304 and 431:10C-308.5 were amended by Act 138, which added subparagraph 6 to HRS § 431:10C-304 and section (e) to HRS § 431:10C-308.5. The new subparagraph (6) states:
If the provider and the insurer are unable to resolve the dispute, the provider, insurer, or claimant may submit the dispute to the commissioner, arbitration, or court of competent jurisdiction. The parties shall include documentation of the efforts of the insurer and the provider to reach a negotiated resolution of the dispute.
HRS § 431:10C-308.5(e) (Supp. 2004).9. The time to appeal was tolled by AIG's filing of its motion for costs on July 1, 2004, pursuant to Hawai‘i Rules of Appellate Procedure (HRAP) Rule 4(a)(3) (2004) ("If, not later than 10 days after entry of judgment, any party files a motion that seeks . . . attorney's fees or costs, the time for filing the notice of appeal is extended until 30 days after entry of an order disposing of the motion[.]"). AIG withdrew its motion on August 2, 2004, thus requiring any appeal from the June 25, 2004 judgment to be taken within thirty days thereof.
10. HRS § 431:10C-103(10)(A) states in relevant part:
11. PMC directs us to the bottom right corner
of each of its bills that states nothing more than "FORM HCFA-1500
(12-90); FORM OWCP-1500; FORM
RRB-1500." These acronyms, without more, do not carry any significance
in determining whether PMC's charges are certified in accordance with
HAR Title
16, Chapter 23.
12. HAR § 16-23-57 provides in
relevant part: