§431:10C-212  Administrative hearing oninsurer's denial of claim.  (a)  If a claimant or provider of servicesobjects to the denial of benefits by an insurer or self-insurer pursuant tosection 431:10C-304(3)(B) and desires an administrative hearing thereupon, theclaimant or provider of services shall file with the commissioner, within sixtydays after the date of denial of the claim, the following:

(1)  Two copies of the denial;

(2)  A written request for review; and

(3)  A written statement setting forth specificreasons for the objections.

(b)  The commissioner has jurisdiction toreview any denial of personal injury protection benefits.

(c)  The commissioner shall:

(1)  Conduct a hearing in conformity with chapter 91to review the denial of benefits;

(2)  Have all the powers to conduct a hearing as setforth in section 92-16; and

(3)  Affirm the denial or reject the denial and orderthe payment of benefits as the facts may warrant, after granting an opportunityfor hearing to the insurer and claimant.

(d)  The commissioner may assess the cost ofthe hearing upon either or both of the parties.

(e)  Either party may appeal the final order ofthe commissioner in the manner provided for by chapter 91. [L 1987, c 347, ptof §2; am L 1992, c 124, §7; am L 1997, c 251, §35]

 

Case Notes

 

  The first party to choose a forum for resolution of no-faultdispute binds the other party to that forum unless the circuit court finds thatthe parties have entered into a mandatory and binding arbitration agreement. 86 H. 59, 947 P.2d 371.

  1992 amendment to subsection (a) applies to claims arisingfrom injuries sustained in accidents occurring before January 1, 1993; thus,provider had standing to contest insurer's denial of no-fault insurancebenefits.  90 H. 1, 975 P.2d 211.