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JOU v. SCHMIDT

No. SCWC-29868.

298 P.3d 1034 (2013)

129 Haw. 270

Emerson M.F. JOU, M.D., Petitioner/Provider-Appellant, v. J.P. SCHMIDT, Insurance Commissioner, Department of Commerce and Consumer Affairs, State of Hawai`i, Respondent/Respondent-Appellee, and Dai-Tokyo Royal Insurance Company, Respondent/Respondent-Appellee.

Supreme Court of Hawai`i.

April 16, 2013.

Attorney(s) appearing for the Case

Stephen M. Shaw , Del Mar, for petitioner/provider-appellant.

J. Patrick Gallagher , for respondent/respondent-appellee Dai-Tokyo Royal Insurance Company.

Elmira K.L. Tsang , Honolulu, for respondent/respondent-appellee J.P. Schmidt, Insurance Commissioner, Department of Commerce and Consumer Affairs, State of Hawai`i.

NAKAYAMA, Acting C.J., ACOBA, McKENNA, and POLLACK, JJ., and Circuit Judge KIM, In Place of RECKTENWALD, C.J., Recused.

Opinion of the Court by NAKAYAMA, Acting C.J.

When a medical provider has challenged a reduction or denial of payment from an insurer prior to exhaustion of benefits under an insured's policy, the provider's pursuit of his or her claim for those benefits, even if ultimately unsuccessful, is not unreasonable for the purpose of seeking attorney's fees and costs pursuant to Hawai`i Revised Statutes (HRS) § 431:10C-211(a).

In this case, Petitioner/Provider...

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