Auto Accident, PIP & Medical Billing State Guides
Hawaii Auto Accident, PIP & Medical Billing Laws
Hawaii operates a mandatory No-Fault automobile insurance system governed by Hawaii Revised Statutes Chapter 431, Article 10C. Policies must provide at least $10,000 in Personal Injury Protection (PIP) medical benefits. Healthcare provider reimbursement is statutorily capped at 110% of the Hawaii Workers' Compensation Medical Fee Schedule pursuant to HRS § 431:10C-308.5.
Plain-language overview
No-Fault (Mandatory PIP under HRS § 431:10C-103.5)
Every motor vehicle registered in Hawaii must carry a no-fault insurance policy providing basic PIP benefits for medical and rehabilitation expenses incurred due to motor vehicle accidents. Tort liability for bodily injury against an at-fault driver is limited under HRS § 431:10C-306 unless medical expenses exceed $5,000 or the injury results in permanent disfigurement or significant permanent loss. Medical billing is subject to strict fee schedules benchmarked to workers' compensation allowances.
PIP and MedPay coverage
Mandatory Coverage
$10,000 statutory minimum per person in PIP medical, hospital, and rehabilitation benefits (HRS § 431:10C-103.5)
Balance Billing Prohibition
Healthcare providers are prohibited by statute from billing patients for any amount exceeding the allowable fee schedule cap (HRS § 431:10C-308.5(b))
Assignment Of Benefits
Insurers pay medical providers directly upon presentation of an executed assignment of benefits and required treatment records
Medical fee schedule and reimbursement rules
Name
Hawaii Motor Vehicle Medical Fee Schedule (HRS § 431:10C-308.5)
Rules
Charges for medical care, hospital services, and physical therapy are capped at 110% of the maximum allowable amount under the Hawaii Workers' Compensation Medical Fee Schedule (HAR Title 12, Chapter 15), which incorporates Medicare RBRVS relative value units with regional conversion factors.
Cpt Basis
HCPCS/CPT codes with Hawaii Department of Labor and Industrial Relations conversion factors
Appeals and dispute resolution
Thirty Day Prompt Payment
Under HRS § 431:10C-304, PIP medical benefits must be paid or formally denied in writing within 30 calendar days after the insurer receives the bill and clinical notes. Overdue payments bear interest at 1.5% per month (18% annually).
Dcca Administrative Hearings
Disputes regarding denial of benefits, fee schedule reductions, or medical necessity may be filed with the Hawaii Department of Commerce and Consumer Affairs (DCCA) Insurance Division for an administrative hearing under HRS § 431:10C-212.
Court Litigation
Disputes may also be brought as civil actions in Hawaii District Court (claims up to $40,000) or Circuit Court. A prevailing provider or claimant may recover reasonable attorney fees and costs.
Claim and dispute deadlines
Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.
| Event | Timeframe |
|---|---|
| Accident Notice | Notice to insurer as soon as practicable following the crash |
| Medical Bill Submission | Submission within reasonable prompt filing standards on standard forms |
| Carrier 30-Day Pay or Deny | 30 calendar days from receipt of complete billing proof (HRS § 431:10C-304) |
| DCCA Administrative Appeal | Within 60 calendar days of receiving formal written denial |
| Statute of Limitations | 2 years from accident date or 2 years from last PIP payment (HRS § 431:10C-315) |
Documentation checklist
- Hawaii Motor Vehicle No-Fault Claim Application
- Executed Assignment of Benefits (AOB) form
- Itemized CMS-1500 or UB-04 claim form with CPT/HCPCS and ICD-10 diagnostic codes
- Contemporary treatment notes, chart notes, physical therapy evaluations, and diagnostic reports
- Formal denial notice or Explanation of Review (EOR) issued by the insurer
Responsible agencies
- Hawaii Department of Commerce and Consumer Affairs (DCCA) - Insurance DivisionInsurance Oversight, Fee Regulation & Administrative Dispute Hearings
Primary legal and regulatory sources
- Hawaii Revised Statutes Chapter 431, Article 10C (Motor Vehicle Insurance)Hawaii State Legislature · 2024
- Hawaii Revised Statutes Section 431:10C-308.5 (Limitation on Charges)Hawaii State Legislature · 2024
This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.
Common questions
- What rules govern auto accident, pip & medical billing state guides in Hawaii?
- Hawaii operates a mandatory No-Fault automobile insurance system governed by Hawaii Revised Statutes Chapter 431, Article 10C. Policies must provide at least $10,000 in Personal Injury Protection (PIP) medical benefits. Healthcare provider reimbursement is statutorily capped at 110% of the Hawaii Workers' Compensation Medical Fee Schedule pursuant to HRS § 431:10C-308.5.
- What dispute deadlines should providers track in Hawaii?
- Accident Notice: Notice to insurer as soon as practicable following the crash; Medical Bill Submission: Submission within reasonable prompt filing standards on standard forms; Carrier 30-Day Pay or Deny: 30 calendar days from receipt of complete billing proof (HRS § 431:10C-304). Verify the trigger date, current agency notices, and any extension before acting.
- Which agencies administer these rules in Hawaii?
- The guide identifies Hawaii Department of Commerce and Consumer Affairs (DCCA) - Insurance Division. The correct agency depends on the plan and claim jurisdiction.