For purposes of this section, the term “personal injury protection insurer” includes personal injury protection self-insurers. Every personal injury protection insurer shall provide personal injury protection benefits for accidental harm as follows:

(1) Except as otherwise provided in section 431:10C-305(d), in the case of injury arising out of a motor vehicle accident, the insurer shall pay, without regard to fault, to the provider of services on behalf of the following persons who sustain accidental harm as a result of the operation, maintenance, or use of the vehicle, an amount equal to the personal injury protection benefits as defined in section 431:10C-103.5(a) payable for expenses to that person as a result of the injury:

Terms Used In Hawaii Revised Statutes 431:10C-304

  • Accidental harm: means bodily injury, death, sickness, or disease caused by a motor vehicle accident to a person. See Hawaii Revised Statutes 431:10C-103
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Contract: A legal written agreement that becomes binding when signed.
  • Injury: means accidental harm not resulting in death. See Hawaii Revised Statutes 431:10C-103
  • Insured: means :

    (1) The person identified by name as insured in a motor vehicle insurance policy complying with § 431:10C-301; and

    (2) A person residing in the same household with a named insured, specifically:

    (A) A spouse or reciprocal beneficiary or other relative of a named insured; and

    (B) A minor in the custody of a named insured or of a relative residing in the same household with a named insured. See Hawaii Revised Statutes 431:10C-103

  • Insurer: means every person holding a valid certificate of authority to engage in the business of making contracts of motor vehicle insurance in this State. See Hawaii Revised Statutes 431:10C-103
  • Medical fee schedule: refers to the Medicare Resource Based Relative Value Scale System applicable to Hawaii, entitled "Workers' Compensation Supplemental Medical Fee Schedule". See Hawaii Revised Statutes 431:10C-103
  • month: means a calendar month; and the word "year" a calendar year. See Hawaii Revised Statutes 1-20
  • Motor vehicle: means any vehicle of a type required to be registered under chapter 286, including a trailer attached to such a vehicle, but not including motorcycles and motor scooters. See Hawaii Revised Statutes 431:10C-103
  • Motor vehicle accident: means an accident arising out of the operation, maintenance, or use of a motor vehicle, including an object drawn or propelled by a motor vehicle. See Hawaii Revised Statutes 431:10C-103
  • Owner: means a person who holds the legal title to a motor vehicle; except that in the case of a motor vehicle which is the subject of a security agreement or lease with a term of not less than one year with the debtor or lessee having the right to possession, such term means the debtor or lessee. See Hawaii Revised Statutes 431:10C-103
  • Person: means , when appropriate to the context, not only individuals, but corporations, firms, associations, and societies. See Hawaii Revised Statutes 431:10C-103
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Without regard to fault: means irrespective of fault as a cause of accidental harm, and without application of the principle of liability based on negligence. See Hawaii Revised Statutes 431:10C-103
(A) Any person, including the owner, operator, occupant, or user of the insured motor vehicle;
(B) Any pedestrian, including a bicyclist;
(C) Any user or operator of a moped as defined in § 249-1; or
(D) Any user or operator of an electric foot scooter as defined in § 249-1;

provided that this paragraph shall not apply in the case of injury to or death of any operator or passenger of a motorcycle or motor scooter as defined in § 286-2 arising out of a motor vehicle accident, unless expressly provided for in the motor vehicle policy;

(2) Payment of personal injury protection benefits shall be made as the benefits accrue, except that in the case of death, payment of benefits under section 431:10C-302(a) (5) may be made immediately in a lump sum payment, at the option of the beneficiary;
(3)

(A) Payment of personal injury protection 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. All providers shall produce descriptions of the service provided in conformity with applicable fee schedule codes;
(B) 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 a format approved by the commissioner. In the case of benefits for services specified in section 431:10C-103.5(a) the insurer shall also mail a copy of the denial to the provider; and
(C) If the insurer cannot pay or deny the claim for benefits because additional information or loss documentation is needed, the insurer shall, within the thirty days, forward to the claimant an itemized list of all the required documents. In the case of benefits for services specified in section 431:10C-103.5(a) the insurer shall also forward the list to the service provider;
(4) Amounts of benefits that are unpaid thirty days after the insurer has received reasonable proof of the fact and the amount of benefits accrued, and demand for payment thereof, after the expiration of the thirty days, shall bear interest at the rate of one and one-half per cent per month;
(5) No part of personal injury protection benefits paid shall be applied in any manner as attorney’s fees in the case of injury or death for which the benefits are paid. The insurer shall pay, subject to section 431:10C-211, in addition to the personal injury protection benefits due, all attorney’s fees and costs of settlement or suit necessary to effect the payment of any or all personal injury protection benefits found due under the contract. Any contract in violation of this provision shall be illegal and unenforceable. It shall constitute an unlawful and unethical act for any attorney to solicit, enter into, or knowingly accept benefits under any contract;
(6) Disputes between the provider and the insurer over the amount of a charge or the correct fee or procedure code to be used under the workers’ compensation supplemental medical fee schedule shall be governed by section 431:10C-308.5; and
(7) Any insurer who violates this section shall be subject to section 431:10C-117(b) and (c).

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